Journal of the American Pharmacists Association最新文献

{"title":"Probable chlorthalidone-induced hypokalemic rhabdomyolysis","authors":"Gagandeep Singh,&nbsp;Caitlin Canton,&nbsp;Diana R. Langworthy","doi":"10.1016/j.japh.2024.102249","DOIUrl":"10.1016/j.japh.2024.102249","url":null,"abstract":"<div><h3>Purpose</h3><div>A case of hypokalemic rhabdomyolysis related to chlorthalidone use is reported</div></div><div><h3>Case</h3><div>A 52-year-old male was admitted to the hospital for acute onset generalized weakness and was found to have severe hypokalemia and rhabdomyolysis. The patient had been on chlorthalidone therapy with a dose increase from 25 mg daily to 50 mg daily 2 months prior to admission. Extensive workup ruled out neurologic, rheumatologic, and endocrinologic causes of hypokalemia. In the absence of other causes, it was determined that the patient was experiencing a severe presentation of chlorthalidone-induced hypokalemia resulting in rhabdomyolysis. The patient’s rhabdomyolysis and weakness improved with aggressive potassium correction, and potassium wasting eventually resolved with discontinuation of chlorthalidone.</div></div><div><h3>Conclusion</h3><div>Although mild hypokalemia is a known side effect of thiazide and thiazide-like diuretics, health care providers should be aware of the possibility of severe manifestations of this adverse reaction, even at relatively small dose increases.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 6","pages":"Article 102249"},"PeriodicalIF":2.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orlando Veterans Affairs stratification tool for opioid risk mitigation (STORM) very high risk interdisciplinary team review: A brief report","authors":"Lauren Hundley,&nbsp;Dalena Nguyen,&nbsp;Anna Alexander,&nbsp;Mariellen Moore,&nbsp;Christina Coakley,&nbsp;Tho Nguyen,&nbsp;Jenny Szabo,&nbsp;Kimberly Reno-Ly","doi":"10.1016/j.japh.2024.102250","DOIUrl":"10.1016/j.japh.2024.102250","url":null,"abstract":"<div><h3>Background</h3><div>Compared to the general population, Veterans Health Administration (VHA) patients have higher rates of mental illness, chronic pain, and substance use disorders (SUD), conditions that increase risk for opioid-related adverse events. VHA developed the Stratification Tool for Opioid Risk Mitigation (STORM) and mandated case reviews by an interdisciplinary team (IDT) for patients identified as very high risk, a process implemented and led by clinical pharmacist practitioners at the Orlando Veterans Affairs Healthcare System (OVAHCS) in 2018.</div></div><div><h3>Objective</h3><div>To evaluate and describe the implementation and process for IDT reviews of patients identified as very high risk by the STORM clinical decision support tool at OVAHCS.</div></div><div><h3>Methods</h3><div>A single center, retrospective, observational chart review was conducted. Veterans reviewed by the STORM IDT between January and September 2018 were reviewed for change in Morphine Equivalent Daily Dose (MEDD), naloxone, nonopioid analgesics, medications for SUD, benzodiazepines, engagement with clinical services (e.g., mental health, SUD, and pain clinic), and overdose or suicide attempts in the year prior versus the year after IDT review. The frequency of follow-up IDT reviews was evaluated.</div></div><div><h3>Results</h3><div>Seventeen patients were identified. Four were excluded due to nonopioid related death within 12 months after review. The average baseline MEDD was 82.2 mg (range 10–496 mg) and average 12 months after review was 7.5 mg (range 0 – 67.5 mg), a decrease of 74.7 mg, or 90.9% reduction. An increase in medications for SUD (3 patients; 23%), SUD engagement (3 to 6 patients), and urine drug tests was observed (79% increase). Benzodiazepine use decreased by 50%.</div></div><div><h3>Conclusion</h3><div>This report provides insight on the IDT case review process at OVAHCS, a process that may vary widely across facilities. A reduction in MEDD, increase in SUD treatment, and improved risk mitigation was observed. The central role of clinical pharmacy and expanded process for continued follow-up warrants further study.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 6","pages":"Article 102250"},"PeriodicalIF":2.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Megesterol acetate as an overlooked cause of hyperglycemia in end-stage renal disease: A case of polypharmacy","authors":"John Aurora Jr.,&nbsp;Theresa Zheng,&nbsp;Julieta Rossi Fortunati,&nbsp;Feyza Erenler","doi":"10.1016/j.japh.2024.102248","DOIUrl":"10.1016/j.japh.2024.102248","url":null,"abstract":"<div><h3>Background</h3><div>This case report highlights an overlooked cause of hyperglycemia and risk of polypharmacy in a patient with end-stage renal disease (ESRD).