Meridia (Sibutramine)
Manufacturer: Abbott
Dosing: 5-15mg once daily
Schedule: C-V
Mechanism of Action: Appetite suppressant- Combined norepinephrine and serotonin reuptake inhibitor
Adverse Effects: modest elevations in heart rate and blood pressure, nervousness, and insomnia
Xenical (Orlistat)
Manufacturer: Roche
Dosing: 120mg three times daily before meals
Schedule: none
Mechanism of Action: Lipase inhibitor – decreased absorption of fat
Adverse Effects: GI- oily stools, diarrhea, flatulence, bloating, abdominal pain, and dyspepsia
Alli (see previous post in this blog)
Manufacturer: GlaxoSmithKline
Dosing: 60mg three times daily before meals
Schedule: none
OTC
Adipex-P (Phentermine)
Manufacturer: Teva
Dosing: 37.5mg once daily, generally given before breakfast
Schedule: C-IV
Mechanism of Action: Appetite suppressant- sympathomimetic amine
Adverse Effects: palpitations, tachycardia, and GI
Tenuate Dospan (Diethylpropion)
Manufacturer: Sanofi-aventis
Dosing: 75mg once daily (for controlled-release formulation)
Schedule: C-IV
Mechanism of Action: Appetite suppressant- sympathomimetic amine
Adverse Effects: palpitations, tachycardia, insomnia and GI
Adapted from Pharmacy Today 13(4), 2007
Monday, November 5, 2007
Health Topic: Medications Used for Weight Loss
Sunday, November 4, 2007
New Drug: Tekturna (Aliskiren)
Tekturna (Aliskiren) was approved in March 2007 as the first renin inhibitor for the treatment of hypertension. It maybe used as monotherapy or adjunct therapy with other antihypertensives. Tekturna is manufactured by Novartis. The most common adverse reaction is dose-related diarrhea. Tekturna is supplied as 150- and 300-mg tablets. Tekturna is FDA pregnancy category C in the first trimester and category D in the second and third trimesters. treament with this agent should be discontinued as soon as possible in pregannat patients.
Go to http://www.tekturna.com
Saturday, November 3, 2007
ASHP CareerPharm
American Society of Health-System Pharmacists (ASHP) CareerPharm offers three vehicles for recruiting: in print, in person, and online. Visit online at http://www.careerpharm.com.
OTC Product Review: Zaditor Antihistamine Eye Drops
Zaditor (Ketotifen Fumarate) ophthalmic solution is used for the temporary prevention of itching of the eye caused by allergies. Zaditor should not be used to treat eye irritations related to contact lenses. Zaditor is available without prescription. Compared with other OTC allergy eye drops, Zaditor has the following advantages:
1. Zaditor lasts up to 12 hours with single dose
2. Zaditor provides triple modes of action: potent antihistamine action, mast cell stabilization and eosinophil inhibition
3. Zaditor is safe and effective for children as young as 3 years old
4. Zaditor contains no vasoconstrictor
General Precautions with Zaditor:
1. You should not wear contact lenses if your eyes are red.
2. If you wear soft contact lenses and your eyes are not red, remove the lenses before using Zaditor. Wait at least 10 minutes after using Zaditor before putting in your contact lenses, because Zaditor contains a preservative that may be absorbed by the lens.
Some possible side effects of Zaditor:
Redness
Headache
Runny nose
Temporary burning or stinging of the eye
New Drug Review: Exforge (Amlodipine/Valsartan) for Hypertension
New Drug Review: Neupro (Rotigotine Transdermal System) for Parkinson's Disease
Neupro is indicated for the treatment of the signs and symtoms of early-stage idiopathic Parkinson's disease. Key points about Neupro:
1. Offers simple, once-daily dosing
2. Available patch: 2mg/24 hr, 4mg/24hr, 6mg/24hr
3. Most commonly reported side effects: nausea, application site reactions, somnolence, dizziness, headache, vomiting, and insomnia
4. Neupro should be used with caution in patients, especially those at risk for cardiovascular disease, because of the potential for symptomatic hypotension, syncope, elevated heart rate, elevated blood pressure, fluid retension, and/or weight gain
Neupro is manufactured by Schwarz Pharma. For more information please go to: http://www.neupro.com/
OTC Drug Review: Alli (Orlistat) Weight Loss Aid
The FDA approved the GlaxoSmithKline weight loss medication to be available OTC. Alli (Orlistat) is avavliable as 60 mg capsule without prescription. Go to http://www.allihcp.com/ to learn more. Alli is an inhibitor of gastric and pancreatic lipases. It works by blocking the absorption of about 25% of ingested fat. Remember Alli is not for everyone. Alli should be recommended to only those overweight adult patients who are ready to commit to eating reduced-calorie, low-fat meals and becoming more physically active.
