Pharmacy

25 pages, 363 KiB

Open AccessReview

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

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)

10 pages, 468 KiB

Open AccessReview

Clinical Pharmacist-Led Collaboration of Multiple Clinical Professions Model Focusing on Continuity of Pharmacotherapy: Japanese Version of the Lund Integrated Medicines Management (LIMM) Model

by Rie Sato, Syuichi Aoshima and Tommy Eriksson

Pharmacy 2024, 12(6), 184; https://doi.org/10.3390/pharmacy12060184 - 5 Dec 2024

Abstract

(1) Background: In general, it is known that continuity of care can contribute to an increase in patient satisfaction, reduce health care costs, and improve patient outcomes. A guarantee of continuity in pharmacotherapy is a big challenge facing Japanese health care as a [...] Read more.

(1) Background: In general, it is known that continuity of care can contribute to an increase in patient satisfaction, reduce health care costs, and improve patient outcomes. A guarantee of continuity in pharmacotherapy is a big challenge facing Japanese health care as a system that encourages cooperation/collaboration for pharmacists with other health care professions is currently lacking. (2) Method: This is a narrative review. (3) Results: The Lund Integrated Medicine Management (LIMM) model describes a systematic approach to individuals and was developed in Sweden to optimize pharmacotherapy among elderly inpatients. The aim of the LIMM model is to provide patients with continuous pharmacotherapy at different levels of care. The LIMM model, in which a clinical pharmacist is the catalyst and leads other health care professions in completing the process, has the potential to reduce potentially inappropriate prescriptions, reduce rehospitalization risk, unscheduled hospital revisits due to problems related to medications, reduce total medical expenditure, and provide a comprehensive understanding of patients’ conditions of taking medicine. (4) Conclusions: Introducing a framework such as Sweden’s LIMM model, anchored by clinical pharmacists, could provide a good opportunity to promote collaborations among different health care professionals and improve continuity in pharmacotherapy. Full article

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22 pages, 8986 KiB

Open AccessArticle

Insights from a National Survey on Controlled Substance Diversion Practices in U.S. Hospital Pharmacies: Opportunities for Enhanced Surveillance and Compliance

by Samantha S. Bastow, Eric P. Borrelli, Julia D. Lucaci, Heather Nelkin, April Graves and Amanda Hays

Pharmacy 2024, 12(6), 183; https://doi.org/10.3390/pharmacy12060183 - 4 Dec 2024

Abstract

This study explored controlled substance (CS) diversion surveillance practices within hospital pharmacies across the United States. A survey with questions based on published CS diversion risk points was conducted in May 2024. A total of 66 participants from 31 states responded, with 54.5% [...] Read more.

This study explored controlled substance (CS) diversion surveillance practices within hospital pharmacies across the United States. A survey with questions based on published CS diversion risk points was conducted in May 2024. A total of 66 participants from 31 states responded, with 54.5% from single facilities and the remaining from health systems. Most respondents were pharmacy directors, managers, or those in dedicated drug diversion roles. Over 70% have dedicated surveillance teams and use drug diversion software. Results highlight variation in practices, with larger institutions generally showing better compliance. Compliance in procurement and receiving was high for access measures; however, auditing of processes was lower. The lowest procurement compliance was in monitoring periodic automatic replacement (PAR) levels and validating orders with wholesalers. Storage practices showed high compliance in deploying cameras, but low compliance in monitoring them. Dispensing practices had high compliance for restricting CS in automated dispensing cabinets, but low incidence of witness verification during stocking. Waste and disposal practices were well-followed, but training on detecting potential signs of medication tampering was less common. The survey highlights that while strategies to prevent CS diversion exist, their implementation varies. Enhancing monitoring, auditing, and training is essential to strengthen diversion prevention efforts in hospital pharmacies. Full article

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

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13 pages, 227 KiB

Open AccessArticle

Latvian Healthcare Professionals’ Self-Reported Knowledge, Attitudes, and Behaviors Related to Pregnancy Prevention Program Materials for Valproate-Containing Medicines

by Milana Špoģe, Mirdza Kursīte and Elita Poplavska

Pharmacy 2024, 12(6), 182; https://doi.org/10.3390/pharmacy12060182 - 4 Dec 2024

Abstract

Background: Valproates are recognized for their significant teratogenic risks, which can lead to physical defects and developmental disorders when used during pregnancy. To mitigate these risks, the Pregnancy Prevention Program (PPP) was developed by European regulators for patients and healthcare professionals (HCPs). Despite [...] Read more.

