Journal of Pharmacy Practice (J Pharm Pract)
Today's pharmacist needs to know the basics in many areas of practice. Many are turning to the Journal of Pharmacy Practice for a quick - yet comprehensive - background to specific topics vital to the profession. This is because each timely issue focuses in-depth on a single theme. Recent themes included: Asthma Pharmacotherapy, Emergency Toxicology, Chemical Dependency, Interdisciplinary Carepaths, Biotechnology, Diet Drug Disaster, Drug Information, Pain Management, Critical Care. The Journal of Pharmacy Practice is presented in a scholarly peer-review format. Guest editors are selected for particular expertise in the subject area, and then recruit contributors from that practice specialty, and bring the information together in a relevant and timely fashion for the pharmacist reader.
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|Website||Journal of Pharmacy Practice website|
|Other titles||Journal of pharmacy practice (Online), Journal of pharmacy practice|
|Material type||Document, Periodical, Internet resource|
|Document type||Internet Resource, Computer File, Journal / Magazine / Newspaper|
- Author can archive a pre-print version
- Author can archive a post-print version
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- "as published" final version with layout and copy-editing changes cannot be archived but can be used on secure institutional intranet
- Must link to publisher version with DOI
- Publisher last reviewed on 29/07/2015
Publications in this journal
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To summarize the literature on cholesterol point-of-care tests (POCTs). This article would serve as a resource to assist community pharmacists in developing cholesterol point-of-care (POC) pharmacy services. Data sources: A literature search was performed in MEDLINE Ovid, PubMed, EMBASE, and Cochrane database using the following medical subject headings (MeSH) terms: point-of-care test, cholesterol, blood chemical analysis, rapid testing, collaborative practice, community pharmacy, and ambulatory care. Additional resources including device manufacturer web sites were summarized to supplement the current literature. Study selection and data extraction: All human research articles, review articles, meta-analyses, and abstracts published in English through September 1, 2014, were considered. Data synthesis: A total of 36 articles were applicable for review. Information was divided into the following categories to be summarized: devices, pharmacists' impact, and operational cost for the pharmacy. Conclusions: The current literature suggests that POCTs in community pharmacies assist with patient outcomes by providing screenings and referring patients with dyslipidemia for further evaluation. The majority of studies on cholesterol POC devices focused on accuracy, revealing the need for further studies to develop best practices and practice models with successful reimbursement. Accuracy, device specifications, required supplies, and patient preference should be considered when selecting a POC device for purchase.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To determine whether there is an association between higher vancomycin trough concentrations and attainment of a calculated area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) ≥400. Methods: A retrospective analysis was conducted among vancomycin-treated adult patients with a positive methicillin-resistant Staphylococcus aureus (MRSA) culture. Attainment of a calculated AUC/MIC ≥400 was compared between patients with troughs in the reference range of 15 to 20 mg/L and those with troughs in the following ranges: <10, 10 to 14.9, and >20 mg/L. Nephrotoxicity was assessed as a secondary outcome based on corrected average vancomycin troughs over 10 days of treatment. Results: Overall, 226 patients were reviewed and 100 included. Relative to troughs ≥10, patients with vancomycin troughs <10 mg/L were 73% less likely to attain an AUC/MIC ≥400 (odds ratio [OR] 0.27, 95% confidence interval [CI]: 0.01-0.75). No difference was found in the attainment of an AUC/MIC ≥400 in patients with troughs of 10 to 14.9 mg/L and >20 mg/L when compared to patients with troughs of 15 to 20 mg/L. The mean corrected average vancomycin trough was higher in patients developing nephrotoxicity compared to those who did not (19.5 vs 14.5 mg/L, P < .001). Conclusion: Achieving vancomycin serum trough concentrations of 15 to 20 mg/L did not result in an increased attainment of the AUC/MIC target relative to troughs of 10 to 14.9 mg/L but may increase nephrotoxicity risk.