Journal of Pharmacy Technology

To review the pharmacologic properties of and uses for the most commonly prescribed antiviral agents.

A MEDLINE/PubMed search (1966–September 2010) was conducted for English-language articles using the terms HIV, hepatitis, cytomegalovirus (CMV), herpes simplex virus (HSV), antiviral agents, antiretroviral agent, acyclovir, valganciclovir, valacyclovir, interferon, ribavirin, ritonavir, efavirenz, zidovudine, darunavir, lopinavir, tenofovir, raltegravir, lamivudine, atazanavir, and emtricitabine. Book chapters and recent guidelines pertaining to the pathophysiology or pharmacologic properties of antiviral agents were also reviewed.

Articles, chapters, and guidelines pertaining to the relevant pharmacologic agents were collected for review.

Viral pathogens affect multiple organs, causing direct and indirect damage by activating an immune response. Unlike bacterial infections, which can be eradicated from the host system, viral infections are not curable. Antiviral treatments are prescribed to reduce morbidity and mortality. There are many antiviral and more than 20 antiretroviral agents currently approved by the FDA. These include acyclovir, valacyclovir, and famciclovir for HSV; ganciclovir, valganciclovir, foscarnet, and cidofovir for CMV; interferon and ribavirin for hepatitis; efavirenz, tenofovir, emtricitabine, atazanavir, darunavir, lopinavir, ritonavir, raltegravir, zidovudine, and lamivudine as first-line agents for HIV.

Viral illnesses affect a large portion of the population. Given the multitude of drugs available, pharmacists and pharmacy technicians should be educated about common treatment options. Having a strong knowledge of commonly prescribed antiviral drugs allows these frontline professionals to make a significant impact on the quality of care that they provide to their patients and community.

To provide background on immunizations and community pharmacies and identify opportunities for pharmacy technicians to assist pharmacists in providing community pharmacy-based immunization programs.

Articles were identified through searches of MEDLINE/PubMed (1950–July 2010) with the following search terms: vaccination and technician, immunization and technician, vaccination and pharmacist, and immunization and pharmacist. Additionally, immunization resources from the American Pharmacists Association, the American Society of Health-System Pharmacists, and the Centers for Disease Control and Prevention were used.

Pharmacy technicians can help facilitate immunization programs and help reduce some of the barriers to providing superior services. Specific tasks that can be performed by pharmacy technicians include documentation, billing, assisting in the reporting of adverse events, and facilitating communication. Technicians can also take an active role in pharmacy-based immunization programs by obtaining cardiopulmonary resuscitation training and certification.

Pharmacy technicians can help facilitate immunization programs and help pharmacists offer more robust and comprehensive immunization services.

New and innovative ways to efficiently and effectively deliver pharmacy services are necessary to ensure the future viability of the pharmacy profession. We believe that the practice of telepharmacy may be one potential option for some health-care institutions.

To measure the impact of a satellite telepharmacy on medication adherence by making 340B medication pricing more accessible to uninsured, underserved patients in an urban setting and to assess the level of patient acceptance of pharmacy services provided through the use of a telepharmacy.

A retrospective electronic review of medication claims data submitted by community pharmacies was used to ascertain medication adherence rates of patients using our telepharmacy. Using a 30-day supply, the mean number of days between refills for all prescriptions was determined for each patient at his/her respective pharmacy setting (telepharmacy, retail chain, or both). Statistical analyses were conducted to determine whether significant differences existed in the overall mean number of days between refills for each setting. Additionally, patient satisfaction surveys were distributed to patients using the telepharmacy.

There was no statistically significant difference in the mean (SD) number of days between refills for those using telepharmacy (37.1 [7.3]) versus retail chain (38.8 [10.3]; p = 0.610). Among patients using the telepharmacy, 95/250 (38%) completed patient satisfaction survey questionnaires; 87% indicated that the telepharmacy always made it easier to refill prescriptions, while 85% felt that speaking with the pharmacist through the videotelephone improved medication understanding.

Similar outcomes were observed in the telepharmacy and retail chain settings. Medications were consistently refilled in both settings beyond the time in which they were actually due to be refilled. Patient assessment of the telepharmacy indicated high degrees of satisfaction with accessibility, service, and patient counseling.

To evaluate the scientific rationale and efficacy of pharmacologic and nonpharmacologic treatments for sympathomimetic-induced hyperthermia and related sequelae.

Literature was accessed through MEDLINE (1940-September 2010) using the terms MDMA [3,4-methylenedioxymethamphetamine], methamphetamine, toxicity, and hyperthermia. In addition, reference citations from identified publications were reviewed.

All articles written in English identified from data sources were evaluated.

The treatment of sympathomimetic-induced hyperthermia is a challenging problem for health-care professionals. The lack of clinical trials further complicates the development of evidence-based treatment algorithms. Preclinical studies have mostly been with the sympathomimetic MDMA and have demonstrated a reversal of MDMA-induced hyperthermia with a mixed serotonin 5-HT_1A agonist/5-HT_2A antagonist or mixed α₁- and β_1,2,3-adrenergic receptor antagonists.

Because of the nature by which patients are exposed to these agents, therapeutic interventions for sympathomimetic-mediated hyperthermia still lack evidence from clinical trials with human subjects. Pharmacologic treatments that should be avoided are antipyretics and the ryanodine receptor antagonist dantrolene. Promising future therapies may involve mixed 5-HT_1A agonist/5-HT_2A antagonists such as the atypical antipsychotic olanzapine, or mixed α₁- and β_1,2,3-adrenergic receptor antagonists such as carvedilol, as current preclinical research suggests.

Medication repurposing, the practice of using old drugs in new ways, is becoming more common. Old drugs that had previously fallen out of favor due to safety concerns, lack of efficacy, or development of more desirable therapeutic alternatives have been resurfacing in the literature and on pharmacy shelves. Developing new uses for old drugs may provide patients with access to helpful therapies but may also present challenges and risks.

To explore the rationale for, and historical context of, the developing trend of recycling existing drugs for new, innovative uses, and to provide pharmacy practitioners with information about how to find clinical evidence regarding these new uses.

The process of obtaining marketing approval for new drugs can take an average of over 10 years and exceed $1 billion. Repurposing old drugs (both approved and unapproved) for new uses requires considerably fewer resources since information about production needs, pharmacology, and pharmacokinetics is already known. Other advantages of using old drugs include faster availability for patient use and known safety concerns for the original indication. Disadvantages of new uses for old drugs may include lack of clinical evidence, unknown safety for the new clinical context, limited availability of information about new uses, and liability or legal concerns. Several methods of identifying potential new uses exist, including the observance of previously unknown desirable pharmacologic effects during clinical use, new knowledge of a mechanism of action leading to exploration of innovative therapeutic areas, or screening compound libraries for targeted clinical activity.

There are many examples of recycling existing medications for new purposes. Pharmacy practitioners should be aware of this developing trend and know how to find information about utilizing old drugs in new ways.