In the third of a three-part series, topics such as drug approvals and shortages, therapeutic interchanges, and pharmacoeconomic assessments are discussed.
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P&T® Journal contents for January 2010
An Interview Series with Members of the ASHP Expert Panel on Formulary Management. Part 3: Sabrina W. Cole, PharmD
An order form for subcutaneous insulin was created to improve blood glucose control in hospitalized diabetic patients. Although use of the form by the staff was relatively low, teaching health care personnel about hyperglycemia and proper use of the form may help reduce complications after patient discharge.
Alvimopan (Entereg) for the Management of Postoperative Ileus in Patients Undergoing Bowel Resection
Postoperative ileus is common after surgery, especially abdominal procedures. In clinical studies, alvimopan appeared to speed up gastrointestinal tract recovery, was associated with fewer adverse effects, and led to shorter hospital stays.
Sessions covered the ARBITER 6-HALTS trial of ezetimibe (Zetia) and niacin (Niaspan); the HEAAL study of losartan (Cozaar); the relationships between statins, high-density lipoprotein-cholesterol (HDL-C) levels, and cardiovascular events; and the association of higher HDL-C levels with lower rates of breast cancer.
Topics include ecallantide (Kalbitor) for hereditary angioedema; a capsaicin 8% patch (Qutenza) for pain management; and romidepsin (Istodax) for patients with cutaneous T-cell lymphoma.
Interventions to Curb the Overuse of Acid-Suppressive Medications on an Inpatient General Medicine Service
A retrospective review was conducted to assess the effect of various interventions on inappropriate prescribing of acid-suppressive agents in the hospital. Providing educational lectures was helpful, but adding a pharmacist to the health care team resulted in the greatest decline in inappropriate use of these drugs.
Implications for Prescribing Practice and Therapeutic Interchange
Although low-molecular-weight heparins (LMWHs) have similar antithrombotic effects, they differ in their pharmacological and biochemical profiles. The authors discuss therapeutic interchange programs for currently available LMWHs and the risks to patients when agents are not clinically interchangeable.
Drugs discussed include dasatinib (Sprycel), nilotinib (Tasigna), and imatinib (Gleevec) for patients with chronic myelogenous leukemia; deferasirox (Exjade) for beta-thalassemia major with iron overload; eculizumab (Soliris) for thrombocytopenia; and romiplostim (Nplate) for myelodysplastic syndromes.
Topics include an influenza vaccine (Fluzone High-Dose) to prevent virus subtypes A and B in older patients; von Willebrand factor/coagulation factor VIII complex (Wilate) to treat spontaneous and trauma-induced bleeding in patients with von Willebrand’s disease; and tranexamic acid (Lysteda) for heavy menstrual bleeding.
Industry’s Agenda Is Clear, but Its Future Path Is Not
Pharmacists are divided over provisions in the House and Senate health care reform bills, but most agree on the need to expand medication therapy management services, reduce patient readmissions, and provide access to discounted drugs.
Rituximab prolongs survival in patients with aggressive lymphomas, but more study is needed to clarify its effect on survival of patients with indolent lymphomas.
Representative studies focus on aromatase inhibitors, tamoxifen, and bisphosphonates. Agents for pancreatic, colorectal, and gastric cancers are also reviewed.
Topics include agents for multiple sclerosis, rheumatoid arthritis, and hypertension.
Continuing Education Credit
Applying the 2010 Joint Commission Patient Safety Goal Requirements
Ensuring continuity of care for patients needing erythrocyte-stimulating agents helps to prevent hemoglobin fluctuations, avoids duplications, and lowers hospital costs.
Five medications have been approved for use in patients with Alzheimer’s disease; nonetheless, there remains an urgent need for new and effective drugs. This article describes the role of these agents, with an emphasis on their efficacy, effectiveness, costs, and associated controversies.
Hospital administrators are beginning to focus on bar-code scanning as a part of a multi-pronged strategy to reduce medication errors. The experience with bar-coding technology at four medical institutions is described.
Caveat Emptor! (and Other Advice from Cyberspace)
The decades-old debate over generic versus brand-name drugs, once mainly the stuff of medical journals, is now a hot topic on the blogosphere as well. The author provides a sampling of postings from bloggers.
Topics include liraglutide injection (Victoza) for type-2 diabetes; Prevnar 13 vaccine for protection against invasive pneumococcal diseases in children; and olmesartan medoxomil (Benicar) for children with elevated blood pressure.
Continuing Education Credit
Clinical Considerations for the Health System Pharmacist
Targeted therapies are improving outcomes in patients with colorectal, non–small-cell lung cancer, and pancreatic cancer. The authors evaluate the efficacy of these agents and suggest strategies for preventing and managing adverse effects from these treatments to ensure optimal patient care.
Emphasis on Preventive, Holistic Therapies Offers Possibilities for Pharmacists
The passage of the Patient Protection and Affordable Care Act represents an opportunity to begin repairing parts of our health care system. For example, pharmacists might be able to expand their scope of practice and become more involved with patients and prescribers. However, several roadblocks, including a lack of funding and some ambiguous congressional language, must first be overcome.