Background: Valproates are recognized for their significant teratogenic risks, which can lead to physical defects and developmental disorders when used during pregnancy. To mitigate these risks, the Pregnancy Prevention Program (PPP) was developed by European regulators for patients and healthcare professionals (HCPs). Despite the crucial nature of this program, the implementation of the PPP does not appear to be fully effective. This situation highlights the need for a deeper understanding of HCPs’ knowledge, attitudes, and behaviors regarding the PPP. Methods: A cross-sectional study using anonymous electronic questionnaires was conducted. The questionnaires were developed by a board of experts from eight different EU countries and were distributed among prescribers (general practitioners (GPs), neurologists, and psychiatrists) and pharmacists. Descriptive statistics were used to analyze the obtained data on participants’ knowledge, attitudes, and behaviors regarding the prescribing and dispensing of valproate-containing medicines to women of reproductive age, as well as the impact of PPP materials on their work. Results: The study results indicate that while HCPs in Latvia are generally aware of valproate teratogenic risks, significant gaps remain in the implementation of the PPP. A considerable number of both prescribers and pharmacists expressed the belief that they are not responsible for educating patients about the PPP, attributing this responsibility to other specialists. Furthermore, barriers such as a lack of time and accessible materials were identified. Conclusions: The roles and responsibilities of HCPs should be clearly defined to improve adherence to the PPP. Further research is needed to assess prescription and dispensing strategies, as well as HCPs’ attitudes toward the PPP. Additionally, re-evaluating and enhancing the accessibility of PPP materials is essential in effective risk management and better patient care. Full article

(This article belongs to the Special Issue Women's Special Issue Series: Pharmacy and Pharmacists)

13 pages, 2267 KiB

Open AccessArticle

High-Performance Liquid Chromatography with DAD Detection for the Determination of Cannabinoids in Commercial Veterinary CBD Oil

by Zehra Hajrulai-Musliu, Elizabeta Dimitreska Stojkovikj, Dimitar Gusheski, Dea Musliu and Daniel Velkovski

Pharmacy 2024, 12(6), 181; https://doi.org/10.3390/pharmacy12060181 - 2 Dec 2024

Abstract

The study highlights the need for quality control in evaluating medicinal plant products, especially CBD oils, before market release. Due to varying regulatory requirements, product labeling can sometimes be misleading, especially regarding cannabinoid concentrations such as CBD and THC. This research focused on [...] Read more.

The study highlights the need for quality control in evaluating medicinal plant products, especially CBD oils, before market release. Due to varying regulatory requirements, product labeling can sometimes be misleading, especially regarding cannabinoid concentrations such as CBD and THC. This research focused on developing a validated high-performance liquid chromatography (HPLC) method for accurately identifying and quantifying key cannabinoids in Commercial Veterinary CBD Oil. The main compounds identified included Cannabidivarin (CBDV), Cannabidiolic Acid (CBD-A), Cannabigerolic Acid (CBG-A), Cannabigerol (CBG), Cannabidiol (CBD), Tetrahydrocannabivarin (THCV), Cannabinol (CBN), ∆⁹-Tetrahydrocannabinol (d9-THC) ∆8-Tetrahydrocannabinol (d8-THC), Cannabicyclol (CBL), Cannabichromene (CBC), and Tetrahydrocannabinolic Acid (THCA), determined in line with the International Conference on Harmonization’s (ICH) guidelines. The method was validated for linearity, accuracy, precision, limit of detection (LOD), and limit of quantitation (LOQ). It was determined to be linear, with a correlation coefficient (R²) > 0.999. The LOD and LOQ values calculated from the calibration curve ranged from 0.05 to 0.13 and 0.50 to 0.61 µg/mL, respectively. The method also exhibited acceptable precision, with relative standard deviation values lower than or equal to 2%. The method’s accuracy was assessed through recovery percentages and fell within an acceptable range of 98–102 if the RSD was 2%. This study’s rigorous methodology and comprehensive findings significantly contribute to cannabinoid analysis. This validated protocol was used to analyze cannabinoids in 14 commercial veterinary CBD oil products from the Republic of North Macedonia. The performance parameters demonstrated that the method is reliable for quantitatively measuring cannabinoids in CBD oil. The analysis showed that the cannabinoid levels in the products were consistent with the manufacturers’ declared specifications, with no significant discrepancies in labeling. Full article

