Over-the-counter Pediculus humanus capitis treatment: The nit comb is not appropriate for all hair types!

Biological diversity of hair affects what stress the hair can withstand. This proves to create a gap in care when evaluating over-the-counter (OTC) products available to treat Pediculus humanus capitis (head lice) in the United States. The nit comb would not be conducive for use in an individual with African hair, yet all OTC product instructions list the requirement of the nit comb. Lice treatment products provide instructions that are applicable for only specific hair types and do not address treatment recommendations for African hair. The OTC product instructions are outdated and exclusionary. A clear discrepancy and gap in care exist for many Americans seeking self-care treatment of pediculosis capitis. Pharmacists should remain aware of this discrepancy and counsel on alternative practices such as applying the active formulations in the hair but refrain from using the nit comb following the application of the topical medication.

Dietary supplements, cytochrome metabolism, and pharmacogenetic considerations.

BACKGROUND: Dietary supplement use has continued to rise. In addition to supplement-drug interactions, it is prudent to consider how dietary supplements may interact with a patient's specific pharmacogenetics. Variations in genes associated with CYP 450 enzymes have evidence of impacting drug metabolism and adverse effects. AIMS: This research was performed to evaluate CYP P450 enzyme activity of the top 15 dietary supplements used in the USA in order to initiate pharmacogenetic considerations specific to commonly used dietary supplements. METHODS: The most common dietary supplements used in the USA were obtained from the National Health and Nutrition Examination Survey (NHANES). Primary literature detailing supplement CYP P450 activity was compiled from PubMed using MeSH search terms: supplement name(s), cytochrome P450 enzymes, metabolism, and pharmacokinetics. Additional resources utilized for documented CYP enzyme genotypes were the pharmacogenetic databases from Clinical Pharmacogenetics Implementation Consortium and The Pharmacogenomic Variation Consortium. RESULTS: Of the 15 most common dietary supplements used in the USA, 53% (cranberry, echinacea, garlic, ginkgo biloba, ginseng, melatonin, milk thistle, and valerian) exhibit CYP P450 metabolism, with some having possible induction activity as well. Melatonin and garlic are substrates of CYP1A2 and CYP2C19, respectively. Additionally, there is evidence of echinacea having possible CYP3A4 induction activity. CONCLUSION: CYP P450 activity is an important consideration for any patient but becomes increasingly critical if patients have certain CYP P450 phenotypes that impact metabolism. These popular supplements have the potential for changes in supplement exposure, and adverse effects based on pharmacogenetic profiles. Furthermore, these sites of metabolism are shared with many medications, setting the stage for possibly more profound interactions between medications and supplements. This paper highlights the mechanisms in which dietary supplements may constitute a risk for patients with certain CYP P450 phenotypes. Further research is needed in the area of dietary supplements and their pharmacogenomic implications.

Melatonin Use in Pediatrics: Evaluating the Discrepancy in Evidence Based on Country and Regulations Regarding Production.

Melatonin manufacturers in the United States have begun producing melatonin products specifically targeted for use in the pediatric population. This paper aims to critically evaluate the evidence available regarding the use of melatonin in children based on where the clinical trials are performed and the regulations regarding the production of melatonin in that country. Melatonin is regulated differently around the world with the least amount of regulation placed on OTC supplements in the United States. The majority of studies evaluating melatonin use in the pediatric population are conducted with children who have comorbidities, such as autism spectrum disorder or attention-deficit/hyperactivity disorder. Evidence supporting the use of US formulations of melatonin in the otherwise healthy pediatric population is non-existent. Based on the lack of safety regulations in place in the United States and the lack of evidence regarding US melatonin products, they should be used sparingly in the otherwise healthy pediatric population, if they are used at all.

Colorado community pharmacists' survey and their perspectives regarding marijuana.

