Determining the gluten content of nonprescription drugs: Information for patients with celiac disease

Celiac disease is a common chronic autoimmuse disorder causing patients with this disorder to have gluten intolerance. If they are exposed to gluten, a variety of clinical effects may occur, such as gastrointestinal problems, nutritional deficiencies, and forms of cancer. As little as 30 to 50 mg of gluten in one day can cause damage to the small intestine. Therefore, these patients must keep a strict lifelong gluten-free diet.

Gluten found in drugs is often referred to as a hidden source of gluten. The FDA currently does not require labeling of gluten content in medications. Information about the gluten content is available on some internet-based listings and publications, but there is not one universally accepted reliable information source.

The purpose of the study was to determine if information about the gluten content of nonprescription drugs is readily available to patients. The results of the study showed that the average amount of time to receive a response about the content was 6.2 minutes. Out of the 41 medications involved in the study, gluten information was found on websites of 6 products, and 4 of those websites indicated a gluten status different than information that was provided via a phone call with the manufacturer.

I think this article is important because it shows how there is a lack of certain information on medication labels that is necessary. Even though not all patients are affected with celiac disease, it is still essential to provide gluten content of medications on labels. This information may be available on some manufacturers’ websites, but not all, and if a patient wants to find that information, then he or she has to take the time to search for it themselves. In addition, pharmacists can play a role in helping patients obtain information about a medication’s gluten content through contacting the manufacturers themselves to ensure that the patient is receiving accurate infromation from a reliable source.

Mangione R, Patel P, Shin E, et al. Determining the gluten content of nonprescription drugs: information for patients with celiac disease. J Am Pharm Assoc. 2011;51(6):734-37.

Evaluation of calcium and vitamin D supplementation in bisphosphonate therapy

The National Osteoporosis Foundation recommends that patients consume at least 1,200 mg of calcium and 400-800 IU of vitamin D each day. Bisphosphonates are considered a first-line therapy for osteoporosis. Between 1994 and 2003, bisphosphonate prescriptions increased from 14% to 73%, while the amount of osteoporosis patients treated with calcium supplements decreased by 50%. Calcium and vitamin D are needed for bisphosphonate efficacy. Bisphosphonates require adequate calcium intake to deposit new bone material, and vitamin D helps in calcium absorption.

The purpose of this study was to evaluate the calcium intake in osteoporosis patients taking bisphosphonates. Out of the 29 patients involved in the study, 41% were not taking calcium supplements and many of the patients were unaware of the need to supplement their bisphosphonate therapy with calcium and vitamin D.

I think this study is important because it shows the need for pharmacists, along with other healthcare providers, to educate their patients about the importance of calcium and vitamin D supplementation while taking bisphosphonates. Being informed by their healthcare providers might be the only way that patients will learn this information. Therefore, it is a necessity for healthcare providers to increase patient understanding of their therapy in order for patients to receive the most effective treatment possible.

Rush D. Evaluation of calcium and vitamin D supplementation in bisphosphonate therapy. J Am Pharm Assoc. 2007;47(6):725-28,729a-730a.

Safety of Nonsteroidal Antiinflammatory Drugs in Patients with Cardiovascular Disease

Nonsteriodal antiinflammatory drugs (NSAIDs) are commonly used for the relief of pain and inflammation in a variety of disease states. However, their prevalence is likely underreported because of their widespread availability and the idea that nonprescription medications do not need to be reported during the recording of medication history. This can be problematic because NSAIDs are associated with many adverse effects, especially in people with cardiovascular disease (CVD). Patients with CVD tend to be older, placing them at a greater risk of harm.

This article detailed the conduction of retrospective and observational studies that assessed the safety of NSAIDs in patients with CVD. The risks associated with NSAID use have been consistently experienced in pateints with coronary artery disease, heart failure, and hypertension. NSAIDs increase the risk of bleeding when used as a monotherapy as well as when used in combination with antiplatelet and anticoagulant drugs. If NSAIDs are deemed medically necessary, then they should be used at the lowest effective dose for the shortest duration possible.

I found this article to be very important due to the prevalence of NSAID use. It is important for healthcare providers to be aware of the potential risks associated with NSAIDs in patients with CVD. Patients with CVD tend to be older in age, thus they are more likely to have conditions, such as arthritis, which pose symptoms that are relieved by using NSAIDs. It is necessary for healthcare providers to make sure that patients with CVD are aware of the risks posed by using NSAIDs as well as to inform them of the importance of reporting NSAIDs when detailing their medication history.