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

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21 pages, 2029 KiB

Open AccessSystematic Review

Addition of Bevacizumab to Chemotherapy and Its Impact on Clinical Efficacy in Cervical Cancer: A Systematic Review and Meta-Analysis

by Aleena Shahzad, Anees ur Rehman, Tehnia Naz, Muhammad Fawad Rasool, Alisha Saeed, Saba Rasheed, Sadia Shakeel, Saleh Karamah Al-Tamimi and Rabia Hussain

Pharmacy 2024, 12(6), 180; https://doi.org/10.3390/pharmacy12060180 - 1 Dec 2024

Abstract

Background and Objectives: Cervical cancer is the third leading cause of cancer-related mortality in females. One of the most successful therapeutic modalities to date is suppressing vascular endothelial growth factor (VEGF)-mediated angiogenesis. Bevacizumab is a monoclonal antibody that targets VEGF-A. The outcomes [...] Read more.

Background and Objectives: Cervical cancer is the third leading cause of cancer-related mortality in females. One of the most successful therapeutic modalities to date is suppressing vascular endothelial growth factor (VEGF)-mediated angiogenesis. Bevacizumab is a monoclonal antibody that targets VEGF-A. The outcomes for cervical cancer patients treated with bevacizumab in combination with platinum-based chemotherapy have been explored in several studies. This study aimed to assess the impact of bevacizumab on progression-free survival (PFS) and overall survival (OS) in patients with metastatic cervical cancer. Materials and Methods: This systematic review was registered in PROSPERO (CRD42023456755). Following PRISMA guidelines, a comprehensive literature search on PubMed and Google Scholar identified 28 studies meeting the inclusion criteria. The outcomes of interest were PFS and OS. The statistical analysis computed hazard ratios (HRs) with 95% confidence intervals (CIs). The study also included a subgroup analysis by cervical cancer stage. Results: The pooled analysis revealed that bevacizumab-based therapy significantly improved both PFS with HR 0.77 (95% CI: 0.58–0.96; p < 0.01; I² = 58%) and OS with HR 0.63 (95% CI: 0.45–0.89; p < 0.01; I² = 41%) in cervical cancer patients. Subgroup analysis by stage of cervical cancer demonstrated better efficacy of bevacizumab in metastatic stage IVB cervical cancer patients indicated by HR for PFS (0.69, 95% CI: 0.54–0.79; p < 0.01) and HR for OS (0.57, 95% CI: 0.46–0.73; p < 0.01). Conclusions: Bevacizumab exhibits a significant increase in PFS and OS, underscoring the efficacy of anti-angiogenesis therapy in cervical cancer, particularly in stage IVB metastatic cervical cancer patients. Full article

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19 pages, 3878 KiB

Open AccessArticle

Current Situation for Pharmacists in Japanese Veterinary Medicine: Exploring the Pharmaceutical Needs and Challenges of Veterinary Staff to Facilitate Collaborative Veterinary Care

by Taisuke Konno, Hiroyuki Suzuki, Naoto Suzuki, Kouji Okada, Yosuke Nishikawa, Daisuke Kikuchi, Hitoshi Nakamura and Yuriko Murai

Pharmacy 2024, 12(6), 179; https://doi.org/10.3390/pharmacy12060179 - 29 Nov 2024

Abstract

While veterinary pharmacy is common overseas, it has yet to gain traction in Japan. To clarify the actual situation in Japan, two surveys were conducted, targeting 4017 facilities (2000 pharmacies/drug stores, 2000 veterinary medical facilities, and 17 university-affiliated veterinary hospitals). We received 324 [...] Read more.

While veterinary pharmacy is common overseas, it has yet to gain traction in Japan. To clarify the actual situation in Japan, two surveys were conducted, targeting 4017 facilities (2000 pharmacies/drug stores, 2000 veterinary medical facilities, and 17 university-affiliated veterinary hospitals). We received 324 responses from pharmacy staff and 217 from veterinary hospital staff. Pharmacists were involved in drug therapy for companion animals either via direct discussion with veterinarians or by referrals for prescriptions from veterinarians (11 respondents). Veterinary staff and pharmacists showed a disparity regarding pharmacists’ involvement in companion animal healthcare. Veterinary staff wanted pharmacists to provide pharmaceutical guidance, perform audits, supply drug information, and prepare drugs. Strong demand (72.2% of the veterinary staff) existed for consultations with pharmacists regarding medication issues. Veterinary medicine has evolved to meet the demand for the advanced care of companion animals. Veterinary staff have diverse and substantial requests for pharmacists. Integrating the expertise of both veterinary staff and pharmacists may facilitate a team-based approach to veterinary medicine and improve the quality of care for companion animals. Tailoring approaches to suit Japan’s unique circumstances and creating a conducive environment for effective communication between pharmacists and veterinary staff are pivotal for advancing veterinary pharmacy in Japan. Full article