OBJECTIVES: With one of the highest prevalence rates for marijuana use in the United States, Colorado provides a great opportunity for insight on common encounters with consumers in the community pharmacy setting. Currently, there is limited data on community pharmacists and their experiences with patients and marijuana. This study aims to identify the most common questions community pharmacists receive about marijuana, how comfortable they are in answering those questions, and to identify knowledge gaps regarding marijuana and pharmaceutical care. METHODS: A cross-sectional study design was chosen to survey community pharmacists. A convenience sample of community pharmacists from the greater Denver metro area counties were surveyed about recreational and medical marijuana questions they receive from patients and consumers. Statistical methods included descriptive statistics, Chi-square, Kruskal-Wallis, and Mann-Whitney. RESULTS: Of the 51 pharmacists who completed the survey, 20% received questions about medical marijuana daily or weekly, 57% monthly, and 22% never, while 16% received questions about recreational marijuana weekly, 41% monthly, and 43% never. In addition, 53% were comfortable answering questions about medical marijuana, while 41% were comfortable answering questions about recreational marijuana. The most common questions received were related to indications, uses, and efficacy (33%), followed by drug interactions (30%). CONCLUSION: The increased acceptance of marijuana by patients warrants pharmacists and other healthcare providers to be confident and familiar with its use. Our findings suggest that the majority of pharmacists are not asking about marijuana use/consumption, and this may be a gap in care. Studies support that other healthcare providers also exhibit hesitancy in initiating these conversations. Consumers are using marijuana products now, so increasing marijuana education for all healthcare professionals during both didactic education and continuing education will be key to ensuring patients have access to evidence-based care regarding the use of marijuana, rather than care based on belief, alone.

Cardiovascular Risk Assessment and Therapeutic Implications in Rheumatoid Arthritis.

Patients with rheumatoid arthritis (RA) suffer from a magnitude of excess cardiovascular risk. A paradoxical lipid pattern has been observed in rheumatoid arthritis patients where low levels of total cholesterol and low-density lipoprotein are associated with a higher risk of cardiovascular disease. This paper aims to break down the evidence explaining why patients with low to normal LDL, and total cholesterol have such excess cardiovascular risk. A component of the enhanced cardiovascular risk is systemic inflammation and the subsequent pro-atherogenic dyslipidemia patterns. Due to this "lipid paradox," current risk algorithms and guidelines designed for the general population may underestimate cardiovascular risk in patients with rheumatoid arthritis. The purpose of this paper is to critically evaluate some of the discrepancies and layers of cardiovascular risk in RA patients, the role RA medication may have in mitigating or increasing cardiovascular risk, and the possible role of statin therapy.

Integrating a Pharmacy Student into a Marriage and Family Therapy Counseling Course: A Pilot.

THE PROBLEM: Interprofessional educational experiences are a requirement in pharmacy and counseling curricula. However, scheduling conflicts between professional programs and lack of administrative support create barriers for students who want to take a course in another healthcare program. INNOVATION: This pilot enabled a pharmacy student to participate in a counseling course for 8 weeks. The course "Integrated Healthcare" is a 3-credit required core-course in the Master of Arts in marriage and family therapy (MFT) program. It explores the connection between emotional, psychological and physical health, covering information on behavior change, psychopharmacology, and common ways in which mood and anxiety manifest in the body. Class activities were matched to pharmacy interprofessional standards, in addition to Interprofessional Collaborative Practice competencies (IPEC). CRITICAL ANALYSIS: All IPEC core competencies were achieved during this course. One pharmacy student and 18 counseling students helped one another understand the importance of their different roles in patient care. The course also established relationships between pharmacy and counseling faculty, paving the way for more interprofessional class experiences. CONCLUSION: This pilot integrating pharmacy and counseling students in a course demonstrates that administrative barriers can be overcome and collaborative learning benefit is achieved for everyone involved.

Banned and discouraged-use ingredients found in weight loss supplements.

OBJECTIVES: To identify banned and discouraged-use ingredients, such as ephedra, 1,3-dimethylamylamine, and beta-methyl-phenylethylamine, in readily available weight loss dietary supplements within a 10-mile radius of Regis University. METHODS: A list of banned and discouraged-use ingredients was compiled with the use of the Food and Drug Administration (FDA) dietary supplement website which provides information on supplement ingredients that are no longer legal or are advised against owing to adverse event reporting. Investigators visited all retail outlet stores within a 10-mile radius of Regis University in Denver, Colorado. Retail chains were not duplicated and only one of each chain was evaluated. RESULTS: A total of 51 weight loss supplement products from retail stores were found with banned or discouraged-use substances listed on their labels. At least one banned ingredient was found to be listed on the product labels in 17 of the 51 studied supplements (33%). At least one discouraged-use ingredient was found in 46 of the 51 products (90%). Retail outlet stores dedicated to supplements and sports nutrition alone were found to have the greatest number of weight loss supplements that included banned and discouraged-use ingredients. CONCLUSION: The FDA has taken action to remove some weight loss supplements from the market that contain banned ingredients. Unfortunately, based on the findings of this study, it is evident that products containing these ingredients remain on the market today.