Pharmacy

12 pages, 651 KB

Open AccessEditor’s ChoiceReview

Drug Manipulation in Pediatric Care: A Scoping Review of a Widespread Practice Signaling Systemic Gaps in Pharmaceutical Provision

by Charlotte Vermehren, Laura Giraldi, Sarah Al-Rubai, Ida M. Heerfordt, Yasmine Merimi, Rene Mathiasen, Anette Müllertz, Jon Trærup Andersen, Susanne Kaae and Christina Gade

Pharmacy 2026, 14(1), 2; https://doi.org/10.3390/pharmacy14010002 - 24 Dec 2025

Viewed by 549

Abstract

Background: Pediatric patients often receive medicines manipulated from adult formulations due to a lack of age-appropriate products. While such practices are clinically routine, they may reflect deeper systemic deficiencies in pediatric pharmacotherapy. Objective: This scoping review aimed to map the prevalence, definitions, and [...] Read more.

Background: Pediatric patients often receive medicines manipulated from adult formulations due to a lack of age-appropriate products. While such practices are clinically routine, they may reflect deeper systemic deficiencies in pediatric pharmacotherapy. Objective: This scoping review aimed to map the prevalence, definitions, and types of pediatric drug manipulation and to conceptualize manipulation as an indicator of structural gaps in formulation science, regulation, and access. Methods: A systematic search of PubMed (January 2014–July 2024) included 10 studies reporting the frequency of drug manipulation in children aged ≤18 years. Eligible studies were synthesized narratively according to PRISMA-ScR guidelines. Results: Ten studies from nine countries were included, reporting manipulation frequencies ranging from 6.4% to 62% of all drug administrations and up to 60% at the patient level. Manipulated formulations most commonly included oral solid doses, altered through dispersing, splitting, or crushing. Definitions and methodologies varied considerably. The findings revealed five recurring structural gaps: limited pediatric formulations, inconsistent regulatory implementation, lack of standardized definitions and guidance, insufficient evidence on manipulation safety, and inequitable access across regions. Conclusion: Manipulation of finished dosage forms for use in children is a widespread, measurable phenomenon reflecting systemic inadequacies in formulation development, regulation, and access. Recognizing manipulation as a structural indicator may guide policy, innovation, and equitable pediatric pharmacotherapy worldwide. Full article

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36 pages, 4070 KB

Open AccessEditor’s ChoiceReview

Monoclonal Antibodies as a Breakthrough in Personalised Leukaemia Therapy: What Pharmacists and Doctors Should Know

by Anastasiia Ryzhuk, Sergiy M. Kovalenko, Marine Georgiyants, Kateryna Vysotska and Victoriya Georgiyants

Pharmacy 2025, 13(6), 169; https://doi.org/10.3390/pharmacy13060169 - 20 Nov 2025

Viewed by 1654

Abstract

Monoclonal antibodies (mAbs) are an important medical innovation in modern medicine. They are an effective therapy for several subtypes of leukaemia but may have undesirable effects, which may be minimised through the provision of interdisciplinary care including a pharmacist. The goals of this [...] Read more.

Monoclonal antibodies (mAbs) are an important medical innovation in modern medicine. They are an effective therapy for several subtypes of leukaemia but may have undesirable effects, which may be minimised through the provision of interdisciplinary care including a pharmacist. The goals of this narrative review were twofold: first, to summarise the literature on the side effects of mAbs and the challenges of their preparation, and to provide recommendations for the safe preparation of mAb drug formulations for clinicians. Second, to suggest clinical roles for pharmacists to improve patient safety and clinical outcomes for leukaemia patients receiving mAb therapy. The review covers data from 178 scientific and official sources of information on the types of targeted immunobiological drugs for the treatment of various types of leukaemia. The results are a detailed description of the possible side effects from mAb therapy and a list of suggested actions that can be taken to prevent them. Pharmaceutical aspects of the use of mAbs, such as pharmacoeconomics, compounding and stability, are also discussed. The discussion is organised according to the current classification of leukaemia. The drugs considered include blinatumomab, inotuzumab ozogamicin, gemtuzumab ozogamicin, rituximab, ofatumumab, obinutuzumab, and alemtuzumab. The review offers a comprehensive resource to equip pharmacists and other clinicians to optimise mAb therapy and promote the safe use of these novel therapies. Full article

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16 pages, 213 KB

Open AccessEditor’s ChoiceArticle

Responsible Adoption of Artificial Intelligence (AI) in Pharmacy Practice: Perspectives of Regulators in Canada and the United States

by Paul A. M. Gregory and Zubin Austin

Pharmacy 2025, 13(6), 152; https://doi.org/10.3390/pharmacy13060152 - 27 Oct 2025

Viewed by 2172

Abstract

Background: Use of Artificial Intelligence (AI) is proliferating in society and in pharmacy practice. For some, this represents a great advancement that will enhance effectiveness and efficiency of health care. For others, it is an existential risk that will worsen inequalities, lead to [...] Read more.

Background: Use of Artificial Intelligence (AI) is proliferating in society and in pharmacy practice. For some, this represents a great advancement that will enhance effectiveness and efficiency of health care. For others, it is an existential risk that will worsen inequalities, lead to deskilling of the workforce, and spiral beyond the comprehension or control of humans. Human-in-the-loop (HiL) vs. human-out-of-the loop (HoL) AI have different potential risks and challenges that raise questions regarding patient safety. Defining principles for responsible adoption of AI in pharmacy practice will be an important safeguard for both patients and the profession. Methods: Semi-structured interviews with 12 pharmacy regulators from across Canada and the United States were undertaken, with informed consent. Constant comparative data analysis using nVivo v15 was used to identify common themes. The COREQ framework was applied to assure quality of research processes used. Results: Pharmacy regulators highlighted the value of a principles-based, rather than rules-based, approach to AI. Core principles related to transparency, redundancy, audit and feedback, quality assurance, privacy/data security, alignment with codes of ethics, and interoperability were identified. There was limited consensus on the role of consent and choice as principles to be considered. Conclusions: The role of regulation in shaping responsible adoption of AI in pharmacy will be significant. This study highlighted a series of agreed-upon principles but also identified lack of consensus with respect to how consent and choice could be operationalized in pharmacy practice. Full article

(This article belongs to the Special Issue AI Use in Pharmacy and Pharmacy Education)

36 pages, 2417 KB

Open AccessEditor’s ChoiceReview

Optimizing Drug Therapy in ECMO-Supported Critically Ill Adults: A Narrative Review and Clinical Guide

by Abraham Rocha-Romero, Jose Miguel Chaverri-Fernandez, Fianesy Chaves-Fernández and Esteban Zavaleta-Monestel

Pharmacy 2025, 13(6), 151; https://doi.org/10.3390/pharmacy13060151 - 23 Oct 2025

Viewed by 2513

Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly used to support critically ill adults with severe cardiac or respiratory failure, but ECMO circuits and the physiological disturbances of critical illness significantly alter drug pharmacokinetics (PK) and pharmacodynamics (PD), complicating dosing and monitoring. This narrative review [...] Read more.

Extracorporeal membrane oxygenation (ECMO) is increasingly used to support critically ill adults with severe cardiac or respiratory failure, but ECMO circuits and the physiological disturbances of critical illness significantly alter drug pharmacokinetics (PK) and pharmacodynamics (PD), complicating dosing and monitoring. This narrative review synthesizes current clinical evidence on ECMO-related PK/PD alterations and provides practical guidance for optimizing pharmacotherapy in adult intensive care. A structured literature search (January–May 2025) was conducted across PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library, Sage Journals, ScienceDirect, Taylor & Francis Online, SpringerLink, and specialized databases, focusing on seven therapeutic classes commonly used in ECMO patients. Eligible studies included clinical trials, observational studies, systematic reviews, and practice guidelines in adults, while pediatric and preclinical data were excluded. Evidence quality varied substantially across drug classes. Hydrophilic, low-protein-bound agents such as β-lactams, aminoglycosides, fluconazole, and caspofungin generally showed minimal ECMO-specific PK alterations, with dose adjustment mainly driven by renal function. Conversely, lipophilic and highly protein-bound drugs including fentanyl, midazolam, propofol, voriconazole, and liposomal amphotericin B exhibited substantial circuit adsorption and variability, often requiring higher loading doses, prolonged infusions, and rigorous therapeutic drug monitoring. No ECMO-specific data were identified for certain neuromuscular blockers, antivirals, and electrolytes. Overall, individualized dosing guided by therapeutic drug monitoring (TDM), organ function, and validated PK principles remains essential to optimize therapy in this complex population. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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19 pages, 827 KB

Open AccessEditor’s ChoiceArticle

Developing Soft Skills for Sustainable Community Pharmacy Practice Through a Competency-Based Modular Programme

by Ivana Zimonjić, Lazar Dražeta, Valentina Marinković and Tatjana Milošević

Pharmacy 2025, 13(4), 110; https://doi.org/10.3390/pharmacy13040110 - 20 Aug 2025

Cited by 2 | Viewed by 1464

Abstract

This study explored a competency-based soft-skills programme supporting evolving community pharmacy professionals’ roles and sustainable practice in Serbia. Four researchers with academic and practice backgrounds developed the programme using healthcare guidelines and the International Pharmaceutical Federation’s competency framework. The process involved defining objectives, [...] Read more.

This study explored a competency-based soft-skills programme supporting evolving community pharmacy professionals’ roles and sustainable practice in Serbia. Four researchers with academic and practice backgrounds developed the programme using healthcare guidelines and the International Pharmaceutical Federation’s competency framework. The process involved defining objectives, selecting methods, designing and organising activities, accreditation, and evaluating outcomes based on the Kirkpatrick model. From January 2021 to March 2025, the “Galenika Academy” was implemented through webinars, accredited tests, onsite courses, and a mobile application. Satisfaction was assessed via a validated online questionnaire among participants attending ≥80% of sessions, following evaluation of attendance and test performance. The programme reached 5107 participants, 10,427 webinar views, and 8252 test completions. The “Galiverse” mobile app, launched in February 2023, had 5558 users by March 2025. The most attended webinar was “Burnout” (787). Average test success was 82.9%, with 95.3% for “Resilience” and 61.0% for “Team Management.” Satisfaction was 95.5% for content, 94.2% for quality, 92.3% for materials, 77.1% for the application, and 96.3% would recommend it. Among those reporting improved resilience, 96.9% believed it could positively impact pharmacy operations. Pharmacists found the programme relevant and effective. Further research is needed to evaluate its impact on practice and patient outcomes. Full article

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21 pages, 716 KB

Open AccessEditor’s ChoiceReview

Improving Hemorrhoid Outcomes: A Narrative Review and Best Practices Guide for Pharmacists

by Nardine Nakhla, Ashok Hospattankar, Kamran Siddiqui and Mary Barna Bridgeman

Pharmacy 2025, 13(4), 105; https://doi.org/10.3390/pharmacy13040105 - 30 Jul 2025

Cited by 3 | Viewed by 10707

Abstract

Hemorrhoidal disease remains a prevalent yet often overlooked condition, affecting millions worldwide and imposing a substantial healthcare burden. Despite the availability of multiple treatment options, gaps persist in patient education, early symptom recognition, and optimal treatment selection. Recent advancements are evolving the pharmacist’s [...] Read more.

Hemorrhoidal disease remains a prevalent yet often overlooked condition, affecting millions worldwide and imposing a substantial healthcare burden. Despite the availability of multiple treatment options, gaps persist in patient education, early symptom recognition, and optimal treatment selection. Recent advancements are evolving the pharmacist’s role in hemorrhoid management beyond traditional over-the-counter (OTC) and prescription approaches. The 2024 American Society of Colon and Rectal Surgeons (ASCRS) guidelines introduce updates on the use of phlebotonics, a class of venoactive drugs gaining recognition for their role in symptom management, yet largely underutilized in U.S. clinical practice. In parallel, novel clinical tools are reshaping how pharmacists engage in assessment and care. The integration of digital decision-support platforms and structured evaluation algorithms now empowers them to systematically evaluate symptoms, identify red flag signs, and optimize patient triage. These tools reduce diagnostic variability and improve decision-making accuracy. Given their accessibility and trusted role in frontline healthcare, pharmacists are well-positioned to bridge these critical gaps by adopting emerging treatment recommendations, leveraging algorithm-driven assessments, and reinforcing best practices in patient education and referral. This narrative review aims to equip pharmacists with updated insights into evidence-based hemorrhoid management strategies and provide them with structured assessment algorithms to standardize symptom evaluation and treatment pathways. By integrating these innovations, pharmacists can enhance treatment outcomes, promote patient safety, and contribute to improved quality of life (QoL) for individuals suffering from hemorrhoidal disease. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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17 pages, 222 KB

Open AccessEditor’s ChoiceArticle

Enhancing the Role of Community Pharmacists in Medication Safety: A Qualitative Study of Voices from the Frontline

by Annesha White, Erika L. Thompson, Solyi Kim, Janice A. Osei, Kimberly G. Fulda and Yan Xiao

Pharmacy 2025, 13(4), 94; https://doi.org/10.3390/pharmacy13040094 - 9 Jul 2025

Cited by 4 | Viewed by 4210

Abstract

Preventable adverse drug events (ADEs) remain a significant threat in community settings, a challenge that is critical in community pharmacy settings where continuity of care and healthcare access can be limited. This qualitative study explored the perspectives of 13 community pharmacists through focus [...] Read more.