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18 pages, 1033 KiB

Open AccessReview

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

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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11 pages, 988 KiB

Open AccessArticle

The Role of Pharmacists in Minimizing the Risk Inherent in Unbundled Telehealth Services: A 12-Month Retrospective Case Study

by Louis Talay, Matt Vickers and Tiffany Cheng

Pharmacy 2024, 12(6), 177; https://doi.org/10.3390/pharmacy12060177 - 25 Nov 2024

Abstract

Pharmacists have often been viewed as the last line of defence against prescription errors in traditional care models. Although a large number of chronic care patients are using telehealth services to increase their access to continuous care, researchers have yet to investigate prescription [...] Read more.

Pharmacists have often been viewed as the last line of defence against prescription errors in traditional care models. Although a large number of chronic care patients are using telehealth services to increase their access to continuous care, researchers have yet to investigate prescription safety in such settings in Australia. The absence of this literature is particularly concerning in the context of the Australian Government’s admission in a 2024 report that the national health system has not adequately addressed the World Health Organization’s ‘Medication without harm’ objective. One of the report’s key findings was that knowledge on digital direct-to-consumer services is insufficient. A defining feature of some of these services is their unbundling of the pharmacy component, which logically increases the risk for prescription errors. This study analyzed the frequency of which the Cloud pharmacy network intercepted prescription errors in an unbundled digital sexual dysfunction service for men. Investigators found that Cloud pharmacists were responsible for intercepting 22 (5.31%) the 414 prescribing errors observed in the Pilot Australia service in 2023, including 12 (8.05%) of the 149 prescription errors for premature ejaculation (PE) patients and 10 (3.77%) of the 265 errors for erectile dysfunction (ED) patients. Seven of the errors intercepted by Cloud pharmacists were of high or medium severity, including four drug contraindications, two cases of inadequate patient history reviews, and one case of inadequate counselling. This study also appears to be the first to provide digital prescribing error rate data in an Australian sexual healthcare setting, observing an error rate of 0.86% from 30,649 ED prescriptions, 1.13% from the 13,154 PE prescriptions, and a total prescription error rate of 0.95% (414 out of 43,792 prescriptions). These findings demonstrate the vital role of pharmacists in intercepting prescribing errors in unbundled telehealth services. Possible implications of these findings include the allocation of additional resources across the pharmacy sector and the establishment of regulatory safety standards for unbundled telehealth services. Full article

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19 pages, 963 KiB

Open AccessArticle

Cannabidiol Supplements in Romania: Bridging the Gap Between Marketed Claims and Clinical Reality

by Corina Andrei, George Mihai Nitulescu, Georgiana Nitulescu and Anca Zanfirescu

Pharmacy 2024, 12(6), 176; https://doi.org/10.3390/pharmacy12060176 - 25 Nov 2024

Abstract

In recent years, the European market, including Romania, has witnessed a significant increase in the promotion of cannabidiol (CBD)-based products, often presented as effective treatments for various health conditions. This study investigates the inconsistencies between the health claims associated with these supplements and [...] Read more.

In recent years, the European market, including Romania, has witnessed a significant increase in the promotion of cannabidiol (CBD)-based products, often presented as effective treatments for various health conditions. This study investigates the inconsistencies between the health claims associated with these supplements and the evidence from clinical trials. To identify products available on the Romanian market, a systematic review of online pharmacies and websites that specialize in selling CBD-based products has been performed. Additionally, a systematic review of clinical trials has been conducted to assess the efficacy of CBD for the specified indications. Our analysis revealed that some claims, such as those related to post-traumatic stress disorder, lack substantial clinical evidence. Moreover, even when clinical support exists, the dosages recommended for the supplements are often significantly lower than those used in trials, raising concerns about their efficacy. These findings highlight the need for stricter regulatory oversight and more transparent communication to ensure that consumer expectations are aligned with scientific evidence, ultimately promoting informed decision-making and consumer safety. Full article

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

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12 pages, 464 KiB

Open AccessArticle

Attitudes and Experiences of Patients Regarding Gender-Specific Aspects of Pain Management

by Carolin Alexandra Boldt, Dirk Keiner, Norman Best and Thilo Bertsche

Pharmacy 2024, 12(6), 175; https://doi.org/10.3390/pharmacy12060175 - 22 Nov 2024

Abstract

Background: Biological, pharmacological, and socio-cultural aspects influence gender-specific effects in pain management. Methods: Gender-specific aspects of pain management were assessed in a rural outpatient center via semi-structured patient interview: (i) general gender aspects (total population) from 1 = “fully disagree” to 5 = [...] Read more.

