Patient attitudes toward community pharmacist attire.

The white coat has symbolized professionalism, while representing provider-patient fiduciary relationship. Although well described in the literature for physicians, few studies examine the impact of pharmacist attire on patients' opinions regarding professionalism and trust. Therefore, understanding patient perceptions regarding pharmacist's attire and its influence on comfort, confidence, trust, and professionalism may provide guidance on ways to enhance the quality of the provider-patient relationship. A 43-item Likert-type questionnaire was administered to 347 adults in a community pharmacy setting to determine preferences about the pharmacist's attire, accessories, and body art incorporating 8 photographs depicting a male pharmacist in various degrees of dress formality (ie, casual to professional). Descriptive and inferential statistics were used to summarize and analyze the data. Survey respondents reported it was desirable/strongly desirable that pharmacists be dressed in a shirt and tie, dress shoes, white coat, and name tag (mean 4.21-4.72), whereas they should not be dressed in jeans, casual shoes, or have visible body art (mean 2.17-2.78). Over 86% of the respondents felt that a pharmacist with a white coat instilled feelings of comfort, confidence, trust, and professionalism. In a community pharmacy setting, a pharmacist wearing a white coat appears to be the mainstay in displaying professionalism and inspiring trust in adult patients.

Results of a safety initiative for patients on concomitant amiodarone and simvastatin therapy in a Veterans Affairs medical center.

BACKGROUND: The FDA revised the labels of amiodarone and simvastatin in 2002 to warn of increased risk of rhabdomyolysis, the most severe form of myopathy, when the 2 drugs are taken concomitantly in doses greater than 20 milligrams (mg) per day of simvastatin. The FDA reissued the warning in 2008 after receiving reports of 52 cases of rhabdomyolysis in the Adverse Event Reporting System (AERS) after the label changes in 2002 and suggested use of an alternative statin for patients receiving amiodarone who require more than 20 mg simvastatin to attain lipid goals. OBJECTIVES: To (a) assess the prevalence of concomitant amiodarone and simvastatin in doses greater than 20 mg per day and the frequency of additional risk factors for myopathy in these patients, and (b) implement and evaluate a protocol to convert patients receiving this combination to alternative statins. METHODS: A review was conducted of all patients with active prescriptions for both simvastatin at doses greater than 20 mg per day and amiodarone from a Veterans Affairs (VA) medical center as of November 1, 2008. Data collected included demographics, duration of therapy, baseline lipid and aminotransferase values, and risk factors for myopathy (i.e., aged 80 years or older; female sex; small body frame; hypothyroidism; hepatic or renal insufficiency; diabetes; alcohol abuse; and use of medications, such as gemfibrozil and nicotinic acid, that may increase the risk of myopathy). Patients were converted to either pravastatin or rosuvastatin based on baseline simvastatin dose, low-density lipoprotein cholesterol (LDL-C) level, and renal function. The conversion protocol was developed to maintain LDL-C lowering with potentially safer statins. Follow-up lipid and aminotransferase values were collected as customary clinical markers of efficacy and safety, respectively, for patients converted per the protocol. Because creatine kinase values are not routinely assessed in clinical practice, they were not available as part of the current protocol. RESULTS: Of the 48,612 patients who accessed the pharmacy in this VA medical center, 17,760 (36.5%) had an active order for simvastatin 40 mg or 80 mg per day, and 92 of these patients (0.52%) also had an active order for amiodarone. These patients were prescribed simvastatin primarily for secondary prevention (88 [95.7%] with coronary artery disease [CAD] as the indication for statin therapy), and were highly controlled with mean (SD) baseline LDL-C of 71 (21) mg per deciliter. The mean (median) duration of therapy on the combination of amiodarone plus simvastatin 40 mg or more per day was 43 (37) months. Of the 92 patients, 26 (28.3%), 35 (38.0%), and 18 (19.6%) patients had 1, 2, or 3 or more additional risk factors for myopathy, respectively. 16 patients were not converted per protocol to an alternate statin (4 were taken off amiodarone, 2 were taken off statin therapy, 6 had the simvastatin dose reduced to 20 mg per day or less, and 4 were converted to an alternate statin off-protocol), and 14 patients did not have follow-up laboratory values. For the 62 patients converted per protocol and with follow-up laboratory values, there were no statistically significant changes in mean lipid or aminotransferase values after conversion. One patient reported symptoms of myalgia after conversion to rosuvastatin; however, the conversion protocol did not require obtaining creatine kinase values. CONCLUSION: 0.19% of patients (n=92) with pharmacy dispensing records in this VA facility in 2008 received amiodarone in combination with simvastatin in doses greater than 20 mg per day, and the majority of patients had additional risk factors for myopathy. There were no significant changes in mean laboratory values for lipids or aminotransferase for the 62 patients (67%) who were converted and who had baseline and follow-up values; there was 1 case of self-reported myalgia in a patient converted to rosuvastatin.

Review of nifedipine GITS in the treatment of high risk patients with coronary artery disease and hypertension.

Nifedipine is a dihydropyridine calcium-channel blocker (CCB) introduced approximately 30 years ago for the prophylaxis of angina symptoms, and then later utilized as an anti-hypertensive agent. In the 1990s, several meta-analyses and a case-control study were published which raised concern regarding increased mortality and increased risk for myocardial infarction with short-acting nifedipine. Further evaluation of these meta-analyses and case control study underscores some important limitations and the need to further elucidate the role of this class of medications in high-risk patients. Until 2000, there was a paucity of data on the long-term effects as well as the long-term outcomes of CCBs in the treatment of stable coronary disease or in patients with manifestations of the disease such as hypertension or angina. While it has been well established that nifedipine and other dihydropyridines lower blood pressure and improve symptoms of angina, several studies were designed to evaluate the effect of dihydropyridines on "hard" outcomes, specifically cardiovascular and cerebrovascular events. In this review, we describe the clinical studies evaluating the use of nifedipine when compared to placebo as well as other anti-hypertensive therapies in an attempt to identify the most appropriate place in therapy for this class of medications and to further clarify its utilization in high-risk patients.

