BackgroundThe elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design.MethodsAll reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for classification as misprescribed, underprescribed or overprescribed -subtypes.ResultsThe analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available for the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed to a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77) received 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric indications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of the institutionalized patients’ medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.41 % of the institutionalized patients’ medical files contained 140 PIM. The potential underprescribing of cardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM), while for the institutionalized patients’ medical files, the misprescribed and overprescribed PIM were those predominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of ambulatory prescriptions and 35.63 % of institutionalized patients’ data) and benzodiazepines (26.66 % of ambulatory prescriptions and 24.13 % of institutionalized patient’s data) were predominantly misprescribed. Anticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from institutionalized patients’ data).ConclusionsThe PIM identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population. Larger studies, both observational and interventional, are needed to ensure a safer therapeutic approach.
A high-throughput liquid chromatography method with detection by tandem mass spectrometry (LC-MS/MS) was developed and validated for the quantification of apixaban in human plasma. The separation was performed on a
Background & AimsThe pharmaceutical care practice represents a model of responsible pharmacist involvement in the pharmacotherapy optimization of various population groups, including the elderly, known to be at risk for drug-related problems. Romanian pharmacists could use validated pharmaceutical care experiences to confirm their role as health-care professionals.This descriptive research presents the application in two real and different environments of practice of a structured pharmaceutical care approach conceived as the basis for a medication review activity and aiming at the identification and resolution of the drug related problems in the elderlyPatients and methodsTwo patients with similar degree of disease-burden complexity, receiving care in different health-care environments (The Geriatric Ward of the Royal Victoria Hospital from the McGill University Health Centre in Montréal, Québec, Canada, in November 2010, and an urban nursing-home facility in Cluj-Napoca, Romania, in March 2011), were chosen for the analysis. One clinical pharmacist suggested solutions for the management of each of the active drug-related problems identified, using the systematic pharmaceutical care approach and specific published geriatric pharmacotherapy recommendations. The number of the drug-related problems identified and the degree of the care-team acceptance of the pharmacists’ solutions were noted for each patient.ResultsThe pharmacist found 6 active drug-related problems for the hospitalized patient (72 year-old, Chronic Disease Score 9) and 7 potential ones for the nursing-home resident (79 year-old, Chronic Disease Score 8), involving misuse, underuse and overuse of medications. Each patient had 3 geriatric syndromes at baseline. The therapy changes suggested by the pharmacist were implemented for the hospitalized patient, through collaboration with the health-care team. For the nursing home resident, the pharmacist identified the need for additional 6 medications and safety and efficacy arguments to cease 7 initial therapies, simplifying the therapeutic daily schedule (from 24 daily doses to 15).ConclusionThe pharmacist’s potential contribution to the optimization of the Romanian elderly patients’ pharmacotherapy needs further exploration, as potential drug related problems reported as characteristic for this population were easily identified. The presented structured and validated model of pharmaceutical care approach could be used to this end. Its dissemination and use could be encouraged along with the enhancement of pharmacotherapy information and care team collaboration skills.
In clinical practice, the simultaneous use of zolpidem and phenytoin cannot always be avoided, although it can be associated with additive depressants effects on the central nervous system. Considering the common metabolic pathways involving CYP3A and CYP2C, a pharmacokinetic interaction between phenytoin and zolpidem is possible, although not previously quantified. The study was designed as a non-randomized, two-period preclinical trial. Twenty male subjects were included in a study consisting of two periods. Between these, subjects were treated for 6 days with a single daily dose of 150 mg phenytoin. For each treatment period, pharmacokinetic parameters of zolpidem were determined. The multiple-dose administration of phenytoin influenced zolpidem's pharmacokinetics in healthy volunteers, decreasing its exposure through enzymatic induction.
The reimbursement model for pharmaceutical care remains a barrier to successful widespread implementation of pharmacist-provided services. In some instances, community pharmacists have been successful in obtaining direct compensation for services from patients; however, evidence suggests that lack of patient demand for pharmacist-services may ultimately undermine the campaign for widespread third-party payment. The purpose of this study is to conduct a secondary analysis of data indicating consumer/patients' rationale for not purchasing pharmacist-provided disease management services when offered the opportunity to do so in community pharmacies. Our review of the data indicates that while financial concerns are clearly important in consumer demand for pharmacist-provided services, other considerations exist. The consumer/patient belief that pharmacist-provided services are duplicative or that these services are not needed are significant barriers to overcome. Intensive education and marketing campaigns are needed to sway consumer opinion on the value of pharmacist-provided services.
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