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Dong X, Tsang CCS, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Browning JA, Garuccio J, Zeng R, Wang J. Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer's disease and related dementias: An observational study. Explor Res Clin Soc Pharm 2024; 13:100420. [PMID: 38420610 PMCID: PMC10900920 DOI: 10.1016/j.rcsop.2024.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
Background Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias. Objectives This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias. Methods This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities. Results Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99). Discussion The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias. Conclusions Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN 38163, USA
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Christopher K. Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Jack W. Tsao
- Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN 38163, USA
| | - Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Joseph Garuccio
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
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Hall EA, Finch CK, March KL. Leading beyond the Script: A Cross-Sectional Study Exploring Preparedness of Pharmacy Academic Administrators. Pharmacy (Basel) 2024; 12:25. [PMID: 38392932 PMCID: PMC10891591 DOI: 10.3390/pharmacy12010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Limited research exists on the preparedness of pharmacy academic administrators for their roles. This cross-sectional survey aimed to explore the self-perceptions of pharmacy academic administrators, including deans, associate deans, assistant deans, department chairs, and directors, within United States-based Colleges or Schools of Pharmacy. Participants answered questions regarding their demographics, self-perceived readiness for administrative roles, self-perceived leadership skills, and strategies used to develop these skills. Data were analyzed using descriptive statistics, and subgroup comparisons were made using Student's t-test for normally distributed continuous variables, Mann-Whitney tests for ordinal variables or non-normally distributed continuous variables, and Chi-squared tests for nominal variables. A total of 193 responses were analyzed. Respondents reported feeling least prepared in two areas: entrepreneurial revenue and handling grievances and appeals. There were gender differences noted in preparedness to conduct performance reviews, manage unit finances, and develop entrepreneurial revenue, with men rating themselves significantly higher than women in all three areas. Despite high self-ratings of leadership skills in the overall cohort, significant gender differences were noted in micromanagement with men rating themselves lower than women. Seeking advice from senior colleagues was the most used development strategy, and women showed a significantly higher preference for programs facilitated by professional organizations. This study contributes valuable insights into the preparedness of pharmacy academic administrators to inform future strategies that better support individuals to be successful in their roles.
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Affiliation(s)
- Elizabeth A. Hall
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN 38163, USA; (C.K.F.); (K.L.M.)
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Browning JA, Tsang CCS, Zeng R, Dong X, Garuccio J, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Wang J. Racial/ethnic disparities in the enrollment of Medication Therapy Management programs among Medicare beneficiaries with Alzheimer's disease and related dementias. Curr Med Res Opin 2022; 38:1715-1725. [PMID: 35852087 PMCID: PMC9529863 DOI: 10.1080/03007995.2022.2103962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD). METHODS Medicare claims/records (from 2013-2014 and 2016-2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016-2017. RESULTS In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016-2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016-2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86-0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016-2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05-1.16) across study periods among those with ADRD. CONCLUSIONS Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.
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Affiliation(s)
- Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Joseph Garuccio
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 N. Pauline, Memphis, TN 38163, United States
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Christopher K. Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jack W. Tsao
- Department of Neurology, University of Tennessee Health Science Center & Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN 38163, United States
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
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Moore CH, March KL, Hudson JQ, Finch CK, Twilla JD. Evaluation of Hospitalized Patients Receiving High versus Low-Dose Opioids for Non-Cancer Pain. J Pain Palliat Care Pharmacother 2022; 36:71-78. [PMID: 35648759 DOI: 10.1080/15360288.2022.2063470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Limited studies suggest that opioid-related adverse effects (ORAEs) may worsen hospitalized patient outcomes, but there is insufficient data related to the impact of high-dose opioids compared to low-dose on adverse patient events. Given the paucity of data, our study aims to evaluate these ORAEs in the general hospitalized patient with non-cancer pain. A retrospective study of adult patients receiving opioids with a primary diagnoses of myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, sepsis, or diabetes was conducted. Average oral morphine milligram equivalents (MMEs) administered over the entire LOS was collected, and patients were categorized as high-dose (≥50 MMEs/day) or low-dose (<50 MMEs/day). The primary composite endpoint was the incidence of ORAEs (naloxone use, decreased oxygen saturations, nausea/vomiting). Secondary outcomes included LOS, 30-day readmission, ORAEs with >100 MMEs/day. A total of 100 patients were included (n = 58 low-dose group; n = 42 high-dose group). For the primary outcome, more patients in the high-dose group experienced ORAEs (50% high-dose vs. 22.4% low-dose; p < 0.006). No statistically significant differences in LOS or 30-day readmission rates were identified between the groups. For patients receiving >100 MMEs/day, ORAEs occurred in 61% of patients. Hospitalized patients receiving high-dose opioids for non-cancer pain may have an increased incidence of ORAEs.
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Browning JA, Tsang CCS, Dong X, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Liu C, Wang J. Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis. BMC Health Serv Res 2022; 22:159. [PMID: 35130899 PMCID: PMC8822650 DOI: 10.1186/s12913-022-07483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.
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Affiliation(s)
- Jamie A Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN, 38163, USA
| | - Marie A Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Christopher K Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jack W Tsao
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap St, Memphis, 38105, USA.,Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN, 38163, USA
| | - Colin Liu
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA, 19104, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
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Acquisto NM, Beavers CJ, Bolesta S, Buckley MS, Dobbins KF, Finch CK, Hayes SM, Holdren DB, Johnson ST, Kane‐Gill SL, Lat I. Development and application of quality measures of clinical pharmacist services provided in inpatient/acute care settings. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Scott Bolesta
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | | | | | - Ishaq Lat
- American College of Clinical Pharmacy Lenexa Kansas USA
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Dong X, Tsang CCS, Zhao S, Browning JA, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Hines LE, Wang J. Effects of the Medicare Part D comprehensive medication review on medication adherence among patients with Alzheimer's disease. Curr Med Res Opin 2021; 37:1581-1588. [PMID: 34039232 PMCID: PMC8419788 DOI: 10.1080/03007995.2021.1935224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Older patients with Alzheimer's disease (AD) are challenged with adhering to complex medication regimens. We examined effects of Comprehensive Medication Review (CMR), a required Medicare Part D Medication Therapy Management (MTM) program component, on medication adherence among AD patients. METHODS This retrospective study analyzed 100% of 2016-2017 Medicare claims covering the entire United States, linked to Area Health Resources Files. Medicare beneficiaries aged ≥65 years were included. Propensity score matching identified comparable intervention and comparison groups with the intervention defined as receiving a CMR in 2017. A difference-in-differences analysis included in multivariate logistic regressions an interaction term between CMR receipt and year 2017. The outcome measured was nonadherence to diabetes, hypertension and hyperlipidemia medications, with nonadherence defined as proportion of days covered <80% for study medications. RESULTS Unadjusted comparisons indicated the proportion of nonadherence for intervention group members decreased from 2016 to 2017 but increased for the comparison group. In adjusted analyses, reduction in medication nonadherence among the intervention group remained higher: odds ratios for the interaction term were 0.62 (95% confidence interval [CI] = 0.54-0.71), 0.54 (95% CI = 0.50-0.58) and 0.50 (95% CI = 0.47-0.53) respectively for diabetes, hypertension and hyperlipidemia medications. This suggests that the likelihood of nonadherence in the intervention group was respectively reduced by 38%, 46% and 50% more than the comparison group. CONCLUSIONS CMR was found to reduce nonadherence to diabetes, hypertension and hyperlipidemia medications among older Medicare beneficiaries with AD. This provides evidence that the MTM program is effective for a population with unique medication compliance challenges.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Shirong Zhao
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee College of Medicine, 66 N. Pauline, Memphis, TN 38163, United States
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Christopher K. Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jack W. Tsao
- Department of Neurology, University of Tennessee Health Science Center & Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN 38163, United States
| | - Lisa E. Hines
- Pharmacy Quality Alliance, 5911 Kingstowne Village Parkway, Alexandria, VA 22315, United States
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
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McGowan KE, March KL, Finch CK. The Hunger for Mirtazapine: A Discontinuation Syndrome. J Pain Palliat Care Pharmacother 2021; 35:113-116. [PMID: 33856954 DOI: 10.1080/15360288.2021.1883183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
While mirtazapine is primarily prescribed for major depressive disorder, it is less commonly prescribed for anorexia related to various disease states. Mirtazapine is associated with few adverse events but potential for a discontinuation syndrome does exist. Here we describe a case of a 53-year-old man prescribed mirtazapine 15 mg/day for appetite stimulation who experienced anxiousness, nausea, tremor, loss of appetite, lack of desire for food, and an 8-pound weight loss after abrupt, inadvertent discontinuation. Symptom onset was acute and presented within 48-hours of stopping his medication. Mirtazapine was restarted at the same dose after 14 days of ongoing symptoms and his symptoms subsided immediately. Scant literature exists to highlight the potentially serious adverse events associated with abrupt mirtazapine discontinuation, even at low doses, and this case contributes to advocating for the need of mirtazapine taper when medication cessation is being considered.
