Cardiac Events in Patients with Gout Treated with Colchicine

It seems like Colchicine is not only beneficial for patients who have gout. After a study by Solomon and colleagues, Colchicine also seems to help lower the risk of a cardiovascular event. Although there have been studies in the past that related colchicine to cardiovascular risk, it has never been concluded its CV risk effects on patients who have gout.

Using a patient population of 501, the group was split evenly between users of Colchicine for gout, and non-users. The scientists followed up with patients about 16 months after. It was found that 25 of roughly 250 patients using Colchicine had a cardiovascular event, while 82 of the non-users experienced a cardiovascular event. After a comprehensive data analysis, it was concluded that Colchicine is associated with a 49% lower risk for a CV event, as well as 73% in mortality.

I think that this article is relevant for us because there are always so many different uses for medications that it is sometimes hard to keep on top of it all. This is good information to know if we have somebody who has or even does not have gout being treated with Colchicine. I think that this “off-label” use is also important for us to recognize, and important for us to ask new prescription patients “what did your doctor tell you that you were using this for?”.

Link to article

Solomon D, Liu C, Kuo I, Zak A, Kim S. Effects of colchicine on risk of cardiovascular events and mortality among patients with gout: a cohort study using electronic medical records linked with Medicare claims. Ann Rheum Dis. 2015. doi:10.1136/annrheumdis-2015-207984

Social Media in Pharmacy: Heeding its call, leveraging its power

This article looks into the use of social media as a major information outlet to consumers. The power of social media is that it reaches millions of people, and companies can choose who to reach out to specifically by sponsoring the outlet. Although this article cautions the information that is to be posted, pharmaceutical companies should not be hindered to inform people on vital health tips. Such tips are important because it allows pharmacists to put all of the information that they learned throughout school into the palms of the consumers who utilizing their products. As long as the consumer has a grasp on the information of the medications they are taking, a stronger bond can be made between pharmacist and consumer through social media outlets.

The article gives points for being concise and effective in language, knowing what audience you want to target, and getting immediate attention of social media goers.

Not only can social media connect pharmacists to patients, but to other healthcare professionals as well. I think it is important to understand and utilize social media now that it has grown so much. Reaching consumers on a personal level is something that should be taken full advantage of, but with caution. I can even say that while scrolling through Instagram at night I’ve seen multiple sponsored posts by UPMC. These posts have quick health tips, encourage screenings and vaccinations, and many more. As a professional it is important to realize that we must be cautious about what we post, but it is also important to be aware of utilizing social media outlets.

Link to Article

O’Hara B, Fox B, Donahue B. Social media in pharmacy: heeding its call, leveraging its power. JAPhA. 2015;53(6):561-68.

 

Pharmacists and physicians get smart about antibiotics: A prescription for change

Antibiotic resistance has been growing nationally and it is of definite concern to not only us, as healthcare professionals, but to our communities. Every time someone is dosed an antibiotic they have increased chance of developing a antibiotic resistant infection, and put those around them at the same risk. Approximately 258 million antibiotic prescriptions were written from an outpatient setting in 2010, while about 50% of those prescriptions were thought to be inappropriate. Not only was the number of written prescriptions outrageous but the price to pay was even more for these prescriptions, 10.7 billion to estimate.

This article pulls from multiple studies and highlights one particularly about collaborative care agreements. This study focused on pharmacist physician collaborative care agreements in the prescribing of antibiotics from an outpatient setting. Pharmacists were able to ask questions and challenge the antibiotic course that the physicians were recommending. Patients in the collaborative care were prescribed more “narrow spectrum”, first-line antibiotic regimens. The cost of their antibiotic also decreased by a third. Not only can pharmacists help to cut costs or input on the prescribed medication, but they can also counsel patients to provide optimal outcomes.

I think that it is important to become aware of the role of pharmacists in a collaborative health care agreements. Not only are pharmacists useful for the over-prescribing and inappropriate prescribing of antibiotics, but we are the best resource for medication information and are known to be cost effective. Overall, pharmacists have a huge impact on collaborative care agreements and can impact prescribing challenges.

