The International Pharmaceutical Federation 71st Annual Congress held in September 2011 featured a report from Katja Hakkarainen, MSc Pharm, PhD candidate, from the Nordic School of Public Health in Gothenburg, Sweden that finds approximately half of all adverse drug reactions (ADRs) can be prevented. This includes ADRs that happen in and outside hospitals.

When a patient is given (or takes) an inappropriate dose or when health care providers miss contraindications for specific treatments, preventable ADRs may occur. Information provided by the conference reports there are multiple types of preventable ADRs, including internal bleeding attributed to anticoagulant therapy with insufficient monitoring and gastrointestinal bleeding brought about by an inappropriate use of painkillers.

These ADRs can come from “poor coordination of care, lack of time and knowledge among health professionals, and lack of patient education,” according to Hakkarainen, “Unfortunately there is no consensus today on what to do to prevent ADRs.”

Hakkarainen says improved patient safety procedures can help reduce unnecessary drug-related deaths. She and her research team looked at seven databases to study articles about ADRs (both in and outpatient) in which the patient had an unscheduled hospital or emergency room visit. Hakkarainen said “There was no previous meta-analysis on the proportion of patients with preventable ADRs and the preventability of ADRs among inpatients and outpatients.”

The team concluded 51 percent of all ADRs were preventable, while 72 percent of ADRs with elderly patients were preventable. And 45 percent of inpatient ADRs could have been prevented.

While the researchers note a “cautious interpretation” of the study is important, it does show “a large proportion of patients suffer from preventable ADRs, and that many ADRs are preventable.”

“It is imperative to create a climate in which they are not hidden and where there is no ‘blame and shame’ involved. Human error will occur as humans continue to work in healthcare and use medicines. Thus, safety measures need to be incorporated into the health system,” she concluded.

According to Roche Diagnostics, nearly half of all patients with late-stage melanoma have a mutation in BRAF. The American Society of Health-System Pharmacists notes on its website that U.K. researchers found 80% of the BRAF mutations in malignant melanomas were caused by Mutation V600E. This is when a glutamate residue appears in the protein kinase instead of a valine residue.

On August 17, 2011 Roche Diagnostics announced it has received FDA approval for Vemurafenib (brand name Zelboraf), a genetics-based therapy designed to help patients diagnosed with melanoma that has a certain gene mutation that has spread or cannot be removed surgically.

The drug is designed to work specifically with patients who have late-stage melanoma in which the tumors’ protein kinase known as BRAF has the V600E mutation.

Roche Group’s Genentech will market Zelboraf and Roche Diagnostics will sell the companion diagnostic, called the cobas 4800 BRAF V600 Mutation Test. A spokesperson for the company said the diagnostic will on the market “in a few weeks.”

A study of 675 patients with late-stage melanoma and the V600E mutation in BRAF underwent trials to test the safety and effectiveness of vemurafenib; patients with no previous treatment for their melanoma received either dacarbazine or vemurafenib. FDA reports said slightly less than two-thirds of the dacarbazine-treated patients were still living, while more than three-fourths of the vemurafenib-treated patients were alive at the time of data reporting. The drug has not been studied in melanoma patients whose tumors did not have the V600E mutation.

Vemurafenib’s FDA-approved labeling suggests an oral dosage of 960 mg twice daily; the doses should be taken approximately 12 hours apart. The product will come packaged in bottles of 120 240-mg tablets; this is 15 day’s worth of the recommended dosage.

• Sulfonylureas
• Meglitinides
• Biguanides
• Thiazolidinediones
• Alpha-glucosidase inhibitors
• DPP-4 inhibitors

On July 25, 2011 Japanese drug maker Daii chi Sankyo announced regulatory approval for a new formulation of its product Welchol (colesevelam hydrochloride), which can now be combined with fruit juice and diet soft drinks. This offers additional accessibility to patients who may be interested in the convenience of a drinkable medication.

Welchol was approved as a diabetes medication that could be mixed with water in 2009; it is unique in that it is the only drinkable diabetes drug that lowers both blood glucose levels and LDL, or “bad cholesterol.”

The February 2011 issue of the Journal of Infectious Diseases published a study that found two doses of the varicella vaccine prevented chickenpox 98.3 percent of the time, compared to just 86 percent of the time in those who received only one dose.