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DiPiro JT, Fox ER, Kesselheim AS, Chisholm-Burns M, Finch CK, Spivey C, Carmichael JM, Meier J, Woller T, Pinto B, Bates DW, Hoffman JM, Armitstead JA, Segovia D, Dodd MA, Scott MA. ASHP Foundation Pharmacy Forecast 2021: Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems. Am J Health Syst Pharm 2021; 78:472-497. [PMID: 33539516 PMCID: PMC7944506 DOI: 10.1093/ajhp/zxaa429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Joseph T DiPiro
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA
| | - Erin R Fox
- Drug Information and Support Services, University of Utah Health, and Adjunct Associate Professor, University of Utah College of Pharmacy, Salt Lake City, UT
| | - Aaron S Kesselheim
- Professor of Medicine, Harvard Medical School, Director, Program on Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, MA
| | - Marie Chisholm-Burns
- University of Tennessee Health Science Center College of Pharmacy, and Professor of Surgery, University of Tennessee Health Science Center College of Medicine, Memphis, TN
| | - Christopher K Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | - Christina Spivey
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN
| | | | - Joy Meier
- VA Sierra Pacific Network, Pleasant Hill, CA
| | - Thomas Woller
- Pharmacy Services, Advocate Aurora Health, Waukesha, WI
| | | | - David W Bates
- Professor of Medicine, Harvard Medical School, and Chief of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA
| | - James M Hoffman
- Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis TN
| | | | - Dorinda Segovia
- Vice President Pharmacy Services, Memorial Healthcare System, Hollywood, FL
| | - Melanie A Dodd
- The University of New Mexico College of Pharmacy, Albuquerque, NM
| | - Mollie Ashe Scott
- UNC Eshelman School of Pharmacy, Asheville Campus, and Clinical Associate Professor, UNC School of Medicine Division of Family Medicine, Asheville, NC
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March KL, Peters MJ, Finch CK, Roberts LA, McLean KM, Covert AM, Twilla JD. Pharmacist Transition-of-Care Services Improve Patient Satisfaction and Decrease Hospital Readmissions. J Pharm Pract 2020; 35:86-93. [PMID: 32945206 DOI: 10.1177/0897190020958264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pharmacists ability to directly impact patient satisfaction through increases in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys utilizing transitions-of-care (TOC) services is unclear. METHODS Retrospective analysis of TOC patients from 07/01/2018 to 03/31/2019 was conducted. Intervention (INV) patients received pharmacist medication reconciliation and education prior to discharge and post-discharge telephone follow-up. All other patients served as control group (CON). Primary outcome: Evaluate impact of TOC services on HCAHPS scores for "Communication about Medicines" and "Care Transitions." Secondary outcomes: 30-day readmissions, quantification of prevented potential safety events, assessment of discharge prescriptions sent to the academic medical center outpatient pharmacy (MOP) for TOC patients. RESULTS Of 1,728 patients screened, 414 patients met inclusion criteria (INV = 414, CON = 1314). A significant improvement (14.7%; p = <0.0001) in overall medication-related HCAHPS results was seen when comparing pre- vs post-implementation of the TOC service. Statistically significant increases for individual questions "staff told you what the medicine was for" (14.2%; p = 0.018), "staff describe possible effects" (21.2%; p = 0.004), and "understood the purpose of taking medications" (11.4%; p = 0.035) were observed. A non-significant decrease in 30-day readmission rates for the groups was observed (CON 16.4%, INV 13.3%; p = 0.133); however, an unplanned subgroup analysis evaluating impact of discharge phone calls on 30-day readmission rates revealed a significant reduction of 17.3% to 12.4% (p = 0.007). One hundred forty-three medication safety event(s) were potentially prevented by the TOC pharmacist. Lastly, 562 prescriptions were captured at the MOP as a result of the TOC initiative. CONCLUSIONS Pharmacy-based TOC models can improve patient satisfaction, prevent hospital readmissions, and generate revenue.
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Affiliation(s)
- Katherine L March
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, TN, USA.,University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA
| | - Michael J Peters
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, TN, USA.,University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA
| | - Christopher K Finch
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, TN, USA.,University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA
| | - Lauchland A Roberts
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, TN, USA.,University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA
| | - Katie M McLean
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, TN, USA.,University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA.,Methodist University Outpatient Pharmacy, Memphis, TN, USA
| | - Ashley M Covert
- Clinical Pharmacy Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jennifer D Twilla
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, TN, USA.,University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA
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Twilla JD, Algrim A, Adams EH, Samarin M, Cummings C, Finch CK. Comparison of Nafcillin and Cefazolin for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia. Am J Med Sci 2020; 360:35-41. [PMID: 32376001 DOI: 10.1016/j.amjms.2020.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Traditionally, the antibiotic of choice for Methicillin-susceptible Staphylococcus aureus related blood stream infections (MSSA-BSI) are the antistaphylococcal penicillins. Cefazolin is considered an alternative agent, with recent evidence showing similar clinical efficacy. This study further evaluates the utility of nafcillin versus cefazolin in MSSA bacteremia including high disease burden sources of infection and its impact on treatment failure. METHODS This retrospective study included patients admitted to Methodist LeBonheur Healthcare adult hospitals from 2011 to 2016. Patients were included if they received at least 3 days of either nafcillin or cefazolin and had a positive blood culture for MSSA. The primary objective was to evaluate rates of treatment failure between groups. Secondary outcomes included clinical and microbiological cure, MSSA-BSI associated readmissions, identification of risk factors for treatment failure including disease burden, in-hospital and 90 day mortality. RESULTS A total of 277 patients were included (nafcillin n = 126; cefazolin n = 151). Treatment failure and microbiologic cure were similar between nafcillin and cefazolin (20.6% vs. 16.6%; 91.2% vs. 87.2%, respectively). Clinical cure was significantly higher in the cefazolin treatment arm (93.4 vs. 83.3%; P = 0.012). However, the total number of patients with high disease burden was greater in the nafcillin group (54.8% vs. 39.1%; P = 0.011). Higher rates of in-hospital mortality were observed in the nafcillin group (15.1% vs. 6%; P = 0.016). CONCLUSIONS Our study observed significantly higher rates of clinical cure and reduced in-hospital mortality in patients who received cefazolin. Further analysis is warranted to evaluate the effectiveness of these agents and identifying predictors of treatment failure.
