Provision of pharmacotherapy services in a rural nurse practitioner clinic.

PURPOSE: Clinical pharmacy interventions and services provided in collaboration with a nurse practitioner in a medically underserved rural health center are described. METHODS: Data were collected via retrospective chart review of clinical pharmacy notes for all patients referred to the clinical pharmacist from July 2001 through February 2004. Data collected included demographic information, reasons for referral, duration of follow-up, insurance status, use of medication assistance programs, educational interventions, clinical interventions, and clinical outcomes. Changes in mean low-density-lipoprotein (LDL) cholesterol levels, blood pressures, and glycosylated hemoglobin (HbA(1c)) were analyzed using a paired Student's t test. Smoking cessation, the number of times the international normalized ratio (INR) was in a goal range, and attainment of goal LDL cholesterol, blood pressure, and HbA(1c) levels were also recorded. RESULTS: Clinical pharmacy interventions were summarized for 101 patients who were seen in 708 patient visits. A mean of 5.6 educational interventions were provided per visit, and a mean of 1.0 clinical intervention occurred per visit. Initiation of new drug therapy or dosage adjustment accounted for 52% of the clinical interventions. A large percentage of patients attained their goals for LDL cholesterol (76%), blood pressure (86%), HbA(1c) (69%), INR (82%), and smoking cessation (43%) during the study period. CONCLUSION: Pharmacotherapy services provided by a clinical pharmacist at a rural nurse practitioner clinic positively affected clinical outcomes and increased patients' attainment rates for LDL cholesterol, systolic and diastolic blood pressures, and HbA(1c).

Drug interactions between linezolid and selective serotonin reuptake inhibitors: case report involving sertraline and review of the literature.

A 47-year-old woman developed confusion, incoordination, and hypertension after she was given linezolid in addition to sertraline for 5 days. Her symptoms resolved within 4 days of discontinuing linezolid. One and a half months later, she received a second course of linezolid; sertraline was discontinued on day 1 of linezolid therapy. On day 9 of therapy, the patient developed confusion, myoclonus, and incoordination, and cardiopulmonary arrest occurred, leaving the patient in a coma. Diarrhea, hypertension, and tachycardia developed after cardiopulmonary arrest. Linezolid was discontinued on day 10, and cyproheptadine was given. Linezolid is a weak monoamine oxidase inhibitor and has been reported to interact with selective serotonin reuptake inhibitors (SSRIs). Several cases of serotonin syndrome in patients taking linezolid and SSRIs have been reported, including two reports with sertraline, one with paroxetine, four with citalopram, and two with fluoxetine. One abstract of a retrospective analysis reported that serotonin syndrome did not occur in patients who received linezolid and fluoxetine, paroxetine, or sertraline. Because of several limitations, however, no conclusions can be drawn from that retrospective analysis. A drug interaction involving escitalopram and linezolid has not been documented. Caution should be used when linezolid is used in patients receiving an SSRI. Other antibiotic options should be considered first, and linezolid should be reserved as the last resort if possible. If the infection requires linezolid, the SSRI should be discontinued, and the patient should be monitored closely for serotonin syndrome.

Use of beta-blockers in patients with COPD.

OBJECTIVE: To evaluate the safety and cardiovascular benefits of beta-blocker therapy in patients with chronic obstructive pulmonary disease (COPD). DATA SOURCES: Clinical literature was accessed through MEDLINE (1966-February 2003). Key search terms included chronic obstructive pulmonary disease and adrenergic beta-antagonists. DATA SYNTHESIS: beta-Blockers are often avoided in patients with COPD because of fear of bronchoconstriction, despite the known cardiovascular mortality benefits. A review of studies evaluating the use of beta-blockers in COPD was undertaken. CONCLUSIONS: The literature supports the safety and mortality benefits of using beta-blockers in COPD. Patients with mild to moderate COPD should receive cardioselective beta-blocker therapy when a strong indication exists.