Journal of Pharmacy Technology

Stroke is the second leading cause of death in the world and the main cause of long-term disability in Western countries. Evaluating health-related quality of life (HRQOL) in patients who have survived a stroke provides a more complete picture of the effects of different interventions in a patient's condition. Dapsone has been shown to have neuroprotective effects during the acute phase of stroke.

To evaluate HRQOL in patients who received dapsone versus placebo after stroke.

This was an observational pilot study of 21 patients who randomly received dapsone or placebo during the acute phase of a stroke. HRQOL was evaluated with the Stroke-Specific Quality of Life (SSQOL) questionnaire 6 months after the stroke.

There was no significant difference in the total SSQOL score 6 months after a stroke between patients who received dapsone or placebo (3.41 vs 3.19; p = 0.434). Patients who received dapsone had higher mean values for 9 of the 12 domains of the SSQOL than patients who received placebo. However, the difference was not statistically significant. The highest score for the patients who received dapsone was in the self-care domain. Overall SSQOL scores were lower in women than in men (p < 0.01).

SSQOL was slightly better for patients who received dapsone, showing a possible improvement in their functional level. More prospective, randomized, and placebo-controlled studies with a larger number of patients are needed to confirm these results.

The need for long-term thromboprophylaxis in children using warfarin therapy is increasing. Natural health products (NHPs) are administered to children by parents who perceive them to be useful and acceptable adjuncts or alternatives to conventional therapies. Interactions of NHPs with prescribed therapies may result in serious adverse events. NHP usage is underevaluated in children and there are no studies evaluating NHP usage in warfarinized children.

To explore NHP use in warfarinized children and their siblings to determine the prevalence, varieties, and reasons for NHP usage, as well as the potential effect on warfarinization (eg, time in therapeutic range [TTR]).

This is a 3-phase cross-sectional cohort study that includes the (1) prevalence (2) NHP education and knowledge assessment, and (3) the follow-up NHP utilization phase.

Forty-six percent of warfarinized children consumed NHPs, with time in therapeutic range of 74%. The mean score for baseline knowledge of NHPs and warfarin following the education phase was 67%. Follow-up NHP use was 30%, and increased consistency of utilization with TTR was 83% (p < 0.05), consistent with education provided.

The consistent prevalence rates over time of NHP usage in warfarinized children indicate the need for future studies. Education remains vital to combat the potential risks of NHP-warfarin interaction, encouraging patient disclosure and consistency.

To review the use of belatacept as an alternative to calcineurin inhibitor-based regimens for maintenance immunosuppression in renal transplant recipients.

To provide an extensive overview of the pharmacology, pharmacokinetics, efficacy, and safety of belatacept, a MEDLINE/PubMed search (1980–December 2011) was performed for all articles evaluating belatacept's properties and patient outcomes, as well as abstracts from recent meetings, using key words belatacept, pharmacology, efficacy, pharmacokinetics, and safety.

Phase 2 and 3 studies in humans describing use, adverse reactions, pharmacology, pharmacokinetics, efficacy, and safety of belatacept were identified and reviewed. Other articles were identified through PubMed.

Belatacept, a costimulation blocker, is a biologic recombinant fusion protein that has been shown to prevent acute cellular rejection in kidney transplant recipients and preserve renal function. It was recently approved by the FDA as an antirejection immunosuppressant agent for use in kidney transplant recipients. It is the first biologic agent used for maintenance immunosuppression. It acts as an antagonist to CD80 and CD86 receptors located on the surface of antigen presenting cells, thereby blocking CD28 T-cell activation and, thus, preventing acute rejection. In comparison with patients receiving other current therapies, patients on belatacept have demonstrated superior renal function with comparable outcomes in patient and graft survival.

Belatacept has potential for use as an alternative to current maintenance immunosuppression regimens, with potentially fewer adverse effects.

The role of a rapid response team (RRT) or medical emergency team is to bring the expertise of specialists trained in critical care to patients on general medicine and surgical wards who are rapidly deteriorating and to treat them accordingly. The involvement of pharmacists on cardiopulmonary resuscitation teams has been reported. However, the role of a pharmacist member of an RRT has not been extensively researched.

