High dose perioperative atorvastatin and acute kidney injury following cardiac surgery

In a double blind, placebo-controlled, randomized design, researchers conducted a trial involving cardiac surgery patients, acute kidney injury, and post operative statin treatment. Patients were either dispensed 80 mg of atorvastatin the day before the surgery, 40 mg of atorvastatin the morning of the surgery, and 40 mg of atorvastatin daily following the surgery, or given the same amount of placebo.

Acute kidney injury was defined as a rise in 0.3 mg/dL or higher of serum creatinine concentrations with two days after the surgery. Using this definition, the researchers concluded that high-dose statin treatment did not end up decreasing the risk of acute kidney injury as compared to the placebo. The same results were shown in both statin naïve patients as well as patients who were already taking statins.

These results are important because in up to 30 percent of patients who had undergone cardiac surgery, acute kidney injury becomes a complication. From these results, more precautions can be taken to prevent this rather common complication. Other drugs may be used in place of high dosage atorvastatin. This relates to our future as student pharmacists because we now know to be even more careful in selecting certain medications for postoperative surgery.

Billings FT, Hendricks PA, Schildcrout JS, et al. High dose perioperative atorvastatin and acute kidney injury following cardiac surgery. JAMA. doi:10.1001/jama.2016.0548 (published February 23, 2016).

http://jama.jamanetwork.com/article.aspx?articleid=2492851 

Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency

Vitamin B12 deficiency is more common than most people are aware of, especially in the older adult population. If left untreated, this deficiency may lead to serious complications including anemia, dementia, and other neurologic damage. In this study, researchers studied the effects of proton pump inhibitors and histamine 2 receptor antagonists, two of the most commonly used types of medication used in the United States, and how they are associated with this type of vitamin deficiency.

The study evaluated almost 26,000 patients who were currently diagnosed with vitamin B12 deficiency and compared the evaluation of about 184,000 patients who were not vitamin B12 deficient. Through this study, researchers discovered that both a two-year use of proton pump inhibitors and a two-year use of histamine 2 receptor antagonists lead to a correlation with vitamin B12 deficiency.

This study was important because I feel that vitamin B12 is not as commonly discussed as other vitamins such as vitamin D or vitamin C. It is important to recognize that other vitamins are just as essential to the human body as those. An understanding of potentially dangerous risks associated with proton pump inhibitors and histamine 2 receptor antagonists will allow for prevention of the neurologic damage associated with vitamin B12 deficiency.

 

Lam JR, Schneider JL, Zhao W, et al. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310:2435-42.

http://jama.jamanetwork.com/article.aspx?articleid=1788456&resultClick=3

Comparison of dietary supplement product knowledge and confidence between pharmacists and health food store employees

A common topic discussed within the pharmaceutical world is the subject of complementary and alternative medicine (CAM). In a recent study, researchers compared knowledge about the safety and efficacy of common dietary supplements between pharmacists and health food employees. In retail settings located in central and western New York, participants were told to answer a survey about CAM safety and efficacy using the Likert scale, which ranged from scores of 0, or “very hesitant,” to 4, or “very confident.” Afterward, the participants were asked to answer a knowledge assessment portion, in which the participants were asked to answer True or False questions with the responses “true”, “false”, or “I don’t know.”

A total of 31 pharmacists and 27 health food store employees participated in this study. Results determined that pharmacists’ mean score was higher than that of the health food store employees. However, the pharmacists’ response confidence was significantly lower. Because of this, it is determined that pharmacists must improve on the subject of CAM.

This study is interesting because I had recently researched about a specific supplement in relation to depression for my drug information assignment. Prior to pharmacy school, I did not realize the amount of herbal and alternative medicines that were available on the market. It is important that current and future pharmacists improve their knowledge about this subject in order to give patients a proper recommendation.

Coon SA, Stevens VW, Brown JE, et al. Comparison of dietary supplement product knowledge and confidence between pharmacists and health food store employees: J Am Pharm Assoc. 2015;55:161-8.

http://www.japha.org/article/S1544-3191(15)30037-6/abstract 

A prospective three-step intervention study to prevent medication errors in drug handling in paediatric care

Each year, the United States emergency department treats up to 158,520 children for adverse drug effects. According to previous studies, up to 21$ of these are caused by medication errors. In this study, researchers performed a prospective intervention study in the University of Heidelsberg’s children hospital. 18 beds were systematically studied through a three-step intervention to prevent medication errors in the drug-handling processes.

Each step of the intervention was directed at different causes of errors. After three interventions, there was a significant decrease in the frequency of errors performed by the nurses, from 91% to 26%. There was also a decrease from 88% to 49% in the number of patients who were exposed to at least one medication error. It is evident that the three step intervention decreased the amount of medication errors in the hospital setting.

This study is important and interesting because while performing pediatric care, it is necessary to be certain of what medications the patient needs administered. Implementation of this three-step intervention in other hospitals around the world will decrease the amount of emergency visits children take. It is worth it in the end to take the extra precautions to reassure that the medication being administered to the patient is correct.

Niemann D, Bertsche A, et al. A prospective three-step intervention study to prevent medication errors in drug handling in paediatric care. Journal of Clinical Nursing. 2015;24:101-14.

http://onlinelibrary.wiley.com/doi/10.1111/jocn.12592/full

Histamine-1 receptor antagonism for treatment of insomnia

A double-blind, randomized research study was conducted to compare and contrast the effects of histamine-1 receptor antagonist treatment in insomniacs versus a placebo control, versus an already FDA-approved insomnia treatment. In this study, researchers compared several previously lead studies. Total sleep time, number of awakenings, sleep latency, and sleep efficiency were evaluated in 65 trials.

