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Counseling the Patient
Published in Harvey M. Rappaport, Kelly S. Straker, Tracy S. Hunter, Joseph F. Roy, The Guidebook for Patient Counseling, 2020
Harvey M. Rappaport, Kelly S. Straker, Tracy S. Hunter, Joseph F. Roy
The concept of pharmaceutical care and new national and state regulations are demanding radical changes in the everyday practice of pharmacy. Prospective drug utilization review requirements to counsel each and every patient will significantly change the work habits of pharmacists. Some pharmacists may respond that counseling is nothing new and that they have always provided it. However, closer examination reveals that this requirement changes the extent and liability of this service.
An Agenda for Action I: Diminishing Supply
Published in Barry Stimmel, Drug Abuse and Social Policy in America, 2014
Federal guidelines for state implementation of drug utilization review by pharmacists should be evaluated as to their effectiveness. If successful, guidelines should be established for Medicare patients as well. In the process pharmacists should become an integral member of the health care team, providing information not only to patients but physicians as well.
Drug Utilization Evaluation of Medications Used by Hypertensive Patients in Hospitals in Nigeria
Published in Hospital Topics, 2022
Theophilus Ehidiamen Oamen, Kanayo Patrick Osemene
However, the impact of increasing cost of obtaining newer anti-hypertensive medications by patients is an economic challenge to healthcare providers. This is due to a higher risk of noncompliance and consequently linked to sub-optimal therapeutic outcomes (Powell et al. 2018; Osemene, Ihekoronye, and Lamikanra 2020). In a developing country like Nigeria, the burden of hypertension treatment is significant, eroding a chunk of patients’ income. Particularly for patients on multi-drug therapy and medical complications (Dalvi and Mekoth 2018; Powell et al. 2018). In order to manage available but scares resources on effective medicines (mainly generics) arising from quality prescribing, this study on drug utilization review (DUR) is very important. The outcome of this study could assist physicians in carrying out evidence-based prescribing and prevent inappropriate prescription in the future. DUR studies are scarce in Nigeria; and this study would provide current data for policy makers and users in the health sector. Furthermore, DUR improves medical care and provides better understanding of cost containment as well as useful in measuring economic impact of drug use particularly in resource-limited population such as Nigeria. However, further studies should be carried out in other settings using different drugs.
Emerging oral VEGF inhibitors for the treatment of renal cell carcinoma
Published in Expert Opinion on Investigational Drugs, 2019
Lea Stitzlein, PSS Rao, Richard Dudley
Drug metabolism is another important consideration when comparing the safety of the approved and investigational VEGFR inhibitors. The approved TKIs all undergo CYP-mediated metabolism creating the risk of drug–drug interactions when co-administered with CYP-inhibitors or substrates [69,70]. Drug accumulation can also pose an issue for these agents especially in patients with hepatic or renal impairment, thereby warranting discontinuation of therapy. Pharmacokinetic data collected to date suggest that anlotinib, rivoceranib, and tivozanib are primarily metabolized by various cytochrome P450 enzymes and could have CYP-based drug interactions as well [39,45,52]. The metabolism of the investigational agents, vorolanib, and sitravatinib, has yet to be reported and thus warrants further metabolism studies. Given the chemical structures of the investigational agents discussed, a metabolic pathway, which circumvents CYP-mediated oxidation seems unlikely. Future drug design and subsequent development of VEGFR inhibitors and other TKIs should strive to incorporate chemical moieties which allow for facile metabolism and excretion and present minimal risk for metabolic interactions. Until such molecules are discovered, prudent prospective drug utilization review at the time of study enrollment or at the time of outpatient dispensing remains a critical function of the healthcare system. Such judicious screening will remain an absolute to avoid preventable toxicities.
Greater Changes in Drug Burden Index (DBI) during Hospitalization and Increased 30-Day Readmission Rates among Older In-Hospital Fallers
Published in Hospital Topics, 2020
Rafia S. Rasu, Walter Agbor-Bawa, Nahid J. Rianon
Aside from health care costs, readmissions among the geriatric patient population is a concern because it impedes functional recovery after hospitalizations that may be linked to another fall and readmission (American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity 2012). Our study showed a significant association with higher differences in DBI (between admission and the in-hospital fall) and >7 admissions within 30 days of discharge (Tables 3 and 4). Higher differences in DBI mean that the sedative and cholinergic burden was increased at the time of the fall, most likely due to new prescriptions added during the hospital stay. Acute hospitalization adds 5 − 8 new medications to a patient’s medication list and put them at greater risk of receiving prescriptions of inappropriate medication and increasing DBI (Onder et al. 2003; American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity 2012; Holmes et al. 2013). Awareness about the DBI and medication reconciliation at the time of adding new drugs, especially for a sedative or anticholinergic drug, may help keep the DBI low. Having said that, one has to appreciate the complexity of treatment of older patients with a high CCI and polypharmacy (Page et al. 2010; American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity 2012). Often, the already complex treatment plan cannot be changed, either in number or class types of the continuing medications, for these patients’ complex multi-morbidities (Page et al. 2010; American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity 2012). Behavioral symptoms, including delirium, may require a physician to prescribe an anticholinergic to the hospitalized patient as well. Partnerships between the hospitalists/physicians taking care of patients and in-hospital pharmacists have shown improvement of polypharmacy and inappropriate prescription in older adults (Nishtala et al. 2009; Lowry et al. 2012). The use of validated drug utilization review tools, e.g., Beers criteria and STOPP, have shown success in ‘de-prescribing’ or limiting new prescriptions for inappropriate medications (Page et al. 2010). Identifying patients at high risk for falls using established assessment tools, e.g., AHRQ Tool 3H and 3I (AHRQ 2013), may also help identify high-risk patients when prescribing new medications during hospitalization.