Senior Care Pharmacist最新文献

Background Vibegron, a beta₃-adrenergic receptor agonist for overactive bladder, can be administered as an intact tablet or crushed and mixed with applesauce for patients with dysphagia. Objectives To evaluate the suitability of crushed vibegron for administration via enteral feeding tubes. Methods Vibegron 75 mg tablets were crushed, suspended in 15 mL water, and delivered through seven commonly used enteral tubes. Minimum required flush volume was assessed by flushing with 10, 20, or 30 mL water and quantifying dose delivery using high-performance liquid chromatography (HPLC). Material compatibility was assessed by holding doses in each tube for 5, 15, and 30 minutes and using HPLC to quantify dose delivery and detect impurities in vibegron and control (vibegron tablet) samples. Dosing repeatability was assessed by delivering six replicates through each tube and quantifying dose delivery. Tube occlusion was evaluated visually in all assays. Mean dose delivery through each tube was assessed using pooled data and analyzed by ANOVA. Results Delivery of > 90% was achieved in all assays, for all tubes assessed, with ≥ 20 mL flush volume; 5-, 15-, or 30-minute hold times; and delivery of 1 to 6 doses through the same tube. No additional impurities were detected in vibegron samples compared with controls. Tube occlusion was not observed. Mean dose delivery was > 95% for all tubes assessed and not significantly different between tubes (F = 1.02; P = 0.4). Conclusions Crushed vibegron tablets dispersed in 15 mL of water were delivered consistently and completely through a variety of enteral tubes with no evidence of material incompatibility or clogging.

Lupus treatment recently saw the approval of new drugs after a 12-year gap since the last approval of belimumab (Benlysta) in 2011. This article reviews these newly FDA-approved agents, which have demonstrated efficacy and safety in the management of systemic lupus erythematosus and lupus nephritis, a severe complication of the disease.

Background: In recent years, aspirin use has been controversial for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events. Numerous clinical trials have proven that aspirin does not improve outcomes and increases major bleeding rates. Despite clinical trial data and guideline recommendations, there remains a large number of older adults taking aspirin for primary prevention. Objective: Describe the impact that pharmacists had on the discontinuation of inappropriately prescribed aspirin in a geriatric primary care clinic. Methods: This is a retrospective review of patients taking aspirin. A report was generated for all patients with aspirin on their medication list. The pharmacist determined the indication for aspirin. If patients were taking aspirin for primary prevention, the pharmacist recommended aspirin be discontinued. Results: A total of 528 patients were included in this study. There were 321 (61%) females and 207 (39%) males. After analyzing aspirin indication, 122 (48%) were taking aspirin for primary prevention, 273 (52%) were taking aspirin for secondary prevention, and 133 (52%) were taking aspirin for another indication. The recommendation to discontinue aspirin was accepted 91 times and declined 30 times, yielding a 75% acceptance rate. Conclusion: Aspirin has several appropriate indications for use; however, previous studies have shown that risk outweighs benefit when used for primary prevention of ASCVD events in the geriatric population. When aspirin is on a patient's medication list, it should be assessed routinely for appropriateness. This retrospective review by pharmacists highlights the need for review and discontinuation of aspirin when appropriate.

Alzheimer's disease is the most common cause of dementia. Behavioral and psychological symptoms in dementia (BPSD) are neuropsychiatric signs accompanying dementia that carry a significant impact on prognosis and management. Management of BPSD is challenging because of its complex and multifactorial nature. Historically, no medications were specifically approved for the treatment of BPSD, and any pharmacological use was considered off-label. In May 2023, brexpiprazole was the first and only atypical antipsychotic agent to receive US Food and Drug Administration approval for the treatment of agitation associated with dementia because of Alzheimer's disease. The purposes of this article are to discuss the clinical characteristics of brexpiprazole with a focus on safety and efficacy in older adults, to review the studies that led to the approval for agitation associated with dementia, and to examine its potential place in therapy and impact on patient care. Brexpiprazole is a second-generation antipsychotic with affinity for multiple monoaminergic receptors. Efficacy, safety, and tolerability of brexpiprazole for the treatment of agitation associated with dementia because of Alzheimer's disease was evaluated in two Phase III studies with results suggesting that brexpiprazole has potential to be a safe, effective, and well-tolerated treatment for this indication. Given the individualized and complicated nature of BPSD, brexpiprazole is another option in the treatment landscape that may improve symptoms of agitation but requires careful assessment to ensure benefits outweigh any risks.

Objective To review the topical therapies for adults, including older adults, with atopic dermatitis. A background on atopic dermatitis in adults, overview of treatment recommendations, and the pharmacists' role for care is included. Data Sources Articles indexed in PubMed, Cochrane Reviews, and Google Scholar in the past 10 years using the search terms atopic dermatitis, atopic dermatitis and treatment, and atopic dermatitis and adults were reviewed. Current guidelines and manufacturers' prescribing information were reviewed. Primary sources were used to locate additional resources. Study Selection/Data Extraction Forty-five publications were reviewed and criteria supporting the objectives identified useful resources. Data Synthesis Selected literature included practice guidelines, review articles, research articles, product prescribing information, and drug information databases. Conclusion Atopic dermatitis is a common chronic inflammatory cutaneous disease that may present at any age. Atopic dermatitis has a relapsing course with active disease followed by periods of remission. Atopic dermatitis is not curable, but available and recommended regimens can control patient symptoms. Topical therapies are the preferred treatment and are able to control atopic dermatitis in most adults. Topical moisturizers are the mainstay of therapy. Despite regular use of a moisturizer, most patients will need a topical anti-inflammatory agent to control disease flares. The Food and Drug Administration-approved topical anti-inflammatory agents include the corticosteroids, calcineurin inhibitors, a phosphodiesterase-4 enzyme inhibitor, and a Janus Kinase inhibitor. Pharmacists are in a unique position to counsel patients about the appropriate use and benefits and risks of atopic dermatitis therapies.

Purpose: Evaluate the impact of senior care pharmacists' medication management when a Do Not Crush (DNC) list is used to identify patients inappropriately receiving crushed medications. Methods: Participating senior care pharmacists retrospectively assessed skilled nursing residents with active medications on the DNC list for study inclusion. Study outcomes included assessing prevalence of residents with the inability to receive medications whole orally yet receiving DNC medication(s). Additional outcomes included prevalence rate of patients receiving DNC medications who also have enteral feeding tubing, nothing by mouth orders (NPO), or inability/unwillingness to swallow medications whole. Results: A total of 1,070 skilled nursing patients were reviewed with 778 meeting inclusion criteria. Of those 778 patients, approximately 27% were receiving inappropriately crushed medications. Of those patients, 90% warranted pharmacist intervention associated with a total of 473 medications. Females represented 67% of the patient population, and 90% of patients were 65 years of age or older. The average number of DNC medications was three per patient. The reasons for crushing medications varied. Four patients were classified as NPO, 13 had enteral feeding tubes, 130 patients could not physically swallow medications due to dysphagia, and 122 refused to receive medications whole. Conclusion: Senior care pharmacists can play an integral role in ensuring patients receive medications in accordance with manufacturer guidelines, safe medication practices, and use of alternative formulations as appropriate. The rate of inappropriately crushed medications administered in skilled nursing facilities is high at 27% in the present study. This rate could be further confounded because of the possibility of medications being crushed despite the fact that there is not an indication to do so in the patient chart.