Histamine-1 receptor antagonists include over-the-counter antihistamines. This is important to recognize because many community pharmacists and healthcare providers prescribe over the counter sleep aids, and so it is necessary to evaluate the effectiveness of these drugs. Historically, some OTC antihistamines have been FDA-approved for insomnia treatment.

However, this study concludes that there have been no sound studies to support the use of histamine-1 receptor antagonists for this indication. It was also discovered that over the counter antihistamines should not be used in younger adults in the long term, as rapid tolerance develops.

This study was very interesting and useful to research for the future. Other over the counter drugs may be studied to compare effects, and insomniacs are one step closer to being able to be better treated for their condition to receive better sleep quality.

Griend JP, Anderson SL. Histamine-1 receptor antagonism for treatment of insomnia. J Am Pharm Assoc. 2012;52:210-19.

http://www.japha.org/article/S1544-3191(15)30587-2/fulltext

Subarachnoid hemorrhage in a patient taking phentermine for weight loss

A 45-year-old female was reported for developing a subarachnoid hemorrhage associated with the use of phentermine. Upon admission into the facility, the patient was screened for a grading scale of a subarachnoid hemorrhage. It was discovered that the patient had a moderate to severe headache with neck stiffness, cranial nerve palsy, and the hemorrhage was classified to be more than 1 mm thick. Luckily, the patient was able to be treated with a strict diet and attention to maintain the proper amount of blood and fluid.

The patient was counseled to discontinue taking phentermine, which is a sympathomimetic agent. It is commonly used in weight-loss products. However, sympathomimetics have often been linked to an increase in hypertension within the patient taking it, which can then lead to neurologic hemorrhages, such as a subarachnoid hemorrhage found in the patient described.

This article is important because with growing mass media today, the topic of weight loss is a widely discussed issue. Many people are eager for easier ways to lose weight, and phentermine is commonly prescribed for improvement in weight loss. This is important to pharmacists because it will be important to describe this kind of adverse effect to a patient who is being prescribed this drug. I found this article interesting, and I wonder how many other reported cases there are of patients on this drug developing brain hemorrhages. In addition, I wonder if other drugs designed for weight loss also increase patients’ risk of developing hemorrhages.

Bain, JA, Dority JS, Cook Aaron M. Subarachnoid hemorrhage in a patient taking phentermine for weight loss. J Am Pharm Assoc. 2014;54:548-551.

 

http://www.japha.org/article/S1544-3191(15)30242-9/fulltext

Blood Pressure kiosks for medication therapy management programs

For one month, the total revenue collected by using blood pressure kiosks was generated and measured to identify how valuable kiosks could be in identifying hypertensive patients. Studies currently show that hypertension affects twenty to thirty percent of North American adults, and one-half of this hypertensive population remain uncontrolled. Uncontrolled hypertension leads to many adverse effects, some of which include heart failure, myocardial infarction, and stroke. By implementing blood pressure kiosks, patients may more easily obtain their blood pressure readings, and therefore find help from pharmacists if deemed necessary.

From this study, researchers concluded that on average, 189 hypertensive patients per month would qualify for a drug review and patient consult with a pharmacist. These reviews and consults would qualify for revenue collected. Overall, more than 7.5 million readings from 341 pharmacies were taken on the blood pressure kiosks. Through calculations, researchers determined by pharmacies could collect an average of $12,270 annually in revenue from MTM services provided to patients who discovered their hypertension. It is evident that blood pressure kiosks are very valuable in a pharmaceutical setting.

I found this article interesting because I myself have used a similar kiosk at a local pharmacy. Although I had already known that I was not hypertensive and I was merely just playing with the technology, I did wonder how beneficial the kiosk was to the company that I was in. From this study, I have no doubt implementing a blood pressure kiosk can help pharmacists generate more patients, thereby providing the assistance and improving patient outcomes.

 

Houle SK, Chuck AW, Tsuyuki RT. Blood pressure kiosks for medication therapy management programs: Business opportunity for pharmacists.. J Am Pharm Assoc. 2003;52:188-194.

http://japha.org/article.aspx?articleid=1044014#Methods

Developing school-pharmacist partnerships to enhance correct medication use and pain medication literacy in Taiwan

In this study, researchers evaluated the effectiveness of the implementation of a health promoting school (HPS) – community pharmacist partnership program in schools located in Taiwan. Previous studies have found that most adolescents are unaware of the correct use of certain medications, especially acetaminophen. This is concerning because in 1995, Taiwan developed a program that allowed patients to obtain a large assortment of drugs from health industries. Since 2012, the number of yearly outpatient visits in the country has increased twofold, and acetaminophen has become the primary cause of drug overdose and liver failure.

The HPS program was launched in Taiwan 2002, and expanded in 2009 to provide a more comprehensive medication education to children and adolescents in school. The total current number of schools enrolled in the program has increased since, and has the program has also been implemented in several other countries. This survey in particular included 89 intervention schools and 4,643 students. In the program, hospital and community pharmacists are invited to the schools to educate children about certain medication use. The primary teachings include how pain relievers work, how acetaminophen affects the liver, and the maximum dose of acetaminophen. The data analysis of the study shows that the students’ knowledge of correct medication use has increased since the implementation of the program.

This study is important because it demonstrates that current medication use is not well-understood in patents. It will be efficient to look into implementing education programs. Starting these programs in schools will give younger patients a head start on learning more about the pills that they are taking, and will allow them to prevent medication misuse.

 

Chang FC, Chi HY, Huang LJ, et al. Developing school-pharmacist partnerships to enhance correct medication use and pain medication literacy in Taiwan. J Am Pharm Assoc. 2003;44:595-602.

 

http://japha.org/article.aspx?articleid=2463334