Journal of Pharmacy Practice

Chronic liver disease encompasses a large number of hepatic disorders. One of the most important etiologies of liver disease is drug-induced liver disease, which is the leading cause of liver failure in patients referred for liver transplantation in the United States. Drug-induced liver disease can present in all forms of acute and chronic liver disease with highly variable clinical presentations. There is no effective treatment for most drug-induced liver disease and the recognition and prevention of drug-induced liver disease remain the most important management strategy. Drug dosing in patients with liver disease represents an even more challenging task to clinicians, as there is only scant information on biomarkers that can be used to predict the pharmacokinetic changes of drugs in patients with underlying liver disease. Several factors contribute to alterations in drugs metabolism and clearance in cirrhotic patients, including the severity of the liver disease and the metabolic pathways of each individual drug. Only general guidelines on dosage adjustment in patients with hepatic impairment are available. When drugs with extensive hepatic metabolism are required in patients with preexisting liver disease, benefit of therapeutic effect must be evaluated against the risk of toxicity, and the drugs must be initiated with extreme caution with appropriate dosage reduction.

Liver cirrhosis is the encapsulation or replacement of injured tissue by collagen, resulting in end-stage liver disease and portal hypertension. The consequences of cirrhosis are impaired hepatocyte function, increase intrahepatic circulatory resistance, portal hypertension, and the development of hepatocellular carcinoma. Complications include encephalopathy, coagulopathy, varices, ascites, spontaneous bacterial peritonitis, epatorenal syndrome, and hepatopulmonary syndrome. Managing patients with acute or chronic liver failure is challenging, and liver failure may have profound effects on other organ systems. Most therapies are directed at managing the complications and bridging patients to liver transplantation. The clinician must be aware of the pathologic presentations and the appropriate management, including pharmacologic and nonpharmacologic therapies, goals and end points of therapy, and monitoring of therapy. This review focuses on the management of the complications directly associated with liver dysfunction (encephalopathy and coagulopathy) and portal hypertension (varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome).

The study objectives were to determine a change in the self-perceived knowledge and skills of the third-professional year Doctor of Pharmacy students after taking a course on developing, implementing, and evaluating a disease/medication therapy management program. The study used a cross-sectional before-and-after design in which the data were collected once at the beginning of the course and then upon course completion. A self-administered questionnaire that had 4 sections and 36 questions, focusing on self-perceived knowledge and skills was administered. The data were analyzed using SPSS version 14.0. Descriptive statistics, paired sample t tests, and repeated measures analysis of variance were conducted. A total of 95 students completed the pretest, and 69 students completed the posttest. There was an overall increase in average self-perceived knowledge and skills about disease/medication therapy management programs after the students completed the course. Therefore, classes focusing on disease/medication therapy management can significantly increase the knowledge and skills about these programs for the Doctor of Pharmacy students who will soon enter professional careers and be expected to perform these services.

The emergence of the glucoregulatory hormone, glucagon-like peptide-1, has expanded our understanding of glucose homeostasis. The glucoregulatory actions of glucagon-like peptide-1 include enhancement of glucose-dependent insulin secretion, suppression of inappropriately elevated glucagon secretion, slowing of gastric emptying, and reduction of food intake. Two approaches have been developed to potentiate the effects of glucagon-like peptide-1 in those with type 2 diabetes. The glucagon-like peptide-1 analogs, such as exenatide, and dipeptidyl peptidase-IV inhibitors, such as sitagliptin, are currently available whereas others are in the final stages of development. These agents effectively reduce hemoglobin A1c while providing the other benefits associated with increased glucagon-like peptide-1. They also offer the potential to preserve the β-cell function. The effects on cardiovascular disease, if any, are unknown. Based on the current evidence, these agents represent viable second-and third-line options in the management of type 2 diabetes.

Fall-related injuries are a serious public health issue among older adults. In addition to having a significant impact on our economy, these injuries are associated with considerable morbidity. Each year, 1 out of every 3 adults aged 65 and older fall; of these adults, 10% to 20% sustain serious injuries such as fractures or head traumas. Such injuries account for about 6% of medical expenditures for adults 65 years and older. Pharmacist interventions can prevent falls, thereby improving the quality of life of these older adults, preserving their independence, and significantly reducing health care costs.