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1.
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
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.
Curr Pharm Teach Learn ; 10(11): 1501-1506, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30514541

RESUMEN

BACKGROUND AND PURPOSE: The Society of Teachers of Family Medicine Group on Pharmacotherapy recommends a formal curriculum during family medicine residency training and describes benefits of utilizing pharmacists. Limited literature exists on how programs have incorporated questions from family medicine board preparation sources into pharmacotherapy academic education. The primary objective was to assess the impact on family medicine residents' perceived knowledge after incorporation of board review items into pharmacotherapy sessions. EDUCATIONAL ACTIVITY AND SETTING: Pharmacists affiliated with the University of Alabama Family Medicine Residency program incorporated questions from board preparation sources into monthly interactive pharmacotherapy sessions as part of a didactic curriculum between 2014 and 2016. An anonymous survey was administered for two consecutive years in 2015 and 2016 to assess residents' perceptions of the sessions and utilization of board-type questions as an active learning component. The change in residents' perception of knowledge was quantitatively analyzed and written comments were evaluated for recurring themes. FINDINGS: The cumulative survey response was 78% (68/87). Over 80% of residents reported that pharmacotherapy sessions and the use of board-type questions was quite or very helpful. The percent of residents that rated their knowledge as good or excellent significantly increased after every session compared to baseline. Residents noted the sessions' information, applicability, interactive nature, and relevance as strengths. SUMMARY: Incorporation of board preparation questions into interactive pharmacotherapy sessions was well received and improved residents' perception of pharmacotherapy knowledge. Utilizing this model in a formal pharmacotherapy curriculum taught by pharmacists is beneficial for family medicine resident learners.


Asunto(s)
Curriculum/tendencias , Medicina General/educación , Internado y Residencia/normas , Innovación Organizacional , Educación Médica/métodos , Educación Médica/normas , Educación Médica/tendencias , Humanos , Internado y Residencia/métodos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios
4.
Drugs Context ; 4: 212282, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26213555

RESUMEN

Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding.

5.
Int J Womens Health ; 7: 615-24, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26124682

RESUMEN

BACKGROUND: Vasomotor symptoms (VMS), characterized by hot flashes and night sweats, are the most commonly reported symptoms associated with estrogen deficiency during menopause and occur in up to 70% of women. The goal of treatment is to reduce the frequency and severity of symptoms. Although hormone therapy (HT) is generally recommended as first-line treatment, it is not appropriate for all patients. Antidepressants, specifically selective serotonin reuptake inhibitors, have been evaluated and utilized internationally for alternative treatment for VMS. In 2013, paroxetine mesylate (Brisdelle(®)) received a US Food and Drug Administration-labeled indication for moderate-to-severe hot flashes, making it the first nonhormonal treatment for VMS associated with menopause. The objective of this review is to critically evaluate available clinical data regarding the efficacy and safety of paroxetine for the treatment of VMS in menopausal women. METHODS: MEDLINE, PubMed, and Google Scholar were searched using the keywords paroxetine, vasomotor symptoms, hot flashes, and menopause. Searches were limited to humans, English language, and clinical trial design with a primary outcome of hot flash/vasomotor changes. RESULTS: Paroxetine (hydrochloride and mesylate) has been associated with a 33%-67% reduction in hot flash frequency with 6-12 weeks of treatment compared to 13.7%-37.8% reductions with placebo in patients both with and without a history of breast cancer. It was also associated with significant reductions in hot flash severity. Benefits of treatment persisted through 24 weeks in the study of the longest duration. Most adverse effects reported were of mild-to-moderate severity, with improved tolerability associated with lower doses (7.5-12.5 mg/day). CONCLUSION: Paroxetine is a safe and effective therapy for the treatment of VMS during menopause. Paroxetine (7.5-12.5 mg/day) should be considered a first-line therapy option for VMS in patients when HT is either inappropriate or intolerable.