Background: Biological, pharmacological, and socio-cultural aspects influence gender-specific effects in pain management. Methods: Gender-specific aspects of pain management were assessed in a rural outpatient center via semi-structured patient interview: (i) general gender aspects (total population) from 1 = “fully disagree” to 5 = “fully agree”; and (ii) individual pain (matched pairs) via numeric analog scale (NAS) from 0 = “no pain” to 10 = “maximum pain”. Patient charts were assessed for pain management (WHO-ladder). Results: In total, 113 patients were enrolled (59.18 [SD: 12.76] years, 46% female, 54% male, 0% diverse), and 42 were matched into female-male pairs. (i) Women and men agreed that men and women should be treated equally despite biological differences (median: 5 [women] vs. 5 [men]; p = 0.789). As a reason for gender-specific aspects, “medication concentration” was reported more frequently by women (p = 0.038) and “no answer” by men (p = 0.014). (ii) Mean value (SD) of pain (NAS) was 4.0 (SD 2.3) for women and 3.3 (SD 2.6) for men (p = 0.215) with a positive correlation between pain management escalation (WHO-ladder) and the pain score (NAS) only in men (r = 0.704, p = 0.001). Women rather reported an influence of adverse drug reactions on treatment contentment than men (p = 0.042). Conclusions: Although patients pleaded for gender-independent equal treatment, gender-specific differences in pain therapy were found. Full article

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

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11 pages, 248 KiB

Open AccessArticle

Assessment of Potential Drug–Drug Interactions of Psycholeptics and Antidepressants in Outpatient Settings

by Iva Marović, Ivana Marinović, Vesna Bačić Vrca and Ivana Samardžić

Pharmacy 2024, 12(6), 174; https://doi.org/10.3390/pharmacy12060174 - 22 Nov 2024

Abstract

Mental health is an important segment in preserving overall health and represents a significant public health issue. In modern times, mental health disorders have risen, often requiring complex pharmacotherapy and chronic monitoring. The aim of this research was to determine the prevalence and [...] Read more.

Mental health is an important segment in preserving overall health and represents a significant public health issue. In modern times, mental health disorders have risen, often requiring complex pharmacotherapy and chronic monitoring. The aim of this research was to determine the prevalence and clinical significance of potential psychotropic drug interactions in outpatient settings and compare the differences in potential drug–drug interaction (pDDIs) exposure with age. The psychotropic drugs included antipsychotics—N05A, anxiolytics—N05B, hypnotics and sedatives—N05C, and antidepressants—N06A. This retrospective study analyzed prescribed pharmacotherapy in 492 outpatients who were treated with at least one psychotropic drug. We determined 1.64 prescribed psychotropic drugs per patient and 2.2 pDDIs that involved psychotropic drugs. In total, 2285 pDDIs were recorded, of which almost half (47.6%) were pDDIs with psychotropic drugs. More prescribed psychotropic drugs were found in patients younger than 65 years, and equal exposure to pDDIs of psychotropic drugs (p = 0.5077) was found in both age groups. The most commonly identified psychotropics involved in pDDIs were benzodiazepines, promazine, and zolpidem. The results indicate that psychotropic drug interactions represent important drug-related problems for primary health care. The widespread use of psychotropic drugs and the determined clinical significance of their interactions require pharmacist interventions which can reduce the prevalence of pDDIs and increase patient safety. Full article

8 pages, 548 KiB

Open AccessCommentary

Tackling Pharmaceutical Pollution Along the Product Lifecycle: Roles and Responsibilities for Producers, Regulators and Prescribers

by Gillian Parker and Fiona A. Miller

Pharmacy 2024, 12(6), 173; https://doi.org/10.3390/pharmacy12060173 - 22 Nov 2024

Abstract

Pharmaceuticals produce considerable environmental harm. The industry’s resource-intensive nature, coupled with high energy costs for manufacturing and transportation, contribute to the “upstream” harms from greenhouse gas emissions and ecosystem pollution, while factors such as overprescription, overuse, and pharmaceutical waste contribute to the “downstream” [...] Read more.

