Journal of Pharmacy Technology

The benefit of pharmacist-run clinics for anticoagulation, dyslipidemia, diabetes, and hypertension has been described in the literature as individual services. We describe a clinic model in which anticoagulation and other chronic disease states are managed concomitantly.

To evaluate the control of anticoagulation, hypertension, dyslipidemia, and diabetes in anticoagulation patients enrolled in a pharmacotherapy/anticoagulation clinic.

Patients seen in the pharmacotherapy/anticoagulation clinic for management of anticoagulation were included in a retrospective review. Demographic information, blood pressure measurements, and laboratory values were recorded. Initial and final results were compared and statistically analyzed. Benchmark goals were set for each parameter analyzed.

Between August 2007 and July 2008, 282 patients were enrolled in the clinic. While slightly increasing the average time in therapeutic range from 69.9% to 70.7%, the clinical pharmacists also managed hypertension, dyslipidemia, and diabetes, if present. Systolic (p = 0.0075; 95% CI 0.98 to 6.31) and diastolic (p = 0.004; 95% CI 1.26 to 4.33) blood pressures decreased during the study period such that the number of patients with controlled blood pressure increased to 81%. Low-density lipoprotein cholesterol measurements decreased by an average of 5.9 mg/dL (p < 0.0001; 95% CI 3.121 to 8.789), with an increase in number of patients at goal to 86%. Although not significant, mean hemoglobin A_1c (A1C) values decreased an average of 0.12% (p = 0.1138; 95% CI 0.029 to 0.271), with an increase to 59% of those achieving a goal A1C.

A pharmacotherapy/anticoagulation clinic can be considered a practice model for effective management of anticoagulation patients who require management of other chronic disease states.

Although increased patient access and reimbursement opportunities are available through medication therapy management (MTM), strategies must be employed to decrease barriers to providing MTM services in a retail pharmacy.

To describe a program for training community pharmacy technicians about their role in the provision of MTM services while evaluating their attitudes about and understanding of MTM.

A training program was developed for community pharmacy technicians, aimed at defining MTM and designating nonclinical skills that can be developed to decrease the burden on pharmacists who perform MTM. All pharmacy technicians within a zone of a supermarket chain were invited to participate in the training program. Immediately prior to the training program, participants completed a pretest survey. After the training program, technicians completed a posttest survey. Surveys were designed to capture technicians' understanding of MTM and their attitudes about performing functions in the MTM process.

Of 150 technicians available in the designated zone, 28 volunteered to complete the MTM training program and surveys. More technicians responded that they believe that they have a role in MTM services after the training program (21.4%) than did before the training program (3.6%). Posttest results, compared with pretest results, indicated that technicians strongly agreed that they can help with MTM services (p < 0.01). Posttest responses showed that more technicians agreed that MTM services are important for patients, compared with pretest responses.

Participants indicated that they are willing to help pharmacists complete MTM cases by performing nonclinical tasks. The widespread use of MTM training programs for pharmacy technicians is necessary to evaluate effective ways to prepare pharmacy technicians to assist with the MTM process.

To review the literature available on the use of methylnaltrexone, a peripherally acting quaternary opioid antagonist, approved for the treatment of opioid-induced constipation (OIC) in patients with advanced illness who are receiving palliative care, when response to laxative therapy has not been sufficient.

Primary literature and review articles were obtained via a MEDLINE search (1992–2009), using the key term methylnaltrexone. Additional articles were identified from the bibliographies of reviewed literature.

English-language articles identified from the data sources were reviewed. Randomized controlled trials were evaluated to assess the efficacy of methylnaltrexone.

Opioids are the cornerstone of therapy for moderate-to-severe pain in patients with serious illness. The prevalence of OIC approaches 90% of patients with advanced illness. The symptoms associated with constipation include abdominal pain and distention, nausea and vomiting, and anorexia. For patients, this can become a significant source of distress and pain. Complications associated with fecal impaction, such as incontinence and confusion, may occur. OIC is currently managed with a variety of commercially available laxatives, stool softeners, suppositories, or enemas; however, they may be compromised by poor response, adverse effects such as bloating or cramping, or other outcomes that may impair quality of life, such as pill burden or unpredictable timing of laxation. Naloxone, an opioid antagonist, has been considered for the treatment of refractory OIC. It has low oral bioavailability but the relatively high doses required and variations in individual sensitivity to the drug may result in enough systemic absorption to reverse analgesia or induce central nervous system opioid withdrawal. To avoid these centrally mediated effects, new compounds that have little ability to cross the blood-brain barrier have been developed. Methylnaltrexone is a peripherally acting quaternary opioid antagonist approved for the treatment of OIC. It does not cross the blood-brain barrier in humans and offers the therapeutic potential to reverse adverse effects of opioid pain medications mediated by receptors peripherally located (eg, in the gastrointestinal tract). This effect is critical because it spares the opioid effects mediated at receptors in the central nervous system, most importantly analgesia, and has been proven to be effective in the treatment of OIC.