6.
Pharm Pract (Granada) ; 12(4): 528, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25580176

RESUMEN

BACKGROUND: Worldwide, gestational diabetes affects 15% of pregnancies. It is recommended in patients with gestational diabetes to initiate diet therapy and if this is not adequate, insulin is the next treatment modality. While insulin is the preferred drug therapy to manage gestational diabetes in the majority of women, it may not always be the best option for all women. OBJECTIVE: The purpose of this review is to assess the efficacy and safety of oral agents for treatment of gestational diabetes. METHODS: A literature search of the MEDLINE, Ovid databases and Google Scholar was performed using the search term "gestational diabetes" combined with each "metformin" and "glyburide". The time frame for the search was inception through August 2014. Randomized controlled trials and cohort (both prospective and retrospective) trials, published in English, with human participants were included. Studies included only pregnant women diagnosed with gestational diabetes. RESULTS: There were no significant differences in preterm deliveries, delivery modes, macrosomia, and birth weights and large for gestational age when utilizing glyburide vs insulin for gestational diabetes management. There were significantly higher neonatal intensive care unit admissions as well as longer lengths of stay for hypoglycemia and respiratory distress in babies whose mothers were treated with glyburide versus insulin. For the studies comparing metformin to insulin, there are no significant differences reported for birth weight, gestational age, delivery mode, prematurity and perinatal deaths. Women taking metformin may require supplemental insulin more frequently than those taking glyburide. CONCLUSION: Glyburide and metformin appear to be safe and effective to manage blood glucose in patients with gestational diabetes who prefer to not utilize insulin or who cannot afford insulin therapy. All other oral therapies to manage blood glucose levels during gestational diabetes should be reserved until additional evidence is available regarding safety and efficacy to both mother and fetus.

7.
J Pharm Pract ; 25(3): 352-67, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22544624

RESUMEN

One of the most difficult challenges health care providers encounter is drug selection for pregnant patients. Drug selection can be complex as efficacy and maternal side effects must be weighed against potential risk to the embryo or fetus. Verification of an individual drug's fetal safety is limited as most evidence is deduced from epidemiologic, prospective cohort, or case-control studies. Medication selection for the pregnant inpatient is a particularly complex task as the illnesses and conditions that require hospitalization mandate different medications, and the risk versus benefit ratio can vary significantly compared to the outpatient setting. Some degree of acute pain is not uncommon among inpatients. Acetaminophen is generally considered the drug of choice in pregnancy for mild to moderate acute pain, while most opioids are thought to be safe for short-term use to manage moderate to severe pain. Providing sedation is particularly challenging as the few options available for the general population are further limited by either known increased risk of congenital malformations or very limited human pregnancy data. Propofol is the only agent recommended for continuous sedation, which has a Food and Drug Administration classification as a pregnancy category B medication. Treatment of infections in hospitalized patients requires balancing the microbiology profile against the fetal risk. Older antimicrobials proven generally safe include beta-lactams, and those with proven fetal risks include tetracyclines. However, little to no information regarding gestational use is available on the newer antimicrobials that are frequently employed to treat resistant infections more commonly found in the inpatient setting. Management of maternal blood pressure is based on the severity of blood pressure elevations and not the hypertensive classification. Agents generally considered safe to use in hypertensive pregnant patients include methyldopa, labetolol, and hydralazine, while angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, hydrochlorothiazide, and atenolol should be avoided.


Asunto(s)
Antiinfecciosos/efectos adversos , Antihipertensivos/efectos adversos , Hipertensión/tratamiento farmacológico , Hipnóticos y Sedantes/efectos adversos , Complicaciones del Embarazo/tratamiento farmacológico , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Manejo de la Enfermedad , Femenino , Hospitalización/tendencias , Humanos , Hipertensión/epidemiología , Dolor/tratamiento farmacológico , Dolor/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Efectos Tardíos de la Exposición Prenatal/prevención & control
8.
Pharm. pract. (Granada, Internet) ; 9(3): 117-121, jul.-sept. 2011.
Artículo en Inglés | IBECS | ID: ibc-90923

RESUMEN

Vasomotor flushes are common complaints of women during and after menopause, affecting about 75 percent of this population. Estrogen therapy is the most effective treatment for hot flashes. However, there are a significant number of women who have contraindications or choose not to use estrogen due to potential risks such as breast cancer and thromboembolic disorders. These women need alternative options. The selective norepinephrine reuptake inhibitors, venlafaxine and desvenlafaxine, have shown efficacy in alleviating hot flashes. Objective: The purpose of this review is to assess the efficacy and tolerability of these two agents for treatment of hot flashes in healthy postmenopausal women. Methods: A literature search of the MEDLINE and Ovid databases from inception to June 2011 was conducted. Randomized controlled trials, published in English, with human participants were included. Studies included postmenopausal women, and trials with breast cancer only populations were excluded. Results: Venlafaxine reduced hot flashes by 37 to 61 percent and desvenlafaxine by 55 to 69 percent. Both agents were well tolerated. The most common adverse effects were headache, dry mouth, nausea, insomnia, somnolence, and dizziness. Conclusion: Based on the evidence, venlafaxine and desvenlafaxine are both viable options for reducing the frequency and severity of hot flashes (AU)


