Journal of pharmacy practice最新文献

{"title":"Actionable Renal Dosing Content for Nephrotoxic Medications in 4 Drug Information Resources Commonly Used in the United States.","authors":"Heather Ipema, Erika Maslennikov, Faria Munir, Patricia Hartke, Ruba Alomari, Anna Dazy, Alexandra Wierzbiak","doi":"10.1177/08971900251364049","DOIUrl":"https://doi.org/10.1177/08971900251364049","url":null,"abstract":"<p><p><b>Introduction:</b> Inclusion of numeric, actionable renal dosing recommendations in drug information resources enhances the safe use of nephrotoxins. <b>Purpose:</b> The purpose of this study was to systematically and descriptively characterize the renal dose recommendations for nephrotoxic medications in 4 common drug information resources. <b>Methods:</b> A list of nephrotoxins (N = 154) was generated from previously published lists. Renal dosing information was collected for each drug from the package insert, Lexi-comp (now called UpToDate Lexidrug), Micromedex, and Clinical Pharmacology. Dosing recommendations were categorized using a previously published 6-category scale based on whether recommendations were included vs missing, and numeric vs non-numeric. <b>Results:</b> Actionable renal impairment recommendations (numeric, non-numeric, contraindicated, no dose adjustment required) in the package insert, Lexi-comp, Micromedex, and Clinical Pharmacology were present for 88.3%, 98.1%, 94.2%, and 98.1% of drugs, respectively. Numeric recommendations were available for 54.5% to 75.3% of medications, depending on the source. Actionable recommendations for hemodialysis, peritoneal dialysis, continuous renal replacement, and hybrid dialysis modalities were more common in Lexi-comp (83.1%, 75.3%, 62.3%, and 53.9% of medications, respectively) vs the other resources. Actionable pediatric renal impairment (76.0%) and older adult (95.5%) recommendations were also more common in Lexi-comp than other resources. <b>Conclusions:</b> Drug information resources included actionable renal dosing recommendations for most known nephrotoxins, with Lexi-comp being most likely to include this information. Numeric and/or actionable recommendations for specific dosing populations (eg, renal replacement modalities, pediatric renal impairment, older adults) were generally lacking. Lack of agreement among resources suggests a need to check multiple sources in practice.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251364049"},"PeriodicalIF":1.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731912","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":"Fournier's Gangrene Associated With Ertugliflozin.","authors":"Megan Kunka Fritz","doi":"10.1177/08971900251364050","DOIUrl":"https://doi.org/10.1177/08971900251364050","url":null,"abstract":"<p><p>To describe a case of Fournier's gangrene associated with ertugliflozin. A 51-year-old male was admitted due to scrotal pain, urinary urgency, and subjective infectious symptoms. He was diagnosed with Fournier's gangrene, likely related to patient's home medication of ertugliflozin. Management and hospital course included antimicrobial and antifungal courses and was complicated by numerous surgical debridements by the urology team. After over 2 weeks, patient was discharged to rehabilitation facility. This report reiterates the importance of awareness of Fournier's gangrene as a potential adverse event of sodium-glucose cotransporter-2 inhibitors, including ertugliflozin.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251364050"},"PeriodicalIF":1.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731923","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":"Enteral Feeding Tube Administration of Oral Sirolimus Tablets in a Critically Ill Adult.","authors":"Jordan N Livingston, Sarah S Harlan, Dmitry M Yaranov, Julie E Farrar","doi":"10.1177/08971900251364068","DOIUrl":"https://doi.org/10.1177/08971900251364068","url":null,"abstract":"<p><p>Sirolimus is an immunosuppressive agent for solid organ transplant recipients and is commercially available as an oral tablet and liquid solution. Current package labeling does not support crushing tablets for administration via feeding tubes. A 72 year old white male presented to the trauma intensive care unit after a motor vehicle crash with a reported history of an orthotopic cardiac transplantation on maintenance sirolimus and prednisone, both of which were resumed on hospital day 1. During admission, the patient required intubation with placement of a nasogastric tube (NG) due to worsening respiratory status. Sirolimus was subsequently given by crushing the tablet and administering via the NG tube. Prior to sirolimus resumption on hospital day 1, a baseline sirolimus level resulted as 2.4 ng/mL and repeat trough levels of 1.7 ng/mL and 2.1 ng/mL were obtained on hospital days 17 and 24, respectively. The patient was discharged to a long term care facility after placement of a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube with orders to continue maintenance sirolimus and prednisone administered crushed via PEG tube. This report describes a novel administration method of sirolimus in a critically ill adult with detectable sirolimus levels throughout admission. This administration technique appears to be safe and warrants further investigation as a potentially efficacious alternative to standard oral administration.