Pub Date : 2016-07-04DOI: 10.1177/8755122516657566
Bethany W. Ibach, Peter N. Johnson, K. Ernst, D. Harrison, Jamie L. Miller
Background: Methadone and morphine are commonly used to treat neonatal abstinence syndrome (NAS). Limited data exist to describe the most appropriate initial doses and taper regimens of these agents. Objectives: Describe the median initial dose and frequency of methadone and morphine for NAS. Compare dose adjustments, time to symptom relief, and taper complexity between groups. Methods: Retrospective study of neonates receiving enteral methadone or morphine for NAS over a 4-year period. Data collection included medication regimen, abstinence scores based on the Modified Finnegan Neonatal Abstinence Scoring Tool, and adverse events. Planned home taper complexity was assessed using the Medication Taper Complexity Score–Revised (MTCS-R). The primary outcome was initial opioid dose. Secondary outcomes included number of dose adjustments, time to symptom relief, and MTCS-R score. Results: Fifty neonates were initially treated for NAS with methadone (n = 36) or morphine (n = 14). The median initial dose was 0.09 mg/kg (range = 0.03-0.2) for methadone and 0.04 mg/kg (range = 0.03-0.4) for morphine. The most common initial dosing interval was q8h for methadone versus q3h for morphine. Number of dose adjustments and time to symptom relief were similar between groups. Median MTCS-R scores were similar between groups. There was no difference in adverse events between groups. Limitations included small sample size, preference toward methadone use, and variability of initial opioid dosing and titration. Conclusions: There was significant variability in initial doses of both agents. Neonates receiving methadone required less frequent dosing than morphine, which may result in easier administration and may allow for safer outpatient administration.
{"title":"Initial Dosing and Taper Complexity of Methadone and Morphine for Treatment of Neonatal Abstinence Syndrome","authors":"Bethany W. Ibach, Peter N. Johnson, K. Ernst, D. Harrison, Jamie L. Miller","doi":"10.1177/8755122516657566","DOIUrl":"https://doi.org/10.1177/8755122516657566","url":null,"abstract":"Background: Methadone and morphine are commonly used to treat neonatal abstinence syndrome (NAS). Limited data exist to describe the most appropriate initial doses and taper regimens of these agents. Objectives: Describe the median initial dose and frequency of methadone and morphine for NAS. Compare dose adjustments, time to symptom relief, and taper complexity between groups. Methods: Retrospective study of neonates receiving enteral methadone or morphine for NAS over a 4-year period. Data collection included medication regimen, abstinence scores based on the Modified Finnegan Neonatal Abstinence Scoring Tool, and adverse events. Planned home taper complexity was assessed using the Medication Taper Complexity Score–Revised (MTCS-R). The primary outcome was initial opioid dose. Secondary outcomes included number of dose adjustments, time to symptom relief, and MTCS-R score. Results: Fifty neonates were initially treated for NAS with methadone (n = 36) or morphine (n = 14). The median initial dose was 0.09 mg/kg (range = 0.03-0.2) for methadone and 0.04 mg/kg (range = 0.03-0.4) for morphine. The most common initial dosing interval was q8h for methadone versus q3h for morphine. Number of dose adjustments and time to symptom relief were similar between groups. Median MTCS-R scores were similar between groups. There was no difference in adverse events between groups. Limitations included small sample size, preference toward methadone use, and variability of initial opioid dosing and titration. Conclusions: There was significant variability in initial doses of both agents. Neonates receiving methadone required less frequent dosing than morphine, which may result in easier administration and may allow for safer outpatient administration.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"11 1","pages":"216 - 222"},"PeriodicalIF":1.0,"publicationDate":"2016-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90768884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-23DOI: 10.1177/8755122516655544
Kayla M. Natali, J. Goldman
Objective: A case of insulin allergy to insulin aspart, insulin aspart protamine/insulin aspart 70/30, insulin lispro, and insulin lispro protamine/insulin lispro 75/25 in a patient with type 2 diabetes mellitus is reported. Case Summary: A 76-year-old Caucasian male weighing 81 kg presented with complaints of burning, lumps, and a rash where his insulin aspart protamine/insulin aspart 70/30 was injected 2 months after initiation. Because poor injection technique can mimic insulin allergy, the patient was counseled again on proper injection technique. The patient presented 2 weeks later with the same complaints. Insulin aspart protamine/insulin aspart 70/30 was discontinued and insulin lispro protamine/insulin lispro 75/25 was initiated. The patient presented 3 months later with a localized reaction. Insulin lispro protamine/insulin lispro 75/25 was discontinued and insulin U100 glargine and insulin lispro were initiated. One week later, the patient still had complaints of a localized reaction and was referred to an allergist for testing. Skin prick tests revealed insulin allergy to insulin aspart and insulin lispro but not to insulin U100 glargine or insulin glulisine. The patient’s regimen was changed to insulin U100 glargine and insulin glulisine, and he has not experienced any reaction since. Discussion: Allergic reactions to human insulin preparations are rare and may present as a localized reaction or a generalized reaction. Different types of allergic reactions to human insulin have been reported, including type I, type III, and type IV hypersensitivity reactions. If insulin allergy is suspected, the following steps should be taken to confirm such allergy: evaluation of injection technique, switching to a different insulin preparation, and referral to an allergist for allergy testing if necessary. Conclusion: A patient with type 2 diabetes mellitus experienced a type I hypersensitivity reaction to insulin aspart, insulin aspart protamine/insulin aspart 70/30, insulin lispro, and insulin lispro protamine/insulin lispro 75/25.
