Injectable promethazine in clinics and hospitals: What's the alternative?

The Institute for Safe Medication Practices and the American Society of Health-System Pharmacists have advocated for removing all injectable promethazine from inpatient and outpatient settings; however, this drug is still being used despite the risk for tissue necrosis, gangrene, and possible amputation when it inadvertently is given by the subcutaneous or intra-arterial route. This article describes alternative injectable medications that can be selected based on patient comorbidities, indications, and clinician experience.

Clinical Pharmacy Services in Canadian Emergency Departments: A 2022 National Survey.

Background: Support for the role of an emergency department (ED) clinical pharmacy team is evidence-based and recognized in numerous professional guidelines, yet previous literature suggests a low prevalence of ED clinical pharmacy services in Canadian hospitals.

Objectives: To update (from a survey conducted in 2013) the description and quantification of clinical pharmacy services in Canadian EDs.

Methods: All Canadian hospitals with an ED and at least 50 acute care beds were contacted to identify the presence of dedicated ED pharmacy services (defined as at least 0.

Heart on hypertension: Improving hypertension control in the FQHC setting through a group visit program.

Introduction: Many solutions for increasing hypertension control rates have been proposed yet the social determinants of health create health disparities within the populations served by Federally Qualified Health Centers (FQHC) that can complicate reaching these goals. This study observes impact of a group visit program on hypertension control within the patient population served by an FQHC.

Methods: Retrospective review and analysis of blood pressure data was performed for patients enrolled in the first 4 cohorts of the Heart on Hypertension Group Visit Program at the end of the program as well as 3 months, 6 months, and 12 months after the program ended.

Between what is and what could be: a survey of pharmacists' practices, attitudes, and beliefs in the provision of mental health care.

Background: Pharmacists can have an essential role in providing care for patients with mental illness. There are gaps in the understanding of the current extent of pharmacists' involvement in caring for patients with mental illness and their readiness to effectively provide this care.

Aim: To describe the current practices, attitudes, and beliefs of pharmacists in providing care to individuals with mental illness, and to assess factors that may impact these practices.

Which patient factors increase the risk of fluoroquinolone-associated reactions?

Fluoroquinolones commonly are used to treat a variety of infections in the urinary, gastrointestinal, and respiratory tracts. Clinicians should evaluate patients to ensure that a fluoroquinolone is a safe and effective therapy to treat the infection. This article discusses patient factors that increase the risk for serious adverse drug reactions that can occur with fluoroquinolone use.

Which four medication classes have important pharmacogenetic considerations?

Medications often are prescribed without knowledge of a patient's pharmacogenetic profile. Initial therapy may require subsequent modification due to adverse reactions or lack of efficacy. Although many variables, including changes in pharmacokinetics, pharmacodynamics, or patient nonadherence, may account for these outcomes, information about a patient's ability to metabolize or transport drugs across membranes may be used to optimize therapy, resulting in improved medication outcomes.

Adrenal Insufficiency Caused by Chronic Corticosteroid Use, Identified through Medication Therapy Management.

To report a case of adrenal insufficiency caused by chronic corticosteroid treatment. This case study describes a 71-year-old Caucasian woman diagnosed with secondary adrenal insufficiency (SAI). She had a long history of multiple medical problems that affected her quality of life.

Oral Semaglutide: Balancing Promising Therapeutics with Adverse Effects and Access Barriers.

No funding was received for this commentary. The author has nothing to disclose.

Corticosteroids.

Corticosteroids are commonly prescribed for a variety of indications due to the wide range of effects on the human body. Although they exhibit many therapeutic uses, corticosteroids are unfortunately known for their many dose- and duration-dependent toxicities. The purpose of this review is to explore indications for corticosteroid use, differences among formulations, and adverse effects and their management.

The Impact of Completing Medication Reconciliation and Depression Treatment History in an Outpatient Depression Clinic.

Objectives: To enhance depression care by improving medication information available prior to initial patient consultations.

Experimental Design And Sample: Single-center, with intervention delivered to all new patient referrals at a tertiary care depression clinic. Trained pharmacy students utilizing a standard script prior to the first consultation visit conducted a medication review and depression treatment telephone assessment.

Direct-Thrombin Inhibitor Utilization in Patients With Heparin-Induced Thrombocytopenia and Undergoing Catheter-Directed Thrombolysis: A Summary of Published Case Reports.

Background: Catheter-directed thrombolysis (CDT) is one of the emerging venous thromboembolism management modalities. There are fairly limited data regarding the use of direct-thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia and undergoing CDT.

Objectives: The aim of this study was to provide a summary of the available evidence supporting the use of DTIs in patients undergoing CDT.

Survey highlights the need to expand offerings of introductory pharmacy practice experiences in psychiatry and neurology: Benefits and example experiences.

Introduction: Introductory pharmacy practice experiences (IPPEs) are 1 requirement schools and colleges of pharmacy must fulfill to meet accreditation standards. The purpose of this manuscript is to report existing IPPEs in psychiatry and neurology across the United States.

Methods: Two separate electronic surveys were administered to individual College of Psychiatric and Neurologic Pharmacists members with board certification in psychiatric pharmacy with an academic affiliation and academic institutions in the 2014-15 academic year to assess the neuropsychiatric curriculum in pharmacy programs.

Evaluation of the Diabetes, Multidisciplinary, Experiential (DIAMANTE) Program for Retail Pharmacists: A Mixed-Method Study.