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Affiliation(s)
- Jennifer D Twilla
- Methodist University Hospital, Memphis, Tennessee; College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Amie Algrim
- Methodist University Hospital, Memphis, Tennessee
| | - Ethan H Adams
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Michael Samarin
- Methodist University Hospital, Memphis, Tennessee; College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Carolyn Cummings
- Methodist University Hospital, Memphis, Tennessee; College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Christopher K Finch
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee.
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12
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Nathans AM, Bhole R, Finch CK, George CM, Alexandrov AV, March KL. Impact of a Pharmacist-Driven Poststroke Transitions of Care Clinic on 30 and 90-Day Hospital Readmission Rates. J Stroke Cerebrovasc Dis 2020; 29:104648. [PMID: 32033902 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/29/2019] [Accepted: 01/01/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Stroke impacts nearly 800,000 people annually and the risk of recurrent stroke and hospital readmission is increased early following the initial event. Due to the increase in morbidity and mortality associated with secondary events, a pharmacist-driven poststroke transitions of care clinic was created at Methodist University Hospital to provide risk factor modification in an effort to decrease risk of recurrence and hospital readmissions. METHODS A retrospective matched-cohort study was conducted between 9/1/2017 and 2/28/2019. Adult patients with a primary diagnosis of stroke, discharged to home, and attended a poststroke transitions of care clinic visit were included. Patients were matched on the basis of age ±3 years, race, gender, and type of stroke to those who did not receive pharmacist intervention during the same time period. The primary endpoint was 30-day hospital readmissions. Secondary endpoints included 90-day readmissions, 30 and 90-day emergency department visits, and recurrent stroke rates. Type and quantity of pharmacist interventions was also assessed. RESULTS One hundred and eighty-eight patients were included in the analysis. Baseline differences existed between the groups in the following: history of transient ischemic attack, stroke severity score, and insurance status. No significant difference was found in 30-day readmissions. There was a significant difference found in 90-day readmissions (5.3% versus 21.3%, P = .001). There were no significant differences in emergency department utilization at 30 or 90 days or stroke recurrence rates. Pharmacists made a mean of 3.5 interventions made during each visit. CONCLUSIONS Although the primary goal to reduce 30-day readmission was not met, a pharmacist-driven poststroke transitions of care clinic significantly decreased 90-day hospital readmission rates.
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Affiliation(s)
- Alissa M Nathans
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, Tennessee; Methodist University Specialty Clinic, Memphis, Tennessee; University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee; Methodist LeBonheur Healthcare - University Hospital 1265 Union Ave, Memphis, Tennessee
| | - Rohini Bhole
- Methodist LeBonheur Healthcare - University Hospital 1265 Union Ave, Memphis, Tennessee; University of Tennessee Health Science Center, College of Medicine, Department of Neurology, Memphis, Tennessee
| | - Christopher K Finch
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee; Methodist LeBonheur Healthcare - University Hospital 1265 Union Ave, Memphis, Tennessee
| | - Christa M George
- Methodist University Specialty Clinic, Memphis, Tennessee; University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee
| | - Andrei V Alexandrov
- Methodist LeBonheur Healthcare - University Hospital 1265 Union Ave, Memphis, Tennessee; University of Tennessee Health Science Center, College of Medicine, Department of Neurology, Memphis, Tennessee
| | - Katherine L March
- Clinical Pharmacy Department, Methodist University Hospital, Memphis, Tennessee; Methodist University Specialty Clinic, Memphis, Tennessee; University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee; Methodist LeBonheur Healthcare - University Hospital 1265 Union Ave, Memphis, Tennessee.
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Marler J, Twilla JD, Finch CK, Animalu C. Severe Ceftaroline-Induced Thrombocytopenia With Rapid Onset on Rechallenge. Ann Pharmacother 2020; 54:187-188. [DOI: 10.1177/1060028019879086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Alabdan N, AlRuthia Y, Yates MED, Sales I, Finch CK, Hudson JQ. Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy: A cross-sectional study. PLoS One 2017; 12:e0188390. [PMID: 29182650 PMCID: PMC5705120 DOI: 10.1371/journal.pone.0188390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
Background Erythropoiesis-stimulating agents (ESAs) are recommended for treating anemia in patients with chronic kidney disease and end-stage renal disease. However, misappropriate and over-use of these agents can be costly and unnecessary in some settings. Objective The primary aim was to identify predictors of adherence to a newly approved ESA inpatient ordering policy. The secondary aims were to evaluate the impact of a 5-day delay in the initiation of ESA therapy on ESA usage, hemoglobin (Hb) levels, and costs. Methods This retrospective observational record review included a sample of adult patients admitted to four tertiary care hospitals from November 1, 2013 to August 31, 2014. Multivariable logistic and linear regression analyses were used to calculate the odds of adherence to the new ESA inpatient ordering policy and the impact of this policy on discharge Hb level, respectively. Results A total of 242 patients were included. The majority of the prescribers (77%) adhered to the new ESA ordering policy. Hemoglobin (OR = 1.306; 95% CI: 1.03–1.65) and ferritin (OR = 3.91; 95% CI: 1.23–12.51) levels at admission and length of hospital stay were positively correlated with the odds of patients receiving ESAs after day 5 (OR = 1.12; 95% CI:1.05–1.20). Furthermore, adherence to the new policy did not have a significant impact on discharge Hb level (β = 0.02349; P = 0.895). Conclusions Prescribers were adherent to a 5-day delay in the initiation of ESA therapy policy which resulted in a reduction in ESA usage, did not impact the discharge Hb levels, and was proven to be cost effective.
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Affiliation(s)
- Numan Alabdan
- Department of Pharmacy Practice, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Mary E. D. Yates
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Pharmacy, Methodist Germantown Hospital, Germantown, Tennessee, United States of America
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Christopher K. Finch
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee, United States of America
| | - Joanna Q. Hudson
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Medicine, Division of Nephrology, Methodist University Hospital, Memphis, Tennessee, United States of America
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Schaapveld-Davis CM, Negrete AL, Hudson JQ, Saikumar J, Finch CK, Kocak M, Hu P, Van Berkel MA. End-Stage Renal Disease Increases Rates of Adverse Glucose Events When Treating Diabetic Ketoacidosis or Hyperosmolar Hyperglycemic State. Clin Diabetes 2017; 35:202-208. [PMID: 29109609 PMCID: PMC5669126 DOI: 10.2337/cd16-0060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IN BRIEF Treatment guidelines for diabetic emergencies are well described in patients with normal to moderately impaired kidney function. However, management of patients with end-stage renal disease (ESRD) is an ongoing challenge. This article describes a retrospective study comparing the rates of adverse glucose events (defined as hypoglycemia or a decrease in glucose >200 mg/dL/h) between patients with ESRD and those with normal kidney function who were admitted with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). These results indicate that current treatment approaches to DKA or HHS in patients with ESRD are suboptimal and require further evaluation.
