Amy Heck Sheehan

Prazosin Treatment of Nightmares Related to Posttraumatic Stress Disorder

OBJECTIVE: To describe current data evaluating the use of prazosin in adults with posttraumatic stress disorder (PTSD) who are experiencing nightmares. DATA SOURCES: A literature search using MEDLINE (1966–March 2007) and the Published International Literature on Traumatic Stress database (1982–March 2007) was conducted using the search terms α-antagonist, α-blocker, prazosin, and posttraumatic stress disorder. References of identified articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION: All English-language articles regarding the use of prazosin in adults with nightmares related to PTSD were reviewed. DATA SYNTHESIS: PTSD is a psychiatric disorder that develops in some people after exposure to trauma. Sleep disturbances occur in up to 70% of patients with PTSD. Several neurotransmitters have been implicated in the pathophysiology of sleep disturbances in PTSD. Adrenergic agents that inhibit norepinephrine, such as prazosin, may decrease the arousal produced by norepinephrine in response to a stressor. Four open-label studies, 1 retrospective chart review, and 2 placebo-controlled trials reporting the use of prazosin for nightmares related to PTSD were reviewed. All studies included a small number of patients (4–59) and evaluated prazosin dosages ranging from 1 to 20 mg/day. Despite various limitations, all of the studies showed significant improvements in the sleep-related symptoms of PTSD following the addition of prazosin therapy, based on the Clinician Administered PTSD Scale recurrent distressing dreams item and the Clinical Global Impression of Change scale. CONCLUSIONS: Prazosin appears to be a promising and fairly well tolerated agent for the management of PTSD-related nightmares and sleep disturbances. Further well designed trials are warranted to establish its place in therapy.

Use of Social Media by Pharmacy Preceptors

Objective. To define current use patterns of Facebook and Twitter among pharmacy preceptors and assess perceptions regarding use of social media within professional practice. Methods. An electronic survey instrument was sent to 315 pharmacists registered as advanced pharmacy practice experience (APPE) preceptors for Purdue University College of Pharmacy. Results. Approximately 60% of the 155 respondents used a Facebook account and 9% used a Twitter account. Respondents were willing to complete continuing education (CE) credit (46%) using social media, and were interested in following professional organizations (39%) on social media; however, the majority were not interested in obtaining drug or disease-state information, identifying employment opportunities, or participating in clinical discussion forums via social media. Conclusion. Despite the growing popularity of social media across multiple disciplines, the majority of pharmacy preceptors surveyed were not willing to use these venues in professional practice.

Evaluation of Pharmacist Use and Perception of Wikipedia as a Drug Information Resource

