Prescribing and the older patient in the community
David Beales, Michael Denham, Alistair Tulloch in Community Care of Older People, 2018
Polypharmacy in nursing homes is widespread, with four out of every five patients on medications and with many patients being prescribed a mean of three to four medicines.5,6 The potential for adverse drug reactions, drug/drug interactions and inappropriate medications is considerable. Unfortunately, the use of sedation remains widespread – nearly two-thirds of patients in one study of nursing homes were prescribed psychotropic drugs. The situation to avoid is that found in the USA, where sedation is used to ‘switch the patient out with the light’. Many studies have shown that large numbers of residents of homes are prescribed potentially interacting drug combinations, in particular drugs with addictive sedative or anticholinergic effects. All these problems may be compounded by less than satisfactory dispensing arrangements in some nursing homes which have been identified by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC). Studies have also shown that prescribing patterns between nursing homes with similar types of patients can vary widely, suggesting differing patterns of prescribing by individual doctors.
Engaging Patients with Personal Health IT for Quality
Jan Oldenburg, Dave Chase, Kate T. Christensen, Brad Tritle in Engage!, 2020
Many more studies document quality gaps in different areas. EHR data is consistently found to be missing or error-prone. A 2004 study by Kaboli et al found almost 95% of medication lists had some inaccuracies.11 Omissions (medicines taken by the patient but not listed in the EHR) were 25%; commissions (medicines not taken by the patient but listed in the EHR) were 12%. These results highlight the importance of medication reconciliation at each patient visit, as well as the limitations of clinical decision support in accurately processing drug-drug and other types of interactions that rely on accurate data. One third of patients had errors in their allergy and adverse drug reaction list—mostly omissions. Schnipper found gaps not only in medication information, but family history data as well.12 Putting medication lists and medication allergies online can help here too. Some practices are engaging patients in reconciling their medications.13 Patient-facing drug-drug interaction checkers can help, too.
Orthopaedic Pharmacology
Manoj Ramachandran, Tom Nunn in Basic Orthopaedic Sciences, 2018
Haemorrhage: in overdose can be reversed acutely with clotting factor concentrates or fresh frozen plasma; if severe, consider intravenous vitamin K (phytomenadione).Drug interactions: drugs that induce (e.g. barbiturates, carbamazepine) or inhibit (e.g. ethanol, metronidazole) hepatic microsomal enzymes may have an effect on the action of warfarin; either leading to reduction or enhancement of anticoagulant effect respectively.Teratogenicity: absolute contraindication in pregnancy.
Therapeutic drug monitoring-guided dosing for pediatric cystic fibrosis patients: recent advances and future outlooks
Published in Expert Review of Clinical Pharmacology, 2023
Siân Bentley, Jamie Cheong, Nikesh Gudka, Sukeshi Makhecha, Simone Hadjisymeou-Andreou, Joseph F Standing
New therapies known as “CFTR modulators” have revolutionized the treatment landscape for people with CF. CFTR modulators target specific CFTR gene mutations, restoring CFTR protein function and addressing the underlying cause of CF. Patients eligible for these have seen significant improvements in lung function, reduced pulmonary exacerbations and sputum production, enhanced nutritional status, and improved quality of life [8]. However, it is important to acknowledge that these therapies are not without challenges [8]. With the improved symptomatology seen in patients receiving modulator therapy, there is a risk of decreased adherence with other aspects of CF treatment. Additionally, reduced sputum production can pose challenges in monitoring airway pathogens. Some patients have reported drug interactions and side effects, raising concerns over their tolerability [9]. So further research and ongoing monitoring are necessary to optimize the benefits and address the limitations associated with CFTR modulators.
Toxicity of chloroquine and hydroxychloroquine following therapeutic use or overdose
Published in Clinical Toxicology, 2021
Cassandra Doyno, Diana M. Sobieraj, William L. Baker
While generally well tolerated, short-term toxicity is associated with hydroxychloroquine and most often includes gastrointestinal effects. Other rare effects include glucose abnormalities, dermatologic reactions, and neuropsychiatric events. Cardiotoxicity was considered rare with short-term use but data from the COVID-19 pandemic has heightened concerns for QTc prolongation and ventricular arrythmias. Hemolysis has been reported in patients with glucose-6-phosphate dehydrogenase deficiency when hydroxychloroquine has been prescribed for COVID-19 treatment. The most clinically important features associated with long-term use of hydroxychloroquine include retinopathy, neuromyotoxicity, and cardiovascular abnormalities (conduction disorders and cardiomyopathy). Drug interactions may increase the risk of toxicity occurring. Deaths from overdoses most often result from cardiovascular collapse.
A Pharmacist Collaborative Practice Agreement Improves Oral Oncolytic Workflow and Reduces Treatment Delays
Published in Oncology Issues, 2021
Amanda L. Wright, Stephanie F. Matta, Julia R. Kerr
Our review process follows these steps. Patient charts are reviewed for diagnosis and medication indication, followed by a review of the prescription for appropriate dosing based on treatment guidelines and patient specific factor such as renal and hepatic function. The patient’s drug interaction report is reviewed to note medications with possible interactions that may need to be addressed with the patient or provider. The patient is then contacted via telephone to introduce the oral oncolytic medically integrated pharmacy and discuss the filling process for a specialty medication, including prior authorization through insurance and possible co-pay assistance. Any outstanding questions regarding medications or appointments for baseline exams are addressed with the patient and the provider, when necessary, to complete the prescription review.
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