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251364068"},"PeriodicalIF":1.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731922","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":"Supporting Pharmacists with Legislative Changes: Pharmacist Knowledge and Comfort with Contraception Prescribing.","authors":"Emily J Zielinski, Todd A Walroth, Kala L Sanders, Christopher J Wickesberg, Todd Bailey Cox, Rajarpreet Sandhu, Charity Cicak, Ashley H Meredith","doi":"10.1177/08971900251356350","DOIUrl":"https://doi.org/10.1177/08971900251356350","url":null,"abstract":"<p><p>BackgroundDue to contraceptive access scarcity and other variables, the U.S. exhibits high rates of unintended pregnancy, and Healthy People 2030 has a goal to address this through increased use of birth control. In 2023, Indiana passed legislation allowing pharmacists to prescribe self-administered contraception. Uptake of pharmacist contraceptive prescribing has been limited, and many states are not utilizing this opportunity to advance reproductive equity. We aimed to address significant gaps in literature assessing pharmacists' comfortability and knowledge regarding the implementation and utilization of this protocol.ObjectivesThe purpose of this study was to evaluate pharmacists' comfort and knowledge level before and after a formal education program on conducting contraceptive care via a pharmacist-driven protocol.MethodsThis was a retrospective, cohort study conducted at a safety-net, academic medical center in Indianapolis, Indiana. A formal education program with associated pharmacist surveys took place over two training sessions in November and December 2023.ResultsA total of 30 paired pre- and post-pharmacist surveys were included in analysis (63% response rate). The median [IQR] composite score (knowledge and comfort level) increased pre- vs post-survey from 38 [34,57] to 86 [81,91] (<i>P</i> < .001). Overall correct median [IQR] knowledge scores increased from 40% [40,50] to 70% [60,80] (<i>P</i> < .001). Overall median [IQR] comfort level scores increased from 36% [27,68] to 95% [86 100] (<i>P</i> < .001).ConclusionFollowing completion of a formal education program, pharmacists demonstrated an increase in knowledge and comfort level with prescribing contraception. Intentional training opportunities should be provided to pharmacists prior to implementation. Other health-systems could benefit from offering a similar program.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251356350"},"PeriodicalIF":1.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649801","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":"Revisiting Rhinitis Medicamentosa: Examining the Evidence on Topical Nasal Decongestants.","authors":"Martina Hagen, Gabor Varbiro, Elisa Montanari, Mariane Ballerini Fernandes","doi":"10.1177/08971900251350510","DOIUrl":"10.1177/08971900251350510","url":null,"abstract":"<p><p><b>Background:</b> Over-the-counter topical nasal decongestants are effective and well-tolerated treatments for the temporary relief of nasal congestion, a symptom that can impair quality of life. Their duration of use is limited owing to potential for rhinitis medicamentosa (RM) or rebound congestion (RC), despite uncertainties around the clinical occurrence or onset of these phenomena. <b>Objective:</b> To investigate the clinical occurrence and onset of RM, RC or tolerance with topical nasal decongestants to inform evidence-based recommendation practices for pharmacists and ensure patients do not forego potentially beneficial treatments. <b>Methods:</b> A literature search was conducted with ProQuest to identify and synthesize evidence on RM, RC or tolerance with nasal decongestant sprays or drops. A respiratory specialist and community pharmacist provided clinical perspectives. <b>Results:</b> Eighteen articles were assessed, reporting 13 studies with oxymetazoline, five studies with xylometazoline. There was no evidence of RM or RC after 7 days with oxymetazoline (up to 400 μg total daily dose) or up to 10-days with xylometazoline (840 μg total daily dose). Well-designed studies suggested no occurrence of RM, RC or tolerance with up to 4 weeks of oxymetazoline. No studies evaluating naphazoline, phenylephrine or ephedrine were identified. <b>Conclusion:</b> Oxymetazoline and xylometazoline are highly effective at rapidly improving nasal congestion and have well-established safety profiles. Well-designed studies yielded no evidence of RM, RC or tolerance when used short-term at commonly recommended dosing and frequency. Since some patients may exceed the duration of use in the label, pharmacists can play a vital role in counseling patients on proper intranasal decongestant use and treatment duration.