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Annual Meeting Abstracts 2004 FEATURE demonstrate clinical pharmacy services can improve patient knowledge base and diabetes outcomes. 37—IMPACT OF PHARMACEUTICAL CARE: A RANDOMIZED, CONTROLLED TRIAL OF BLOOD PRESSURE CONTROL IN HYPERTENSIVE PATIENTS. Amruso N, Eckerd PatientCARE Network. E-mail: namru1@eckerd.com Objective: To determine the ability of pharmacists within community pharmacies to manage hypertensive patients. Methods: Design/Setting: Randomized, prospective, controlled study within community pharmacies. Patients: Patients were included if they had an average blood pressure (BP) reading above goal based on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines. Patients were excluded if they had one or more of the following conditions: status-post–transplant procedure requiring long-term immunosuppressive therapy, terminal illness, end-stage renal disease, renal artery stenosis, or other unstable condition potentially contributing to hypertension. Patients were excluded if they were participating in another hypertension management program or refused to consent to the conditions of the study. Patients were randomized into high intensity (HI) or low intensity (LI) groups. HI patients met individually with the pharmacist for BP measurements, medication assessment, and education. Patients were scheduled for visits at 2 to 4 week intervals until BP was controlled, then periodically until the end of 12 months. LI patients were mailed educational materials quarterly and had their BP measured at 12 months. Data Collection: A progress note was developed to ensure complete data collection at each visit. The completed note was sent to the study coordinator for input into a database. Outcomes measures: Change in systolic blood pressure (SBP) and diastolic blood pressure (DBP), percentage of patients who achieved goal BP and percentage on first-line therapy. Analysis: A statistician performed the data analysis. Results: Overall, 109 patients were randomized into HI and 103 into LI, and 35 HI and 13 LI patients completed the study. Among HI patients, SBP declined by an average of 17 mm Hg, compared with a 1 mm Hg decrease for LI patients. Among HI patients, DBP declined by an average of 3 mm Hg, compared with a 1 mm Hg increase for LI patients. A total of 66% percent of HI patients and 8% of LI patients achieved goal BP; 57% of HI patients and 23% of LI patients were on first-line therapy. Conclusions: Patients enrolled in a hypertension management program conducted by pharmacists in the community setting achieved BP control to a greater extent than patients not enrolled. 38—IMPACT OF PHARMACIST INTER- VENTION THROUGH A TELEPHONE RUN SMOKING CESSATION CLINIC. Foust S, Porter J, Drake University College of Pharmacy. E- mail: sharon.foust@drake.edu Objective: To determine the impact of a pharmacist-run, telephone smoking cessation clinic on patient success. Methods: Patients were obtained based upon patient interest and primary care referral at the Department of Veterans Affairs. Inclusion criteria included patients at either the precontemplation or contemplation stages of the Transtheoretical Model. Duration of patient enrollment was 1 year from patient’s quit date. The pharmacist contacted patients 2 weeks and again 7 days before the quit day. Patients were also contacted on quit day (Day 0) and on days 3, 7, 14, 21, 28, 42, 56, 70, 84, 114, 144, 174, and 365. Counseling consisted of behavioral and pharmacological cessation methods, such as proper use of nicotine-replacement therapy (NRT) and trigger, stress, and weight management. Data collected will include patient self-reported frequency and duration of tobacco use throughout the program and response to initial assessment questionnaire. The initial assessment questionnaire will be used to obtain Fagerstrom Tolerance Scores, previously used NRT therapy by the patient, patient-perceived negative effects of smoking, patient concerns, and planned methods to be used in smoking cessation. The primary outcome is participants’ abstinence rate 1 year from quit date. Secondary outcomes include initial Fagerstrom Tolerance Scores compared with quit rate, duration of NRT or bupropion therapy, number of telephone calls placed to patient, and number of patient-reported relapses. Results: Preliminary results show that subjects were all men with a mean age of 55. Descriptive statistics will be used to evaluate primary and secondary outcomes for presentation at APhA2004. Conclusions: If favorable outcomes result from this research, this study will show that pharmacists can have an impact on patient success in smoking cessation through the use of a telephone smoking cessation clinic. 