Pharmaceuticals produce considerable environmental harm. The industry’s resource-intensive nature, coupled with high energy costs for manufacturing and transportation, contribute to the “upstream” harms from greenhouse gas emissions and ecosystem pollution, while factors such as overprescription, overuse, and pharmaceutical waste contribute to the “downstream” harms. Effectively addressing pharmaceutical pollution requires an understanding of the key roles and responsibilities along the product lifecycle. In this commentary, we argue that three actors—producers, regulators, and prescribers—have unique and interdependent responsibilities to address these issues. Producers and market access regulators are upstream actors who can manage and mitigate harms by both shifting manufacturing, business practices, and regulatory requirements and producing transparent, robust data on environmental harms. By contrast, prescribers are downstream actors whose capacity to reduce environmental harms arises principally as a “co-benefit” of reducing inappropriate prescribing and overuse. Potentially complicating the prescriber’s role are the calls for prescribers to recommend “environmentally preferable medicines”. These calls continue to increase, even with the sparsity of transparent and robust data on the impact of pharmaceuticals on the environment. Recognizing the interdependencies among actors, we argue that, rather than being ineffectual, these calls draw needed attention to the critical responsibility for upstream actors to prioritize data production, reporting standards and public transparency to facilitate future downstream efforts to tackle pharmaceutical pollution. Full article

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7 pages, 213 KiB

Open AccessArticle

Evaluating Pharmacists’ Knowledge of Food–Drug Interactions in Croatia: Identifying Gaps and Opportunities

by Josipa Bukić, Doris Rušić, Antonela Turic, Dario Leskur, Toni Durdov, Joško Božić, Martin Kondža, Darko Modun and Ana Šešelja Perišin

Pharmacy 2024, 12(6), 172; https://doi.org/10.3390/pharmacy12060172 - 21 Nov 2024

Abstract

Food–drug interactions (FDIs) are pharmacokinetic or pharmacodynamic changes in drug effects caused by the presence of specific foods. To identify and prevent FDIs, pharmacists, alongside other healthcare professionals, should possess a certain level of knowledge. This study aimed to assess knowledge of FDIs [...] Read more.

Food–drug interactions (FDIs) are pharmacokinetic or pharmacodynamic changes in drug effects caused by the presence of specific foods. To identify and prevent FDIs, pharmacists, alongside other healthcare professionals, should possess a certain level of knowledge. This study aimed to assess knowledge of FDIs among Croatian pharmacists. A total of 206 participants were included in this cross-sectional study. The median knowledge score among Croatian pharmacists was 69.44%, with an interquartile range of 19.44. Croatian pharmacists most commonly recognized FDIs involving theophylline, warfarin, and tetracycline, while the lowest rate of correct answers was observed with digoxin interactions. Future studies should evaluate pharmacists’ clinical practice concerning FDIs. Additionally, more research is needed to develop educational programs on this topic, either at the university level or for continuing education. Full article

(This article belongs to the Special Issue Medication Safety and Pharmacy Practice)

17 pages, 319 KiB

Open AccessArticle

Cardiovascular Diseases and Metabolic Medications in the Lebanese Population: A Post Hoc Analysis from a Nationwide Cross-Sectional Study

by Rony M. Zeenny, Rachel Abdo, Chadia Haddad, Aline Hajj, Rouba Karen Zeidan, Pascale Salameh and Jean Ferrieres

Pharmacy 2024, 12(6), 171; https://doi.org/10.3390/pharmacy12060171 - 20 Nov 2024

Abstract

Objective: This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients’ subgroups. Methods: A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, [...] Read more.

Objective: This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients’ subgroups. Methods: A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, lifestyles, comorbidities, and medication use. Logistic regression models were employed to analyze the data and determine associations between CVD and metabolic drugs. Stratification analyses were performed based on diabetes and dyslipidemia status. Results: The study found significant associations with CVD among the 2048 participants. Higher scores on the Lebanese Mediterranean Diet Score (LMDS; ORa = 1.06), hypertension (ORa = 1.71), diabetes (ORa = 1.75), dyslipidemia (ORa = 1.89), family history of CVD (ORa = 1.58), and smoking (previous: ORa = 1.63, current: ORa = 2.15) were linked to increased CVD odds. Higher income (intermediate: ORa = 0.64, high: ORa = 0.40) was inversely related to it. A subsequent model that included hypoglycemic and lipid-lowering medications yielded similar results. However, neither hypoglycemic nor lipid-lowering medications demonstrated a significant association with CVD risk. A third regression model was conducted by taking the classes of drugs as an independent variable. Also, the result revealed that all the classes of medication were not associated with the risk of CVD. Stratification by diabetes revealed LMDS and hypertension as risk factors in both groups. Among non-diabetic participants, dyslipidemia (ORa = 2.40), current smoking (ORa = 2.28), and higher income (intermediate: ORa = 0.57, high: ORa = 0.62) were linked to CVD. Among people with diabetes, a family history of CVD (ORa = 2.69) increased the CVD odds, while being an employer (ORa = 0.49) lowered it. Stratification by dyslipidemia showed consistent risk factors, and higher LMDS (ORa = 1.07), diabetes (ORa = 2.14), hypertension (ORa = 1.79), and previous smoking (ORa = 1.95) were linked to CVD without dyslipidemia. Being a female (ORa = 0.52) and having a lower income (ORa = 0.40) were associated with lower CVD odds in those with dyslipidemia. Subgroup analyses showed that medications were not significantly associated with CVD odds among patients with diabetes or hyperlipidemia. Conclusions: This study’s findings highlight the importance of addressing modifiable risk factors and socioeconomic factors to reduce the burden of CVD. Targeted interventions and longitudinal research are necessary to optimize preventive strategies and improve the management of CVD in individuals using hypoglycemic and hypolipemic agents in low- and medium-income countries. Full article

