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Ullal TV, Marks SL, Evenhuis JV, Figueroa ME, Pomerantz LK, Forsythe LR. Evaluation of gastroprotectant administration in hospitalized cats in a tertiary referral hospital. J Feline Med Surg 2023; 25:1098612X231201769. [PMID: 37874311 PMCID: PMC10812023 DOI: 10.1177/1098612x231201769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVES The primary objective of this study was to evaluate the prescription patterns and appropriateness of the use of gastroprotectant medication in cats. METHODS Pharmacy dispensation logs from an academic tertiary referral center were reviewed between 1 January 2018 and 31 December 2018. Cats that were administered proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, misoprostol, antacids or a combination were included. Data regarding medication, dosage, formulation, duration of administration, completeness of discharge instructions and clinical rationales for administration were obtained from medical records. The appropriateness of gastroprotectant use was assessed according to the American College of Veterinary Internal Medicine consensus statement guidelines. RESULTS Of the 110 cases, 67 (60.9%) were prescribed a gastroprotectant medication without an appropriate indication. The most common reason for prescription was acute kidney injury in 26/67 (38.8%). PPIs were the most common gastroprotectant medication administered in 95/110 (86.3%) cats, followed by sucralfate in 18/110 (16.4%) and H2RAs in 11/110 (10%). Of the 35 cases in which gastroprotectant therapy was indicated, the medication chosen or dosage administered was considered suboptimal in 16 (45.7%). Instructions regarding the duration of administration, potential adverse effects and timing of administration in relation to meals or other medications were inconsistently provided in discharge instructions to pet owners. Of the 29 cases discharged with omeprazole, only 13 (44.8%) instructions included a duration of administration, while 6 (20.7%) recommended continuing gastroprotectants indefinitely until further notice, 16 (55.2%) discussed the timing of the administration in relation to a meal and six (20.7%) mentioned potential adverse effects; none advised tapering of omeprazole before discontinuation. CONCLUSIONS AND RELEVANCE When prescribed, gastroprotectant medications were frequently prescribed injudiciously to cats in this referral population over a 12-month period. Discharge instructions to pet owners also often lacked information and recommendations regarding optimal administration, potential adverse effects, and tapering or discontinuation of the medications.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, University of California-Davis School of Veterinary Medicine, Davis, CA, USA
| | - Stanley L Marks
- Department of Medicine and Epidemiology, University of California-Davis School of Veterinary Medicine, Davis, CA, USA
| | - Janny V Evenhuis
- Department of Medicine and Epidemiology, University of California-Davis School of Veterinary Medicine, Davis, CA, USA
| | - Monica E Figueroa
- Department of Medicine and Epidemiology, University of California-Davis School of Veterinary Medicine, Davis, CA, USA
- VCA East Bay Veterinary Emergency Hospital, Antioch, CA, USA
| | - Leah K Pomerantz
- Department of Medicine and Epidemiology, University of California-Davis School of Veterinary Medicine, Davis, CA, USA
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Lauren R Forsythe
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, IL, USA
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Stark JE, Montgomery CM. Administering a Soda Beverage With the Hepatitis C Treatment Sofosbuvir/Velpatasvir and the Proton-Pump Inhibitor Pantoprazole: A Case Report. J Pharm Pract 2023:8971900231183036. [PMID: 37390478 DOI: 10.1177/08971900231183036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
PURPOSE The manufacturer of sofosbuvir/velpatasvir recommends avoiding coadministration with proton pump inhibitors (PPI) due to decreased velpatasvir serum concentrations which could translate to an increased risk of HCV treatment failure. A recent open-label study in healthy adults reported overcoming this interaction through co-administration of velpatasvir and a PPI with soda, but there is no clinical outcome data in HCV-infected patients. SUMMARY A 64 year-old male with a past medical history significant for decompensated cirrhosis, chronic HCV infection, upper gastrointestinal bleed, anemia, esophagitis, and previous HCV treatment failures required HCV treatment. The patient's medications included a PPI but no other significant DDI were present. The patient was instructed to take one sofosbuvir/velpatasvir tablet, soda, and pantoprazole 40 mg tablet at the same time once daily. Treatment was well tolerated, and clinical cure of HCV was achieved. CONCLUSION Scenarios may arise during HCV treatment that necessitate coadministration of a PPI. Interfering with optimal absorption of HCV treatment could lead to development of resistance or treatment failure. Future studies should include this strategy for overcoming this common DDI. This case demonstrates sofosbuvir/velpatasvir administered orally with soda and a PPI is potentially safe and effective for treatment of chronic HCV infection.
