Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
Más filtros










Intervalo de año de publicación
1.
Ann Pharmacother ; 53(10): 1050-1059, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30966785

RESUMEN

Objective: To review the use of nondihydropyridine calcium channel blockers (non-DHP CCBs) for the treatment of proteinuria in diabetic and nondiabetic kidney disease. Data Sources: A search using PubMed and MEDLINE, Scopus, and Google Scholar was performed from 1964 through February 2019 using the following search terms alone or in combination: verapamil, diltiazem, non-dihydropyridine calcium channel blocker, proteinuria, albuminuria, microalbuminuria, kidney disease, renal disease. Study Selection and Data Extraction: All prospective English-language trials examining one or more non-DHP CCB for the treatment of proteinuria were evaluated. Data Synthesis: A total of 13 clinical trials examining the use of non-DHP CCBs to treat proteinuria alone or in combination with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) were included in the evaluation. Most studies evaluated patients with macroalbuminuria secondary to diabetes and hypertension. Verapamil was the most common agent studied. Non-DHP CCBs were effective in reducing proteinuria in diabetic kidney disease but did not reduce renal or cardiovascular outcomes in the one trial that evaluated clinical end points. They were generally well tolerated, with the most common adverse effect reported being constipation. Relevance to Patient Care and Clinical Practice: This review evaluates and summarizes the available evidence on non-DHP CCBs for treatment of proteinuria in patients with existing kidney disease. Conclusion: Non-DHP CCBs may be a reasonable therapeutic option for patients with diabetic kidney disease and persistent proteinuria despite maximum doses of ACE inhibitors or ARBs. Additionally, they may be reasonable alternatives to ACE inhibitors or ARBs if a contraindication or intolerance exists.

2.
Curr Pharm Teach Learn ; 10(12): 1574-1578, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30527822

RESUMEN

INTRODUCTION: Descriptions of SOAP note requirements and assessment methods used during advanced pharmacy practice experiences (APPEs) are limited in the literature. This study aimed to gather information from preceptors regarding SOAP note writing and assessment methods utilized during ambulatory care APPEs. METHODS: A survey was developed and distributed to ambulatory care preceptors with data collected via Qualtrics and analyzed using descriptive statistics, Fisher's exact test to assess the significance for associations between dependent and independent variables, and the Gamma test to assess dependent variables in grading habits and feedback types. RESULTS: The survey response rate was 62% with 75% of preceptors having students write SOAP notes during APPEs. A majority of preceptors (84%) do not formally grade SOAP notes with full-time faculty being more likely to grade and provide written feedback. Half of the preceptors perceived students as either prepared or very prepared to write SOAP notes but the majority felt that students struggle with the assessment portion of the note. There were significant differences between schools in the percentage of preceptors that formally grade SOAP notes, ranging from 2 to 45%. CONCLUSIONS: Preceptors' perception of student preparedness to write SOAP notes on ambulatory APPEs was similar, despite assessment methods varying widely.


Asunto(s)
Documentación/normas , Educación en Farmacia/normas , Percepción , Preceptoría/métodos , Atención Ambulatoria/métodos , Documentación/métodos , Educación en Farmacia/métodos , Evaluación Educacional/métodos , Retroalimentación , Humanos , Servicios Farmacéuticos , Encuestas y Cuestionarios
3.
Am J Pharm Educ ; 82(9): 6725, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30559501

