Julie L. Cunningham

Development and Evaluation of a Pharmacogenomics Educational Program for Pharmacists

Objectives. To evaluate hospital and outpatient pharmacists’ pharmacogenomics knowledge before and 2 months after participating in a targeted, case-based pharmacogenomics continuing education program. Design. As part of a continuing education program accredited by the Accreditation Council for Pharmacy Education (ACPE), pharmacists were provided with a fundamental pharmacogenomics education program. Evaluation. An 11-question, multiple-choice, electronic survey instrument was distributed to 272 eligible pharmacists at a single campus of a large, academic healthcare system. Pharmacists improved their pharmacogenomics test scores by 0.7 questions (pretest average 46%; posttest average 53%, p=0.0003). Conclusions. Although pharmacists demonstrated improvement, overall retention of educational goals and objectives was marginal. These results suggest that the complex topic of pharmacogenomics requires a large educational effort in order to increase pharmacists’ knowledge and comfort level with this emerging therapeutic opportunity.

Investigation of Antidepressant Medication Usage after Bariatric Surgery

BackgroundMany patients seeking bariatric surgery have a history of mood disorders and are actively prescribed antidepressants. While extensive documentation exists on the impact of weight loss surgery on reductions in cardiac, diabetic, and hypertensive medications, little is known about the impact of bariatric surgery on the use of antidepressant medications.MethodsA retrospective study of 439 patients who had undergone Roux-en-Y gastric bypass (RYGB) from January 2001 to November 2004 was examined for postoperative changes in the use of antidepressant medications.ResultsAfter RYGB, 23% of the patients had an increase in their antidepressant use, 40% continued to require the same antidepressant, 18% had a change in antidepressant medication, and only 16% had a decrease or discontinued their antidepressant.ConclusionUnlike most medications, antidepressant usage did not decrease in the majority of patients after RYGB. These results highlight the prevalence of antidepressant prescription use in patients before and after RYGB and support the need for the careful monitoring of depressive symptoms.

Reduction in Medication Costs for Patients with Chronic Nonmalignant Pain Completing a Pain Rehabilitation Program: A Prospective Analysis of Admission, Discharge, and 6‐Month Follow‐Up Medication Costs

OBJECTIVE Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. DESIGN This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. RESULTS Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was

Considerations on Safety Concerns About Citalopram Prescribing

9.31 (

Hypovitaminosis D in Psychiatric Inpatients: Clinical Correlation with Depressive Symptoms, Cognitive Impairment, and Prescribing Practices

12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was

Associations Between Spousal or Significant Other Solicitous Responses and Opioid Dose in Patients with Chronic Pain

6.68 (

Acute dystonia associated with paliperidone overdose.

14.40). CONCLUSION Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs.

Management of Psychotropic Drug–Induced DRESS Syndrome: A Systematic Review

Citalopram (Celexa, Forest Laboratories, New York, NY) is one of the most widely prescribed selective serotonin reuptake inhibitors (SSRIs) in our practice. It has had good tolerability and low discontinuation rates in practice and in clinical trials.1-3 The recent US Food and Drug Administration (FDA) recommendation to not use doses higher than 40 mg/d because of potential QTc prolongation has been causing various difficulties.4 This warning has raised concerns from both psychiatrists and generalists at our institution both in regard to continuation of therapy that has been effective for patients that have responded to doses over 40 mg/d and in regard to the potential to use this medication above that dose range in future patients. Specifically, in our practices, there are patients who are doing well on higher doses. These patients are predominantly in our general and subspecialty psychiatry practices. Further, in our primary care practices, large numbers of patients take citalopram, and drug-drug interactions with agents such as proton pump inhibitors (PPIs), which can increase blood levels in patients taking 40 mg/d or less of citalopram, have also caused substantial prescribing problems. Members of the Mayo Clinic Neurology/Psychiatry Task Force as well as selected members from the Heart Rhythm Services group reviewed factors that should be communicated to prescribers in relation to citalopram prescribing in light of these new warnings regarding QTc prolongation and the risk for potential morbidity and mortality from drug-induced arrhythmias including torsades de pointes and sudden cardiac arrest.

Benzodiazepine use in patients with chronic pain in an interdisciplinary pain rehabilitation program

OBJECTIVE The association of hypovitaminosis D with measures of depressive symptoms and cognitive impairment remains unclear. This correlation and subsequent prescribing practices of vitamin D supplementation were evaluated in a population of psychiatric inpatients. METHODS A retrospective study was conducted of 548 patients with a serum 25-hydroxyvitamin D [25(OH)D] level measured during hospitalization. Outcomes included the association of hypovitaminosis D with Patient Health Questionnaire (PHQ-9) and Folstein Mini-Mental State Exam (MMSE) scores, including an evaluation of vitamin D dosing upon hospital discharge. RESULTS Two hundred three patients (37%) had hypovitaminosis D. The majority [183 (90%)] had moderate (10-24 ng/mL), while 20 (10%) had severe hypovitaminosis D (<10 ng/mL). There was no significant association between hypovitaminosis D and PHQ-9 or MMSE scores (p = 0.107 and p = 0.271, respectively). Overall, 33% of patients with moderate hypovitaminosis D and 45% of patients with severe hypovitaminosis D were newly prescribed vitamin D or received a dose increase. Initiation of vitamin D or increased vitamin D dose was significantly higher in patients with hypovitaminosis D (p < 0.001). CONCLUSIONS No association was found between hypovitaminosis D and depressive symptoms or cognitive function. However, patients with hypovitaminosis D were more likely to be prescribed additional vitamin D at hospital discharge.

A Lack of Systemic Absorption Following the Repeated Application of Topical Quetiapine in Healthy Adults

OBJECTIVE The primary aim of this study was to determine the effects of spouse or significant other solicitous responses on morphine equivalent dose among adults with chronic pain. DESIGN Retrospective design. SETTING Multidisciplinary pain rehabilitation center. PATIENTS The cohort included 466 consecutively admitted patients who had a spouse or significant other and were using daily opioids. Intervention. Three-week outpatient pain rehabilitation program. OUTCOME MEASURES Solicitous subscale of the Multidimensional Pain Inventory and morphine equivalent dose upon admission. RESULTS The mean solicitous subscale score and morphine equivalent dose were 49.8 (standard deviation [SD] = 8.7) and 118mg/day (SD =149), respectively. Univariate linear regression analysis showed that greater subscale scores were associated with greater doses of opioids (P = 0.007). In a multivariate model adjusted for age, sex, ethnicity, years of education, employment status, pain duration, depression, and pain severity, the association retained significance (P = 0.007). CONCLUSIONS These findings suggest solicitous responses from a spouse or significant other may have an important influence on opioid dose among adults with chronic pain.