Effectiveness of Various Methods of Teaching Proper Inhaler Technique: The Importance of Pharmacist Counseling

This article delves into the role of a pharmacist in patient inhaler education.  There were four different interventions that were compared in this study. The purpose of the study was to determine the efficacy of direct patient education vs. video or print education.

  1. Patient reads a metered dose inhaler (MDI) package insert pamphlet.
  2. Patient watches a Centers for Disease Control and Prevention (CDC) video demonstrating MDI technique.
  3. Patient watches a YouTube video demonstrating MDI technique
  4. Pharmacist gives patient direct instruction of MDI technique (2 minutes long)

This study had a patient population of 72 and each was screened for demographic information, including literacy. All patients used inhalers. These patients were randomized to one of the four interventions and then evaluated by their ability to demonstrate proper inhaler technique using a placebo MDI. The effectiveness of each intervention was measured by the patient’s ability to complete each step of proper inhaler technique, and no partial credit was given. The result of the study showed that only 29.2% of the patients were able to do this correctly. There was also a statistically significant increase in correct inhaler technique in the group of patients given direct inhaler technique education.

This study showed that pharmacists can positively influence patent inhaler outcomes (in comparison to other methods) by giving direct patient education. This is important for the advancement of our profession because it shows that we can provide care outside of simply dispensing medications. Studies like this may provide a framework for allowing pharmacists to provide other services.

What other services do you see pharmacists being able to provide in the future?

View the article here:

Axtell S, Haines S, Fairclough J. Effectiveness of Various Methods of Teaching Proper Inhaler Technique: The Importance of Pharmacist Counseling. J Pharm Pract. 2016 Feb 23. pii: 0897190016628961.

Sphaeranthus indicus: Traditional Wisdom to Modern Medicine—An Orally Active, Potent Cytokine Inhibitor for the Management of Inflammatory Disorders

This article is about the efficacy of Sphaeranthus Indicus extract for use as an immunomodulator for the treatment of inflammation in rheumatoid arthritis. Rheumatoid arthritis inflammation has successfully been treated with cytokine blockade agents such as anti-TNF-a and anti-IL-17 biologics which are immunomodulatory. Sphaeranthus Indicus is a plant extract that has immunomodulatory effects similar to certain biologics. The purpose of this study was to determine the effectiveness of Sphira (another name for the plant extract) of treating inflammation via anti-TNF activity and other inflammatory pathways intervention

The methods used to test Sphira were done in vitro and in vivo throughout several mediums including blood from healthy donors, synovial cells from RA patients and in mice. The primary results from the study confirms a variety of beneficial effects, including validating the use of Sphira to modulate the release of inflammatory cytokines This extended to T-cell mediated cytokines such as IL-17 as well as IL-12/IL-23. The extract was also shown to reduce the production of TNF-a  and IL-1B in mice, which are known to be utilized in inflammatory pathways. Another benefit of Sphira was modulation of cell adhesion molecules that produce inflammation such as ICAM-1.

This study shows that synthetic approaches to drug development are not always the norm, and that effective natural extracts such as Sphaeranthus Indicus have potential to become useful therapeutic agents. Sphira was shown to reduce pathogenic signal transduction responses that lead to inflammation in rheumatoid arthritis. This provides a reason for more research and clinical trials to be done on Sphira to perhaps introduce this agent to the market someday. This article also shows that cytokines can be useful drug targets, as they are involved in many signal transduction pathways that cause symptoms associated with disease. It is important as pharmacists to be educated on aspects of drug development and keep up to date on current research on potential therapeutic agents such as Sphira.

As a pharmacist, how would you go about informing a patient or student about natural extracts and their use in therapy and research?

Find the article here:

Trivedi J, Kharas F, Parikh S, et al.  Sphaeranthus indicus: Traditional Wisdom to Modern Medicine—An Orally Active, Potent Cytokine Inhibitor for the Management of Inflammatory Disorders. J. Pharm. Pharmacol  (7) 106-116. doi: 10.4236/pp.2016.72014

Red ginseng and vitamin C increase immune cell activity and decrease lung inflammation induced by influenza A virus/H1N1 infection

 

This article goes into detail about the efficacy of vitamin C and ginseng as a supplement for decreasing lung inflammation and increasing immune activity to treat influenza type A and H1N1 infection. The study was done in rats with and without influenza type A/H1N1 infection. The purpose of the study was to see how supplementation affected the disease state. The parameters being measured were T-cell activation,natural killer (NK) cells, CD25, CD69, and human peripheral blood mononuclear cells (PBMC) and sarcoma associated herpesvirus (KSHV)-infected BCBL-1 that were inserted into the mice. PBMC and KSHV were administered in separate groups.