15 pages, 277 KiB

Open AccessArticle

Medication Reconciliation of Patients by Pharmacist at the Time of Admission and Discharge from Adult Nephrology Wards

by Hossein Ahmadi, Yalda Houshmand, Ghanbar Ali Raees-Jalali and Iman Karimzadeh

Pharmacy 2024, 12(6), 170; https://doi.org/10.3390/pharmacy12060170 - 18 Nov 2024

Abstract

Purpose: The aim of the present study was to investigate the impact of medication reconciliation by pharmacists at both admission and discharge in hospitalized patients with different kidney diseases. Methods: A prospective study was performed in adult nephrology wards of a teaching referral [...] Read more.

Purpose: The aim of the present study was to investigate the impact of medication reconciliation by pharmacists at both admission and discharge in hospitalized patients with different kidney diseases. Methods: A prospective study was performed in adult nephrology wards of a teaching referral hospital in Iran from September 2020 to March 2021. All patients hospitalized in the nephrology ward for at least 1 day who received the minimum of one medication during their ward stay within the study period were considered eligible. Medication reconciliation was performed by taking a best-possible medication history from eligible patients during the first 24 h of ward admission. Medications were evaluated for possible intentional as well as unintentional discrepancies. Results: Here, 178 patients at admission and 134 patients at discharge were included. The mean numbers of unintentional drug discrepancies for each patient at admission and discharge were 6.13 ± 4.13 and 1.63 ± 1.94, respectively. The mean ± SD numbers of prescribed medications for patients before ward admission detected by the nurse/physician and pharmacist were 6.06 ± 3.53 and 9.22 ± 4.71, respectively (p = 0.0001). The number of unintentional discrepancies at admission and discharge had a significant correlation with the number of drugs used and underlying diseases. The number of unintentional discrepancies at admission was also correlated with patients’ age. The number of comorbidities was significantly associated with the number of unintentional medication discrepancies at both admission and discharge. At the time of ward discharge, all patients were given medication consultations. Conclusions: The rate of reconciliation errors was high in the adult nephrology ward. The active contribution of pharmacists in the process of medication reconciliation can be significantly effective in identifying these errors. Full article

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

11 pages, 397 KiB

Open AccessArticle

A Qualitative Study of Pharmacists’ Perceptions of the Advantages and Disadvantages of Telepharmacy

by Masaki Shoji and Mitsuko Onda

Pharmacy 2024, 12(6), 169; https://doi.org/10.3390/pharmacy12060169 - 16 Nov 2024

Abstract

In Japan, telepharmacy is becoming increasingly popular due to deregulation triggered by the outbreak of COVID-19. The purpose of this study was to gain an understanding of the actual state of telepharmacy in Japan by interviewing pharmacists who have experience with telepharmacy and [...] Read more.

In Japan, telepharmacy is becoming increasingly popular due to deregulation triggered by the outbreak of COVID-19. The purpose of this study was to gain an understanding of the actual state of telepharmacy in Japan by interviewing pharmacists who have experience with telepharmacy and describing its advantages and disadvantages, as well as their outlook for its use going forward. The interviews were conducted online using Zoom. Each interview lasted approximately 30 min. Eleven people were interviewed. The advantages mentioned by the pharmacists were classified into three main categories: “Better communication”, “Time savings”, and “Improved safety”. The disadvantages were classified into the following nine categories: “Drug delivery problems”, “Communication failures”, “Ease of use for patients”, “Emotional reactions”, “Pharmacy system”, “Communication issues”, “Healthcare system issues”, “App system issues”, and “Cost”. Many of these factors correspond to the Unified Theory of Acceptance and Use of Technology (UTAUT) constructs presented by Venkatesh, et al. Many of the pharmacists mentioned that the use of telepharmacy is likely to expand further in the future, but that this will require further development of communication technology and the widespread use of systems such as electronic prescriptions. Full article

