Kathy E. Komperda

Potential Interaction Between Pomegranate Juice and Warfarin

To my knowledge, no published reports have described an interaction between pomegranate juice and warfarin. Investigators from previous animal and in vitro studies have reported a potential for pomegranate juice to inhibit metabolism involving the cytochrome P450 system, an effect that could translate into a clinical drug‐diet interaction with warfarin. This case report describes a 64‐year‐old Caucasian woman who was treated with warfarin for recurrent deep vein thrombosis. She had been receiving a relatively stable dosage of warfarin 4 mg/day for several months, with stable international normalized ratios (INRs). During that time, the patient was consuming pomegranate juice 2–3 times/week. She stopped drinking the juice, and her INRs became subtherapeutic. Her dosage of warfarin was increased to maintain therapeutic anticoagulation. No rechallenge with pomegranate juice was performed. Use of the Drug Interaction Probability Scale indicated a possible relationship between the patients subtherapeutic INR and the pomegranate juice. Although this potential interaction needs to be explored further, clinicians should be aware of the interaction and thoroughly interview and closely monitor their patients who are receiving warfarin.

Effect of postgraduate training on job and career satisfaction among health-system pharmacists

PURPOSE The effect of postgraduate training on job and career satisfaction among health-system pharmacists was evaluated. METHODS A mail-based questionnaire was sent to a random sample of pharmacist members of the American Society of Health-System Pharmacists. Previously validated questions for job and career satisfaction among pharmacists were utilized. The questionnaire was designed to obtain information regarding general employment, work environment, job satisfaction, career satisfaction, postgraduate training, and demographic characteristics. Pharmacists who had completed either a pharmacy residency or fellowship were classified as having postgraduate training. Questionnaires returned within two months of the original mailing date were included in the analysis. Responses from pharmacists who were retired, employed in a nonpharmacy career, or unemployed were excluded. Data were analyzed using SPSS software. RESULTS Of the 2499 questionnaires mailed, 36 were undeliverable; 1058 were completed, yielding a response rate of 43%. Of these, 48 were excluded, resulting in 1010 questionnaires suitable for analysis. Approximately 37% of respondents indicated completion of postgraduate training. The most common practice setting was a community, not-for-profit hospital (40.9%). Overall, 90.7% of respondents indicated they were either satisfied or highly satisfied with their current employment. Approximately 45% of pharmacists with postgraduate training indicated they were highly satisfied with their employment, compared with 32.7% of pharmacists without postgraduate training (p < 0.001). CONCLUSION Pharmacists who completed postgraduate training were more satisfied with their job than those who did not complete such training.

Survey of bisphosphonate regimen preferences in an urban community health center.

OBJECTIVE to determine patient preference for bisphosphonate therapy based on dosage form and dosing schedule. DESIGN prospective telephone survey. SETTING urban community health center. PATIENTS, PARTICIPANTS all patients who were seen in the osteoporosis clinic during the 22-month time period were contacted. Patients were excluded if they could not complete the survey in English, had difficulty hearing, had cognitive impairment, or were unable to be reached by telephone. INTERVENTIONS patients were asked which route and frequency of bisphosphonate therapy was preferred, convenient, and easiest to remember. MAIN OUTCOME MEASURE(S) patient-reported preference for route and frequency of bisphosphonate administration. RESULTS ninety patients were included in the final analysis. Preference for bisphosphonate therapy illustrated that equal numbers of respondents preferred either once-monthly or once-yearly regimens (24.4% for each, n = 22). One-third of respondents (n = 30) indicated that a once-yearly infusion was the most convenient method of administration. The survey revealed no strong association of which regimen was easiest to remember. CONCLUSION the majority of patients preferred once-monthly or less frequent dosing schedules. Clinicians may consider discussing patient preferences during initiation and throughout therapy.

Pharmacists’ perspectives on postgraduate training

Pharmacy residency programs foster lifelong commitments to achieving excellence within the profession.[1][1] Postgraduate training not only contributes to personal development but also promotes leadership. Numerous factors have been shown to influence the pursuit of postgraduate training, including

BISPHOSPHONATES IN RENAL INSUFFICIENCY: COMPARISON OF ESTIMATED GLOMERULAR FILTRATION RATE METHODS

bladder catheterization is not possible, to resolve urine retention, emergent real-time ultrasound-guided suprapubic cystostomy might be performed, which will cause the aneurysm to rupture and may cause massive internal bleeding. Isolated IAAs are rare and account for approximately 2% to 7% of all abdominal aneurysms. Atherosclerotic vascular disease is the most common cause of aneurysm; other causes, such as pregnancy or infection, are infrequent. Most IAAs occur in elderly men; the mean age at diagnosis is 74, and the male:female ratio is 5:1. Another study reported similar results in the past 12 years and showed the mean age to be 72, with 96% of IAAs occurring in men. Because of their pelvic location, symptoms of solitary IAAs are variable and nonspecific and include lower abdominal, flank, and groin pain. They are usually found incidentally using CT or ultrasonography; IAAs are silent or asymptomatic in 45% to 73% of patients and are diagnosed using imaging studies or when they rupture or enlarge enough to compress adjacent organs, such as the bladder, ureter, colon, and rectum. In the current case, the IAA was large enough to compress the bladder, resulting in LUTSs. The average size of isolated IAAs at diagnosis is 5.5 cm, with a rupture rate of 33%. The operative mortality rate is as high as 40% if IAAs rupture. Therapeutic management depends on size. IAAs smaller than 3 cm in diameter can be closely observed using ultrasound or CT; IAAs larger than 3 cm in diameter are managed using open surgical or endovascular repair. The previous study reported that endovascular repair of isolated IAA is a safe and effective alternative in appropriately selected patients and is associated with a significantly shorter hospital stay, less need for transfusion, and less mortality than with open repair.