{"title":"Insulin Allergy","authors":"Kayla M. Natali, J. Goldman","doi":"10.1177/8755122516655544","DOIUrl":"https://doi.org/10.1177/8755122516655544","url":null,"abstract":"Objective: A case of insulin allergy to insulin aspart, insulin aspart protamine/insulin aspart 70/30, insulin lispro, and insulin lispro protamine/insulin lispro 75/25 in a patient with type 2 diabetes mellitus is reported. Case Summary: A 76-year-old Caucasian male weighing 81 kg presented with complaints of burning, lumps, and a rash where his insulin aspart protamine/insulin aspart 70/30 was injected 2 months after initiation. Because poor injection technique can mimic insulin allergy, the patient was counseled again on proper injection technique. The patient presented 2 weeks later with the same complaints. Insulin aspart protamine/insulin aspart 70/30 was discontinued and insulin lispro protamine/insulin lispro 75/25 was initiated. The patient presented 3 months later with a localized reaction. Insulin lispro protamine/insulin lispro 75/25 was discontinued and insulin U100 glargine and insulin lispro were initiated. One week later, the patient still had complaints of a localized reaction and was referred to an allergist for testing. Skin prick tests revealed insulin allergy to insulin aspart and insulin lispro but not to insulin U100 glargine or insulin glulisine. The patient’s regimen was changed to insulin U100 glargine and insulin glulisine, and he has not experienced any reaction since. Discussion: Allergic reactions to human insulin preparations are rare and may present as a localized reaction or a generalized reaction. Different types of allergic reactions to human insulin have been reported, including type I, type III, and type IV hypersensitivity reactions. If insulin allergy is suspected, the following steps should be taken to confirm such allergy: evaluation of injection technique, switching to a different insulin preparation, and referral to an allergist for allergy testing if necessary. Conclusion: A patient with type 2 diabetes mellitus experienced a type I hypersensitivity reaction to insulin aspart, insulin aspart protamine/insulin aspart 70/30, insulin lispro, and insulin lispro protamine/insulin lispro 75/25.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"12 1","pages":"210 - 215"},"PeriodicalIF":1.0,"publicationDate":"2016-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86698297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-23DOI: 10.1177/8755122516653970
Zachary Mueller, Kaitlyn Craddock, Jamie M. Pitlick, Andrew J. Crannage
Objective: To evaluate the safety and efficacy of 2 human monoclonal antibodies, alirocumab and evolocumab, on reduction of low-density lipoprotein cholesterol (LDL-C), cardiovascular benefits, and their place in current practice. Data Sources: A search of MEDLINE and Scopus databases (1966 to May 2016) with search terms “alirocumab,” “evolocumab,” “LDL,” and “PCSK9.” Study Selection and Data Extraction: The search identified phase 3 randomized control trials in English language in the past 10 years that studied LDL-C reduction of alirocumab or evolocumab. The studies were assessed for all efficacy and safety endpoints. Data Synthesis: Twelve total studies were identified evaluating alirocumab or evolocumab. These monoclonal antibodies have been shown to significantly decrease LDL-C as monotherapy and in combination with statins in phase 3 clinical trials in patients with primary hypercholesterolemia as well as familial hypercholesterolemia by inhibiting PCSK9. Alirocumab significantly reduced LDL-C by up to 61%, while evolocumab significantly reduced LDL-C by up to 66%. Adverse effects of these medications have been low and overall well tolerated. Conclusion: Although these monoclonal antibodies have shown to significantly reduce LDL-C, their effect on cardiovascular outcomes has not yet been determined. Further studies are being conducted to assess the cardiovascular benefit of both alirocumab and evolocumab. Until these studies demonstrate a reduction in atherosclerotic cardiovascular disease risk, statins should remain first-line therapy for most patients. However, alirocumab and evolocumab can be used as an effective adjunctive therapy option to lower LDL-C or in patients who are statin intolerant.
