Targeting peripheral ϰ-opioid receptors for the non-addictive treatment of pain.

Drug addiction to prescription mu-opioid agonists used in the setting of pain is a major public health threat, affecting millions of Americans. Kappa opioid agonists (KOAs) may serve as a possible solution. KOAs have demonstrated indistinguishable analgesic activity relative to mu-opioid agonists in models of acute and chronic pain; however, conventional KOAs suffer from central nervous system-mediated psychoactive side-effects.

Analysis of dosing-button compliance.

Purpose: A project was undertaken at an academic medical center to assess use of available dosing buttons within the computerized provider-order-entry (CPOE) system in order to identify opportunities for optimization of medication builds.

Methods: A retrospective observational study was conducted to identify medication records within a CPOE system meeting prespecified inclusion and exclusion criteria. A report capturing all inpatient adult medication orders associated with the identified medication records over a 6-month period was generated.

Non-addictive orally-active kappa opioid agonists for the treatment of peripheral pain in rats.

Addiction to conventional opioid pain analgesics is a major societal problem that is increasing at an alarming rate. New drugs to combat the effects of opioid abuse are desperately needed. Kappa-opioid agonists are efficacious in peripheral pain models but suffer from centrally-mediated effects.

Evaluation of Dosing Practices of Rivaroxaban and Dabigatran.

Anticoagulation is standard practice for the prevention and treatment of thromboembolic events. Two of the newer agents, rivaroxaban (Xarelto) and dabigatran (Pradaxa) are being utilized frequently in the inpatient and outpatient settings. Prescribers may not appreciate the need for dose reduction in the setting of renal insufficiency.

Development of a Peptide-derived orally-active kappa-opioid receptor agonist targeting peripheral pain.

Kappa-opioid agonists are particularly efficacious in the treatment of peripheral pain but suffer from central nervous system (CNS)-mediated effects that limit their development. One promising kappa-agonist is the peptidic compound CR665. Although not orally available, CR665 given i.

A retrospective evaluation of the efficacy of intravenous bumetanide and comparison of potency with furosemide.

Background: The potency of intravenous bumetanide to furosemide using a ratio of 1:40 has been suggested; however, there are little data supporting this ratio. Recent drug shortages required the use of bumetanide in a large patient population, enabling further characterization of the efficacy of IV bumetanide.

Objective: The primary objective of this study was to estimate a dose-response effect of IV bumetanide on urine output (UOP) in all patients that received 48 hours of therapy as well as in a subgroup of patients with heart failure (HF).

An academician preparation program for pharmacy residents.

Objective: To assess the evolution and effectiveness of the Academician Preparation Program to provide knowledge and skills in teaching and evaluating to pharmacy residents, as well as generate interest in academic careers.

Design: Participants attended seminars and participated in additional teaching, precepting, facilitating, and evaluating activities. Residents maintained a teaching portfolio and met with a faculty mentor quarterly to review their progress toward completion of the requirements for the Academician Preparation Program certificate.

Strategies for transitioning therapy to aripiprazole from other antipsychotics in schizophrenia.

Objective: To determine the optimal approach for transitioning therapy to aripiprazole from other antipsychotics in schizophrenia and to describe these strategies.

Data Sources: MEDLINE (January 2000-March 2012) and PubMed (January 2000-March 2012) searches were conducted using the search terms aripiprazole, switch, and switching. Citations from references were reviewed to identify additional primary literature.

A diabetes self-management education class taught by pharmacy students.

Objective: To assess the impact of pharmacy students teaching a diabetes self-management education (DSME) class on their competence and confidence in providing diabetes education.

Design: Pharmacy students enrolled in a service-learning elective first observed pharmacy faculty members teaching a DSME class and then 4 weeks later organized and taught a DSME class to a different group of patients at a student-run free medical clinic.

Assessment: Student performance as assessed by faculty members using a rubric was above average, with a mean score of 3.

Updates in hormonal emergency contraception.

In recent years, there have been many updates in hormonal emergency contraception. Levonorgestrel emergency contraception has been available for several years to prevent pregnancy when used within 72 hours after unprotected intercourse or contraceptive failure, and it was recently approved for nonprescription status for patients aged 17 years or older. Current research suggests that the primary mechanism of action is delaying ovulation.

Aldosterone and aldosterone receptor antagonists in patients with chronic heart failure.

Aldosterone is a mineralocorticoid hormone synthesized by the adrenal glands that has several regulatory functions to help the body maintain normal volume status and electrolyte balance. Studies have shown significantly higher levels of aldosterone secretion in patients with congestive heart failure compared with normal patients. Elevated levels of aldosterone have been shown to elevate blood pressure, cause left ventricular hypertrophy, and promote cardiac fibrosis.

Application of antimicrobial stewardship to optimise management of community acquired pneumonia.