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Affiliation(s)
| | - Ana L. Negrete
- Methodist University Hospital, Memphis, TN
- University of Tennessee Health and Science Center College of Pharmacy, Memphis, TN
| | | | - Jagannath Saikumar
- University of Tennessee Health and Science Center College of Medicine, Memphis, TN
| | - Christopher K. Finch
- Methodist University Hospital, Memphis, TN
- University of Tennessee Health and Science Center College of Pharmacy, Memphis, TN
| | - Mehmet Kocak
- University of Tennessee Department of Preventative Medicine, Memphis, TN
| | - Pan Hu
- University of Tennessee Department of Preventative Medicine, Memphis, TN
| | - Megan A. Van Berkel
- Methodist University Hospital, Memphis, TN
- University of Tennessee Health and Science Center College of Pharmacy, Memphis, TN
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16
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Sakaan S, Ulrich D, Luo J, Finch CK, Self TH. Inhaler Use in Hospitalized Patients with Chronic Obstructive Pulmonary Disease or Asthma: Assessment of Wasted Doses. Hosp Pharm 2015; 50:386-90. [PMID: 26405325 DOI: 10.1310/hpj5005-386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospitalized patients with chronic obstructive pulmonary disease (COPD) or asthma routinely have inhaled medications ordered for acute and maintenance therapy. Treatment may be administered via metered-dose inhaler (MDI) or dry-powder inhaler (DPI). These products must be appropriately labeled to be released home with the patient or discarded before discharge. OBJECTIVE To assess the amount and estimated cost of wasted doses of medications via MDI or DPI for hospitalized patients with COPD/asthma. METHODS A retrospective study was conducted at a university-affiliated hospital. Patients admitted between January 2011 and June 2012 with a primary diagnosis of COPD or COPD with asthma and who were ≥40 years of age were included. Information collected included use of albuterol, ipratropium, inhaled corticosteroids, long-acting beta agonist, or tiotropium and whether treatments were given by nebulizer, MDI, MDI plus valved holding chamber (VHC), or DPI. The number of doses dispensed, as well as doses not used, via MDI, MDI + VHC, or DPI were collected from electronic medical records. Costs associated with wasted medications were evaluated. RESULTS Of 555 patient admissions screened, 478 (mean age, 66 years; 58% women; 74% African American) met study criteria. Of the total MDI or DPI doses dispensed, 87% were wasted, and associated hospital cost was approximately $86,973. CONCLUSIONS Substantial waste of inhaled medications was found in our study. Practical strategies are needed to reduce wasted inhalers. Further assessment of this problem is needed in other US hospitals.
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Affiliation(s)
- Sami Sakaan
- Clinical Pharmacist, Methodist University Hospital , Memphis, Tennessee
| | - Dagny Ulrich
- University of Tennessee Health Science Center , Memphis
| | - Jenny Luo
- University of Tennessee Health Science Center , Memphis
| | - Christopher K Finch
- Assistant Director, Clinical Pharmacy Services, Methodist University Hospital , Memphis, Tennessee ; Associate Professor of Clinical Pharmacy, University of Tennessee Health Science Center , Memphis
| | - Timothy H Self
- Professor of Clinical Pharmacy, University of Tennessee Health Science Center , Memphis ; Program Director, PGY2 Internal Medicine Pharmacy Residency, Methodist University Hospital , Memphis, Tennessee
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Self TH, Patterson SJ, Headley AS, Finch CK. Action plans to reduce hospitalizations for chronic obstructive pulmonary disease exacerbations: focus on oral corticosteroids. Curr Med Res Opin 2014; 30:2607-15. [PMID: 24926733 DOI: 10.1185/03007995.2014.934795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is associated with a huge burden of suffering and healthcare expenditures. Patients hospitalized due to COPD have increased risk of death. Starting in 2015, reimbursements by the Centers for Medicaid Medicare Services will be significantly reduced to hospitals with excess 30 day readmissions for COPD. Oral corticosteroid (OCS) therapy is established in improving outcomes in COPD patients treated in the emergency department and hospital. The objective of this article is to review the evidence evaluating home OCS treatment of COPD exacerbations as part of a comprehensive self-management action plan. METHODS We reviewed the English literature via PubMed, Embase, and Scopus using the search terms: chronic obstructive pulmonary disease exacerbations AND: oral corticosteroids, prednisone, prednisolone, methylprednisolone, treatment, self-management, disease management, written action plans. When pertinent articles were found, we reviewed the relevant articles cited. FINDINGS Two randomized trials enrolling 933 patients provide evidence of reduced rates of hospitalization by using comprehensive COPD action plans, including OCS therapy. Three trials with 790 patients enrolled did not reveal reduced rates of hospitalization. Among all five trials together, there were no differences in deaths (76 in the intervention groups [home action plans]; 81 in the usual care groups). Additional studies not assessing hospitalizations have found home use of OCSs increases time to the next exacerbation and decreases recovery time. CONCLUSION Further randomized trials are needed to establish that home use of OCS therapy, as part of a comprehensive action plan, reduces the rate of hospitalizations. Such action plans should include structured patient education, early initiation of OCSs, oral antibiotics, and frequent telephone reinforcement and support from case management.
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Affiliation(s)
- Timothy H Self
- University of Tennessee Health Science Center, Methodist University Hospital , Memphis, TN , USA
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18
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Abstract
BACKGROUND Monitoring peak expiratory flow (PEF) values is one option as part of asthma action plans per national guidelines. PEF assessment is also recommended in emergency department and hospitalized patients. Incorrect use of peak flow meters (PFM) has obvious implications for appropriate decisions by patients and clinicians. METHODS We searched the English literature via PubMed and SCOPUS using the following search terms: PEF maneuver; incorrect use of PFM. When pertinent articles were found, we assessed publications cited in those papers. All studies related to incorrect use of PFM in patients with asthma were included. RESULTS Nine studies have reported errors in performing the PEF maneuver, including three pediatric and six adult studies. Errors were found at most steps of the maneuver, and inability to perform all steps correctly was common in these investigations. Examples of errors included failure to inhale fully or give maximum effort on exhalation, accelerating air with the tongue and buccal musculature, and performing only one attempt versus three. Gender differences in correct use of PFM are suggested by three adult studies. One study described falsifying PEF values by manipulating the PFM indicator, and another investigation assessed the PEF maneuver in two positions in bed versus the correct posture of standing. CONCLUSION Many pediatric and adult patients do not use PFM correctly. Clinicians should regularly observe patients use PFM to detect errors and help ensure correct use and accurate PEF measurements.
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Affiliation(s)
- Timothy H Self
- Department of Clinical Pharmacy, University of Tennessee Health Science Center , Memphis, TN , USA
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Woods JA, Wheeler JS, Finch CK, Pinner NA. Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:421-30. [PMID: 24833897 PMCID: PMC4014384 DOI: 10.2147/copd.s51012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic and progressive disease that affects an estimated 10% of the world's population over the age of 40 years. Worldwide, COPD ranks in the top ten for causes of disability and death. Given the significant impact of this disease, it is important to note that acute exacerbations of COPD (AECOPD) are by far the most costly and devastating aspect of disease management. Systemic steroids have long been a standard for the treatment of AECOPD; however, the optimal strategy for dosing and administration of these medications continues to be debated. OBJECTIVE To review the use of corticosteroids in the treatment of acute exacerbations of COPD. MATERIALS AND METHODS Literature was identified through PubMed Medline (1950-February 2014) and Embase (1950-February 2014) utilizing the search terms corticosteroids, COPD, chronic bronchitis, emphysema, and exacerbation. All reference citations from identified publications were reviewed for possible inclusion. All identified randomized, placebo-controlled trials, meta-analyses, and systematic reviews evaluating the efficacy of systemic corticosteroids in the treatment of AECOPD were reviewed and summarized. RESULTS The administration of corticosteroids in the treatment of AECOPD was assessed. In comparison to placebo, systemic corticosteroids improve airflow, decrease the rate of treatment failure and risk of relapse, and may improve symptoms and decrease the length of hospital stay. Therefore, corticosteroids are recommended by all major guidelines in the treatment of AECOPD. Existing literature suggests that low-dose oral corticosteroids are as efficacious as high-dose, intravenous corticosteroid regimens, while minimizing adverse effects. Recent data suggest that shorter durations of corticosteroid therapy are as efficacious as the traditional treatment durations currently recommended by guidelines. CONCLUSION Systemic corticosteroids are efficacious in the treatment of AECOPD and considered a standard of care for patients experiencing an AECOPD. Therefore, systemic corticosteroids should be administered to all patients experiencing AECOPD severe enough to seek emergent medical care. The lowest effective dose and shortest duration of therapy should be considered.