Danelich I, Wright S, Lose J, et al. Safety of nonsteroidal antiinflammatory drugs in patients with cardiovascular disease. Pharmacotherapy. 2015;35(5):520-35.

Home INR Monitoring Improves Warfarin Therapy

Since the 1950s, warfarin has been the principal oral anticoagulant in use in the United States. However, warfarin has many disadvantages, primarily the complexity and labor-intensiveness of managing its therapy, which leads to adverse events. The therapy involves a small, portable device that allows a patient to perform an INR from a finger stick sample of blood. These are used in physician offices, but they can also be used at home, which allows patient’s to self-manage their anticoagulation dosing.

Home monitoring is convenient for patients, allows INR to be monitored frequently, provides consistency of testing reagents and instrument, and gives patients a feeling of empowerment through involvement in their own care. To be eligible for home monitoring, patients must be able to and compliant with monitoring. They have to be able to perform self-testing as well as show compliance with previous anticoagulation management.

Home monitoring has shown to be effective in improving the outcomes of therapy. Clinical trials demonstrated that quality of care improved through patients being in the therapeutic INR range a greater percentage of the time as well as a decrease in major adverse effects as compared to other models of care.

I think home monitoring in INR therapy would be very beneficial to many patients. For patients who travel a lot or who are not as able to come to physician offices often due to transportation issues, home monitoring would be very convenient for them to ensure that their INR levels fall within the therapeutic range. This ensures that they are receiving the most effective treatment plan possible, leading to the bettering of their overall health and wellbeing.

Ansell J. Home INR monitoring improves warfarin therapy. Today’s Geriatric Medicine. 2014;7:28.



Pharmacist-provided diabetes management and education via a telemonitoring program

In the United States, 29 million people have diabetes. The self-care demands of diabetes treatment can be overwhelming, which could lead to health care issues, such as nonadherence. Pharmacists can help patients manage their diabetes through telemonitoring. Telemonitoring gives recommendations to patients after their health data is transmitted to medical providers at different locations.

This article discusses a study that assessed how telemonitoring can improve disease management of diabetic patients by evaluating the clincal outcomes, such as A1C, blood pressure, and lipids, and other measurements, like adherence and disease state knowledge. The study included 150 patients – 75 received pharmacist-provided diabetes management via telemonitoring and 75 received usual medical care. In the former group, daily blood glucose and blood pressure values were reviewed and the pharmacist provided follow-ups to manage values that were not at goal. The results found a significant decrease in A1C levels in those who received pharmacist-directed care compared to those who got usual care. Blood pressure and LDL levels were also lower, but not by a statistically significant amount. Patient disease state knowledge and medication adherence improved in the telemonitoring group.

This shows the role that pharmacists can have in their patients’ medication experiences. By taking an active part in their patients’ treatment, pharmacists can not only expand the patients’ knowledge about their treatment, but also improve their compliance in taking their medications. This ensures that the patients are receiving optimal care, bettering their health. Telemonitoring can help pharmacists play a more active role by enabling them to monitor patients’ health data even when the patient is not at the pharmacy with them. I look forward to seeing if telemonitoring will be implemented in more pharmacies today, and I am excited to see what the future holds as we continue to progress in our technological advancements.

Lenert L, Peterson M, Woolsey S, et al. Pharmacist-provided diabetes management and education via a telemonitoring program. J Am Pharm Assoc. 2015;55(5):516-26.

Pharmacist-led blood pressure intervention demonstrates positive results

A study was conducted to see the effect that a pharmacist-managed antihypertensive therapy coupled with a home telemonitoring intervention has on blood pressure. In the study, pharmacists performed MTM services at 8 clinics, while 8 other clinics just had usual care provided. The patients who were not at the usual care clinics received an initial 1-hour education with the pharmacist and got a home blood pressure monitoring device that delivered at least 6 blood pressure readings per week to the pharmacist. In addition, they received twice-monthly phone call follow-ups. The patients at the usual care clinics only received the initial 1-hour session.

The result of the study showed that a significantly larger number of patients achieved lower blood pressure in the pharmacist-managed group than the usual care group. After 18 months, 71.8% of pharmacist-managed patients kept their blood pressure under control as compared to the 57.1% of usual care patients. It was concluded that the pharmacist-management interventions were “safe and effective”.