The aim of this study was to review the application of antimicrobial stewardship principles to the management of community-acquired pneumonia (CAP). Data from 14 published clinical studies, meta-analyses and practice guidelines regarding the application of antimicrobial stewardship strategies to the management of CAP were identified and analysed. In the context of CAP, application of stewardship strategies (alone or in combination) has been shown to increase physician awareness of guidelines, improve appropriate antimicrobial use and reduce unnecessary antimicrobial prescribing.

Identification and functional characterization of a stable, centrally active derivative of the neurotensin (8-13) fragment as a potential first-in-class analgesic.

The neurotensin hexapapetide fragment NT(8-13) is a potent analgesic when administered directly to the central nervous system but does not cross the blood-brain barrier. A total of 43 novel derivatives of NT(8-13) were evaluated, with one, ABS212 (1), being most active in four rat models of pain when administered peripherally. Compound 1 binds to human neurotensin receptors 1 and 2 with IC(50) of 10.

Apoptosis as a host defense mechanism in Crassostrea virginica and its modulation by Perkinsus marinus.

Dermo disease caused by the obligatory intracellular protozoan Perkinsus marinus causes extensive oyster mortalities leading to tremendous losses in the oyster industry and damage to estuarine ecosystems. To better understand the mechanisms of the parasite's evasion of the host immune defense system, we have investigated the molecular mechanisms of P.marinus-induced inhibition of apoptosis in oyster cells as a potential parasite's survival strategy.

Rufinamide: a new antiepileptic medication for the treatment of seizures associated with lennox-gastaut syndrome.

Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of rufinamide in the treatment of epileptic seizures and describe its potential place in therapy.

Data Sources: MEDLINE (1966-January 2010) and PubMed (1966-January 2010) literature searches were conducted to identify primary literature investigating rufinamide. References from selected publications discussing rufinamide, as well as the package insert, were reviewed.

Evaluation of compliance with osteoporosis treatment guidelines after initiation of a pharmacist-run osteoporosis service at a family medicine clinic.

Background: Osteoporosis affects more than 10 million Americans, and fracture complications are devastating to patients and society. Despite the availability of guidelines and performance measures, osteoporosis is not optimally managed. Pharmacists have been pivotal in management of other disease states, and a multidisciplinary approach to osteoporosis management may improve patient outcomes.

Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics.

Unlabelled: Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory.

Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT) device versus venipuncture within ambulatory care clinics at our institution.

A method for educating patients and documenting smoking status in an electronic medical record.

Background: Published evidence demonstrates benefit from pharmacist smoking cessation interventions; however, there is limited research evaluating the impact of a template within an electronic medical record used at pharmacy disease state management visits.

Objective: To determine the rates of smoking cessation and movement along the transtheoretical model of change after implementation of a template into existing pharmacy-related progress notes within the electronic medical record.

Methods: Patients who were routinely followed by clinical pharmacists for anticoagulation and diabetes mellitus education at 3 clinics at the Medical University of South Carolina were included.

Use of community pharmacy-provided diabetes services to aid physicians in the National Committee for Quality Assurance recognition program.

Background: Pay-for-performance (P4P) models are being adopted by many health care payers, including Medicare, for payment of physician services. To receive financial incentives in P4P programs, physicians are encouraged to attain recognition or credentialing from an agency, such as the National Committee for Quality Assurance (NCQA).

Objective: To explore the potential roles of a community pharmacy-provided diabetes services in collaboration with physicians and to assist them in becoming acknowledged by the NCQA Diabetes Physician Recognition Program.

Achievable benchmarks of care for primary care quality indicators in a practice-based research network.

A number of sources publish health care quality reports in the United States, but there is limited information about achievable performance in primary care settings. The objective of this article is to report Achievable Benchmarks of Care (ABCs) for 54 quality indicators. Eighty-seven practices participating in a demonstration project in the Practice Partner Research Network (PPRNet), representing 35 US states and 711 969 patients, were included in the analyses.

Prevalence of anemia in clinic patients with heart failure and cost analysis of epoetin treatment.

Study Objectives: To determine the prevalence of anemia in an outpatient heart failure clinic, describe the type of anemia in patients treated there, and evaluate the potential costs associated with epoetin therapy in this cohort.

Design: Single-center, retrospective cohort analysis (part 1) and a literature-based economic decision analysis (part 2).

Data Source: Medical records from a multidisciplinary, outpatient, heart failure clinic, and published hospitalization and drug-use data.

Life after the women's health initiative: evaluation of postmenopausal symptoms and use of alternative therapies after discontinuation of hormone therapy.

Study Objective: To determine the number of women who have menopausal symptoms after discontinuing hormone therapy, to determine how many of these women subsequently require nonhormonal alternatives to manage their symptoms, and to assess the effectiveness of those therapies.

Design: One-year retrospective study.

Setting: Department of Family Medicine outpatient clinic at a university medical center.