Preventable adverse drug events (ADEs) remain a significant threat in community settings, a challenge that is critical in community pharmacy settings where continuity of care and healthcare access can be limited. This qualitative study explored the perspectives of 13 community pharmacists through focus groups and interviews to identify barriers and propose solutions to enhance their role in patient care. Pharmacists emphasized their critical position in ensuring safe medication use, particularly for older adults managing multiple chronic conditions. Key findings revealed five themes: (1) defining medication safety as minimizing risk and empowering patients; (2) characteristics of the “perfect patient,” including medication awareness and proactive engagement; (3) the pharmacist’s role in detecting and resolving medication-related problems; (4) systemic barriers such as time constraints, lack of access to patient records, insufficient privacy, and undervaluation of pharmacists’ roles; and (5) proposed solutions including private counseling areas, increased staffing, integrated electronic health records, and legislative recognition of pharmacists as healthcare providers. Strengthening collaboration with physicians and empowering patients through education were also highlighted as key strategies. These findings underscore the need for systemic changes—especially in light of lessons learned during the pandemic—to support pharmacists in delivering comprehensive medication management and improving patient safety. Full article

(This article belongs to the Collection New Insights into Pharmacy Teaching and Learning during COVID-19)

12 pages, 715 KB

Open AccessEditor’s ChoiceArticle

Visual Thinking to Explore “Relational Pharmacology”: Systemic Maps for Managing Non-Selective Antidepressants in Cardiovascular Prevention

by Irene García-Domínguez, Azahara Rodríguez-Luna and Manuel Machuca

Pharmacy 2025, 13(4), 91; https://doi.org/10.3390/pharmacy13040091 - 27 Jun 2025

Viewed by 3037

Abstract

Relational pharmacology introduces an innovative approach using visual thinking to understand how drugs interact with multiple body systems, addressing the limitations of the traditional “reductionist approach”. While conventional pharmacology focuses on individual drug effects, it struggles with the complexities of polypharmacy, where multiple [...] Read more.

Relational pharmacology introduces an innovative approach using visual thinking to understand how drugs interact with multiple body systems, addressing the limitations of the traditional “reductionist approach”. While conventional pharmacology focuses on individual drug effects, it struggles with the complexities of polypharmacy, where multiple medications interact via shared metabolic pathways. This article highlights integrating systemic maps into educational methodologies to empower students in identifying and assessing medication risks. By visualizing the body and drug therapy as interconnected systems, students can better understand complex pharmacological interactions beyond linear frameworks. This approach enables active learning and real-life case analysis, such as cardiovascular prevention with non-selective antidepressants, where multiple drug interactions must be considered. It also fosters global health education by promoting the exchange of effective teaching practices and addressing challenges in healthcare training. Systemic maps prepare students for clinical decision-making by enhancing their ability to manage risks and complex cases effectively. Full article

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15 pages, 506 KB

Open AccessEditor’s ChoiceArticle

Exploring Pharmacy Students’ Perceptions of Feedback and Self-Reflection in Patient Counselling Simulations: Implications for Professional Development

by Jessica Pace, Andrew Bartlett, Tiffany Iu, Jessica La and Jonathan Penm

Pharmacy 2025, 13(3), 74; https://doi.org/10.3390/pharmacy13030074 - 27 May 2025

Viewed by 2094

Abstract

(1) Background: Structured use of feedback and self-reflection in simulated counselling sessions has a number of benefits, including identification of strategies for improvement, improvement in key skills and adaptability and a patient-centred approach which will help them to succeed as effective healthcare practitioners. [...] Read more.

(1) Background: Structured use of feedback and self-reflection in simulated counselling sessions has a number of benefits, including identification of strategies for improvement, improvement in key skills and adaptability and a patient-centred approach which will help them to succeed as effective healthcare practitioners. The aim of this study was therefore to explore students’ perceptions of self-reflection and feedback in patient counselling simulations and the development of patient counselling skills; (2) Methods: Focus groups explored student perceptions of how the combination of self-reflection, self-assessment and teacher and peer feedback impacted their performance in simulated patient counselling assessments; (3) Results: Four focus groups with 21 pharmacy students were conducted. We identified three main themes and associated subthemes: consistency and continuity (sub-themes learning through repetitive assessment and inconsistent expectations), perceptions of feedback (sub-themes tutor feedback, peer feedback and self-reflection) and real-life practice (sub-themes authenticity of simulation cases, perceptions of empathy and professional development); (4) Conclusions: This study highlights the critical role of integrating consistent, high-quality feedback, peer assessment, and self-reflection in pharmacy education to enhance students’ learning experiences and prepare them for professional practice. As workplace-based assessment becomes more common and expected by accreditation bodies, these insights underscore the need for structured and continuous feedback processes to be integrated into all areas of pharmacy curricula. Full article

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21 pages, 579 KB

Open AccessEditor’s ChoiceReview

Ustekinumab in the Treatment of Crohn’s Disease—A Narrative Review on Clinical Efficacy and Safety Profile

by Dawid Piecuch, Edyta Hańczyk, Szymon Kopciał, Natalia Pawelec, Weronika Mazur and Karolina Kornatowska

Pharmacy 2025, 13(3), 73; https://doi.org/10.3390/pharmacy13030073 - 21 May 2025

Cited by 3 | Viewed by 5511

Abstract

Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract that leads to significant deterioration in patients’ quality of life. Biologic therapy, including the use of ustekinumab (UST), is a modern approach to treating the moderate to severe form of CD, [...] Read more.

Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract that leads to significant deterioration in patients’ quality of life. Biologic therapy, including the use of ustekinumab (UST), is a modern approach to treating the moderate to severe form of CD, especially in patients refractory to traditional treatments. UST, which acts as an interleukin IL-12 and IL-23 antagonist, has shown high efficacy in reducing inflammation, improving quality of life, and promoting mucosal regeneration and fistula healing. However, the use of biologic therapies, such as UST, has challenges related to the timing of treatment and patient response, including the problem of immunogenicity. To determine the clinical efficacy and safety profile of UST in the treatment of CD, a review of the literature published in the PubMed database over the last 5 years was conducted. After excluding articles that did not meet the inclusion criteria, we analyzed 42 clinical studies. The review discusses the available data on the efficacy and safety of UST, as well as its comparison with other biologic therapies, such as infliximab and adalimumab. UST, although not significantly greater to adalimumab, has lower immunogenicity and higher treatment retention. The therapeutic value of UST is also confirmed by biosimilars such as ABP 65 and FYB202, which show comparable efficacy and safety profile. The analysis of predictive biomarkers, such as serum drug levels and baseline eosinophil levels, could be an important element in the future personalization of CD treatment. The review’s findings point to the importance of further research to improve the tailoring of therapies to individual patients and improve long-term treatment outcomes. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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10 pages, 1096 KB

Open AccessEditor’s ChoiceOpinion

Heat Therapy for Musculoskeletal Pain Conditions: Actionable Suggestions for Pharmacists from a Panel of Experts

by Flavia Nossa, Massimiliano Franco, Alberto Magni, Emanuela Raimondo, Giuseppe Ventriglia and Fabrizio Gervasoni

Pharmacy 2025, 13(3), 63; https://doi.org/10.3390/pharmacy13030063 - 29 Apr 2025

Viewed by 8983

Abstract

Musculoskeletal disorders represent one of the most pervasive health concerns that drive frequent medical consultations and pharmacy encounters. Community pharmacies are well placed to help address this demand as they are accessible settings for healthcare advice and support for patients with musculoskeletal disorders [...] Read more.

Musculoskeletal disorders represent one of the most pervasive health concerns that drive frequent medical consultations and pharmacy encounters. Community pharmacies are well placed to help address this demand as they are accessible settings for healthcare advice and support for patients with musculoskeletal disorders complaining of pain. Heat therapy stands as a valuable component of a multimodal approach to the management of musculoskeletal pain by virtue of multiple effects: pain relief, reduction of muscle spasms and stiffness, and enhanced muscle flexibility and range of motion. However, there is limited guidance on heat therapy use in routine practice, particularly on indications and contraindications, mode of application, and precautions. Such an educational gap has been documented among pharmacists. Therefore, it is paramount that pharmacists gain knowledge about when and how to effectively integrate superficial heat therapy with both pharmacological and physical therapy, to provide patients with a comprehensive, multimodal approach to alleviating musculoskeletal pain. A multidisciplinary panel of experts gathered to develop practical guidance on heat therapy-appropriate application in patients with musculoskeletal pain. In this work, we provide actionable suggestions to build pharmacists’ competency in managing musculoskeletal pain and empower them in effectively using heat therapy as a single therapeutic option or in combination with over-the-counter analgesics. Full article

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11 pages, 183 KB

Open AccessEditor’s ChoiceArticle

Challenges of Key Performance Indicators and Metrics for Measuring Medical Science Liaison Performance: Insights from a Global Survey

by Samuel Dyer, Cherie Hyder and Jeff Kraemer

Pharmacy 2025, 13(2), 51; https://doi.org/10.3390/pharmacy13020051 - 2 Apr 2025

Cited by 1 | Viewed by 6665

Abstract

Background: Medical Science Liaisons (MSLs) serve a vital role in facilitating the exchange of scientific knowledge between pharmaceutical companies and health care professionals (HCPs), including pharmacists, ensuring the dissemination of accurate, evidence-based information to support clinical decision-making. Evaluating MSL performance is critical for [...] Read more.

Background: Medical Science Liaisons (MSLs) serve a vital role in facilitating the exchange of scientific knowledge between pharmaceutical companies and health care professionals (HCPs), including pharmacists, ensuring the dissemination of accurate, evidence-based information to support clinical decision-making. Evaluating MSL performance is critical for demonstrating their value, yet defining appropriate key performance indicators (KPIs) remains challenging due to the combination of scientific engagement, relationship-building, and other activities that are difficult to measure. Objective: This study examines the current and perceived ideal use of quantitative and qualitative metrics for MSL performance evaluation, the difficulties in measuring MSL impact, and the perceived effectiveness of existing KPIs. Methods: A global survey of 1023 medical affairs professionals across 63 countries was conducted, gathering data on which KPIs are currently used versus which should be used, the preferred weighting of qualitative vs. quantitative metrics, and opinions on measurement difficulty and KPI effectiveness. Results: The results reveal a strong preference for qualitative metrics (52%) over quantitative metrics (7%), though most organizations primarily use activity-based metrics such as the number of key opinion leader (KOL) engagements (92%). Despite these practices, many respondents believe that MSL KPIs should focus more on impact-based qualitative metrics, such as the quality of KOL/HCP relationships and/or engagements (70%) and the quality of actionable insights gathered (67%). Furthermore, 67% of participants reported it is “difficult” or “very difficult” to measure MSL performance accurately, and only 3% revealed current KPIs and metrics used to measure MSL performance are “very effective”. These findings highlight a disconnect between the way MSLs are evaluated and the value they provide. Conclusions: This study demonstrates the need for a balanced KPI framework that integrates both qualitative and quantitative measures. A more refined performance evaluation system (incorporating stakeholder feedback, insight quality, and strategic impact) can ensure fair assessments and drive MSL effectiveness. Full article

18 pages, 745 KB

Open AccessEditor’s ChoiceSystematic Review

Factors and Disparities Influencing Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-like Peptide 1 Receptor Agonists Initiation in the United States: A Scoping Review of Evidence

by Josiah Moore, Ndidi Iheme, Nicholas S. Rebold, Harriet Kusi, Constance Mere, Uzoamaka Nwaogwugwu, Earl Ettienne, Weerachai Chaijamorn and Dhakrit Rungkitwattanakul

Pharmacy 2025, 13(2), 46; https://doi.org/10.3390/pharmacy13020046 - 19 Mar 2025

Cited by 3 | Viewed by 1990

Abstract

Introduction: Health disparities affecting minority populations and resulting in poorer outcomes for disadvantaged groups have been documented in the literature. Sodium/glucose-cotransporter 2 (SGLT2i) inhibitors and GLP-1 receptor agonists (GLP-1RA) markedly decrease mortality from kidney and cardiovascular events. However, little is known about the [...] Read more.

