Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations.

Long-acting injectable (LAI) antipsychotics (APs) each have an oral equivalent formulation, while aripiprazole, olanzapine, and ziprasidone each also have a short-acting injectable (SAI) equivalent formulation. Inpatient prescribing patterns of LAIs and their oral/SAI equivalents are less characterized in populations other than Medicaid, Medicare, and Veterans Affairs populations. Mapping out inpatient prescribing patterns remains an important first step to ensure appropriate use of antipsychotics during this critical juncture of patient care prior to discharge.

Community Pharmacist Telephonic Medication Reviews with Uncontrolled Asthma Patients: A Pilot Study.

This study reports the process of telephonic medication reviews conducted by community pharmacists for patients with asthma. The study occurred at an independent community chain in association with a Missouri Medicaid consulting group. Participants were identified utilizing claims data and met the National Quality Forum criteria for uncontrolled moderate-to-severe persistent asthma.

Initiative to improve student perceptions of relevance and value in a top 200 drugs course through improved curricular alignment and course modification.

Problem description: When course evaluations and student feedback demonstrated a decline in student perceptions of a Top 200 Drugs course, proposed modification focused on curricular alignment to impact those perceptions in a positive manner. Quality improvement methods: Student course evaluations and feedback from student leaders were reviewed to determine elements of course structure and design for modification. The following areas were identified: quantity of assessment content, frequency of class meetings, in-person vs.

Evaluation of obsessive-compulsive symptoms in relation to smartphone use.

Introduction: The use of smartphones throughout the United States continues to rise. Although smartphones have increased our capacity to access information, there is concern if excessive use may impact mental health. The purpose of this study was to examine whether a relationship exists between smartphone use and the presence of obsessive-compulsive symptoms (OCS) or behaviors.

Impact of community pharmacist-performed post-discharge medication reviews in transitions of care.

Objectives: To describe a community pharmacist-led transitions of care process for patients discharged from the inpatient to the outpatient setting.

Setting: Independent community pharmacy chain in northwestern and central Missouri and a rural nonprofit hospital in Marshall, Missouri.

Practice Description And Innovation: This innovative transitions of care service model relies on the inpatient pharmacy team for recruitment and referral of patients who use Red Cross Pharmacy.

Management of serious cardiac adverse effects of antipsychotic medications.

The use of antipsychotic medications has now expanded to multiple mental health conditions beyond schizophrenia. This has increased the overall population exposure to these medications, which have been associated with both metabolic changes and adverse cardiovascular effects. QTc prolongation, torsades de pointes, sudden cardiac death, myocarditis, and cardiomyopathy are all very real concerns that clinicians face on a regular basis.

Community pharmacy transition of care services and rural hospital readmissions: A case study.

Objectives: To explore community pharmacist involvement in the transition of care (TOC) process for patients discharged with acute myocardial infarction (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), or elective total hip or knee arthroplasty (THA/TKA).

Setting: Patients discharged from a 60-bed acute care hospital located in rural Missouri were seen by a community pharmacist in 2 independent community pharmacy locations.

Practice Innovation: Patients admitted with 1 of the 5 qualifying conditions and identifying the participating pharmacy as their primary pharmacy spoke with a community pharmacist within 72 hours of discharge to complete a comprehensive medication review.

Health Literacy and Medication Adherence Among Patients Treated in a Free Health Clinic: A Pilot Study.

Background: A patient's health literacy is not routinely assessed during visits with a health care provider. Since low health literacy is a risk factor for poor health outcomes, assessing health literacy should be considered as part of the standard medical workup.

Objectives: To evaluate the health literacy levels and medication adherence of patients treated by pharmacists in both the general medicine and the chronic care clinics at an urban free health clinic.

Physicians' Preferences for Communication of Pharmacist-Provided Medication Therapy Management in Community Pharmacy.

Objectives: (1) To identify physicians' preferences in regard to pharmacist-provided medication therapy management (MTM) communication in the community pharmacy setting; (2) to identify physicians' perceived barriers to communicating with a pharmacist regarding MTM; and (3) to determine whether Missouri physicians feel MTM is beneficial for their patients.

Methods: A cross-sectional prospective survey study of 2021 family and general practice physicians registered with MO HealthNet, Missouri's Medicaid program.

Results: The majority (52.

Community pharmacy patient perceptions of a pharmacy-initiated mobile technology app to improve adherence.

Objectives: To determine patient perceptions of using a demonstration application (app) of mobile technology to improve medication adherence and to identify desired features to assist in the management of medications.

Methods: A qualitative study using key informant interviews was conducted in a community pharmacy chain for patients aged 50 and older, on statin therapy and owning a smart device.

Key Findings: Three main themes emerged from 24 interviews at four pharmacy locations, which included benefits, barriers and desired features of the app.

Essential elements for a pharmacy practice mentoring program.

Formal guidelines for mentoring faculty members in pharmacy practice divisions of colleges and schools of pharmacy do not exist in the literature. This paper addresses the background literature on mentoring programs, explores the current state of mentoring programs used in pharmacy practice departments, and provides guidelines for colleges and schools instituting formal mentoring programs. As the number of pharmacy colleges and schools has grown, the demand for quality pharmacy faculty members has dramatically increased.

Asenapine: a clinical review of a second-generation antipsychotic.