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Affiliation(s)
- J Andrew Woods
- School of Pharmacy, Wingate University, Wingate, NC, USA
| | | | | | - Nathan A Pinner
- Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
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20
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Wallace JL, George CM, Tolley EA, Winton JC, Fasanella D, Finch CK, Self TH. Peak expiratory flow in bed? A comparison of 3 positions. Respir Care 2014; 58:494-7. [PMID: 22906434 DOI: 10.4187/respcare.01843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current guidelines for the correct peak expiratory flow (PEF) maneuver include standing. In the hospital setting, PEF values are often ordered to assess response to asthma therapy for exacerbations. We have observed that the PEF is sometimes performed with the patient in bed. METHODS Healthy adults performed the PEF maneuver in random order, standing, lying back at an ~45° angle on pillows, and sitting, slumped forward ~10° with legs extended. PEF was recorded for 3 attempts in each of the 3 positions. RESULTS We enrolled 94 subjects (39 male, 55 female, mean age 24 y) in 2011. Mean PEF in the standing position (669 ± 42 L/min) was significantly higher than in the lying back (621 ± 42 L/min) (P < .001) and sitting (615 ± 42 L/min) positions in males (P < .001), and, similarly, in females, standing produced a significantly higher mean PEF (462 ± 42 L/min) than the lying back (422 ± 42 L/min) (P < .001) and sitting (447 ± 42 L/min) positions (P < .05). CONCLUSIONS Clinicians should ensure that PEF is obtained with patients out of bed and in the standing position.
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Affiliation(s)
- Jessica L Wallace
- Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee, USA
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21
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Abstract
Chronic obstructive pulmonary disease (COPD) is the third most common cause of death in the USA. In 2010, the cost of COPD in the USA was projected to be approximately US$50 billion, which includes $20 billion in indirect costs and $30 billion in direct health care expenditures. These costs can be expected to continue to rise with this progressive disease. Costs increase with increasing severity of disease, and hospital stays account for the majority of these costs. Patients are diagnosed with COPD following a multifactorial assessment that includes spirometry, clinical presentation, symptomatology, and risk factors. Smoking cessation interventions are the most influential factor in COPD management. The primary goal of chronic COPD management is stabilization of chronic disease and prevention of acute exacerbations. Bronchodilators are the mainstay of COPD therapy. Patients with few symptoms and low exacerbation risk should be treated with a short-acting bronchodilator as needed for breathlessness. Progression of symptoms, as well as possible decline in forced expiratory volume in the first second of expiration (FEV1), warrant the use of long-acting bronchodilators. For patients with frequent exacerbations with or without consistent symptoms, inhaled corticosteroids should be considered in addition to a long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) and may even consist of "triple therapy" with all three agents with more severe disease. Phosphodiesterase-4 inhibitors may be an option in patients with frequent exacerbations and symptoms of chronic bronchitis. In addition to a variety of novel ultra-LABAs, LAMAs and combination bronchodilator and inhaled corticosteroid (ICS) therapies, other bronchodilators with a variety of mechanisms are also being considered, to expand therapeutic options for the treatment of COPD. With more than 50 new medications in the pipeline for the treatment of COPD, optimal management will continue to evolve and grow more complex as benefits of therapy are balanced with the limitations and needs of each patient.
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Affiliation(s)
| | - Shauntá M Ray
- University of Tennessee College of Pharmacy, Knoxville, USA
| | - Christopher K Finch
- University of Tennessee College of Pharmacy, Memphis, TN, USA
- Methodist University Hospital, Memphis, TN, USA
| | - Timothy H Self
- University of Tennessee College of Pharmacy, Memphis, TN, USA
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Abstract
BACKGROUND Rifampin is a potent inducer of both cytochrome P-450 oxidative enzymes and the P-glycoprotein transport system. Among numerous well documented, clinically significant interactions, examples include warfarin, oral contraceptives, itraconazole, digoxin, verapamil, simvastatin, and human immunodeficiency virus-related protease inhibitors. Rifabutin reduces serum concentrations of antiretroviral agents, but less so than rifampin. Rifapentine is also an inducer of drug metabolism. METHODS A literature search of English language journals from 2008 to March 2012 was completed using several databases, including PubMed, EMBASE, and SCOPUS. Search terms included rifampin, rifabutin, rifapentine AND drug interactions. FINDINGS Examples of clinically relevant interactions with rifampin demonstrated by recent reports include posaconazole, voriconazole, oxycodone, risperidone, mirodenafil, and ebastine. CONCLUSIONS To avoid a reduced therapeutic response, therapeutic failure, or toxic reactions when rifampin, rifabutin, or rifapentine are added to or discontinued from medication regimens, clinicians need to be aware of these interactions. Recent studies have indicated that other transporter systems play a role in these drug interactions. As reports of rifampin drug interactions continue to grow, this review is a reminder to clinicians to be vigilant.
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Abstract
Purpose A case of hyperglycemia and subsequent diabetic ketoacidosis (DKA) possibly associated with aripiprazole use in an adult patient with no previous history of diabetes mellitus is reported. Summary A 55-year-old man presented to the emergency department with altered mental status and complaints of nausea, vomiting, and abdominal pain. The patient's past medical history was significant only for depression and hyperlipidemia. His home medications included sertraline 200 mg once daily and aripiprazole 10 mg once daily, which was initiated 6 months prior. The patient had no documented history of diabetes mellitus. Laboratory test results at the time of admission revealed hyponatremia, elevated serum creatinine, a blood glucose of 714 mg/dL, elevated amylase and lipase, and ketonuria. The patient's hemoglobin A1C was 13.5%. DKA was diagnosed. The patient was admitted to the hospital and given a normal saline bolus and infusion. Home medications were not continued. An insulin infusion was also initiated. On the second day of admission, his blood glucose continued to decrease, the insulin infusion was slowly titrated down, and NPH was started. On hospital day 3, the NPH was increased and the insulin infusion was discontinued. The patient was discharged home following 4 days of hospitalization on insulin therapy and aripiprazole was not restarted. Conclusions Although the glucose dysregulatory effect of aripiprazole is not widely appreciated, our case report emphasizes the importance of monitoring patients who receive any atypical antipsychotic, particularly aripiprazole, for glucose and metabolic abnormalities.
