Community Practice

A 24-year-old woman, R.S., who is two months' pregnant, presents to your ER with a severe migraine that has lasted >48 hours. She reports having several migraines a week since she became pregnant, but until now has successfully "slept them off" in a quiet, dark room. Prior to her pregnancy, R.S. had used zolmitriptan nasal spray (Zomig, AstraZeneca) to abort migraines. She was also using amitriptyline 100 mg daily for prophylaxis. The neurologist on call is debating how to treat R.S. He requests a pharmacist consult. What do you recommend and why?

Treating heart attacks and agents affecting risk factors for heart disease were among the hot topics explored at the American Heart Association's 2006 annual meeting held recently in Chicago. Also, a program on increasing adherence to pharmacotherapy among the elderly was of interest to attendees.

As Medicare Part D moves into its second year, the program has undergone modest yet important changes. Still, despite sometimes significant premium increases and lack of coverage in the donut hole, most seniors seem to be sticking with the prescription drug plans (PDPs) they picked last year.

A survey commissioned by pharmacist groups indicates once again that patients are often not adhering to directions for prescription medications.

The Centers for Medicare & Medicaid Services' proposal to share claims information data with researchers and other government agencies has met with widespread support as well as hope that the agency will take it even further. Pharmaceutical companies, some pharmacy organizations, and even Democratic Party leaders all welcomed the change, and many urged CMS to broaden the data sharing to include state Medicaid officials. The proposed rule change can be found in the Oct. 18, 2006, Federal Register

With traumatic brain injury (TBI), the first question we often ask is, Will the patient recover? Beyond concerns about cognitive function and disability, little is generally known about the milestones and setbacks patients encounter while recovering from a TBI.

It's hard enough to get an employer and labor union to sit at the table, but what happens when you add pharmacists, a wholesaler, and a pharmacy benefit administrator to the mix? For Aerospace Contractors Trust (ACT) union members working at Jacobs Engineering, the answer is a transparent pharmacy benefit plan that seeks to strengthen the tie between healthcare providers and patients, providing low-cost coverage, while at the same time supporting local pharmacy businesses.

A recent study by researchers at the Mayo Clinic College of Medicine has raised questions about the safety of administering nicotine replacement therapy (NRT) to smokers in the intensive care unit (ICU). Until now, use of NRT was not thought to be associated with serious adverse events. In fact, the Agency for Healthcare Research & Quality (AHRQ) recommends smoking cessation treatment for hospitalized patients.

This past April, methylphenidate (Daytrana, Shire) was approved as a transdermal drug delivery system (TD-DDS) for the treatment of attention deficit hyperactivity disorder. And many more patches are on the horizon. Novartis is seeking Food & Drug Administration approval for its rivastigmine (Exelon) patch to aid in the treatment of Alzheimer's disease. Researchers in the United Kingdom are working on a TD-DDS to deliver synthetic cannabinoids for use as antiemetics and appetite stimulants in patients with AIDS and cancer.

An expert panel convened by the Alzheimer?s Drug Discovery Foundation recently released consensus recommendations on the treatment of Alzheimer?s disease and related dementias (ADRD) in managed care. The guidelines were published as a supplement to the American Journal of Geriatric Pharmacotherapy.

A recent study by researchers at the Mayo Clinic College of Medicine has raised questions about the safety of administering nicotine replacement therapy (NRT) to smokers in the intensive care unit (ICU). Until now, use of NRT was not thought to be associated with serious adverse events. In fact, the Agency for Healthcare Research & Quality (AHRQ) recommends smoking cessation treatment for hospitalized patients.

Medicare Part D is still not for wimps, be they health professionals or consumers, any more than it was in early 2006, according to a Kaiser Family Foundation (KFF) analyst. Indeed, there is high risk that many beneficiaries are getting into plans, both for 2006 and 2007, that are not good for covering their medications and there could be health consequences, said Patricia Neuman, Sc.D., director of the foundation's Medicare Policy Project.

