Congestive heart failure is a complex clinical hemodynamic disorder characterized by chronic and progressive pump failure and fluid accumulation. Although the overall impact of diuretic therapy on congestive heart failure mortality remains unknown, diuretics remain a vital component of symptomatic congestive heart failure management. Over time, sodium and water excretion are equalized before adequate fluid elimination occurs. This phenomenon is thought to occur in one out of three patients with congestive heart failure on diuretic therapy and is termed diuretic resistance. In congestive heart failure, both pharmacokinetic and pharmacodynamic alterations are thought to be responsible for diuretic resistance. Due to disease chronicity, symptomatic management is vital to improved quality of life and enhancing diuretic response is therefore pivotal.
In light of the current limited over-the-counter status of emergency contraception, the role of rural and frontier pharmacies in ensuring access to emergency contraception will increase in the future.
At 6 months after discontinuation of the pharmacist-managed anticoagulation service, the frequency of adverse events increased significantly, resulting in both an increased number of hospitalizations and an increased number of hospital days accrued. This coordinated anticoagulation program using a pharmacist reduced warfarin-related complications.
Numerous case reports have documented an enhanced hypoprothrombinemic effect caused by an interaction between fluoroquinolones (most notably, ciprofloxacin) and warfarin sodium. Conflicting data exist regarding the clinical significance of this interaction. Two patients who had elevated international normalized ratios after receiving concurrent levofloxacin and warfarin sodium are described.
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are a frequently prescribed class of drugs that are generally well tolerated by most patients. A rare, yet serious side effect associated with these drugs is rhabdomyolysis. Although all HMG-CoA reductase inhibitors can cause this adverse effect, prevalence may differ among specific agents. Over a 16-month period, in three hospitals, 11 patients experienced cerivastatin-induced rhabdomyolysis, but no cases of rhabdomyolysis associated with any other HMG-CoA reductase inhibitors were reported.
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