Patient-perceived content and formatting expectations for prescription container labeling.

OBJECTIVES: The objectives of the study were to identify patient expectations for prescription label content and formatting and to explore how United States Pharmacopeia Chapter 17 Standards for prescription container labeling meet patient expectations. DESIGN: Focus group. SETTING: St. Louis, Missouri, in July and August 2014. PARTICIPANTS: Patients 18 years and older who were taking at least 2 chronic prescription medications and managing their medications independently. MAIN OUTCOME MEASURE: Qualitative themes. INTERVENTION: Not applicable. METHODS: Five focus groups (17 total participants) were conducted in St. Louis in 2014. Focus groups were audio-recorded and consent was obtained from the participants. The audio files were professionally transcribed. Atlas.ti software (version 7.5.3) was used to analyze the transcript data, which were then coded to identify key themes. To ensure consistency of interpretation, a constant comparative analytic framework approach was used. RESULTS: Analysis produced 6 themes related to patient perceptions and expectations of prescription label content and formatting: importance of drug name, dose, and directions; lack of side effects on the label; improved organization and larger font size; using the color red; lack of familiarity with auxiliary labels; and the importance of pharmacy information. Themes focused on how patients use prescription labels and the relative value of different aspects of prescription container labeling. CONCLUSIONS: Patient-perceived prescription content and formatting expectations for prescription container labeling were generally consistent with published USP Chapter 17 guidelines. The importance of pharmacy phone numbers, white space, and highlighting were noteworthy.

Maintenance of Goal Blood Pressure, Cholesterol, and A1C Levels in Veterans With Type 2 Diabetes After Discharge From a Pharmacist-Managed Ambulatory Care Clinic.

Objective. This study evaluated the ability of patients with type 2 diabetes to maintain systolic blood pressure (SBP), LDL cholesterol, and A1C at goal levels after being discharged from a pharmacist-managed ambulatory care clinic. The goals of this study were to 1) document the length of time to failure of maintenance of each goal and 2) characterize risk factors that may be associated with a shorter time to failure. Methods. Researchers reviewed the medical records of veterans with diabetes who were discharged from the clinical pharmacy ambulatory care clinic between 1 July 2007 and 30 June 2009 after attaining their goal SBP, LDL cholesterol, or A1C. The time to goal failure, medical history, laboratory data, medications, demographic information, and clinic appointment attendance were documented. Results. A total of 69 patients who were discharged from the clinic after meeting their SBP, LDL cholesterol, or A1C goal subsequently failed to maintain that goal. The mean time to failure was 9.4 months (SD 8.75 months) for SBP, 25.8 months (27.45 months) for LDL cholesterol, and 20.4 months (15.1 months) for A1C. Multiple risk factors were associated with a shorter time to failure of maintenance of SBP and A1C goals. Conclusion. Veterans with type 2 diabetes in this study demonstrated durable maintenance of their goal LDL cholesterol and A1C levels after being discharged from a pharmacist-managed ambulatory care clinic. However, maintenance of xSBP goals did not demonstrate the same durability. Patients who meet their SBP goal may benefit from receiving continued disease state management services from a pharmacist-managed ambulatory care clinic instead of being discharged to receive their usual care.

Use of onabotulinumtoxinA for overactive bladder with concomitant warfarin.

The symptoms of overactive bladder (OAB) can be treated with oral medications using a variety of antimuscarinic medications and, more recently, mirabegron, a beta-3 agonist. However, the use of these medications may be limited for patients because of adverse drug reactions, contraindications, and those who are refractory to oral medications. Recently, intravesical injections of onabotulinumtoxinA (onaBoNTA) have been proven to be safe and effective as an alternative to oral OAB medications. Although this procedure is typically thought to be outside the realm of a consultant pharmacist, there are incidences in which a pharmacist can make a substantial impact on patient care. The patient, a 71-year old female, presents to her urologist for evaluation to assess appropriateness of intravesical onaBoNTA injections. She has failed multiple oral medications for the treatment of her OAB with urge incontinence. The procedure is further complicated by the patient's past medical history of atrial fibrillation (A fib), deep vein thrombosis (DVT), and pulmonary embolism (PE) that require anticoagulation with warfarin therapy. This case demonstrates the use of onaBoNTA for OAB in a patient concomitantly receiving warfarin for A fib, PE, and DVT. Specifically, it demonstrates discontinuation, bridge therapy, and reinitiation of warfarin on a patient undergoing intravesical injections of onaBoNTA for OAB, and a collaborative approach to care between a pharmacist and a urologist.