39—MEDICATION UTILIZATION EVAL- UATION OF HMG-COA REDUCTASE INHIBITORS IN LIPID CLINIC. Booth H, Tomich D, Kassebaum P, Madigan Army Medical Center. E-mail: helen.booth@nw.amedd.army.mil Objective: (1) To identify patients in lipid clinic who are being treated with a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (statin) other than our formulary agent, simvastatin, and to document the reason behind starting on or switching to a nonformulary statin, (2) to identify trends in prescribing pattern of HMG-CoA reductase inhibitors, and (3) to document the rate of discontinuation of simvastatin and to assess for the opportunities for clinical interventions to improve patient care. Methods: This is a retrospective analysis of use of HMG-CoA reductase inhibitors in a pharmacistmanaged lipid clinic. A query from Access-based database used in the lipid clinic enabled identification of patients who were being treated with a HMG- CoA reductase inhibitor between January 1, 2002 and September 30, 2003. A retrospective chart review was conducted in patients who were identified as being treated with a HMG-CoA reductase inhibitor other than simvastatin. Results: A total of 565 patients were identified as being treated with HMG-CoA reductase inhibitors. Of these patients, 403 patients were being treated with simvastatin, 114 patients with atorvastatin, 42 patients with pravastatin, and 1 patient with lovastatin. Retrospective analysis of prescribing pattern of HMG-CoA reductase inhibitors, rate and rationale behind discontinuation of simvastatin, and potential opportunities for clinical interventions will be presented. Conclusions: NA. 40—MEDICATION UTILIZATION REVIEW OF ALENDRONATE. Seah J, Lim W, Wee I, Changi General Hospital. E-mail: jonathan_seah@cgh.com.sg Objective: To determine the prescribing patterns, drug-related problems, range of patient monitoring, and daily calcium intake associated with oral alendronate amongst inpatients. To recommend appropriate measures for rational prescribing of alendronate and improvements in patient monitoring. Methods: A retrospective review of clinical case notes, laboratory data, and pharmacy medication records was performed for all ward patients prescribed alendronate during a 5-week study period. Results: A total of 44 patients receiving either once-daily or once-weekly alendronate were identified. Alendronate was prescribed most commonly to treat postmenopausal osteoporosis. Six patients were switched from alternative pharmacological treatments for osteoporosis to alendronate therapy. Seven patients were also prescribed concomitant intranasal calcitonin, with two being on long-term combination treatment. One patient was given alendronate despite the drug being contraindicated; two tube-fed patients and another patient with dysphagia received crushed tablets. No significant drug interactions were noted, though many patients were on multiple medications. Approximately one third of patients had their baseline bone mineral density (BMD) assessed, but none received follow-up BMD scans. Calcium levels were checked in 56.8% of patients, and none was hypocalcemic. Constipation was the most common adverse event; other less common adverse effects included esophagitis, gastric ulcers, and gastritis. None of the patients received the recommended 1,500 mg/day of elemental calcium, although almost one half of them had a total calcium intake (meals plus supplements) of 800–1000 mg/day. Conclusions: Alendronate was generally prescribed appropriately for registered indications. The use of long-term concomitant intranasal calcitonin should be reviewed as clinical evidence for this practice is lacking. Alendronate was generally well tolerated; however, its contraindications and precautions should be closely noted before initiating therapy. Increased use of BMDs, more frequent serum calcium level determinations, and adequate calcium intake should also be considered. 2004 Abstracts of Contributed Papers Vol. 44, No. 2 March/April 2004 www.japha.org Journal of the American Pharmacists Association 235 Downloaded From: http://japha.org/ on 01/25/2014
