Journal of Pharmacy Practice

The safety and efficacy of warfarin depend on maintaining the international normalized ratio (INR) in an established range.

The purpose was to determine whether a coordinated pharmacist-led approach improved percentage of INRs in therapeutic range in comparison to a physician-led anticoagulation management service (AMS).

A retrospective chart review was conducted for patients at a multisite primary care organization. INR data for patients receiving warfarin management by a physician were collected from December 1, 2009 to May 31, 2010. These were compared to INR results from December 1, 2010 to May 31, 2011, during which patients received warfarin management from a pharmacist. The primary end points were percentage of INRs within a goal range of 2.0 to 3.0 and an expanded goal range of 1.8 to 3.2 for the physician-led group versus the pharmacist-led group.

The percentage of INR results within the goal range (2.0-3.0) was greater among patients in the pharmacist-led group (n = .130) than the physician-led group (n = 96; 57.5% vs 50.0%, respectively; P = .0004). The percentage of INR results <1.5 (7.3% vs 5.1%) and >3.5 (11.4% vs 7.1%) was also statistically significant in favor of the pharmacist-led AMS, with P values of .03 and .0004, respectively.

A pharmacist-led AMS improved the percentage of INRs in range, with significantly less out-of-range results.

The objectives of this study were to (1) examine the relationships between Emotional Thinking Scale (ETS) scores and demographic variables such as income, years worked as a pharmacist, and hours worked per week and (2) determine the distribution of ETS scores among this sample of pharmacists. These objectives are significant to explore because they may provide important data regarding effective and ineffective pharmacist work-related behaviors that affect career and life success.

A convenience sample of practicing pharmacists was selected. Participants completed the 8-item ETS and a demographic survey. The ETS predicts how an individual’s thoughts might influence his or her emotions and behaviors. Researchers analyzed participant’s ETS scores with his or her demographic responses. Data were analyzed using SPSS statistical software.

One hundred twenty-five pharmacists completed the survey. Twenty-one percent of the sample scored between slightly high and very extremely high on the ETS. “often being incapacitated by strong feelings” correlated negatively with annual income r = −.309 (P = .008); “relying on feelings to deal with complex situations” correlated negatively with annual income r = −.253 (P = .026), with the “number of years practicing pharmacy” r = −.317 (P = .007), and “number of hours worked each week” r = −.317 (P = .007); and “focusing on details thus losing the big picture” was correlated negatively with annual income r = .215 (P = .05). These findings are consistent with the previous ETS research.

The variables of interest in this study were negatively but significantly related. Emotional thinking scores decreased with pharmacy practice experience and may be counterproductive for career goals. Entry-level pharmacy education and continuing education programs may help develop self-awareness to this issue.

Nonprescription emergency contraception (EC) is now available for purchase without age restrictions. This is a great opportunity for pharmacists to provide counseling to ensure that customers use EC correctly.

This pilot study explored the impact of student pharmacist counseling on customer knowledge of EC in a retail pharmacy setting and assessed customer satisfaction with the counseling.

Counseling was performed at 2 retail pharmacies during June and July 2012. Participants completed a 12-question pretest that measured baseline knowledge of EC prior to a 5- to 10-minute education session, followed by the same 12-question posttest. A follow-up test was conducted via telephone within 1 to 3 months after the counseling.

Eighty-seven women participated with a mean age of 30.2 (standard deviation = 7.2) years. The average posttest score was significantly higher than the pretest score (11.5 ± 1.0 vs 8.5 ± 2.5; P < .001). The mean follow-up score (9.9 ± 1.1) was significantly higher than the pretest score (P = .014), which indicated retained knowledge. Participants reported being highly satisfied with the counseling session and strongly agreed that the counseling would help them use EC correctly.

Student pharmacist-provided EC counseling increased participants’ EC knowledge both immediate and long term. This study suggests that EC counseling is feasible and valued by customers.

Studies in recent years have exposed concerns about the safety of hormone replacement therapy (HRT) in the treatment of vasomotor symptoms (VMS) in menopausal women. Numerous studies have examined the use of antidepressants for relief of VMS. Despite recommendations to deny approval of paroxetine mesylate (Brisdelle™) for the treatment of VMS, the Food and Drug Administration (FDA) recently granted it approval for this indication.

To evaluate all published literature examining use of paroxetine salts (mesylate and hydrochloride) in the treatment of menopausal VMS.