{"title":"PCSK9 Inhibitors","authors":"Zachary Mueller, Kaitlyn Craddock, Jamie M. Pitlick, Andrew J. Crannage","doi":"10.1177/8755122516653970","DOIUrl":"https://doi.org/10.1177/8755122516653970","url":null,"abstract":"Objective: To evaluate the safety and efficacy of 2 human monoclonal antibodies, alirocumab and evolocumab, on reduction of low-density lipoprotein cholesterol (LDL-C), cardiovascular benefits, and their place in current practice. Data Sources: A search of MEDLINE and Scopus databases (1966 to May 2016) with search terms “alirocumab,” “evolocumab,” “LDL,” and “PCSK9.” Study Selection and Data Extraction: The search identified phase 3 randomized control trials in English language in the past 10 years that studied LDL-C reduction of alirocumab or evolocumab. The studies were assessed for all efficacy and safety endpoints. Data Synthesis: Twelve total studies were identified evaluating alirocumab or evolocumab. These monoclonal antibodies have been shown to significantly decrease LDL-C as monotherapy and in combination with statins in phase 3 clinical trials in patients with primary hypercholesterolemia as well as familial hypercholesterolemia by inhibiting PCSK9. Alirocumab significantly reduced LDL-C by up to 61%, while evolocumab significantly reduced LDL-C by up to 66%. Adverse effects of these medications have been low and overall well tolerated. Conclusion: Although these monoclonal antibodies have shown to significantly reduce LDL-C, their effect on cardiovascular outcomes has not yet been determined. Further studies are being conducted to assess the cardiovascular benefit of both alirocumab and evolocumab. Until these studies demonstrate a reduction in atherosclerotic cardiovascular disease risk, statins should remain first-line therapy for most patients. However, alirocumab and evolocumab can be used as an effective adjunctive therapy option to lower LDL-C or in patients who are statin intolerant.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"12 1","pages":"201 - 209"},"PeriodicalIF":1.0,"publicationDate":"2016-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75323423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-08DOI: 10.1177/8755122516653611
N. Borja‐Hart, Bethany G. Leachman
Background: Community pharmacists are a highly utilized drug information resource for patients and health care providers. Good retrieval skills and the availability of credible references are key to providing necessary information. Objective: This study aimed to identify the types of drug information resources used by chain community pharmacists in Tennessee. Methods: A phone survey was conducted by a trained pharmacy student to 39 pharmacists working at chain community pharmacies. Demographic questions, types of drug information resources available, Internet availability, smartphone applications (apps) used, and most common drug information questions received were identified. Results: Electronic tertiary drug resources were used by the majority of pharmacists, with the top 2 resources being Clinical Pharmacology and Facts and Comparisons. Seventy-four percent of pharmacists surveyed used smartphone apps to access information more quickly. Few pharmacists stated access to primary literature, while 4 pharmacists cited using the secondary resource PubMed. The 2 most commonly asked questions were concerning adverse drug reactions and side effects. Conclusions: Electronic drug information resources are widely available and utilized. In order to comply with all of the demands that a pharmacists comes across, these resources need to be very familiar and easy to operate from an efficiency stand-point.