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Affiliation(s)
- Jack Watkins
- MD Anderson Cancer Center, Houston, Texas (At the time of writing, Dr. Watkins was a PGY-1 Pharmacy Resident at Methodist University Hospital in Memphis, Tennessee)
| | - Shaunta' M. Ray
- University of Tennessee, College of Pharmacy. Knoxville, Tennessee; ‡Emergency Department Specialist, Methodist Hospital, North, Memphis, Tennessee
| | - Amanda Gillion
- Clinical Pharmacy Services, Methodist University Hospital, Memphis, Tennessee
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Woods A, Usery JB, Ray SM, Self TH, Finch CK. An Evaluation of Inhaled Bronchodilator Therapy in Patients Hospitalized for Non-Life-Threatening COPD Exacerbations. Chest 2010. [DOI: 10.1378/chest.10248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Woods A, Usery JB, Self TH, Finch CK. An Evaluation of the Management of Non-Life-Threatening COPD Exacerbations in Hospitalized Patients. Chest 2010. [DOI: 10.1378/chest.10245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lobo B, Finch CK, Howard-Thompson A, Gillion A. Pharmacist-Managed Direct Thrombin Inhibitor Protocol Improves Care of Patients with Heparin-Induced Thrombocytopenia. Hosp Pharm 2010. [DOI: 10.1310/hpj4509-705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of direct-thrombin inhibitors (DTIs) for the management of patients with heparin-induced thrombocytopenia (HIT) is challenging. A pharmacist-managed DTI protocol was implemented to standardize and improve the care of patients with HIT. A background study that compared DTI protocol–treated patients to those who did not receive treatment with the DTI protocol found that significantly more of the DTI protocol–treated patients received care that was consistent with level 1 guidelines from the American College of Chest Physicians (41% vs 0%). Because outcomes were poor regardless of whether the DTI protocol was used, the protocol was revised to require pharmacist implementation and oversight. A follow-up study compared DTI protocol patients from the background study (non-pharmacist-managed) to the pharmacist-managed DTI protocol group. There were significantly fewer dosing errors, improved nursing documentation, and less reexposure to heparin when the pharmacist was responsible for managing the DTI protocol. A trend toward reduced bleeding was noted. The management of patients with HIT is complex, and there are a number of pitfalls that may lead to poor outcomes. DTIs are high-risk medications that require careful dosing and monitoring to minimize risk for adverse drug events. A DTI protocol may improve care of patients with HIT, and pharmacist oversight of DTI use can help to reduce risk for errors and adverse medication events.
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Affiliation(s)
- Bob Lobo
- Department of Pharmaceutical Services, Vanderbilt University Hospital, Nashville, Tennessee
| | - Christopher K. Finch
- Methodist University Hospital, College of Pharmacy, University of Tennessee, Memphis, Tennessee
| | | | - Amanda Gillion
- Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee
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Affiliation(s)
- Christopher K. Finch
- Christopher K. Finch, PharmD, BCPS, is Manager, Clinical Pharmacy Services, Methodist University Hospital, and Associate Professor, University of Tennessee, College of Pharmacy, Memphis, Tennessee, USA
| | - James Eason
- James Eason, MD, is Medical Director, Transplant Institute, Methodist University Hospital, and Professor, University of Tennessee, College of Medicine, Memphis, Tennessee, USA
| | - Justin B. Usery
- Justin B. Usery, PharmD, BCPS, is Internal Medicine Pharmacy Specialist, Methodist University Hospital, and Assistant Professor, University of Tennessee, College of Pharmacy, Memphis, Tennessee, USA
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Abstract
This study was conducted to identify current practice in provision of enteral nutrition (EN) and to determine effects of early enteral nutrition (EEN) on length of stay in the medical intensive care unit (ICU). In this prospective, observational study, medical ICU patients were evaluated to determine their candidacy for EEN. If patients were candidates for EN and expected to remain nothing-by-mouth for 48 hours, they were classified as receiving EEN (within 24 hours of admission) or delayed EN. Thirty-six patients were candidates for EEN. Eighteen received EEN and 18 received delayed EN. In the delayed group, the median time to start of EN was 2.1 +/- 4.8 days. Median ICU length of stay was 4.7 +/- 3.5 days in the EEN group compared with 8.5 +/- 8.3 days in the delayed group. Although hospital length of stay was shorter in the EEN group, this was not statistically significant (10.4 +/- 6.9 vs 16.9 +/- 11.5 days). Time on the ventilator was significantly shorter in the EEN group vs delayed (n = 30, 3.0 +/- 4.2 vs 6.0 +/- 9.2 days). The incidence of new pneumonia was lower in the EEN group (5.5% vs 44%), but no difference was found in the incidence of bacteremia. Hospital mortality was lower in the EEN group (1 vs 7 deaths). Given its association with numerous benefits, EEN within 24 hours of admission should be encouraged and implemented by clinicians in medical ICU patients, but additional research is needed.
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Abstract
BACKGROUND Documenting a detailed smoking history is of obvious importance. Failure to adequately document the smoking history may result in the misdiagnosis and management of asthma, and may be associated with a deficiency of care in patients with cardiovascular disease and several other common diseases. SCOPE The purpose of this article is to review the evidence over the past decade that demonstrates inadequate documentation of smoking history. A literature search of English language journals from 1999 to 2009 was completed using several databases, including PubMed, MEDLINE, EMBASE, and SCOPUS. FINDINGS Fourteen studies demonstrated inadequate documentation of smoking histories by primary care clinicians, specialists, residents, and medical students. Failure to document smoking histories was observed in patients with conditions such as heart failure, coronary artery disease, and asthma. Electronic decision support systems and simple medical record reminders were effective in improving the documentation of smoking histories. CONCLUSIONS Failure to adequately document the smoking history appears to be common. Strategies such as electronic decision support systems are needed to correct this problem in order for patients to receive optimal therapy for their appropriate diagnoses.
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Affiliation(s)
- Timothy H Self
- University of Tennessee Health Science Center; Methodist University Hospital, Memphis, TN 38163, USA.
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Usery JB, Michael LM, Sills AK, Finch CK. A prospective evaluation and literature review of levetiracetam use in patients with brain tumors and seizures. J Neurooncol 2010; 99:251-60. [DOI: 10.1007/s11060-010-0126-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 01/25/2010] [Indexed: 11/24/2022]
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Abstract
Hyperkalemia is an electrolyte abnormality that can lead to severe consequences. Paralysis induced by hyperkalemia has been described in only a few reports. We describe a 60-year-old man who experienced paralysis presumably due to hyperkalemia. He presented to the emergency department with severe weakness in all extremities. The patient's serum potassium concentration was greater than 8 mEq/L and his serum creatinine concentration was 7 mg/dl. Findings on electrocardiography were abnormal. Of note, his drug therapy included lisinopril and naproxen. After treatment for hyperkalemia, the patient's symptoms resolved; however, he was admitted for further workup for renal failure. The patient was discharged after approximately 1 week with a diagnosis of end-stage renal disease. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient's paralysis and hyperkalemia. Although hyperkalemia as a cause of paralysis is extremely rare, clinicians should be aware of this potentially life-threatening, noncardiac toxicity.