Introduction: Health disparities affecting minority populations and resulting in poorer outcomes for disadvantaged groups have been documented in the literature. Sodium/glucose-cotransporter 2 (SGLT2i) inhibitors and GLP-1 receptor agonists (GLP-1RA) markedly decrease mortality from kidney and cardiovascular events. However, little is known about the factors and disparities that lead to differences in SGLT2i and GLP-1RA initiation across different ethnic groups. Methods: This scoping review queried databases using key terms related to disparities in the initiation of SGLT2i and GLP-1RA among high-risk populations. Relevant data from eligible studies were extracted, organized, and analyzed thematically to identify key trends and patterns in the literature. Result: Nineteen studies were included in this review. Key risk factors influencing uptake included age, provider type, race, sex, education, comorbidities, insurance, and income, with minority patients consistently showing lower rates of initiation due to systemic barriers and socioeconomic disparities. Patients who were younger, male, had higher education or income levels, and received care from specialists were more likely to use these therapies. Conclusion: The adoption of SGLT2i and GLP-1RA remains suboptimal despite their proven kidney and cardiovascular benefits. Targeted efforts to reduce socioeconomic and racial inequities based on the factors identified should be encouraged. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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21 pages, 958 KB

Open AccessEditor’s ChoiceArticle

Methadone and Buprenorphine as Medication for Addiction Treatment Diversely Affect Inflammation and Craving Depending on Their Doses

by Christonikos Leventelis, Aristidis S. Veskoukis, Andrea Paola Rojas Gil, Panagiotis Papadopoulos, Maria Garderi, Asimina Angeli, Antzouletta Kampitsi and Maria Tsironi

Pharmacy 2025, 13(2), 40; https://doi.org/10.3390/pharmacy13020040 - 6 Mar 2025

Viewed by 4087

Abstract

Buprenorphine and methadone are widely used as medication for addiction treatment (MAT) in patients with opioid use disorders. However, there is no compelling evidence of their impact on the immune–endocrine response. Therefore, the aim of this study was to examine the effects of [...] Read more.

Buprenorphine and methadone are widely used as medication for addiction treatment (MAT) in patients with opioid use disorders. However, there is no compelling evidence of their impact on the immune–endocrine response. Therefore, the aim of this study was to examine the effects of the aforementioned medications on craving and on biomarkers of inflammation and cortisol, approaching the dose issue concurrently. Sixty-six patients (thirty-four under methadone and thirty-two under buprenorphine) who had just entered a MAT program and were stabilized with the suitable administered doses after a two-week process were divided into four groups based on medication dose (i.e., methadone high dose, buprenorphine high dose, methadone medium dose, and buprenorphine medium dose). The heroin craving questionnaire for craving assessment was completed, and the blood biomarkers were measured on Days 1 and 180. According to the results, high doses of both medications were accompanied by low levels of craving, cortisol, and inflammation on Day 1, and no alterations were observed on Day 180. On the contrary, medium doses reduced the tested psychosocial and biochemical parameters in terms of time, indicating a positive action for the patients. Concludingly, modifications in MAT doses are needed soon after the stabilization process to prevent inflammation and avoid relapse, thus helping opioid-addicted patients toward rehabilitation. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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26 pages, 3885 KB

Open AccessEditor’s ChoiceArticle

Pharmaceutical Public Health: A Mixed-Methods Study Exploring Pharmacy Professionals’ Advanced Roles in Public Health, Including the Barriers and Enablers

by Diane Ashiru-Oredope, Roeann Osman, Adeola H. Ayeni, Eleanor J. Harvey, Maria Nasim, Emma Wright, Christina Narh, Uju Okereke, Tasmin Harrison, Christopher Garland, Cecilia Pyper, Andrew Evans and Marion Bennie

Pharmacy 2025, 13(2), 37; https://doi.org/10.3390/pharmacy13020037 - 1 Mar 2025

Cited by 2 | Viewed by 4544

Abstract

Background: In the UK and globally, pharmacy professionals (pharmacists and pharmacy technicians) contribute to the delivery of local and national public or population health interventions. The existing literature on pharmaceutical public health predominantly focuses on micro-level activities, primarily describing community pharmacies delivering public [...] Read more.

Background: In the UK and globally, pharmacy professionals (pharmacists and pharmacy technicians) contribute to the delivery of local and national public or population health interventions. The existing literature on pharmaceutical public health predominantly focuses on micro-level activities, primarily describing community pharmacies delivering public health interventions to individuals. There is little-known evidence on pharmacy professionals’ involvement in delivering public health interventions at meso- (e.g., organisational) and macro (national/policy) levels, nor to what extent pharmacy professionals have specialist/advanced roles within public health practice. This study specifically explored pharmacy professionals’ specialist/advanced roles within public health as well as the opportunities and barriers to career development. The analyses of this mixed-methods study makes a series of important recommendations for future action. Methods: This study included two independent cross-sectional electronic surveys for pharmacy professionals and public health professionals, a call for evidence, and two workshops to develop recommendations. Results: Pharmacy professionals (n = 128) and public health professionals (n = 54) across the UK participated in the surveys. Most of the Pharmacy Professionals respondents were female (70%), pharmacists (85%), working in primary (33%) or secondary (25%) care settings, mainly based in England (75%), and most (63%) lacked formal public health qualifications although they were involved in a diverse range of public health interventions. The public health professionals were mostly females (67%), practicing in England (58%). Both professional groups identified opportunities and barriers to pharmacy professionals’ involvement in public health. Almost half of the public health professionals respondents (44%) stated that they had a pharmacy professional working as part of their current public health teams. Eighty-seven percent of public health professional respondents (45/52) agreed that having pharmacists or pharmacy technicians specialising in public health would be beneficial or very beneficial. Most of the documents, reports, and case histories provided through the call for evidence were unpublished. The workshops generated 94 recommendation statements, highlighting collaboration and the need to acknowledge pharmacy professionals’ contributions to public health. Conclusion: The recommendations for strategic action at meso- and macro-levels included three main themes: adopting a national strategic approach to pharmaceutical public health, including improving commissioning; formalising pharmaceutical public health workforce development; and promoting further evidence-based pharmaceutical public health research and development. Full article

(This article belongs to the Special Issue Pharmacy: State-of-the-Art and Perspectives in UK)

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27 pages, 1353 KB

Open AccessEditor’s ChoiceReview

Disparities in Postoperative Pain Management: A Scoping Review of Prescription Practices and Social Determinants of Health

by Aidan Snell, Diana Lobaina, Sebastian Densley, Elijah Moothedan, Julianne Baker, Lama Al Abdul Razzak, Alexandra Garcia, Shane Skibba, Ayden Dunn, Tiffany Follin, Maria Mejia, Panagiota Kitsantas and Lea Sacca

Pharmacy 2025, 13(2), 34; https://doi.org/10.3390/pharmacy13020034 - 24 Feb 2025

Cited by 7 | Viewed by 5703

Abstract

Background: Opioid analgesic therapy has been traditionally used for pain management; however, the variability in patient characteristics, complexity in evaluating pain, availability of treatment within facilities, and U.S. physicians overprescribing opioids have contributed to the current opioid epidemic. Despite large research efforts [...] Read more.

Background: Opioid analgesic therapy has been traditionally used for pain management; however, the variability in patient characteristics, complexity in evaluating pain, availability of treatment within facilities, and U.S. physicians overprescribing opioids have contributed to the current opioid epidemic. Despite large research efforts investigating the patterns of postsurgical pain management and influencing factors, it remains unclear how these overall trends vary across the varying sizes and available resources of academic hospitals, community hospitals, and outpatient surgery centers. The primary aim of this scoping review was to examine the patterns of contemporary postoperative pain management across healthcare settings, including academic medical centers, community hospitals, and outpatient surgery centers. Specifically, this study investigates how prescription practices for opioids, NSAIDs, and acetaminophen are influenced by patient demographics, including sex, race, gender, insurance status, and other social determinants of health (SDoH), to inform equitable and patient-centered pain management strategies. Methods: This study utilized The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and was used as a reference checklist. The Arksey and O’Malley methodological framework was used to guide the review process. To ensure comprehensive coverage, searches were conducted across three major databases: PubMed, Embase, and Cochrane Library. Results: A total of 43 eligible studies were retained for analysis. The highest reported Healthy People 2030 category was Social and community context (n = 39), while the highest reported category of SDoH was age (n = 36). A total of 34 articles listed sex and age as SDoH. Additional SDoH examined were race/ethnicity (n = 17), insurance (n = 7), employment (n = 1), education (n = 4), and income (n = 1). This review suggests that there are significant gaps in the implementation of institution-specific, patient-centered, and equitable pain management strategies, particularly in academic hospitals, which our findings show have the highest rates of opioid and NSAID prescriptions (n = 26) compared to outpatient surgical centers (n = 8). Findings from our review of the literature demonstrated that while academic hospitals often adopt enhanced recovery protocols aimed at reducing opioid dependence, these protocols can fail to address the diverse needs of at-risk populations, such as those with chronic substance use, low socioeconomic status, or racial and ethnic minorities. Conclusions: Findings from this review are expected to have implications for informing both organizational-specific and nationwide policy recommendations, potentially leading to more personalized and equitable pain management strategies across different healthcare settings. These include guidelines for clinicians on addressing various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. Full article

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13 pages, 903 KB

Open AccessEditor’s ChoiceArticle

A Physicochemical Stability Study of Pembrolizumab Vial Leftovers: Let Us Stop Pouring Good Money Down the Drain

by Alexandra Porlier, Pierre-Yves Gagnon, Valérie Chénard, Marc Veillette, Nicolas Bertrand, Caroline Duchaine, Chantale Simard and Benoît Drolet

Pharmacy 2025, 13(1), 22; https://doi.org/10.3390/pharmacy13010022 - 8 Feb 2025

Cited by 1 | Viewed by 6475

Abstract

Background: Pembrolizumab is a monoclonal antibody (mAb) approved for treating Non-Small Cell Lung Cancer (NSCLC), melanoma and lymphomas. Commercialized in single-size (100 mg/4 mL) vials, the pembrolizumab solution contains no preservative. As such, the manufacturer recommends using pembrolizumab vials only once, and thus, [...] Read more.

Background: Pembrolizumab is a monoclonal antibody (mAb) approved for treating Non-Small Cell Lung Cancer (NSCLC), melanoma and lymphomas. Commercialized in single-size (100 mg/4 mL) vials, the pembrolizumab solution contains no preservative. As such, the manufacturer recommends using pembrolizumab vials only once, and thus, to rapidly dispose of any unused portion. Thus, appreciable amounts of this costly product are wasted. Objective: To evaluate the physical, chemical and microbiological stability of pembrolizumab vial leftovers stored at room temperature or at 4 °C, 7 and 14 days after first vial puncturing. Methods: Following pH assessments, submicronic aggregation and turbidity of pembrolizumab were measured by dynamic light scattering (DLS) and spectrophotometry, respectively. In addition, SE-HPLC (size-exclusion high-performance liquid chromatography), IEX-HPLC (ion exchange HPLC) and peptide mapping HPLC served to respectively evaluate aggregation and fragmentation, distribution of charge and primary structure of pembrolizumab. Incubation at 37 °C for 48 h of pembrolizumab vial leftovers on blood agar plates was used to determine their microbiological stability. Results: Physical, chemical and microbiological stability of pembrolizumab leftovers was demonstrated for at least two full weeks. Conclusions: These results argue forcefully in favor of allowing prolongation of pembrolizumab vial leftovers usage well beyond a single day. Full article

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13 pages, 1392 KB

Open AccessEditor’s ChoiceReview

Targeting Amyloid Pathology in Early Alzheimer’s: The Promise of Donanemab-Azbt

by Nadia Khartabil and Ayda Awaness

Pharmacy 2025, 13(1), 23; https://doi.org/10.3390/pharmacy13010023 - 8 Feb 2025

Cited by 6 | Viewed by 11808

Abstract

Objective: The purpose of this review is to examine the potential role of donanemab-azbt in the treatment and management of early-stage Alzheimer’s disease (AD), with a focus on its efficacy, safety, and clinical relevance based on data from key clinical trials. Data Sources: [...] Read more.