{"title":"Drug Information Resources Used by Chain Community Pharmacists in Tennessee","authors":"N. Borja‐Hart, Bethany G. Leachman","doi":"10.1177/8755122516653611","DOIUrl":"https://doi.org/10.1177/8755122516653611","url":null,"abstract":"Background: Community pharmacists are a highly utilized drug information resource for patients and health care providers. Good retrieval skills and the availability of credible references are key to providing necessary information. Objective: This study aimed to identify the types of drug information resources used by chain community pharmacists in Tennessee. Methods: A phone survey was conducted by a trained pharmacy student to 39 pharmacists working at chain community pharmacies. Demographic questions, types of drug information resources available, Internet availability, smartphone applications (apps) used, and most common drug information questions received were identified. Results: Electronic tertiary drug resources were used by the majority of pharmacists, with the top 2 resources being Clinical Pharmacology and Facts and Comparisons. Seventy-four percent of pharmacists surveyed used smartphone apps to access information more quickly. Few pharmacists stated access to primary literature, while 4 pharmacists cited using the secondary resource PubMed. The 2 most commonly asked questions were concerning adverse drug reactions and side effects. Conclusions: Electronic drug information resources are widely available and utilized. In order to comply with all of the demands that a pharmacists comes across, these resources need to be very familiar and easy to operate from an efficiency stand-point.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"22 1","pages":"185 - 190"},"PeriodicalIF":1.0,"publicationDate":"2016-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84678812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-13DOI: 10.1177/8755122516646384
J. J. Peterson, J. Hoehns
Objective: To review literature regarding direct oral anticoagulants (DOACs) and determine their viability of administration in solution or via enteral tubes. Data Sources: MEDLINE literature searches identified articles published 2007-present using MeSH terms: factor Xa inhibitors, antithrombins, biological availability, and enteral nutrition. Package inserts were included. Manufacturers were asked to provide literature. Study Selection and Data Extraction: We included studies emphasizing bioavailability or enteral administration. Data Synthesis: Dabigatran and edoxaban package inserts recommend against altering the dosage form, and against enteral administration. One rivaroxaban study was identified. Given with food, enteral administration was comparable to the oral tablet. The mean AUC (0.889, 90% CI 86.12-91.84%) was within the equivalency margins; however Cmax (0.820, 90% CI 78.84-85.86%) was slightly below the 80% threshold. One apixaban study was identified. They showed bioequivalence between oral and enteral administration in different vehicles, but decreased bioavailability when crushed tablets were given along with nutritional support. AUC and Cmax were 32% and 19% lower, respectively, when apixaban solution was given via nasogastric (NG) tube with nutritional supplement versus oral administration of solution. Conclusions: Dabigatran capsules should not be altered, due to large variations in drug exposure. Rivaroxaban can be given as oral solution or via NG tube. Larger doses must be given with nutritional supplementation and enteral tubes must not be distal to the stomach. Apixaban can be given as oral solution or via nasogastric or gastric tube on an empty stomach. Food impairs bioavailability of the crushed tablets. There are insufficient data to recommend enteral administration of edoxaban and the package insert recommends against altering tablets.
目的:回顾有关直接口服抗凝剂(DOACs)的文献，并确定其在溶液或肠内管给药方面的可行性。数据来源:MEDLINE文献检索确定2007年至今发表的文章，使用MeSH术语:Xa因子抑制剂、抗凝血酶、生物利用度和肠内营养。包括包装说明书。制造商被要求提供文献资料。研究选择和数据提取:我们纳入了强调生物利用度或肠内给药的研究。资料综合:达比加群和依多沙班的说明书不建议改变剂型，也不建议肠内给药。一项利伐沙班研究被确认。与食物一起给药，肠内给药与口服片剂相当。平均AUC (0.889, 90% CI 86.12-91.84%)在等效范围内;Cmax (0.820, 90% CI 78.84 ~ 85.86%)略低于80%的阈值。一项阿哌沙班研究被确认。在不同的载体中口服和肠内给药表现出生物等效性，但当粉碎片剂与营养支持一起给药时，生物利用度降低。与口服阿哌沙班溶液相比，经鼻胃管加营养补充给予阿哌沙班溶液的AUC和Cmax分别降低32%和19%。结论:达比加群胶囊不应该改变，因为药物暴露有很大的变化。利伐沙班可口服或经胃管给药。必须在营养补充的同时给予更大剂量，肠内管不能离胃很远。阿哌沙班可作为口服溶液或通过鼻胃管或胃管在空腹给予。食物会损害压碎片剂的生物利用度。没有足够的数据来推荐肠内使用依多沙班，包装说明书也不建议更换片剂。
{"title":"Administration of Direct Oral Anticoagulants Through Enteral Feeding Tubes","authors":"J. J. Peterson, J. Hoehns","doi":"10.1177/8755122516646384","DOIUrl":"https://doi.org/10.1177/8755122516646384","url":null,"abstract":"Objective: To review literature regarding direct oral anticoagulants (DOACs) and determine their viability of administration in solution or via enteral tubes. Data Sources: MEDLINE literature searches identified articles published 2007-present using MeSH terms: factor Xa inhibitors, antithrombins, biological availability, and enteral nutrition. Package inserts were included. Manufacturers were asked to provide literature. Study Selection and Data Extraction: We included studies emphasizing bioavailability or enteral administration. Data Synthesis: Dabigatran and edoxaban package inserts recommend against altering the dosage form, and against enteral administration. One rivaroxaban study was identified. Given with food, enteral administration was comparable to the oral tablet. The mean AUC (0.889, 90% CI 86.12-91.84%) was within the equivalency margins; however Cmax (0.820, 90% CI 78.84-85.86%) was