</div></div><div><h3>Case summary</h3><div>A 75-year-old non-English speaking male with type 2 diabetes mellitus, hypertension, coronary artery disease status post percutaneous coronary intervention, and ESRD secondary to immunoglobulin G kappa nephropathy on nightly peritoneal dialysis reported a loss of appetite, decrease in weight, and an increase in symptoms of depression. As a result of these symptoms, his nephrologist initiated megestrol acetate (MA), an agent commonly used in ESRD to help stimulate appetite and improve weight. After starting MA, his blood glucose (BG) significantly worsened, due to its glucocorticoid properties. Basal insulin was started to manage his hyperglycemia, but there was minimal improvement in BG. As the patient was referred to the endocrinology clinical pharmacist for diabetes management, it was identified that his weight loss began after starting dulaglutide, which led to a weight loss of 11 kg (12.9%). The Naranjo algorithm was used, and he had a score of 6, which is a probable reaction. The patient’s endocrinology and nephrology teams agreed to discontinue MA and dulaglutide as they resulted in opposing effects on appetite and BG, as well as insulin glargine. The patient’s BG was tightly controlled off MA and his appetite, weight, and mood improved off dulaglutide.</div></div><div><h3>Practice implications</h3><div>This case report reflects the potential effects of polypharmacy in ESRD, resulting in poor patient outcomes and drug interactions. It is imperative that a comprehensive medication reconciliation is completed on all patients, especially for patients on dialysis. It is also important for healthcare professionals to be cognizant of medications that may exhibit glucocorticoid properties, which can cause hyperglycemia. Including a clinical pharmacist in the care team can assist with medication reconciliation, screening for drug interactions and polypharmacy, and optimizing chronic disease management.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 6","pages":"Article 102248"},"PeriodicalIF":2.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a pharmacist-led multidisciplinary approach to the treatment of latent tuberculosis in refugee patients in the primary care setting","authors":"Sara Farooqi,&nbsp;Lara Horvath,&nbsp;Eddie Miljkovic,&nbsp;Ayan Mohamed,&nbsp;Sha-Phawn Williams","doi":"10.1016/j.japh.2024.102246","DOIUrl":"10.1016/j.japh.2024.102246","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of latent tuberculosis infection (LTBI) is essential for refugee patients who have been relocated to the United States to prevent progression to active infection.</div></div><div><h3>Objective</h3><div>This study aimed to determine the effectiveness of a multidisciplinary team approach, embedded within a primary care clinic, to treatment of LTBI in newly resettled refugee patients compared with a local health department.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective chart review of newly resettled refugee patients 18-89 years old with a diagnosis of LTBI. The primary objective was completion rate of LTBI therapy within 1 year of resettlement. Secondary objectives were incidence of adverse events, regimen switches, and adherence rate.</div></div><div><h3>Results</h3><div>A total of 58 patients were included in the study: 14 individuals through the multidisciplinary clinic and 44 individuals with the local health department. Completion of therapy within 1 year of resettlement was seen in 71.4% of patients (n = 10) in the multidisciplinary clinic compared with 72.7% (n = 32) at the health department. There were 7 patients who underwent a regimen switch, all of whom were in the health department arm. Adverse effects occurred in 14.2% of patients in the multidisciplinary clinic and 15.9% of patients in the health department arm. Treatment adherence was 98.6% in the multidisciplinary clinic and 90.5% in the local health department arm.</div></div><div><h3>Conclusion</h3><div>Use of a multidisciplinary team was successful in completion of LTBI treatment in refugee patients, helping to alleviate barriers to treatment completion by ensuring adherence and close follow-up.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 6","pages":"Article 102246"},"PeriodicalIF":2.