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Yusof F, Sanguanhong S, Soorapan S, Pongwecharak J. Trends in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties: a three-year retrospective study in a tertiary hospital in Thailand. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:80-85. [PMID: 36773006 DOI: 10.1093/ijpp/riac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/26/2022] [Indexed: 02/12/2023]
Abstract
OBJECTIVES The study determined a comparative three-year trend in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties of a tertiary hospital. METHODS Prescription data for three consecutive fiscal years (2016-2018) were extracted from a tertiary hospital electronic database, for the gastrointestinal, cardiovascular and orthopaedic outpatient specialties. The data collected were individual proton pump inhibitors, overall and individual prescribing volumes (capsule/tablet) and costs, stratified by specialty and fiscal year. KEY FINDINGS Of the three specialties, the largest volume of proton pump inhibitor prescriptions, mostly for omeprazole, comes from the orthopaedic specialty (46%). In terms of prescribing costs, at the top is the cardiovascular specialty (45.75%). Lansoprazole, which is one of the proton pump inhibitors on in the national list of essential medicines, contributed most to the cost. Prescribing proton pump inhibitors that are not included in the national list of essential medicines were responsible for over 90% of the costs in the cardiovascular and gastrointestinal specialties. An escalating trend in prescribing varied proton pump inhibitors, that is, esomeprazole, lansoprazole, pantoprazole, dexlansoprazole and rabeprazole, all of which were not on the list of essential medicines, was evident in the latter. CONCLUSIONS The highest volume of proton pump inhibitor prescribing-mostly of omeprazole, was issued by the orthopaedic specialty. The cardiovascular specialty was responsible for the largest amount of cost. The increases in the uses and costs of varying proton pump inhibitors which were outside the national list of essential medicines were notable in the gastrointestinal specialty.
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Affiliation(s)
- Fitriya Yusof
- Division of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Pathum Thani, 12121, Thailand
| | - Siriprapha Sanguanhong
- Division of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Pathum Thani, 12121, Thailand
| | - Suchada Soorapan
- Division of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Pathum Thani, 12121, Thailand.,Pharmacy Practice and Management Research Unit, Faculty of Pharmacy, Thammasat University, Pathum Thani, 12121, Thailand
| | - Juraporn Pongwecharak
- Division of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Pathum Thani, 12121, Thailand.,Pharmacy Practice and Management Research Unit, Faculty of Pharmacy, Thammasat University, Pathum Thani, 12121, Thailand
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Dumlu HI, Sancar M, Ozdemir A, Okuyan B. Impact of a clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy in older hospitalized patients: a non-randomized controlled study. Int J Clin Pharm 2022; 44:914-921. [PMID: 35449351 DOI: 10.1007/s11096-022-01394-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The potentially inappropriate use of the proton pump inhibitors is prevalent in older adults. AIM To evaluate the impact of a clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy in older hospitalized patients. METHOD This parallel nonrandomized controlled study was conducted at an internal medicine service of a tertiary training and research hospital between September 2019 and August 2021. Older patients (≥ 65 years old and received proton pump inhibitors within 48 h of admission) were allocated to two groups according to their number of medical file records, whether odd or even, two groups: control and clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy (including medication reconciliation and medication review) during the hospital stay. Primary outcome measures were the rate of appropriate use of proton pump inhibitors during hospitalization and potentially inappropriate proton pump inhibitor use at discharge. RESULTS The rate of appropriate proton pump inhibitor use during hospitalization was significantly higher in the clinical pharmacist-led program (n = 100) than in the control group (n = 97) (46.4% vs. 79.0%; P < 0.001). The rate of potentially inappropriate proton pump inhibitor use at discharge was significantly lower (61.7% vs. 35.1%; P < 0.05) in the clinical pharmacist-led program among the older patients discharged with a proton pump inhibitor prescription. CONCLUSION A clinical pharmacist-led stewardship program for the appropriate use of acid suppression therapy improved the rate of appropriate proton pump inhibitor use and reduced the potentially inappropriate proton pump inhibitor use during the hospital stay. TRIAL REGISTRATION NCT05113667 (17 October 2021-registered retrospectively).
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Affiliation(s)
- Hatice Ikra Dumlu
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Mesut Sancar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Ali Ozdemir
- Department of Internal Medicine, Health Sciences University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Betul Okuyan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey.
