Showing papers in "The Journal of pharmacy technology in 2018"
TL;DR: The available literature indicates that OIMs are associated with clinically significant drug interactions and subsequent adverse reactions and Clinicians in all practice settings should be mindful of this potential to minimize adverse effects and optimize therapy.
Abstract: Objective: To evaluate the potential for drug interactions with oral inhaled medications (OIMs). OIMs include bronchodilators (β-agonists and antimuscarinics), corticosteroids, combination products...
18 citations
TL;DR: The comprehensive medication review (CMR) is one of the most commonly delivered medication therapy management services, and it is a required service to be provided to Medicare Part D be....
Abstract: Background: The comprehensive medication review (CMR) is one of the most commonly delivered medication therapy management services, and it is a required service to be provided to Medicare Part D be...
14 citations
TL;DR: The purpose of this study is to quantify the amount of time spent during each step of a PGx POCT encounter in a community pharmacy setting, and to explore how practice could change if PGx testing were routinely performed in the pharmacy.
Abstract: Background: With recent advances in pharmacogenomics (PGx) comes the potential to customize medication use based on genetic data Support for PGx has found practical limitations in terms of workflow and turnaround time of a test However, with the expansion of point-of-care testing (POCT) in pharmacy practice models comes opportunity for PGx testing in the pharmacy setting Objective: The purpose of this study is to quantify the amount of time spent during each step of a PGx POCT encounter in a community pharmacy setting Methods: A time and motion study was conducted using a mock community pharmacy space for a simulated PGx-focused encounter to manage antiplatelet therapy following hospital discharge PGx POCT was conducted using the Spartan RX instrument Simulated patient encounters were divided into 7 categories Time spent in each step, as well as total time spent, was tracked Results: A total of 54 simulated PGx POCT encounters took place with an average time of 949 minutes (SD ± 138 minutes) In
11 citations
TL;DR: The resistance pattern of uropathogens should be considered prior to initiating therapy and controlled trials with large samples are needed to compare the treatment duration of various antimicrobial regimens and the specific role of prophylactic antimicrobials.
Abstract: Objective: To discuss the risk factors, microbial resistance rates, and pharmacotherapy, including antimicrobial choices and medication dosage regimens, for urinary tract infections (UTIs) in pedia...
10 citations
TL;DR: This is the first study to explore barriers and facilitators to medication adherence among Marshallese patients and can be used to develop methods to improve medication adherence in the Marshallese population.
Abstract: Background: Significant health disparities are present in Marshallese adults residing in the United States, most notably a high incidence of type 2 diabetes and other chronic conditions. There is l...
8 citations
TL;DR: Prescription drug use is on the rise, and the use of dietary supplementation remains common, and drug-nutrient interactions are becoming an important consideration when pharmacists counsel patients about their drug regimens.
Abstract: Objective: Prescription drug use is on the rise, and the use of dietary supplementation remains common. In the United States, more than half of all adults take a dietary supplement in any given mon...
8 citations
TL;DR: Kidney injury is associated with increased vancomycin trough concentrations and concomitant receipt of nephrotoxins, particularly piperacillin/tazobactam.
Abstract: Background: Particularly with the current increased vancomycin dosing trends, the true risk of the agent’s nephrotoxicity is not well characterized and remains of concern. Objective: To determine t...
7 citations
TL;DR: It is suggested that a substantial portion of pharmacists lack the knowledge needed to process and dispense the veterinary prescriptions most commonly encountered in community pharmacies and that implementation of an educational intervention can increase pharmacists’ knowledge of core concepts necessary to safely care for animal patients.
Abstract: Background: To date, there is very limited data regarding pharmacists’ preparedness to handle animal prescriptions. No previous studies exist examining the impact of a veterinary-pharmacy–focused e...
6 citations
TL;DR: Three states allow pharmacists to autonomously prescribe medications for international travel using the Centers for Disease Control and Prevention Yellow Book as a guide.
Abstract: Pharmacists have provided travel health services in some capacity for more than 25 years. The ability of pharmacists to autonomously prescribe travel medications is growing. Three states (California, Idaho, and New Mexico) allow pharmacists to autonomously prescribe medications for international travel using the Centers for Disease Control and Prevention Yellow Book as a guide. Idaho also allows pharmacists to autonomously prescribe select medications appropriate to domestic travel (motion sickness prevention and Lyme disease prophylaxis), and Florida allows for the prescribing of drugs for motion sickness. Core elements from each state law including education, patient assessment, provider notification, and documentation are reviewed.
