Feng Chang

Evolution of Peroxisome Proliferator-Activated Receptor Agonists:

OBJECTIVE: To discuss the evolution of peroxisome proliferator-activated receptor (PPAR) agonists from single site to multiple subtype or partial agonists for the treatment of type 2 diabetes, dyslipidemia, obesity, and the metabolic syndrome. DATA SOURCES: Information was obtained from MEDLINE (1966-March 2007) using search terms peroxisome proliferator-activated receptor agonist, PPAR dual agonist, PPAR α/γ agonist, PPAR pan agonist, partial PPAR, and the specific compound names. Other sources included pharmaceutical companies, the Internet, and the American Diabetes Association 64th-66th Scientific Sessions abstract books. STUDY SELECTION AND DATA EXTRACTION: Animal data, abstracts, clinical trials, and review articles were reviewed and summarized. DATA SYNTHESIS: PPAR α, γ, and δ receptors play an important role in lipid metabolism, regulation of adipocyte proliferation and differentiation, and insulin sensitivity. The PPAR dual agonists were developed to combine the triglyceride lowering and high-density lipoprotein cholesterol elevation from the PPAR-α agonists (fibrates) with the insulin sensitivity improvement from the PPAR-γ agonists (thiazolidinediones). Although the dual agonists reduced hemoglobin A1C(A1C) and improved the lipid profile, adverse effects led to discontinued development. Currently, PPAR-γ agonists (GW501516 in Phase I trials), partial PPAR-γ agonists (metaglidasen in Phase II and III trials), and pan agonists (α, γ, δ netoglitazone in Phase II and III trials) with improved cell and tissue selectivity are undergoing investigation to address multiple aspects of the metabolic syndrome with a single medication. By decreasing both A1C and triglycerides, metaglidasen did improve multiple aspects of the metabolic syndrome with fewer adverse effects than compared with placebo. Metaglidasen is now being compared with pioglitazone. CONCLUSIONS: Influencing the various PPARs results in improved glucose, lipid, and weight management, with effects dependent on full or partial agonist activity at single or multiple receptors. Although the dual PPAR compounds have been associated with unacceptable toxicities, new PPAR agonist medications continue to be developed and investigated to discover a safe drug with benefits in multiple disease states.

Pharmacy practice, research, education, and advocacy for older adults

In the United States, older adults have become the fastest growing segment of the population and are expected to double in number to 70 million by 2030. As a whole, older adults have different health care needs than younger patients, and some of these needs should be met by pharmacists. Clinical pharmacy practice affecting older adults occurs in a variety of settings, including community, ambulatory care, primary care, hospital, assisted living, nursing home, home health care, hospice, and Alzheimers disease units. Although specialty training in geriatrics or gerontology is not required for pharmacists to care for older adults, it is extremely helpful. Pharmacy education related to the care of older adults has improved slightly in the past several years but will need to increase even more to provide all pharmacists with the basic skills and knowledge to care for this unique group of patients. In addition, pharmacotherapy research targeting older adults needs to increase. Although it can be challenging, funding for this type of research is available. Patient and political advocacy is also important to support this growing population.

Drug-Related-Problem Outcomes and Program Satisfaction from a Comprehensive Brown Bag Medication Review

To classify and quantify drug‐related problems (DRPs), determine acceptance of DRP recommendations, and assess medication review satisfaction.

The "Rising Tide" of dementia in Canada: What does it mean for pharmacists and the people they care for?

Dementia is an umbrella term for a large class of brain disorders. The prevalence of dementia was estimated at 44.4 million people worldwide in 2013, and in the absence of any significant new scientific discovery, prevalence rates are estimated to increase to 75.6 million in 2030 and 135.5 million in 2050.1 Alzheimer’s disease is the most common irreversible form of dementia. It is a fatal, progressive and degenerative disease that destroys brain cells.2 The syndrome consists of a number of symptoms that include changes in memory, judgment, reasoning, mood, behaviour, communication abilities and the ability to function on a day-to-day basis. Rising Tide: The Impact of Dementia on Canadian Society3 is a report released by the Alzheimer Society in 2010 following 2 years of intensive study. It is the first study to estimate the health and economic burden of dementia in Canada over the next 30 years. It also reviews and makes recommendations on policy options to address this issue. The 5 main pillars are as follows: Provide support for family caregivers (family includes anyone in the supportive network of the individual). Emphasize risk reduction and early intervention. Build an integrated system of care. Strengthen and supplement Canada’s dementia workforce. Increase investment in dementia research. Approximately 747,000 Canadians are living with cognitive impairment including dementia.4 Additional statistics from Rising Tide are similarly compelling. Despite advancing age being the biggest risk factor for Alzheimer’s disease, more than 70,000 of those living with dementia are under the age of 65. Women make up 72% of those living with Alzheimer’s disease. Within a generation, incidences of new cases will increase from 1 every 5 minutes to 1 every 2 minutes. The total cost of care for persons with dementia was about

Parkinson's disease guidelines for pharmacists.