Friday, November 2, 2007
Topic: Vitamins For Vision
Ocuvite DF (Bausch & Lomb)
http://www.bausch.com/en_US/ecp/pharma/product/vitamins/ocuvite-df.aspx
A combination of nutrients, like alpha lipoic acid and the antioxidant genistein, have been shown to help combat the effects of oxidative stress. Intended to provide nutritional support for people with diabetes
Optisharp (DSM Nutritional Products)
http://www.optisharp.com/
Optisharp contains zexanthin. The manufacturer claims zexanthin plays a role in reducing the risk of certain eye diseases, such as age-related macular degeneration and cataracts.
Bayer Nutritional Science Eye Health & Vitality (Bayer HealthCare)
http://www.bayernutritionalscience.com/nutritional/eye.aspx
Product intended to help maintain eye health by supporting healthy cells and tissue. It contains vitamins A, C, E and calcium, selenium, copper, a lutein/zeaxanthin blend, bilberry powder (leaf), blueberry juice powder (fruit), carrot juice powder (root), and tomato juice powder (fruit).
Prevention Vision Support Tablets (Windmill)
http://www.walgreens.com/store/product.jsp?CATID=304169&navAction=jump&navCount=1&id=prod2401909
Contains lutein and zeaxanthin.
ICaps Eye Vitamin & Mineral Supplement (Alcon)
http://www.icapsvitamins.com/
ICaps® MV Eye Vitamin and Mineral Supplement is a lutein-enriched multivitamin providing high levels of lutein and zeaxanthin for eye health in a formula for overall body health
ICaps® AREDS formula contains the same dosage of vitamins and minerals clinically proven in the Age-Related Eye Disease Study (AREDS) by the National Eye Institute (NEI). This study demonstrated that high levels of antioxidants and zinc significantly reduced the risk of age-related macular degeneration (AMD) by about 25% in patients most at risk for age-related vision loss.
ICaps Lutein & Zeaxanthin (formulated for people at risk of age-related eye conditions),
Diabetes Support Pack Multivitamin & Mineral Supplement (Nature’s Bounty)
http://www.walgreens.com/store/product.jsp?CATID=100137&navAction=jump&navCount=1&id=prod3430763
Intended to promote eye health contains a multivitamin with lutein, alpha lipoic acid, cinnamon and chromium picolinate, selenium, folic acid, CoQ10, and vitamin C.
Ocu-Omega (Douglas Laboratories)
Dietary supplement for patients who want to support optimal eye function
Multi-betic Multi-Vitamin Tablets (Hi-Tech Pharmacal’s Health care Products)http://www.walgreens.com/store/product.jsp?CATID=100146&navAction=jump&navCount=0&id=prod396855
TheraTears (Advanced Vision Research)
http://www.theratears.com/
TheraTears brand provides a comprehensive, science-based solution to your dry eye problem. TheraTears brand includes a range of topical drops for dry eye, an omega-3 nutritional supplement for dry eye, and a gentle & effective eyelid cleanser.