At the 15th annual Murray and Bernard Schuss Memorial pharmacy lecture, Edith Rosato, R.Ph., argued that community pharmacy must unite and work together to confront a range of challenges. Rosato, senior VP of pharmacy affairs for the National Association of Chain Drug Stores, addressed an audience of more than 200 students and faculty at the Arnold & Marie Schwartz College of Pharmacy & Health Sciences, Long Island University. NACDS interim president and CEO Robert Hannan was originally scheduled to deliver the lecture.

Our current system is not working and needs reform was the take-away message from a three-hour workshop examining both Medicare Part D and the future of drug pricing. Held at the American Public Health Association's 134th Annual Meeting, which convened in Boston in November, the workshop included speakers discussing the various issues surrounding the drug benefit and potential methods for reform.

As reimbursements for drugs keep falling, chains must fill more prescriptions-and apply even more pressure on their pharmacists to dispense quickly-to make up for their loss. But pharmacists claim this is leading to more drug errors.

If there is a lesson from the last election, it may be this: Beware of seniors bearing donuts. Pennsylvania Representative Melissa Hart, a Republican from the southwestern part of the state, certainly should have. Instead, just two weeks before the mid-term elections, Hart called the police to handle a group of 40 Association of Retired Americans (ARA) activists who brought donuts as a demonstration against the donut-hole gap in coverage in the Medicare Part D benefit. Hart, who was leading in polls at the time, went on to lose the election.

This past April, methylphenidate (Daytrana, Shire) was approved as a transdermal drug delivery system (TD-DDS) for the treatment of attention deficit hyperactivity disorder. And many more patches are on the horizon. Novartis is seeking Food & Drug Administration approval for its rivastigmine (Exelon) patch to aid in the treatment of Alzheimer's disease. Researchers in the United Kingdom are working on a TD-DDS to deliver synthetic cannabinoids for use as antiemetics and appetite stimulants in patients with AIDS and cancer.

Peak and trough serum levels should be measured for patients on vancomycin, right? Well, sort of. According to Sharon See, Pharm.D., BCPS, associate clinical professor at St. John's University College of Pharmacy in New York, only trough levels are necessary. And in most cases, no levels are needed at all. That was one medical myth that was exploded at the recent American College of Clinical Pharmacy (ACCP) annual meeting in St. Louis in October.

New molecular entities on the horizon for the treatment of osteoporosis face a tough row to hoe in their quest for approval from the Food & Drug Administration. That was the subject of a presentation at the 2006 Annual Meeting of the American College of Clinical Pharmacy (ACCP), held in October in St. Louis.

An expert panel convened by the Alzheimer?s Drug Discovery Foundation recently released consensus recommendations on the treatment of Alzheimer?s disease and related dementias (ADRD) in managed care. The guidelines were published as a supplement to the American Journal of Geriatric Pharmacotherapy.

The Centers for Disease Control & Prevention (CDC) estimates that 1.25 million Americans are chronically infected with hepatitis B virus (HBV). Now a new, oral, once-daily treatment has been approved by the Food & Drug Administration and is indicated for the treatment of the illness in adult patients with both evidence of viral replication and either persistent elevations in serum aminotransferases or histologically active disease.

The long-delayed drug pedigree regulations announced by the Food & Drug Administration in mid-November have evoked a storm of criticism and lawsuits. No one is objecting to the FDA's stated goal of reducing drug diversion and counterfeits, but the cure may be worse than the disease.

The recently approved Zolinza (vorinostat), the first anticancer drug to be developed by Merck & Co. in 20 years, targets a little-known malignancy that's often mistaken for eczema or psoriasis. Vorinostat, also known as suberoylanilide hydroxamic acid (SAHA), is indicated for the treatment of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL), a rare form of non-Hodgkin's lymphoma, who have progressive, persistent, or recurrent disease on or following two systemic therapies.

Our chain has a policy of returning prescriptions to stock if they're not picked up within 10 days.

One funny story I will never forget is when I received a phone call from an older lady, saying, "I just picked up my cream from your pharmacy, and the directions say to apply it locally. I'm going out of town tonight.