Treatment of IgA nephropathy: an update.

OBJECTIVE: To review current literature regarding treatment options for immunoglobulin A nephropathy (IgAN). DATA SOURCES: A MEDLINE search was performed using the terms IgA nephropathy, Berger's disease, immunoglobulin A nephropathy, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, fish oil, omega-3 fatty acids, statins, hydroxymethylglutaryl-CoA reductase inhibitors, immunosuppressive therapy, corticosteroids, mycophenolate mofetil, cyclophosphamide, cyclosporine, azathioprine, leflunomide, antiplatelets, anticoagulants, vitamin E, infliximab, calcitriol, and intravenous immunoglobulins. A date limit was not set; however, focus was on publications from 1999 to June 2011 to review recent literature and therapeutic recommendations. STUDY SELECTION AND DATA EXTRACTION: All articles in English, including studies conducted in humans, meta-analyses, review articles, guidelines, statements, and reference citations, were identified and evaluated. DATA SYNTHESIS: IgAN is the most common primary glomerulonephritis worldwide, leading to end-stage renal disease in 20-30% of patients. Evidence guiding management of IgAN has been sparse and clinical trials have not conclusively demonstrated effective treatments, largely due to suboptimal methodologies. Treatment strategies have included management of blood pressure and lipids, improvement or stabilization of kidney function, and reduction of proteinuria. This review of IgAN provides an update regarding standard and nonconventional treatment options based on recently published literature. CONCLUSIONS: Supportive therapies, including angiotensin blockade, should be considered as first-line therapy for patients with urine protein >0.5 g/day and/or blood pressure >140/90 mm Hg. Corticosteroids could be considered as add-on or monotherapy for patients with urine protein >1 g/day with preserved renal function. Conclusive data are lacking for general treatment recommendations for the use of other therapies for IgAN.

The role of lamotrigine in the treatment of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome.

OBJECTIVE: To evaluate the efficacy of lamotrigine for treatment of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. DATA SOURCES: Literature was accessed through MEDLINE (1950-June 2010) using the terms lamotrigine, triazines, SUNCT, and trigeminal autonomic cephalgia. STUDY SELECTION AND DATA EXTRACTION: All articles in English and studies conducted in humans were identified and evaluated. DATA SYNTHESIS: SUNCT syndrome can be an extremely challenging headache type to manage and has been considered refractory to pharmacotherapy. Many anticonvulsants have been evaluated as promising SUNCT treatments, with lamotrigine specifically reported as an effective first-line treatment option. There is a lack of randomized placebo-controlled clinical trials evaluating lamotrigine in SUNCT syndrome therapy; however, 2 observational studies, 3 case series, and 5 case reports were reviewed. Lamotrigine appears to decrease the frequency and severity of SUNCT attacks, leading to complete resolution in some patients. A decrease in symptoms was achieved with doses ranging from 25 to 600 mg/day. In some cases, there was initial response to low doses, but dosage titrations were often necessary when symptoms returned several days after being managed at the same dose. Lamotrigine should be initiated at 25 mg/day and gradually titrated, guided by response and adverse effects. The risk of Stevens-Johnson syndrome, a dose-related adverse effect, can be minimized with gradual titration. CONCLUSIONS: According to case reports and observational studies, lamotrigine therapy has resulted in decreased frequency or resolution of SUNCT syndrome attacks. Randomized, controlled trials are necessary to confirm the efficacy of lamotrigine for this indication.

Smoking cessation treatment for adolescents.

Cigarette smoking in the adolescent population remains a public health concern. A significant portion of the adolescent population currently uses tobacco. Nicotine is particularly addicting in adolescents, and quitting is difficult. The goals for adolescent cigarette smoking efforts must include both primary prevention and smoking cessation. Bupropion and nicotine replacement therapies-including nicotine patches, gum, and nasal spray-have been studied to a limited extent in the adolescent population. Varenicline has not been evaluated as a treatment modality in adolescents. Long-term quit rates in the pharmacotherapy trials have not been optimal; however, decreases in cigarettes smoked per day have been observed. Several evidencebased guidelines include recommendations for smoking cessation in adolescents that include counseling and pharmacotherapy. Pharmacotherapy may be instituted for some adolescents in addition to counseling and behavioral interventions. Therapy should be individualized, based on smoking patterns, patient preferences, and concomitant disease states. Smoking cessation support for parents should be instituted as well. The pharmacist can play a large role in helping the adolescent quit smoking. Further studies evaluating pharmacotherapy options for smoking cessation in adolescents are necessary. If pharmacotherapy is used, it should be individualized and combined with psychosocial and behavioral interventions.

