RESUMO
In this report, we discuss the case of a 9-year-old male with Attention Deficit Hyperactivity Disorder (ADHD) on long-term methylphenidate and guanfacine who experienced acute orofacial dystonia that resolved immediately with the administration of benztropine. Current literature describes various cases of methylphenidate-induced dystonia, but ours appears to be the first reported instance of spontaneous dystonia without a recent change in dose or medication change. This may suggest the possibility of methylphenidate-induced dystonia spontaneously occurring several years after initiation.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Distonia , Metilfenidato , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Benzotropina/uso terapêutico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Criança , Distonia/induzido quimicamente , Distonia/diagnóstico , Guanfacina/farmacologia , Guanfacina/uso terapêutico , Humanos , Masculino , Metilfenidato/efeitos adversosRESUMO
OBJECTIVE: The objective of this study was to determine strategies to implement influenza pandemic vaccinations effectively at grocery store chain community pharmacies. METHODS: Clinical pharmacy coordinators and pharmacy managers representing 3 grocery store chain community pharmacies across Pennsylvania were identified for participation in semistructured telephone interviews. Interviews were audio-recorded and transcribed. Transcripts were independently coded by 2 investigators and coding discrepancies were resolved. A thematic analysis was conducted, and supporting quotes were selected for each theme. RESULTS: Twelve pharmacists participated in the interviews, which were conducted from September 2016 to November 2017. Five key themes were identified: (1) mobilize pharmacy staff members to specific locations to prepare for a high volume of vaccinations; (2) implement vaccination clinics during high-volume scenarios; (3) utilize nonpharmacy spaces to increase vaccination capabilities; (4) determine vaccine distribution by highest risk populations that each pharmacy serves; and (5) conduct training customized to the pharmacy chain that supplements national pandemic influenza training. CONCLUSION: Grocery store chain community pharmacies are desirable sites for pandemic vaccination because of a variety of factors, such as space and staffing flexibility. Developing a pandemic vaccination plan will enable community pharmacists to contribute more effectively during influenza pandemics.