Los sofocos vasomotores son quejas frecuentes en mujeres durante y después de la menopausia, afectando a cerca del 75% de esta población. La terapia estrogénica es el tratamiento más efectivo para los sofocos. Sin embargo, hay un número significativo de mujeres que presentan contraindicaciones o no eligen la terapia estrogénica por los posibles riesgos como el cáncer de mama o las alteraciones tromboembólicas. Estas mujeres necesitan opciones alternativas. Los inhibidores selectivos de la recaptación de noradrenalina, venlafaxina y dexvenlafaxina, han demostrado eficacia en el alivio de los sofocos. Objetivo: El objetivo de esta revisión es evaluar la eficacia y tolerabilidad de estos dos agentes para el tratamiento de los sofocos en mujeres postmenopáusicas sanas. Métodos: Se realizó una búsqueda de la literatura en las bases de datos MEDLINE y Ovid desde su inicio a junio de 2011. Se incluyeron ensayos controlados aleatorizados, publicados en inglés, con participantes humanos. Los estudios que incluían sólo mujeres postmenopáusicas y ensayos únicamente con poblaciones de cáncer de mama fueron excluidos. Resultados: La venlafaxina redujo los sofocos en un 37 a 61% y la desvenlafaxina del 55 al 69%. Ambos agentes fueron bien tolerados. Los efectos adversos más comunes fueron dolor de cabeza, boca seca, nauseas, insomnio, somnolencia y mareos. Conclusión: Basándose en la evidencia, la venlafaxina y la desvenlafaxina son opciones viables para reducir la frecuencia y gravedad de los sofocos (AU)


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Menopausia , Sofocos/inducido químicamente , Sofocos/tratamiento farmacológico , Norepinefrina/uso terapéutico , Sofocos/complicaciones , Eficacia/métodos , Evaluación de Eficacia-Efectividad de Intervenciones
9.
Ann Pharmacother ; 45(3): 388-94, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21343402

RESUMEN

OBJECTIVE: To review the literature examining the use of gabapentin for treatment of hot flashes during natural or surgically induced menopause. DATA SOURCES: A literature search was conducted via PubMed, MEDLINE, and International Pharmaceutical Abstracts (1948-November 2010) using the search terms gabapentin, hot flashes, and menopause. Literature was limited to English-language, human studies. Additional material was identified by reviewing reference citations of the articles retrieved. STUDY SELECTION AND DATA EXTRACTION: Studies with data describing gabapentin for hot flash management during natural or surgically induced menopause were included. Any studies including women with a history of breast cancer were excluded. Four studies met the inclusion criteria. DATA SYNTHESIS: Gabapentin significantly decreased hot flash frequency and hot flash composite scores by 45-71% from baseline in the 4 trials included in this review. In 2 of the trials, gabapentin was comparable to hormone replacement therapy (71% vs 72%, respectively, p=0.63) in decreasing hot flash composite scores at the end of 12 weeks and in decreasing hot flash frequency at the end of 8 weeks (58.9% vs 70.1%, p>0.05). In all trials, the most common adverse effects with gabapentin were somnolence/drowsiness, unsteadiness, and dizziness. These adverse effects were most pronounced during the first 1-2 weeks of therapy, but resolved and were similar to those reported with placebo by week 4. These trials were short (<12 weeks) and had small sample sizes; however, their results appear to show that gabapentin is safe and effective for short-term treatment of hot flashes in women who have entered menopause either naturally or surgically. CONCLUSIONS: Gabapentin 600-2400 mg/day in divided doses may be a viable option for treating hot flashes in menopausal women who do not want to use hormone replacement therapy.