slightly below the 80% threshold. One apixaban study was identified. They showed bioequivalence between oral and enteral administration in different vehicles, but decreased bioavailability when crushed tablets were given along with nutritional support. AUC and Cmax were 32% and 19% lower, respectively, when apixaban solution was given via nasogastric (NG) tube with nutritional supplement versus oral administration of solution. Conclusions: Dabigatran capsules should not be altered, due to large variations in drug exposure. Rivaroxaban can be given as oral solution or via NG tube. Larger doses must be given with nutritional supplementation and enteral tubes must not be distal to the stomach. Apixaban can be given as oral solution or via nasogastric or gastric tube on an empty stomach. Food impairs bioavailability of the crushed tablets. There are insufficient data to recommend enteral administration of edoxaban and the package insert recommends against altering tablets.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"55 1","pages":"196 - 200"},"PeriodicalIF":1.0,"publicationDate":"2016-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85838713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-13DOI: 10.1177/8755122516649204
R. P. Hickson, Candace J. Brancato, D. Moga
Background: Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, underutilization of this pharmacotherapy continues in patients with type 2 diabetes (T2DM) compared to the general post-MI population. Objective: This study aimed to (1) quantify the proportion of T2DM patients utilizing β-blocker therapy within 30 days of hospital discharge after MI and (2) identify clinical and demographic characteristics predicting initiation of β-blocker therapy. Methods: A retrospective cohort of US employed, commercially insured individuals was assembled using de-identified enrollment files, medical claims, and pharmacy claims from 2007 to 2009. Inclusion criteria were the following: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Multivariable logistic regression with adjusted odds ratios (ORadj) using manual backward elimination was used to identify predictors of β-blocker initiation within 30 days of discharge from index hospitalization. Results: Of 341 T2DM patients, 167 (49.0%) were new users and 174 (51.0%) were nonusers of β-blockers within 30 days of post-MI hospital discharge. Patients on a calcium channel blocker (ORadj 2.63) and patients taking 1 to 5 medications (ORadj 3.59) were more likely to initiate β-blockers post-MI. Patients with heart failure (ORadj 0.45) or an arrhythmia (ORadj 0.44) were less likely to initiate β-blockers as well as patients with renal failure not taking a diuretic (ORadj 0.17). Conclusions: These results confirm previous findings that β-blockers are underutilized in T2DM patients post-MI. Predictors from the regression model can guide future research investigating how this deviation from guidelines is attributed to prescriber versus patient behavior.
{"title":"Predictors of β-Blocker Initiation After Myocardial Infarction in Patients With Type 2 Diabetes","authors":"R. P. Hickson, Candace J. Brancato, D. Moga","doi":"10.1177/8755122516649204","DOIUrl":"https://doi.org/10.1177/8755122516649204","url":null,"abstract":"Background: Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, underutilization of this pharmacotherapy continues in patients with type 2 diabetes (T2DM) compared to the general post-MI population. Objective: This study aimed to (1) quantify the proportion of T2DM patients utilizing β-blocker therapy within 30 days of hospital discharge after MI and (2) identify clinical and demographic characteristics predicting initiation of β-blocker therapy. Methods: A retrospective cohort of US employed, commercially insured individuals was assembled using de-identified enrollment files, medical claims, and pharmacy claims from 2007 to 2009. Inclusion criteria were the following: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Multivariable logistic regression with adjusted odds ratios (ORadj) using manual backward elimination was used to identify predictors of β-blocker initiation within 30 days of discharge from index hospitalization. Results: Of 341 T2DM patients, 167 (49.0%) were new users and 174 (51.0%) were nonusers of β-blockers within 30 days of post-MI hospital discharge. Patients on a calcium channel blocker (ORadj 2.63) and patients taking 1 to 5 medications (ORadj 3.59) were more likely to initiate β-blockers post-MI. Patients with heart failure (ORadj 0.45) or an arrhythmia (ORadj 0.44) were less likely to initiate β-blockers as well as patients with renal failure not taking a diuretic (ORadj 0.17). Conclusions: These results confirm previous findings that β-blockers are underutilized in T2DM patients post-MI. Predictors from the regression model can guide future research investigating how this deviation from guidelines is attributed to prescriber versus patient behavior.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"24 1","pages":"160 - 168"},"PeriodicalIF":1.0,"publicationDate":"2016-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77281595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-04DOI: 10.1177/8755122516644622
Poupak Rahmani, Charlotte Guzman, A. Kezouh, M. Blostein, S. Kahn