Both PubMed and International Pharmaceutical Abstracts (IPA) were searched using the keywords hot flashes, vasomotor symptoms, menopause, and paroxetine. In PubMed, MeSH terms were used for paroxetine, menopause, and hot flashes. Searches were limited to humans, English language, and clinical trial design. The references for each study identified in this search process were examined in order to locate any additional relevant articles.

Compared with placebo, paroxetine salts offer a modest benefit in the treatment of menopausal VMS reducing the frequency and severity of weekly hot flashes.

Paroxetine (mesylate or hydrochloride) is an effective alternative to HRT for the reduction in VMS in menopausal women. Future head-to-head studies with active medications are needed in order to identify the best algorithm of treatment for this condition.

To describe 2 cases of drug-induced eosinophilic pneumonia in patients with variable exposure to daptomycin.

In our first case, a 77-year-old male was transferred to our facility for hypoxic respiratory failure, which occurred 1 day after completing a course of daptomycin. There was high clinical suspicion for daptomycin-induced eosinophilic pneumonia, thus the patient was started on intravenous methylprednisolone 40 mg every 6 hours. Within 72 hours, he was liberated from mechanical ventilation, as he experienced dramatic clinical improvement in regard to his oxygenation and radiographs. Approximately 6 weeks after case 1, a second case of eosinophilic pneumonia related to daptomycin was diagnosed. This case occurred in a 74-year-old female who developed respiratory failure requiring noninvasive positive pressure ventilation 72 hours after initiation of a second course of daptomycin. She was treated with methylprednisolone 60 mg every 6 hours and avoided the need for endotracheal intubation and mechanical ventilation.

Since this potentially life-threatening adverse effect of daptomycin appears more common than previously reported, clinicians should have a high level of suspicion in any patient with recent daptomycin exposure who presents with pulmonary symptoms. In many cases, this process is highly responsive to prompt initiation of corticosteroid therapy.

To determine medical residents’ day-to-day use of drug information resources since their choices of these resources, when faced with common questions, are unknown.

An online survey including simulated drug information questions was administered to 146 medical residents in the Department of General Internal Medicine during July 2012. Residents were given a wide range of choices in drug information resources to answer these questions and were instructed to select what they would choose in actual practice. A score was assigned to each resource corresponding to a “best,” “intermediate,” or “not good” choice.

Seventy-three respondents completed the survey and results were analyzed for statistical significance. Fifty-seven percent of respondents reported receiving no formal training regarding drug information. Statistical analyses revealed there were no significant differences in performance based on postgraduate year (P = .43) or extent of prior training (P = .45). Individual question responses revealed a generally infrequent selection of “best” choices. Less than 10% of the respondents chose the “best” answer for drug information questions related to drug interactions, herbal supplements, adverse events, and medication identification.

Further training in drug information resource selection is warranted in the medical residency program to increase the frequency of use of higher quality resources.

To report a case of Candida glabrata and tropicalis pneumonia in an immunocompetent patient.

A 72-year-old male was transferred from an outside institution due to worsening respiratory status, acute kidney injury secondary to intravenous contrast media, sepsis, and pneumonia with fever and leukocytosis. Upon admission, he was initiated on treatment for hospital-acquired pneumonia, but was also concomitantly tested for many other opportunistic infections due to his recent month-long trip to Ecuador where he participated in a tribal treatment for neuropathy that involved direct exposure to dead guinea pigs. With completion of cultures and bronchoalveolar lavage, C. glabrata was identified in the blood culture and C. glabrata and C. tropicalis in the bronchoalveolar lavage specimen. One month later, he was admitted due to recurrent pneumonia. The patient unfortunately expired during the second admission, due to complications from chronic respiratory pulmonary disease and pneumonia.

Initially, this patient was treated for hospital-acquired pneumonia, but due to a recent trip to Ecuador, it was soon discovered that this patient had developed an invasive Candida pneumonia. His pulmonary biopsies showed growth of invasive C. glabrata and C. tropicalis, while his blood culture showed C. glabrata. Candida-related lower respiratory tract infections are exceptionally rare in immunocompetent patients and require histopathologic evidence to confirm the diagnosis. A second blood culture showed that the C. glabrata was still present and the patient had worsening leukocytosis, so micafungin was added to his antimicrobial therapy.

It is understood that pneumonia is rarely caused by Candida species in patients who are admitted to the hospital. However, health care professionals should be aware that Candida pneumonia should be suspected as part of the differential diagnosis even in immunocompetent patients, particularly if they have recently traveled outside the United States.