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a drug deactivation system for safe disposal of opioids after ambulatory surgery","authors":"William C. Oles,&nbsp;Eric S. Vilsmark,&nbsp;Carly Magoon,&nbsp;Kate Weathersbee,&nbsp;Francis Melaragni,&nbsp;Antje M. Barreveld","doi":"10.1016/j.japh.2024.102247","DOIUrl":"10.1016/j.japh.2024.102247","url":null,"abstract":"<div><h3>Background</h3><div>Prescription opioids are commonly prescribed postoperatively and increase the risk of diversion or misuse when left unused and accessible. Despite awareness of the risks associated with unused opioids, harm reduction strategies like safe storage and drug take-back events may be limited by inconvenience and patient-specific barriers to access.</div></div><div><h3>Objective</h3><div>To evaluate a quality improvement project designed to facilitate at-home disposal of unused opioids after day surgery.</div></div><div><h3>Methods</h3><div>An observational, prospective quality improvement project was conducted in patients undergoing elective outpatient surgery at Newton-Wellesley Hospital from December 2019 to June 2020. Upon discharge, eligible patients received a Deterra drug disposal packet which deactivates unused medication. Follow-up surveys assessed packet use and reasons for nonuse 1 to 2 weeks after surgery.</div></div><div><h3>Results</h3><div>One hundred six participants received a disposal packet and responded to the survey. Among the 67 respondents with unused medication, 30% used the packet. Women were more likely to use the packet than men (predicted probability 30.2% vs. 10.4%, <em>P</em> = 0.033), and patients aged 18–25 were more likely to use the packet than those aged 26–40 (40.0% vs. 9.5%, <em>P</em> = 0.049). The most common reasons for packet nonuse included procrastination, holding onto prescriptions in case of future pain, and waiting to dispose of multiple medications.</div></div><div><h3>Conclusion</h3><div>The majority of patients surveyed had unused opioids 1 to 2 weeks after surgery, and approximately 1 in 3 patients with unused doses utilized the disposal packet. Common reasons for nonuse included procrastination and concerns about needing future medication for pain. Going forward, safe drug disposal efforts may emphasize improved patient education, partial prescription fill options, or alert systems to remind patients to safely dispose of unused medication.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 6","pages":"Article 102247"},"PeriodicalIF":2.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of health literacy-conscious medication educational videos on primary medication nonadherence rates","authors":"Mel Nelson,&nbsp;Carlyn E. Vogel,&nbsp;Alexis Caronis,&nbsp;Joel Montavon,&nbsp;Patrick J. Campbell","doi":"10.1016/j.japh.2024.102219","DOIUrl":"10.1016/j.japh.2024.102219","url":null,"abstract":"<div><h3>Background</h3><div>Primary medication nonadherence (PMN) occurs when a new medication is prescribed, but the patient does not obtain the medication, or an appropriate alternative. Medication knowledge may be a factor contributing to high PMN rates. A variety of approaches and technologies have been developed to enhance patient medication knowledge, though the impact of these interventions on PMN rates has not been studied.</div></div><div><h3>Objectives</h3><div>The objectives of this study were to: 1) compare community pharmacy PMN rates between pharmacies that offer patient medication educational video services and those that do not, and 2) assess the relationships between video service delivery and PMN status.</div></div><div><h3>Methods</h3><div>This cohort study utilized data from 6 pharmacies (3 case and 3 control). Adult individuals with a new electronic prescription for medications were assessed for PMN using the Pharmacy Quality Alliance measure specifications. A 6-month measurement period was used to assess if medications or an appropriate alternative were dispensed within 30 days. Descriptive statistics were used to evaluate differences in PMN rates between case and control pharmacies. The relationships between medication education video service use and PMN status were assessed using multivariable logistic regression models.</div></div><div><h3>Results</h3><div>A total of 4038 patients were included in the analyses, contributing 6311 prescriptions for PMN assessment. Case pharmacies had significantly lower (25.9% vs. 29.1%) PMN rates than control pharmacies (<em>P</em> = 0.0090). Prescriptions filled at pharmacies that utilized medication educational videos had lower odds of PMN status [odds ratio (OR) = 0.58 (0.43, 0.78)] than controls. Video use was associated with lower odds of PMN status [OR = 0.83 (0.70, 0.98)] when compared to prescriptions where patients did not receive the service.