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: The study investigated the level of adherence and factors affecting adherence to antiretroviral treatment (ART). Methods: The study sample consisted of 300 HIV-infected patients who received ART in the Antiretroviral Clinic of Central Hospital, Agbor, Delta State, Nigeria. Self-reported adherence to ART in the previous 1 month prior to the study as well as determinants of adherence were assessed using a questionnaire. Results: The most frequently used ART regimen was zidovudine + lamivudine + nevirapine. On the whole, a total of 33 (11%) respondents missed 3 doses or less in the previous month prior to the survey. There was a statistically significant association between adherence to ART and marital status, source of income, and occupation (P < .05). The most commonly reported reasons for missed doses were forgetfulness (60.4%), busy daily task (18.3%), and avoiding being seen while taking medications (11%). Conclusion: The prevalence of adherence among the participants was high. However, more serious efforts are needed to reduce the number of in-adherent patients. Interventions to improve adherence to ART should address challenges such as forgetfulness among the patients and frequent occurrence of adverse effects and consider specific patient-related factors such as daily tasks.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To compare the return on investment (ROI) of an integrated practice model versus a "hub and spoke" practice model of pharmacist provided medication therapy management (MTM). Methods: A cohort retrospective analysis of MTM claims billed in 76 pharmacies in North Carolina in the 2010 hub and spoke practice model and the 2012 "integrated" practice model were analyzed to calculate the ROI. Results: In 2010, 4089 patients received an MTM resulting in 8757 claims in the hub and spoke model. In 2012, 4896 patients received an MTM resulting in 13 730 claims in the integrated model. In 2010, US$165 897.26 was invested in pharmacist salary and $173 498.00 was received in reimbursement, resulting in an ROI of +US$7600.74 (+4.6%). In 2012, US$280 890.09 was invested in pharmacist salary and US$302 963 was received in reimbursement, resulting in an ROI of +US$22 072.91 or (+7.9%). Conclusion: The integrated model of MTM showed an increase in number of claims submitted and in number of patients receiving MTM services, ultimately resulting in a higher ROI. While a higher ROI was evident in the integrated model, both models resulted in positive ROI (1:12-1:21), highlighting that MTM programs can be cost effective with different strategies of execution.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: The national initiative, Project IMProving America's Communities Together (IMPACT): Diabetes, was intended to scale a proven American Pharmacists Association (APhA) Foundation process model, which integrates pharmacists on the collaborative health-care team, in communities greatly affected by diabetes to improve key indicators of diabetes. This article discusses the results from 1 community in Mississippi. Methods: This national prospective study followed patients with a hemoglobin A1c (HbA1c) >7% from September 2011 to January 2013. Pharmacists collaborated with providers and other health-care professionals to provide medication therapy management services for a minimum of 3 visits. Outcome measures included HbA1c, systolic and diastolic blood pressure (SBP and DBP), fasting cholesterol panel, body mass index (BMI), influenza vaccine and smoking status, and foot and eye examination dates. Results: At this site, there were statistically significant outcomes including mean HbA1c decrease of 1.2% in SBP and DBP of 8.3 mm Hg and 3.5 mm Hg, respectively, and reduction in low-density lipoprotein of 16.6 mg/dL, all of which were greater improvements compared to overall results from combined sites. Conclusion: Patients in this community who received care from the collaborative team, including a pharmacist, had improvement in most key indicators of diabetes, with a clinically significant reduction in HbA1c.