Objective: The purpose of this review is to examine the potential role of donanemab-azbt in the treatment and management of early-stage Alzheimer’s disease (AD), with a focus on its efficacy, safety, and clinical relevance based on data from key clinical trials. Data Sources: A comprehensive literature search of PubMed was conducted using relevant keywords such as “donanemab”, “Alzheimer’s disease”, “Kisunla”, “TRAILBLAZER clinical trials”, and “amyloid-related imaging abnormalities (ARIA)”. Additional data were extracted from clinical trial records (clinicaltrials.gov), conference abstracts, and product monographs. Study Selection and Data Extraction: Only English-language studies conducted in human populations were included. Clinical trials and peer-reviewed studies detailing the efficacy, safety, and mechanistic insights of donanemab-azbt were prioritized. Data Synthesis: Key findings from the TRAILBLAZER series of clinical trials highlighted the potential of donanemab-azbt in slowing cognitive and functional decline in early-stage AD: (1) TRAILBLAZER-ALZ (Phase 2): This trial focused on participants with intermediate levels of tau protein. Results demonstrated a statistically significant slowing of cognitive and functional decline. (2) TRAILBLAZER-ALZ 2 (Phase 3): A large-scale, randomized, double-blind, placebo-controlled study confirmed the efficacy of donanemab-azbt in reducing amyloid plaque accumulation and cognitive decline. Key results included a 35% slowing of decline on the Integrated Alzheimer’s Disease Rating Scale (iADRS) and a 36% slowing on the Clinical Dementia Rating-Sum of Boxes (CDR-SB). Additional secondary outcomes showed improvements in activities of daily living and reduced risk of disease progression. (3) TRAILBLAZER-ALZ 3: This ongoing trial is evaluating donanemab’s potential in delaying or preventing Alois Alzheimer in cognitively normal individuals with amyloid plaques, broadening the scope of early intervention strategies. (4) TRAILBLAZER-ALZ 4: A head-to-head comparison with aducanumab revealed superior amyloid plaque clearance with donanemab. (5) TRAILBLAZER-ALZ 5: Currently recruiting, this trial aims to evaluate safety and efficacy across diverse populations with varying tau levels and comorbidities. (6) TRAILBLAZER-ALZ 6 (Phase 3b): This trial investigates modified dosing regimens to reduce ARIA while maintaining efficacy, particularly in populations with genetic risk factors like ApoE ε4 homozygotes. Relevance to Patient Care and Clinical Practice: Donanemab-azbt represents a promising treatment option for patients with early-stage AD. It specifically targets and reduces amyloid beta plaques, a hallmark of the disease, potentially slowing progression and preserving cognitive function. However, its administration requires careful patient selection, including genetic testing for ApoE ε4 status, to mitigate risks of ARIA. Furthermore, the findings emphasize the importance of close monitoring during treatment. Conclusions: Donanemab-azbt offers a new avenue for managing early-stage AD, showing promise in reducing amyloid burden and slowing cognitive decline. While its efficacy and safety have been demonstrated in clinical trials, further research is essential to validate long-term outcomes, assess effectiveness across diverse populations, and refine dosing strategies to minimize side effects. With continued investigation, donanemab-azbt could significantly impact the clinical landscape of AD treatment. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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13 pages, 1051 KB

Open AccessEditor’s ChoiceArticle

Social Determinants of Health and Medication Adherence in Older Adults with Prevalent Chronic Conditions in the United States: An Analysis of the National Health and Nutrition Examination Survey (NHANES) 2009–2018

by Omolola A. Adeoye-Olatunde, Tessa J. Hastings, Michelle L. Blakely, LaKeisha Boyd, Azeez B. Aina and Fatimah Sherbeny

Pharmacy 2025, 13(1), 20; https://doi.org/10.3390/pharmacy13010020 - 7 Feb 2025

Cited by 5 | Viewed by 5162

Abstract

Background: The older adult population is rapidly expanding in the United States (US), with a high prevalence of high blood pressure, high cholesterol, and diabetes. Medication nonadherence is prevalent in this population, with less evidence on the influence of social determinants of health [...] Read more.

Background: The older adult population is rapidly expanding in the United States (US), with a high prevalence of high blood pressure, high cholesterol, and diabetes. Medication nonadherence is prevalent in this population, with less evidence on the influence of social determinants of health (SDoH). Thus, the objective of this study was to identify and prioritize SDoH associated with medication adherence among US older adults with these comorbidities. Method: Using the World Health Organization Commission on Social Determinants of Health and Pharmacy Quality Alliance Medication Access Conceptual Frameworks, publicly available National Health and Nutrition Examination Survey datasets (2009–2018) were cross-sectionally analyzed among respondents aged 65 and older who were diagnosed with study diseases. Data analyses included descriptive statistics, and logistic regression using an alpha level of 0.05. Result: Analyses included 5513 respondents’ data. Bivariate analysis revealed significant differences in medication adherence based on several structural (e.g., ethnicity) and intermediary (e.g., disability status) determinants of health. Multivariable analysis revealed significant differences in medication adherence for alcohol consumption (p = 0.034) and usual healthcare place (p = 0.001). Conclusions: The study findings underscore pertinent implications for public health and policy, with specific SDoH being the most likely to affect medication adherence in common chronic conditions among older adults in the US. Full article

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35 pages, 786 KB

Open AccessEditor’s ChoiceSystematic Review

Medication Non-Adherence in Inflammatory Bowel Disease: A Systematic Review Identifying Risk Factors and Opportunities for Intervention

by Kathryn King, Wladyslawa Czuber-Dochan, Trudie Chalder and Christine Norton

Pharmacy 2025, 13(1), 21; https://doi.org/10.3390/pharmacy13010021 - 7 Feb 2025

Cited by 8 | Viewed by 5979

Abstract

Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take their prescribed treatment. Identifying factors associated with IBD medication adherence is crucial for supporting effective disease management and maintaining remission. Quantitative and [...] Read more.

Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take their prescribed treatment. Identifying factors associated with IBD medication adherence is crucial for supporting effective disease management and maintaining remission. Quantitative and qualitative studies researching IBD medication adherence between 2011 and 2023 were reviewed. In total, 36,589 participants were included in 79 studies. The associated non-adherence factors were contradictory across studies, with rates notably higher (72–79%) when measured via medication refill. Non-adherence was lower in high-quality studies using self-report measures (10.7–28.7%). The frequent modifiable non-adherence risks were a poor understanding of treatment or disease, medication accessibility and an individual’s organisation and planning. Clinical variables relating to non-adherence were the treatment type, drug regime and disease activity. Depression, negative treatment beliefs/mood and anxiety increased the non-adherence likelihood. The non-modifiable factors of limited finance, younger age and female sex were also risks. Side effects were the main reason cited for IBD non-adherence in interviews. A large, contradictory set of literature exists regarding the factors underpinning IBD non-adherence, influenced by the adherence measures used. Simpler medication regimes and improved accessibility would help to improve adherence. IBD education could enhance patient knowledge and beliefs. Reminders and cues might minimise forgetting medication. Modifying risks through an adherence support intervention could improve outcomes. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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20 pages, 906 KB

Open AccessEditor’s ChoiceReview

Therapeutic Evaluation and Utilization Analysis of Mental Health Prescription Digital Therapeutics Within the Current Regulatory Landscape

by Sherry Huinan Xia, Megha Mohan Narayanan, Venkatesh Swamy and Kari Franson

Pharmacy 2025, 13(1), 19; https://doi.org/10.3390/pharmacy13010019 - 5 Feb 2025

Cited by 3 | Viewed by 4810

Abstract

Prescription digital therapeutics (PDTs) are emerging as a pivotal component of digital healthcare, providing software-based therapies for various diseases. This review aims to analyze the regulatory landscape in the U.S., safety, efficacy, and current challenges of PDTs, focusing on mental health conditions. Relevant [...] Read more.

Prescription digital therapeutics (PDTs) are emerging as a pivotal component of digital healthcare, providing software-based therapies for various diseases. This review aims to analyze the regulatory landscape in the U.S., safety, efficacy, and current challenges of PDTs, focusing on mental health conditions. Relevant articles were searched on PubMed, Google Scholar, ClinicalTrials.gov, and FDA Guidance Documents databases, supplemented by manual searches of reference lists from included studies. Inclusion criteria covered English-language studies on the development and application, therapeutic efficacy, and regulatory guidelines of PDTs in mental health. Data extraction and synthesis were conducted to summarize key findings and trends in the literature. FDA regulatory frameworks for PDTs are evolving through pathways of de novo and 510(k) applications, with patient-centric guidance. Clinical trials and real-world data support PDTs’ safety and efficacy, while highlighting regulatory needs. Challenges include payer coverage, patient accessibility, and data privacy concerns. Mixed patient feedback reveals areas for improvement. Limited healthcare provider engagement and payer coverage contributed to financial challenges for PDT manufacturers. Future trends suggest that PDTs will expand beyond mental health. The evolving landscape underscores the need for continued research, regulatory refinement, and collaborative efforts across stakeholders to ensure the successful integration of PDTs into healthcare. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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20 pages, 324 KB

Open AccessEditor’s ChoiceReview

Intravenously Administered Nonsteroidal Anti-Inflammatory Drugs in Clinical Practice: A Narrative Review

by Axel Maurice-Szamburski, Cyril Quemeneur, Romain Rozier, Philippe Cuvillon and Claude Ecoffey

Pharmacy 2025, 13(1), 18; https://doi.org/10.3390/pharmacy13010018 - 4 Feb 2025

Cited by 4 | Viewed by 10447

Abstract

Intravenously administered nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a crucial component of multimodal analgesia strategies in surgical settings. This narrative review aims to provide an up-to-date evaluation of the efficacy, safety, and clinical use of intravenous (IV) NSAIDs for perioperative pain management in adults [...] Read more.

Intravenously administered nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a crucial component of multimodal analgesia strategies in surgical settings. This narrative review aims to provide an up-to-date evaluation of the efficacy, safety, and clinical use of intravenous (IV) NSAIDs for perioperative pain management in adults and children. The NSAIDs and selective COX-2 inhibitors (coxibs) approved in Europe for the short-term symptomatic treatment of acute, moderate perioperative pain via IV infusion in adults and/or children have been influenced by US and global guidelines and practice: the drugs primarily reviewed here are ibuprofen, ketorolac, ketoprofen, naproxen, paracetamol, and acetylsalicylic acid. Furthermore, intravenous ibuprofen is authorized for the short-term symptomatic treatment of fever. In contrast to intravenous ketoprofen, intravenous ibuprofen is authorized for administration to children over 6 years of age or weighing more than 20 kg. Overall, IV ibuprofen had a more favorable profile with regard to peri- and postoperative opioid sparing and pain relief. Oral ibuprofen and IV ibuprofen have similar levels of efficacy, although IV ibuprofen has a shorter onset of action and is required in patients who are unable to take oral medications. The frequency of significant adverse events appears to be similar for ibuprofen and paracetamol. Systematic reviews and meta-analyses report that intravenous NSAIDs reduce postoperative opioid consumption by approximately 20–60%, improving pain management with fewer opioid-related side effects. In indications in infants, the choice of medication is limited, and the oral route is not always feasible; IV formulations of ibuprofen are preferred in this setting. Topics for further research should include head-to-head trials of IV NSAIDs. Full article

15 pages, 684 KB

Open AccessEditor’s ChoiceArticle

Impact and Enablers of Pharmacogenetic-Informed Treatment Decisions—A Longitudinal Mixed-Methods Study Exploring the Patient Perspective

by Anna Bollinger, Melissa Semedo Fortes, Henriette E. Meyer zu Schwabedissen, Kurt E. Hersberger, Céline K. Stäuble and Samuel S. Allemann

Pharmacy 2025, 13(1), 14; https://doi.org/10.3390/pharmacy13010014 - 31 Jan 2025

Cited by 3 | Viewed by 1876

Abstract

Pharmacogenetic (PGx) testing is a promising approach for optimizing drug therapies. However, there is limited knowledge regarding its real-world utilization and long-term impact in clinical practice. This study assessed how often PGx information informs treatment decisions and evaluated patients’ perspectives on its use [...] Read more.

Pharmacogenetic (PGx) testing is a promising approach for optimizing drug therapies. However, there is limited knowledge regarding its real-world utilization and long-term impact in clinical practice. This study assessed how often PGx information informs treatment decisions and evaluated patients’ perspectives on its use and non-use, identifying enablers for PGx implementation. A mixed-methods study was conducted with 24 patients with a median of 1 year after PGx testing. Medication and health-related data were collected at enrollment and at the follow-up 1 year later using a semi-structured questionnaire. At the follow-up, 62 medication changes were identified in 18 patients. A median of four medication changes per patient were initiated mainly by medical specialists (58%). PGx information was considered for 15 patients in 39 medication changes (63%). Patient-reported factors contributing to the non-use of PGx information included a lack of knowledge and interest among healthcare professionals (HCPs), structural and administrative barriers, and an over-reliance on patient advocacy. Potential enablers should address targeted PGx education, interprofessional collaboration, awareness among policymakers, and concise recommendations focused on PGx-actionable drugs from testing providers. By implementing these interdependent enablers, PGx can evolve into a long-term, clinically integrated cornerstone of individualized pharmacotherapy. Full article

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21 pages, 657 KB

Open AccessEditor’s ChoiceArticle

Exploring the Benefits, Barriers and Improvement Opportunities in Implementing Automated Dispensing Cabinets: A Qualitative Study

by Abbas Al Mutair, Alya Elgamri, Kawther Taleb, Batool Mohammed Alhassan, Mohamed Alsalim, Horia Alduriahem, Chandni Saha and Kawthar Alsaleh

Pharmacy 2025, 13(1), 12; https://doi.org/10.3390/pharmacy13010012 - 29 Jan 2025

Cited by 3 | Viewed by 6870

Abstract

Technology has increasingly influenced the provision of healthcare services by enhancing patient safety, optimising workflows, and improving efficiency. Large healthcare facilities have adopted automated dispensing cabinets (ADCs) as an advanced technological solution. A key gap exists in understanding the ADC implementation experience in [...] Read more.