The study was carried out over 6-24 hour periods depending on the treatment given. The study arrived at several conclusions based on the results. Red ginseng and vitamin C supplementation suppressed the replication of KSHV virus. In addition, supplementation also increased survival and decreased lung inflammation in mice with H1N1. Other findings include increased activation of t-cells and NK cells, which coincides with a better immune response. The study provides a foundation for potential antiviral uses of ginseng and vitamin C supplements.

This is related to pharmacy because it is important to keep up to date on supplement research, as supplements are usually sold in the pharmacy. Supplements may also cause drug interactions that could affect a patient’s health. H1N1 or bird flu was a big health scare that prompted a rapid search for a vaccine. If the bird flu became a bigger issue than it did, pharmacists would be on the forefront of vaccination efforts.

Do you think pharmacists should be more proactive about promoting the use of supplements?

 

Find the article here:

Kim H, Jang M, Kim Y,  Red ginseng and vitamin C increase immune cell activity and decrease lung inflammation induced by influenza A virus/H1N1 infection. J. Pharm. Pharmacol. doi: 10.1111/jphp.12529

Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention

This article goes over a novel technique to try and improve the quality of patient metabolic monitoring during the use of 2nd generation antipsychotics by using a computer interface and pop-up alert system. Patients taking 2nd generation psychotics can have side effects related to essential metabolic processes. These effects can include weight gain, diabetes occurrence, and others. Therefore the efficiency and rate at which metabolic parameters are important to prevention of further health problems. The metabolic parameters being measured were blood glucose levels, hemoglobin A1C, and a lipid panel, which were then compared to to the initial implementation.

The goal of the study was to determine if the computer system with pop-up alerts was a better option than conventional methods by measuring the rate of monitoring in an inpatient setting. A total of 129 patients (159 in the initial cohort) were monitored and the study was carried out over a period of 4 years. A comparison was done between the computerized physician order entry (CPOE) pop-up alert system and the conventional systems via long term chart reviews. Patient chart reviews were also used to determine if monitoring improved patient outcomes or alerted medical personnel to health risks.

The end result of the study is that the new computer pop-up alert system to did not significantly change monitoring rates. Although there were interventions from the psychiatry team as a result of the computerized system, which shows potential for the use of the system in the future.

We are learning about 2nd generation antipsychotics currently in POP.

How do you think techonology could be better implemented in this special patient population to improve outcomes?

Find this article here:

Lee J, Dalack GW, Casher MI, et al. Persistence of metabolic monitoring for psychiatry inpatients treated with second generation antipsychotics utilizing a computer-based intervention.            J Clin Pharm Ther. 2016 Feb 26. doi: 10.1111/jcpt.12368.

Smartphone-Based Fluorescent Diagnostic System for Highly Pathogenic H5N1 Viruses

In this article, a collaborative research team from South Korea has developed a diagnostic system for use with smart phone technology that is able to identify viruses such as H5N1, or bird flu. The method for this identification being fluorescence excitation and analysis. All of which were smartphone battery powered. The complete setup includes as smartphone (galaxy S3 +others), an apparatus for the device, and samples on test strips.

In order to improve the optical quality of the smartphone features, an apparatus was created that held the phone in place in alignment with an LED light, excitation fiber, emission filter, and upper and lower reflector (parabolic mirrors). The apparatus had the smart phone facing downward to detect the fluorescence using an application in coordination with the diagnostic apparatus, which relayed information back to the phone. Test strips containing unidentified biological specimens would be placed underneath the phone.

Preliminary tests indicate that this method can be used with great accuracy. Of the 29 patients with H5N1, only 1 of them showed of false negative when subjected to smartphone analysis. This relates to pharmacy because potent viruses like H5N1 are public health concerns that could potentially warrant mass vaccinations. Vaccinations fall under the responsibility of a pharmacist, and we are often the most accessible healthcare professional when it comes to vaccinations on a large scale.

Do you think smartphone technology like this will become more prevalent in the future?

You can view the article here: Smartphone-Based Fluorescent Diagnostic System for Highly Pathogenic H5N1 Viruses.