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Affiliation(s)
- Nikita S Wilson
- Department of Pharmacy, Methodist University Hospital, Memphis, TN 38104, USA
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Wallace JL, Arnold LB, Usery JB, Finch CK, Deaton PR, Self TH. INADEQUATE DOCUMENTATION OF SMOKING HISTORY IN HOSPITALIZED PATIENTS FOR ASTHMA WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (ICD-9 CODE 493.2). Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.119s-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Usery JB, Self TH, Muthiah MP, Finch CK. Potential role of leukotriene modifiers in the treatment of chronic obstructive pulmonary disease. Pharmacotherapy 2009; 28:1183-7. [PMID: 18752388 DOI: 10.1592/phco.28.9.1183] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract Chronic obstructive pulmonary disease (COPD) is characterized by progressive, irreversible airflow limitation coupled with an abnormal inflammatory process. It is associated with high morbidity and mortality. Leukotriene modifiers, approved by the United States Food and Drug Administration as treatment for asthma and allergic rhinitis, may also alleviate the abnormal inflammatory response seen in patients with COPD. To explore the outcomes of research in this area, we conducted a literature search from 1950-2007, using the PubMed database. We found no published studies that provided conclusive evidence that the available leukotriene modifiers benefit patients with COPD. However, data do suggest that leukotriene modifiers may offer benefits to patients with COPD, including effects that pertain to airflow limitation, neutrophil and lymphocyte chemotaxis, and neutrophil longevity. Added to conventional treatment, these agents appear to reduce symptoms, improve objective measures of disease, and control inflammation. Further studies are needed to determine the precise role of leukotriene modifiers in the treatment of COPD.
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Affiliation(s)
- Justin B Usery
- Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee 38104, USA
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Czosnowski QA, Swanson JM, Lobo BL, Broyles JE, Deaton PR, Finch CK. Evaluation of glycemic control following discontinuation of an intensive insulin protocol. J Hosp Med 2009; 4:28-34. [PMID: 19140192 DOI: 10.1002/jhm.393] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intensive insulin protocols (IIPs) have been demonstrated to reduce morbidity and mortality in critically ill patients. Currently, there are no published studies evaluating glycemic control after discontinuation of an IIP. OBJECTIVE The purpose of this study was to compare blood glucose (BG) control during an IIP and for 5 days following its discontinuation (follow-up period). METHODS The study was a retrospective review of intensive care unit patients who received an IIP for >or=24 hours. Data were collected during the last 12 hours of the IIP and subsequent follow-up period. RESULTS For all 65 included patients, the mean +/- standard deviation for BG on the IIP was 123 +/- 26 mg/dL versus 168 +/- 50 mg/dL following discontinuation of the IIP (P < 0.001). The median (interquartile range) insulin that was administered decreased from 40 (22-65) units on the IIP to 8 (0-18) units after the IIP was stopped (P < 0.001). The mean daily BG during the follow-up period was significantly higher than that during the IIP (P < 0.001). Additionally, an insulin requirement of >20 units during the last 12 hours of the IIP was identified as a risk factor for poor glycemic control during the follow-up period (odds ratio: 4.62; 95% confidence interval: 1.17-18.17). CONCLUSIONS This study demonstrates a significant increase in BG following discontinuation of an IIP. Higher insulin requirements during the last 12 hours of an IIP were identified as an independent risk factor for poor glycemic control following the IIP. A standardized insulin transition protocol may help better control BG after discontinuation of an IIP.
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Arnold LB, Usery JB, Wallace J, Finch CK, Deaton P, Self T. DOCUMENTATION OF ASTHMA MANAGEMENT IN HOSPITALIZED PATIENTS: A RETROSPECTIVE REVIEW. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p92002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Howard-Thompson A, Usery JB, Lobo BL, Finch CK. Heparin-induced thrombocytopenia complicated by warfarin-induced skin necrosis. Am J Health Syst Pharm 2008; 65:1144-7. [PMID: 18541684 DOI: 10.2146/ajhp070352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amanda Howard-Thompson
- College of Pharmacy, University of Tennessee (UT), Memphis; at the time of writing she was Internal Medicine Pharmacy Resident, Methodist University Hospital (MUH), Memphis
| | - Justin B. Usery
- College of Pharmacy, UT; at the time of writing he was Internal Medicine Pharmacy Resident, MUH
| | - Bob L. Lobo
- MUH, and Associate Professor, College of Pharmacy, UT
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Howard-Thompson A, Hurdle AC, Arnold LB, Finch CK, Sands C, Self TH. Intracerebral hemorrhage secondary to a warfarin-metronidazole interaction. ACTA ACUST UNITED AC 2008; 6:33-6. [DOI: 10.1016/j.amjopharm.2008.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2008] [Indexed: 01/22/2023]
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Abstract
PURPOSE A case of spontaneous pneumothorax with a subsequent bronchopleural fistula (BPF) treated with endoscopically administered fibrin glue is presented. SUMMARY A 76-year-old white man with a history of a benign lung mass and chronic obstructive pulmonary disease was admitted to the hospital with right-sided, anterior, pleuritic chest pain for the past three days and shortness of breath at rest, which worsened during exertion. Initial chest radiograph revealed a right 95% spontaneous tension pneumothorax. A chest tube was immediately placed in the right pleural space, resulting in reinflation of the lung. However, air leaks continued to be present, requiring the need for surgical intervention. The patient required both coronary artery bypass graft surgery and right blebectomy with pleurodesis. Postsurgery, the patient required two pleural chest tubes for the persistence of a BPF. A critical care clinical pharmacist was consulted regarding potential use of an endoscopic fibrin seal. Fiberoptic bronchoscopy was performed, and diffuse bronchiectasis was noted in all right lower respiratory airways. The day after the fibrin sealant was administered, one of the pleural chest tubes was removed because the air leak was significantly reduced in size. The patient was discharged home two days later with a Heimlich chest valve. One week postdischarge, a chest radiograph revealed no pneumothorax. CONCLUSION Use of a fibrin sealant injected through a fiberoptic bronchoscope was effective in reducing an air leak associated with a spontaneous pneumothorax and subsequent BPF.
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Affiliation(s)
- Christopher K Finch
- Department of Pharmacy, Methodist University Hospital, Methodist LeBonheur Healthcare, Memphis, TN 38104, USA.
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Brooks TWA, Finch CK, Lobo BL, Deaton PR, Varner CF. Blood pressure management in acute hypertensive emergency. Am J Health Syst Pharm 2007; 64:2579-82. [DOI: 10.2146/ajhp070105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tyson W. A. Brooks
- St. Louis College of Pharmacy, St. Louis, MO; at the time of this study he was Pharmacy Practice Resident, Methodist University Hospital (MUH), Memphis, TN
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Affiliation(s)
- Christopher K Finch
- Methodist University Hospital and College of Pharmacy, University of Tennessee, Memphis, TN, USA
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Self TH, Cross LB, Nolan SE, Weibel JB, Hilaire M, Franks AR, Finch CK, Tolley EA. Gender differences in the use of peak flow meters and their effect on peak expiratory flow. Pharmacotherapy 2005; 25:526-30. [PMID: 15977914 DOI: 10.1592/phco.25.4.526.61026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine if gender differences in the skill of using peak flow meters affect peak expiratory flow (PEF). DESIGN Prospective observational study. SETTING University classroom. SUBJECTS One hundred sixteen first-year pharmacy students (76 women, 40 men). INTERVENTION Students were taught correct use of a peak flow meter by means of classroom discussion and demonstrations. MEASUREMENTS AND MAIN RESULTS The students' technique in use of the peak flow meter was scored 3 times, and their PEF was recorded. Men scored higher than women (p=0.03) for the steps of "inhale fully" and "exhale as hard and as fast as you can" in the first attempt. Percentage increases in PEF did not significantly differ between the groups. Percentage change in PEF improved from the second attempt to the third attempt in women (p=0.036) but not men. On the third attempt, 13.2% of women versus 2.6% of men had an increase in PEF of more than 50% (p=0.1). CONCLUSION This study found that men learned the correct technique for using a peak flow meter and attained their best PEF more quickly than women.