6 citations
TL;DR: Data support recommendations for metformin use in patients with diabetes and renal insufficiency with an estimated glomerular filtration rate above 30 mL/min/1.73 m2 and suggest that baseline and periodic testing of vitamin B12 levels are warranted and supported by clinical guidelines due to the risk ofitamin B12 deficiency in metformIn-treated patients.
Abstract: Objective: The Food and Drug Administration recently updated metformin prescribing recommendations for patients with diabetes and renal disease. The American Diabetes Association as well as the Ame...
5 citations
TL;DR: The close temporal relationship between chlordiazepoxide initiation and onset of SJS provides a convincing theory as to the etiology of S JS in this patient.
Abstract: Objective: To report a case of chlordiazepoxide-associated Stevens-Johnson syndrome (SJS). Case Summary: This case provides insight into a serious adverse drug reaction secondary to a drug not comm...
TL;DR: Patients in academic centers are more likely to receive recently approved products or to be enrolled in clinical trials than those in community-based settings, and the differences in treatment approach per type of setting are illustrated.
Abstract: Background: Treatment of advanced BRAF-mutant melanoma has changed dramatically in the past 3 years thanks to the approval of new immunotherapy and targeted therapy agents. Objectives: The goal of ...
TL;DR: Although all uroselective alpha-blockers have been found to be effective, most data are with tamsulosin 0.4 mg daily, which can be considered post-lithotripsy for stones 5 to 10 mm, but little benefit may be seen.
Abstract: Objective: To review the literature for α-blocker treatment of kidney stones. Data Sources: PubMed search performed November 15, 2017, using the following search terms: alpha-blocker, alfuzosin, si...
TL;DR: DRP-RAT could make it possible to more effectively involve PNs in medication risk management among older HC clients, and was able to provide clinically important timely patient information for clinical decision making.
Abstract: Background: Home care (HC) clients are increasingly older, have many chronic diseases, and use multiple medicines and thus are at high risk for drug-related problems (DRPs). Objective: Establish th...
TL;DR: Enhanced knowledge of the common complications, associated pharmacotherapy, and monitoring strategies facilitate the pharmacist’s ability to provide increased pharmacotherapeutic insight in a multidisciplinary intensive care unit setting.
Abstract: Objective: To review the fundamentals of invasive positive pressure ventilation (IPPV) and the common complications and associated pharmacotherapeutic management in order to provide opportunities f...
TL;DR: Focus group discussions among African American residents in Detroit, Michigan reported positive experiences with pharmacy-based immunization services and expansion of these services may influence more African Americans to receive recommended vaccines in this community.
Abstract: Background: Although vaccination rates improved modestly in the United States during the 2014-2015 season, racial and ethnic disparities in the use of vaccines persist Pharmacy-based immunization
TL;DR: Cardiac conduction abnormalities manifested as chest pain when a patient is treated with fluphenazine decanoate demonstrates that it may also play a role in causing or exacerbating cardiovascular adverse events.
Abstract: Objective: Patients with psychiatric illnesses are at an increased risk for heart disease, and many antipsychotic medications elicit adverse effects on the heart. This report summarizes conduction ...
TL;DR: The results suggest that semaglutide may have a place in therapy as a GLP-1 RA add-on therapy with higher weight loss as compared with other GLp-1 RAs and PTD and CV benefit.
Abstract: Objective: To detail studies investigating the efficacy/safety of semaglutide as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in the treatment of type 2 diabetes mellitus. Data Sources: A ...
TL;DR: Significant improvement in the HgbA1c and body mass index from baseline to postintervention is revealed, indicating the clinical importance of adding pharmacists to the health care team in obesity and diabetes management.
Abstract: Obesity is linked to many accompanying comorbidities and has a substantial effect on the cost of health care. Pharmacist are able to provide management and intervention for the treatment of these disease states. This study examined outcomes 12 months prior to pharmacist intervention and 6 months postintervention. The primary outcome was to determine if pharmacist service intervention resulted in improved markers of weight and diabetes. This study revealed significant improvement in the HgbA1c and body mass index (BMI) from baseline (A1c 7.9%, BMI 35.3 kg/m2) to postintervention (A1c 7%, BMI 34.1 kg/m2). These results were statistically significant (P < .001, Bonferroni correction applied for multiple comparisons), indicating the clinical importance of adding pharmacists to the health care team in obesity and diabetes management.
