Vitamins: the wise choice for women with cardiovascular disease.

Objective: Enhance the pharmacist's ability to recognize and make treatment recommendations for the safe use of vitamins and supplements for an ambulatory, postmenopausal woman with cardiovascular disease.

Data Sources: Literature listed in MEDLINE, IDIS, and PubMED, with emphasis on material published since 2002, were reviewed. An online search of government and proprietary nutrition Web sites as well were reviewed.

Endogenous histamine and cortisol levels in subjects with different histamine N-methyltransferase C314T genotypes : a pilot study.

Background: Histamine N-methyltransferase (HNMT) catalyzes the methylation of histamine and plays an important role in histamine biotransformation in bronchial epithelium. Enzymatic activity of HNMT has been shown to be regulated by genetic factors, including polymorphisms in the HNMT gene. In this pilot study we determined endogenous levels of histamine and cortisol in plasma and whole blood samples from subjects with different genotypes for the HNMT C314T polymorphism, and investigated whether these parameters differed between individuals with the HNMT CC genotype and those with the CT genotype.

Megestrol acetate therapy in geriatric patients: case reviews and associated deep vein thrombosis.

Objective: To provide a brief review of the literature discussing treatment of unplanned weight loss in geriatric patients, focusing on megestrol acetate and to report two cases of deep vein thrombosis (DVT) associated with megestrol acetate therapy in geriatric nursing facility residents.

Data Sources: Biomedical literature accessed through MEDLINE and PubMed (1990-2003); product manufacturer information.

Discussion: Unplanned weight loss, a common problem among frail geriatric nursing facility residents, is associated with increased morbidity and mortality.

Altered methylprednisolone pharmacodynamics in healthy subjects with histamine N-methyltransferase C314T genetic polymorphism.

This study investigated the potential differences in methylprednisolone pharmacodynamics between healthy subjects with different histamine N-methyltransferase (HNMT) C314T genotypes. Six individuals with C/C genotype and 4 with C/T genotype were administered a single intravenous dose of methylprednisolone 0.6 mg/kg ideal body weight in a randomized 2-period manner.

Application of TZERO calibrated modulated temperature differential scanning calorimetry to characterize model protein formulations.

The objective of this study was to evaluate the feasibility of using T(ZERO) modulated temperature differential scanning calorimetry (MDSC) as a novel technique to characterize protein solutions using lysozyme as a model protein and IgG as a model monoclonal antibody. MDSC involves the application of modulated heating program, along with the standard heating program that enables the separation of overlapping thermal transitions. Although characterization of unfolding transitions for protein solutions requires the application of high sensitive DSC, separation of overlapping transitions like aggregation and other exothermic events may be possible only by use of MDSC.

Angioedema associated with aspirin and rofecoxib.

Objective: To report the probable association of angioedema with aspirin therapy and the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib.

Case Summary: A 44-year-old white woman, previously tolerant to aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs), developed angioedema of the lips after ingesting two 325-mg aspirin tablets during one day. The reaction occurred 3 hours after taking the second aspirin and resolved within 3 hours.

Survey of the use of corticosteroids among neonatal intensive care units for the prevention or treatment of bronchopulmonary dysplasia.

Objective: To survey neonatal intensive care units (NICUs) at academic medical centers to determine the current use of inhaled and systemic corticosteroids for the prevention or treatment of bronchopulmonary dysplasia (BPD).

Methods: A survey was developed to evaluate aspects of systemic and inhaled corticosteroid use in neonates. Eighty academic medical centers with neonatal/perinatal medicine fellowship programs were surveyed.

The role of oral direct thrombin inhibitors in the prophylaxis of venous thromboembolism.

Venous thromboembolism, which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. Two million people/year are affected by VTE, making it the third most common cardiovascular disease after coronary heart disease and stroke. The rationale for VTE prophylaxis stems from the clinically silent presentation of the disease and its prevalence among hospitalized patients.

Pharmacoeconomics of thrombosis management.

Venous thromboembolism (VTE) is the cause of significant morbidity and mortality and may lead to other complications, including recurrent VTE and long-term postthrombotic syndrome. Venous thromboembolism represents a huge health economic burden of nearly 500 million dollars/year in the United States. Without adequate prophylaxis, patients undergoing major orthopedic surgery are at high risk of developing VTE.

Limitations of traditional anticoagulants.