Background: Whether the level of patient’s knowledge about warfarin plays any role in maintenance of therapeutic international normalized ratio (INR) is controversial. Several studies have looked at patients’ warfarin knowledge and the level of patients’ anticoagulation control (AC). Most studies had small numbers and did not use validated questionnaires. Objectives: To use the Oral Anticoagulation Knowledge (OAK) test to assess patients’ knowledge of AC and to examine associations between knowledge, INR, and adverse events. Methods: In this cross-sectional study, patients were asked to complete the OAK test. Data on clinical and demographic characteristics, INR values, and thrombosis or bleeding events during the preceding 1 year period were collected. Associations between OAK scores, patient characteristics, proportion of therapeutic INRs, and bleeding/thrombosis events were assessed. Results: A total of 225 patients completed the OAK test. Mean (SD) age was 70 (13.4) years, 53% were male, and 75% were on warfarin for >3 years. Over the preceding year, 57.3% of INRs were therapeutic, and there were 22 bleeding and 6 thrombotic events. The mean OAK score was 12/20 (passing score = 15/20); 64% of patients failed the OAK test. Predictors of passing the OAK test were younger age (P = .01) and higher level of education (P = .03). There was no association between OAK score and proportion of therapeutic INRs, or OAK score and bleeding or thrombosis events. Conclusion: We used the OAK test to assess patients’ AC knowledge. Results suggests that while younger and more educated patients were more likely to pass the OAK test, the OAK test results may not predict INR control or occurrence of bleeding or thrombotic events.
{"title":"Association Between Patient Knowledge of Anticoagulation, INR Control, and Warfarin-Related Adverse Events","authors":"Poupak Rahmani, Charlotte Guzman, A. Kezouh, M. Blostein, S. Kahn","doi":"10.1177/8755122516644622","DOIUrl":"https://doi.org/10.1177/8755122516644622","url":null,"abstract":"Background: Whether the level of patient’s knowledge about warfarin plays any role in maintenance of therapeutic international normalized ratio (INR) is controversial. Several studies have looked at patients’ warfarin knowledge and the level of patients’ anticoagulation control (AC). Most studies had small numbers and did not use validated questionnaires. Objectives: To use the Oral Anticoagulation Knowledge (OAK) test to assess patients’ knowledge of AC and to examine associations between knowledge, INR, and adverse events. Methods: In this cross-sectional study, patients were asked to complete the OAK test. Data on clinical and demographic characteristics, INR values, and thrombosis or bleeding events during the preceding 1 year period were collected. Associations between OAK scores, patient characteristics, proportion of therapeutic INRs, and bleeding/thrombosis events were assessed. Results: A total of 225 patients completed the OAK test. Mean (SD) age was 70 (13.4) years, 53% were male, and 75% were on warfarin for >3 years. Over the preceding year, 57.3% of INRs were therapeutic, and there were 22 bleeding and 6 thrombotic events. The mean OAK score was 12/20 (passing score = 15/20); 64% of patients failed the OAK test. Predictors of passing the OAK test were younger age (P = .01) and higher level of education (P = .03). There was no association between OAK score and proportion of therapeutic INRs, or OAK score and bleeding or thrombosis events. Conclusion: We used the OAK test to assess patients’ AC knowledge. Results suggests that while younger and more educated patients were more likely to pass the OAK test, the OAK test results may not predict INR control or occurrence of bleeding or thrombotic events.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"3 1","pages":"150 - 159"},"PeriodicalIF":1.0,"publicationDate":"2016-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72739322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-30DOI: 10.1177/8755122516640297
Yan Xie, J. LaFleur, A. Kamauu, K. Knippenberg, S. Duvall, J. Haselkorn, R. Nelson
Background: Early treatment of patients with multiple sclerosis (MS) may prevent neurological damage and reduce the risk of disability. However, little is known about the timing of treatment initiation following diagnosis and long-term outcomes in the general population of the Department of Veterans Affairs (VA) benefits-eligible patients. Objective: Our objective was to characterize treatment for MS patients in the VA at various time points following diagnosis date. Methods: In our historical database cohort study of US veterans, we calculated the proportion of MS patients from 1999 through 2010 with at least one prescription for a medication used to treat the condition at 6, 12, 24, 36, 48, 60, and 72 months following the index date. We also stratified the treatments given into 3 categories based on their role within the course of the disease: disease modifying, relapse, and symptom. Finally, we performed our calculations separately by MS subtype: relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Results: A total of 6803 patients were included in the analysis. Only 27.4% of MS patients received a prescription for MS medication within the first 6 months after diagnosis. The most common treatments were interferon β-1a, glatiramer, amantadine, and prednisone, with disease-modifying agents being more than twice as frequently prescribed as medications for relapse or symptoms. Patients with relapsing-remitting MS were the most likely to be treated, followed by progressive-relapsing MS. Conclusions: Our results suggest that treatment rates are low in VA MS patients in the 6 years following their first diagnosis of MS.