Rimegepant: acute treatment for migraine headaches.

Migraine headache treatment is quickly evolving. There have been three new acute migraine treatment options (i.e., lasmiditan, rimegepant, ubrogepant) and four new preventive migraine treatment options (i.e., erenumab, fremanezumab, galcanezumab, eptinezumab) released in the past 3 years. The new migraine treatments are focusing on pathways within the newly, better understood neurovascular hypothesis that further describes the pathophysiology of migraine headaches in more detail than before. The discovery of vasoactive peptides, such as calcitonin gene-related peptide, has led to the development of many of these migraine agents. Rimegepant is one of these newly approved agents for acute migraine treatment in adults with or without aura. Rimegepant has been found to decrease pain and symptoms associated with migraine attacks and is generally well-tolerated.

Migraine overview and summary of current and emerging treatment options.

Migraine is a leading cause of disability worldwide. Approximately 15% of Americans experience migraines. Most people who have migraines feel that people who do not have them often underestimate their condition. Migraines affect people's quality of life and ability to participate in work, family, and social events. A new class of medication, calcitonin gene-related peptide (CGRP) antagonists, has been approved for migraine prevention in adults. The newly approved CGRP antagonists are erenumab, fremanezumab, and galcanezumab, while eptinezumab looks to 2020 for approval. Lasmiditan, ubrogepant, and rimegepant are currently emerging acute migraine therapies that may be added to the arsenal of current migraine management.

Faculty perception of team-based learning over multiple semesters.

INTRODUCTION: Perspectives from faculty regarding team-based learning (TBL) are not well understood. Previous studies describe faculty preference for TBL due to increased student interaction despite requiring increased time for design. The perception of changes in faculty workload over multiple semesters has not been measured. This research evaluates faculty workload and perceived student engagement after implementing TBL in a required non-prescription medication course over multiple semesters. METHODS: TBL was implemented in the non-prescription medication course and continued for three consecutive semesters. Faculty members' perception of TBL was captured using an anonymous survey. The survey was an 11 item questionnaire with five Likert-type response options to identify changes in workload, training, and student interaction using TBL. RESULTS: Twenty-eight total responses were collected from 10 faculty members who taught in at least one of the four semesters. Results were aggregated based on the number of semesters faculty continually taught in the course. More respondents agreed than disagreed that participation from and interactions with students increased with the TBL course compared to traditional lectures. However, more respondents believed the TBL course approach was more difficult and reported increased workload in the initial semester taught. Enjoyment of teaching increased for a majority of respondents. DISCUSSION AND CONCLUSIONS: This is the first study to explore the impact of TBL implementation over multiple semesters. These data can be used to help implement TBL in pharmacy school curricula.

Edoxaban: A Comprehensive Review of the Pharmacology and Clinical Data for the Management of Atrial Fibrillation and Venous Thromboembolism.

Historically, vitamin K antagonists have been the only class of oral anticoagulants available. Despite our experience with warfarin over the past 60 years, its use is associated with several pharmacokinetic and clinical disadvantages including unpredictable dosing, frequent monitoring, and delayed onset and offset. Edoxaban, an oral direct Xa inhibitor, may provide clinicians with an additional option in patients requiring chronic anticoagulation. This review examines the pharmacology and clinical data of edoxaban as a therapeutic alternative.