Erin C. Raney

Cranberry and warfarin interaction: a case report and review of the literature.

This case reports on a patient whose International Normalized Ratio (INR) increased after ingestion of cranberry sauce while stabilized on warfarin. It is followed by a review of the published literature on the potential interaction between the two.An 85-year-old woman on chronic warfarin therapy for atrial fibrillation experienced INR elevations of two- to three-fold after two separate ingestions of cranberry sauce. In each case, her INR values decreased after withholding three to four doses and resuming a similar maintenance dose of warfarin. Although the majority of the pharmacokinetic and pharmacodynamic studies did not find a significant interaction between cranberry and warfarin, several case reports indicate that cranberry products may increase INR values in patients on warfarin. Practitioners should consider cranberry usage as a potential contributor in the evaluation of supratherapeutic INR values in patients on warfarin.

The pharmacist's role in promoting preconception health.

OBJECTIVE To review the pharmacists role in preconception health. DATA SOURCES PubMed search using the terms preconception, immunizations, epilepsy, diabetes, depression, tobacco, asthma, hypertension, anticoagulation, pharmacist, pregnancy, and current national guidelines. DATA SYNTHESIS Preconception health has become recognized as an important public health focus to improve pregnancy outcomes. Pharmacists have a unique role as accessible health care providers to optimize preconception health by screening women for tobacco use, appropriate immunizations, and current medication use. Counseling patients on preconception risk factors and adequate folic acid supplementation as well as providing recommendations for safe and effective management of chronic conditions are also critical and within the scope of practice for pharmacists. CONCLUSION Pharmacists play an important role in medication screening, chronic disease state management, and preconception planning to aid women in preparing for healthy pregnancies.

Safety of Varenicline in Patients With Cardiovascular Disease

Smoking cessation lowers the risk of death substantially in patients with cardiovascular disease. Although varenicline is an effective medication for smoking cessation, its safety in this population has been questioned and evaluated in several studies. In 2 randomized controlled trials of patients with cardiovascular disease, the rates of serious cardiovascular events were up to 2% higher in patients receiving varenicline than placebo, though the differences were not statistically significant. In the first meta-analysis of mostly trials involving patients with a history of cardiovascular disease, varenicline was found to significantly increase the risk of cardiovascular events by 72%; however, a second meta-analysis did not find a significant increased risk. In an observational study, varenicline was not associated with an increased risk of events when compared to bupropion in a subgroup analysis of patients with a history of cardiovascular disease. Because the evidence on the safety of varenicline in this population is limited and conflicting, additional data are needed to formulate stronger conclusions. In the meantime, health care professionals should consider individual smoking patterns, concomitant medical conditions, and cost when recommending smoking cessation pharmacotherapy for patients with cardiovascular disease.

Impact of Pharmacist-Provided Osteoporosis Education and Screening in the Workplace

1. Pharmacy Facts and Figures. Drug Topics [serial online]. Accessed at www.drugtopics.com/drugtopics/article/articleList.jsp?categoryId=7604, November 8, 2004. 2. Vanderbush RE, Kirtley J, West DS. Evaluating Internet-based multimedia vignettes for teaching ophthalmic and otic drug administration techniques. Am J Pharm Educ. 2005;69(4):article 64. 3. U.S. Department of Health and Human Services. The pharmacist workforce: a study of the supply and demand for pharmacists. U.S. Department of Health and Human Services, Health Resources Services Administration, Bureau of Health Professions; 2000. Accessed at http://bhpr.hrsa.gov/healthworkforce/reports/pharmacist.htm, November 8, 2004. 4. National Association of Chain Drug Stores Web site. Industry facts-at-aglance. Accessed at www.nacds.org/wmspage.cfm?parm1=507, November 8, 2004.

An Elective Course on Pharmacy-Based Health Screenings

Objective. To provide an elective course for pharmacy students focused on the knowledge and skills necessary to implement health screenings in a pharmacy environment. Design. Course lectures focused on expert recommendations for health screenings as well as regulatory requirements and procedures integral to the implementation of screening services. Workshops provided hands-on experience with blood glucose, body composition, bone density, and cholesterol testing devices. Assessment. Attainment of knowledge and skills was assessed by patient case assignments, screening device demonstrations, group projects, and a final quiz. Annual course evaluations revealed consistently favorable student feedback regarding the course design and content. Students reported a high level of preparedness and interest in participating in health screening services in future practice. Conclusion. An elective course focused on the delivery of health screenings in pharmacy settings was well received by student participants and exposed students to a unique opportunity in patient care.

Immunizations and pregnancy: An update for pharmacists

OBJECTIVE To review the safety of immunizations in pregnancy. DATA SOURCES PubMed search using the terms vaccine, immunizations, and pregnancy, as well as current national guidelines. DATA SYNTHESIS Immunizations for women of childbearing age are an integral component of pregnancy planning. Some vaccines are compatible with pregnancy, whereas others, in particular live-attenuated vaccines, are contraindicated because of the theoretical risk to the fetus. The immunizing pharmacist must be aware of updated guidelines regarding the safe and appropriate use of vaccines during pregnancy. Certain routine adult vaccines are contraindicated during pregnancy, including the live-attenuated intranasal influenza, measles-mumps-rubella, varicella, zoster, and human papillomavirus vaccines. The trivalent inactivated influenza vaccine is specifically recommended for all women who are pregnant during influenza season. The hepatitis B, tetanus-diphtheria-acellular pertussis, and several other routine adult and travel vaccines may be administered safely in pregnancy if the patient meets certain risk criteria. Breast-feeding is compatible with all routine adult vaccines. Vaccinia (smallpox) and yellow fever vaccines are cautioned against use except in certain circumstances. CONCLUSION Pharmacists can play an important role in recommending safe and appropriate vaccines before and during pregnancy.

Assessment of a Revised Method for Evaluating Peer-graded Assignments in a Skills-based Course Sequence.

Objective. To evaluate the modified peer-grading process incorporated into the SOAP (subjective, objective, assessment, plan) note sessions in a skills-based pharmacy course sequence. Design. Students assessed a de-identified peer’s SOAP note in a faculty-led peer-grading session followed by an optional grade challenge opportunity. Using paired t tests, final session grades (peer-graded with challenge opportunity) were compared with the retrospective faculty-assigned grades. Additionally, students responded to a survey using 4-point Likert scale and open-answer items to assess their perceptions of the process. Assessment. No significant difference was found between mean scores assigned by faculty members vs those made by student peers after participation in 3 SOAP note sessions, which included a SOAP note-writing workshop, a peer-grading workshop, and a grade challenge opportunity. The survey data indicated that students generally were satisfied with the process. Conclusion. This study provides insight into the peer-grading process used to evaluate SOAP notes. The findings support the continued use of this assessment format in a skills-based course.

Recent Advances in Hormonal and Barrier Contraception

Hormonal and barrier contraceptive choices have undergone unprecedented expansion over the past decade. Oral contraceptives have been joined by products with alternative hormone delivery systems, including transdermal, injectable, and intravaginal. In addition, the doses and chemical structures of the estrogen and progestin components have been altered to improve tolerability. Barrier methods continue to offer nonhormonal options with varied levels of protection from sexually transmitted infections. With the expansion of choices, consideration of individual needs is key to maximizing effectiveness and tolerability. Future advancements will continue to focus on individualized options as well as expanded male contraceptive devices.