RESUMEN

Objective. To develop and establish validity for a grading rubric to evaluate diabetes subjective, objective, assessment, plan (SOAP) note writing on primary care (PC) advanced pharmacy practice experiences (APPEs), and to assess reliability and student perceptions of the rubric. Methods. Ten PC APPE faculty members collaborated to develop a rubric to provide formative and summative feedback on three written SOAP notes per APPE student over a 10-month period. Correlation analyses were conducted between rubric scores and three criterion variables to assess criterion-related validity: APPE grades, Pharmaceutical Care Ability Profile Scores, and Global Impression Scores. Inter-rater and intra-rater reliability testing were completed using Cohen's kappa and Intraclass Correlation Coefficients (ICC). Student perceptions were assessed through an anonymous student survey. Results. Fifty-one students and 167 SOAP notes were evaluated using the final rubric. The mean score significantly increased from the first to second SOAP note and from the first to third SOAP note. Statistically significant positive correlations were found between final rubric scores and criterion variables. The ICC for inter-rater reliability was fair (.59) for final rubric scores and excellent for intra-rater reliability (.98 to1.00). Students responded that the rubric improved their ability (84.9%) and confidence (92.4%) to write SOAP notes. Conclusion. The rubric may be used to make valid decisions about students' SOAP note writing ability and may increase their confidence in this area. The use of the rubric allows for greater reliability among multiple graders, supporting grading consistency.


Asunto(s)
Documentación/normas , Evaluación Educacional/métodos , Educación en Farmacia/métodos , Docentes , Retroalimentación Formativa , Metas , Humanos , Reproducibilidad de los Resultados , Estudiantes de Farmacia , Escritura
5.
Pharm Pract (Granada) ; 13(1): 518, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25883689

RESUMEN

BACKGROUND: Medication reconciliation in the outpatient setting is an important part of preventing medication errors, and is mandated by the Joint Commission. OBJECTIVE: To describe and quantify medication reconciliation efforts by student pharmacists in an outpatient family medicine center. METHODS: A retrospective review was conducted of medication reconciliation documentation forms completed by student pharmacists during an outpatient clinical rotation between May 2012 and April 2013. Discrepancies were defined as any lack of agreement between the medication list in the electronic medical record and the patient reported regimen. Descriptive statistics were used to report results. RESULTS: A total of 557 medication reconciliation documentation forms from 12 student pharmacists were reviewed. The average number of medications per patient interviewed was 9 (range 0-25). A total of 1,783 medication discrepancies were found with an average of 3.2 discrepancies per patient. An additional 272 medication allergy discrepancies were identified. The most common discrepancy was medications the patient was no longer taking (37.3%, n=766). The second most common discrepancy was over-the-counter and herbal medications that had not been added to the medication list (16.2%, n=335). Patient counseling was documented 159 times during the medication reconciliation process. CONCLUSIONS: Medication reconciliation by student pharmacists in an outpatient family medicine center resulted in the identification of many discrepancies in medication lists in an electronic health record. Student pharmacists also documented and clarified medication allergies and performed patient counseling.

6.
J Manag Care Spec Pharm ; 21(4): 281-6, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25803761

RESUMEN

BACKGROUND: Physicians commonly use formulary medication coverage information generated by electronic heath records (EHRs) and the Epocrates mobile drug database application when making medication selection decisions. Nonformulary selections may lead to higher out-of-pocket patient costs and nonadherence with prescribed regimens. Nonformulary selections also contribute to higher overall health plan spending. However, the accuracy of these systems compared with actual insurance coverage is not known.  OBJECTIVE: To assess the accuracy of formulary status icons generated by an EHR system and the Epocrates mobile application for patients with Alabama Medicaid and Blue Cross Blue Shield of Alabama (BCBS), the primary insurance providers in the state of Alabama. METHODS: Patients of all ages who had a chart review performed at the outpatient family medicine or pediatric clinics at the University of Alabama at Birmingham Huntsville Medical Regional Campus from May to October 2013 were included in this retrospective analysis. Patients who were not insured by either Alabama Medicaid or BCBS were excluded. Patients who did not have new medications added at the time of the visit were also excluded. For each medication prescribed, the formulary status provided in the EHR system and Epocrates was compared with the actual Medicaid and BCBS formularies published online, and the accuracy of the 2 databases was determined.  RESULTS: A total of 1,529 medication records were analyzed. The EHR and Epocrates provided accurate formulary information for 93.1% and 89.4% of medications, respectively. Formulary information generated by the EHR was 96.3% accurate for Medicaid patients and 80.1% accurate for BCBS patients. Epocrates was 88.2% accurate for Medicaid patients and 94.4% accurate for BCBS patients. A total of 936 medication records from the pediatric clinic were analyzed, and the majority of these patients (88.4%) had Medicaid insurance. In this population, the EHR was more accurate (96.9%) than Epocrates (86.6%). Of the small number of pediatric medication records (n = 109) associated with patients who had BCBS, Epocrates was more accurate (92.7%) than the EHR (83.5%). In family medicine, 593 medication records were analyzed. Again, for Medicaid patients, the EHR was more accurate (95.3%) than Epocrates (91.5%). For those with BCBS, Epocrates was more accurate (95.3%) than the EHR (78.2%). When over-the-counter (OTC) medications (n = 232) were analyzed separately from prescription medications, it was found that overall the EHR was 90.5% accurate, and Epocrates was 41.4% accurate. It is important to note that when only prescription medications were analyzed, the accuracy rates were high (93.6% for the EHR and 98.0% for Epocrates). CONCLUSIONS: Formulary information generated by the EHR system and the Epocrates mobile application is a useful tool for physicians when prescribing medications, but neither source is completely accurate. Prescribers should be particularly cautious when making OTC formulary decisions using the Epocrates mobile application, since the formulary information provided for these medications was found to be the least accurate.


