Differential Impact of Selective Serotonin Reuptake Inhibitors on Platelet Response to Clopidogrel: A Randomized, Double-Blind, Crossover Trial

SSRIs and other antidepressant medications constitute one of the most commonly prescribed drug classes that pharmacists will see in the community setting. When taken alone, any one of these medications can be a good treatment option for patients experiencing depression; however, these drugs can cause a patient who is taking multiple drugs  to experience significant interactions with his/her other medications. For this reason, it is crucial to know how the effects of other medications can be altered through this therapy.  This study analyzed the effects of two SSRIs (citalopram and fluvoxamine) on the blood thinning medication clopidogrel. These medications all work on the same CYP enzyme (CYP2C19)  and have opposing effects. Researches tested these medications on healthy individuals and found that fluvoxamine was the only drug that caused significant inhibition of clopidogrel action.

I think this is important to note because these medications are commonly utilized by patients and thus there is a high likelihood that they may be taken together. As pharmacists, we should be able to provide adequate care in response to possible drug-drug interactions. To do this, we have to be able to recognize when there could potentially be a problem in medication therapy. By taking the proper precautions when these situations arise, pharmacists will be more likely to help patients avoid adverse medical events associated to drug therapy methods.

Access to patients’ health records for drug therapy problem determination by pharmacists

Patients receiving care at both a community pharmacy and primary care clinic were selected and were evaluated by pharmacy residents to identify drug therapy problems, create a care plan, and a follow-up visit. The pharmacists first completed the assessment in the pharmacy without access to their patient’s health record and recorded their level of confidence in their identified drug therapy problem and any additional data they needed. The pharmacist then completed the same process with access to their patients’ health records from their primary care provider.

Following the study, it was determined that a change in the pharmacist’s initial assessment without access to the patients’ health records was made in all cases studied. 72% of the initially found drug therapy problems were confirmed, while 31 problems were found to be false and 9 new were identified after access the health records.

Overall, this study proves that pharmacist access to primary care health records of the patients they treat is extremely beneficial in accurately determining drug therapy problems and creating their care plans. The chance of either identifying an incorrect problem or failing to identify is largely increased when pharmacists only have access to the patient’s medication record in the pharmacy. Providing pharmacists access to health records can help to reduce the amount of time and limit the possibility of error when conducting medication therapy management to provide optimal patient care. With the advancement of electronic health records, the ability of pharmacists in any setting to access information about their patient can become possible.

I found this study to be significant in highlighting the importance of the collaboration of an interprofessional healthcare team in caring for patients. When the pharmacists were able to access another provider’s documentation and care plans, they could accurately identify problems and were able to provide more effective care plans themselves. I believe that this further emphasizes what we have learned in POP1/2 in interacting with patients. We have always communicated with the patient’s provider so that the healthcare team is well informed of the actions taken with each patient and so that nothing is overlooked. It is reassuring to know that we are developing as student pharmacists and will be prepared to begin our careers knowing newly developing and effective methods of practice.

Reference:

J Am Pharm Assoc. 2015;55:278-281.

http://www.japha.org/article/S1544-3191(15)30060-1/pdf