Background: Schizophrenia and bipolar disorder are both prevalent types of psychiatric illness in the United States. As second-generation antipsychotics have become a more viable first-line treatment option, their use has been associated with a new era of adverse events (AEs), most notably metabolic and cardiovascular concerns. Although treatment options for schizophrenia and bipolar disorder have arguably improved, there continues to be a need for medications that achieve and maintain desired efficacy with minimal AEs.

Psychiatric pharmacy residency training.

The role of the psychiatric pharmacist in the care of the mentally ill has continually evolved since the late 1960s and early 1970s. Pharmacists in the field of psychiatric pharmacy work to improve the health, safety, and welfare of those impacted by one or more psychiatric conditions. Specialty residency training programs are accredited to establish minimum training standards and a board-certification process ensures that individuals provide a high level of quality of care.

Suspected neuroleptic malignant syndrome during quetiapine-clozapine cross-titration.

Neuroleptic malignant syndrome (NMS) is a physiologic phenomenon that has been associated with the use of both first- and second-generation antipsychotics resultant to their ability to block dopamine blockade in the basal ganglia and hypothalamic regions of the brain. The typical reaction involves the presentation of muscle rigidity, changes in mental status, temperature elevation, labile blood pressure, and elevations in creatinine kinase and white blood cell counts. The reaction is most often reported early in the course of therapy but is well documented to have the potential to occur at any point in time.

An exploratory retrospective evaluation of ropinirole-associated psychotic symptoms in an outpatient population treated for restless legs syndrome or Parkinson's disease.

Background: Traditional treatment approaches for the management of restless legs syndrome (RLS) and Parkinson's disease (PD) include the use of medications that either directly or indirectly increase dopamine levels. In turn, a potential adverse event that could be expected is the development or exacerbation of psychiatric-related symptoms.

Objective: To evaluate and describe the incidence of psychosis and associated behavioral features in patients taking ropinirole for RLS or PD.

Delayed-onset neutropenia with divalproex sodium.

Objective: To report the development of neutropenia in a patient after almost 8 years of being stabilized on delayed-release divalproex sodium (DVPX).

Case Summary: A 45-year-old man had been maintained on DVPX for nearly 8 years, with serum valproic acid concentrations of 85-128 mg/L and normal white blood cell (WBC) counts and absolute neutrophil counts (ANCs). Five months prior to the development of neutropenia (defined as ANC <1800 cells/microL), the patient's DVPX dosage was decreased by 250 mg to 1250 mg every morning and 1500 mg every evening.

Extended-release divalproex in bipolar and other psychiatric disorders: A comprehensive review.

Bipolar disorder can be a devastating disease state for individuals with the disease and also for family members. Proper recognition and treatment is vital to the successful management of this disease state. Through increased community and practitioner awareness, along with efforts to increase awareness for proper assessment, the rate of diagnosed bipolar disorder is increasing.

Augmentation of aripiprazole with low-dose clozapine.

An issue under much clinical debate is whether treatment with two antipsychotic agents simultaneously is advantageous for optimizing response in patients whose previous monotherapy with antipsychotic agents has failed. Minimal evidence supports treatment with multiple antipsychotics, even when the agents have different mechanisms of action. The standard of care for treating schizophrenia is to first use monotherapy of adequate dosage and duration, including a trial of clozapine before adding a second agent.

Agitation associated with aripiprazole initiation.

Aripiprazole is a novel antipsychotic with a mechanism of action different from those of traditional first- and second-generation antipsychotics. We describe three patients with long histories of treatment for schizophrenia or schizoaffective disorder in whom conversion to aripiprazole was being attempted. After they started aripiprazole, their psychosis, agitation, anxiety, or aggression worsened.

Historical review of carbamazepine for the treatment of bipolar disorder.

The management of bipolar disorder has seen significant evolution in terms of the number of treatment options now approved for both the acutely manic phase and the maintenance stages of the illness. In addition, new formulations of traditional agents are available for clinicians to use in their treatment approach. One such example is carbamazepine, which has approval by the United States Food and Drug Administration for the treatment of acute and mixed mania in an extended-release formulation that uses a three-bead delivery system.

Quetiapine use in a patient with chronic schizophrenia and severe parkinsonism.

A 52-year-old patient with treatment-resistant paranoid schizophrenia developed severe parkinsonian features after more than 20 years of antipsychotic drug therapy. The role of this therapy was thought to have been a contributing factor to the patient's clinical presentation, although Parkinson's disease could not be ruled out. Originally, parkinsonian symptoms developed acutely and progressed to hand tremor, sialorrhea, upper body rigidity, masked facies, striatal hand, bradykinesia, and a severe, unsteady, shuffling gait.

Levetiracetam for mood stabilization and maintenance of seizure control following multiple treatment failures.

Objective: To report the case of a patient who experienced adverse events in succession to antiepileptic medications being used for both antiepileptic and mood-stabilization benefit.

Case Summary: A 46-year-old white woman developed hyponatremia with carbamazepine, hyperammonemia with divalproex, cognitive impairment with topiramate, and hyponatremia with oxcarbazepine. The patient was stabilized physically and psychiatrically on levetiracetam without any noted adverse events.

Extended-release divalproex sodium for mood stabilization.

Study Objective: To evaluate the efficacy, safety, and tolerability of extended-release divalproex sodium.

Design: Prospective, open-label, 4-week study

Setting: Long-term care facility of the Missouri Department of Mental Health.

Patients: Ten hospitalized patients (mean age 39.