This study shows how important it is for pharmacists to have a relationship with their patients. The consistent pharmacist follow-ups with the patients showed direct care for the patients to ensure that they were monitoring their blood pressure. Knowing that their pharmacist was going to be checking on their readings may provide patients with incentive to be adherent to their medications, keeping their blood pressure under control. Additionally, the follow-ups allow the patients to address any concerns that they have about their treatment with the pharmacist, ensuring that they reach their ultimate health goal.

Margolis, K.L., Asche, S.E., Bergdall, A.R. et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. J Am Med Assoc. 2013;310: 46–56

Communication needs of patients with altered hearing ability

As discussed in Healthy People 2020, language barriers are a public health issue since they can lead to a decreased access to health care. People who are functionally deaf and hard of hearing (HOH) have difficulty communicating with health care providers as well as have low medication adherence. They have a lower health literacy compared to those who can hear well. The purpose of this research was to identify communication barriers between deaf or HOH patients and pharmacists along with how these barriers affect medication adherence and medication errors. The study consisted of focus group discussions among deaf or HOH patients who used American Sign Language as their primary method of communication.

Several participants expressed how challenging it is to communicate with the pharmacy staff. Some said that the staff would assume that the patient could read lips, even when he or she could not. Many participants tried using written methods to communicate, but found the complexity and amount of information to be overwhelming when written in long paragraphs.

Participants talked about their lack of understanding on the use of their medication, such as when to take it and how it should be taken. Due to this lack of understanding, several participants experienced adverse effects. They stated that to feel comfortable with how to take their medication they had to “learn from experience”. To get more information about their medications, most of the participants look at online resources or ask their friends or spouses – only two ask the pharmacist.

I found this article to be very interesting, especially after having an encounter with a deaf patient at my Community Health site. In the health care system today, disparities exists among patients. As a health care provider, it is important to identify these disparities and address them in an effective way to ensure that all patients are receiving an equal quality of care. In regards to the deaf and HOH, communication can be improved between the patient and pharmacist by perhaps using written methods that involve lists, instead of long paragraphs, so that it is not as overwhelming to read. In addition, the instructions on how to take the medication as well as any warning or adverse effects should be emphasized in a way that the patient can notice them and be cautious. By doing this, pharmacists can show their deaf and HOH patients that they care. Thus, the patients can be comfortable enough with the pharmacist to address any problems or issues that they have, ensuring that they receive the best treatment possible.

Ferguson M, Liu M. Communication needs of patients with altered hearing ability: Informing pharmacists’ patient care services through focus groups. J Am Pharm Assoc. 2015;55:153-60.

Patient perceptions of e-prescribing and its impact on their relationships with providers

In our health care system, prescription information can be electronically transferred from the prescriber to the pharmacist, causing an increase in efficiency and safety along with a decrease in cost. This allows for an improvement in the quality of patient care. This study focused on the perspective of the patients on electronic-prescribing. Its objective was to find the impact of these e-prescribing systems on quality of care, on patient-pharmacist interaction, and on engagement in health care. The study conducted interviews with 12 patients. The results found both positive and negative perceptions on the e-prescribing system.

The positive perceptions were related to an improvement in convenience, safety and quality, and cost. There were less medication errors, such as those caused by the illegibility of a prescriber’s handwriting. The negative perceptions were associated with communication challenges between pharmacists and prescribers, prescriptions being sent to the wrong pharmacy, and the patient feeling as if he or she less control over prescriptions. A common concern expressed by the patients was the lack of opportunity to talk with the community pharmacist during the prescription drop-off step. Patients viewed this step as a chance to learn more about their medication before deciding to have it filled. As well, it provided pharmacists with a chance to discuss nonadherence issues with patients. Another concern was that, oftentimes, a patient would have no knowledge about their prescription, such as drug name or dosage, until reaching the pharmacy.

I found this study very interesting because it looked at the patients’ viewpoints on the use of technology in our health care system. Technology should not only benefit the health care providers, but it should also benefit the patients. Therefore, it is important to understand where patients stand on these issues. This study that was conducted may have allowed researchers to realize that e-prescribing may be decreasing opportunities for a patient-pharmacist relationship to develop. With knowledge about this information, pharmacists may want to put in extra effort to talk with their patients when they are picking up prescriptions to ensure that the patients are fully informed about the medications that they are taking. Being able to develop a relationship with patients is an important aspect of delivering high-quality patient care.

Frail CK, Kline M, Snyder ME. Patient perceptions of e-prescribing and its impact on their relationships with providers: A qualitative analysis. J Am Pharm Assoc. 2014;54:630-33