Journal of Pharmacy Practice and Research最新文献

{"title":"Drug treatment of Alzheimer's disease: what has changed in 30 years?","authors":"Michael C. Woodward AM, MBBS, MD, FRACP","doi":"10.1002/jppr.1905","DOIUrl":"10.1002/jppr.1905","url":null,"abstract":"<p>The Geriatric Therapeutics Review series in this journal can look proudly on what has been achieved over the last 30-plus years — pharmacists, doctors and other health professionals are now more aware of the issues impacting on prescribing and administering medications to older people. In some respects, it is ‘job done’ for the series — the end of a long journey. The mission of developing effective and safe therapies for Alzheimer's disease sadly cannot yet make the same claim, but we can say we are at the end of the beginning, with disease-modifying drugs, such as the monoclonal antibody lecanemab, now approved in some countries and under consideration by the Therapeutic Goods Administration in Australia. These drugs target the underlying disease process — accumulation of amyloid — and have been demonstrated to impact favourably on the progression of symptoms.<span><sup>1, 2</sup></span> This is a significant milestone in a very long mission.</p><p>It is grounding to re-read the article reprinted below, written in 1994 by Hopwood and Morris,<span><sup>3</sup></span> two leading clinicians in the diagnosis and treatment of Alzheimer's disease at that time, based at the Heidelberg Repatriation Hospital. In describing the limited treatment options for Alzheimer's disease in 1994, their vision, and even desperation, are apparent. But also clear is what has plagued this mission for so many decades — lots of possible therapeutic targets that ultimately came to nothing. For a quarter of a century, since the cholinergic therapies and memantine, we had nothing new that was effective in treating the progressive cognitive and functional impairments caused by Alzheimer's. The brain is a hard nut to crack, as those on similar missions with other neurodegenerative diseases (think Parkinson's and motor neuron disease) have found.</p><p>Hopwood and Morris<span><sup>3</sup></span> concentrated on the restoration of chemical neurotransmission to boost the ‘function of surviving neurons’. That was reasonable — it was a ‘low hanging fruit’, with a well-demonstrated reduction in the activity of choline acetyltransferase (the enzyme responsible for the synthesis of acetylcholine) in people with Alzheimer's disease and early promising results with the short-acting cholinesterase inhibitor physostigmine. The first clinical trials of Alzheimer's disease therapeutics, with tacrine (a longer-acting cholinesterase inhibitor), began in Australia following the publication of a 1986 study by Summers et al.<span><sup>4</sup></span> that was cited in the Hopwood and Morris article,<span><sup>3</sup></span> but concentrating on these chemicals was never likely to have the more fundamental effect needed — disease modification.</p><p>In their article, Hopwood and Morris<span><sup>3</sup></span> stated that ‘effective preventative strategies aimed at preventing neuronal degeneration remain speculative’, but they did flag this as a future direction (‘[e]ventually strategies may b","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 6","pages":"314-319"},"PeriodicalIF":1.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1905","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developments in diabetes management for older people 1991–2023","authors":"Tilenka R. J. Thynne MBBS, FRACP","doi":"10.1002/jppr.1908","DOIUrl":"10.1002/jppr.1908","url":null,"abstract":"<p>The landscape of type 2 diabetes management has changed dramatically in the 32 years since Mario De Luise's 1991 Geriatric Therapeutics paper on ‘Treatment of diabetes mellitus in the elderly’.<span><sup>1</sup></span> As De Luise predicted, the combined effect of an ageing population and real increases in the age-specific incidence of diabetes has led to a significant impact on the healthcare system. The number of people living with diabetes in Australia increased more than 2-fold between 2001 and 2022, and almost one in five (18.7%) people aged over 75 years now has diabetes.<span><sup>2</sup></span></p><p>Our understanding of the pathophysiology of diabetes and its complications has been enhanced by landmark trials such as the UK Prospective Diabetes Study (UKPDS), published in 1998, which challenged the thinking of the time that there was little evidence that tight glycaemic control could reduce the progression of established microvascular complications (kidney disease, retinopathy and neuropathy).<span><sup>3</sup></span> With tight glycaemic control, however, can come harm. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, published in 2008, found that intensive therapy with drugs that cause hypoglycaemia can increase mortality in patients with, or at high risk of, cardiovascular disease.<span><sup>4</sup></span> Hypoglycaemia in older people may also increase the risk of falls and has been associated with reduced quality of life.<span><sup>5</sup></span></p><p>The therapeutic options for treating type 2 diabetes have expanded dramatically in the last 30 years, particularly in the second half of that period. In 1991 the available drugs were limited to sulfonylureas, metformin and insulin.