Asunto(s)
Prescripciones de Medicamentos/normas , Registros Electrónicos de Salud/normas , Beneficios del Seguro/normas , Aplicaciones Móviles/normas , Farmacia/normas , Planes de Seguros y Protección Cruz Azul/economía , Planes de Seguros y Protección Cruz Azul/normas , Prescripciones de Medicamentos/economía , Registros Electrónicos de Salud/economía , Humanos , Beneficios del Seguro/economía , Medicaid/economía , Medicaid/normas , Estudios Retrospectivos , Estados Unidos
7.
Pharm. pract. (Granada, Internet) ; 13(1): 0-0, ene.-mar. 2015. tab
Artículo en Inglés | IBECS | ID: ibc-134474

RESUMEN

Background: Medication reconciliation in the outpatient setting is an important part of preventing medication errors, and is mandated by the Joint Commission. Objective: To describe and quantify medication reconciliation efforts by student pharmacists in an outpatient family medicine center. Methods: A retrospective review was conducted of medication reconciliation documentation forms completed by student pharmacists during an outpatient clinical rotation between May 2012 and April 2013. Discrepancies were defined as any lack of agreement between the medication list in the electronic medical record and the patient reported regimen. Descriptive statistics were used to report results. Results: A total of 557 medication reconciliation documentation forms from 12 student pharmacists were reviewed. The average number of medications per patient interviewed was 9 (range 0-25). A total of 1,783 medication discrepancies were found with an average of 3.2 discrepancies per patient. An additional 272 medication allergy discrepancies were identified. The most common discrepancy was medications the patient was no longer taking (37.3%, n=766). The second most common discrepancy was over-the-counter and herbal medications that had not been added to the medication list (16.2%, n=335). Patient counseling was documented 159 times during the medication reconciliation process. Conclusions: Medication reconciliation by student pharmacists in an outpatient family medicine center resulted in the identification of many discrepancies in medication lists in an electronic health record. Student harmacists also documented and clarified medication allergies and performed patient counseling (AU)