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: To evaluate whether statin use influences gastrointestinal cancer prognosis in patients with diabetes mellitus (DM). Methods: We reviewed all DM patients diagnosed at Roswell Park Cancer Institute with emergent gastrointestinal malignancy (January 2003 to December 2010) (N = 222). Baseline demographic, clinical history, and cancer outcomes were documented. Overall survival (OS) and disease-free survival (DFS) comparisons across various treatment groups were assessed by Kaplan-Meier and Cox proportional hazards. Results: Use of statin, alone or in combination, was associated with improved OS and DFS (hazard ratio [HR] = 0.65, P = .06; HR = 0.60, P < .02). We report similar OS and DFS advantage among users of mono- or combined metformin therapy (HR = 0.55, P < .01; HR = 0.63, P < .02). Concomitant use of metformin and statin provided a synergistic OS and DFS benefit (HR = 0.42, P < .01; HR = 0.44, P < .01). Despite significant tobacco and alcohol use history, patients with upper gastrointestinal cancers derived enhanced cancer outcomes from this combination (HR = 0.34, P < .01; HR = 0.43, P < .02), while receiving a statin without metformin or metformin without a statin did not provide significant cancer-related benefits. Conclusion: Use of statin and metformin provides a synergistic improvement in gastrointestinal malignancies outcomes.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To report 3 cases of subdural bleeding associated with rivaroxaban managed by 3-factor prothrombin complex concentrate (PCC3). Case summaries: Case 1 presented with a 1-cm thick subdural hematoma (SDH) 12 hours after her last dose of rivaroxaban. Case 2 presented with a right 1-cm acute right SDH with 2 to 3 mm of midline shift 24 hours after his last dose of rivaroxaban. Case 3 presented with a 1.8-cm thick right cerebral convexity hematoma 12 hours after her last dose of rivaroxaban. All patients received 23 to 35 units/kg PCC3 with 1 to 3 units of fresh frozen plasm (FFP) and demonstrated no progression in lesions measured by repeat computed tomography (CT). Two patients were discharged to rehabilitation facilities and 1 patient ultimately died due to the location of the lesion. Discussion: Rivaroxaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and no clinical experience has been reported to date. These cases begin to illuminate differences among choices for managing bleeding associated with Xa inhibitors. Conclusion: In this case series, 25 to 35 units/kilogram PCC3 and FFP 1 to 3 units ceased rivaroxaban-associated bleeding without thrombogenic complications.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To report a case of isolated daptomycin-induced acute liver injury without elevations in creatine kinase (CK) levels or kidney dysfunction. Summary: A 49-year-old female with a history of pancreatitis, lupus, diabetes, congestive heart failure, hypertension, and chronic pain syndrome presented to the emergency department with alteration in mental status and acute liver failure. The patient had been treated with daptomycin for methicillin-resistant Staphylococcus aureus (MRSA) endocarditis for 3 weeks. After ruling out other possible etiologies, daptomycin was suspected as a cause of acute liver failure. Her liver failure resolved gradually following withdrawal of daptomycin. Conclusion: Although hepatic abnormalities caused by daptomycin are rare, a handful of cases with daptomycin-induced liver injury have been reported in the literature. Of note, in most cases, patients on daptomycin therapy developed liver damage with elevations in CK levels. Our case report suggests possible severe liver injury associated with high-dose and long-term daptomycin treatment in the absence of rhabdomyolysis. Future research is warranted to further investigate the relationship between daptomycin use and liver injury, yet it is reasonable to monitor liver function tests at baseline and weekly thereafter along with CK levels, especially in patients requiring long-term daptomycin therapy.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: Summarize available information regarding clinical impact of citalopram on the QTc interval. Methods: A literature search was conducted in Pubmed, EMBASE, and Cochrane databases using the MeSH term "long QT syndrome" and key word "citalopram" on July 11, 2014. Results: Thirty-one studies were evaluated with 4 included in this review. Studies were excluded if they reported acute overdoses of citalopram or did not report on patient-specific risk factors for long QT syndrome (eg, hypokalemia, bradycardia, and increased age). The majority of the available data is derived from case reports. A number of confounders complicate the determination of a causal link between QTc prolongation and citalopram. Of the 4 studies included for review, none identified significant QTc prolongation in patients taking citalopram 20 to 60 mg daily without the patients having one or more patient-specific risk factors for prolonged QTc. Conclusion: There is insufficient evidence to establish a causal link between citalopram 20 to 60 mg orally daily and increased risk of TdP. Further research is required to determine the clinical impact and association between citalopram 20 to 60 mg daily and QTc prolongation.