Technology has increasingly influenced the provision of healthcare services by enhancing patient safety, optimising workflows, and improving efficiency. Large healthcare facilities have adopted automated dispensing cabinets (ADCs) as an advanced technological solution. A key gap exists in understanding the ADC implementation experience in different contexts. Therefore, this study seeks to fill this literature gap by exploring key stakeholders’ perspectives on the benefits, barriers, and improvement opportunities related to ADCs, offering valuable insights to support their effective integration across various healthcare settings. This qualitative study was conducted in Saudi Arabia. The implementation of ADCs generally has positive outcomes for all staff. The system has brought about enhanced medication tracking, greater time efficiency, along with reduced workload and medication errors. However, there are barriers to their implementation, including changes in workflow and workload distribution, cabinet design, technical medication management challenges, and the need for staff training. To maximise the effectiveness of ADCs, healthcare organisations should focus on improving operational workflows, providing ongoing staff training, and maintaining robust system monitoring. Additionally, manufacturers should focus on advancing technology to further enhance the efficiency and functionality of ADCs. Full article

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58 pages, 1984 KB

Open AccessEditor’s ChoiceReview

Unveiling the Complexities of Medications, Substance Abuse, and Plants for Recreational and Narcotic Purposes: An In-Depth Analysis

by Iasmina-Alexandra Predescu, Alex-Robert Jîjie, Dalia Pătraşcu, Aida-Luisa-Vanessa Pasc, Elisaveta-Ligia Piroş, Cristina Trandafirescu, Cristian Oancea, Cristina Adriana Dehelean and Elena-Alina Moacă

Pharmacy 2025, 13(1), 7; https://doi.org/10.3390/pharmacy13010007 - 22 Jan 2025

Cited by 2 | Viewed by 10390

Abstract

The complexities surrounding the use of medications, substance abuse, and the recreational use of plants are multifaceted and warrant a comprehensive examination. This review highlights the complexities surrounding the consumption of chemical substances in excess or for non-medical purposes, obtained through legal prescriptions, [...] Read more.

The complexities surrounding the use of medications, substance abuse, and the recreational use of plants are multifaceted and warrant a comprehensive examination. This review highlights the complexities surrounding the consumption of chemical substances in excess or for non-medical purposes, obtained through legal prescriptions, over-the-counter purchases, or illicit means, with an emphasis on the predictive role of stressors and individual-level variables in the development of substance use disorders, as well as the influence of the regulatory environment on patterns of consumption. Additionally, the alarming escalation in the mortality rate associated with illicit drug and opioid overdoses is also underscored. The recreational use of prescription medications can lead to significant health risks, particularly when combined with other substances; therefore, the need for interventions and preventive measures to address substance abuse among various populations is imperative. Furthermore, novel insights on substance abuse addiction, exploring the neurobiological mechanisms underlying addiction, and discussing treatment approaches and interventions are elucidated. Advancements in technology for detecting substance abuse are also highlighted, displaying innovative tools for more effective identification and monitoring. In conclusion, the complexities of medications, substance abuse, and the recreational use of plants reveal a landscape marked by overlapping motivations and health implications. The distinction between medical and recreational use is critical for understanding user behavior and addressing public health concerns. Full article

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25 pages, 363 KB

Open AccessEditor’s ChoiceReview

Rationale and Logistics of Continuous Infusion Cephalosporin Antibiotics

by Abbie L. Blunier, R. Jake Crocker, Rachel Foster, Stephanie S. May, Caroline E. Powers and P. Brandon Bookstaver

Pharmacy 2024, 12(6), 185; https://doi.org/10.3390/pharmacy12060185 - 5 Dec 2024

Cited by 1 | Viewed by 4719

Abstract

Cephalosporins have traditionally been administered as an intermittent infusion. With the knowledge that cephalosporins demonstrate a time-dependent pharmacodynamic profile, administration via continuous infusion may provide more effective antibiotic exposure for successful therapy. Proposed benefits of administration via continuous infusion include less IV manipulation, [...] Read more.

Cephalosporins have traditionally been administered as an intermittent infusion. With the knowledge that cephalosporins demonstrate a time-dependent pharmacodynamic profile, administration via continuous infusion may provide more effective antibiotic exposure for successful therapy. Proposed benefits of administration via continuous infusion include less IV manipulation, decreased potential for antibiotic resistance, and potential cost savings. The objective of this review was to provide a detailed assessment of available evidence for the use of continuous infusion cephalosporins and practical dosing and administration recommendations. Studies were gathered and assessed for inclusion via a literature search of PubMed and Ovid MEDLINE using mesh terms [“continuous infusion” and “cephalosporin”], “intermittent infusion”, [“intermittent versus continuous” and “cephalosporin”], “continuous infusion cephalosporin”, as well as specific drug names. References from included studies were also evaluated for inclusion. Data which compared the two administration methods (continuous infusion vs. intermittent infusion) were evaluated. Thirty-five studies were analyzed among several cephalosporins with variable delivery. Dosing regimens utilized in the selected studies were assessed with known compatibility and stability data and further summarized. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

18 pages, 1033 KB

Open AccessEditor’s ChoiceReview

A Systematic Review of Controlled Trials: Can Patient Adherence to Antibiotics Be Improved Through Pharmaceutical Communication-Based Interventions?

by Carla Pires

Pharmacy 2024, 12(6), 178; https://doi.org/10.3390/pharmacy12060178 - 26 Nov 2024

Cited by 1 | Viewed by 4681

Abstract

Background: Patient adherence to antibiotics is vital to ensure treatment efficiency. Objective: To evaluate the impact of pharmacist communication-based interventions on patients’ adherence to antibiotics. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for systematic review (PRISMA) [...] Read more.

Background: Patient adherence to antibiotics is vital to ensure treatment efficiency. Objective: To evaluate the impact of pharmacist communication-based interventions on patients’ adherence to antibiotics. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for systematic review (PRISMA) checklist and flow diagram. Controlled trials were included. Databases: PubMed, Cochrane Library, SciELO, and Google Scholar. Quality, risk of bias, and confidence in cumulative evidence were evaluated. Results: Twenty-one trials were selected, with better patient adherence for the intervention than the control group. However, statistically significant differences were only found in two-thirds of these trials. The use of educational leaflets, personalized delivery of antibiotics, follow-up measures, and structured counseling were among the most impactful and significant interventions. The fact that community and/or hospital pharmacists were required to intervene in both groups (e.g., intervention vs. control/usual care) may explain that statistically significant differences were not achieved in all trials. Moderate quality issues and/or risk of bias were detected in some of the evaluated trials. The cumulative evidence was classified as high to moderate, which was considered acceptable. Conclusion: It seems that more intense and structured pharmacist interventions can improve patient adherence to antibiotics. Full article

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9 pages, 1504 KB

Open AccessEditor’s ChoiceArticle

Enhancing Operational Efficiency and Service Delivery through a Robotic Dispensing System: A Case Study from a Retail Pharmacy in Brazil

by Karen Basile, Monserrat Martínez, Julia D. Lucaci, Claudia Goldblatt and Idal Beer

Pharmacy 2024, 12(5), 130; https://doi.org/10.3390/pharmacy12050130 - 23 Aug 2024

Cited by 2 | Viewed by 6811

Abstract

Drug dispensing in retail pharmacies typically involves several manual tasks that often lead to inefficiencies and errors. This is the first published quality improvement study in Latin America, specifically in Brazil, investigating the operational impacts of implementing a robotic dispensing system in a [...] Read more.

Drug dispensing in retail pharmacies typically involves several manual tasks that often lead to inefficiencies and errors. This is the first published quality improvement study in Latin America, specifically in Brazil, investigating the operational impacts of implementing a robotic dispensing system in a retail pharmacy. Through observational techniques, we measured the time required for the following pharmacy workflows before and after implementing the robotic dispensing system: customer service, receiving stock, stocking inventory, separation, invoicing, and packaging of online orders for delivery. Time savings were observed across all workflows within the pharmacy, notably in receiving stock and online order separation, which experienced 70% and 75% reductions in total time, respectively. Furthermore, customer service, stocking, invoicing, and packaging of online orders, also saw total time reductions from 36% to 53% after implementation of the robotic dispensing system. This study demonstrates an improvement in the pharmacy’s operational efficiency post-implementation of the robotic dispensing system. These findings highlight the potential for such automated systems to streamline pharmacy operations, improve staff time efficiency, and enhance service delivery. Full article

(This article belongs to the Special Issue Pharmaceutical Care Services in Pharmacy Practice II)

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24 pages, 2510 KB

Open AccessEditor’s ChoicePerspective

Redesigning Pharmacy to Improve Public Health Outcomes: Expanding Retail Spaces for Digital Therapeutics to Replace Consumer Products That Increase Mortality and Morbidity Risks

by Grzegorz Bulaj, Melissa Coleman, Blake Johansen, Sarah Kraft, Wayne Lam, Katie Phillips and Aarushi Rohaj

Pharmacy 2024, 12(4), 107; https://doi.org/10.3390/pharmacy12040107 - 12 Jul 2024

Cited by 2 | Viewed by 7088

Abstract

United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and [...] Read more.

United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines. Full article

(This article belongs to the Special Issue Pharmacy: State of the Art and Perspectives in USA (2nd Edition))

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20 pages, 364 KB

Open AccessEditor’s ChoiceReview

Exploring the Significance of Pharmaceutical Care in Mental Health: A Spotlight on Cannabis

by Claudete da Costa-Oliveira, Michele Lafayette Pereira, Nicole Ferrari de Carvalho, Luiza Aparecida Luna Silvério, Ygor Jessé Ramos and Priscila Gava Mazzola

Pharmacy 2024, 12(4), 100; https://doi.org/10.3390/pharmacy12040100 - 27 Jun 2024

Viewed by 3047

Abstract

Although preliminary evidence suggests Cannabis’s efficacy in symptom control for anxiety and depression—psychiatric disorders that significantly impact mental health—much remains to be understood about its effects on the central nervous system (CNS) and how to optimize treatment for these disorders. This study [...] Read more.

Although preliminary evidence suggests Cannabis’s efficacy in symptom control for anxiety and depression—psychiatric disorders that significantly impact mental health—much remains to be understood about its effects on the central nervous system (CNS) and how to optimize treatment for these disorders. This study aims to conduct a narrative review to evaluate pharmaceutical care in treating symptoms of anxiety and depression alongside Cannabis use, focusing on safety and therapeutic efficacy optimization. We seek to conceptualize anxiety and depression disorders, review evidence on Cannabis use, evaluate the evidence quality, and identify knowledge gaps. Twelve articles were identified, revealing a significant gap in the literature regarding the integration of pharmaceutical care with Cannabis-based therapies, specifically for anxiety and depression. Despite a growing interest in the relationship between Cannabis and mental health, current research is insufficient for a comprehensive understanding. The relationship between Cannabis use and anxiety and depression disorders requires further, more targeted investigations. This study underscores the importance of future research to fill existing gaps, providing informed insights and robust guidelines for the safe and effective use of Cannabis as part of the treatment for anxiety and depression. It is crucial that pharmaceutical care integrates these therapies responsibly to improve the overall well-being of patients. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

14 pages, 280 KB

Open AccessEditor’s ChoiceReview

Interventions to Expand Community Pharmacists’ Scope of Practice

by Zaynah Zureen Ali, Helen Skouteris, Stephanie Pirotta, Safeera Yasmeen Hussainy, Yi Ling Low, Danielle Mazza and Anisa Rojanapenkul Assifi

Pharmacy 2024, 12(3), 95; https://doi.org/10.3390/pharmacy12030095 - 19 Jun 2024

Cited by 13 | Viewed by 4861

Abstract

Background: The role of community pharmacists has evolved beyond the dispensing of medicines. The aim of this scoping review was to describe the interventions that expand the pharmacist’s scope of practice within a community pharmacy setting and assess their effectiveness. Methods: We performed [...] Read more.

Background: The role of community pharmacists has evolved beyond the dispensing of medicines. The aim of this scoping review was to describe the interventions that expand the pharmacist’s scope of practice within a community pharmacy setting and assess their effectiveness. Methods: We performed a scoping review to identify randomised controlled trials (RCTs), published worldwide from 2013 to 2024, which focused on interventions designed to expand pharmacists’ scope of practice in the community. The review was undertaken in accordance with the Joanna Briggs Institute methodology for scoping reviews. To address the aim of this scoping review, the included RCTs were mapped to themes influenced by the Professional Practice Standards 2023 as developed by the Pharmaceutical Society of Australia: medication management, collaborative care and medication adherence. Results: Twelve studies demonstrated the potential to expand community pharmacists’ scope of practice. Two RCTs resulted in no effect of the intervention. One RCT (conducted in Italy) led to an actual change to community pharmacists’ scope of practice, with a statistically significant improvement in the proportion of patients with controlled asthma. Conclusions: On the whole, this scoping review synthesised the findings of peer-reviewed RCT studies that revealed expanding community pharmacists’ scope of practice may result in improved patient outcomes, a reduced burden for the healthcare system, and greater productivity. Full article

12 pages, 864 KB

Open AccessEditor’s ChoiceArticle

Using Team-Based Learning to Teach Pharmacology within the Medical Curriculum

by Nora L. D. Luitjes, Gisela J. van der Velden and Rahul Pandit

Pharmacy 2024, 12(3), 91; https://doi.org/10.3390/pharmacy12030091 - 12 Jun 2024

Cited by 9 | Viewed by 3723

Abstract

The primary goal of pharmacology teaching is to prepare medical students to prescribe medications both safely and efficiently. At the Utrecht University Medical School, pharmacology is integrated into the three-year bachelor’s curriculum, primarily through large group sessions with limited interaction. A recent evaluation [...] Read more.