</div></div><div><h3>Conclusions</h3><div>The use of health literacy-conscious, patient educational videos were associated with improved (lower) PMN rates. Medication education technologies represent a scalable solution to improve PMN and medication access.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 6","pages":"Article 102219"},"PeriodicalIF":2.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploration of network facilitator experiences implementing payer-partner programs within a nationwide clinically integrated network","authors":"Jessica B. Finke,&nbsp;Cody Clifton,&nbsp;Laura A. Rhodes","doi":"10.1016/j.japh.2024.102240","DOIUrl":"10.1016/j.japh.2024.102240","url":null,"abstract":"<div><h3>Background</h3><div>The Community Pharmacy Enhanced Services Network (CPESN) is a clinically integrated network (CIN) of approximately 3500 community-based pharmacies in 48 local networks across the United States. CPESN USA promotes expansion of innovative programs within community-based pharmacies including value-based contracting for patient care services. As opportunities grow, it is important to define strategies and tools needed to implement payer-partner programs.</div></div><div><h3>Objective</h3><div>This study aimed to explore strategies and resources used when implementing payer-partner programs within a CIN.</div></div><div><h3>Methods</h3><div>This cross-sectional electronic survey was e-mailed to 48 managing network facilitators (MNFs) representing 48 local CPESN networks across the United States. An electronic survey was e-mailed to the MNF of each local CPESN network. Fourteen questions collected the MNFs experience with (1) opportunities at the local network, (2) resources found helpful for implementing payer-partner programs, (3) barriers to implementing payer-partner programs, (4) confidence with tasks related to payer-partner program implementation, and (5) reporting what types of teammates they work with or manage when implementing a payer-partner program. The survey was open for data collection for 65 days. Data were analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>A total of 42 completed surveys were returned (response rate, 87.5%). MNFs ranked the barriers most frequently experienced as buy-in effect (n = 16, 41.0%) and management of pharmacy/network follow-through (n = 11, 28.2%). MNFs reported helpful resources for program implementation as peer-to-peer guidance (n = 31, 79.5%) and program handouts/guides (n = 30, 76.9%). MNFs reported additional resources needed as subject matter experts (n = 23, 59.0%) and templated communications (n = 22, 56.4%). MNFs expressed their highest levels of confidence in tasks related to leadership management (n = 30, 76.9%) and implementing programs (n = 28, 71.8%).</div></div><div><h3>Conclusion</h3><div>Barriers to payer-partner program implementation within the CIN were buy-in effect, management of pharmacy/network follow-through, management of peers, and management of pharmacy/network implementation. Leaders within the CIN reported desires for a toolkit that iterates successful strategies and education on building community and accountability within local networks. Development of tailored support and resources can enhance the capacity of network leaders to scale payer-partner programs within community-based pharmacies.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 6","pages":"Article 102240"},"PeriodicalIF":2.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Student pharmacists lead the charge at 2024 APhA–ASP HoD","authors":"Mark Nagel","doi":"10.1016/j.japh.2024.102206","DOIUrl":"10.1016/j.japh.2024.102206","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 5","pages":"Article 102206"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The age of the machine is here … are you ready?","authors":"Wendy Mobley-Bukstein","doi":"10.1016/j.japh.2024.102209","DOIUrl":"10.1016/j.japh.2024.102209","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 5","pages":"Article 102209"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"","doi":"10.1016/S1544-3191(24)00260-7","DOIUrl":"10.1016/S1544-3191(24)00260-7","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"64 5","pages":"Article 102234"},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}