FEATURE Annual Meeting Abstracts 2004 41—NATIONWIDE DISSEMINATION OF THE RX FOR CHANGE TOBACCO CESSA- TION CURRICULUM: IMPACT OF A TRAIN- THE-TRAINER PROGRAM FOR PHARMA- CY FACULTY. Corelli R, Fenlon C, Kroon L, Lem K, Sullivan M, Hudmon K, University of California, San Francisco. E-mail: corelli@itsa.ucsf.edu Objective: Research consistently demonstrates that students in the health professions receive inadequate training for assisting patients with tobacco cessation. In response to this need, the California schools of pharmacy collaborated to develop Rx for Change, a 6- to 8-hour comprehensive tobacco cessation curriculum that is being disseminated to schools of pharmacy across the U.S. via a faculty train-the-trainer model. The purpose of this study is to assess pharmacy faculty members’ posttraining perceptions regarding adoptability of the Rx for Change curriculum. Methods: Pharmacy faculty attended one of three train-the-trainer conferences offered during summer 2003. Participants completed an eight-page posttraining survey that assessed key factors potentially associated with adoption of the program. Participants rated their pretraining and posttraining ability to teach comprehensive tobacco cessation on a 5-point scale (1 = poor; 2 = fair; 3 = good; 4 = very good; 5 = excellent). Results: A total of 132 faculty members representing 76 pharmacy schools participated in the trainthe-trainer program and completed a posttraining survey. Before the training, 48.5% of the faculty had received no formal training for treating tobacco use and dependence, and 82.2% had not taught students about this subject. Participants’ self-rated abilities to teach tobacco cessation to pharmacy students significantly increased on the posttest, compared with the pretest (2.77 versus 4.39; P < .001), with 25.7% and 96.2% rating their abilities as either very good or excellent before and after the training, respectively. Nearly all participants believed the Rx for Change curriculum materials were either moderately (47.3%) or highly (50.4%) compatible for integration into their existing curricula, and 69.5% of the participants indicated they were highly likely to adopt Rx for Change at their school. A total of 96% of attendees said they would recommend the train-the-trainer program to other pharmacy faculty members. Conclusions: Participation in a train-the-trainer program significantly increased pharmacy faculty confidence to provide comprehensive tobacco cessation education to pharmacy students. The majority of participants are highly likely to adopt the Rx for Change curriculum at their school, which will eventually translate into an increased proportion of pharmacists who are adequately trained to treat tobacco use and dependence. 42—OXYMORPHONE EXTENDED RELEASE PROVIDES SAFE AND EFFECTIVE ANALGESIA FOR CANCER PATIENTS: A RANDOMIZED,. Ahdieh H, Endo Pharmaceuticals, Inc., Dvergsten C, INC Research, Inc., Ma T, Frailey A, Endo Pharmaceuticals, Inc., Nashat G, not applicable. E-mail: livinginpa135@aol.com Objective: To compare the analgesic efficacy and tolerability of oxymorphone extended release (ER) and oxycodone controlled release (CR) in moderate to severe cancer pain. Methods: In this Phase III, randomized, doubleblind, two-way crossover study, patients were stabilized with oral opioid medication during a 7- to 10- day titration/stabilization phase, followed by 7 to 10 days of double-blind treatment with oxycodone CR or oxymorphone ER (estimated conversion ratio of 2:1 for oxycodone CR:oxymorphone ER). Dosages remained fixed from days 4 to 7; two rescue doses of morphine sulfate 15 mg/day were allowed. Patients then crossed over to the alternate treatment for 7 to 10 days. Efficacy was assessed by pain intensity and relief (via the Brief Pain Inventory), global evaluations, and Karnofsky performance status. Routine safety evaluations were performed. During doubleblind treatment, the ratio of the average total daily dose from the last 2 days of each treatment period was calculated for each patient. Results: A total of 44 patients received at least 1 dose of study drug. Mean pain intensity following double-blind treatment was 2.8 for oxycodone CR and 2.5 for oxymorphone ER. Results of all other efficacy parameters were equivalent, indicating equianalgesia was achieved. The mean daily dose of oxycodone CR was 91.9 mg versus 45.9 mg for oxymorphone ER, an equianalgesic dose ratio of 2:1. Karnofsky scores were 81% for patients taking oxycodone and 82% for patients taking oxymorphone ER, equating to normal activity with effort. Rescue