Asunto(s)
Aminas/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Sofocos/tratamiento farmacológico , Menopausia/efectos de los fármacos , Ácido gamma-Aminobutírico/uso terapéutico , Femenino , Gabapentina , Humanos , Menopausia/fisiología , Posmenopausia/efectos de los fármacos , Posmenopausia/fisiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedades Uterinas/tratamiento farmacológico , Enfermedades Uterinas/cirugía
10.
Pharm Pract (Granada) ; 9(3): 117-21, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24367464

RESUMEN

UNLABELLED: Vasomotor flushes are common complaints of women during and after menopause, affecting about 75 percent of this population. Estrogen therapy is the most effective treatment for hot flashes. However, there are a significant number of women who have contraindications or choose not to use estrogen due to potential risks such as breast cancer and thromboembolic disorders. These women need alternative options. The selective norepinephrine reuptake inhibitors, venlafaxine and desvenlafaxine, have shown efficacy in alleviating hot flashes. OBJECTIVE: The purpose of this review is to assess the efficacy and tolerability of these two agents for treatment of hot flashes in healthy postmenopausal women. METHODS: A literature search of the MEDLINE and Ovid databases from inception to June 2011 was conducted. Randomized controlled trials, published in English, with human participants were included. Studies included postmenopausal women, and trials with breast cancer only populations were excluded. RESULTS: Venlafaxine reduced hot flashes by 37 to 61 percent and desvenlafaxine by 55 to 69 percent. Both agents were well tolerated. The most common adverse effects were headache, dry mouth, nausea, insomnia, somnolence, and dizziness. CONCLUSIONS: Based on the evidence, venlafaxine and desvenlafaxine are both viable options for reducing the frequency and severity of hot flashes.

11.
J Am Pharm Assoc (2003) ; 50(5): e106-15, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20833608

RESUMEN

OBJECTIVE: To review the literature on alternative over-the-counter (OTC) therapies for the treatment of hot flashes in menopausal women. DATA SOURCES: A literature search was conducted using PubMed, International Pharmaceutical Abstracts, and Medline from inception to June 2010, combining the term hot flash individually with black cohosh, isoflavones, red clover, soy, vitamin E, ginseng, dong quai, evening primrose oil, wild yam, kava, and melatonin. All publication types including human participants and published in English were eligible for review. These articles, relevant abstracts, and additional references were used to collect pertinent data. STUDY SELECTION AND DATA EXTRACTION: Clinical trials comparing the above single-ingredient agents with placebo or active treatment were selected. In addition, only studies assessing the effects of these single-ingredient agents on vasomotor symptoms in menopausal women were included. DATA SYNTHESIS: Since the Women's Health Initiative and Heart and Estrogen/Progestin Replacement Study II, women have sought lifestyle changes and other drug therapies as alternatives to menopausal hormone therapy to relieve hot flashes associated with menopause. The currently available literature is conflicting in regard to efficacy and does not support the use of alternative OTC therapies for hot flash management associated with menopause. In addition, long-term safety data are lacking for any of these therapies. CONCLUSION: Women should be encouraged to implement therapeutic lifestyle changes to assist them with hot flash management. Based on the current literature, alternative OTC therapies do not have consistent, beneficial data to support their use in hot flash management.


Asunto(s)
Terapia de Reemplazo de Hormonas/efectos adversos , Sofocos/tratamiento farmacológico , Menopausia , Medicamentos sin Prescripción/uso terapéutico , Fitoterapia , Ensayos Clínicos como Asunto , Terapias Complementarias , Interacciones de Drogas , Femenino , Sofocos/fisiopatología , Humanos , Medicamentos sin Prescripción/efectos adversos , Conducta de Reducción del Riesgo , Factores de Tiempo
12.
Pharmacotherapy ; 29(11): 1357-74, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19857151

RESUMEN

A growing body of evidence suggests that antidepressant therapies, particularly selective serotonin reuptake inhibitors and venlafaxine, are effective in the management of hot flash symptoms. Several of these agents have the support of the American College of Obstetricians and Gynecologists and the North American Menopause Society. To review the literature on antidepressants for the treatment of hot flashes in women, we searched the PubMed, International Pharmaceutical Abstracts, and MEDLINE databases from inception through May 2009. All publication types that included human participants and that were published in English were eligible for review. These articles, relevant abstracts, and additional references were used to collect pertinent data. Although initial small pilot trials were conducted solely in breast cancer survivors, additional studies have been conducted both in breast cancer survivors and in relatively healthy menopausal women. Data on the benefits with many of these agents are conflicting. Venlafaxine and paroxetine have been studied more extensively than any of the other antidepressants and are more consistent in effectively reducing the frequency and severity of hot flashes, based on these study results. Desvenlafaxine, sertraline, fluoxetine, and citalopram should be considered second- or third-line options if patients fail therapy with or cannot tolerate venlafaxine or paroxetine, based on the current published data. Duloxetine, escitalopram, fluvoxamine, and mirtazapine should be reserved as last-line therapy until more rigorous studies are conducted assessing their use in the management of hot flashes.