{"title":"Rates of Early Treatment for US Veterans With Multiple Sclerosis","authors":"Yan Xie, J. LaFleur, A. Kamauu, K. Knippenberg, S. Duvall, J. Haselkorn, R. Nelson","doi":"10.1177/8755122516640297","DOIUrl":"https://doi.org/10.1177/8755122516640297","url":null,"abstract":"Background: Early treatment of patients with multiple sclerosis (MS) may prevent neurological damage and reduce the risk of disability. However, little is known about the timing of treatment initiation following diagnosis and long-term outcomes in the general population of the Department of Veterans Affairs (VA) benefits-eligible patients. Objective: Our objective was to characterize treatment for MS patients in the VA at various time points following diagnosis date. Methods: In our historical database cohort study of US veterans, we calculated the proportion of MS patients from 1999 through 2010 with at least one prescription for a medication used to treat the condition at 6, 12, 24, 36, 48, 60, and 72 months following the index date. We also stratified the treatments given into 3 categories based on their role within the course of the disease: disease modifying, relapse, and symptom. Finally, we performed our calculations separately by MS subtype: relapsing-remitting, secondary-progressive, primary-progressive, and progressive-relapsing. Results: A total of 6803 patients were included in the analysis. Only 27.4% of MS patients received a prescription for MS medication within the first 6 months after diagnosis. The most common treatments were interferon β-1a, glatiramer, amantadine, and prednisone, with disease-modifying agents being more than twice as frequently prescribed as medications for relapse or symptoms. Patients with relapsing-remitting MS were the most likely to be treated, followed by progressive-relapsing MS. Conclusions: Our results suggest that treatment rates are low in VA MS patients in the 6 years following their first diagnosis of MS.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"497 1","pages":"143 - 149"},"PeriodicalIF":1.0,"publicationDate":"2016-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78135173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-30DOI: 10.1177/8755122516640800
J. Newsome
Objective: To review if utilizing statin therapy in patients with nonalcoholic fatty liver disease (NAFLD) is safe and efficacious. Data Sources: A MEDLINE literature search was performed using the search terms statins, nonalcoholic fatty liver disease, NAFLD, safety, effectiveness, and efficacy. The literature search was not limited to a predetermined set of dates. The literature search included information from 2003 until February 2016. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language randomized controlled trials, case reports, meta-analyses, and guidelines assessing the use of statins in patients with NAFLD were evaluated. Data Synthesis: Clinical data demonstrate that statins can increase serum transaminases; however, these effects appear to be dose dependent. Data show that statins do not exacerbate liver injury. The Statin Liver Safety Task Force indicates that statins are safe to use in patients with chronic liver diseases and compensated cirrhosis. Studies conducted to determine if statins are efficacious have been limited to small trials or case reports. However, data suggest that statins can reduce elevated serum transaminases and improve liver histology. Conclusions: Guidelines indicate that statins can be used to treat dyslipidemia in patients with NAFLD and nonalcoholic steatohepatitis. Statins may be a viable treatment option for NAFLD in patients who have an increased cardiovascular risk. Additional large, randomized controlled trials need to be conducted in order to confirm the beneficial effects of statins in NAFLD.