Effect of faculty-mediated interventions on pharmacy students' pursuit of postgraduate training.

PURPOSE: The influence of faculty-mediated interventions on the pursuit of postgraduate training (PGT) by pharmacy students was studied. METHODS: Three weeks before graduation, members of the class of 2005 (control group) at a Florida pharmacy school completed a questionnaire assessing their understanding of PGT opportunities. Members of the class of 2006 (intervention group) were exposed to faculty-mediated interventions during their final academic year of pharmacy school. The interventions consisted of informational pamphlets, a PGT booth during the school's career day, and PGT-related dinner programs. These students were surveyed before and after the interventions. RESULTS: Seventy-three percent (120/165) of control-group students and 63% (132/211) of intervention-group students completed the survey. Of the control students, 14% (15/108) reported plans to enter PGT after graduation. Sixteen percent (21/132) of intervention-group students reported such plans; the difference was not significant. All faculty-mediated interventions were reported to be helpful to students in making their postgraduation plans. Analysis of the combined groups suggested that students' interaction with faculty and residents during advance practice experiences positively affected pursuit of PGT. CONCLUSION: Students who received faculty- mediated interventions designed to inform them about PGT were not significantly more likely to pursue such training than students who did not receive the interventions. However, students reported the information to be helpful.

Lercanidipine in the treatment of hypertension.

OBJECTIVE: To review the literature regarding the efficacy, tolerability, and utility of lercanidipine in the treatment of hypertension. DATA SOURCES: A search of the literature was performed using MEDLINE (1966-September 2006), EMBASE Drugs and Pharmacology (1980-September 2006), and Current Contents/Clinical Medicine (week 24, 2005-week 30, 2006). Package inserts from lercanidipine, nifedipine, felodipine, and amlodipine were also reviewed for comparison of adverse effects. STUDY SELECTION AND DATA EXTRACTION: Articles were limited to clinical trials, abstracts, and review articles published in English. DATA SYNTHESIS: Lercanidipine is a novel dihydropyridine (DHP) calcium-channel blocker indicated for the treatment of mild-to-moderate hypertension. Although it is not yet available in the US, lercanidipine has been utilized extensively in other countries. In 2 randomized controlled trials of approximately 400 patients with mild-to-moderate hypertension, lercanidipine showed efficacy similar to that of 2 other DHPs, felodipine and slow-release nifedipine, in significantly reducing systolic blood pressure and diastolic blood pressure (DBP) after 4 weeks. In a longer trial (12 mo), lercanidipine 10 mg/day led to normalized blood pressure in 49% of patients after 4 weeks. A postmarketing trial of 9050 patients corroborated the results observed in previous clinical trials, with 64% of patients achieving a DBP of less than 90 mm Hg and 32% attaining blood pressure control (<140/90 mm Hg). In elderly patients, lercanidipine was found comparable with lacidipine and nifedipine, showing similar decreases in DBP when compared with nifedipine (-18.3 vs -17.7 mm Hg, respectively). What distinguishes lercanidipine from other members of the DHP class is its lower incidence of adverse effects, particularly edema. One study showed that fewer patients withdrew secondary to adverse drug reactions in the lercanidipine (0.9%) and nifedipine (3.8%) group compared with the felodipine (4.5%) group. Lercanidipine has also shown efficacy similar to that of other antihypertensives, including atenolol, captopril, and losartan. CONCLUSIONS: Lercanidipine may be an option in the treatment of hypertension, as current literature suggests comparable antihypertensive efficacy and better tolerability. Further randomized, double-blind clinical trials must be conducted in order to clarify its position among other antihypertensive medications.

Pegaptanib: a novel approach to ocular neovascularization.

OBJECTIVE: To review pegaptanib, a novel aptamer for the treatment of age-related macular degeneration (AMD). DATA SOURCES: A literature search using MEDLINE (1980-January 2006) and the Cochrane Database of Systematic Reviews (1978-January 2006) for peer-reviewed, English-language publications was conducted. Abstracts from recent meetings, including the Association for Research in Vision and Ophthalmology and American Society of Retinal Specialists, were reviewed for relevant abstracts and poster presentations. STUDY SELECTION AND DATA EXTRACTION: Pharmacokinetic and pharmacology data were extracted from animal and human studies, and double-blind, randomized, controlled trials were included to describe the efficacy and adverse effects of pegaptanib. DATA SYNTHESIS: The efficacy of pegaptanib has been evaluated in 2 concurrent, prospective, randomized, double-blind trials. Patients with AMD were randomly assigned to receive placebo or pegaptanib intravitreous injection into 1 eye every 6 weeks for 48 weeks. The effectiveness of pegaptanib was realized as early as week 6 and continued through week 54. At week 54, 38% of patients receiving pegaptanib 0.3 mg were classified as legally blind versus 56% of those receiving the sham injection. CONCLUSIONS: Pegaptanib, a new inhibitor of ocular neovascularization, provides patients with an alternative to photodynamic therapy with verteporfin and offers a novel approach to future drug developments for AMD. Pegaptanib offers the advantage of not requiring photodynamic therapy in conjunction with drug delivery and may be a viable option for institutions where this service is not easily accessible. Results of clinical trials have shown that pegaptanib is effective in delaying progression of AMD.