TO THE EDITOR: Approximately 80% of pharmacists use the Internet to obtain drug information.1 Wikipedia, often found at the top of Internet search results, is a free-access, collaborative, online encyclopedia that can be edited by anyone.2 Incidents of vandalism have occurred, since the site allows anyone to contribute. For example, an incident occurred in which a fake biography was created as a joke to implicate prominent writer and journalist John Seigenthaler for the assassination of John F Kennedy. It took about 4 months until the fake biography was detected and deleted by Wikipedia.3 Although Wikipedia does have an internal quality review, the ability of internal editors to find and correct erroneous information may not be timely. As reported by Clauson et al.,4 the information found on Wikipedia may not be complete and accurate, especially in regard to drug information. Published data regarding pharmacists’ use of Wikipedia to obtain drug information is lacking. Therefore, the objective of this study was to measure pharmacists’ use and perception of Wikipedia for obtaining drug information. Seventy-eight state pharmacy associations in the US were contacted between February 2 and March 14, 2009, and requested to forward a link to an electronic questionnaire (Appendix I) to their pharmacist members. Forty-two percent (33/78) of the state pharmacy associations, representing 66% of states (33/50), participated. A total of 38,110 emails were sent, and 1067 questionnaires were completed, resulting in a 3% response rate. Eleven questionnaires were excluded because they were from students. Fifty-four percent (572/1056) of respondents were male, the mean age was 48 years (range 23–86 y), and mean time in practice was 23 years (0–65 y). Of the respondents, 52% had a bachelor’s degree, 40% had a PharmD degree, and 9% had other degrees (eg, PhD, Master’s). The majority of respondents did not have residency training (78%), with most practicing in either retail (40%) or hospital (37%) pharmacy settings. Thirty-five percent (369/1056) of respondents reported use of Wikipedia. Of the 687 who did not report use of Wikipedia, 51% (351/687) indicated that they do not use Wikipedia because they have other resources available. Other reasons for not using Wikipedia included lack of trust (27%; 183/687) or lack of familiarity with the site (11%; 75/687). In regard to their perception of Wikipedia, 19% (69/369) of users reported that they trusted Wikipedia, 12% (43/369) indicated that they would recommend Wikipedia to other pharmacists, and 7% (25/369) would recommend Wikipedia to consumers/patients. In terms of using Wikipedia specifically to obtain drug information, 28% (105/369) reported using it for this purpose, with the majority of these respondents reporting use of Wikipedia to identify medication indications. Of concern, only 28% (29/105) of the respondents who reported using Wikipedia to obtain drug information were familiar with who edits and manages the Web site. This study is limited by a low response rate and the fact that only pharmacists who were members of state pharmacy associations received the survey; also, not all areas of pharmacy practice were represented. In conclusion, although the majority of respondents reported that they do not use Wikipedia as a drug information resource, only one third of pharmacists who reported use of Wikipedia for drug information were aware that anyone can edit the information. These results warrant an effort to educate pharmacists about the limitations and appropriate use of online resources for drug information.

Effect of Vitamin A on Fracture Risk

OBJECTIVE To describe current data evaluating the effect of vitamin A intake on fracture risk. DATA SOURCES A literature search using MEDLINE (1966–March 2005) was conducted using the search terms bone density, fractures, osteoporosis, retinol, and vitamin A to identify published studies evaluating the effects of vitamin A on bone. DATA SYNTHESIS Studies evaluating vitamin A consumption and fracture risk were reviewed. Current data suggest a potential inverse relationship between excess vitamin A consumption and bone mineral density leading to an increased risk for fracture. CONCLUSIONS Although current data are limited, consumption of large amounts of vitamin A may be associated with decreased bone mineral density and increased fracture risk. Until further information is available, patients should be made aware of the potential risks of consuming vitamin A in amounts that exceed the recommended dietary allowance. Further research is needed to clarify the relationship between vitamin A and fracture risk.

Graduating Pharmacy Students’ Perspectives on E-Professionalism and Social Media

Objective. To determine the use patterns of social media among graduating pharmacy students, characterize students’ views and opinions of professionalism on popular social media sites, and compare responses about social media behavior among students seeking different types of employment. Methods. All graduating pharmacy students (n=516) at Purdue University, The University of Findlay, Butler University, and Midwestern University were invited to complete a survey instrument during the fall semester of 2011. Results. Of 212 (41%) students who responded to the survey, 93% (194/209) had a social media profile. Seventy-four percent (120/162) of participants felt they should edit their social media profiles prior to applying for a job. Conclusions. Many graduating pharmacy students use social media; however, there appears to be a growing awareness of the importance of presenting a more professional image online as they near graduation and begin seeking employment as pharmacists.

Redesign of a statewide teaching certificate program for pharmacy residents.

Objectives. To identify and assess changes made to the Indiana Pharmacy Resident Teaching Certificate program over 10 years to adapt to the growing number and changing needs of pharmacy educators in the next generation. Design. In 2011, all resident program participants and directors were sent an electronic survey instrument designed to assess the perceived value of each program component. Assessment. Since 2003, the number of program participants has tripled, and the program has expanded to include additional core requirements and continuing education. Participants generally agreed that the speakers, seminar topics, seminar video recordings, and seminar offerings during the fall semester were program strengths. The program redesign included availability of online registration; a 2-day conference format; retention of those seminars perceived to be most important, according to survey results; implementation of a registration fee; electronic teaching portfolio submission; and establishment of teaching mentors. Conclusion. With the growing number of residents and residency programs, pharmacy teaching certificate programs must accommodate more participants while continuing to provide quality instruction, faculty mentorship, and opportunities for classroom presentations and student precepting. The Indiana Pharmacy Resident Teaching Certificate program has successfully evolved over the last 10 years to meet these challenges by implementing successful programmatic changes in response to residency program director and past program participant feedback.