<span><sup>1</sup></span> Dexfenfluramine, a serotoninergic anorectic drug, introduced in De Luise's paper as having a potential evolving role in the management of type 2 diabetes,<span><sup>1</sup></span> was later that decade withdrawn, along with fenfluramine, due to an increased risk of valvular heart disease and pulmonary hypertension. The tale of diabetes drug advances has a central theme of pharmacovigilance. In 2008 the US Food and Drug Administration issued a Guidance for Industry requiring all new type 2 diabetes drug development programs to rule out unacceptable cardiovascular risk. In part this was motivated by concern about the potential signal of an increased cardiovascular risk with the thiazolidinedione drug, rosiglitazone.<span><sup>6</sup></span> Rather than dampening enthusiasm for diabetes drug development, what followed has been the approval of multiple new drugs for type 2 diabetes, including dipeptidyl peptidase-4 (DPP4) inhibitors (‘gliptins’), sodium-glucose cotransporter-2 (SGLT2) inhibitors (‘gliflozins’) and glucagon-like peptide-1 (GLP-1) receptor agonists (incretin mimetics), each with cardiovascular outcome trial data that was required to include older adults at higher risk of cardiovascular events. The ","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 6","pages":"308-313"},"PeriodicalIF":1.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139603091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A trip down memory lane: 37 years of Geriatric Therapeutics","authors":"Robyn J. Saunders BPharm, Grad Dip Hosp Pharm, AACPA","doi":"10.1002/jppr.1907","DOIUrl":"10.1002/jppr.1907","url":null,"abstract":"<p>It is with great pleasure and pride that I introduce this reprint of Rohan Elliott and Michael Woodward's article, ‘Thirty years of Geriatric Therapeutics’, originally published in 2016.<span><sup>1</sup></span> As a founding member of the Geriatric Therapeutics Editorial Committee in 1986, reading this article feels like a nostalgic stroll down memory lane, to a time where knowledge of the impact of ageing on medication safety was limited, and we were innocently oblivious to the impending explosion of information and therapeutic advances that lay ahead.</p><p>Driven by altruistic ambition, in 1986 the pharmacy department at Melbourne's Heidelberg Repatriation Hospital (‘the Repat’) embarked on an educational mission to improve prescribing for our ageing war veteran population. Our aim was to raise prescribers' awareness of the fact that older individuals handle medications differently, and respond differently, compared to their younger counterparts. To achieve this aim, we approached consultant physicians at the Repat, requesting them to write an article within their specialty, with a focus on treating older people. By doing so, we aimed to deepen their understanding of the complexities associated with elderly patients. We hoped that this subtle approach would enhance the consultant's knowledge, while also educating a broader clinical readership.</p><p>Fortunately, the newly appointed director of geriatrics at the Repat, Dr David Fonda, enthusiastically agreed to join our small editorial team. It was his task to approach the consultants and encourage their contributions to the newsletter. We had no reservations about leveraging our greatest asset: it was indeed challenging for authors to decline David's requests. Each Geriatric Therapeutics article was published in the pharmacy's monthly newsletter, which was distributed across all clinical areas within the hospital.</p><p>The enduring interest in our articles persisted over the ensuing years and was further bolstered by the addition of geriatrician Dr Michael Woodward to the editorial team. The column's professionalism received a significant boost when this <i>Journal</i> agreed to publish our articles from 1991, leading to an expanded distribution. With Michael at the helm of the editorial committee, and articles published in the <i>Journal</i>, authors were able to be recruited beyond the initial primary targets at the Repat hospital, and over the years leading physicians from throughout Australia contributed articles. As clinical pharmacy practice developed and matured, pharmacists with expertise in the care of older people were also invited to contribute articles.</p><p>The Geriatric Therapeutics series (more recently known as Geriatric Therapeutics Review) also owes much to the dedication and unparalleled commitment of Rohan Elliott, who joined the editorial committee in 1999 and became the editor in 2014. Without his input, Geriatric Therapeutics Review would not have achieved a remark","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 6","pages":"328-336"},"PeriodicalIF":1.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139604514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability of extemporaneously prepared clofazimine oral suspensions","authors":"Ellie Ponsonby-Thomas BPharmSc,&nbsp;Charis Lau BPharm,&nbsp;Sherine Tan BPharm,&nbsp;Malinda Salim PhD,&nbsp;Ben J. Boyd PhD","doi":"10.1002/jppr.1893","DOIUrl":"10.1002/jppr.1893","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clofazimine is recommended as a treatment for tuberculosis in infants. Extemporaneously prepared clofazimine oral suspensions are more appropriate dosage forms for infants than tablets, however no data exist to inform appropriate storage conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To examine the physical and chemical stability of extemporaneously prepared clofazimine oral suspensions and determine appropriate storage conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>An