medication use was low in both groups; however, fewer patients receiving oxymorphone ER required rescue. Opioid adverse events were similar between groups. Conclusions: Patients taking oxycodone CR can convert to oxymorphone ER at one half the dose and rapidly achieve a stable dose that provides adequate pain relief with similar opioid adverse events. Nearly 90% of patients rated oxymorphone ER as “good,” “very good,” or “excellent.” Original Citation: Poster Presentation; American Society of Clinical Oncology, May 28–June 3, 2003, Chicago, IL. 43—PREDICTING EMETOGENICITY OF NEW CANCER CHEMOTHERAPY AGENTS. Terenzi L, Waddell J, Walter Reed Army Medical Center. E-mail: varoom007@hotmail.com Objective: Serotonin receptor antagonists are standard of care for prevention of acute cancer chemotherapy induced nausea and vomiting. To guide the use of serotonin receptor antagonists, Hesketh et al. classified cancer chemotherapy agents according to frequency of acute emesis. Their classification remains unchanged since 1997 and several new agents are on the market since then. Our objective is to classify new cancer chemotherapy agents by emetogenicity according to the Hesketh nomogram. Methods: Literature searches will be conducted to find emetogenicity data from the serotonin antagonist era for a subset of agents in the Hesketh nomogram. This data will be used to determine ratios of pre-serotonin versus serotonin era emetogenicity for these agents. If there is a consistent ratio for all agents or consistent ratios within drug classes, this information will be used to predict the emetogenicity of new agents. Literature searches and data analysis will be conducted by the oncology pharmacy residency program director and oncology pharmacy resident at an academic military medical center. Results: NA. Conclusions: NA. 44—THE CHALLENGE: ACHIEVING ADEQUATE ORAL ANTICOAGULATION IN ONCOLOGY PATIENTS WITH DEEP VEIN THROMBOSIS. Swenson C, Shaw D, Berry J, Madigan Army Medical Center. E-mail: claudia.swenson@nw.amedd.army.mil Objective: Recently published studies suggest higher rates of both recurrent deep-vein thrombosis (DVT) as well as bleeding in oncology patients treated with warfarin. To help assess the risk–benefit ratio of warfarin versus low molecular weight heparin or other options for this population, the rate of therapeutic anticoagulation in patients with DVT with or without an oncology diagnosis at our institution was needed. Methods: A retrospective, comparative study of patients receiving oral anticoagulation with a diagnosis of DVT and an oncology diagnosis versus no oncology diagnosis was undertaken. A query of the institutional database for the 800 active anticoagulation clinic patients who also carried an oncology diagnosis yielded 150 patients. A further screen for DVT diagnosed within the last 12 months yielded 27 patients. A control group of 27 patients with DVT but without an oncology diagnosis was identified using the anticoagulation clinic database. The diagnosis of DVT was confirmed by usual tests (ultrasonography). The demographics of the groups were similar: Average age (years): nononcology = 66.6, oncology = 61.6; sex (men/women): nononcology = 10/17, oncology = 13/14. The international normalized ratio (INR) values for analysis were included after the patient was in the 2.0–3.0 range for two values and the percentage of values in range calculated. Results: The percentage of INR values in range was much higher for the nononcology DVT patients versus oncology DVT patients: 70.7% (220 of 311 patients) versus 42% (268 of 636 patients). The range and median for the percentage of therapeutic INRs for the nononcology DVT patients versus oncology DVT patients: 25–90%, median 72%; 0–80%, median 47%. Conclusions: This retrospective comparative study of the rate of therapeutic anticoagulation in patients with DVT with or without an oncology diagnosis at our institution demonstrated results similar to those in the published literature. These data will be key in assessing other therapeutic options for these patients. 45—USE OF MIXED-EFFECT MODELING TO DETERMINE THE INFLUENCE OF ALBUMIN, BILIRUBIN, VALPROIC ACID, WARFARIN, AND ASPIRIN ON PHENYTOIN UNBOUND FRACTION AND PHARMACOKI- NETICS. Bauer L, University of Washington. 236 Journal of the American Pharmacists Association www.japha.org March/April 2004 Vol. 44, No. 2 Downloaded From: http://japha.org/ on 01/25/2014
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