New Drug Review: Emsam (Selegiline) Patch
Emsam (Selegiline) patch was approved by FDA in February 2006, and it is available in 3 sizes that deliver 6, 9, or 12 mg of selegiline per 24 hours. The patch is a matrix containing three layers consisting of a backing, and adhesive drug layer, and a release liner that is placed against the skin. Emsam patch is the first skin (transdermal) patch for use in treating major depression. The once a day patch works by delivering selegiline, a monoamine oxidase inhibitor or MAOI, through the skin and into the bloodstream. At its lowest strength 6mg/24hr, Emsam can be used without the dietary restrictions that are needed for all oral MAO inhibitors that are approved for treating major depression. Emsam has been shown safe and effective for treatment of major depressive disorder in two 6-8 week studies and also in a longer-term study of patients. The data for EMSAM 6mg/24hr support the recommendation that a modified diet is not required at this dose. Patients are advised to change the patch once a day. The more limited data available for EMSAM 9mg/24hr and 12mg/24hr do not rule out food effects so that patients receiving these higher doses should follow dietary restrictions that advise them to avoid certain foods or beverages. This includes foods and beverages such as aged cheese and wine.
The only common side effect of Emsam detected in placebo-controlled trials was a mild skin reaction where the patch is placed. There may be mild redness at the site when a patch is removed. If the redness does not go away within several hours after removing the patch or if irritation or itching continues, patients are advised to contact their doctor
Thursday, November 1, 2007
Pharmacy Organization Links
Professional Associations and Institutions
Academy of Managed Care Pharmacy
American Association of Colleges of Pharmacy
American College of Clinical Pharmacy
American Council on Pharmaceutical Education
American Institute of the History of Pharmacy American Pharmaceutical Association
American Society for Pharmacy Law
American Society of Consultant Pharmacists
American Society of Health-System Pharmacists
AMSUS-The Society of the Federal Health Agencies
Board of Pharmaceutical Specialties
Commissioned Officers Association
Drug Information Association
Food and Drug Law Institute
National Association of Boards of Pharmacy
National Council on Patient Information and Education
National Guideline Clearinghouse
Pharmacy Technician Certification Board Regulatory Affairs Professionals Society
US Pharmacopeia
Pharmacy Graduate Employment and Salary Statistics
You can access the full report by clicking: http://www.pharmacy.purdue.edu/students/prospective/EmploymentPU07.php
Topic: Flu Season and Flu Vaccine
The following Questions & Answers are taken directly from CDC (Center for Disease Control and Prevention). Here is link: http://www.cdc.gov/flu/about/qa/flushot.htm
You could also get more information from MyFluVaccine for Consumers. The web address is: http://www.myfluvaccine.com/patientreferral.aspx
Seasonal Flu Shot
What is the flu shot?
The flu shot is an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. It contains three influenza viruses. The three vaccine strains – one A (H3N2) virus, one A (H1N1) virus, and one B virus – are representative of the influenza vaccine strains recommended for that year. Viruses for the flu shot are grown in eggs.
Who should get a flu shot?
In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year. They are either people who are at high risk of having serious flu complications or people who live with or care for those at high risk for serious complications. During flu seasons when vaccine supplies are limited or delayed, the ACIP makes recommendations regarding priority groups for vaccination.
People who should get vaccinated each year are:
1. People at high risk for complications from the flu, including:
1. Children aged 6 months until their 5th birthday,
2. Pregnant women,
3. People 50 years of age and older, and
4. People of any age with certain chronic medical conditions;
5. People who live in nursing homes and other long term care facilities.
2. People who live with or care for those at high risk for complications from flu, including:
0. Household contacts of persons at high risk for complications from the flu (see above)
1. Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
2. Healthcare workers.
Use of the Nasal Spray Flu Vaccine
It should be noted that vaccination with the nasal-spray flu vaccine is always an option for healthy persons aged 5-49 years who are not pregnant.
Who should not get a flu shot?
Talk with a doctor before getting a flu shot if you:1) Have ever had a severe allergic reaction to eggs or to a previous flu shotor 2) Have a history of Guillain-Barré syndrome (GBS).
If you are sick with a fever when you go to get your flu shot, you should talk to your doctor or nurse about getting your shot at a later date. However, you can get a flu shot at the same time you have a respiratory illness without fever or if you have another mild illness.
How effective is the flu shot?