oral suspension of clofazimine 10 mg/mL was prepared by grinding six 100 mg clofazimine tablets to produce a fine powder. Ora-Blend SF (sugar free) was added to make a final volume of 60 mL. Six 10 mL aliquots were placed in amber plastic bottles with plastic bottle caps. Three bottles were stored at room temperature, and three bottles were refrigerated at 4°C. Following shaking, a 1 mL sample was taken from each bottle on days 0, 7, 14, 28, and 60. Samples were assayed using the high-performance liquid chromatography method. The samples were visually examined for colour change and separation at each time point. Stability was defined as the retention of at least 90% of the initial concentration. Ethics approval was not required for this research article as it was a stability study that did not involve human subjects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The clofazimine content remained &gt;94% of the initial concentration throughout the 60-day period for samples that were kept at room temperature, and slightly &lt;90% (87.4%) for samples that were kept refrigerated at 4°C. No separation or colour change was noted throughout the 60-day period for both preparations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Extemporaneously prepared suspensions of clofazimine in Ora-Blend SF were chemically stable for at least 60 days when stored at room temperature. Clofazimine degraded slightly more rapidly at 4°C compared to room temperature.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 1","pages":"55-60"},"PeriodicalIF":2.1,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139527073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of drug prescribing for older people","authors":"David Fonda MB BS, BMedSc(Hon), FRACP, FAFRM, MD","doi":"10.1002/jppr.1904","DOIUrl":"10.1002/jppr.1904","url":null,"abstract":"&lt;p&gt;It is with pleasure that I write this introduction to the reprint of the first article in the ‘Geriatric Therapeutics’ series, published in this &lt;i&gt;Journal&lt;/i&gt; in 1991 (then known as the &lt;i&gt;Australian Journal of Hospital Pharmacy&lt;/i&gt;).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The Geriatric Therapeutics initiative arose from the Pharmacy Department at the Heidelberg Repatriation Hospital in Melbourne, with support from the Aged and Extended Care Department.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Initially published as an internal bulletin from 1986 to 1990, its aim was to provide awareness to the physicians at the hospital to the special needs of the older veteran population. Geriatric medicine as a specialty was very much in its infancy at that time, and patients were generally treated under similar guidelines as the general younger adult population. I had the opportunity to write the first article for the bulletin in 1986, entitled ‘Problems associated with drug use in the elderly’. That early version was re-written for the &lt;i&gt;Journal&lt;/i&gt; in 1991.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As I look back now to 1983, when I became the first geriatrician to be appointed to an acute care hospital in Victoria, the number of geriatricians overall was exceptionally low. Today, geriatric medicine is the largest training specialty within the Royal Australasian College of Physicians (RACP), with 392 trainees, ahead of other specialties such as oncology (268), cardiology (245) and respiratory medicine (242). This remarkable evolution of geriatric medicine as a specialty in Australia is a recognition of the significant ageing of the population and the special needs it brings to their care. The life expectancy at birth in 1983 was 71.4 years for males and 78.0 years for females. In 2021, it was 81.3 years and 85.4 years respectively.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This marked increase in life expectancy has resulted in older people now making up a very large proportion of patients in acute care hospitals and large numbers of older people requiring rehabilitation, care at home and residential aged care services. Hence, issues related to drug prescribing are even more important today and need to be understood by all involved.&lt;/p&gt;&lt;p&gt;The first Geriatric Therapeutics article highlighted the reasons for increased vulnerability of older people to adverse drug outcomes, which included altered pharmacokinetics, polypharmacy, multiple comorbidities, atypical disease presentation, inappropriate prescribing, use of non-prescribed over-the-counter medications, drug hoarding and issues with poor drug compliance.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; These issues remain equally relevant today, but with some added caveats.&lt;/p&gt;&lt;p&gt;Since 1986 a plethora of new drugs have been developed, along with guidelines for various conditions that add more drugs to a patient's list, leading to much higher rates of polypharmacy.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; For example, ischaemic heart disease, heart failure, diabetes and stroke result in the presc","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 6","pages":"302-307"},"PeriodicalIF":1.