Evaluation of seven i.v. drug compatibility references by using requests from a drug information center.

PURPOSE: The scope of coverage and clinical performance of i.v. drug compatibility references were evaluated for drug pairs. METHODS: Compatibility pairs were selected from a drug information center database of previous questions. Duplicate pairs, contrast media, and nondrug chemicals were excluded. Scope of coverage was defined as whether i.v. compatibility information was present for each pair and was reported as a percentage. Clinical performance included the agreement among the references on compatibility, the inclusion of specific concentration information for each drug in a pair, and the presence of references for the information provided. The analysis included one print reference (Handbook on Injectable Drugs, 14th edition) and six electronic i.v. drug compatibility references (King Guide to Parenteral Admixtures, Trissel's 2 Clinical Pharmaceutics Database, Micromedex's IV INDEX, Gold Standard's Clinical Pharmacology, Facts and Comparisons 4.0 IV Chek, and CompoundingToday.com). The manufacturers' online labeling was also consulted. RESULTS: A total of 97 unique drug pairs were analyzed. Four databases contained i.v. compatibility information on 76% of the drug pairs, one contained 62%, one contained 58%, one contained 56%, and the manufacturers' labeling contained 13% of the pairs. Seventy-nine percent of the pairs had agreement among the references as to whether the pair was compatible, incompatible, or variable. Compounding Today.com, Facts and Comparisons IV Chek, the Handbook on Injectable Drugs, IV INDEX, and Trissel's 2 reported concentrations and references for the information given on all pairs. CONCLUSION: The highest-performing references included in the evaluation used the compatibility information provided in Trissel's 2 database as their source of information. Other popular references identified fewer pairs, and the manufacturers' labeling rarely contained compatibility information.

Drug information: from education to practice.

Drug information is a specialty area within the realm of clinical pharmacy that has evolved as technology and clinical practice have changed. Drug information specialists are trained individuals who have clinical knowledge and skills that allow them to provide clear, concise, and accurate recommendations regarding drug use. The constant changing culture of drug information and health care in general has prompted the need for continual growth and refinement of the standards that govern drug information practice. This article outlines specific standards to help ensure that the education and practice of drug information will continue to meet the needs of the health care community. This opinion paper is divided into two sections: Education and Training, and Practice Areas. The Education and Training section is organized to describe the role of drug information and that of the drug information specialist in the training of all pharmacy students and advanced trainees, as well as to describe the role of focused training for those individuals wishing to specialize in drug information. This article also affirms the recommendations for the standards-based approach to drug information education and specialty training. The Practice Areas section is organized to describe the role of the drug information specialist within various practice settings, to identify some of the challenges faced by the drug information specialist within those settings, and to provide recommendations for the different practice areas. The areas found within this section include academia, institutional health systems, managed care, industry, medical writing, and informatics.

A regional poison prevention education service-learning project.

OBJECTIVE: To create a service-learning project to provide poison prevention education to preschool through fifth-grade students. DESIGN: The School of Pharmacy collaborated with the Illinois Poison Center and campus departments to train pharmacy students as poison prevention educators. Seventy-eight first-year pharmacy students developed and gave age-appropriate, interactive presentations to more than 8,000 students at preschools and elementary schools. ASSESSMENT: Preintervention and postintervention evaluations and reflections were collected from the pharmacy students. Ninety-nine percent agreed that they enjoyed the experience and 88% stated that they would continue to provide poison prevention presentations. Based on written assessment of the presentations, most of the preschool and elementary teachers agreed or strongly agreed that the presentations were organized, clear, appropriate for the students, and relevant, and that the pharmacy students appeared knowledgeable and professional. CONCLUSION: Poison prevention education was an appropriate service-learning project for pharmacy students and provided a beneficial service to the community.