Asunto(s)
Antidepresivos/uso terapéutico , Sofocos/tratamiento farmacológico , Femenino , Humanos , Menopausia , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
Ann Pharmacother ; 43(4): 754-60, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19336651

RESUMEN

OBJECTIVE: To report a case of fatal intracranial bleeding possibly due to an interaction between warfarin and inactivated influenza vaccination. CASE SUMMARY: A 64-year-old white male was admitted to the hospital after becoming unresponsive. The family reported a 2-day history of bleeding from the patient's rectum prior to admission. He had no recent changes in medical conditions or medication regimen, which included warfarin for stroke prophylaxis secondary to atrial fibrillation. The patient had received an inactivated influenza vaccine 4(1/2) weeks prior to presentation, at which time his international normalized ratio (INR) was 2.0. Upon admission, the patient's INR was greater than 15; INR values over the previous 6 months had been relatively stable (range 1.4-4.7). A noncontrast computed tomography scan of the head showed a large parenchymal hemorrhagic infarction involving the left temporal, parietal, and occipital lobes. In the emergency department, the patient received a nitroglycerin infusion to maintain systolic blood pressure in the range of 140-160 mm Hg as well as an infusion of 4 units of fresh frozen plasma and 10 mg of vitamin K. Following a neurosurgery evaluation, it was determined that nothing meaningful could be done to alter the patient's outcome positively, and he died approximately 17 hours after admission. DISCUSSION: To date, most reports of concomitant warfarin therapy and influenza vaccination indicate no significant change in average anticoagulation parameters. However, there are reports of individuals who may have experienced increased anticoagulation following influenza vaccination. The reason for these increases is unknown, but may involve only certain components of the vaccine, which is altered almost annually. Our patient's significant INR elevation, after being relatively stable for at least 6 months, was thought to be due to an interaction between warfarin and the influenza vaccination. The Horn Drug Interaction Probability Scale indicated a possible interaction between warfarin and the influenza vaccination. CONCLUSIONS: Considering the outcome in our patient, as well as outcomes in other individuals who have experienced an increased INR in a similar scenario, it appears justified to implement more frequent INR evaluations during the 4-6 weeks following influenza vaccination.


Asunto(s)
Vacunas contra la Influenza/efectos adversos , Hemorragias Intracraneales/inducido químicamente , Warfarina/efectos adversos , Interacciones de Drogas/fisiología , Resultado Fatal , Humanos , Vacunas contra la Influenza/farmacocinética , Hemorragias Intracraneales/diagnóstico , Masculino , Persona de Mediana Edad , Warfarina/farmacocinética
14.
Ann Pharmacother ; 42(5): 680-5, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18413687

RESUMEN

OBJECTIVE: To critically evaluate a possible increased anticoagulant response during concomitant warfarin and fluoroquinolone therapy. DATA SOURCES: A literature search was conducted using PubMed, International Pharmaceutical Abstracts, and MEDLINE, from inception to January 2008, combining the term warfarin individually with ciprofloxacin, levofloxacin, and moxifloxacin. These 3 quinolones were selected based on their commercial availability and use in the US. STUDY SELECTION AND DATA EXTRACTION: All publication types including human participants and published in English were eligible for review. Reports were selected based on the use of typical treatment courses of fluoroquinolones during concomitant warfarin therapy and the reporting of prothrombin time (PT) or international normalized ratio (INR). DATA SYNTHESIS: Twenty-two publications were evaluated including 16 case reports or case series, 2 retrospective cohort studies, and 4 prospective studies, which included 2 placebo-controlled investigations. Identified reports covered a wide range of patient ages with multiple comorbidities. Changes in PT and INR values were considerably variable and inconsistent during concomitant warfarin and fluoroquinolone therapy. Results from the 6 structured reports demonstrated mean increases in PT and INR values that were clinically insignificant. However, some patients experienced significant increases above the desired therapeutic range. Increased anticoagulation was typically observed within the first week of concomitant fluoroquinolone therapy. Bleeding complications during times of increased anticoagulation were not always observed, but did result in death for 2 patients. CONCLUSIONS: Published data show no consistent increase in anticoagulant effects during concomitant warfarin and 3 commonly prescribed fluoroquinolones. Therefore, more frequent monitoring during concomitant therapy would be prudent.