{"title":"Evaluation of Statin Treatment for Nonalcoholic Fatty Liver Disease","authors":"J. Newsome","doi":"10.1177/8755122516640800","DOIUrl":"https://doi.org/10.1177/8755122516640800","url":null,"abstract":"Objective: To review if utilizing statin therapy in patients with nonalcoholic fatty liver disease (NAFLD) is safe and efficacious. Data Sources: A MEDLINE literature search was performed using the search terms statins, nonalcoholic fatty liver disease, NAFLD, safety, effectiveness, and efficacy. The literature search was not limited to a predetermined set of dates. The literature search included information from 2003 until February 2016. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language randomized controlled trials, case reports, meta-analyses, and guidelines assessing the use of statins in patients with NAFLD were evaluated. Data Synthesis: Clinical data demonstrate that statins can increase serum transaminases; however, these effects appear to be dose dependent. Data show that statins do not exacerbate liver injury. The Statin Liver Safety Task Force indicates that statins are safe to use in patients with chronic liver diseases and compensated cirrhosis. Studies conducted to determine if statins are efficacious have been limited to small trials or case reports. However, data suggest that statins can reduce elevated serum transaminases and improve liver histology. Conclusions: Guidelines indicate that statins can be used to treat dyslipidemia in patients with NAFLD and nonalcoholic steatohepatitis. Statins may be a viable treatment option for NAFLD in patients who have an increased cardiovascular risk. Additional large, randomized controlled trials need to be conducted in order to confirm the beneficial effects of statins in NAFLD.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"19 1","pages":"169 - 173"},"PeriodicalIF":1.0,"publicationDate":"2016-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81141298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-10DOI: 10.1177/8755122515624221
A. Wooley, Amie D. Brooks, Zachary A. Stacy
Background. Evidence indicates pharmacist-managed hypertension clinics are beneficial in reducing blood pressure (BP). There is currently no evidence evaluating the effect of pharmacist-managed resistant hypertension clinics in a medically underserved patient population. Objective. To determine the impact of a pharmacist-managed resistant hypertension service on BP in a medically underserved population. Methods. This was a prospective cohort study evaluating 12 medically underserved patients enrolled in a pharmacist-managed resistant hypertension service at the St Louis County Department of Health. BP was measured in clinic and at home. Follow-up occurred biweekly by phone and in clinic at least monthly while uncontrolled. This study was approved by the St Louis College of Pharmacy Institutional Review Board and St Louis County Department of Health director for clinical and research services. Primary outcome of change in home systolic BP and secondary outcomes of change in home diastolic BP and clinic systolic and diastolic BP were evaluated. Results. Twelve patients were included in the analysis (2 patients did not receive home BP monitors). Home systolic BP was reduced from the first encounter, 140 (12) mm Hg, to last contact, 130 (15) mm Hg (P = .01). Clinic systolic BP also decreased significantly from the first encounter, 152 (10) mm Hg, to last contact, 136 (17) mm Hg (P = .004). Clinic BP goal and home BP goal was attained by 30% and 40% of participants, respectively. Conclusions. A pharmacist-managed resistant hypertension service is effective in significantly reducing BP in medically underserved patients.
{"title":"Effect of a Clinical Pharmacist–Managed Service on Blood Pressure in an Underserved Population With Resistant Hypertension","authors":"A. Wooley, Amie D. Brooks, Zachary A. Stacy","doi":"10.1177/8755122515624221","DOIUrl":"https://doi.org/10.1177/8755122515624221","url":null,"abstract":"Background. Evidence indicates pharmacist-managed hypertension clinics are beneficial in reducing blood pressure (BP). There is currently no evidence evaluating the effect of pharmacist-managed resistant hypertension clinics in a medically underserved patient population. Objective. To determine the impact of a pharmacist-managed resistant hypertension service on BP in a medically underserved population. Methods. This was a prospective cohort study evaluating 12 medically underserved patients enrolled in a pharmacist-managed resistant hypertension service at the St Louis County Department of Health. BP was measured in clinic and at home. Follow-up occurred biweekly by phone and in clinic at least monthly while uncontrolled. This study was approved by the St Louis College of Pharmacy Institutional Review Board and St Louis County Department of Health director for clinical and research services. Primary outcome of change in home systolic BP and secondary outcomes of change in home diastolic BP and clinic systolic and diastolic BP were evaluated. Results. Twelve patients were included in the analysis (2 patients did not receive home BP monitors). Home systolic BP was reduced from the first encounter, 140 (12) mm Hg, to last contact, 130 (15) mm Hg (P = .01). Clinic systolic BP also decreased significantly from the first encounter, 152 (10) mm Hg, to last contact, 136 (17) mm Hg (P = .004). Clinic BP goal and home BP goal was attained by 30% and 40% of participants, respectively. Conclusions. A pharmacist-managed resistant hypertension service is effective in significantly reducing BP in medically underserved patients.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"17 1","pages":"135 - 142"},"PeriodicalIF":1.0,"publicationDate":"2016-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86974592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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