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Affiliation(s)
- Timothy H Self
- Colleges of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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Abstract
OBJECTIVE: To report a case of neurotoxicity and subsequent hospitalization due to abuse of an ethyl chloride inhalant. CASE SUMMARY: A 41-year-old African American male presented to the emergency department due to mental status changes and an inability to walk. After the blood alcohol and urine drug screen returned negative, a family member revealed that the patient frequently abused an inhalant containing the volatile solvent ethyl chloride. DISCUSSION: Inhalant abuse is common and is facilitated by the widespread availability of volatile solvents that have legitimate commercial or household uses. Most inhalants are central nervous system depressants and are highly lipophilic. Maximum Impact, which contains ethyl chloride, is sold in stores and is readily available over the Internet. While the product has a legitimate use as a VCR head cleaner, it is often illicitly marketed over the Internet as a means of getting a “rush” or “high” and for enhancing sexual pleasure. Neurologic symptoms have been reported after deliberate inhalational exposure to ethyl chloride, and 2 deaths have been associated with its use. An objective causality assessment using the Naranjo probability scale revealed a probable adverse drug event. CONCLUSIONS: Inhalants should be included in the differential diagnosis of patients presenting with acute mental status changes and neurologic impairment that resolve over less than one week.
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Affiliation(s)
- Christopher K Finch
- Department of Pharmacy, Methodist University Hospital, Memphis, TN 38104-3499, USA.
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Abstract
Nicotine has been documented to regulate the release of plasma arginine vasopressin (AVP). The literature is inconclusive about the effects of nicotine replacement therapy on AVP release, although cigarette smoking has been shown to increase the release of AVP. No clinical case reports have documented the possible association between nicotine replacement and hyponatremia through AVP release. We report a case of a 39-year-old man who experienced syndrome of inappropriate antidiuretic hormone while on nicotine patch therapy. We theorize that the constant serum concentration of nicotine levels provided through the patch may cause hyponatremia through the continuous stimulation of vasopressin.
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Abstract
OBJECTIVE To report a case of possible gatifloxacin-induced hyperglycemia in a nondiabetic middle-aged woman. CASE SUMMARY A 64-year-old Indian woman with an extensive cardiovascular history was admitted for urosepsis. On admission, her blood glucose was 117 mg/dL. She was empirically started on gatifloxacin 400 mg/day; after 3 days of gatifloxacin therapy, her blood glucose was 607 mg/dL. On day 4, therapy was changed to cefazolin for sensitive Escherichia coli and her blood glucose levels began to return to normal. DISCUSSION Although gatifloxacin has been previously reported as a potential cause of both hyper- and hypoglycemia, the exact mechanism is unknown. Several factors that may have been involved in our patient's hyperglycemia are discussed. She experienced hyperglycemic changes more rapidly than did the typical patients of previous reports. The Naranjo probability scale suggests a possible drug-related event. CONCLUSIONS The temporal relationship between gatifloxacin administration and the patient's hyperglycemia suggests an iatrogenic cause. Based on our experience and the product labeling, clinicians should be more aware of the blood glucose—altering effects of gatifloxacin.
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Affiliation(s)
- Amy R Donaldson
- Harrison School of Pharmacy, Auburn University, Auburn, AL, USA.
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Abstract
We describe the case of a patient in whom anticonvulsant hypersensitivity syndrome developed during treatment with phenytoin and progressed when therapy was changed to phenobarbital. Although therapeutic options remain controversial, corticosteroids and IV immunoglobulin were used in our patient. The patient had a complete recovery, suggesting the potential benefit of corticosteroids and IV immunoglobulin for anticonvulsant hypersensitivity syndrome.
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Abstract
A 63-year-old African-American woman was admitted to the hospital with urosepsis and altered mental status. She had a history of schizophrenia and was treated with olanzapine 5 mg/day and lithium carbonate 300 mg 3 times/day. During her hospital stay, her sodium level and serum osmolality increased and her urine osmolality decreased, whereas her lithium levels remained within normal limits. Based on these findings, the patient was diagnosed with diabetes insipidus secondary to lithium therapy and was treated successfully with amiloride. Clinicians have been aware of lithium toxicity for many years and traditionally have administered thiazide diuretics for lithium-induced polyuria and nephrogenic diabetes insipidus. Recently, amiloride, a potassium-sparing diuretic, has been reported as a successful treatment for nephrogenic diabetes insipidus.
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Affiliation(s)
- Christopher K Finch
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, AL, USA.
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Finch CK, Green CA, Self TH. Fluconazole-carbamazepine interaction. South Med J 2002; 95:1099-100. [PMID: 12356123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The patient we describe had elevated carbamazepine serum concentrations during concomitant fluconazole administration (400 mg/day), including serial concentrations both before and after antifungal therapy. Since fluconazole is a known inhibitor of the cytochrome P450 enzyme system, this suggests an inhibition of carbamazepine metabolism.
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Affiliation(s)
- Christopher K Finch
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis 38163, USA
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Abstract
Serum digoxin concentrations (SDC) have been used clinically since the early 1970s. Whereas the therapeutic range for SDC is frequently cited as either 0.8 to 2.0 ng/mL or 0.5 to 2.0 ng/mL, studies over the past decade suggest an upper limit of 1.0 ng/mL for treating heart failure. The same upper limit for SDC is suggested for patients with heart failure and atrial fibrillation with rapid ventricular response. Reducing the upper limit of the therapeutic range to 1.0 ng/mL on computerized and paper laboratory report forms may guide clinicians to avoid unnecessarily high SDC, thus minimizing risk of digoxin toxicity without sacrificing therapeutic benefit for heart failure.
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Affiliation(s)
- Roya M Sameri
- Department of Clinical Pharmacy, University of Tennessee, Memphis 38163, USA
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Abstract
Rifampin is a potent inducer of cytochrome P-450 oxidative enzymes. A few examples of well-documented clinically significant interactions include interactions with warfarin, oral contraceptives, cyclosporine, glucocorticoids, ketoconazole or itraconazole, theophylline, quinidine sulfate, digitoxin or digoxin, verapamil hydrochloride, human immunodeficiency virus-related protease inhibitors, zidovudine, delavirdine mesylate, nifedipine, and midazolam. Recent reports have demonstrated clinically relevant interactions with numerous other drugs, such as buspirone hydrochloride, zolpidem tartrate, simvastatin, propafenone hydrochloride, tacrolimus, ondansetron hydrochloride, and opiates. Rifabutin reduces serum concentrations of antiretroviral agents, but less so than rifampin. To avoid a reduced therapeutic response, therapeutic failure, or toxic reactions when rifampin is added to or discontinued from medication regimens, clinicians need to be cognizant of these interactions. Enhanced knowledge of known interactions will continue to develop, including research on the induction of specific cytochrome P-450 isoenzymes and on the importance of the P-glycoprotein transport system. New rifampin and rifabutin interactions will be discovered with further investigations.
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Affiliation(s)
- Christopher K Finch
- Department of Clinical Pharmacy, University of Tennessee, 26 S Dunlap, Suite 210, Memphis, TN 38163, USA
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Self TH, Finch CK. Studies demonstrating improved outcomes in patients with asthma: a 10-year review. Am J Manag Care 2001; 7:187-97; quiz 198-200. [PMID: 11216335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- T H Self
- College of Pharmacy, University of Tennessee, 26 S Dunlap, Memphis, TN 38163, USA.
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