Antecedentes: La reconcialización de la medicación en pacientes ambulatorios es un elementoimportante de la prevención de errores de medicación, y es obligatoria para la Joint Commission. Objetivo: Describir y cuantificar los esfuerzos en reconciliación de la medicación de los estudiantes de farmacia en un centro ambulatorio de medicina de familia. Métodos: Se realizó una revisión retrospectiva de la documentación de la reconciliación de la medicación completada por estudiantes de farmacia durante la rotación clínica en ambulatorio entre mayo de 2012 y abril de 2013. Se definieron las discrepancias como la falta de acuerdo entre la lista de medicación en la historia clínica electrónica y el régimen comunicado por el paciente. Se utilizaron estadísticas descriptivas para comunicar los resultados. Resultados: se revisaron un total de 557 formularios de documentación de reconciliación de medicación de 12 estudiantes de farmacia. La media de medicamentos por paciente fue de 9 (rango 0-25). Se encontraron un total de 1.783 discrepancias con una media de 3,2 discrepancias por paciente. Se identificaron 272 discrepancias de alergias medicamentos adicionales. La discrepancia más común era la medicación que el paciente ya no tomaba (37,3%; n=766). La segunda discrepancia más común fue medicamentos sin receta o plantas medicinales que no habían sido añadidas a la lista (16,2%; n=335). Se documentó el consejo a pacientes en 159 ocasiones durante el proceso de reconciliación de la medicación. Conclusiones: La reconciliación de medicación por estudiantes de farmacia en un centro ambulatorio de medicina de familia resultó en la identificación de muchas discrepancias en la lista de medicación en las historias clínicas electrónicas. Los estudiantes de farmacia también documentaron y clarificaron alergias a medicamentos y realizaron consejo a pacientes (AU)


Asunto(s)
Humanos , Masculino , Femenino , Conciliación de Medicamentos , Errores de Medicación/prevención & control , Estudiantes de Farmacia , Hipersensibilidad a las Drogas/prevención & control , Medicina Familiar y Comunitaria , Instituciones de Atención Ambulatoria , Registros Electrónicos de Salud
8.
Pharm. pract. (Granada, Internet) ; 10(2): 78-82, abr.-jun. 2012. tab
Artículo en Inglés | IBECS | ID: ibc-100500

RESUMEN

The Joint Commission continues to emphasize the importance of medication reconciliation in all practice settings. Pharmacists and student pharmacists are uniquely trained in this aspect of patient care, and can assist with keeping accurate and complete medication records through patient interview in the outpatient setting. Objective: The objective of this study was to quantify and describe medication reconciliation efforts by student pharmacists in an outpatient family medicine center. Methods: A retrospective review was conducted of all standard medication reconciliation forms completed by student pharmacists during patient interviews from April 2010 to July 2010. The number of reviews conducted was recorded, along with the frequency of each type of discrepancy. A discrepancy was defined as any lack of agreement between the medication list in the electronic health record (EHR) and the patient-reported regimen and included any differences in dose or frequency of a medication, duplication of the same medication, medication no longer taken or omission of any medication. Results: A total of 213 standard medication forms from the 4 month period were reviewed. A total of 555 discrepancies were found, including medications no longer taken, prescription medications that needed to be added to the EHR, over-the-counter(OTC) and herbal medications that needed to be added to the EHR, medications taken differently than recorded in the EHR, and medication allergies which needed to be updated. An average of 2.6 discrepancies was found per patient interviewed. Conclusion: Student pharmacist-initiated medication reconciliation in an outpatient family medicine center resulted in the resolution of numerous discrepancies in the medication lists of individual patients. Pharmacists and student pharmacists are uniquely trained in medication history taking and play a vital role in medication reconciliation in the outpatient setting (AU)