Methylnaltrexone appears to be an effective treatment option for OIC.

To review the current data on the role of antioxidant vitamins in cardiovascular disease.

Articles were obtained from a MEDLINE search covering all years. Terms used in the search included combinations of antioxidant, vitamin, vitamin E, vitamin C, beta-carotene, and cardiovascular disease. Reference lists from articles were examined for additional references.

Randomized clinical trials were selected and evaluated for study design and data obtained. Observational studies, meta-analyses, and basic science articles were also reviewed for background.

The use of dietary supplements, including vitamins, minerals, and herbal products, is common among patients in the US. Vitamin E, vitamin C, and beta-carotene are all supplements with reported antioxidant activity. Because oxidative stress has been implicated in the development of cardiovascular disease, there has been significant research at the basic science level as well as observational studies and randomized placebo-controlled trials examining the potential impact of vitamin E, vitamin C, and beta-carotene in the prevention and treatment of cardiovascular disease. While basic science data and data from observational studies have identified benefit from antioxidant vitamin supplementation, randomized clinical trials have failed to support a role for antioxidant vitamin supplementation in the prevention or treatment of cardiovascular disease.

Data from randomized clinical trials do not support the use of antioxidant vitamins in cardiovascular disease. Therefore, antioxidant vitamins should not be recommended to patients for prevention or treatment of cardiovascular disease.

To review the role of tapentadol in the treatment of moderate-to-severe acute pain.

Primary literature was retrieved by searching MEDLINE (1950–August Week 3, 2010), EMBASE (1980–Week 34, 2010), International Pharmaceutical Abstracts (1970-August 2010), and Google Scholar, A bibliographic review of published articles was also performed. Search terms included tapentadol, Nucynta, and acute pain.

Randomized controlled trials available in the English language that evaluated the efficacy and/or safety of tapentadol were included in this review.

Tapentadol is a centrally acting analgesic that simultaneously activates μ-opioid receptors and inhibits the reuptake of norepinephrine in the central nervous system without affecting serotonin reuptake. We identified 6 randomized controlled trials that evaluated the use of tapentadol in over 3,000 adult patients in various acute pain models. Tapentadol was found to be superior to placebo for the management of moderate-to-severe acute pain and was found to be noninferior to oxycodone in the setting of post-bunionectomy pain and acute pain related to end-stage joint disease. Although the incidence of somnolence and dizziness was similar to that of oxycodone, tapentadol was less likely to cause nausea, vomiting, or constipation.

Tapentadol is a novel analgesic with dual mechanisms of action that appears to be safe and effective for the management of moderate-to-severe acute pain. Future studies should focus on comparative efficacy as well as the role of tapentadol in chronic pain.

Desvenlafaxine is the major active metabolite of the serotonin norepinephrine reuptake inhibitor venlafaxine and is prescribed for the treatment of major depressive disorder.

To compare desvenlafaxine and venlafaxine ingestions reported to a statewide poison center system.

Cases included all desvenlafaxine and venlafaxine ingestions reported to Texas poison centers during 2008–2009. The distribution of all cases by selected demographic factors was identified. After cases that involved coingestants and/or were not followed to a final medical outcome were excluded, the distribution of the remaining cases by clinical and management factors was determined.

There were 144 desvenlafaxine and 777 venlafaxine ingestions. The distribution of desvenlafaxine and venlafaxine ingestions was, respectively, female patients 61.8% versus 64.2%, age 0–5 years 31.9% versus 19.3%, unintentional 47.2% versus 39.8%, and involving no coingestants 56.3% versus 46.7%. There were no coingestants and the medical outcome was known for 47 desvenlafaxine and 208 venlafaxine cases. The distribution of this subset of ingestions was, respectively, managed on site 40.4% versus 24.0%, already at or en route to a health-care facility 36.2% versus 52.9%, and referred to a health-care facility 23.4% versus 23.1%. The medical outcome was no effect 72.3% versus 56.3%, minor 14.9% versus 26.4%, moderate 10.6% versus 14.9%, and major 2.1% versus 2.4% for desvenlafaxine and venlafaxine, respectively.

The patterns of desvenlafaxine and venlafaxine ingestions were generally similar. However, desvenlafaxine ingestions were more likely to involve young children, be unintentional, not involve coingestants, be managed on site, and involve no effect.