Prevalence of self-reported nonmedical use of prescription stimulants in North Carolina Doctor of Pharmacy students.

OBJECTIVES: To evaluate the prevalence, associated factors, and opinions regarding nonmedical use of prescription stimulants (NMUPS) in Doctor of Pharmacy (PharmD) students. METHODS: An electronic survey was distributed to professional year 1 through 4 for students at 2 schools of pharmacy (public and private) in North Carolina. The survey was available for 3 weeks. Descriptive statistics (proportion of responders plus 95% confidence intervals [CIs]) were used to describe the primary objective. RESULTS: Of the 1043 surveys distributed, 407 were completed giving a 39% response rate. The results indicated that 9% (95% CI: 6.44-11.93) of PharmD students acknowledge NMUPS at least once during their pharmacy education. Additionally, 3% (95% CI: 1.90-5.45) acknowledge NMUPS at least once during the current pharmacy school year (past 5 months). Nonmedical prescription stimulant users were 9 times more likely to participate in NMUPS prior to pharmacy school (P < .0001) and 4.5 times more likely to use other illicit substances (P = .0076). CONCLUSION: The study identified the PharmD student population as high risk of abuse of prescription drug stimulants, which requires further research and attention. Additionally, there was a clear upward trend in the prevalence of NMUPS, and this misuse was associated with other detrimental behaviors.

A review of remediation programs in pharmacy and other health professions.

The Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines 2007 states that colleges and schools of pharmacy must have a remediation policy. Few comparative studies on remediation have been published by colleges and schools of pharmacy, making it challenging to implement effective and validated approaches. Effective remediation policies should include early detection of problems in academic performance, strategies to help students develop better approaches for academic success, and facilitation of self-directed learning. While the cost of remediation can be significant, revenues generated either cover or exceed the cost of delivering the remediation service. Additional research on remediation in pharmacy education across the United States and abroad is needed to make sound decisions in developing effective policies. This paper provides a review of current practices and recommendations for remediation in pharmacy and health care education.

Elevated serum transaminase levels resulting from concomitant use of rosuvastatin and amiodarone.

PURPOSE: The case of a patient whose serum transaminase levels became elevated after concomitant use of rosuvastatin and amiodarone is described. SUMMARY: A 73-year-old white woman with a medical history of diabetes mellitus, hypertension, hypothyroidism, hyperlipidemia, and aortic stenosis reported to a clinic on February 9, 2006. Laboratory tests revealed the following values: total cholesterol, 172 mg/dL; low-density-lipoprotein cholesterol, 96 mg/dL; high-density-lipoprotein cholesterol, 55 mg/dL; triglycerides, 105 mg/dL; aspartate transaminase (AST), 14 IU/L; alanine transaminase (ALT), 13 IU/L; alkaline phosphatase (ALP), 68 IU/L; and serum creatinine (SCr), 1.1 mg/dL. At this time, rosuvastatin 5 mg daily was initiated. On April 20, 2006, laboratory tests revealed an AST of 30 IU/L, ALT of 58 IU/L, ALP of 99 IU/L, and SCr of 1.0 mg/dL. Because of the severity of her aortic stenosis, the patient underwent aortic valve replacement on May 15, 2006, and amiodarone was initiated. Laboratory tests completed on May 31, 2006, revealed an AST of 192 IU/L, ALT of 336 IU/L, ALP of 322 IU/L, and SCr of 1.1 mg/dL. She did not report any symptoms of myopathy or liver dysfunction. Ultrasound revealed no liver abnormalities. The rosuvastatin was discontinued because of a potential interaction with the amiodarone. One week after the rosuvastatin was stopped, her laboratory tests showed an AST of 68 IU/L, an ALT of 126 IU/L, an ALP of 292 IU/L, a creatine kinase concentration of 22 IU/L, and an SCr of 1.0 mg/dL. Two months later, her liver function test values had continued to decline. CONCLUSION: A potential interaction between rosuvastatin and amiodarone resulted in asymptomatic elevation of serum transaminase levels in a 73-year-old woman.