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Goncuoglu C, Guven GS, Sener B, Demirkan K. Effect of gastric acid suppression on Clostridioides difficile-induced diarrhea and appropriateness of gastric acid suppressors in hospitalized patients: A matched case-control study. Arab J Gastroenterol 2021; 22:292-296. [PMID: 34531136 DOI: 10.1016/j.ajg.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/05/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND STUDY AIMS The effects of gastric acid suppressors (GASs) on Clostridioides difficile infection remain controversial. Moreover, studies have shown that GASs are overused. This study was designed to evaluate the effects of GAS use on the risk of C. difficile-induced diarrhea (CDID) development and to investigate the appropriate use of GASs. PATIENTS AND METHODS In this observational case-control study, patients hospitalized between January 2010 and December 2016 who had diarrhea after 3 days of hospitalization were included. The study (n = 122) and control (n = 122) groups were matched according to the patients' hospitalization dates and departments. RESULTS No significant difference in CDID development was observed between the study and control groups. However, GAS use was excessive in the study and control groups (usage rates were 90.2% and 91.8%, respectively) (p > 0.05). Most proton pump inhibitors and histamine-2 receptor antagonists were used without an appropriate indication. Surprisingly, the use of nonsteroidal anti-inflammatory drugs for 7 days and longer showed a significant difference between the study and control groups (p < 0.05). Additionally, significant differences in enteral feeding, oral nutritional support products, carbapenem, penicillin, glycopeptide antibiotics, antifungals, hypoalbuminemia, and increased leukocyte levels were observed between the study and control groups (p < 0.05). CONCLUSION A significant difference in CDID development was not detected. The use of non-steroidal anti-inflammatory drugs for 7 days and longer was a risk factor for CDID development. Additionally, an excessive inappropriate use of GASs was observed. Clinicians should be cautious of all these factors, which may increase the risk of CDID development.
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Affiliation(s)
- Cansu Goncuoglu
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, P.O. Box 06100, Sıhhiye, Ankara, Turkey.
| | - Gulay Sain Guven
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, P.O. Box 06100, Sıhhiye, Ankara, Turkey
| | - Burcin Sener
- Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, P.O. Box 06100, Sıhhiye, Ankara, Turkey
| | - Kutay Demirkan
- Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, P.O. Box 06100, Sıhhiye, Ankara, Turkey
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Zhang Y, Yang H, Kong J, Liu L, Ran L, Zhang X, Yun J, Gu Q. Impact of interventions targeting the inappropriate use of proton-pump inhibitors by clinical pharmacists in a hepatobiliary surgery department. J Clin Pharm Ther 2020; 46:149-157. [PMID: 33015848 DOI: 10.1111/jcpt.13273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE At present, studies on the usage of proton-pump inhibitors (PPIs) have universal significance. In clinical practice, PPIs are widely used to treat a variety of acid-related diseases, but they can be inappropriately prescribed, leading to increased medical costs and patient harm. The study comprehensively evaluated the clinical effects of a clinical pharmacist intervention on inappropriate PPI prescriptions in a tertiary general hospital hepatobiliary surgery ward. METHODS A retrospective, single-centre intervention study covering the periods of July-December 2018 and July-December 2019 was conducted. In the intervention group, clinical pharmaceutical care was initiated by a clinical pharmacist in the hepatobiliary surgery ward. Outcomes, including the clinical pattern of PPI utilization, the rate of inappropriate PPI use and safety outcomes, were compared between the two periods. RESULTS AND DISCUSSION In total, 1150 patients were admitted to the hepatobiliary surgery ward in our hospital in the study periods. Of these, 717 patients met the inclusion criteria for this study, and 420 and 297 patients were included in the preintervention and post-intervention groups, respectively. The PPI utilization rates before and after the intervention were 82.0% and 55.0%, respectively. The rates of inappropriate PPI use before and after the intervention were 48.9 and 22.7 per 100 patient-days, respectively. Clinical safety outcomes were nearly identical between before and after the intervention, but patients treated with PPIs were more likely to experience nosocomial pneumonia (2.4% vs. 0.6%). WHAT IS NEW AND CONCLUSION The implementation of a clinical pharmacist intervention for PPI use decreased inappropriate PPI use during hospitalization without sacrificing clinical safety outcomes.
