Balancing risk versus benefit: the elderly patient's perspective on warfarin therapy.

Unlabelled: Warfarin therapy is underused in the target at-risk elderly population. Clinicians perceive that older patients are reluctant to use this therapy, however the perspective of patients or their carers has yet to be explored.

Objective: To explore in-depth the perspectives of elderly patients and/or their carers regarding the use of warfarin therapy.

Clinical implications of changes in hepatic drug metabolism in older people.

Prescribing for older people is challenging because of the paucity of clinical trial evidence of therapeutic benefit in this population and the presence of evidence that older people are at increased risk of adverse drug reactions. The outcomes of pharmacotherapies in older people depend on age-related changes in both pharmacokinetics and pharmacodynamics. Of the pharmacokinetic changes, those in hepatic metabolism are the most significant.

Management of warfarin in atrial fibrillation: views of health professionals, older patients and their carers.

Objective: To identify the views of health professionals, patients and their carers on strategies to improve the use and management of warfarin in older patients with atrial fibrillation.

Design: Qualitative study based on analysis of group interviews.

Setting: A major metropolitan teaching hospital, from 1 March to 30 April 2003.

Therapeutic drug monitoring.

Purpose Of Review: Traditionally, therapeutic drug monitoring has been used for the management of epilepsy, cardiac arrhythmias, asthma and depression. This review provides an update, particularly for the newer clinical applications, and how therapeutic drug monitoring (including use of analytical and interpretation tools) can improve clinical outcomes.

Recent Findings: Improved drug assay methodologies and a greater understanding of pharmacokinetic and pharmacodynamic mechanisms has allowed the use of therapeutic drug monitoring for immunosuppressant drugs in organ transplant recipients, antiretroviral agents for HIV/AIDS and antimetabolite drugs for leukaemia.

Warfarin use in the elderly: the nurses' perspective.

Objective: To explore the barriers to warfarin use from the perspective of nurses working in aged care.

Design: A qualitative study, involving a semi-structured group interview, during March-April 2001.

Setting And Subjects: Eleven nurses, employed within the catchment of the Northern Sydney Area Health Service, who were involved in the care of elderly warfarinised patients.

Optimizing the use of antithrombotic therapy for atrial fibrillation in older people: a pharmacist-led multidisciplinary intervention.

Objectives: To develop, implement, and evaluate a pharmacist-led multidisciplinary intervention in a hospital setting that would optimize antithrombotic use in elderly atrial fibrillation patients. The hypothesis that there would be an increase in the proportion of patients receiving antithrombotic therapy at discharge was tested.

Design: Evidence-based algorithms were developed to define the criteria (stroke risk vs contraindications) by which an elderly patient's requirement for antithrombotic therapy was assessed.

Access to medicines and high-quality therapeutics: global responsibilities for clinical pharmacology.

A major theme of the 2004 World Congress of Clinical Pharmacology and Therapeutics was worldwide equity of access to medicines.

Health professionals rarely record history of complementary and alternative medicines.

Aims: To identify the completeness of documentation of Complementary And Alternative Medicine (CAM) use in hospital medical records of patients before and after an education programme.

Methods: Documentation of CAM in all parts of the medical records was compared to patients' self-reported use. Data were collected for one month before and one month after an education programme for hospital staff.

Drug combinations and impaired renal function -- the 'triple whammy'.

Background: Recent studies have identified the 'triple whammy' in which combinations of diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), ACE inhibitors (ACEI) and/or angiotensin receptor antagonists (ARA) may impair renal function.

Methods: We performed a cross-sectional study of patients admitted to a general medical ward of a teaching hospital. Age, sex, disease status and prior consumption of the 'target' drugs, diuretics, NSAIDs (including aspirin), ACEI and ARA were correlated with creatinine and creatinine clearance on admission.

Concordance between proguanil phenotype and CYP2C19 genotype in Chinese.

Objective: To investigate whether urinary proguanil (chlorguanide) metabolite ratios incorporating its minor metabolite, 4-chlorophenylbiguanide, define individuals as extensive metabolisers (EMs) or poor metabolisers (PMs) of CYP2C19 more reliably than the standard phenotyping ratio [proguanil/cycloguanil (PG/CG)].

Methods: Thirty-eight ethnic Chinese subjects ingested 100 mg proguanil, collected urine for 8 h and were genotyped for CYP2C19*1, *2 and *3 alleles. Proguanil metabolite ratios (PG/CG; proguanil/4-chlorophenylbiguanide (PG/CPB); proguanil/(cycloguanil+4-chlorophenylbiguanide) [PG/(CG+CPB)] were determined from the urinary recoveries of proguanil, cycloguanil and 4-chlorophenylbiguanide.