With the flu shot, when the "match" between vaccine and circulating strains is close, the vaccine prevents influenza in about 70%-90% of healthy persons younger than age 65 years. Among elderly persons living outside chronic-care facilities (such as nursing homes) and those persons with long-term (chronic) medical conditions, the flu shot is 30%-70% effective in preventing hospitalization for pneumonia and influenza. Among elderly nursing home residents, the flu shot is most effective in preventing severe illness, secondary complications, and deaths related to the flu. In this population, the shot can be 50%-60% effective in preventing hospitalization or pneumonia and 80% effective in preventing death from the flu.
What are the risks from getting a flu shot?
The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. The risk of a flu shot causing serious harm, or death, is extremely small. However, a vaccine, like any medicine, may rarely cause serious problems, such as severe allergic reactions. Almost all people who get influenza vaccine have no serious problems from it.
What are the side effects that could occur?
· Soreness, redness, or swelling where the shot was given
· Fever (low grade)
· Aches
If these problems occur, they begin soon after the shot and usually last one to two days.
Can severe problems occur?
· Life-threatening allergic reactions are very rare. Signs of serious allergic reaction can include breathing problems, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat, or dizziness. If they do occur, it is within a few minutes to a few hours after the shot. These reactions are more likely to occur among persons with a severe allergy to eggs, because the viruses used in the influenza vaccine are grown in hens' eggs. People who have had a severe reaction to eggs or to a flu shot in the past should not get a flu shot before seeing a physician.
· Guillain-Barré syndrome: Normally, about one person per 100,000 people per year will develop Guillain-Barré syndrome (GBS), an illness characterized by fever, nerve damage, and muscle weakness. In 1976, vaccination with the swine flu vaccine was associated with getting GBS. Several studies have been done to evaluate if other flu vaccines since 1976 were associated with GBS. Only one of the studies showed an association. That study suggested that one person out of 1 million vaccinated persons may be at risk of GBS associated with the vaccine.
· More facts about potential side effects of the influenza vaccine can be found in Prevention & Control of Influenza - Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007 Jul 13;56(RR06):1-54. Also available as PDF (720K).
What should I do if I have had a serious reaction to influenza vaccine?
· Call a doctor, or get to a doctor right away.
· Tell your doctor what happened, the date and time it happened, and when you got the flu shot.
· Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Reporting System (VAERS)* form, or call VAERS at 1-800-822-7967.
*Note: This link leads outside the CDC site to another federal agency or CDC partner site. Any links from these sites to nonfederal organizations' links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links. The link will open the page in a new browser window.
Topic: Self-Treatment For The Common Cold
The common cold is a self-limiting viral infection of the upper respiratory tract. It accounts for about one-half of all illnesses in adults and about three-quarters of all illnesses in young infants. Patients frequently self-medicate with OTC drugs, but the common cold cannot be prevented or cured. Antibiotics, often prescribed for patients with colds, are ineffective against viral infections.
Etiology of the Common Cold
Rhinovirus is the most common cause of the common cold. The most efficient mode of transmission is self-inoculation of the nasal mucosa or conjunctiva following contact with viral-laden secretions on animate or inanimate objects. Smoking, poor nutrition, increased population density, a sedentary lifestyle, and chronic psychological stress increase your chance of getting cold.
Signs and Symptoms of the Common Cold
The cold symptoms follow a predictable path, and usually resolve within 7 days. Sore throat is the first symptom followed by nasal congestion, rhinorrhea, sneezing, and coughs. Patients may have chills, headache, malaise, myalgia, or low-grade fever. The cold is self-limiting. The sore throat resolves quickly. Nasal symptoms dominate by day 2 or 3 and cough appears by day 4 or 5.