Pharmacy Students’ Perceptions of and Attitudes Towards Peer Assessment Within a Drug Literature Evaluation Course

Objective. To assess pharmacy students’ perceptions of and attitudes towards the use of peer assessment within a drug literature evaluation course. Methods. A 15-item, electronic survey instrument was sent to 158 second-year pharmacy students enrolled in a 2-credit required literature evaluation course at the Purdue University College of Pharmacy. Results. One hundred fifty-two (96.2%) responses were received. Approximately 95% of students agreed that they had the necessary skills to assess their peers and 91.8% agreed that their peers possessed these skills as well. More students agreed they were comfortable receiving feedback from peers (95.7%) than agreed they were comfortable providing feedback to peers (80%). The majority of students (91.9%) agreed that peer assessment was a skill they will use in their career as a pharmacist. Conclusion. Students were more comfortable receiving feedback from peers than providing peer assessment. This skill is used by pharmacists throughout their career; therefore, students should become familiar and comfortable with the peer assessment process.

Review of recent evidence: Potential interaction between clopidogrel and proton pump inhibitors

PURPOSE Recent evidence of a potential interaction between clopidogrel and proton pump inhibitors (PPIs) is discussed. SUMMARY The American College of Cardiology and the American Heart Association recommend use of gastroprotective agents, specifically PPIs, in patients receiving aspirin, a thienopyridine, or the combination who have an increased risk for recurrent gastrointestinal bleeding. Available evidence from one small, short-term, randomized, double-blind trial evaluating platelet aggregation and several observational studies suggests that there is a potential for a clinically significant interaction between clopidogrel and PPIs. A post hoc analysis of a large, randomized, double-blind trial found no evidence of a clinically significant drug interaction at 28 days, though a significant difference was observed at one year. The authors concluded that the use of PPIs, regardless of clopidogrel use, increases the risk of adverse cardiovascular events. CONCLUSION Although data are limited, observational studies and prospective trials involving surrogate markers of platelet reactivity suggest a clinically significant interaction between clopidogrel and PPIs. Until further studies are completed to delineate the specifics of the interaction between clopidogrel and PPIs, the risks and benefits of concomitant treatment should be carefully weighed to determine the most appropriate treatment for each individual patient.

Selecting an appropriate medication for treating neuropathic pain in patients with diabetes: a study using the U.K. and Germany Mediplus databases.

Objective:  To evaluate the appropriateness of prescribing select neuropathic pain medications to diabetes patients based on the potential for drug–drug interactions with medications diabetes patients were prescribed continuously for ≥ 3 months (chronic use).

Memantine for the Prevention of Primary Headache Disorders

Objective: To describe the current data evaluating the efficacy and safety of memantine for the prevention of primary headache disorders. Data Sources: A literature search using MEDLINE (1966-July 2014) and EMBASE (1973-July 2014) was conducted using the search terms memantine, headache, migraine, glutamate, and NMDA. References of identified articles were reviewed for additional, relevant citations. Study Selection and Data Extraction: All English-language articles dealing with the use of memantine for prevention of primary headache disorders were included. Data Synthesis: Data from several retrospective reports and 2 prospective clinical trials suggest that memantine may be a useful treatment option for the prevention of primary headache disorders. The majority of available literature focuses specifically on chronic migraine prevention in refractory patients who had failed multiple previous prophylactic therapies. In these patients, 10 to 20 mg of memantine daily reduced the frequency and intensity of migraine headaches and was generally well tolerated, with few adverse events. Data regarding the efficacy of memantine for other primary headache disorders such as chronic tension type and cluster headaches are limited. Conclusion: Although further studies evaluating the efficacy of memantine for prevention of primary headache disorders are warranted, memantine may be a reasonable option, used either as monotherapy or adjunctive therapy, in the refractory chronic migraine prophylaxis setting.