La Joint Commission continúa enfatizando la importancia de la reconciliación de la medicación en todos los entornos sanitarios. Los farmacéuticos y los estudiantes de farmacia están especialmente entrenados en este aspecto de la atención al paciente y pueden ayudar manteniendo historiales de medicación precisos y completos mediante entrevista con los pacientes en el entorno ambulatorio. Objetivo: El objetivo de este estudio fue cuantificar y describir los esfuerzos en reconciliación de la medicación por estudiantes de farmacia en un centro ambulatorio de medicina de familia. Métodos: Se realizó una revisión retrospectiva de todos los formularios estándar de reconciliación de la medicación cumplimentados por estudiantes de farmacia durante las entrevistas a pacientes desde abril-2010 a julio-2010. Se registró el número de revisiones realizadas así como la frecuencia de cada tipo de discrepancia. Se definió una discrepancia como cualquier falta de acuerdo entre la lista de medicación en la historia clínica electrónica (HCE) y el régimen reportado por el paciente e incluía cualquier diferencia en dosis o frecuencia de un medicamento, duplicidad del mismo medicamento, medicación discontinuada u omisión de cualquier medicación. Resultados: Se revisaron un total de 213 formularios estándar de medicación del periodo de 4 meses. Se encontraron un total de 555 discrepancias, incluyendo, medicaciones que ya no se tomaban, medicación que necesitaba ser añadidas a la HCE, medicamentos OTC y plantas medicinales que tenían que añadirse a la HCE, medicación tomadas de modo diferente a lo registrado en la HCE y alergias a medicación que necesitaban actualizarse. Se encontró una media de 2,6 discrepancias por paciente entrevistado. Conclusión: La reconciliación de la medicación iniciada por estudiantes de farmacia en un centro ambulatorio de medicina familiar produjo la resolución de numerosas discrepancias en las listas de medicación de los pacientes. Los farmacéuticos y los estudiantes de farmacia están especialmente entrenados para la toma de historiales de medicación y juegan un papel vital en la reconciliación de la medicación en ambiente ambulatorio (AU)


Asunto(s)
Humanos , Masculino , Femenino , Estudiantes de Farmacia/estadística & datos numéricos , Atención Ambulatoria/organización & administración , Control de Formularios y Registros/métodos , Control de Formularios y Registros/organización & administración , Formularios como Asunto/normas , Servicio Ambulatorio en Hospital/organización & administración , Estudios Retrospectivos , Registros Médicos/normas , Estados Unidos/epidemiología
9.
Pharm Pract (Granada) ; 10(2): 78-82, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24155821

RESUMEN

UNLABELLED: The Joint Commission continues to emphasize the importance of medication reconciliation in all practice settings. Pharmacists and student pharmacists are uniquely trained in this aspect of patient care, and can assist with keeping accurate and complete medication records through patient interview in the outpatient setting. OBJECTIVE: The objective of this study was to quantify and describe medication reconciliation efforts by student pharmacists in an outpatient family medicine center. METHODS: A retrospective review was conducted of all standard medication reconciliation forms completed by student pharmacists during patient interviews from April 2010 to July 2010. The number of reviews conducted was recorded, along with the frequency of each type of discrepancy. A discrepancy was defined as any lack of agreement between the medication list in the electronic health record (EHR) and the patient-reported regimen and included any differences in dose or frequency of a medication, duplication of the same medication, medication no longer taken or omission of any medication. RESULTS: A total of 213 standard medication forms from the 4 month period were reviewed. A total of 555 discrepancies were found, including medications no longer taken, prescription medications that needed to be added to the EHR, over-the-counter(OTC) and herbal medications that needed to be added to the EHR, medications taken differently than recorded in the EHR, and medication allergies which needed to be updated. An average of 2.6 discrepancies was found per patient interviewed. CONCLUSIONS: Student pharmacist-initiated medication reconciliation in an outpatient family medicine center resulted in the resolution of numerous discrepancies in the medication lists of individual patients. Pharmacists and student pharmacists are uniquely trained in medication history taking and play a vital role in medication reconciliation in the outpatient setting.