TL;DR: PCT monitoring in patients with suspected pneumonia and/or sepsis in the community setting failed to show a reduction in duration of inpatient antibiotics after the introduction of PCT monitoring, however, PCT resulted in significantly fewer discharge antibiotics and overall inpatient plus post-discharge antibiotic duration, with no detrimental effect on mortality or readmission.
Abstract: Background: Procalcitonin (PCT) is a biomarker specific for bacterial infections versus viral or noninfectious causes Utilizing PCT as a guide for antibiotic duration could have benefit in limitin
TL;DR: Based on clinical trials, betrixaban appears to be safe and effective in preventing VTE in acutely ill patients who are at risk of developing VTE.
Abstract: Objective: To evaluate the efficacy, safety, and clinical implication of betrixaban for prophylaxis of venous thromboembolism (VTE) in patients with acute medical illness. Data Sources: A search for clinical trials was performed from January 2006 to January 2017 in English language using Clinicaltrials.gov and PubMed/MEDLINE. The following search terms were used: betrixaban, pharmacokinetics, pharmacology, and drug safety. Study Selection: The following limits were used to access the clinical trials: controlled clinical trial, randomized clinical trial, clinical trial, clinical trial phase II, and clinical trial phase III. The search was narrowed to include only humans. Data Extraction: The search criteria resulted in 6 clinical trials assessing the safety and efficacy of betrixaban. Additionally, references from publications assessing the safety and efficacy of betrixaban in atrial fibrillation, treatment and prevention of VTE, and extended duration VTE prophylaxis were assessed. Data Synthesis: Prior to 2017, no anticoagulant therapy had been approved for extended VTE prophylaxis in acutely ill medical patients. Betrixaban is the first direct oral anticoagulant approved for VTE prophylaxis in adult, acutely ill patients at risk for thromboembolisms. Based on the APEX trial, betrixaban 80 mg administered daily for 35 to 42 days was compared to enoxaparin administered daily for 6 to 14 days. In 7441 patients, fewer VTEs were seen in the betrixaban compared to enoxaparin with no significant difference in adverse reactions. Conclusion: Based on clinical trials, betrixaban appears to be safe and effective in preventing VTE in acutely ill patients who are at risk of developing VTE.
TL;DR: Although the rates of baseline delirium screening have significantly increased over the sampled time period, rates are still below the averages referenced in other literature, and this study suggests additional efforts to improve compliance with delIRium screening in this institution.
Abstract: Background: The Ontario Senior Friendly Hospital Strategy recognizes delirium prevention and management as a top priority and recommends implementation of delirium screening as well as management p...
TL;DR: The findings of this study suggest that Facebook may not be an effective method to recruit physicians, but additional recruitment efforts, such as incentives, are needed.
Abstract: Background: Social media offer a novel avenue to engage with and recruit research participants. Facebook in particular is a promising option given its popularity and widespread use. Objective: To e...
TL;DR: This retrospective, cohort study of HCV-positive, genotype 1 or 4 infected, post–liver transplant patients treated with LDV/SOF achieved high rates of sustained virologic response rate post end-of-treatment.
Abstract: Background: Liver damage caused by hepatitis C virus (HCV) is the number one indication for liver transplantation in the United States and Europe. Patients with a detectable HCV level at time of transplant will universally develop a recurrent infection, which can lead to increased morbidity and mortality. Objective: To assess the sustained virologic response rate post end-of-treatment (SVR) in HCV-infected, post-liver transplant patients at the University of Washington Medical Center (UWMC) treated with ledipasvir-sofosbuvir (LDV/SOF). Methods: This retrospective, cohort study of HCV-positive, genotype 1 or 4 infected, post-liver transplant patients treated with LDV/SOF was conducted at a large academic medical center affiliated clinic. Patients treated with 12 weeks of LDV/SOF with or without ribavirin were included in the 12-week group, and patients treated with 24 weeks of LDV/SOF without ribavirin were included in the 24-week group. Results: Twenty-nine patients with recurrent HCV post-liver transplant receiving 12 weeks of LDV/SOF with or without ribavirin and 32 patients receiving 24 weeks of LDV/SOF alone were assessed. SVR was achieved by 100% (29/29) of patients in the 12-week group and 100% (32/32) of patients in the 24-week group. Conclusion: Post-liver transplant patients at UWMC treated with LDV/SOF for recurrent HCV achieved high rates of SVR.