The primary goal of pharmacology teaching is to prepare medical students to prescribe medications both safely and efficiently. At the Utrecht University Medical School, pharmacology is integrated into the three-year bachelor’s curriculum, primarily through large group sessions with limited interaction. A recent evaluation highlighted students’ appreciation for pharmacology teaching, but students admitted to attending these teaching moments unprepared, resulting in passive learning. To address this, team-based learning (TBL) was implemented to facilitate learning through interaction, critical thinking, problem solving and reflection through six steps, from superficial to deeper cognitive learning. This study, conducted over two academic years, assessed students’ perception and performance regarding TBL. Analysis of a digital questionnaire using a 5-point Likert scale showed high student satisfaction with TBL as a teaching methodology. However, confidence in pharmacology knowledge following TBL was moderate. TBL attendees outperformed non-attendees in pharmacology-related exam questions, indicating that TBL has a positive impact on student performance. We conclude that TBL is an engaging and effective method for pharmacology education, positively influencing student learning and performance. This method could be broadly applied for teaching pharmacology within the medical curriculum or other biomedical programs. Full article

(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)

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11 pages, 608 KB

Open AccessEditor’s ChoiceOpinion

Decoding Clozapine-Induced Agranulocytosis: Unraveling Interactions and Mitigation Strategies

by Ali Alalawi, Enas Albalawi, Abdullah Aljohani, Abdullah Almutairi, Abdulraouf Alrehili, Areej Albalawi and Ahmed Aldhafiri

Pharmacy 2024, 12(3), 92; https://doi.org/10.3390/pharmacy12030092 - 12 Jun 2024

Cited by 5 | Viewed by 10282

Abstract

Agranulocytosis represents a severe complication associated with the administration of clozapine. Clozapine is an antipsychotic medication that has demonstrated substantial efficacy in remediating refractory schizophrenia and various other psychiatric disorders. Nonetheless, it is crucial to monitor patients for neutropenia regularly during clozapine therapy. [...] Read more.

Agranulocytosis represents a severe complication associated with the administration of clozapine. Clozapine is an antipsychotic medication that has demonstrated substantial efficacy in remediating refractory schizophrenia and various other psychiatric disorders. Nonetheless, it is crucial to monitor patients for neutropenia regularly during clozapine therapy. Therefore, this article aimed to delve into the prevalence of agranulocytosis during clozapine treatment by scrutinizing the extant literature to discern trends and correlations. This review endeavored to explore factors such as drug interactions, dose-related factors, duration of treatment, and genetic predispositions that could potentially influence the likelihood of patients developing agranulocytosis while undergoing clozapine therapy. Moreover, this review enunciates the ramifications of agranulocytosis on both patients and healthcare providers and meticulously evaluates the strategies to mitigate this risk and ensure optimal patient outcomes. Full article

(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)

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12 pages, 522 KB

Open AccessEditor’s ChoiceArticle

The Role of a Clinical Pharmacist in the Identification of Potentially Inadequate Drugs Prescribed to the Geriatric Population in Low-Resource Settings Using the Beers Criteria: A Pilot Study

by Tijana Kovačević, Maja Savić Davidović, Vedrana Barišić, Emir Fazlić, Siniša Miljković, Vlado Djajić, Branislava Miljković and Peđa Kovačević

Pharmacy 2024, 12(3), 84; https://doi.org/10.3390/pharmacy12030084 - 28 May 2024

Cited by 4 | Viewed by 3452

Abstract

Population aging is a global phenomenon. Each country in the world faces an increased number of older persons in the total population. With aging, a high prevalence of multiple chronic diseases occurs, leading to the use of complex therapeutic regimens and often to [...] Read more.

Population aging is a global phenomenon. Each country in the world faces an increased number of older persons in the total population. With aging, a high prevalence of multiple chronic diseases occurs, leading to the use of complex therapeutic regimens and often to polypharmacy. Potentially inappropriate medication (PIM) is a medicine prescribed to a patient for whom the risks outweigh the benefits. Today, several tools are used to evaluate the use of pharmacotherapy in older adults, one of them is the 2019 AGS Beers Criteria. In this prospective, pilot study, we aimed to investigate if the number of PIMs in elderly patients would be significantly reduced if a clinical pharmacist performed a pharmacotherapy review. The study included 66 patients over 65 years of age who were hospitalized at the 1200-bed university hospital. The intervention was conducted by a clinical pharmacist who reviewed the patients’ pharmacotherapy and provided written suggestions to physicians. The pharmacotherapy was again reviewed at the patients’ discharge from the hospital. A total number of 204 PIMs were identified in the pharmacotherapy of the study population. At discharge, the number of PIMs decreased to 67. A total of 67% of the pharmacist’s suggestions were accepted by the physicians. The pharmacist’s intervention led to significant decrease in the number of PIMs on patients’ discharge letters. Full article

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9 pages, 529 KB

Open AccessEditor’s ChoiceOpinion

Empowering Pharmacists: Strategies for Addressing the Opioid Crisis through a Public Health Lens

by Tamera D. Hughes, Juliet Nowak, Elizabeth Sottung, Amira Mustafa and Geetha Lingechetty

Pharmacy 2024, 12(3), 82; https://doi.org/10.3390/pharmacy12030082 - 23 May 2024

Viewed by 4829

Abstract

Background: The opioid crisis in the US is a severe public health issue, prompting pharmacists to adopt various strategies for prevention, harm reduction, treatment, and recovery. Despite progress, barriers persist. Results: This commentary examines five determinants of public health in relation to pharmacist-led [...] Read more.

Background: The opioid crisis in the US is a severe public health issue, prompting pharmacists to adopt various strategies for prevention, harm reduction, treatment, and recovery. Despite progress, barriers persist. Results: This commentary examines five determinants of public health in relation to pharmacist-led interventions for the opioid crisis: individual behavior, social factors, policymaking, health service accessibility, and biological/genetic considerations. Pharmacists can influence individual behavior through education and support, address social determinants like stigma, advocate for policy changes, ensure health service accessibility, and personalize opioid prescriptions based on biological factors. Conclusion: Pharmacists play a crucial role in addressing the opioid crisis by navigating these determinants. Pharmacists’ engagement is essential for reducing opioid-related harms and improving public health outcomes through advocacy, service provision, and education. Full article

(This article belongs to the Special Issue Pharmacists’ Role in Reducing Problematic Opioid Use)

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12 pages, 491 KB

Open AccessEditor’s ChoiceArticle

Evaluation of Oral Amoxicillin/Clavulanate for Urinary Tract Infections Caused by Ceftriaxone Non-Susceptible Enterobacterales

by Madison E. Salam, Meghan Jeffres, Kyle C. Molina, Matthew A. Miller, Misha Huang and Douglas N. Fish

Pharmacy 2024, 12(2), 60; https://doi.org/10.3390/pharmacy12020060 - 1 Apr 2024

Cited by 2 | Viewed by 13369

Abstract

Urinary tract infections (UTIs) are one of the most common infections and are frequently caused by Gram-negative organisms. The rise of resistant isolates has prompted evaluation of alternative therapies, including amoxicillin-clavulanate which has potent activity against Ambler class A enzymes. This study sought [...] Read more.

Urinary tract infections (UTIs) are one of the most common infections and are frequently caused by Gram-negative organisms. The rise of resistant isolates has prompted evaluation of alternative therapies, including amoxicillin-clavulanate which has potent activity against Ambler class A enzymes. This study sought to evaluate clinical outcomes of patients with ceftriaxone non-susceptible UTIs receiving amoxicillin-clavulanate or standard of care (SOC). This was a single-center, retrospective, cohort study of adult patients with urinary tract infections caused by a ceftriaxone non-susceptible pathogen who received amoxicillin-clavulanate or SOC. The primary outcome was clinical failure at 90 days. Secondary outcomes included time to failure, isolation of a resistant organism, and hospital length of stay. Fifty-nine patients met study inclusion: 26 received amoxicillin/clavulanate and 33 received SOC. Amoxicillin-clavulanate recipients did not have higher failure rates compared to SOC recipients. For patients requiring hospital admission, hospital length of stay was numerically shorter with amoxicillin-clavulanate. The frequency of amoxicillin-clavulanate and carbapenem-resistant organisms did not differ significantly between groups. Amoxicillin-clavulanate may be a useful alternative therapy for the treatment of ceftriaxone non-susceptible Enterobacterales UTIs. Full article

(This article belongs to the Special Issue Pharmacist-Led Antimicrobial Stewardship 2.0)

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11 pages, 233 KB

Open AccessEditor’s ChoiceArticle

Views of the Pharmacists’ Role in HPV Vaccinations: A Qualitative Study in Tennessee

by Alina Cernasev, Kenneth C. Hohmeier, Oluwafemifola Oyedeji, Kristina W. Kintziger and Tracy M. Hagemann

Pharmacy 2024, 12(2), 57; https://doi.org/10.3390/pharmacy12020057 - 28 Mar 2024

Cited by 6 | Viewed by 3316

Abstract

The Human Papillomavirus (HPV) is a frequently occurring sexually transmitted infection in adults and is associated with various cancers that can affect both males and females. Recently, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for the HPV vaccine to include [...] Read more.

The Human Papillomavirus (HPV) is a frequently occurring sexually transmitted infection in adults and is associated with various cancers that can affect both males and females. Recently, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for the HPV vaccine to include patients aged 27–45 years with shared clinical decision-making. A commonly reported obstacle to receiving the HPV vaccine among adults is a lack of healthcare provider recommendations. Considering the suboptimal HPV vaccine coverage figures and noting that the vast majority of hesitancy research has been conducted among children and adolescents, limited research is available on the adult perception of HPV vaccination in pharmacies. This study focuses on understanding adults’ opinions and perceptions regarding the role of pharmacists in the uptake of the HPV vaccine and awareness of its availability in the pharmacy setting. Methods: After receiving approval from the Institutional Review Board (IRB), the qualitative study was initiated using virtual focus groups (FGs). Concepts from the Transtheoretical Model, the Health Belief Model, and the Social Cognitive Theory guided the study design. The corpus of data was collected in 2021 and 2022 by two researchers, and a third party transcribed the FGs to avoid any biases. The data were analyzed using Braun and Clarke’s Thematic Analysis. Results: Out of 35 subjects that participated in six FGDs, most identified as female, with ages ranging from 18 to 45 years. The following four themes emerged: (1) HPV vaccine awareness; (2) stigmas leading to reduced education and vaccination rates; (3) education preferences; (4) follow-up in vaccination series reminders and preferences. Conclusion: Participants’ views of the HPV vaccine and the ability to receive the vaccine in a pharmacy are influenced by a myriad of factors. Common factors include improved awareness, preferences for educational modalities, avoiding stigmas associated with HPV vaccination, combating gender-focused biases, and preferences for the location of vaccination. These barriers provide opportunities for pharmacists to promote and enhance vaccine uptake. Full article

12 pages, 265 KB

Open AccessEditor’s ChoiceReview

A Comparison of Currently Approved Small Interfering RNA (siRNA) Medications to Alternative Treatments by Costs, Indications, and Medicaid Coverage

by Inder Sehgal, Kevin Eells and Imani Hudson

Pharmacy 2024, 12(2), 58; https://doi.org/10.3390/pharmacy12020058 - 28 Mar 2024

Cited by 24 | Viewed by 12375

Abstract

Small interfering RNA (siRNA)-based medications offer the ability to target previously undruggable targets and have now received FDA approval in five instances for orphan or uncommon diseases. The current siRNA “-sirans” are directed towards hepatic molecular targets. Because they are not conventional drug [...] Read more.

Small interfering RNA (siRNA)-based medications offer the ability to target previously undruggable targets and have now received FDA approval in five instances for orphan or uncommon diseases. The current siRNA “-sirans” are directed towards hepatic molecular targets. Because they are not conventional drug formulae, their ultimate clinical success will require overcoming multiple barriers beyond their pharmacology. The minimal patient numbers leave fewer patients to bear the costs of R&D and manufacture; therefore, the cost of these drugs, questionable third-party reimbursement, and competition from other drug classes for the same low number of patients are impediments to patient access. The parenteral route of administration, as well as emerging safety restrictions, are also drawbacks to siRNA. With this review, we document currently approved siRNA drugs by condition, approval date, administration route and frequencies. We have estimated the available patient populations for siran therapies using the U.S. Medicaid and Medicare populations and sought to identify the frequency with which large Medicaid formularies list siRNA drugs. Current comparative costs between the siRNA drugs and alternatives have been presented, and the review summarizes current adverse events as reported to the FDA’s Adverse Event Reporting System. Our review and data indicate that sirans are extremely expensive and seldom recognized in posted Medicaid formularies. However, alternative treatments for these conditions are no less costly, usually do not have significantly different adverse events, and are often less convenient for the patient. Full article

(This article belongs to the Special Issue Pharmacoeconomics and Outcomes Research: A Burgeoning Arena for Decision Making and Health Policy)

13 pages, 1714 KB

Open AccessEditor’s ChoiceArticle

Irrational Use of Medications among Adults with Insomnia: An Observational Study at a Sleep Clinic in Mexico

by Lucelya Carvalho-Silva, Ulises Jiménez-Correa, Rafael Santana-Miranda, Ivo Heyerdahl-Viau, Jonatan Benitez-Morales, Mireya García-Casas and Juan Manuel Martínez-Núñez

Pharmacy 2024, 12(2), 56; https://doi.org/10.3390/pharmacy12020056 - 27 Mar 2024

Viewed by 5398

Abstract

Background: To determine the patterns of irrational use of medications among a sample of adult patients with insomnia. Methods: We included 89 adult patients diagnosed with chronic insomnia who had consumed medications for this disorder during the 12 months prior to admission to [...] Read more.

Background: To determine the patterns of irrational use of medications among a sample of adult patients with insomnia. Methods: We included 89 adult patients diagnosed with chronic insomnia who had consumed medications for this disorder during the 12 months prior to admission to a specialized Sleep Disorders Clinic (SDC) in Mexico City. With a 13-item survey, information was gathered on patterns of medication use and irrational use, considering therapeutic indications, dose, route of administration, and duration of treatment. Results: The participants had taken hypnotics (65%), antidepressants (21%), anticonvulsants (8%), and antipsychotics (6%), and 92% had irrational use of their medication. Irrational use was greatest with benzodiazepines and antipsychotics. There were two main types of irrational use: (1) 47% of participants had consumed a drug unsuitable for their condition, although it was almost always prescribed by a doctor, and (2) 43% had consumed a drug for longer than the maximum time recommended. Conclusion: It is worrisome to find that the irrational use of medications to treat insomnia, especially benzodiazepines and antipsychotics is widespread. Although most participants had acquired their medication by prescription, for many the drug was inappropriate to treat their condition. It should be mandatory that patients with insomnia receive specialized medical attention in primary clinical care. Full article

(This article belongs to the Special Issue Medication Use and Patient Safety in Clinical Pharmacy)

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9 pages, 233 KB

Open AccessEditor’s ChoiceReview

Rational Prescribing of Pancreatic Enzymes for Patients with Pancreatic Cancer

by Mary Acelle G. Garcia, Syed Imam, Ursula K. Braun and Leanne K. Jackson

Pharmacy 2024, 12(2), 47; https://doi.org/10.3390/pharmacy12020047 - 6 Mar 2024

Cited by 2 | Viewed by 8193

Abstract

Most patients with pancreatic cancer at some point present with symptoms related to exocrine pancreatic insufficiency (EPI). These include diarrhea, abdominal bloating, indigestion, steatorrhea, weight loss, and anorexia. Even though up to 80% of pancreatic cancer patients eventually present with symptoms related to [...] Read more.

Most patients with pancreatic cancer at some point present with symptoms related to exocrine pancreatic insufficiency (EPI). These include diarrhea, abdominal bloating, indigestion, steatorrhea, weight loss, and anorexia. Even though up to 80% of pancreatic cancer patients eventually present with symptoms related to exocrine pancreatic insufficiency, only 21% are prescribed pancreatic enzyme replacement therapy (PERT). Its effectiveness is also highly dependent on its proper timing of administration, and patients must be thoroughly educated about this. The impact of symptoms of EPI can lead to poorer overall well-being. Pharmacists play a crucial role in properly educating patients on the correct use of pancreatic enzyme replacement therapy. PERT is a key strategy in managing the symptoms of EPI and can improve quality of life, which is a central focus in palliative care. This treatment is profoundly underutilized in the palliative care of these patients. The objective of this review is to discuss the pharmacology, pharmacokinetics, side effects, available evidence of the effectiveness of pancreatic enzyme use for patients with pancreatic cancer, and challenges, along with proposed solutions regarding its use. Full article

(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)

16 pages, 1949 KB

Open AccessEditor’s ChoiceReview

A Systematic Review of Naldemedine and Naloxegol for the Treatment of Opioid-Induced Constipation in Cancer Patients

by Ursula K. Braun, Leanne K. Jackson, Mary A. Garcia and Syed N. Imam

Pharmacy 2024, 12(2), 48; https://doi.org/10.3390/pharmacy12020048 - 6 Mar 2024

Cited by 9 | Viewed by 6932

Abstract

Background: Opioid-induced constipation (OIC) is a pervasive and distressing side effect of chronic opioid therapy in patients with cancer pain, significantly impacting their quality of life. Peripherally acting μ-opioid receptor antagonists (PAMORAS) were developed for treatment-resistant OIC but most studies were conducted with [...] Read more.

Background: Opioid-induced constipation (OIC) is a pervasive and distressing side effect of chronic opioid therapy in patients with cancer pain, significantly impacting their quality of life. Peripherally acting μ-opioid receptor antagonists (PAMORAS) were developed for treatment-resistant OIC but most studies were conducted with non-cancer patients. Objective: to discuss two oral formulations of PAMORAs, naldemedine and naloxegol, and to review available evidence of the effectiveness of these drugs for OIC in cancer patients. Methods: a comprehensive search to identify primary literature for either naldemedine or naloxegol for OIC in cancer patients. Results: Only three prospective randomized, double-blind, placebo-controlled clinical trials for naldemedine enrolling cancer patients were identified; the results of a subgroup analysis of two of those studies and two non-interventional post marketing surveillance studies of these trials are also reported here. For naloxegol, only two randomized controlled trials were identified; both were unsuccessful in enrolling sufficient patients. An additional four prospective non-interventional observational studies with naloxegol were found that enrolled cancer patients. There were significantly higher rates of responders in the PAMORA groups than in the placebo groups. The most common side effect for both PAMORAs was diarrhea. Limitations: All studies were industry-funded, and given that only three trials were randomized controlled studies, the overall quality of the studies was lacking. Conclusion: Naldemedine or naloxegol appeared safe and useful in the treatment of OIC in cancer patients and may improve their quality of life. Larger-scale randomized placebo-controlled studies of PAMORAs in cancer patients would strengthen existing evidence. Full article

(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)

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10 pages, 242 KB

Open AccessEditor’s ChoiceArticle

Exogenous Melatonin Use in University Students: A Cross-Sectional Survey

by Sulafa T. Alqutub, Faris A. Alzahrani, Abdulrahman S. Hassan, Abdullah H. Alirbidi, Osama A. Alraddadi, Omar A. AlSadah, Mohammad B. Yamani and Mansour Tobaiqy

Pharmacy 2024, 12(2), 41; https://doi.org/10.3390/pharmacy12020041 - 23 Feb 2024

Cited by 1 | Viewed by 9492

Abstract

To assess the prevalence of melatonin use and its perceived benefits among university students in different specialties in Saudi Arabia, a cross-sectional survey was conducted between March and June 2023. Data about demographics, time of melatonin use, perceived reasons for exogenous melatonin use, [...] Read more.

To assess the prevalence of melatonin use and its perceived benefits among university students in different specialties in Saudi Arabia, a cross-sectional survey was conducted between March and June 2023. Data about demographics, time of melatonin use, perceived reasons for exogenous melatonin use, melatonin use in relation to exam periods, perceived safety, and adverse effects was gathered. Of 380 students, ~52% reported using exogenous melatonin for sleep disorders. Most participants reported using melatonin during and after exam periods. Additionally, several (n = 157; 75.4%) believed that its use was safe. The predominant use patterns were daily and as needed, and this study observed a higher rate of use compared with previous studies in Saudi Arabia. The most frequently reported adverse effect was headache (n = 36; 37.5%). A significant number of undergraduate male students in health specialties used melatonin. A high rate of melatonin use was noted during exam periods, which was attributed to sleep deprivation. Additionally, a significant number of students from private universities reported using exogenous melatonin. Melatonin use is common among university students. Future research should use a reliable psychometric measure to test its effect on university students’ sleep quality and quantity. Full article

(This article belongs to the Topic Drug Utilization and Medication Adherence: Strategies, Technologies and Practices)

7 pages, 841 KB

Open AccessEditor’s ChoiceCase Report

Two Cases of Vancomycin-Induced Neutropenia

by Kirsten Ganaja, Sarah Scoular and Staci Hemmer

Pharmacy 2024, 12(1), 38; https://doi.org/10.3390/pharmacy12010038 - 19 Feb 2024

Cited by 3 | Viewed by 5489

Abstract

(1) Background: The incidence of vancomycin-induced neutropenia in hospitalized patients is estimated to be around 2 to 8 percent Data surrounding vancomycin-induced neutropenia is limited as it is based on a small number of observational case reports. Additionally, it is difficult to provide [...] Read more.

(1) Background: The incidence of vancomycin-induced neutropenia in hospitalized patients is estimated to be around 2 to 8 percent Data surrounding vancomycin-induced neutropenia is limited as it is based on a small number of observational case reports. Additionally, it is difficult to provide generalized conclusions since patient characteristics and indications for treatment vary between reports. (2) Case Reports: We present two cases of vancomycin-induced neutropenia that occurred at our facility; a 50-year-old male who developed neutropenia after treatment with vancomycin for a gluteal abscess and a 51-year-old female who developed neutropenia after treatment with vancomycin for lumbar osteomyelitis. In both cases, neutropenia resolved within 2 days of discontinuation of vancomycin. (3) Conclusions: Vancomycin-induced neutropenia is thought to be a relatively uncommon adverse drug reaction. These two cases of neutropenia likely caused by prolonged exposure to vancomycin occurred at our facility within 3 months of each other. Additional studies are needed to better understand the true incidence of this adverse drug reaction and to identify risk factors that may predispose patients to vancomycin-induced neutropenia. Full article

(This article belongs to the Special Issue Antimicrobial Adverse Reaction and Drug-Drug Interactions)

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16 pages, 658 KB

Open AccessEditor’s ChoiceReview

Medication Review: What’s in a Name and What Is It about?

by Anneleen Robberechts, Maja Brumer, Victoria Garcia-Cardenas, Niurka M. Dupotey, Stephane Steurbaut, Guido R. Y. De Meyer and Hans De Loof

Pharmacy 2024, 12(1), 39; https://doi.org/10.3390/pharmacy12010039 - 19 Feb 2024

Cited by 13 | Viewed by 10833

Abstract

Background: Medication review is a multifaceted service aimed at optimizing the use of medicines and enhancing the health outcomes of patients. Due to its complexity, it is crucial to clearly describe the service, its variants, and its components to avoid confusion and ensure [...] Read more.

Background: Medication review is a multifaceted service aimed at optimizing the use of medicines and enhancing the health outcomes of patients. Due to its complexity, it is crucial to clearly describe the service, its variants, and its components to avoid confusion and ensure a better understanding of medication review among healthcare providers. Aim: This study aims to bring clarity to the origins, definitions, abbreviations, and types of medication reviews, together with the primary criteria that delineate key features of this service. Method: A narrative review approach was employed to clarify the diverse terminology associated with “medication review” services. Relevant references were initially identified through searches on PubMed and Google Scholar, complementing the existing literature known to the authors. Results: The study uncovers a complicated and sometimes convoluted history of “medication review” in different regions around the world. The initial optimization of medicine use had an economic purpose before evolving subsequently into a more patient-oriented approach. A selection of abbreviations, definitions, and types were outlined to enhance the understanding of the service. Conclusions: The study underscores the urgent need for comprehensive information and standardization regarding the content and quality of the services, collectively referred to as “medication review”. Full article

(This article belongs to the Special Issue Pharmacists: Key Players in a Changing Health Care System)

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12 pages, 470 KB

Open AccessEditor’s ChoiceReview

A Review of Olanzapine in the Treatment of Cancer Anorexia-Cachexia Syndrome

by Ivy O. Poon, Veronica Ajewole and Ursula K. Braun

Pharmacy 2024, 12(1), 34; https://doi.org/10.3390/pharmacy12010034 - 17 Feb 2024

Cited by 12 | Viewed by 5791

Abstract

Background: Cancer anorexia-cachexia syndrome (CAS) is a multifactorial condition that is highly prevalent in advanced cancer patients and associated with significant reduction in functional performance, reduction in quality of life, and increased mortality. Currently, no medications are approved for this indication. Recently, the [...] Read more.