11.
Ann Pharmacother ; 44(11): 1810-6, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20923947

RESUMEN

OBJECTIVE: To evaluate the use of topiramate for the treatment of posttraumatic stress disorder (PTSD). DATA SOURCES: Ovid MEDLINE (1950 to June week 4, 2010), International Pharmaceutical Abstracts (1970 to May 2010), ISI Web of Science (1945 to July 3, 2010), and Iowa Drug Information Service (searched July 6, 2010) were searched using the terms posttraumatic stress disorder and topiramate. Guidelines and other sources were identified from bibliography searches. STUDY SELECTION AND DATA EXTRACTION: All English-language human studies and case reports that evaluated the use of topiramate for treatment of PTSD were evaluated. DATA SYNTHESIS: One case report, 1 case series, 2 open-label trials, and 1 placebo-controlled trial that used topiramate (monotherapy or adjunct) to treat civilian PTSD were identified and evaluated. The case report and case series reported subjective reduction of symptoms, and the open-label trials reported a significant reduction in PTSD Checklist-Civilian score. The placebo-controlled trial found no significant difference in Clinician-Administered PTSD Scale (CAPS) score. One open-label trial and 2 placebo-controlled trials that used topiramate in combat-related PTSD were identified and evaluated. The open-label trial reported a significant reduction in CAPS score, and 1 placebo-controlled trial reported a statistically significant difference in CAPS score. However, the other placebo-controlled trial found no significant differences. In some of the trials evaluated, the clinical significance of outcomes reported is difficult to determine. Adverse effects were reported throughout the trials but generally were not considered serious. CONCLUSIONS: Based on the limited evidence available, topiramate is a possible alternative or adjunct option for patients with PTSD that is refractory to standard treatments.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Fructosa/análogos & derivados , Trastornos por Estrés Postraumático/tratamiento farmacológico , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/farmacología , Trastornos de Combate/tratamiento farmacológico , Femenino , Fructosa/efectos adversos , Fructosa/farmacología , Fructosa/uso terapéutico , Humanos , Masculino , Trastornos por Estrés Postraumático/etiología , Topiramato , Resultado del Tratamiento , Estados Unidos , Veteranos
12.
South Med J ; 103(10): 1018-22; quiz 1023, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20818300

RESUMEN

Hepatitis C is a leading cause of liver failure and transplantation in the United States and a major public health issue. Studies have shown that patients with hepatitis C are at an increased risk of cardiovascular disease, which make statins of particular benefit in this patient population. However, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) lists active or chronic liver disease as an absolute contraindication to statin therapy. The available literature regarding the safety of statins in this patient population is limited, but has not shown clinically significant differences in aminotransferase elevations or evidence of hepatotoxicity in patients with hepatitis C who have received statins versus those who have not. Statins should continue to be avoided in advanced end-stage liver disease, as there is a lack of safety data in these patients and drug metabolism would be severely compromised. Treatment with statins can be used in those with chronic, stable hepatitis C with elevated cardiac risk or a previous cardiac event.


Asunto(s)
Hepatitis C/complicaciones , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Adulto , Enfermedades Cardiovasculares/prevención & control , Contraindicaciones , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Hígado/efectos de los fármacos , Pruebas de Función Hepática , Pravastatina/efectos adversos , Pravastatina/uso terapéutico , Transaminasas/sangre
13.
Drugs Aging ; 25(2): 131-44, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18257600

RESUMEN

The incidence of and mortality from both chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) increase with age. In addition, the average age of patients with COPD and CVD is also increasing as a result of improvements in both pharmacological and non-pharmacological treatments. Coronary artery disease is a compelling indication for beta-adrenoceptor antagonist use in a population in whom beta-adrenoceptor antagonism is often viewed as contraindicated. beta-Adrenoceptor antagonists have been proven to improve cardiovascular morbidity and mortality but have been under-utilized in patients with COPD with concomitant CVD because of a fear of bronchoconstriction and adverse effects, particularly in the elderly. The advanced age of patients with COPD and CVD, along with the sheer number of patients with these diseases, necessitates that clinicians understand the treatment of these co-morbidities using seemingly conflicting therapy in the form of beta-adrenoceptor agonists and antagonists. We review changes in the pharmacokinetics and pharmacodynamics of beta-adrenoceptor antagonists in the elderly, the role of beta-adrenoceptor antagonists in CVD and the literature regarding the safety and mortality benefits of beta-adrenoceptor antagonists in elderly patients with COPD and concomitant CVD. We conclude that cardioselective beta-adrenoceptor antagonists appear to be safe to use in elderly male patients with mild-to-moderate COPD who have a compelling indication for beta-adrenoceptor antagonist therapy. Data in female patients are very limited. Nonselective beta-adrenoceptor antagonists should be avoided in general, except in patients with heart failure who might benefit significantly from the use of carvedilol. beta-Adrenoceptor antagonists have been shown to improve mortality in older patients with coexisting CVD and COPD.


Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Antagonistas Adrenérgicos beta/efectos adversos , Antagonistas Adrenérgicos beta/farmacocinética , Factores de Edad , Anciano , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/mortalidad , Ensayos Clínicos como Asunto , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Metaanálisis como Asunto , Enfermedad Pulmonar Obstructiva Crónica/mortalidad
14.
Am J Health Syst Pharm ; 64(3): 294-7, 2007 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-17244879

RESUMEN

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).


Asunto(s)
Quimioterapia , Enfermeras Practicantes , Servicios de Salud Rural/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Alabama , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
16.
Pharmacotherapy ; 26(2): 269-76, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16466332

RESUMEN

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.


Asunto(s)
Acetamidas/efectos adversos , Antibacterianos/efectos adversos , Oxazolidinonas/efectos adversos , Inhibidores de la Captación de Serotonina/efectos adversos , Sertralina/efectos adversos , Acetamidas/uso terapéutico , Muñones de Amputación , Antibacterianos/uso terapéutico , Trastorno Depresivo/complicaciones , Trastorno Depresivo/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Angiopatías Diabéticas/tratamiento farmacológico , Interacciones de Drogas , Resultado Fatal , Femenino , Gangrena/tratamiento farmacológico , Gangrena/etiología , Humanos , Linezolid , Persona de Mediana Edad , Síndromes de Neurotoxicidad/psicología , Oxazolidinonas/uso terapéutico , Inhibidores de la Captación de Serotonina/uso terapéutico , Sertralina/uso terapéutico , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/tratamiento farmacológico
17.
Pharmacotherapy ; 25(2): 279-88, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15767242

RESUMEN

STUDY OBJECTIVES: To determine the success of an outpatient smoking-cessation clinic by assessing smoking abstinence rates and factors associated with lower abstinence rates. We also sought to determine whether smoking abstinence rates differed among various smoking-cessation products. METHODS: Patients were referred by primary care providers to a pharmacist-managed smoking-cessation clinic. Patients received tailored behavioral counseling, educational materials, and drug therapy consisting of sustained-release (SR) bupropion; nicotine patch, inhaler, or nasal spray; or combination therapy. Patients were monitored by phone or clinic visit for 6 months, if possible. Outcomes assessed were abstinence (both point prevalence and continuous abstinence) and adverse effects. Patients lost to follow-up were assumed to be smoking. RESULTS: Over 2 years, 198 patients were enrolled in the program. At the initial visit, 35.4% received the patch, 32.8% bupropion SR, 18.2% a combination of patch plus inhaler, 9.6% inhaler alone, and fewer than 5% other therapies. At 6 weeks, a statistically significant difference was observed in continuous abstinence rates between the nicotine patch versus bupropion SR groups (22.9% vs 7.7%, p=0.02) and between the combination patch-inhaler versus bupropion SR groups (25% vs 7.7%, p=0.02). However, this difference was not significant beyond the 6-week visit. A trend toward higher abstinence rates was noted at 6 weeks in the nicotine patch-inhaler versus the other treatment groups, possibly suggesting the need for more intense treatment regimens with combination therapy. Point prevalence abstinence rates after 12 weeks were 18.6%, 15.4%, 22.2% and 21.1% respectively, for the patch, bupropion SR, patchinhaler, and inhaler alone treatment groups. The corresponding continuous abstinence rates were 10.0%, 3.1%, 11.1%, and 10.5%. CONCLUSION: Although statistically significant differences between products were noted at 6 weeks, no sustained difference in smoking abstinence rates was observed between products. At 6 months, point prevalence and continuous abstinence rates were small, but the decline in success noted over time and the limited overall success rates are consistent with rates for the United States. Our findings suggest that when smokers are assisted in quitting, initial contact as well as follow-up evaluation and monitoring must be intense and sustained to increase the likelihood of successful abstinence. Tobacco dependence is clearly a chronic condition warranting repeated treatment and monitoring until continuous abstinence is achieved.


Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Bupropión/uso terapéutico , Nicotina/uso terapéutico , Agonistas Nicotínicos/uso terapéutico , Cese del Hábito de Fumar/métodos , Instituciones de Atención Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nicotina/administración & dosificación , Agonistas Nicotínicos/administración & dosificación , Resultado del Tratamiento
19.
Pharmacotherapy ; 24(2): 285-90, 2004 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-14998226

RESUMEN

A 67-year-old man receiving a stable maintenance dosage of warfarin experienced an increased international normalized ratio (INR) without bleeding when his atorvastatin therapy was switched to fluvastatin. His warfarin dosage was reduced and his INR stabilized. The fluvastatin was switched back to atorvastatin, and the warfarin dosage was increased to maintain the patient's goal INR. The literature supports a drug interaction between warfarin and fluvastatin due to the strong affinity of fluvastatin for the cytochrome P450 enzyme 2D6. This interaction has not been seen with atorvastatin. Lovastatin also reportedly has caused increases in INR when coadministered with warfarin. It is unclear whether simvastatin interacts with warfarin, but it may increase INRs slightly or increase serum simvastatin levels. One case report describes an interaction between simvastatin and the anticoagulant acenocoumarol, which resulted in an elevated INR. Pravastatin does not appear to interact with warfarin but has caused an increased INR when combined with the anticoagulant fluindione. Thus, until more definitive data are available, clinicians should monitor the INR closely after starting statin therapy in any patient receiving anticoagulation therapy.


Asunto(s)
Anticoagulantes/administración & dosificación , Ácidos Grasos Monoinsaturados/efectos adversos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Indoles/efectos adversos , Acenocumarol/metabolismo , Acenocumarol/farmacología , Acenocumarol/uso terapéutico , Administración Oral , Anciano , Anticoagulantes/metabolismo , Anticoagulantes/farmacocinética , Atorvastatina , Interacciones de Drogas , Ácidos Grasos Monoinsaturados/metabolismo , Ácidos Grasos Monoinsaturados/uso terapéutico , Fluvastatina , Ácidos Heptanoicos/metabolismo , Ácidos Heptanoicos/farmacología , Ácidos Heptanoicos/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/metabolismo , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacocinética , Hiperlipidemias/tratamiento farmacológico , Indoles/metabolismo , Indoles/uso terapéutico , Relación Normalizada Internacional/efectos adversos , Masculino , Cooperación del Paciente , Pirroles/metabolismo , Pirroles/farmacología , Pirroles/uso terapéutico , Simvastatina/metabolismo , Simvastatina/farmacología , Simvastatina/uso terapéutico , Trombosis de la Vena/tratamiento farmacológico , Warfarina/metabolismo , Warfarina/farmacología , Warfarina/uso terapéutico
20.
South Med J ; 97(3): 322-4, 2004 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15043349

RESUMEN

Nicotine has been documented to regulate the release of plasma arginine vasopressin (AVP). The literature is inconclusive about the effects of nicotine replacement therapy on AVP release, although cigarette smoking has been shown to increase the release of AVP. No clinical case reports have documented the possible association between nicotine replacement and hyponatremia through AVP release. We report a case of a 39-year-old man who experienced syndrome of inappropriate antidiuretic hormone while on nicotine patch therapy. We theorize that the constant serum concentration of nicotine levels provided through the patch may cause hyponatremia through the continuous stimulation of vasopressin.


Asunto(s)
Síndrome de Secreción Inadecuada de ADH/etiología , Nicotina/administración & dosificación , Nicotina/efectos adversos , Adulto , Humanos , Masculino , Fumar/fisiopatología , Sodio/sangre
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA