Incorporating the American Pharmacists Association's Delivering Medication Therapy Management services certificate program into an accelerated pharmacy curriculum.

BACKGROUND AND PURPOSE: To describe the incorporation of the American Pharmacists Association (APhA) Delivering Medication Therapy Management (MTM) Services program into a PharmD curriculum and to describe student perceptions of the program. EDUCATIONAL ACTIVITY AND SETTING: The program was delivered over 12 months to students on two campuses via two didactic courses in the second professional year and during the first two advanced pharmacy practice experiences in the third professional year of an accelerated school of pharmacy program. FINDINGS: Student perceptions were assessed by review of responses to the APhA MTM program evaluation survey. DISCUSSION AND SUMMARY: Incorporation of the APhA MTM program into an accelerated PharmD program required careful planning and coordination amongst faculty and course coordinators. Students perceived that the program was valuable, met their educational needs, and incorporated effective learning experiences and cases. These perceptions were reinforced by the high percentage of students who completed the program.

The Impact of Prematriculation Admission Characteristics on Graduation Rates in an Accelerated Doctor of Pharmacy Program.

Objective. To evaluate the impact of admission characteristics on graduation in an accelerated doctor of pharmacy (PharmD) program. Methods. Selected prematriculation characteristics of students entering the graduation class years of 2009-2012 on the Worcester and Manchester campuses of MCPHS University were analyzed and compared for on-time graduation. Results. Eighty-two percent of evaluated students (699 of 852) graduated on time. Students who were most likely to graduate on-time attended a 4-year school, previously earned a bachelor's degree, had an overall prematriculation grade point average (GPA) greater than or equal to 3.6, and graduated in the spring just prior to matriculating to the university. Factors that reduced the likelihood of graduating on time were also identified. Work experience had a marginal impact on graduating on time. Conclusion. Although there is no certainty in college admission decisions, prematriculation characteristics can help predict the likelihood for academic success of students in an accelerated PharmD program.

A Novel Structured Format for Engaging Pharmacy Students in Bioethics Discussions.

OBJECTIVE: To describe an active, structured ethics/professionalism discussion format developed for an elective course titled Ethics and Professionalism in Pharmacy. DESIGN: The format uses the acronym ETHICS (Evaluate, Teach, Hear, Interview, Concede, Self-reflect). Before class, students evaluated (Evaluate) literature pertaining to ethics/professionalism topics. Class consisted of faculty-led ethics/professionalism lecture (Teach), student-driven, case discussion, and online self-reflection. Guided by Hear, Interview, and Concede, groups addressed cases from stakeholder perspectives (patient, pharmacist, etc.) considering ethical rules and principles. At the end of class, students answered self-reflection questions. Precourse and postcourse surveys evaluated the impact on students' perceptions of ethical and professional tenets. ASSESSMENT: The format allowed students to actively engage in ethics/professionalism discussions, transforming class into an interactive, structured, student-centered session with self-reflection. CONCLUSION: The format allowed application of concepts to controversial situations. Although the format was created for a pharmacy elective, it is adaptable to any teaching situation.

Academic performance in a pharmacotherapeutics course sequence taught synchronously on two campuses using distance education technology.

OBJECTIVE: To compare the academic performance of campus-based students in a pharmacotherapeutics course with that of students at a distant campus taught via synchronous teleconferencing. METHODS: Examination scores and final course grades for campus-based and distant students completing the case-based pharmacotherapeutics course sequence over a 5-year period were collected and analyzed. RESULTS: The mean examination scores and final course grades were not significantly different between students on the 2 campuses. CONCLUSIONS: The use of synchronous distance education technology to teach students does not affect students' academic performance when used in an active-learning, case-based pharmacotherapeutics course.

An electronic NAPLEX review program for longitudinal assessment of pharmacy students' knowledge.

OBJECTIVES: To track pharmacy student knowledge over time using a proprietary software program in an accelerated program for curricular assessment. METHODS: All students were required to complete a computerized comprehensive diagnostic examination 3 times during the doctor of pharmacy (PharmD) program: at the beginning of the second year, and near the end of the second and third years. The examination was comprised of 100 questions in 3 content areas: pharmacotherapy, preparation and dispensing of medications, and providing health care information. Within-subject differences in mean area and total percent scores were compared. RESULTS: Based on 123 students' data, mean scores for pharmacotherapy and total percent scores for examination 1 were significantly different from examinations 2 and 3. CONCLUSION: The computer-based comprehensive diagnostic examination shows promise for use as a component of a comprehensive assessment plan.

The role of eszopiclone in the treatment of insomnia.

INTRODUCTION: Insomnia is a common and underdiagnosed condition that can result in significant economic and clinical consequences. Despite numerous behavioral and pharmacotherapeutic treatment options available for insomnia, few receive adequate treatment, and sleep maintenance (staying asleep) remains a significant problem. To date, available sedative-hypnotic agents have limitations that have lead to inadequate treatment of insomnia. This review provides an overview of eszopiclone and its role in the treatment of insomnia. METHODS: Electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts) were searched for applicable primary literature and review articles. RESULTS: Mechanisms of action at the gamma-amino butyric acid (GABA) receptor sites and pharmacologic and pharmacokinetic characteristics are presented. Eszopiclone, a nonbenzodiazepine S-enantiomer of racemic zopiclone, is highlighted as the first sedative-hypnotic agent to be approved by the United States Food and Drug Administration for the treatment of sleep onset latency and sleep maintenance insomnia with no short-term restrictions. Recently, the European Medicines Agency recommended marketing authorization of eszopiclone. CONCLUSION: Eszopiclone has been shown to be an efficacious and cost-effective option for the treatment of transient and chronic insomnia in adults.

Management strategies for premenstrual syndrome/premenstrual dysphoric disorder.

OBJECTIVE: To evaluate the current nonpharmacologic and pharmacologic treatment options for symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). DATA SOURCES: Literature was obtained through searches of MEDLINE Ovid (1950-March week 3, 2008) and EMBASE Drugs and Pharmacology (all years), as well as a bibliographic review of articles identified by the searches. Key terms included premenstrual syndrome, premenstrual dysphoric disorder, PMS, PMDD, and treatment. STUDY SELECTION/DATA EXTRACTION: All pertinent clinical trials, retrospective studies, and case reports in human subjects published in the English language were identified and evaluated for the safety and efficacy of pharmacologic and nonpharmacologic treatments of PMS/PMDD. Data from these studies and information from review articles were included in this review. DATA SYNTHESIS: Selective serotonin-reuptake inhibitors (SSRIs) have been proven safe and effective for the treatment of PMDD and are recommended as first-line agents when pharmacotherapy is warranted. Currently fluoxetine, controlled-release paroxetine, and sertraline are the only Food and Drug Administration-approved agents for this indication. Suppression of ovulation using hormonal therapies is an alternative approach to treating PMDD when SSRIs or second-line psychotropic agents are ineffective; however, adverse effects limit their use. Anxiolytics, spironolactone, and nonsteroidal antiinflammatory drugs can be used as supportive care to relieve symptoms. Despite lack of specific evidence, lifestyle modifications and exercise are first-line recommendations for all women with PMS/PMDD and may be all that is needed to treat mild-to-moderate symptoms. Herbal and vitamin supplementation and complementary and alternative medicine have been evaluated for use in PMS/PMDD and have produced unclear or conflicting results. More controlled clinical trials are needed to determine their safety and efficacy and potential for drug interactions. CONCLUSIONS: Healthcare providers need to be aware of the symptoms of PMS and PMDD and the treatment options available. Treatment selection should be based on individual patient symptoms, concomitant medical history, and need for contraception.

Possible intranasal quetiapine misuse.

PURPOSE: A possible case of intranasal quetiapine misuse in a patient with schizoaffective disorder and substance abuse is presented SUMMARY: A 28-year-old Caucasian female with schizoaffective disorder (bipolar type), comorbid polysubstance abuse, tobacco dependence, and personality disorder was admitted to an inpatient psychiatric facility following a hit-and-run conviction. Medications on admission included quetiapine, benztropine, haloperidol, lorazepam, diphenhydramine, and trazodone. As-needed medication orders included benztropine and lorazepam. The patient was hospitalized in order to undergo rehabilitation and psychiatric stabilization. During the first four weeks of the patient's hospital stay, the nursing staff suspected her of "cheeking" or "palming" her quetiapine dose on several occasions. During this time she was also suspected of using cocaine and alcohol while away from the hospital. The patient demonstrated symptoms that are consistent with cocaine withdrawal, but the patient denied the use of cocaine. Aspirin tablets, quetiapine tablets, and white powder were found in her room. The patient stated that the white powder was aspirin. It was suspected that it also contained quetiapine, which the patient later admitted to crushing and snorting for its "calming" effects. Quetiapine was discontinued. There have been reports in the literature of oral and intranasal quetiapine abuse among prison inmates. CONCLUSION: Possible intranasal quetiapine misuse was detected in a patient with schizoaffective disorder and a history of substance abuse. While antipsychotic medications are not typically thought of as drugs with an abuse potential, reports of the use and diversion of intranasal quetiapine among prison inmates, i.v. quetiapine abuse, and this case report indicate otherwise.

Mild serotonin syndrome associated with concurrent linezolid and fluoxetine.

PURPOSE: A case of serotonin syndrome that developed during concurrent linezolid and fluoxetine is presented. SUMMARY: A 23-year-old white male patient was originally admitted to receive intravenous chemotherapy for acute myelogenous leukemia. He had a history of intravenous amphetamine abuse, hepatitis B virus infection, hepatitis C virus infection, depression, and bipolar disorder. The patient's routine medications before admission included methadone, fluoxetine, voriconazole, transdermal nicotine patch, lorazepam, and quetiapine. The patient developed persistent neutropenia and complications from chemotherapy, including mild mucositis. Despite treatment with levofloxacin, acyclovir, and voriconazole, the patient developed high fevers. Levofloxacin was discontinued and aztreonam and vancomycin were started. After a blood culture revealed that the bacteria were likely vancomycin resistant, vancomycin was discontinued and linezolid was initiated. Nine hours later, the patient began complaining of severe pain in his abdomen. After a total of four doses of linezolid, the patient reported further discomfort. Two days after linezolid initiation, a health care team member identified the interaction between fluoxetine and linezolid as the cause of the patient's symptoms, and linezolid was discontinued. All symptoms resolved within 48 hours. While resolution generally occurs within 24-48 hours after discontinuing the offending agent, the time to resolution may be delayed if the agent has a long half-life or active metabolites, in which case admission to an intensive care unit is recommended. Cyproheptadine and chlorpromazine may also be used to treat symptoms. CONCLUSION: Serotonin syndrome developed in a patient taking concurrent linezolid and fluoxetine.

Therapeutic options for sleep-maintenance and sleep-onset insomnia.

Insomnia, defined as difficulty falling asleep, staying asleep, and/or experiencing restorative sleep with associated impairment or significant distress, is a common condition resulting in significant clinical and economic consequences. Many options are available to treat insomnia, to assist with either falling asleep (sleep onset) or maintaining sleep. We searched MEDLINE for articles published between January 1996 and January 2006, evaluated abstracts from recent professional meetings, and contacted the manufacturer of the most recent addition to the pharmacologic armamentarium for insomnia treatment (ramelteon) to gather information. Nonpharmacologic options include stimulus control, sleep hygiene education, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive behavioral therapy. Prescription and over-the-counter drug therapies include benzodiazepine and nonbenzodiazepine sedative-hypnotic agents; ramelteon, a melatonin receptor agonist; trazodone; and sedating antihistamines. Herbal and alternative preparations include melatonin and valerian. Before recommending any treatment, clinicians should consider patient-specific criteria such as age, medical history, and other drug use, as well as the underlying cause of the sleep disturbance. All pharmacotherapy should be used with appropriate caution, at minimum effective doses, and for minimum duration of time.

Strategies for treating chronic insomnia.

Insomnia is a prevalent condition that remains underdiagnosed and undertreated. Recognizing and treating insomnia are important in decreasing morbidity and restoring quality of life for those who experience sleep disturbances. Appropriate treatment of insomnia should involve multiple interventions designed to address not only the symptoms of insomnia itself, but also any coexisting factors that may be contributing to the sleep disturbances. A combination of pharmacologic and nonpharmacologic therapies may be particularly efficacious in those with chronic and debilitating insomnia. Pharmacotherapy is the most frequently used intervention for insomnia in cases where the goal of therapy is immediate relief of symptoms, insomnia is accompanied by significant distress or impairment, nonpharmacologic approaches alone are ineffective, or the patient prefers medication. The ideal hypnotic has the following characteristics: rapid absorption, rapid sleep induction, optimal duration of action, preservation of sleep architecture, and a favorable safety profile. This review will discuss currently available treatment options for insomnia, the benefits of each, and appropriate treatment regimens.