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251350510"},"PeriodicalIF":1.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528464","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":"Managing Resistant Hypertension in Rural Veterans: A Pharmacist-Led Telehealth Approach.","authors":"Jordan Burnette, Taylor Maynard","doi":"10.1177/08971900251356009","DOIUrl":"https://doi.org/10.1177/08971900251356009","url":null,"abstract":"<p><p>This case study explores the role that pharmacists can have managing resistant hypertension (RH) in rural Appalachian veterans, where health care access is limited. RH, defined as blood pressure above target despite adherence to multiple antihypertensive medications, presents challenges in chronic disease management. The Department of Veterans Affairs (VA) has integrated CPPs to improve medication adherence, reduce hospitalizations, and enhance blood pressure control, particularly in underserved areas. The patient, a 65-year-old male veteran with hypertension, obstructive sleep apnea, depression, and PTSD, had struggled with poorly controlled hypertension for years, experiencing adverse reactions to multiple antihypertensive medications. Living more than 60 minutes from the nearest VA facility, he had not seen his primary care provider since early 2021, exacerbating his condition. Despite initial reluctance to restart medications, the CPP implemented a stepwise management approach, utilizing telehealth for remote blood pressure monitoring and regular follow-ups. Over several months, pharmacologic therapy combined with lifestyle modifications led to significant blood pressure improvement. This case highlights the crucial role of CPPs in rural health care, offering accessible, continuous care and personalized management of complex conditions. Telehealth and remote monitoring further facilitated care, overcoming geographic barriers and enhancing patient engagement. The collaboration between pharmacists and specialists ensured comprehensive care and optimized treatment. This case demonstrates the potential for expanding CPP roles in rural areas to improve chronic disease management, reduce health care disparities, and enhance patient outcomes through telehealth and team-based care.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251356009"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506047","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":"Safety of Intravenous Push Levetiracetam in an Academic Children's Hospital.","authors":"Aneesha Santhosh, Daniel Abazia, Jessica Lise, Nadia Awad","doi":"10.1177/08971900251355333","DOIUrl":"https://doi.org/10.1177/08971900251355333","url":null,"abstract":"<p><p><b>Background:</b> Evidence supports the safe administration of levetiracetam as a rapid intravenous push (IVP) in patients experiencing breakthrough seizures or status epilepticus. Use of this route of administration may decrease morbidity and mortality by reducing time to medication delivery. Though this practice has become increasingly common in adults, the safety of IVP levetiracetam in pediatric patients is not well documented. <b>Objective:</b> To evaluate the safety of IVP levetiracetam in pediatric patients. <b>Methods:</b> Patients who received IV piggyback (IVPB) or IVP levetiracetam and were between the ages of 12 months and 18 years old were eligible for inclusion. Medication regimen data recorded includes the dose of levetiracetam, number of doses administered, and total days of administration. Additionally, time points related to order entry, pharmacist verification, and dose administration was recorded. Safety endpoints included rates of bradycardia, hypotension, behavioral changes, and cutaneous drug reactions. Descriptive and inferential statistical analysis was performed using SPSS software. <b>Results:</b> This study showed IVP levetiracetam has a similar rate of adverse effects when compared to IVPB levetiracetam in patients over the age of one (5.5% vs 7.5%, <i>P</i> = 0.3589). In addition, there was improvement in the time to administration of levetiracetam (50 min in the IVPB group and 23 min in the IVP group [<i>P</i> = .0008]). <b>Conclusion:</b> Pediatric patients who received undiluted (100 mg/mL) levetiracetam IVP over 5 min had a similar adverse event incidence when compared to those who received the anti-epileptic drug (AED) as an IVPB. This evaluation demonstrated that doses up to 1500 mg of undiluted IVP levetiracetam is safe for pediatric patients.