Deborah Stier Carson

Chronic-pain medications: equivalence levels and method of quantifying usage.

Medication use is an important consideration in chronic-pain rehabilitation programs (CPRPs). However, it is difficult to quantify this aspect of chronic-pain treatment, because patients often take multiple medications that can differ by pharmacological class as well as dosage level. The Medication Quantification Scale (MQS) provides a method for quantifying medication use in patients with chronic, nonmalignant pain. Scores are calculated for each medication based on weights assigned by medication class and dosage level, and these scores are summed to provide a quantitative index of total medication usage suitable for statistical analysis. The method for calculating MQS scores is illustrated, and research data on MQS reliability and validity are presented. Interrater reliability was p = 0.985 (p < 0.0001) for 30 MQS scores calculated by two clinicians. MQS scores for 88 patients correlated well with the clinical judgment of 12 health care professionals (mean p = 0.755, p < 0.0001). The MQS scores for 60 chronic-pain patients (30 treated in a CPRP and 30 untreated) were obtained at two time points: evaluation and 1-year follow-up. A two (groups) by two (time points) analysis of variance yielded a significant group-by-time interaction (F = 8.82, p < 0.0043). Treated patients decreased their medication intake significantly (p < 0.0001). whereas untreated patients did not (p > 0.57). The MQS offers a reliable and valid method for quantifying medication usage in chronic-pain patients.

Effects of magnesium oxide on the lipid profile of healthy volunteers

Elevated serum cholesterol is a risk factor in the development of coronary artery disease. Magnesium has been reported to decrease total serum cholesterol, low density lipoprotein, and very low density lipoprotein, and increase high density lipoprotein. A randomized, double-blind, placebo-controlled, crossover study was completed to determine if supplemented magnesium, in the form of magnesium oxide, would produce changes in the lipid profile. Fifty normal volunteers received placebo or magnesium oxide, 400 mg capsules, twice a day for 60 days, then switched to the alternate treatment. Weight, height, blood pressure, serum potassium, serum magnesium, and a lipid profile were determined initially and after each treatment. Analysis of variance (ANOVA), comparing the mean of each component of the lipid profile at baseline and after each treatment, showed no significant difference. In conclusion, supplemental magnesium oxide did not produce statistically significant changes in the lipid profile in this group of healthy volunteers.

Patients' views of pharmacists as providers of smoking cessation services.

Cigarette smoking is widely recognized as the foremost cause of preventable illness and death in the United States. Exposure to secondhand smoke leads to higher rates of smoking-related illnesses in nonsmokers as well.1–3 Reducing the use of tobacco products remains a challenge for smokers, health care professionals, and public health programs.4–7 Most experts recommend that health care providers adopt multifactorial strategies, including asking patients about and documenting their tobacco use, encouraging smokers to quit, and suggesting pharmacotherapy as part of the intervention.4 Because over-the-counter smoking cessation therapies are sold in the pharmacy area, and because of their knowledge regarding these therapies, pharmacists have many opportunities each day to support smokers in their cessation efforts.4 Several obstacles, however, impede the widespread implementation of smoking cessation services in pharmacies. These obstacles are similar to those that affect other pharmacist-provided services and include lack of time, lack of employer support, lack of reimbursement for pharmacists’ cognitive services, and pharmacists’ sense that they are not sufficiently trained in smoking cessation therapies.8,9 In addition, the sale of tobacco products in many pharmacies sends contradictory messages to patients regarding the pharmacy’s motive to continue profiting from tobacco sales versus the pharmacist’s desire to promote patients’ health. Moreover, little is known about consumers’ attitudes toward the pharmacy as a potential location for receiving help with smoking cessation and toward pharmacists as providers of information and advice regarding smoking cessation.

Infectious Diseases in Day-Care Centers: Transmission and Approaches to Prevention

Child day care is used increasingly by both single-parent and two-parent families. With the growth in numbers of children receiving day care outside the home comes a greater awareness of the potential for disease transmission. Epidemiologic patterns of spread of such diseases as Hemophilus influenzae type b, hepatitis A, diarrheal diseases, and cytomegalovirus are changing with respect to attendance at a day-care center. Not only is this a problem for the staff and children who attend a center, but it also may be a public health concern as these diseases could spread to households and the community at large. This review will identify those transmissible infectious agents frequently found in children who attend day-care centers with an emphasis on approaches to prevention and methods for decreasing secondary spread.

Cefuroxime Axetil (Ceftin®): A Brief Review

Cefuroxime axetil is a second-generation cephalosporin that contains the classic [3-1actam ring structure. Bactericidal activity in vivo is resultant of its binding to essential target proteins, termed the penicillin-binding proteins, which are located in the bacterial cell wall. Inhibition of these proteins leads to bacterial cell wall elongation and leakage, thus the bacteria are unable to divide and mature,z

Infertility in Women: An Update

OBJECTIVE To review pharmacologic therapy of infertility disorders in women. DATA SOURCES Current clinical literature. STUDY SELECTION Not applicable. DATA EXTRACTION Not applicable. DATA SYNTHESIS The complex interplay of hormones and cells is the focus of most pharmacotherapeutic interventions in women with infertility problems. Treatment remains more of an art than a science at this time. Since the cause of infertility cannot be identified in many cases, practitioners use medications to overcome potential problems with anovulation, secondary ovarian failures, hypothalamic-pituitary dysfunction, and hyperprolactinemia. This article reviews the use of clomiphene, human chorionic gonadotropin, menotropins such as human menopausal gonadotropin and urofollitropin, gonadotropin-releasing hormone, and dopamine agonists. CONCLUSION Although few pharmacists are closely involved in the treatment of women with infertility, they can be sources of information, monitor families for signs and symptoms of psychologic stress associated with treatments, and help patients with practical instructions.

Menopause and Osteoporosis: The Role of HRT: Pharmacists should educate patients about the benefits of hormone replacement therapy, which can prevent osteoporosis in postmenopausal women.

Bone loss resulting from estrogen deficiency is the leading cause of osteoporosis in postmenopausal women. Oral and transdermal estrogen can prevent osteoporosis. For most women, the benefits of hormone replacement therapy (HRT) outweigh any risks that exist. The recurrence of vaginal bleeding is the most common reason that women discontinue HRT.

Family Medicine Clinical Pharmacy: The South Carolina Experience

Since its inception over 25 years ago, clinical pharmacy has extended into virtually every subspecialty of medicine, including Family Medicine. Family Medicine philosophically supports a team approach to health care that has welcomed the pharmacist as an active member for over 15 years. The association between Family Medicine physicians and pharmacists has evolved into one that embodies the concept of pharmaceutical care. This article provides a historical perspective of the pioneers in Family Medicine clinical pharmacy in South Carolina, reviews the goals and visions of the early pharmacists, and reevaluates this information as it applies to clinical pharmacy today.