Journal of Pharmacy Technology

Glycoprotein (GP) IIb/IIIa antagonists are used routinely for the treatment of acute coronary syndrome and to prevent thromboses during percutaneous coronary interventions. It is not uncommon for patients who initially require a GP IIb/IIIa inhibitor to eventually receive a surgical intervention.

To compare the difference in bleeding indices in patients who undergo coronary artery bypass grafting (CABG) after receiving either eptifibatide or abciximab.

A retrospective chart review was completed on all adults who received abciximab or eptifibatide within 24 hours prior to undergoing CABG. Patients were excluded if they had received a dose of warfarin within 96 hours prior to the procedure or if they had an incomplete medical record, an off-pump procedure, a known hypercoagulable disorder, or hemophilia. A total of 54 patients were included and preoperative data, including doses of anticoagulant and antiplatelet agents, were recorded. Intraoperative and postoperative data collected for analysis included hemoglobin level, chest tube output, and the amount of blood products transfused for 24 hours postprocedure.

There was a statistically significant difference between the eptifibatide and abciximab groups in the amount of fresh frozen plasma (mean ± SD, 21 ± 31 vs 187 ± 125 mL, respectively; p < 0.05) and platelets (212 ± 81 vs 433 ± 118 mL, respectively; p < 0.01) transfused during the intraoperative period. However, when the total amount of blood products transfused intraoperatively (769 ± 243 vs 1395 ± 316 mL, respectively; p = 0.47) was evaluated, no significant difference was detected. Likewise, markers for bleeding that were collected during the 24-hour postoperative window (immediate and 24-h postoperative hemoglobin and total 24-h chest tube output) were not significantly different.

Although there is an increased risk of bleeding when abciximab or eptifibatide is administered prior to CABG, no significant difference in the total amount of blood products used was detected between the 2 agents in this study.

Dietary vitamin K is a recognized variable associated with oral anticoagulant therapy. However, current practices of dietary education and instruction regarding vitamin K, as well as factors influencing related decision-making, are unknown. Research has examined healthcare providers' ability to identify a meal containing vitamin K, but the ability to classify portions of specific vegetables according to vitamin K content has not been evaluated.

To characterize dietary evaluation and instructional methods provided to patients receiving warfarin therapy, assess factors influencing instructional methods, and evaluate clinician knowledge of vitamin K content for specific vegetable portions.

A cross-sectional online survey of US healthcare providers involved with management of outpatient oral anticoagulation therapy was conducted.

One hundred twenty-two responses were received. Seventy-four percent of respondents collected initial dietary history from all patients and 52% asked all patients for dietary history at follow-up visits. Taking a verbal dietary history from all patients was significantly associated with larger clinic size and managing patients in person. Eighty-two percent of respondents reported providing dietary vitamin K education to all patients. Low patient literacy was a common factor influencing instruction to avoid foods high in vitamin K. Overall mean score reflecting the ability to classify vegetable portions by vitamin K content was 64.6 ± 10.9%.

Acquisition of dietary history by anticoagulation providers is not always completed at initial and follow-up patient visits. Provision of patient education at initial visits is relatively high. Patient factors such as low literacy may influence a clinician's decision to provide a specific method of dietary instruction, including avoidance of foods high in vitamin K. Clinicians are least likely to correctly identify vegetable portions containing vitamin K in the range of 10–99 μg and should consider portion size when assessing dietary history.

States have the authority to mandate laws that are more stringent than federal law, which often results in important differences in prescribing and dispensing patterns throughout the country.

To evaluate schedule II controlled substance laws in all 50 states, the District of Columbia, and Puerto Rico to identify important differences.

The current state laws and regulations regarding controlled substances were evaluated using the following criteria: whether prescription expirations dates are mandated, whether partial fills are permitted, whether changes can be made to prescriptions after consulting with a physician, whether maximum days' supplies are mandated, and whether pharmacists can dispense emergency oral prescriptions.

Thirty-nine states and Puerto Rico (77%) mandate prescription expiration dates. Partial filling is permitted in all states, the District of Columbia, and Puerto Rico (100%). All 50 states and the District of Columbia (98%) permit pharmacists to make prescription changes after consulting with the physician. Nine states (17%) have mandated maximum days' supplies that a physician may prescribe. All 50 states, the District of Columbia, and Puerto Rico (100%) permit pharmacists to dispense drugs in an emergency situation with verbal prescription.

Pharmacists should be aware that differences exist among the states, the District of Columbia, and Puerto Rico regarding Schedule II controlled substance laws. Understanding these differences is fundamental to the profession.

To reexamine the existing medications for the potential treatment of extensively drug-resistant tuberculosis (XDR-TB), based on susceptibility data, and to identify potential future medications from the literature.

Relevant information was identified through a search of MEDLINE (1966–November 2007), PubMed (1955–November 2007), American Search Premier (1975–November 2007), International Pharmaceutical Abstracts (1960–November 2007), Science Citation Index Expanded (1996–November 2007), Cochrane Databases (publications archived until November 2007), and various tertiary sources as listed in the references, using the terms extensively drug-resistant tuberculosis (XDR-TB), ethambutol, pyrazinamide, para-aminosalicylic acid, cycloserine, linezolid, diarylquinoline, nitroimidazopyran, fluoroquinolones, β-lactams, new treatments, and ethionamide alone or in combination regimens.

After identification of the relevant information, the data presented in this article were selected based on clinical relevance and value of information.

Based on susceptibility data, pyrazinamide, ethambutol, para-aminosalicylic acid, cycloserine, and ethionamide may be used for the treatment of tuberculosis. However, due to the emergence of XDR-TB, many of these agents are no longer successful treatment regimens. We have found limited data supporting potential future use of β-lactams, clarithromycin, and linezolid in resistant TB infections. TMC207, nitroimidazopyran, and SQ109 compounds may also prove to be viable options in the near future for treatment of tuberculosis, especially in cases with resistance to mainstay medications.

Extensively resistant tuberculosis appears to be a potentially catastrophic disease if allowed to spread. Due to its resistance profile, very few potentially effective agents are available, calling attention to this growing problem.