Asunto(s)
Compuestos Aza/metabolismo , Ciprofloxacino/metabolismo , Levofloxacino , Ofloxacino/metabolismo , Quinolinas/metabolismo , Warfarina/metabolismo , Compuestos Aza/efectos adversos , Ciprofloxacino/efectos adversos , Interacciones de Drogas/fisiología , Monitoreo de Drogas/métodos , Quimioterapia Combinada , Fluoroquinolonas , Humanos , Relación Normalizada Internacional/métodos , Moxifloxacino , Ofloxacino/efectos adversos , Quinolinas/efectos adversos , Warfarina/efectos adversos
15.
Ann Pharmacother ; 41(4): 702-6, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17374624

RESUMEN

OBJECTIVE: To report a case of drug-induced lupus (DIL) in a patient taking Cenestin, a combination product of synthetic conjugated estrogens. CASE SUMMARY: A 54-year-old white female presented with a 4 month history of bilateral arm pain that developed and progressively worsened after initiating Cenestin 0.625 mg daily. The patient's symptoms, findings on physical examination (eg, degenerative changes of the acromioclavicular joint), and laboratory test results (eg, antinuclear antibody titer 1-640 [normal <1-40]) were suggestive of DIL. Her symptoms rapidly resolved with discontinuation of Cenestin and promptly resumed with reinitiation of the drug. Laboratory test values also improved significantly with discontinuation of Cenestin. Based on these findings and the Naranjo probability scale score, this reaction was probably associated with Cenestin. DISCUSSION: DIL differs from systemic lupus erythematosus in that it is caused by prolonged exposure at adequate doses to a drug rather than being an autoimmune reaction. The most commonly reported and studied medications are hydralazine, quinidine, and procainamide. Other medications have been associated with DIL; however, data are limited in these reports, especially with estrogen. There have been no previous reports in the literature of synthetic estrogen products associated with DIL. CONCLUSIONS: A diagnosis of DIL can be very challenging to make, especially since there are no clear criteria on which to base it. While estrogen has rarely been reported to be associated with DIL, it may be considered as a possible cause.


Asunto(s)
Congéneres del Estradiol/efectos adversos , Estrógenos/efectos adversos , Lupus Vulgar/inducido químicamente , Femenino , Humanos , Lupus Vulgar/diagnóstico , Lupus Vulgar/fisiopatología , Persona de Mediana Edad
16.
Am Fam Physician ; 73(3): 457-64, 2006 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-16477892

RESUMEN

Numerous reports in the medical literature and popular media have discussed the effectiveness of various nonhormonal agents in reducing menopausal hot flash symptoms. Data for these therapies are limited, and most of the studies have been conducted in women with a history of breast cancer. Selective serotonin reuptake inhibitors and venlafaxine have been shown to reduce hot flashes by 19 to 60 percent and were well tolerated by study participants. Soy isoflavones reduced hot flashes by 9 to 40 percent in some trials, but most trials showed no difference compared with placebo. Black cohosh and red clover also have had inconsistent results, with some trials showing benefit and some no difference compared with placebo. Soy isoflavones, black cohosh, and red clover were well tolerated in clinical trials. Other agents that have been used to alleviate hot flashes include belladonna/ergotamine tartrate/phenobarbital combination, dong quai, evening primrose oil, gabapentin, ginseng, mirtazapine, trazodone, vitamin E, and wild yam, but few data regarding their effectiveness have been published. Further randomized controlled trials are needed.


