A review of laxative therapies for treatment of chronic constipation in older adults.

Background: Multiple studies have addressed the treatment of chronic constipation in adults in general; however, less guidance is available for treating this condition in older patients.

Objective: The aim of this paper was to review the effectiveness of laxatives for chronic constipation in the elderly.

Methods: Medline, Web of Science, international Pharmaceutical Abstracts, and the Cochrane database of Systematic Reviews were searched for english-language articles evaluating the treatment of chronic constipation in older individuals from the inception of the databases until October 2010.

Tapentadol hydrochloride: a centrally acting oral analgesic.

Background: Tapentadol hydrochloride is a centrally acting oral analgesic approved by the US Food and Drug Administration in November 2008 for the treatment of moderate to severe acute pain. It is available as immediate-release 50-, 75-, and 100-mg tablets.

Objective: The purpose of this article is to review animal studies, pharmacokinetic studies, drug-drug interaction studies, and Phase II/III trials of tapentadol in various conditions producing moderate to severe pain.

Cost-effectiveness of dalteparin versus unfractionated heparin as venous thromboembolism prophylaxis in malignant gynecologic surgery.

Venous thromboembolic events (VTEs) are serious complications that may occur in the patient undergoing surgery for gynecologic malignancies. The American College of Chest Physicians recommends unfractionated heparin or low-molecular weight heparin as prophylaxis for deep vein thrombosis and pulmonary embolism in this patient population. Cost-effectiveness analyses comparing unfractionated heparin 3 times a day versus once daily dalteparin using published efficacy and safety data demonstrate cost savings if dalteparin were routinely utilized as VTE prophylaxis.

Comparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function.

Background: The National Kidney Foundation's practice guidelines for chronic kidney disease recommend using the Modification of Diet in Renal Disease (MDRD) equation for calculating the estimated glomerular filtration rate (GFR).

Objective: The purpose of this article was to compare the use of this estimated GFR with estimated creatinine clearance (CrCl) calculated using the Cockcroft-Gault equation (CG(CrCl)-Eq) in the dosing of drugs requiring adjustments in elderly patients with declining renal function. Existing as well as new serum creatinine assay standards were used.

Fondaparinux sodium in the prophylaxis and treatment of deep vein thrombosis and pulmonary embolism.

Fondaparinux sodium is the first in a new class of anticoagulants that selectively inhibits Factor Xa. It produces a predictable pharmacologic response, obviating the need for coagulation monitoring. Additionally, this agent does not bind to platelet Factor 4, thereby reducing the risk of thrombocytopenia.

New serum creatinine assay standardization: implications for drug dosing.

Objective: To describe the development of new serum creatinine assay standards and discuss their implications for various drug dosing scenarios.

Data Sources: A MEDLINE search (1990-August 2006) was performed to identify literature on newly developed serum creatinine assay standards and the impact those standards will have on drug dosing.

Study Selection And Data Extraction: Data on the development of new creatinine assay procedures and the effect that these new values will have on drug dosing were extracted from identified references.

Pharmacist interventions in geriatric nursing facility NSAID therapy: a one-year follow-up study of costs and outcomes.

Objectives: To document costs and outcomes occurring with acceptance or rejection of ongoing pharmacists' interventions regarding therapy with a nonsteroidal anti-inflammatory drug (NSAID) versus acetaminophen (APAP) therapy in treating osteoarthritis in a long-term care facility in the sixth year of observation.

Design: A nonrandomized observational prospective cohort study with all patients resident for 30 or more days over the 12-month study period receiving NSAID or APAP therapy for osteoarthritis.

Setting: A skilled nursing facility with more than 100 beds.

Concordance among three self-reported measures of medication adherence and pharmacy refill records.

Objective: To evaluate the level of agreement among three previously validated self-reported medication adherence measures and pharmacy refill records (RRs).

Design: Cross-sectional study.

Setting: Five primary care physician office sites in rural northeast Georgia.

Cost analysis of fondaparinux versus enoxaparin as venous thromboembolism prophylaxis in elective hip replacement surgery.

Patients undergoing hip arthroplasty are at high risk for developing venous thromboembolic events (VTE) postoperatively in the absence of prophylaxis. In this study, a cost analysis comparing efficacy and safety data from a published trial evaluating fondaparinux and enoxaparin as VTE prophylaxis in hip replacement patients was performed. Incremental cost effectiveness ratios were calculated to determine cost per VTE avoided.

Cost analysis of fondaparinux versus enoxaparin as venous thromboembolism prophylaxis in hip fracture surgery.

Hip fracture patients are at high risk of developing venous thromboembolic events (VTEs) postoperatively. Efficacy and safety data from a clinical trial comparing fondaparinux and enoxaparin as VTE prophylaxis were used to perform a cost assessment of these 2 agents. Incremental cost calculations demonstrate that enoxaparin offers advantages over fondaparinux when dosed for 7 days postoperatively in this patient population.

A cost analysis of fondaparinux versus enoxaparin in total knee arthroplasty.

Several hundred thousand total knee replacement (TKR) surgeries are performed in the United States each year. The American College of Chest Physicians has classified TKR patients in the "highest-risk" category for developing venous thromboembolic events. Recommended prophylactic agents following TKR surgery include unfractionated heparin and low-molecular weight heparins.

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

Background: Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States.

Methods: This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking.

Determining institution-specific costs of thromboembolic events with an algorithm and spreadsheet.

A systematic process whereby an institution may perform a pharmacoeconomic analysis of all direct medical costs associated with the diagnosis and treatment of venous thromboembolic events (VTEs) that reflects both institution-specific costs and clinical practice patterns is described. Current Content, International Pharmaceutical Abstracts, and MEDLINE were searched to identify English-language articles addressing procedures for diagnosing and treating symptomatic deep-vein thrombosis and pulmonary embolism. From the information gathered, a diagnostic algorithm and a resource spreadsheet were developed.

Cost analysis: fondaparinux versus preoperative and postoperative enoxaparin as venous thromboembolic event prophylaxis in elective hip arthroplasty.

Patients undergoing hip arthroplasty in the absence of prophylaxis for venous thromboembolic events (VTEs) are at high risk for experiencing postoperative VTEs. In the study reported here, we performed cost analyses involving efficacy and safety data from clinical trials evaluating fondaparinux and enoxaparin as VTE prophylaxis. Incremental cost-effectiveness ratios were calculated to determine cost per VTE avoided.

Cost/death averted with venous thromboembolism prophylaxis in patients undergoing total knee replacement or knee arthroplasty.

Study Objective: To compare the cost-effectiveness of warfarin or enoxaparin with no prophylaxis for prevention of venous thromboembolism in patients undergoing total knee replacement (TKR) or knee arthroplasty.

Design: Literature search and retrospective database analysis.

Patients: Cohort of 42,692 patients over 40 years old who underwent TKR or knee arthroplasty, with a subsequent length of stay of at least 1 day, and who did not die postoperatively.