Warfarin and unfractionated heparin have been in clinical use for more than 50 years. Both are effective anticoagulants, but their use is associated with a number of impediments, including the need for intensive coagulation monitoring, wide variation in dose-response relationships, multiple drug interactions (in the case of warfarin), and serious immune-mediated thrombocytopenia (in the case of heparin). The introduction of low-molecular-weight heparins 10 years ago advanced anticoagulation therapy by enhancing efficacy and eliminating the need for intensive coagulation monitoring.

CYP2C9 genetic polymorphisms and warfarin.

The objective of this study was to report 2 cases of CYP2C9 genetic polymorphism and elevated warfarin S:R ratios in patients taking low doses of warfarin, and compare the observed characteristics with those in published reports. Two patients of different age groups and races were evaluated for CYP2C9 genotype and warfarin S:R ratios. The patients had been stabilized on weekly warfarin doses of 10.

Cost analysis of a managed care decentralized outpatient pharmacy anticoagulation service.

Objectives: To determine the per-patient-per-month (PPPM) cost of a decentralized outpatient pharmacy anticoagulation service (OPAS) in patients with chronic atrial fibrillation (AF) who were maintained on warfarin sodium therapy in a managed care setting, to compare the annual costs versus the risk for stroke, and to assess the quality of the anticoagulant management.

Methods: Data were collected retrospectively from clinical, research, and administrative claims databases. Patient demographic data were stratified to include age and risk factors for stroke.

Aggrenox((R)) versus other pharmacotherapy in preventing recurrent stroke.

Stroke is the third leading cause of death in the US with recurrent events a high likelihood in those who survive an initial event. The long-term goal of therapy is to prevent the recurrence of stroke and other atherosclerotic events. Aspirin has been the first-line agent for stroke prevention for a long time.

Clinical trials with factor Xa inhibition in the prevention of postoperative venous thromboembolism.

Factor Xa inhibition is a selective mechanism used for anticoagulation therapy. Clinical trials of drugs designed to inhibit factor Xa for the prevention of venous thromboembolism (VTE) after major orthopedic surgery are discussed. Hemostasis is a balanced process of blood coagulation and clot dissolution.

Warfarin versus aspirin in the secondary prevention of stroke: the WARSS study.

The role of anticoagulation in the secondary prevention of noncardioembolic stroke has long been an area of debate. Previous evidence has shown that anticoagulation is unsafe at an International Normalized Ratio between 3.0 and 4.

Analysis of trials evaluating combinations of acetylsalicylic acid and dipyridamole in the secondary prevention of stroke.

Background: Stroke is one of the leading causes of morbidity and mortality in the United States. Patients who suffer a cerebrovascular event are at high risk of a recurrence, and secondary prevention is crucial to reducing the burden of cerebrovascular disease. Acetylsalicylic acid (ASA, aspirin) is an established method of stroke prophylaxis.

Implications of cytochrome P450 2C9 polymorphism on warfarin metabolism and dosing.

Warfarin is an anticoagulant available as a racemic mixture. The R- and S-isomers differ with respect to relative plasma concentrations, clearance, potency, sites of metabolism, and cytochrome P450 (CYP) isoenzymes responsible for metabolism. S-Warfarin, the more potent isomer, is metabolized primarily by CYP2C9.

Effect of regimen complexity on patient satisfaction and compliance with warfarin therapy.

This study sought to determine patient satisfaction with anticoagulation care in a pharmacist-managed clinic and assess the effect of warfarin regimen complexity on patient satisfaction, compliance, and international normalized ratios (INRs). Retrospective chart reviews of 476 anticoagulation clinic patients were conducted. Patients were divided into groups by complexity of warfarin regimen (whole tablet, split tablet, alternating dose) for comparisons of compliance and INRs.

Clinical and economic effects of pharmacy services in geriatric ambulatory clinic.

Pharmacy services were introduced in an established multidisciplinary geriatric ambulatory clinic. The pharmacist collaborated with primary care providers to optimize patients' drug regimens. Over 8 months there were 250 patient visits to the clinic.

Supportive care for the patient with Alzheimer's disease.

The prevalence of AD, the most common form of dementia, is likely to double in the next 20 years. Although the cause of AD is unknown, risk factors include aging, genetic predisposition, and head trauma. The cholinesterase inhibitors (tacrine, donepezil, and rivastigmine) are the only FDA-approved class of medications for AD.

Major depression in women: a review of the literature.

Objective: To promote pharmacists' understanding and recognition of major depression in women and to review gender/sex-specific differences in its prevalence, etiology, risk factors, clinical features, course, and management.

Data Sources: Clinical literature on this topic in the English language since 1990, searched through MEDLINE.

Study Selection: Selected review articles and clinical trials from peer-reviewed journals.