To identify the role of a pharmacist on an RRT and categorize types of pharmacist interventions during cardiopulmonary resuscitation and initial patient assessments.

This pilot study documented interventions made by the pharmacist on our RRT over a 1-month period. The pharmacist assisted the RRT with evaluations of patients during assessments and cardiopulmonary resuscitations and provided specialized medical information based on our current organizational standards of practice.

The pharmacist attended 34 consultations and 8 resuscitations during cardiopulmonary arrests. There were 96 interventions made during 34 RRT assessments—2.6 interventions per assessment. The most common interventions were treatment recommendations (29%), dosing recommendations (15%), and procuring medications for emergent use (12%). In both the treatment and dosing categories, antibiotic recommendations were the most common.

The pharmacist member of the RRT had the opportunity for intervention on every patient seen by the team. The most common areas for intervention are treatment and dosing recommendations involving antibiotics, as well as providing and preparing emergent medications.

Medication errors due to intravenous administration are common. Metered infusion devices (MIDs) have reduced some administration errors, but the manual programming of these devices allows for continued risk. MIDs with safety features, smart pumps, have been shown to reduce intravenous medication errors, but usage rate of the safety features is reported to be low.

To identify obstacles to the use of the smart pump safety feature and investigate the effectiveness of educational interventions to address these obstacles and improve safety feature use rates.

This cross-sectional study was designed for quality improvement. A 10-question paper survey targeting potential obstacles was distributed to parttime and full-time nurses on the cardiovascular service of an academic hospital to ascertain the limitations to using the safety feature technology. Based on survey results, educational interventions were developed, which included a required educational active-learning, practical session, and optional didactic presentation. The primary end point was change in the rate of use during a prespecified month before (July 2010) and after (April 2011) targeted interventions. Descriptive analysis was performed on survey results. Student t test and χ² analyses were used to compare usage rates.

Surveys were distributed to 60 nurses; 36 were returned and 1 was excluded, leaving 35 in the final analysis. Primary obstacles to using the safety features identified were education/training, technology burden, and drug library accuracy/content. After educational training sessions, usage rates of the smart pump safety feature increased significantly, 5.5 times from baseline (5.5% vs 30.5%; p < 0.001).

Targeting education and providing hands-on training directed to nurses' perceived barriers to use of smart pumps was an effective method to improve use of safety features, although overall utilization can be improved.

To report a case of hyperphosphatemia associated with administration of intravenous clindamycin phosphate in a child with renal dysfunction.

We describe the case of a 12-year-old boy who developed hyperphosphatemia while receiving intravenous clindamycin phosphate. The child had a history of asthma but was otherwise healthy. He was transferred to our facility for management of methicillin-resistant Staphylococcus aureus bacteremia, periorbital cellulitis, osteomyelitis, and necrotizing pneumonia. He received intravenous vancomycin and clindamycin 930 mg administered every 8 hours. Concurrently, he developed acute kidney injury. His baseline phosphorus concentration was within the normal range but increased as high as 11.7 mg/dL while he received clindamycin. Despite receiving oral phosphate binder therapy and a low phosphorus diet, he had little reduction in serum phosphorus values. Intravenous clindamycin was suspected as a potential cause for hyperphosphatemia, and a recommendation was made to switch from intravenous to oral clindamycin solution since it contains a different salt formulation. Given the severity of the child's disseminated infection and questions of whether he could absorb the enteral formulation, the decision was made to continue intravenous clindamycin and he was ultimately transferred to a rehabilitation facility for further care on intravenous clindamycin.

Excess oral or intravenous intake of phosphorus can result in hyperphosphatemia, as the body's plasma phosphate concentration exceeds the kidney's diminished filtration capacity. In this patient, use of the Naranjo probability scale indicated a possible adverse event associated with clindamycin. Phosphate intake from intravenous clindamycin and decreased glomerular filtration rate may have contributed to the child's hyperphosphatemia.

While intravenous clindamycin was not the sole cause for this patient's hyperphosphatemia, health care professionals should be aware of the potential for increased phosphate load when administering this drug to a patient with renal dysfunction.