Self-treatment
1. Wash your hands before touching other people or the objects they have touched to prevent spreading a cold to others
2. Getting adequate rest may help you to recover more quickly
3. Drink more fluids may loosen mucus and promote sinus drainage
4. Sucking on hard candy, gargling with salt water, or drinking fruit juices may soothe a sore throat
5. Ask your pharmacist to help you select OTC products to relieve your most bothersome symptoms
When you need to seek medical attention:
1. Sore throat persists more than several days, is severe, or is associated with persistent fever, headache, or nausea or vomiting
2. Cough does not improve within 7 to 10 days
3. Symptoms worsen while taking nonprescription medications
4. Signs and symptoms of bacterial infections develop, e.g., thick nasal or respiratory secretions that are not clear; temperature higher than 101.5F; shortness of breath; chest congestion; wheezing, rash, or significant ear pain.
Adapted from Handbook of Nonprescription Drugs, APhA.
Wednesday, October 31, 2007
QT Drug List
The Arizona CERT (Center for Education and Research on Therapeutics) is an independent research and education center whose mission is to improve therapeutic outcomes and reduce adverse events caused by drug interactions and drugs that prolong the QT interval, especially those affecting women, through research and a broad range of educational programs for medical professionals and consumers.
The center maintains a QT Drug Lists on its website - four separate lists of drugs, based on risk category, that may prolong the QT interval.
1. Drugs with Risk of Torsades de Pointes
2. Drugs with Possible Risk of Torsades de Pointes
3. Drugs to be Avoided by Congenital Long QT patients Torsades de Pointes
4. Drugs Unlikely to Cause Torsades de Pointes
The website address is http://www.torsades.org/
Opium Tincture and Paregoric
There is a potentially dangerous situation that invites serious medication errors between opium tincture (deodorized) and paregoric (camphorated tincture of opium). Paregoric is camphorated tincture of opium. Paregoric has just 0.4mg/mL of morphine while opium tincture contains 10mg/mL – a 25-fold difference.
IMSP has issued a medication safety alert. Please follow the following two links:
http://www.ismp.org/hazardalerts/recruting.asp
http://www.pharmacytimes.com/article.cfm?ID=492
Monday, October 29, 2007
Acamprosate (Campral): Alcoholism, Maintenance of Abstinence
Order came in for a psychiatry patient, Acamprosate 666mg tid.
Campral is made by Forrest Pharmaceuticals Inc., and it is available as Campral Delayed-Release Tablet 333 mg. Acamprosate is used as an adjunct to comprehensive management programs and psychosocial support to help alcoholics maintain abstinence following ethanol withdrawal. As single therapy, acamprosate offers a better safety profile in comparison to disulfiram or naltrexone. The FDA approved acamprosate on July 29, 2004.
The usual dose for adult patients is 666mg orally three times daily. The drug requires renal dosing. For renally impaired patients, the dose is 333mg tid if CrCl is between 30-50 mL/min; use is not recommended for patients with CrCl less than or equal to 30 mL/min.
Acamprosate has a FDA pregnancy category C rating.
Double Plavix Dose (600mg) Reduces Risk After Stent Procedures
Today there was an order for Plavix (Clopidogrel) 600mg for a patient in the ED. Plavix is manufactured by Bristol-Myers Squibb, and it is an anti-clotting medication (http://www.plavix.com). Plavix blocks the ADP receptors, which prevent fibrinogen binding at that site and thereby reduce the possibility of platelet adhesion and aggregation. Usually the most common loading dose is Plavix 300mg. There is an article in the Pharmaceutical Business Review titled “Double Plavix dose reduces risk after stent procedures”. Here is the link: http://www.pharmaceutical-business-review.com/article_news.asp?guid=7FF46A1A-2F08-4F2E-8736-D6452DF44377. In the article it reports that according to a study, pretreatment with double-dose Plavix 600mg rather than the standard 300mg dose just before stenting cuts the combined risk of heart attack and cardiac death by half. In addition, the higher dose did not increase the risk of serious bleeding.
In the article it says interventional cardiologists give patients a loading dose of this medication before percutaneous coronary intervention (PCI) to protect against blood clotting. After the procedure, most patients take a lower daily dose (75mg) for up to a year, depending on the type of stent used to prop open the clogged coronary artery.
Saturday, October 27, 2007
Chinese Recipe: Spicy Jumbo Scallops with Baby Bok Choy
Spicy Jumbo Scallops with Bay Bok Choy (蒜蓉大干贝).