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1904","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139627163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Farewell to the Geriatric Therapeutics Review series: the end of the beginning","authors":"Rohan A. Elliott BPharm, BPharmSc (Hons), MClinPharm, PhD, FSHP, FANZCAP (GeriMed, Research)","doi":"10.1002/jppr.1900","DOIUrl":"10.1002/jppr.1900","url":null,"abstract":"&lt;p&gt;The Geriatric Therapeutics Review series (originally Geriatric Therapeutics) began as a local publication at the Heidelberg Repatriation Hospital in Melbourne in 1986. Its aim was to raise awareness and educate physicians about the special considerations needed when prescribing for ‘geriatric’ patients, at a time when there were few guidelines and reference texts to guide prescribing for older people. Geriatric Therapeutics Review articles have been published in the &lt;i&gt;Journal&lt;/i&gt; since 1991, expanding its audience to pharmacists and other readers. For many years, reprints were distributed to members of the Australian and New Zealand Society for Geriatric Medicine.&lt;/p&gt;&lt;p&gt;Nearly 40 years later, the landscape has changed. Geriatric medicine has become one of the largest medical specialties in Australia, and an area of specialisation for many Australian pharmacists working in hospitals, residential care, and primary care. Information, guidelines, and professional development related to prescribing and medication management for older people are readily accessible.&lt;/p&gt;&lt;p&gt;The Geriatric Therapeutics Review series, comprising 146 peer-reviewed articles covering many areas of therapeutics and medication management (Table 1), has made a significant contribution to increased awareness and knowledge, thus achieving its aim. And so, the time has come to draw the series to a close.&lt;/p&gt;&lt;p&gt;This issue of the &lt;i&gt;Journal&lt;/i&gt; celebrates the Geriatric Therapeutics Review series by looking back at a selection of vintage and seminal articles. Each article is accompanied by an introduction and commentary from a past author or guest commentator. There are also two new articles to round out the series.&lt;/p&gt;&lt;p&gt;We start with a reprint of the first Geriatric Therapeutics article published in the &lt;i&gt;Journal&lt;/i&gt;, in 1991, titled ‘Problems associated with drug use in the elderly’.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This article was written by Dr David Fonda, the first geriatrician appointed at the Heidelberg Repatriation Hospital (in 1983). David has also written the accompanying introduction and commentary, in which he reflects on the state of geriatric medicine in the 1980s, the origins of the Geriatric Therapeutics series, and how medication use has changed since he wrote his original article more than 30 years ago. Although much has changed, many of the problems addressed in David's original article remain relevant today.&lt;/p&gt;&lt;p&gt;Next is a reprint of an article on diabetes from 1991, written by the late Dr Mario De Luise.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The introduction and commentary are written by Dr Tilenka Thynne, clinical pharmacologist and endocrinologist. Tilenka's commentary reflects on the limited treatment options that were available in the 1990s and the huge advances in diabetes therapeutics that have occurred since. As therapeutic options for diabetes evolved over the years, the Geriatric Therapeutics Review series published additional articles on this topic, including one co-au","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 6","pages":"299-301"},"PeriodicalIF":1.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1900","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138944672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin B12 deficiency in older people: a practical approach to recognition and management","authors":"Nadia Mouchaileh BPharm, GradCertPharmPrac","doi":"10.1002/jppr.1897","DOIUrl":"10.1002/jppr.1897","url":null,"abstract":"<p>Vitamin B₁₂ deficiency is common in older people and is linked to anaemia, cognitive decline, and dementia. Clinical presentation is variable, ranging from no symptoms or subtle, non-specific symptoms, through to serious, irreversible neurological symptoms if left untreated. Although common, it is often under-recognised, with diagnosis usually occurring on incidental blood test screening. Older people are at increased risk of vitamin B₁₂ deficiency due to insufficient dietary intake, malabsorption associated with aged-related changes in gastrointestinal function, higher incidence of pernicious anaemia, and chronic use of interfering medications such as metformin and proton-pump inhibitors. Early detection and treatment in symptomatic deficiency are crucial to prevent irreversible damage. Vitamin B₁₂ intramuscular injection bypasses potential absorption issues and is traditionally the first-line treatment in older people. However, emerging evidence suggests that high-dose oral replacement may be as effective. Older people often require lifelong therapy due to the irreversible nature of the underlying cause of deficiency. This review provides an overview of vitamin B₁₂ deficiency and its management in older people.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 6","pages":"350-358"},"PeriodicalIF":1.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139174980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary care of older adults in the emergency department to influence deprescribing in older adults: a cohort study","authors":"Christopher Reilly BPharm,&nbsp;Elizabeth Buikstra PhD,&nbsp;Edward Strivens MBBS, BSci,&nbsp;Elizabeth Marsden MBBS, PhD,&nbsp;Jarred Brose BNurs,&nbsp;Alison Craswell BNurs, PhD","doi":"10.1002/jppr.1896","DOIUrl":"10.1002/jppr.1896","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Inappropriate polypharmacy in older adults is a major health problem associated with poor clinical and health service outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We aimed to evaluate the effectiveness of a geriatric pharmacist service in the emergency department (ED) identifying potentially inappropriate prescribing (PIP).