TL;DR: When there are more selection options, a change in time reference, or more medications reported, the amount of adherent patients varied.
Abstract: Background: Medication nonadherence is a major barrier to both patients and health care professionals when trying to manage medical conditions An appropriate self-report adherence tool would be he
TL;DR: Buprenorphine appears to be a safe option for treating neonatal abstinence syndrome that is potentially superior to the current standard of care therapies with respect to duration of treatment and hospital length of stay.
Abstract: Objective: To summarize the available data for using buprenorphine in neonatal abstinence syndrome and discuss these data in context of the current standard of care therapies, oral morphine and ora...
TL;DR: Pneumococcal vaccine administration was delayed until the influenza vaccine season in a significant portion of patients, and this unexpected finding represents a target for education: ensuring health care professionals are reminded that PCV13 is not a seasonal vaccine like the flu vaccine, but should be offered throughout the year.
Abstract: Background: The recommendation for the pneumococcal conjugate vaccine (PCV13) in adults 65 years and older is recent, and the dosing schedule of PCV13 and the pneumococcal polysaccharide vaccine (PPSV23) can be complex in this population. Objective: The authors assessed the rate of PCV13 immunization in patients 65 years of age and older and identified barriers that contributed to missed opportunities for PCV13. Methods: This retrospective review evaluated outpatient Veterans age 65 years or older who did not receive PCV13 at a scheduled primary care appointment despite an electronic reminder. Investigators recorded any documented reason for the patient not receiving PCV13. Results: The rate of PCV13 immunizations administered during the primary care visit study period was 37% (89 of 239 PCV13 eligible patients). Of the 150 patients identified who did not receive PCV13, 92% were not offered the vaccine, 6.7% declined vaccination, and 0.7% reported an allergy to vaccination. Electronic immunization records revealed that 48 of the 150 patients who did not receive PCV13 at their clinic appointment did receive PCV13 later the same year. Most patients received PCV13 in influenza vaccine season on the same day as receiving the influenza vaccine. Conclusion: The main barrier identified was not offering the vaccination during primary care visits. Pneumococcal vaccine administration was delayed until the influenza vaccine season in a significant portion of patients. This unexpected finding represents a target for education: ensuring health care professionals are reminded that PCV13 is not a seasonal vaccine like the influenza vaccine, but should be offered throughout the year.
TL;DR: Successful acquisition of HCV DAA therapy relied heavily on pharmacist effort, reflecting the vital role that pharmacists play in this process.
Abstract: Background: The process of obtaining approval for hepatitis C virus (HCV) treatment may be time consuming and complicated due to prior authorizations and the need to appeal denials. Pharmacists are poised to play a critical role in the acquisition and management of oral direct acting antivirals (DAAs) for the treatment of HCV infection; however, the time expended in this activity requires assessment. Objective: The objective of this study was to assess time expenditures by pharmacists to acquire DAAs for HCV therapy. Methods: Patients were enrolled in the Northwestern University Viral Hepatitis Registry, a prospective, observational cohort of ambulatory, adult patients living with human immunodeficiency virus (HIV) coinfected with chronic hepatitis B and/or C virus, and recruited since 2013 from the Infectious Disease Center at Northwestern Memorial Hospital, Chicago, IL. Patients were included in the current study if they were referred to the pharmacist for HCV DAA acquisition, drug-drug interaction management, and adherence counseling between February 1, 2014, and April 30, 2015. Patient demographics, virus-specific characteristics, and time required to secure HCV DAA treatment, counsel patients, and follow-up therapy were collected. Results: Among 54 HIV/HCV coinfected patients referred for treatment, all eventually received approval for DAA therapy. However, 87% (n = 47) required prior authorization. Pharmacists dedicated 2.1 hours/patient (interquartile range 1.5-2.8 hours; range 0.75-6.5 hours) to manage DAA therapy. Conclusion: Successful acquisition of HCV DAA therapy relied heavily on pharmacist effort, reflecting the vital role that pharmacists play in this process. Dedicated resources for medication access should be considered to ensure timely DAA acquisition.