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Affiliation(s)
- Ying Zhang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Yang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jian Kong
- Department of Hepatobiliary Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lihong Liu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li Ran
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xi Zhang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juping Yun
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qing Gu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Sustained proton pump inhibitor deprescribing among dyspeptic patients in general practice: a return to self-management through a programme of education and alginate rescue therapy. A prospective interventional study. BJGP Open 2019; 3:bjgpopen19X101651. [PMID: 31581112 PMCID: PMC6970585 DOI: 10.3399/bjgpopen19x101651] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/10/2019] [Indexed: 12/25/2022] Open
Abstract
Background Dyspepsia guidelines recommend that patients treated with proton pump inhibitors (PPIs) should step down to the lowest effective dose or return to self-care, but rebound hyperacidity can make this difficult. Many patients continue on PPIs in the long term, which may lead to safety and financial implications. Aim To determine if a nurse-led educational support programme and rescue therapy for rebound symptoms can help patients achieve a sustained reduction in PPI use. Design & setting A prospective interventional study was conducted at 26 surgeries across the UK. Method Adult patients, treated with PPIs for ≥2 consecutive months with an active repeat prescription, were invited to a 20-minute dyspepsia clinic appointment with a trained nurse adviser. An action plan to reduce and/or stop their PPI usage was agreed and alginate supplied for the self-management of rebound symptoms. After 12 months, PPI status was reviewed and prescribing cost savings calculated. Results After 12 months, 75.1% of 6249 eligible patients stepped down or off PPIs (35.3% stepped off; 5.0% stepped down then off; 34.8% stepped down only), while 8.7% of patients had reverted to their original PPI dose. PPI prescriptions fell from 89 915 to 45 880 and alginate prescriptions increased from 2405 to 6670. An average of 1.7 bottles (500 ml each) of alginate were used per patient who stepped down or off. Estimated annual cost-saving on prescriptions was £31 716.30. Conclusion A programme of education and short-term rebound symptom management helped the majority of patients to successfully step down or off PPIs, significantly reducing the potential risks associated with chronic therapy.
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Hammond DA, Killingsworth CA, Painter JT, Pennick RE, Chatterjee K, Boye B, Meena N. Impact of targeted educational interventions on appropriateness of stress ulcer prophylaxis in critically ill adults. Pharm Pract (Granada) 2017; 15:948. [PMID: 28943978 PMCID: PMC5597806 DOI: 10.18549/pharmpract.2017.03.948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/24/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Acid suppression therapy (AST) is routinely used in critically ill patients to prevent stress-related mucosal bleeding (SRMB). Objective: Our objective was to determine the impact of a structured educational intervention on AST used for prevention of SRMB on appropriateness of AST. Methods: A single-center, retrospective, cohort study of appropriate use of AST in critically ill patients admitted to the medical intensive care unit (ICU) at an academic medical center between January to June of 2014 (no intervention) and January to June of 2015 (intervention) was conducted. The percentage of patients prescribed inappropriate AST, inappropriate AST at ICU transfer and hospital discharge, doses of inappropriate AST, and adverse effects associated with AST use were compared between periods using chi-square tests. Results: Patients in the intervention group (n=118) were 5 years older than patients in the no intervention group (n=101). AST was inappropriately initiated more frequently in the no intervention group (23% vs. 11%, p=0.012). Continuation of inappropriate AST at ICU transfer and hospital discharge was similar between groups (60% vs. 53%, p=0.277 and 18% vs. 14%, p=0.368, respectively). Conclusion: Patients had appropriate AST initiated and inappropriate AST withheld more frequently when formal education was provided. This low-cost intervention strategy can be implemented easily at institutions where pharmacists interact with physicians on rounding services and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.
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Affiliation(s)
- Drayton A Hammond
- Assistant Professor of Pharmacy Practice. Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy. Little Rock, AR (United States).
| | | | - Jacob T Painter
- Assistant Professor of Pharmacy Practice. Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy. Little Rock, AR (United States).
| | - Rose E Pennick
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy. Little Rock, AR (United States).
| | - Kshitij Chatterjee
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences College of Medicine. Little Rock, AR (United States).
| | - Bradley Boye
- Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences College of Medicine. Little Rock, AR (United States).
| | - Nikhil Meena
- Assistant Professor of Medicine. Department of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences College of Medicine. Little Rock, AR (United States).
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Caroff DA, Yokoe DS, Klompas M. Evolving Insights Into the Epidemiology and Control of Clostridium difficile in Hospitals. Clin Infect Dis 2017; 65:1232-1238. [DOI: 10.1093/cid/cix456] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/12/2017] [Indexed: 12/13/2022] Open
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