Ingredients
5 frozen jumbo scallops
1 cup cooking oil
1 cup shredded carrot
5 heads baby bok choy
1 tsp cornstarch
3 cups cooking oil
Group A
1/8 tsp salt
1/2 egg white
1 tablespoon cornstarch
1 tablespoon cooking oil
Group B
4 oz shredded fresh papaya
1 shredded red chili pepper
pinch rau ram (vietnamese herb)
1/2 tsp fresh minced garlic
1/8 tsp salt
1 tablespoon sugar
1 tablespoon lemon juice
2 tsp sesame oil
Group C
1 tsp minced ginger
1 tsp scallion
1 tsp minced fresh garlic
1 tablespoon minced garlic chili sauce
Group D
1 1/2 tablespoon sugar
1 1/2 tablespoon lemon juice
1 tsp cooking wine
1/3 cup chicken broth
2 tsp cornstarch/water mix (1 tsp of each)
2 tsp sesame oil
1/8 tsp white pepper salt to taste
Cooking Method
1. Defrost, clean, and dry jumbo scallops. Marinate in Group A for several hours
2. Heat 1 cup oil in wok until hot and stir-fry shredded carrot. Drain and set aside
3. Combine Group B ingredients and mound in center of plate
4. Wash baby bok choy and cut in half (from top to bottom). Steam until cooked. Set aside.
5. Toss marinated scallops with 1 tsp cornstarch. Heat 3 cups cooking oil until hot and fry scallops until golden brown. drain nd set aside.
6. Heat 1 tablespoon oil until hot, then stir-fry Group C ingredients. combine Group D and cook until sauce thickens.
7. Add scallops and toss well. Remove contents to plate. Place baby bok choy around scallops
8. Garnish with fried carrot
Distance Pathway for Doctor of Pharmacy
Interested in becoming a pharmacist? Want to get a Doctor of Pharmacy degree? Want to get the PharmD degree without living in dorms? Take a look at the innovative distance-based doctor of pharmacy degree program offered by Creighton University, Omaha, NE. Creighton University offers the first and only accredited Doctor of Pharmacy Program Distance Pathway (Online Pharmacy Program) providing a full-time educational method to obtain a Doctor of Pharmacy degree.
You can find out more information on the school web site: http://pharmacy.creighton.edu/
Web Site for ER Pharmacist
More and more hospitals are hiring ER pharmacist. The University of Rochester maintains a web site dedicated to ER pharmacist. Here is the link: http://www.emergencypharmacist.org/. There are valuable resources and tools for ER pharmacist.
Treatment of Acetaminophen Overdose in ER
I had two cases of acetaminophene (Tylenol) overdose in the ER this week. Both cases patients require IV Acetadote (Acetylcysteine). There is a web site published by Cumberland Pharmaceuticals, maker of Acetadote. Here is the link: http://www.acetadote.net/. There is a dosing calculator on the web site which can do the calculations for you. You can also downloade the calculator to your PDA The website also offers information or how to order Acetadote and emergency locator.
Below are some keypoints:
1. Acetadote, administered intravenously within 8 to 10 hours after ingestion of a potentially
hepatotoxic quantity of acetaminophen, is indicated to prevent or lessen hepatic injury.
2. Three-bag treatment (for patients >=40kg)
The total dose of Acetadote is 300 mg/kg administered over 21 hours.
Loading Dose: Dilute 150 mg/kg in 200 mL of 5% dextrose and administer over 60 minutes.
Second Dose: Dilute 50 mg/kg in 500 mL of 5% dextrose and administer over 4 hours.
Third Dose: Dilute 100 mg/kg in 1000 mL of 5% dextrose and administer over 16 hours.
The total volume administered should be adjusted for patients less than 40 kg (88 lbs) and for those requiring fluid restriction. To avoid fluid overload, the volume of 5% dextrose should be reduced as needed.
3. Renal adjustment/Hepatic adjustment
No data on renal/hepatic dosing adjustment