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

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17 pages, 3463 KiB

Open AccessArticle

Potential Adverse Drug Events Identified with Decision Support Algorithms from Janusmed Risk Profile—A Retrospective Population-Based Study in a Swedish Region

by Tora Hammar, Emma Jonsén, Olof Björneld, Ylva Askfors, Marine L. Andersson and Alisa Lincke

Pharmacy 2024, 12(6), 168; https://doi.org/10.3390/pharmacy12060168 - 15 Nov 2024

Abstract

Adverse drug events (ADEs) occur frequently and are a common cause of suffering, hospitalizations, or death, and can be caused by harmful combinations of medications. One method used to prevent ADEs is by using clinical decision support systems (CDSSs). Janusmed Risk Profile is [...] Read more.

Adverse drug events (ADEs) occur frequently and are a common cause of suffering, hospitalizations, or death, and can be caused by harmful combinations of medications. One method used to prevent ADEs is by using clinical decision support systems (CDSSs). Janusmed Risk Profile is a CDSS evaluating the risk for nine common or serious ADEs resulting from combined pharmacodynamic effects. The aim of this study was to examine the prevalence of potential ADEs identified using CDSS algorithms from Janusmed Risk Profile. This retrospective, cross-sectional study covered the population of a Swedish region (n = 246,010 inhabitants in year 2020) using data on all medications dispensed and administered. More than 20% of patients had an increased risk of bleeding, constipation, orthostatism, or renal toxicity based on their medications. The proportion of patients with an increased risk varied from 3.5% to almost 30% across the nine categories of ADEs. A higher age was associated with an increased risk of potential ADEs and there were gender differences. A cluster analysis identified groups of patients with an increased risk for several categories of ADEs. This study shows that combinations of medications that could increase the risk of ADEs are common. Future studies should examine how this correlates with observed ADEs. Full article

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14 pages, 572 KiB

Open AccessArticle

Views from Multinational Pharmaceutical Companies on Allocation of Clinical Trials in Saudi Arabia—Qualitative Study

by Nouf M. Aloudah and Ahmed M. Shaman

Pharmacy 2024, 12(6), 167; https://doi.org/10.3390/pharmacy12060167 - 12 Nov 2024

Abstract

Clinical trials conducted by pharmaceutical companies are essential for bridging local research efforts with broader populations, facilitating the transfer of valuable insights and solutions. This study aimed to explore the barriers and facilitators affecting clinical trials in Saudi Arabia from the perspective of [...] Read more.

Clinical trials conducted by pharmaceutical companies are essential for bridging local research efforts with broader populations, facilitating the transfer of valuable insights and solutions. This study aimed to explore the barriers and facilitators affecting clinical trials in Saudi Arabia from the perspective of key personnel within the pharmaceutical industry and Contract Research Organizations (CROs). We conducted in-depth semi-structured interviews with nine participants, which provided a holistic understanding of the intricate dynamics shaping the landscape of clinical trials in the country. The analysis revealed three prominent themes: operational challenges, complexities in navigating approval hurdles, and the unique value proposition for conducting clinical trials in Saudi Arabia. The participants expressed pride in the local infrastructure but acknowledged existing flaws, particularly in regulatory processes that contribute to delays in trial initiation. They emphasized the importance of conducting clinical trials in areas such as diabetes, crowd management during pilgrimages, and rare diseases, which are prevalent in the region. Despite the limited number of clinical trials registered (354 from 2009 to 2020, with only 1% being phase 1 studies), Saudi Arabia’s total pharmaceutical market exceeds SAR 13 billion, positioning it as the largest market in the region. Stakeholders recognized the country’s potential as a research hub, particularly within the Gulf Cooperative Council (GCC) region. However, to attract more trials and enhance the medical research landscape, it is crucial to address the identified barriers, streamline processes, and improve stakeholder alignment. The findings highlight the need for targeted interventions to overcome these challenges and leverage Saudi Arabia’s investments in healthcare infrastructure since its transformation program launched in 2010. By enhancing the regulatory environment and fostering collaboration among stakeholders, Saudi Arabia can solidify its role as a key player in international clinical research. Full article

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

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