Drug Eruption From Atorvastatin: With Initial Misdiagnosis of Tinea Cruris.

Objective To present the case of a Latin man 68 years of age who presented to the emergency department with a rash to the right side of his groin 10 weeks after switching from simvastatin 40 mg daily to atorvastatin 40 mg daily. Background Prior to switching to atorvastatin, the patient had been taking simvastatin for 21 years without rash. The rash progressed bilaterally to his arms and hands, legs, buttocks, back, and trunk before the patient was seen by dermatology and atorvastatin was discontinued. Results Within six weeks of discontinuation of atorvastatin, the rash resolved with remaining pigmentation changes. The adverse effect was documented in the patient's chart, and dermatology recommended avoiding other statins in the future. Settings Ambulatory clinic pharmacy practice, emergency room, or urgent care centers. Practice Considerations Atorvastatin is a 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitor or statin that has been FDA approved for the prevention of atherosclerotic cardiovascular disease (ASCVD) and treatment of hypercholesterolemia since 1996. Despite widespread use of atorvastatin over many years, only a handful of published cases report drug eruption from its use. Previous case reports have found that retrial of statins may cause similar drug eruption. Conclusion Pharmacists should consider HMG-CoA reductase inhibitors as a possible cause of new onset rash and should not retrial an alternative statin.

Hypoglycemia in Older People With Type 2 Diabetes: Prevention and Treatment Strategies for Outpatient and Long-Term Care Facility Settings.

Hypoglycemia in the older population is a significant problem accounting for increased hospitalizations, emergency room visits, health care costs, and decreased quality of life. Older patients are more susceptible to hypoglycemia because of the increased prevalence of comorbidities requiring multiple medications, age-related physiologic changes, and a progressive decline in health. Older patients are less likely to present with symptoms of hypoglycemia and symptoms may frequently appear at a lower threshold of blood glucose than in younger patients. Consequently, preventing and treating hyperglycemia in older patients can be challenging. If mismanaged, the impact of hypoglycemia in these patients can lead to acute and chronic negative outcomes. Insulin and sulfonylureas should be closely monitored, and deprescribing should be routinely considered in older patients at high risk for hypoglycemia.

Medication Regimen Complexity Index in the Elderly in an Outpatient Setting: A Literature Review.

Objective To review current literature reporting outcomes associated with utilization of the Medication Regimen Complexity Index (MRCI) with older adults in an outpatient setting. Data sources The National Library of Medicine via PubMed, International Pharmaceutical Abstracts, and the Cochrane Database were used to identify clinical trials evaluating outcomes associated with utilization of the MRCI. The medical subject heading terms "geriatrics" and "medication adherence" were used in combination with key terms "medication regimen complexity index" and "medication complexity." Study selection/data extraction Seventy-five articles met the search criteria and were reviewed. Studies were included if they had MRCI-related outcomes and were performed in patients 60 years of age and older in an outpatient setting. Eleven articles met the stated criteria. Data synthesis Higher MRCI scores may be associated with increased mortality rates, medication nonadherence, and unplanned hospitalizations; however, when compared with medication number, MRCI did not better predict increased medication nonadherence and unplanned hospitalizations. Conclusion The MRCI is a useful tool to determine medication complexity; however, current literature is limited by its observational design. Also, MRCI does not take into account potential factors such as high-risk medications and comorbid conditions, which may affect MRCI scores; therefore, additional trials are warranted before suggesting pharmacists implement this tool in their everyday practice.

The link between non-ergot-derived dopamine agonists and heart failure: how strong is it?

Dopamine agonists are commonly used as initial monotherapy and adjunct treatment for Parkinson's disease. However, the Food and Drug Administration recently linked pramipexole use with an increased risk of heart failure (HF). Several case-control studies demonstrate a possible increased risk of the development of HF in patients taking non-ergot-derived dopamine agonists compared with patients not taking dopamine agonists. In patients taking non-ergot-derived dopamine agonists, the studies associated the risk of increased HF with pramipexole. These studies did not find a possible increased risk with ropinirole, but to date no randomized, controlled trials have been conducted to directly compare ropinirole with pramipexole and the risk of HF. The mechanism by which HF occurs is unknown, but the development of edema after dopamine agonist use could increase the risk of HF. If patients with a history of cardiovascular disease or edema are prescribed pramipexole, additional monitoring for HF signs and symptoms is recommended.

Compounding practices and beliefs of Arizona pharmacists.

Only a few studies have attempted to evaluate various aspects of pharmacy compounding such as the compounding practices and beliefs of pharmacists. Although these studies have reported valuable information, there remains a need to thoroughly assess this professional practice. The objectives of this study were to determine the prevalence of pharmacy compounding within Arizona, the reasons for which Arizona pharmacists do not participate in compounding, and the beliefs of Arizona pharmacists regarding contemporary compounding issues. Pharmacists licensed and residing in Arizona were mailed a postcard containing a brief description of the project and the URL to a 20-item online survey. Reminder postcards were mailed four weeks after the initial mailing, and the online survey was open to participants for two months. The usable response rate was 8.1% (412/5112). Respondents reported approximately 8.1% of all prescriptions and/or medication orders are compounded by a pharmacist with the most frequent aspect of compounding performed being reconstitution and/or flavoring of commercially available, nonsterile products. The most prevalent reason for not compounding was "not recieivng requests" (40%). "Preparation of alternate dosage forms" was the most beneficial aspect of compounding reported (93). The most cited educational method for teaching compounding was as "part of a required course with hands on experience" (76%) and 94% of respondents were taught by this method. Ninety-five percent of respondents agreed that compounding is an important part of the pharmacy profession. Overall, pharmacy compounding is fairly prevalent within Arizona and most respondents are supportive of compounding practices.

Cranberry and warfarin interaction: a case report and review of the literature.

This case reports on a patient whose International Normalized Ratio (INR) increased after ingestion of cranberry sauce while stabilized on warfarin. It is followed by a review of the published literature on the potential interaction between the two.An 85-year-old woman on chronic warfarin therapy for atrial fibrillation experienced INR elevations of two- to three-fold after two separate ingestions of cranberry sauce. In each case, her INR values decreased after withholding three to four doses and resuming a similar maintenance dose of warfarin. Although the majority of the pharmacokinetic and pharmacodynamic studies did not find a significant interaction between cranberry and warfarin, several case reports indicate that cranberry products may increase INR values in patients on warfarin. Practitioners should consider cranberry usage as a potential contributor in the evaluation of supratherapeutic INR values in patients on warfarin.