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Between 1 June 2018–31 May 2019, adults ≥70 years of age presenting to ED were reviewed by the Geriatric Emergency Department Intervention (GEDI) pharmacist. The intervention consisted of pharmacist-led medication review using Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria, patient education on recommendations, an updated medication list, and a letter sent to their general practitioner (GP) electronically. For eligible consenting older adults, telephone calls were made at least 28 days post-discharge to assess the effectiveness of the intervention. A survey with GPs after 6 months determined how recommendations were perceived. Ethics approval was granted by the Metro North Health B Human Research Ethics Committee (reference no: HREC/18QCH/69–1245) and research governance approval was granted by the study site (Cairns Hinterland Hospital and Health Service, reference no: SSA/Q12345/40673). Informed consent was obtained from all participants via a project information sheet and either the completion of a written consent form (patient participants), verbal consent before interview (GP participants), or implied consent via email responses (GP participants). Routinely collected health data obtained for this study were de-identified and data included in the follow-up study was de-identified.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The GEDI pharmacist reviewed 1214 older adults with an average age of 81 years. The median number of prescribed medications was 10 and 36.8% of older adults had STOPP recommendations. When contacted (&lt;i&gt;n&lt;/i&gt; = 35), of those enrolled in the follow-up study, 71% had stated their medications changed, 40% reported all STOPP medications had ceased, and 69% had START medications commenced, suggesting the recommendations provided were clinically appropriate and readily accepted by their GPs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Integration of a geriatric pharmacist demonstrated ample opportunities to address PIP in targeted olde","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 2","pages":"125-134"},"PeriodicalIF":2.1,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138963663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fred J Boyd 2023 oration","authors":"M. Kay Dunkley BPharm, GradDipHospPharm, GradDipHealthAdmin, FANZCAP (Lead&Mgmt), MSHPA, MPSA","doi":"10.1002/jppr.1899","DOIUrl":"10.1002/jppr.1899","url":null,"abstract":"","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"53 6","pages":"359-361"},"PeriodicalIF":1.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138965934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of kidney function for medication dosing in adult patients with chronic kidney disease: a practice update","authors":"Sanja Mirkov BPharm, PGDipPH,&nbsp;Carla Scuderi MClinPharm, BPharm,&nbsp;Jess Lloyd BPharm, GradDipClinPharm,,&nbsp;John Coutsouvelis PhD, MClinPharm, BPharm, FSHP,&nbsp;Shaun O'Connor BPharm, MSHP,&nbsp;Simon Potts BPharm, BSc (Hons),&nbsp;Suzanne Newman BPharm, GradDipHospPharm,&nbsp;Jason Roberts PhD, BPharm (Hons), BAppSc, FSHP, FISAC, FAHMS","doi":"10.1002/jppr.1884","DOIUrl":"10.1002/jppr.1884","url":null,"abstract":"<p>Chronic kidney disease (CKD) is a major health concern with a growing disease burden and inequalities in access to treatments. Glomerular filtration rate (GFR) is accepted as the best overall measure of kidney function and is considered the most important measure for medications cleared by the kidneys. In clinical practice, equations that estimate GFR using validated prediction equations are routinely used. This practice update was developed by a Working Group comprising clinical pharmacists representing the Society of Hospital Pharmacists of Australia (SHPA) Specialty Practice streams of Nephrology, Oncology and haematology, Critical care and Infectious diseases. It is intended to provide practical recommendations for clinical pharmacists who use equations to estimate GFR for medication dosing decisions. The limitations of the various equations in use — such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the Cockcroft–Gault equation and Modification of Diet in Renal Disease — are summarised and compared to direct measures of kidney function using exogenous markers. The CKD-EPI equation is recommended to be used routinely as a primary measure of kidney function. Dose adjustments should also consider medication-specific, patient-related, and disease-related characteristics. Kidney function and the response to therapy should be continuously assessed by monitoring the signs, symptoms and disease outcomes, the emergence of adverse reactions or medication-induced disorders and use therapeutic drug monitoring (if available) to adjust doses accordingly.</p>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 1","pages":"94-106"},"PeriodicalIF":2.1,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1884","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136282180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}