Introduction . Although not definite, studies are finding Alzheimer's disease may be related to loss of cholinergic innervation. In order to impact this loss of function, therapeutic agents have been developed to reduce the breakdown of acetylcholine, a neurotransmitter vital in cognitive processes. Donepezil has been used in Alzheimer's disease for improving cognition. Although the package insert suggests nighttime administration to reduce the instance of daytime side effects, some patients report sleep disturbances. Methods . Patient charts at the Tallahassee Memorial Healthcare Neuroscience Center (TMH-NSC) were reviewed. Charts of those patients who met the inclusion criteria were used to determine the correlation between night time administration of donepezil and sleep disturbances. Results . A total of 186 patient charts were analyzed. Of those 186, 103 of the patients were taking donepezil as directed in the package labeling, at night time. Nearly half (47.6%) of the patients taking donepezil at night reported night time disturbances (NTD) and only 21 of the 83 patients taking donepezil in the morning reported NTD. Conclusion . This retrospective study showed that taking donepezil at night may be associated with sleep disturbances. Although labeling suggests administration in the evening, should NTDs occur, changing the medication administration to the morning should be explored before switching therapeutic agents.

Background. In recent years, pharmacists have become more active in patient care and can demonstrate a positive impact on the outcomes of drug therapy in asthma patients. Objective. The primary objective of this systematic review was to assess the impact of asthma improvement strategies used by pharmacists. The secondary objective was to ascertain if these strategies improve the control and other direct outcomes for patients with asthma compared with no intervention. Methods. Electronic databases were searched from January 2006 to February 2012. Data abstracted from publications included publication details, participants/ setting, intervention study design, outcome measures, and key findings. Results. Forty-seven studies were initially identified; 8 matched our inclusion criteria. Four were US studies and 4 were Canadian. Published studies provided evidence of the clinical effectiveness of pharmacy services in asthma interventions. The role of pharmacists in disease diagnosis, access to private area for consultation, time, and staff support were highlighted as the key barriers to asthma intervention. Reimbursement for consulting services provided a unique opportunity for pharmacists to provide direct patient care. Conclusion. The review demonstrated the contribution of pharmacy-based services to the monitoring, counseling, and educating in asthma care. The evidence supports the wider provision of asthma intervention through pharmacy services. Well-designed studies on the effectiveness of pharmacists' interventions to improve outcomes of patients with asthma need to be performed. In addition, further research is needed regarding the contribution of pharmacy services to disease detection as part of local public health strategies.

Multiple sclerosis, an autoimmune disorder causing the destruction of the impulse carrying myelin sheath of neurons, can be a debilitating and disabling disease. Symptomatic treatment has provided patients with relief through the use of antispasmodics, anticholinergics, and antidepressants, just to name a few, as well as disease treatment by decreasing progression of the illness by treating acute episodes through the use of corticosteroids, interferons, plasmapheresis, and other immunomodulators like glatiramer, mitoxantrone, and natalizumab. With medical advancements and the development of new treatments such as laquinimod, fampridine-SR, and several others, the future looks promising for those living with this illness.

Medication Therapy Management (MTM) has been a way for pharmacist to enhance their position as an integral member of the health care team as the need for improved clinical and economic outcomes in relation to the US health care system became apparent. MTM Certificate training programs are provided by numerous organizations. Collaboration Practice Agreements (CPA) are gaining significance as the role of the pharmacist is expanding in the care of patients as part of a multidisciplinary health care team. One major hurdle that many pharmacists are faced with is receiving reimbursement for the services provided. The Medicare Modernization Act of 2003 recognized that pharmacists play an important role in the management of patient care and that pharmacists bring an expertise and knowledge that will help to identify and resolve patient medication therapy problems.

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Systemic lupus erythematosus (SLE) is an autoimmune disease that affecting at least 1.5 million Americans. The exact cause of SLE is unknown; however there are numerous factors that are thought to play a role in the development of SLE. While there are several medications available for the management of SLE, Belimumab is the first medication approved for SLE management in over 50 years. Researchers are investigating other medications that may provide some benefit in SLE management and improve patient outcomes. These emerging treatments explore other mechanisms for management and targeting symptoms. SLE has a higher mortality rate than other rheumatic diseases and new and continuous research is needed with the aim to decrease the number of deaths and improve patients' quality of life. Key wordsSLE, Autoimmune, Lupus, Pharmacotherapy, Interferon BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease that has the potential to affect every organ in the body; however the disease affects most commonly the skin, kidneys, brain, and joints. According to the Lupus Foundation of America, at least 1.5 million Americans have SLE, although the actual number may be higher; there have been no large-scale studies to solidify the exact number of individuals living with SLE in the U.S. Annually, there are more than 16,000 new cases of SLE reported across the country. Women of childbearing age are considered the population mostly affected by Lupus. Although people of all races and ethnic groups can develop lupus, African-American women are 2-3 times more likely to develop SLE than any other population. Over the years, the life expectancy of such patients has improved from an approximate 4-year survival rate of 50% in the 1950s to a 15 year survival rate of 80% today. The leading cause of death in patients with SLE is kidney failure; however other causes include infections, cerebrovascular disease, cardiovascular disease, and cancer [1] .The exact cause of SLE is not known, however environmental, genetic, and hormonal factors are all thought to possibly lead to the development and expression of SLE. Current data illustrates the risk for development of SLE in siblings of individuals with the disease is about 20 times higher than that of the general population. The rate of identical twins

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Objective: To provide an overview of the use of ramelteon for the treatment of insomnia. Data Sources: A literature review was conducted through PubMed using the terms ramelteon, insomnia, treatment, adverse events, elderly, and melatonin. Additionally, reference citations from publications identified were reviewed. Data from 1982 to 2009 were gathered. Study Selection and Data Extraction: All articles in English that were identified from the data sources were evaluated. Data Synthesis: Long-term clinical trials of ramelteon have demonstrated that it is effective and safe, causing minimal adverse effects and no potential for abuse. Additionally, discontinuation of ramelteon does not result in rebound insomnia, which makes it an ideal agent for the management of insomnia in the elderly population. Conclusions: Ramelteon offers a safe and effective new therapeutic option for patients experiencing transient or chronic insomnia.