Link to Article

 

Goode A, Roberts R. Pharmacists and physicians get smart about antibiotics: A prescription for change. JAPhA. 2015

Fish Intake in Pregnancy and Child Growth

Fish are commonly exposed to persistent organic pollutants, which may have endocrine-disrupting properties that contribute to obesity development. Fish intake of pregnant mothers has been shown to increase fetal growth, but this study set out to see if increased fish consumption affects child obesity as well.

Over 26,000 woman through the span on 15 years were studied through childbirth and followed up with every two years until the child was 6 years old. The results were that woman who consumed fish more than 3 times/ week gave birth to children with higher BMIs compared to those children whose mothers consumed fish less than 3 times/ week. The high fish intake mothers had children who had increased risk of rapid infant growth as well as increased risk for obesity at 4 years and 6 years old.

FDA advice on fish consumption in woman who are pregnant, breast feeding, or thinking about becoming pregnant changed in June of 2104 to match the data found in this trial. FDA now recommends for pregnant woman to consume more fish due to its cognitive benefits for their offspring, but to consume no more than 3 meals of fish/ week.

As pharmacists, we deal with a variety of factors that impact our patients health. Fish oil supplements as well as diet is something that we need to consider when counseling maternal populations.

Link to Article

Stratakis N, Roumeliotaki T, Oken E, Barros H, et al. Fish intake in pregnancy and child growth. JAMA Pediatr. 2015. doi:10.1001

Rhabdomyolysis precipitated by possible interaction of ticagrelor with high-dose atorvastatin

We have learned during top drugs that rhabdomyolysis is a serious side effect of Atorvastatin. Rhabdomyolysis is a breakdown of muscle tissue that causes protein and all intracellular contents to be released into the blood. In this review, the authors discuss a possible drug interaction that can increase the potential of developing rhabdomyolysis.

Ticagrelor is a blood thinning agent that can decrease the risk and prevent the occurrence of heart attack or stroke. Ticagrelor is usually combined with high dose statin therapy, usually atorvastatin 80mg, for secondary prevention of coronary artery disease. Ticagrelor is also metabolized by cytochrome P450 and is a weak CYP 3A inhibitor. Atorvastatin is mainly metabolized by CYP 3A4. Therefore, when dosed together the concentration of atorvastatin in the blood increasing drastically. The AUC of atorvastatin when used in combination with ticagrelor is nearly 50% higher.

Although a patient can develop rhabdomyolysis from atorvastatin alone, their potential risk of having rhabdomyolysis increases greatly. A way doctors are combating this drug interaction is by lowering the dose of atorvastatin to 40mg due to the concentration of the drug in the blood over a longer period of time.

As future pharmacists, I think it is important to be aware of drug interactions that might not be marked as “major”. Different age groups and patient populations metabolize drugs differently. When you add a regimen that increases concentration of a drug into an already poor metabolizer of a certain medication, drug interactions can become more high risk, and the potential for serious side effects will increase. I think it is important to always consider our patient first and match the medications to best fit them individually. As pharmacists, we need to aware of and looking out for any potentially harmful drug regimens for our patient.

Link to article

 

Kido K, Wheeler M, Bailey A, Bain J. Rhabodomyolysis precipitated by possible interaction of ticagrelor with high-dose atorvastatin. JAPhA. 2015; 55.3:320-23

Enhanced Responsibilities for Pharmacy Interns at a Teaching Hospital

An increasing demand has been made on hospital pharmacies with large patient populations and the multiple roles of a pharmacist. To combat this, more responsibility has been placed on pharmacy technicians. In some states, tech-check-tech, or TCT, programs have been implemented. These programs place responsibility on the technicians to check each others work and ensure the correct dosing and filling of medications being distributed. These programs allow pharmacists to do more clinical and collaborative work, all while over-seeing the techs.

Unfortunately Massachusetts does not allow TCT programs. So, instead they have implemented an “intern distribution coordinator” position. This position is currently held by only a couple of qualified interns, all ranging from P1-P3s. The inter distribution coordinator is responsible for usual pharmacist responsibilities, but of course they are always under the direct supervision of a pharmacists. These interns undergo 80 hours of training in medication distribution, workflow of the pharmacy, information systems, communication process, and order entry, to name a few. It is the intern’s responsibility to verify the correct patient name, medical record number, medication, strength, quantity, and expiration date much like a pharmacist would.