- [Show abstract] [Hide abstract] ABSTRACT: Background: The hepatitis C virus (HCV) is the most common chronic blood-borne infection and the leading cause of liver transplantation in the United States. There are approximately 3.2 million people currently infected with HCV in the United States. In late 2013, the introduction of sofosbuvir and simeprevir represented a critical advancement in the treatment of HCV by improving sustained virologic response (SVR) rates. Purpose: The purpose of this study was to evaluate medication utilization and clinical outcomes of patients with HCV who were treated with any Food and Drug Administration-approved combination of ribavirin, peginterferon products, simeprevir, and sofosbuvir. Methods: Prescription records and clinical assessment forms of patients who started HCV therapy and were eligible for SVR between January 1, 2014, and December 31, 2014, were retrospectively reviewed. Data collection included patient demographics, genotype, SVR, patient-reported adverse events, discontinuations, and adherence markers. Results: A total of 367 eligible patients were identified who had initiated treatment during the study period. Genotype 1 was the most common genotype, and an overall SVR rate of 86.9% was observed. Results were similar to those seen in phase III clinical trials. In addition, adverse events of these medications were more tolerable, and discontinuation rates were lower than with previous therapies.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To report a case of hypothermia in a patient with intellectual disability treated with thioridazine. Summary: A 59-year-old female presented to the emergency department with altered mental status, generalized weakness, chills, and fatigue and was diagnosed with a urinary tract infection. Upon completion of a history and physical examination, the patient was found to be hypothermic with a temperature of 91 F. A Bair Hugger protocol was initiated to manage hypothermia, and a taper schedule for thioridazine was initiated as it was identified as a possible culprit for the patient's hypothermia. According to the Naranjo probability scale, thioridazine was a possible cause of this adverse effect. Other patient-specific risk factors for hypothermia were evaluated and ruled out. Conclusion: This case indicates a possible correlation between hypothermia and the use of phenothiazine antipsychotics such as thioridazine. Appropriate measures, including early detection and identification of possible causative agents, should be taken to prevent and treat this adverse event in patients taking these medications, specifically in patients with the inability to participate in self-care.
- [Show abstract] [Hide abstract] ABSTRACT: Zoledronic acid (ZA) administration has been associated with electrolyte abnormalities, including hypocalcemia, hypomagnesemia, hypokalemia, and hypophosphatemia. We describe a case of severe, refractory hypophosphatemia in a patient who received ZA for hypercalcemia of malignancy (HCM). Little data are available that describe the incidence or degree of severity of hypophosphatemia that can occur following ZA administration. In addition, no formal recommendations exist to guide monitoring for or management of electrolyte derangements in the setting of bisphosphonate use. Our patient required daily, high-dose phosphorus replacement beginning day 4 following ZA administration. The average daily dose of phosphorus, including both intravenous and enteral administration, was highest in the first 2 weeks after ZA, averaging 77 mmol/d days 4 through 15, and does not include sources of phosphorus from the patient's nutrition support. Despite this high amount of supplementation, which was well beyond what meets normal daily requirements and the amount expected to treat "usual" hypophosphatemia, the patient did not achieve sustained normal serum phosphorus levels for over 30 days after ZA. ZA is a favorable option for treating HCM because of its longer duration of action, potent serum calcium-lowering effects, and favorable safety profile. The risk of hypophosphatemia with ZA use is reviewed.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To compare survey responses between licensed pharmacists who work with or employ new graduates and graduating senior pharmacy students at a college of pharmacy. Design: This was a retrospective analysis of surveys given to 2 groups of pharmacists and students. Responses to items regarding importance of desirable qualities in new pharmacists and level of preparation of new graduates were analyzed. Qualities included drug information, pharmacology, therapeutics, communication with patients/customers or health care professionals, professionalism, ethics, management, and conflict resolution. Results: There was consensus between pharmacists and students regarding the importance of all items (P > .05 for all comparisons). However, the percentage of pharmacists versus students who agreed that new graduates communicate effectively differed (86.7% vs 100%, respectively, P < .05). Of pharmacists surveyed at a career fair, 64.1% chose communication as the 1 skill that would distinguish an applicant, and retail and hospital pharmacists displayed a statistically significant (P < .05) difference in the audience (patients/customers vs other health care professionals). Conclusion: Pharmacists and students agree on the knowledge and skills essential for pharmacy practice but disagree on the level of preparation for effective communication. These results support ongoing efforts to improve the development of communication skills in the professional pharmacy curriculum.