Yeo S, Choi K, Cuc BT, et al. Smartphone-Based Fluoranalyzeescent Diagnostic System for Highly Pathogenic H5N1 Viruses. Theranostics. 2016 Jan 1;6(2):231-42

 

Oritavancin: A Novel Lipoglycopeptide

The article goes into details about the use of Oritavancin in relation to other glycopeptides. Noted positives include a broad spectrum of activity against gram positive bacteria and a prolonged half life (245 hours) for one time administration. In addition, the medication is not known to cause significant side effects other than gastrointestinal problems consistent with many other antibiotics. Perhaps the best qualities of Oritavancin are the reduced monitoring requirements, which can make it easier for the patient involved as well as the care provider. Detailed information about the pharmacokinetics and drug interactions were also included in the article.

The point of this article is to take a comprehensive look at Oritavancin and how it compares to other antibiotics in the same class.

Do you think the market for drugs like Oritavancin will expand in the coming years despite the growing epidemic of resistant bacteria?

Topical delivery of paclitaxel for treatment of skin cancer

This article gives a novel approach to the application of the chemotherapy agent Paclitaxel in a topical formulation. Paclitaxel is a member of the taxane class of chemotherapy agents and can be used to treat melanoma along with other cancers. The mechanism of action of taxanes is the disruption of microtubule function, which are essential for cell division. Topical formulations of Paclitaxel are not currently available, but are desired because topical application of the chemotherapy agent are speculated to reduce side effects due to increased localization of action.

This article presents an approach to a topical formulation of paclitaxel using solid lipid nanoparticles, which trap the active ingredient in a form that can penetrate skin. In the experiment, a yield of 60-66% was achieved and this product was used in vivo. A steady release of paclitaxel was observed and the effectiveness of this formulation was consistent with adequate therapeutic use in skin cancer patients.

The conclusion of the article is that a new topical formulation of paclitaxel using solid lipid nanoparticles is expected to show reduced side effects of the the drug, and therefore could be used for a potential option in the market.

I found this article interesting because cancer drugs are notoriously difficult to get past the FDA. It’s a risky area of research financially, and I think it’s great that different formulations of existing cancer drugs can be created and further reduce symptoms in patients. As a future pharmacist, I could potentially work in environments where I would be dealing with topical cancer drugs, so this kind of research is very important to keep up with.

Do you think that more research should be put into improving existing chemotherapy agents or discovering new ones?

Bharadwaj R1, Das PJ1, Paul P1, Mazumder B1.
Topical delivery of paclitaxel for treatment of skin cancer
Drug Dev Ind Pharm. 2016 Feb 5:1-58

View the article here: Topical delivery of paclitaxel for treatment of skin cancer

Prebiotics and the Importance of Defining them Correctly

Paul Stangl

In this article published in Elsevier, researchers from several US and international universities collaborated to expand on the scientific definition of prebiotics and then make a case for the use of a universal, consistent definition. Prebiotics are substances usually taken in tablet, powder or capsule form that are indigestible and provide probiotics (beneficial bacteria in our gut) with a food source. Examples include Fructo-oligosaccarides (FOS) and Galacto-oligosaccardes (GOS). The benefits from prebiotics have been observed to positively impact digestive health and there is a variety of prebiotic supplements on pharmacy shelves and online.

According to the article, the problem with prebiotics occurs when different specialties have varying definitions of what a prebiotic is and does. Scientists define that prebiotics should improve host health or otherwise provide a beneficial physiological effect. Regulators, such as the FDA classify prebiotics in the same category as vitamins and mineral supplements and have different standards for use in the market. In the same vein, the food industry does not have any set definition and therefore there are inconsistencies with what regulators determine for the industry and what the scientific definitions are. This confusion escalates further when consumers and even healthcare providers have little understanding of what prebiotics actually are. The article states some surprisingly negative statistics about the understanding of even the basic definitions of prebiotics, which includes the difference between prebiotics and probiotics.

 

The main point of this study is to highlight the confusion between disciplines when the definition of a term is not well defined.

What steps could pharmacists take to promote proper understanding and use of prebiotics in the patient population?

View the article here: Prebiotics: why definitions matter

 

Hutkins RW, Krumbeck JA, Bindels BL, et al.

Prebiotics: why definitions matter:

Elsevier. 2016;37:1-7.