Asunto(s)
Sofocos/tratamiento farmacológico , Menopausia/fisiología , Cimicifuga , Clonidina/farmacología , Clonidina/uso terapéutico , Femenino , Sofocos/fisiopatología , Humanos , Isoflavonas/farmacología , Isoflavonas/uso terapéutico , Fitoterapia , Inhibidores de la Captación de Serotonina/farmacología , Inhibidores de la Captación de Serotonina/uso terapéutico , Soja , Trifolium
17.
Pharmacotherapy ; 24(9): 1186-93, 2004 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15460179

RESUMEN

OBJECTIVE: To review the possible role of topiramate for the treatment of neuropathic pain and, specifically, the pain of diabetic peripheral neuropathy. DATA SOURCES: Clinical studies and abstracts were identified by using PubMed (January 1966--October 2003), Ovid (January 1966--December 2003), and International Pharmaceutical Abstracts (January 1970--December 2003) and by reviewing bibliographies of published studies. Key search terms included pain, peripheral neuropathy, diabetes, and topiramate. English-language studies were identified, as were pertinent references from these articles. DATA SYNTHESIS: Published data are limited on the successful use of topiramate in the treatment of neuropathic pain syndromes, and only three prospective studies evaluated the effectiveness of topiramate in diabetic peripheral neuropathy. In addition, the use of topiramate to treat diabetic neuropathic pain syndromes successfully may be limited by patients' inability to tolerate the adverse effects associated with the agent. CONCLUSIONS: Topiramate has been used successfully in relieving the pain of various neuropathies, including painful diabetic peripheral neuropathy. Randomized controlled trials that specifically focus on the use of topiramate in patients with painful diabetic peripheral neuropathy are needed to confirm the initial findings in case reports, abstracts, and small clinical trials that have focused on treating numerous neuropathic pain syndromes, including diabetic peripheral neuropathy.


Asunto(s)
Neuropatías Diabéticas/tratamiento farmacológico , Fructosa/análogos & derivados , Fructosa/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Adulto , Neuropatías Diabéticas/clasificación , Esquema de Medicación , Fructosa/administración & dosificación , Fructosa/efectos adversos , Humanos , Fármacos Neuroprotectores/administración & dosificación , Fármacos Neuroprotectores/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Topiramato
18.
South Med J ; 96(6): 602-5, 2003 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12938790

RESUMEN

Diabetic peripheral neuropathy affects 5 to 50% of people with diabetes in the United States. It is a progressive disorder that results in a gradual decrease in peripheral sensation and eventually complete loss of sensation. Patients with diabetic peripheral neuropathy are challenging to treat because of intolerable adverse medication effects and the development of tolerance to medical treatment. We present the case of a patient with peripheral neuropathy that was unresponsive to usual therapies. She experienced significant relief with the administration of topiramate. Topiramate is an anticonvulsant that is gaining recognition in the treatment of patients with neuropathic pain syndromes.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Neuropatías Diabéticas/complicaciones , Neuropatías Diabéticas/tratamiento farmacológico , Fructosa/análogos & derivados , Fructosa/administración & dosificación , Fructosa/uso terapéutico , Fármacos Neuroprotectores/administración & dosificación , Fármacos Neuroprotectores/uso terapéutico , Dolor/tratamiento farmacológico , Dolor/etiología , Administración Oral , Femenino , Humanos , Persona de Mediana Edad , Topiramato
19.
Am J Manag Care ; 8(7): 663-75; quiz 676-8, 2002 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12125806

RESUMEN

AUDIENCE: This activity is designed for pharmacists and other healthcare professionals who evaluate and treat perimenopausal and postmenopausal women. GOALS: To understand the benefits, risks, and adverse effects associated with estrogen replacement therapy (ERT) and hormone replacement therapy (HRT) and their influence on a postmenopausal woman's initiation, adherence, and satisfaction with therapy. OBJECTIVES: 1. Discuss menopause and its effects. 2. Identify ERT/HRT's potential benefits and risks. 3. Discuss ERT/HRT's adverse effects and management approaches. 4. Identify various administration routes for ERT/H RT. 5. Identify currently available ERT/HRT products. 6. Recognize potential reasons for lack of initiation and continuation as well as ways to improve adherence in patients.


Asunto(s)
Terapia de Reemplazo de Estrógeno/efectos adversos , Anciano , Toma de Decisiones , Educación Continua en Farmacia , Estrógenos/administración & dosificación , Estrógenos/clasificación , Estrógenos/economía , Femenino , Humanos , Menopausia/efectos de los fármacos , Menopausia/fisiología , Persona de Mediana Edad , Progesterona/administración & dosificación , Progesterona/clasificación , Progesterona/economía , Medición de Riesgo , Estados Unidos
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