Journal of pharmacy practice
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Most critically ill patients receive a myriad of psychoactive medications during their hospital stay. An understanding of the pharmacology of the more commonly used sedative and analgesic therapies enables the clinician to aptly utilize these medications and limit toxicity. ⋯ Limiting these therapies while optimizing patient comfort has been shown to reduce the duration of mechanical ventilation and reduce intensive care unit (ICU) and hospital length of stay and should be the aim of the multidisciplinary medical team. This review is intended to provide the reader with a fundamental understanding of how to facilitate comfort of the mechanically ventilated critically ill adult patients and how to minimize medication-related toxicities.
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Qualitative urine drug assays are frequently used in conjunction with opioid contracts as a means of monitoring use of prescribed controlled substances as well as concurrent use of illicit substances in patients receiving opioids for chronic nonmalignant pain (CNMP) management. Appropriate use of these screening tests, in conjunction with opioid contracts, may provide the health care provider with additional information needed to safely prescribe opioids for selected individuals with CNMP. It is important for the practitioner caring for patients subject to random urine drug screening to understand interferences with the commonly used urine drug assays, as well as knowing options to confirm contested test results. We reviewed the literature on urine drug assay test interferences and present a summary of this information in this article.
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Shock states have multiple etiologies, but all result in hypoperfusion to vital organs, which can lead to organ failure and death if not quickly and appropriately managed. Pharmacists should be familiar with cardiogenic, distributive, and hypovolemic shock and should be involved in providing safe and effective medical therapies. An accurate diagnosis is necessary to initiate appropriate lifesaving interventions and target therapeutic goals specific to the type of shock. ⋯ Rapid therapeutic intervention has been proven to decrease morbidity and mortality and is crucial to providing the best patient outcomes. Pharmacists can provide their expertise in medication selection, titration, monitoring, and dose adjustment in these critically ill patients. This review will focus on parameters used to assess hemodynamic status, the major causes of shock, pathophysiologic factors that cause shock, and therapeutic interventions that should be employed to improve patient outcomes.
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The production and distribution of counterfeit medications has become a significant global public health issue and though not as rampant in the United States as in other parts of the world, the Food and Drug Administration (FDA) has seen a 10-fold increase in the number of cases investigated. The purpose of this study was to examine California pharmacist knowledge of counterfeit medications, impact of technology and barriers to pharmacist involvement, and potential roles pharmacists can undertake. Our results showed that 59.3% of respondents believe counterfeit drugs pose a problem to the profession, but most had little to no experience with counterfeit medications. ⋯ Pharmacist agreed lack of knowledge (46.8%) and resources (82.5%) were barriers to detecting the presence of counterfeits. Half of respondents were award of the CA board of pharmacy's (BOP) future use of Radio Frequency Identification (RFID) technology, but 43% did not believe RFID would be effective. Most pharmacists indicated lack of knowledge regarding new technologies but seemed willing to learn.
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A new set of standards, ACPE Standards 2007, adopted by the Accreditation Council for Pharmacy Education (ACPE), required all pharmacy programs to include introductory pharmacy practice experiences (IPPEs) to represent 5% of the curriculum and advance pharmacy practice experiences (APPEs) to represent 25% of the curriculum. This required many pharmacy programs to revise their curriculum to meet these requirements. The challenge of satisfying the increased accreditation requirements along with the increased number of new pharmacy programs in the United States has resulted in increased competition for experiential sites. ⋯ Senior pharmacy students at UAMS were involved in expanding APPE opportunities by developing immunization clinics and providing immunizations at their experiential sites. Both pharmacy programs were successful in expanding experiential opportunities by focusing on immunizations. Students, preceptors, and patients all benefit from utilizing student pharmacist at experiential sites to provide patient care services.