Journal of Pharmacy Technology

To increase pharmacy technicians' awareness of national drug shortages, enabling them to understand why drug shortages occur and how they can help ameliorate the effects that a drug shortage may have in their workplace.

Articles were identified through searches of MEDLINE and PubMed (1950 through July, 2011) using the following search terms: drug shortages, drug shortages and legislation, drug shortages and law, and drug shortages and safety. Additionally, resources on drug shortages from the American Society of Health-System Pharmacists, the FDA, and the Institute for Safe Medication Practices were used.

Articles describing drug shortages, drug shortages and legislation, and managing drug shortages in the health care setting were included.

The effects of drug shortages on pharmacy departments and the health care system as a whole can place significant strain on pharmacists. Pharmacy technicians can play a key role in the initial management of a drug shortage by being responsible for such tasks as validating shortage details and duration with manufacturers, determining the institution's current stock and history of use of a medication, and remaining up-to-date on current drug shortages to help keep patients and other health care professionals informed.

Pharmacy technicians are a valuable resource for pharmacists in the management of drug shortages and can work with pharmacists to perform operational and assessment tasks after a drug shortage has been identified.

To review the epidemiology and pathophysiology of osteoporosis in patients with HIV infection and discuss vitamin D deficiency and the treatment of HIV-positive patients with osteoporosis.

A search of PubMed (1980–June 2011) was conducted using the terms osteoporosis, HIV, vitamin D deficiency, and treatment.

Epidemiologic studies, clinical trials, and meta-analyses published in English were included. A manual review of the bibliographies of available literature was conducted and relevant articles were reviewed for inclusion.

Patients with HIV infection are living longer with the use of potent antiretroviral therapy (ART) and are at increased risk for osteoporosis. Several studies have shown that HIV infection can affect bone health and increase the risk for osteoporosis. In addition, ART, and tenofovir in particular, may affect bone turnover. Studies and meta-analyses have shown an increased prevalence of osteopenia and osteoporosis in HIV-positive patients compared to noninfected controls. Recent reports also show increased prevalence of fractures and low vitamin D concentrations in HIV-positive patients. Osteoporosis treatments used in patients with HIV infection are similar to treatments for noninfected patients. HIV-positive patients should be monitored and treated to prevent the progression and complications of osteoporosis.

HIV-positive patients are at increased risk for osteoporosis and vitamin D deficiency due to disease and treatment influences on bone health. These patients should be identified and treated to prevent the morbidity and mortality associated with osteoporosis.

To review, analyze, and critique dabigatran etexilate's approved uses as an anticoagulant.

Literature searches were performed via MEDLINE, International Pharmaceutical Abstracts, and Google Scholar through February 2011, using the term dabigatran. Additional data were obtained from tertiary sources and prescribing information.

All published Phase 3 anticoagulation trials investigating dabigatran for currently approved indications were selected. Information from other anticoagulation trials investigating dabigatran was used for critiquing Phase 3 studies.

Dabigatran etexilate has been evaluated in multiple clinical trials as an alternative to enoxaparin for prevention of venous thromboembolism in total hip and knee replacement surgeries. It has also been evaluated as an alternative to warfarin in stroke and systemic embolism prevention in patients with atrial fibrillation. Results have generally been positive, with few exceptions. The standard adult dose of dabigatran 150 mg twice daily, approved for use in the US for stroke prevention in nonvalvular atrial fibrillation, was found to be superior to warfarin in regard to occurrence rates of stroke or systemic embolism and hemorrhagic stroke. The occurrence rates of intracranial bleeding, life-threatening bleeding, and major or minor bleeding were lower with dabigatran 150 mg twice daily than with warfarin; however, the occurrence of gastrointestinal bleeding was significantly higher.

With its numerous benefits, and despite its drawbacks, dabigatran remains a promising option for oral anticoagulation therapy.

To report a case of hypertension secondary to ingestion of licorice root tea.

A 46-year-old African American female with newly diagnosed stage 1 hypertension presented with a blood pressure measurement of 144/81 mm Hg and a reduced plasma potassium level of 3.2 mEq/L. The patient attempted lifestyle modifications prior to initiating an antihypertensive agent, but at a follow-up appointment, her blood pressure remained elevated. A current laboratory panel revealed a depressed morning plasma aldosterone concentration (PAC) of 5 ng/dL and low morning plasma renin activity (PRA) of 0.13 ng/mL/h. Later it was revealed that the patient regularly (1–2 cups/day) consumed “Yogi Calming” tea, a blend of herbs, including licorice root. The patient was advised to discontinue consumption of the herbal tea, and at a subsequent appointment, her blood pressure was 128/73 mm Hg and her laboratory panel had improved, including serum potassium concentration of 4.1 mEq/L, PAC of 6 ng/dL, and PRA of 0.19 ng/mL/h.

Excessive consumption of licorice has been well documented to cause pseudohyperaldosteronism, characterized by hypertension, hypokalemia, and suppressed plasma renin and aldosterone levels. Glycyrrhizin, the active ingredient in licorice, inhibits 11β-hydroxysteroid dehydrogenase type 2, an oxidase responsible for the conversion and inactivation of cortisol to cortisone. Chronic ingestion of licorice-containing foods has been demonstrated to cause pseudohyperaldosteronism. These include soft candies, lozenges, and dietary supplements, but licorice-containing teas have been infrequently described. Based on the Naranjo probability score, our patient's hypertension appears to have been a probable licorice-induced reaction secondary to a licorice-containing tea.

Herbal and dietary supplements are frequently consumed by patients without full knowledge of the contents of the products or the impact on their health. In clinical practice, when hypertension is accompanied by hypokalemia and reduced PRA and PAC, licorice consumption should be investigated and causal hypertension ruled out.