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251355333"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505967","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":"Chronic Hepatitis C Treatment Failure With Crushed Sofosbuvir/Velpatasvir in a Patient With Total Parenteral Nutrition-dependent Short Bowel Syndrome.","authors":"Noelle E Nelson","doi":"10.1177/08971900251352671","DOIUrl":"https://doi.org/10.1177/08971900251352671","url":null,"abstract":"<p><p>We present the case of a 61-year-old patient infected with chronic hepatitis C virus (HCV) genotype 3, F1 fibrosis and history of short bowel syndrome, dependent on total parenteral nutrition (TPN) who was referred to the clinical pharmacist for HCV treatment. Following 12 weeks of treatment with crushed, orally administered sofosbuvir/velpatasvir (SOF/VEL) the patient was unable to achieve sustained virologic response (SVR12), suggesting that this therapy may be ineffective in patients with short bowel syndrome.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251352671"},"PeriodicalIF":1.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310064","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":"From Theory to Therapy: Methylene Blue's Emerging Role in the Management of Septic Shock.","authors":"Brooke A Smith, Rachel Robinson, Amoreena K Most","doi":"10.1177/08971900251350554","DOIUrl":"https://doi.org/10.1177/08971900251350554","url":null,"abstract":"<p><p><b>Purpose:</b> Methylene blue was FDA-approved for the treatment of acquired methemoglobinemia. However, it has also shown benefits in other disease states such as β-blocker and calcium channel blocker overdoses, vasoplegia, and ifosfamide-induced encephalopathy. More recently, methylene blue has emerged as a potential catecholamine sparing agent for the treatment of septic shock through inhibition of the nitric oxide pathway, which is responsible for vasodilation. Studies suggest that methylene blue decreases vasopressor requirements for critically ill patients with minimal safety risks. This clinical review aims to review the pharmacology, efficacy, and safety surrounding methylene blue use in patients with septic shock. <b>Summary:</b> Six studies conducted between 2000 and 2024 were identified. In randomized studies, methylene blue appears to be safe and effective in improving hemodynamics in patients with septic shock. This review discusses pharmacology, pharmacotherapy, and primary literature surrounding methylene blue in septic shock. <b>Conclusion:</b> Based on review of the available literature, authors conclude that methylene blue is an appropriate catecholamine-sparing treatment option for patients with septic shock. However, drug-drug interactions should be carefully reviewed before administration due to the risk of serotonin syndrome when combined with other serotonergic agents.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251350554"},"PeriodicalIF":1.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258268","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":"Delivering Diabetes Education and Enhanced Services Within a Clinically Integrated Community Pharmacy Network.","authors":"Christopher J Daly, Merin V Panthapattu, Frances Murray, Ryan Lindenau, Amanda A Foster, David M Jacobs","doi":"10.1177/08971900251350509","DOIUrl":"https://doi.org/10.1177/08971900251350509","url":null,"abstract":"<p><p><b>Introduction:</b> With the increasing adoption of alternative payment models (APM) in the U.S. healthcare system there is a growing interest in measuring pharmacy performance with a focus on preventive care and chronic disease management. The Community Pharmacy Enhanced Services Network (CPESN) has been established throughout the U.S. to incorporate high-performing pharmacies to provide enhanced services for high-risk patients including those with diabetes. <b>Methods:</b> The primary objective of this study is to assess the readiness of community pharmacists within CPESN to deliver minimum enhanced services (MES) and diabetes self-management education and support (DSMES) among diabetes patients. A cross-sectional survey was distributed via email to all pharmacies within CPESN New York. Descriptive statistics were utilized to assess survey responses. <b>Results:</b> A total of 84 participants responded to the survey. Top DSMES services offered included: education on blood glucose monitoring (95%), education on lifestyle changes (88%), and monitoring medication adherence to diabetes-related medications (88%). The most time spent per week on DSMES services was for monitoring medication adherence to diabetes-related medications (5.9 +/- 7.0 hours). Top facilitators included technology to execute workflow (55%), adequate workflow design (54%), and proper training for pharmacy personnel (53%). Common barriers in executing services are lack of collaboration with other health professionals (54%) and proper training of pharmacy personnel (49%). <b>Conclusion:</b> CPESN-NY pharmacies demonstrate the opportunity to adapt clinical services including DSMES, which will enhance their performance measures in APMs. Facilitators and barriers have been identified thus next steps in the would be to address how to overcome these barriers.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251350509"},"PeriodicalIF":1.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258267","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}