- [Show abstract] [Hide abstract] ABSTRACT: Potentially inappropriate medications (PIMs) have been associated with poor outcomes in older adults. Electronic health record (EHR)-based interventions may be an effective way to reduce PIM prescribing. The main objective of this study was to evaluate changes in PIM prescribing to older adult veterans ≥65 years old in the ambulatory care setting preimplementation and postimplementation of medication alert messages at the point of computerized provider order entry (CPOE). Additional exploratory objectives included evaluating provider type and patient-provider relationship as a factor for change in PIM prescribing. A total of 1539 patients prealert and 1490 patients postalert were prescribed 1952 and 1897 PIMs, respectively. End points were reported as the proportion of new PIM orders of total new prescriptions. There was no significant difference in the rate of new PIMs prealert and postalert overall, 12.6% to 12.0% (P = .13). However, there was a significant reduction in the rate of the top 10 most common newly prescribed PIMs, 9.0% to 8.3% (P = .016), and resident providers prescribed fewer PIMs during both time periods. A simple, age-specific medication alert message during CPOE decreased the incidence of the most frequently prescribed PIMs in older adults receiving care in an ambulatory care setting.
- [Show abstract] [Hide abstract] ABSTRACT: Background: In 2012, pharmacists were integrated into a medical group to provide direct patient care, drug information activities, and health care provider education. The medical group encompasses 40 primary care and 60 specialty offices in Virginia. Objective: To describe the development and implementation of clinical pharmacist services integrated within a medical group. Methods: Pharmacists' roles and responsibilities, type and number of patient encounters, and identification of strategies to facilitate implementation are described. Results: From June 2012 to December 2014, pharmacists had 809 patient encounters, which included patient-centered education, medication consults, Medicare annual wellness visits, senior care visits, and comprehensive medication reviews. Pharmacists addressed 403 drug information requests from nurse navigators, providers, and administrators. Pharmacists also have roles in risk management, quality improvement initiatives, and operations that benefit the medical group. Strategies to facilitate implementation include working with organizational leadership, identifying a physician champion, and establishing credibility by being responsive to practice needs and responding to requests in a timely manner to build trust within the health care team. Conclusion: Integration of pharmacists within health care teams involves more than direct patient care activities. Pharmacists should be involved at the organizational level to have a broader impact on patient and practice levels.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives: To report perceptions of PharmD candidates regarding a behind-the-counter (BTC) class of medications and to identify perceived barriers to its successful implementation. Methods: PharmD candidates in their second, third, and fourth professional years were invited to complete an online survey. Responses were used to assess perceptions of competency and willingness to participate in a BTC program and perceived preparedness of the current community pharmacy practice environment for a BTC class of medications with regard to 8 specific classes of medications. Results: The survey response rate was 28%. In all, 78% of respondents agreed or strongly agreed that a BTC class of medications is a change that they would be willing to embrace, and 54% agreed or strongly agreed that their PharmD curriculum provided them with adequate training in laboratory and diagnostic test interpretation. Less than half of the respondents agreed or strongly agreed that community pharmacies are currently equipped with the resources necessary to clinically assess a patient and dispense BTC medications. Conclusion: PharmD candidates are prepared and willing to participate in a BTC program but believe that the current community practice environment lacks access to resources necessary to do so.
- [Show abstract] [Hide abstract] ABSTRACT: Apixaban, an oral factor Xa inhibitor, has no commercially available assay to measure its activity and no specific antidote. To date, recommendations for managing bleeding associated with apixaban are based on studies with animal models and healthy volunteers (who do not have identified thrombogenic risk factors) and expert opinion. No clinical experience has been published in the literature. Ideally, apixaban would be reversed sufficiently to stop a perilous bleed without producing more thrombogenic risk than the patients' underlying risk factors. Three-factor prothrombin complex concentrate (PCC3) is the least thrombogenic among the suggested reversal agents. Fresh frozen plasma (FFP) is sometimes recommended to add to PCC3, but it adds considerable volume. We describe successful management of an active left gluteal arterial extravasation due to trauma and associated apixaban, in a patient with aortic stenosis and atrial fibrillation, by administration of PCC3 alone, without the added volume of FFP.
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