The use and opportunity for a pharmacy intern to be given some of the responsibility of a pharmacist is very interesting to me. I think this gives interns a great “leg-up” once they are licensed  because they will already have experience in the verification process. As a pharmacy intern now, I do get experience in the order entry and filling process of a script, as well as some inventory management, but I do not get any experience in the verification process, which as a pharmacist in a retail or hospital setting I will have the responsibility of. I think this is a great idea and allows interns to grow and experience more while they are still in pharmacy school.

Link to Article

Gillis C, Anger K, Cotungo M. Enhanced responsibility for pharmacy interns at a teaching hospital. JAPhA. 2015. 55;198-202.

Safer Use of Medications through Risk Evaluation and Mitigation Strategies

REMs or risk evaluation and mitigation strategies are a baseline of communication between drug and patient. The term itself is relatively new, but pharmacists have been practicing medication education since the beginning of practice. REMs are other wise known as risk minimization action places, because they are proposed to do exactly that. The purpose of REMs is to educate the patient on the medication they are taking to increase therapeutic benefit.

The FDA determines which medications go in certain risk categories and have different guidelines on how to ‘do’ the REMs. Most of the approves REMs are a handout that educates the patient on the medication and usually has some FAQs. Other medications may require verbal counseling to ensure the patient knowledgable on the medication they are about to take. Other high risk medications have iPledge and counseling with the pharmacist.

The goal of REMs is to minimize the risk to our patients and increase their therapeutic outcome through the use of different education strategies. Since pharmacists are at the center of patient and prescriber and patient and drug, it is our responsibility to ensure we are conducting necessary REMs. I believe that pharmacists will continue to play a bigger role in medication safety because of REMs, and that we have the ability to do so. As future pharmacist we need to be sure to give our patients all the information needed and answer any questions about medications to increase our patient’s therapeutic benefit. At my pharmacy, I always have information sheets printing out after the labels. I will be sure to always pass them along to be given to the patient.

 

Hennessy K., Williams K., Bongero D.
J Am Pharm Assoc (2003) 2010;50:556-562. doi:10.1331/JAPhA.2010.10532

Link to Article

Long-term Exposure to Antipsychotics in Youth and Type 2 Diabetes

Over the years, antipsychotic use in youth has become increasingly popular. Most youth are prescribed second generation antipsychotic or SGAs. When SGAs were first approved for youth they were restricted to those that were on the schizophrenia spectrum. Since then, they have been approved for diseases such as Tourette syndrome and some autistic characteristics such as bipolar mania and irritability. The issue with SGAs being prescribed to the youth now is that they are being prescribed for a broad range of off label indications. These indications are impulsivity, mood, aggression, depression, and anxiety.

SGAs differ from first generation antipsychotics (FGAs) because of their fewer neuromotor side effects. Although SGAs do not cause many neuromotor adverse effects they do cause cardiometabolic side effects. These side effects include weight gain and other disease states that can lead to type 2 diabetes mellitus (T2DM). The article focuses on the concern that these cardiometabollic adverse effects are present at low dosages, and are more severe in the youth, concerning   that long-term expose can only worsen the adverse effects.

The study concluded that the highest risk for development of T2DM was in the antipsychotic exposed group of approximately 1000 patients. The mean age of the patients was 14 years old with almost two-thirds being males. The patients were The incidence rate of developing T2DM from exposure to SGAs was found to be 0.5% , and is very statistically significant. This shows that long-term exposure of the youth to antipsychotics increased the possible development of T2DM and that antipsychotics should be monitored and used for as short of a duration as possible in the youth.

I find this study to be very interesting because it calls into question not only the adverse effects that can develop in the antipsychotic exposed youth, but also the control in prescribing these medications. Specifically, I wonder what we can do to better control the prescribing of antipsychotics to youth, who present with more side effects? Or what other changes in diet or exercise we can supplement the youth with who are on antipsychotic treatment long-term?

 

Galling B, Roldan A, Nielsen R, et al. Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.2923(published January 20, 2016)

Link to Article