Background: Cancer anorexia-cachexia syndrome (CAS) is a multifactorial condition that is highly prevalent in advanced cancer patients and associated with significant reduction in functional performance, reduction in quality of life, and increased mortality. Currently, no medications are approved for this indication. Recently, the American Society of Clinical Oncology (ASCO) released a rapid recommendation suggesting that low-dose olanzapine once daily may be used to treat cancer cachexia. Many questions still exist on how to use olanzapine for this indication in clinical practice. The objective of this review is to identify existing knowledge on the use of olanzapine for CAS. Methods: A comprehensive search was conducted to identify the primary literature that involved olanzapine for anorexia and cachexia in cancer patients between 2000 and 2023. Results: Seven articles were identified and are discussed here, including two randomized double-blinded placebo-controlled studies, one randomized comparative study, two prospective open-label studies, one retrospective chart review, and one case report. Conclusions: Low dose olanzapine (2.5–5 mg once daily) may be useful in the treatment of CAS for increasing appetite, reducing nausea and vomiting, and promoting weight gain. Further large-scale multi-center randomized placebo-controlled studies will be needed to investigate the impact of olanzapine on weight change in CAS patients. Full article

(This article belongs to the Special Issue Medicine Use and Management in Palliative Care)

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13 pages, 3541 KB

Open AccessEditor’s ChoiceReview

Review of Leishmaniasis Treatment: Can We See the Forest through the Trees?

by Moshe Shmueli and Shalom Ben-Shimol

Pharmacy 2024, 12(1), 30; https://doi.org/10.3390/pharmacy12010030 - 8 Feb 2024

Cited by 24 | Viewed by 6724

Abstract

There are three known clinical syndromes of leishmaniasis: cutaneous (CL), mucocutaneous (MCL), and visceral disease (VL). In MCL and VL, treatment must be systemic (either oral or intravenous), while CL treatment options vary and include observation-only localized/topical treatment, oral medications, or parenteral drugs. [...] Read more.

There are three known clinical syndromes of leishmaniasis: cutaneous (CL), mucocutaneous (MCL), and visceral disease (VL). In MCL and VL, treatment must be systemic (either oral or intravenous), while CL treatment options vary and include observation-only localized/topical treatment, oral medications, or parenteral drugs. Leishmaniasis treatment is difficult, with several factors to be considered. First, the efficacy of treatments varies among different species of parasites prevalent in different areas on the globe, with each species having a unique clinical presentation and resistance profile. Furthermore, leishmaniasis is a neglected tropical disease (NTD), resulting in a lack of evidence-based knowledge regarding treatment. Therefore, physicians often rely on case reports or case series studies, in the absence of randomized controlled trials (RCT), to assess treatment efficacy. Second, defining cure, especially in CL and MCL, may be difficult, as death of the parasite can be achieved in most cases, while the aesthetic result (e.g., scars) is hard to predict. This is a result of the biological nature of the disease, often diagnosed late in the course of disease (with possible keloid formation, etc.). Third, physicians must consider treatment ease of use and the safety profile of possible treatments. Thus, topical or oral treatments (for CL) are desirable and promote adherence. Fourth, the cost of the treatment is an important consideration. In this review, we aim to describe the diverse treatment options for different clinical manifestations of leishmaniasis. For each currently available treatment, we will discuss the various considerations mentioned above (efficacy, ease of use, safety, and cost). Full article

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13 pages, 1440 KB

Open AccessEditor’s ChoiceArticle

Reducing Pharmaceuticals in Water, a New Module Integrated in the Pharmacy Game: Evaluating the Module’s Effects on Students’ Knowledge and Attitudes

by Tanja Fens, Caroline T. A. Moermond, Peter van der Maas, Claudia Dantuma-Wering, Geke H. Lestestuiver, Agata Szperl, Lisette C. M. Schuiling, Eelko Hak and Katja Taxis

Pharmacy 2024, 12(1), 28; https://doi.org/10.3390/pharmacy12010028 - 6 Feb 2024

Cited by 7 | Viewed by 3047

Abstract

Pharmaceutical residues end up in surface waters, impacting drinking water sources and contaminating the aquatic ecosystem. Pharmacists can play a role in reducing pharmaceutical residues, yet this is often not addressed in pharmacy undergraduate education. Therefore, we developed the educational module “Reducing Pharmaceuticals [...] Read more.

Pharmaceutical residues end up in surface waters, impacting drinking water sources and contaminating the aquatic ecosystem. Pharmacists can play a role in reducing pharmaceutical residues, yet this is often not addressed in pharmacy undergraduate education. Therefore, we developed the educational module “Reducing Pharmaceuticals in Water” for pharmacy students; this was integrated in our pharmacy simulation game for third year Master of Pharmacy students at the University of Groningen. In this study, we aim to evaluate the effects of the module on students’ knowledge of pharmaceutical residues in water, to describe students’ experiences in taking the module, and to explore their attitudes towards green pharmacy education in general. This mixed-methods study included quantitative measurements, before and after students took the module (intervention group) and in a control group which did not receive the module. Data were collected between February 2023 and June 2023. Overall, 29 students took the module and 36 students were in the control group. The knowledge score of students in the intervention group (N = 29) increased significantly from 9.3 to 12.9 out of 22 (p < 0.001). The knowledge score of the students in the control group was (8.9 out of 22). Students found the e-learning and the patient cases the most exciting part of this module. Students also recognized the need to including environmental issues in pharmacy education. In conclusion, the module contributes towards improved knowledge and increased awareness of the impact of pharmaceuticals found in water. It represents a promising strategy to strengthen pharmacist’s role in mitigating the amount and the effect of pharmaceuticals on water and the environment in the future. Full article

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14 pages, 523 KB

Open AccessEditor’s ChoiceReview

Digital Solutions Available to Be Used by Informal Caregivers, Contributing to Medication Adherence: A Scoping Review

by Margarida Espírito-Santo, Sancha Santos and Maria Dulce Estêvão

Pharmacy 2024, 12(1), 20; https://doi.org/10.3390/pharmacy12010020 - 23 Jan 2024

Cited by 9 | Viewed by 3553

Abstract

Medication adherence is essential for managing chronic diseases and achieving optimal health outcomes. However, this process is often challenging, particularly for patients with complex care needs. Informal caregivers play a pivotal role in supporting medication management, but they may face resource limitations and [...] Read more.

Medication adherence is essential for managing chronic diseases and achieving optimal health outcomes. However, this process is often challenging, particularly for patients with complex care needs. Informal caregivers play a pivotal role in supporting medication management, but they may face resource limitations and a lack of necessary support. Digital health tools offer a promising avenue to enhance medication adherence by providing reminders, education, and remote monitoring capabilities. This scoping review aimed to identify and evaluate digital solutions available to informal caregivers for improving medication adherence. A systematic search of PubMed and Web of Science was conducted using relevant keywords. Four studies were included in the review, examining a variety of digital tools including mobile apps, SMS messaging, and wearable devices. These tools demonstrated efficacy in improving medication adherence, managing disease symptoms, and enhancing quality of life for patients and caregivers. Digital health interventions hold the potential to revolutionize medication adherence among chronic disease patients. By empowering informal caregivers, these tools can bridge the gaps in medication management and contribute to better health outcomes. Further research is warranted to optimize the design, implementation, and evaluation of digital interventions for medication adherence. Full article

(This article belongs to the Topic Drug Utilization and Medication Adherence: Strategies, Technologies and Practices)

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25 pages, 3581 KB

Open AccessEditor’s ChoiceArticle

Benzodiazepine Boom: Tracking Etizolam, Pyrazolam, and Flubromazepam from Pre-UK Psychoactive Act 2016 to Present Using Analytical and Social Listening Techniques

by Anthony Mullin, Mark Scott, Giorgia Vaccaro, Giuseppe Floresta, Davide Arillotta, Valeria Catalani, John M. Corkery, Jacqueline L. Stair, Fabrizio Schifano and Amira Guirguis

Pharmacy 2024, 12(1), 13; https://doi.org/10.3390/pharmacy12010013 - 12 Jan 2024

Cited by 9 | Viewed by 10028

Abstract

Introduction: The designer benzodiazepine (DBZD) market continues to expand whilst evading regulatory controls. The widespread adoption of social media by pro-drug use communities encourages positive discussions around DBZD use/misuse, driving demand. This research addresses the evolution of three popular DBZDs, etizolam (E), flubromazepam [...] Read more.

Introduction: The designer benzodiazepine (DBZD) market continues to expand whilst evading regulatory controls. The widespread adoption of social media by pro-drug use communities encourages positive discussions around DBZD use/misuse, driving demand. This research addresses the evolution of three popular DBZDs, etizolam (E), flubromazepam (F), and pyrazolam (P), available on the drug market for over a decade, comparing the quantitative chemical analyses of tablet samples, purchased from the internet prior to the implementation of the Psychoactive Substances Act UK 2016, with the thematic netnographic analyses of social media content. Method: Drug samples were purchased from the internet in early 2016. The characterisation of all drug batches were performed using UHPLC-MS and supported with ¹H NMR. In addition, netnographic studies across the platforms X (formerly Twitter) and Reddit, between 2016–2023, were conducted. The latter was supported by both manual and artificial intelligence (AI)-driven thematic analyses, using numerous.ai and ChatGPT, of social media threads and discussions. Results: UHPLC-MS confirmed the expected drug in every sample, showing remarkable inter/intra batch variability across all batches (E = 13.8 ± 0.6 to 24.7 ± 0.9 mg; F = 4.0 ± 0.2 to 23.5 ± 0.8 mg; P = 5.2 ± 0.2 to 11.5 ± 0.4 mg). ¹H NMR could not confirm etizolam as a lone compound in any etizolam batch. Thematic analyses showed etizolam dominated social media discussions (59% of all posts), with 24.2% of posts involving sale/purchase and 17.8% detailing new administration trends/poly-drug use scenarios. Artificial intelligence confirmed three of the top five trends identified manually. Conclusions: Purity variability identified across all tested samples emphasises the increased potential health risks associated with DBZD consumption. We propose the global DBZD market is exacerbated by surface web social media discussions, recorded across X and Reddit. Despite the appearance of newer analogues, these three DBZDs remain prevalent and popularised. Reporting themes on harm/effects and new developments in poly-drug use trends, demand for DBZDs continues to grow, despite their potent nature and potential risk to life. It is proposed that greater controls and constant live monitoring of social media user content is warranted to drive active regulation strategies and targeted, effective, harm reduction strategies. Full article

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11 pages, 502 KB

Open AccessEditor’s ChoiceReview

The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review

by Khang Duy Ricky Le, Kelvin Le and Felicia Foo

Pharmacy 2024, 12(1), 11; https://doi.org/10.3390/pharmacy12010011 - 8 Jan 2024

Cited by 33 | Viewed by 10281

Abstract

Background: Obstructive sleep apnoea (OSA) and associated hypopnoea syndromes are chronic conditions of sleep-disordered breathing with significant sequelae if poorly managed, including hypertension, cardiovascular disease, metabolic syndrome and increased mortality. Glucagon-like peptide 1 receptor agonists (GLP-1RA) have recently garnered significant interest as a [...] Read more.

Background: Obstructive sleep apnoea (OSA) and associated hypopnoea syndromes are chronic conditions of sleep-disordered breathing with significant sequelae if poorly managed, including hypertension, cardiovascular disease, metabolic syndrome and increased mortality. Glucagon-like peptide 1 receptor agonists (GLP-1RA) have recently garnered significant interest as a potential therapeutic, attributed to their durable effects in weight loss and glycaemic control in metabolic syndromes, such as obesity and type 2 diabetes mellitus. This has led to significant investment into companies that produce these medications and divestment from traditional gold standard methods of OSA management such as continuous positive airway pressure machines. Despite these sentiments, the impacts of these medications on OSA outcomes are poorly characterised, with no high-quality evidence at this stage to support this hypothesis. This scoping review therefore aims to address the research question of whether GLP-1RAs lead to a direct improvement in OSA and associated hypopnoea syndromes. Methods: A scoping review was performed following a computer-assisted search of Medline, Embase and Cochrane Central databases. Papers that evaluated the use of GLP-1RA medications related to sleep-disordered breathing, OSA or other sleep-related apnoeic or hypopnoeic syndromes were included. Results: Literature search and evaluation identified 9 articles that were eligible for inclusion. Of these, 1 was a study protocol, 1 was a case report, 1 was an abstract of a randomised controlled trial (RCT), 1 was a non-randomised clinical trial and the remaining 5 were randomised clinical trials of variable rigour. All studies evaluated the outcomes of GLP-1RAs in patients with diagnosed OSA or symptoms suggestive of this condition. Conclusion: This scoping review identified early evidence to suggest that GLP-1RAs may improve OSA as defined by reduction in apnoea-hypopnoea index (AHI). This evidence is however conflicting due to contradicting results demonstrated from other studies. Overall, these medications were tolerated well, with minor gastrointestinal side-effects reported in some cases. Of all included studies, the quality of evidence was low, with short lengths of follow-up to identify durable effects of these medications on OSA outcomes and identify adverse events. More rigorous, RCTs with sufficient length of follow-up are required before consideration of formalising these medications into OSA treatment guidelines, frameworks and policies are warranted. Full article

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