Introduction: The Diabetes, Multidisciplinary, Experiential (DIAMANTE) program was established to enhance collaboration between retail pharmacists and the diabetes care team in the health institutions through interprofessional education. This article describes the program and reports on an evaluation of its impact on attitudes, knowledge, and confidence of the participants in managing diabetic patients.

Methods: This study utilized a mixed-method design with focus group (FG), exit assessment, and survey.

Towards safety of oral anti-cancer agents, the need to educate our pharmacists.

The global prevalence of cancer is rising. Use of oral anticancer medications has expanded exponentially. Knowledge about these medications as well as safe handling guidelines has not kept abreast with the rapidity these medications are applied in clinical practice.

General pharmacokinetic/pharmacodynamic concepts of mood stabilizers in the treatment of bipolar disorder.

Introduction: Mood stabilizers are the recommended treatment for patients who receive a diagnosis of bipolar disorder. Because of the necessity of mood stabilizer treatment in patients with bipolar disorder and the extent of pharmacokinetic and pharmacodynamic principles involved, the purpose of this review is to summarize the pharmacokinetic principles of lithium in addition to the pharmacodynamics of lithium, carbamazepine, lamotrigine, and valproic acid/valproate.

Methods: Practice guidelines, review articles, and clinical trials were located using online databases PubMed, CINAHL, IDIS, and Medline.

Treatment of dyslipidemia with statins by primary care providers in Veterans with and without chronic Hepatitis C.

Objective: The purpose of this study was to describe the current use of statins in United States (US) veterans at W. G. Hefner Veterans Affairs Medical Center (VA Salisbury) with chronic hepatitis C virus (HCV) compared to those without chronic HCV and to examine why statin use may be avoided in this population.

Empagliflozin: a sodium-glucose cotransporter 2 inhibitor for treatment of type 2 diabetes.

Purpose: The pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse effects, dosage and administration, and drug-drug interactions of empagliflozin are reviewed.

Summary: Empagliflozin is a direct inhibitor of sodium-glucose cotransporter 2 (SGLT2), which acts to lower the renal threshold and increase urinary glucose excretion. SGLT2 is found in the proximal tubules of the kidneys and reabsorbs about 90% of the filtered glucose.

Vorapaxar for reduction of thrombotic cardiovascular events in myocardial infarction and peripheral artery disease.

Purpose: The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, dosage and administration, cost, and place in therapy of vorapaxar in the secondary prevention of atherosclerotic events are reviewed.

Summary: Vorapaxar is a highly selective, reversible antagonist of protease-activated receptor-1 expressed on platelets. Vorapaxar competitively inhibits thrombin from activating the receptor, thereby decreasing platelet aggregation.

Identifying opportunities to improve medication management in transitions of care.

Purpose: The types and causes of medication discrepancies during the transition from inpatient to ambulatory care were investigated.

Methods: A descriptive study was conducted at an academic outpatient group practice affiliated with a private nonacademic hospital to (1) describe discrepancies between inpatient discharge summaries and patient-reported medication lists, (2) identify patient and system factors related to breakdowns in medication documentation, and (3) determine reasons for medication discrepancies. During a four-month period, 17 patients at high risk for medication misadventures while transitioning from hospital care to outpatient follow-up were contacted by telephone soon after discharge and asked to provide information on all medications they were taking.

Development and implementation of a writing program to improve resident authorship rates.

Purpose: The development, implementation, and evaluation of a writing program with a formalized writing project as a component of postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residencies are described.

Summary: The writing program at Georgia Regents Medical Center/University of Georgia College of Pharmacy, a collaborative and jointly funded program, was initiated in the 2010-11 residency year. The goals of the program are to teach residents to communicate effectively, apply leadership skills, employ project management skills, and provide medication- and practice- related education and training.

Evaluation of pharmacy services in emergency departments of Veterans Affairs Medical Centers.

Objective: In 2008, the American Society of Health-System Pharmacists (ASHP) published a national survey that revealed only 6.8% of hospitals surveyed had a pharmacist assigned to the emergency department (ED) for any period of time. This survey was distributed among general and children's medical-surgical hospitals in the United States and did not include any Veterans Affairs (VA) Medical Centers.

Single vs Dual Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation: A Systematic Review.

There is wide variability in prescribing of antiplatelet regimens following transcatheter aortic valve implantation (TAVI). The objective of this review was to evaluate published and unpublished reports regarding the efficacy and safety of dual antiplatelet therapy (DAPT) compared with a single antiplatelet agent in patients undergoing TAVI. We searched MEDLINE, CENTRAL, Embase, and unpublished sources of literature from inception to December 2014 using terms synonymous with TAVI and DAPT.

Medication Reconciliation Practices in Canadian Emergency Departments: A National Survey.

Background: As of 2015, Accreditation Canada's Qmentum program expects emergency departments (EDs) to initiate medication reconciliation for 2 groups of patients: (1) those with a decision to admit and (2) those without a decision to admit who meet the criteria of a risk-based, health care organization-defined selection process. Pharmacist-led best possible medication histories (BPMHs) obtained in the ED are considered more complete and accurate than BPMHs obtained by other ED providers, with pharmacy technicians obtaining BPMHs as effectively as do pharmacists. A current assessment of the role of pharmacy in BPMH processes in Canadian EDs is lacking.