15 billion in 2008 in Canada; this is expected to rise to

Knowledge, Perceptions and Attitudes toward Chronic Pain and Its Management: A Cross-Sectional Survey of Frontline Pharmacists in Ontario, Canada

153 billion in 2038.3 Moreover, long-term care beds are projected to have a shortfall of 157,000 in Canada by the year 2038. The number of older persons with dementia living at home is expected to steadily rise from 55% to 62%.3 All of these trends will require community or home-based care to become more responsive to the needs of those living with dementia. Pharmacists play a vital role in the health and overall well-being of all Canadians. Pharmacists are highly visible and regularly accessed by members of the community, forming long-standing relationships with their patients. They are trained to understand pharmacotherapy that can benefit or impair cognitive function, and they can monitor for progression and related issues such as medication adherence. However, like many health care professionals, pharmacists may feel ill-equipped to support the unique needs of people living with dementia and their families or caregivers. Simply put, many pharmacists are uncomfortable dealing with patients with dementia. This article is the first in a series that aims to identify roles, strategies and resources pharmacists can apply in daily practice in service of people with dementia.

Intramuscular Olanzapine in the Management of Behavioral and Psychological Symptoms in Hospitalized Older Adults: A Retrospective Descriptive Study

Parkinson’s disease (PD) is a chronic, progressive, neurodegenerative disorder, characterized by the loss of dopaminergic neurons from the substantia nigra that subsequently results in the loss of control of voluntary movement over time.1-3 An estimated 100,000 Canadians have PD, and the incidence rate is between 10 to 20 per 100,000.4 Although younger people are diagnosed with PD, it is often thought of as a disease of the elderly, and indeed, the mean age of onset is 60 years, with 85% of individuals diagnosed with PD being older than 65 years.1,2,4 Over the course of 6 years, between 1993 and 1999, the prevalence of PD increased by 26% in Ontario, related in part to the increase in the population of those aged 65 years and over.5 A review by Health Canada in 1998 indicated that PD is associated with substantial direct (

Using a Collaborative Research Approach to Develop an Interdisciplinary Research Agenda for the Study of Mobile Health Interventions for Older Adults

87.8 million) and indirect (

Practice recommendations for Parkinson's disease: Assessment and management by community pharmacists.

470.3 million) costs.4 Although 70% of the cost is associated with long-term disability, life expectancy is also significantly shorter, with premature mortality accounting for 14.1% of the cost of the disease.2,4 Although the clinical presentation can vary from one individual to another, patients will typically present with complaints of asymmetrical (i.e., more on one side of the body than the other) tremors at rest in one extremity, whether it be the arm or the leg, and stiffness or rigidity and/or slowness in movement (bradykinesia). Over time, individuals will develop a shuffling gait and postural instability (see Table 1 for a complete list of the motor features of PD).1,2 Motor symptoms are thought to result when 60% to 70% of dopaminergic neurons have been lost.2 The loss of dopaminergic neurons results in a deficiency of dopamine, the primary neurotransmitter involved in the coordination of movement. Currently, the pharmacotherapy of PD is primarily related to replacing dopamine or mimicking the activity of dopamine. As the disease progresses, patients struggle to maintain the balance between the positive and negative effects of pharmacotherapy, often requiring multiple adjustments of drug doses and dosing regimens as well as the addition and removal of adjuvant drugs.1,3 Table 1 Clinical presentation of motor features of PD

Sex and gender-based analysis in pharmacy practice research: a scoping review

The treatment of chronic pain consumes a significant share of primary care. Community and family health team pharmacists frequently see patients with chronic pain, thus have the opportunity to improve their care. To assess the knowledge, perceptions, and attitudes of Ontario pharmacists, we invited 5,324 Ontario pharmacists, to participate in an online survey we developed using Qualtrics. The 31-question survey gathered demographic information, assessed pharmacists’ knowledge of three chronic pain conditions; chronic lower back pain (CLBP, eight true/false statements); chronic headache disorder (CHD, eight true/false statements) and painful diabetic neuropathy (PDN, seven true/false statements), and their attitudes toward and perceptions of patients with these conditions, and knowledge, attitudes, and perceptions of opioids in pain management. We received 688 responses (12.9%) and 392 pharmacists completed the survey. The mean age of respondents was 48.5 years and 48.5% were male. More than 50% of respondents were in practice for more than 20 years and 58.7% worked 25–40 hours per week. The mean knowledge scores were 4.5/8, 5.5/8, and 5.3/8 for CBLP, CHD, and PDN respectively. While 95% of respondents were aware of the increasing death rates due to opioid use, only half were familiar with the Canadian guideline for safe opioid prescribing for non-cancer use. Responses were compared based on gender, time in practice and location of practice. Pharmacists with more than ten years of experience scored significantly higher than those with less experience. Fewer differences were found in comparisons of gender and location of practice. Safe and effective care of chronic pain patients, particularly with opioids, will require additional pharmacist education.