Chat-based telepharmacy in Denmark: design and early results.

OBJECTIVES: Following the introduction of a nationwide online telepharmacy chat-service in Denmark in the spring of 2012, offering free counselling to all Danish citizens, we aimed to investigate the types of enquiries that are made to the telepharmacy. METHODS: We extracted 500 consecutive chat transcripts and categorised them in four categories: drug-related, symptom, technical and other. These categories were further divided into 28 prespecified subcategories. After the categorisation of the 500 transcripts, 7 new subcategories were added and the material was reanalysed. For drug-related enquiries, the drug in question was registered according to the anatomical-therapeutic-chemical system developed by World Health Organization. Veterinary and empty (nonresponding) enquiries were excluded. KEY FINDINGS: Four hundred seventy-six eligible enquiries were identified and categorised. The enquiries were found to be diverse: 170 enquiries (35.7%) were drug-related, 124 (26.1%) were technical in nature, 91 (19.1%) were related to symptoms and 91 (19.1%) of the enquiries were categorised as other. The most common drug class was 'drugs related to the genitourinary system and sex hormones'. Only 50 (10.5%) of the enquiries happened in connection with an actual purchase at the online pharmacy. Of all enquiries, 28.6% led to a referral to a medical doctor. Of the customers, 89.2% were satisfied with the online counselling. CONCLUSION: The diverse enquiries require professional chat operators with broad experience. Some subjects are overrepresented when compared with regular pharmacy counselling and should receive special attention. Continued monitoring is considered essential.

Information on risk of constipation for Danish users of opioids, and their laxative use.

BACKGROUND: While it is well known that use of opioids often cause constipation, little is known about the information given to patients regarding this potential side-effect and their use of laxatives to prevent it. OBJECTIVE: To assess the degree of information provided by the prescriber to users of opioids by the time of the first prescription regarding the risk of constipation. METHOD: Interviews with patients filling an opioid at a community pharmacy were performed by the dispensing pharmacist or pharmaconomist at the pharmacy. Information collected concerned the patient, the opioid, information received regarding constipation, current constipation and current laxative treatment. RESULTS: A total of 286 interviews were completed. Overall, 28.3 % remembered having received information about the risk of constipation by the time of the first prescription. Excluding 49 first-time opioid users, we found 91 laxative users and 146 non-laxative users, of whom 73.6 and 4.8 %, respectively, currently experienced constipation. CONCLUSION: Only a small proportion of patients with a prescription for opioids remembered having had information on potential constipation caused by opioids and having received any recommendation on how to use laxatives to prevent constipation. Interventions should focus on whether constipation is present and on rational use of laxatives.

Evidence for CGRP re-uptake in rat dura mater encephali.

BACKGROUND AND PURPOSE: Calcitonin gene-related peptide (CGRP) is widely distributed in the trigeminovascular system and released from sensory fibres of the cranial dura mater upon noxious stimulation. Such release may be a mechanism underlying migraine headache. Based on data from guinea pig basilar artery preparations, we have here studied CGRP release and uptake in an organ preparation of the hemisected rat skull. EXPERIMENTAL APPROACH: CGRP release from the cranial dura was quantified by a commercial enzyme-linked immunoassay. CGRP was depleted using repetitive challenges of capsaicin. After incubating the tissue with CGRP for 20 min and extensive washing, another capsaicin challenge was performed. Immunohistochemistry was used to visualize CGRP immunofluorescence in dural nerve fibres. KEY RESULTS: Capsaicin-induced CGRP release was attenuated by the transient receptor potential vanilloid receptor type I antagonist capsazepine or by Ca(2+)-free solutions. After the CGRP-depleted preparation had been exposed to exogenous CGRP, capsaicin-induced CGRP release was increased compared to the challenge just prior to incubation. CGRP uptake was not influenced by Ca(2+)-free solutions. Olcegepant and CGRP(8-37) (CGRP receptor antagonists) did not affect uptake of CGRP. However, a monoclonal CGRP-binding antibody decreased CGRP uptake significantly. Release of CGRP after incubation was attenuated by Ca(2+)-free solutions and by capsazepine. Immunohistochemical assays indicated a weak trend towards CGRP uptake in rat dura mater. CONCLUSION AND IMPLICATIONS: We have presented evidence for CGRP uptake in nerves and its re-release in rat dura mater. This may have implications for the pathophysiology and treatment of migraine.