One dose has been the standard since 1995, when the Centers for Disease Control and Prevention (CDC) recommended it for children between the ages of 1 and 13 years old. Pharmacy Today notes the practice helped reduce chicken pox occurrences by 90 percent. Yet even with the large-spread use of the varicella vaccination there were still breakthrough illnesses reported in immunized patients. This prompted the CDC to recommend an additional dose of the vaccine for children between the ages of 4 and 6.

While prior studies have linked two doses of the vaccine with greater antibody levels than a single dose, the study in the February 2011 Journal of Infectious Diseases was the first of its kind to review the effectiveness of two doses on the general population. It found children older than 4 years of age who had two doses of the vaccine were 95 percent less likely to develop varicella.

These findings may reduce the likelihood of developing chickenpox for children in the United States as well as the rest of the world. The authors of the study wrote: “The effects of this 2-dose policy in the United States will also have important implications for national immunization programs in other countries that use varicella vaccine.” Over time, if the two-dose system is implemented successfully, we may see the end of chickenpox all together.

In 2008, the FDA released a formal recommendation advising against using of over-the-counter (OTC) cough and cold medicine to treat children under the age of two. This recommendation was released for two reasons: lack of actual clinical benefit and serious health risks to the children. After this recommendation was released, the Consumer Healthcare Products Association (CHPA) agreed to change product labels on OTC medicines to include “do not use” in children under 4 years of age.

Despite these warnings, the March 2011 issue of Pharmacy Today that 60 percent of parents give their children aged two years and younger OTC cough and cold medicine. More than 50 percent of those parents polled said they were advised such products were safe by their pediatrician, and 50 percent were told by their doctors that OTC cough and cold medicines were effective for treating children.

The C.S. Mott Children’s Hospital National Poll on Children’s Health quoted in the article found there are economic and racial disparities among those using OTC cough and cold remedies for their children. 80 percent of Black parents and 69 percent of Hispanic parents were more likely to treat with OTCs, compared to 57 percent of white parents. At the same time, 80 percent of those who earned an annual income of less than $30,000 were likely to use OTC remedies, while only 41 percent of those who earned $100,000 would do the same.

Family doctors and pharmacists are on the front lines of informing parents about potential risks of OTC cough and cold medicine; on its website, the FDA parents speak to a health care professional regarding any concerns they may have about OTC drugs. “Kids will be safer when parents and doctors are all on the same page in limiting these medications to older children,” said Matthew Davis, MD, Associate Professor in the University of Michigan Medical School.

There are three major types of diabetes: Type 1 diabetes, Type 2 diabetes, and gestational diabetes.  All three types share one main characteristic- the body’s inability to either make or to use insulin.  The body needs insulin in order to use glucose (which comes from food you eat) for energy.  When you don’t have enough insulin, glucose stays in the blood, creating high levels of blood sugar.  Over time, this high blood sugar causes damage to the kidneys, heart, nerves, eyes and other organs.

Type 1 diabetes starts in childhood.  The risk factors for Type 1 diabetes are:

- Genetics and family history

- Diseases of the pancreas

- Infection or illness (some rare infections and illnesses can damage the pancreas and      cause Type 1 diabetes).

Type 2 diabetes occurs when the body cant use the insulin that is produced, a condition called insulin resistance.  Typically it begins in adulthood, but it can begin at any time in life.  Because of the fact that childhood obesity is on the rise, Type 2 diabetes is being found increasingly in teenagers.  The risk factors for developing Type 2 diabetes are:

-Obesity or being overweight

-Impaired glucose tolerance or impaired fasting glucose

-Insulin resistance

-High blood pressure

-History of gestational diabetes

-Sedentary lifestyle

-Family history

-Age

Gestational diabetes is a type of diabetes triggered by pregnancy.  It is caused by hormones that are produced by the placenta during pregnancy, or by too little insulin. Risk factors for Gestational diabetes are:

-Obesity or being overweight

-Previous glucose intolerance

-Family history

-Age

Many of the symptoms of diabetes seems harmless, which is one of the reasons diabetes often goes undiagnosed.  Early detection of diabetes symptoms and treatment can reduce the chance of developing the complications of diabetes.

Symptoms of Type 1 diabetes are:

-Frequent urination

-Unusual thirst

-Extreme hunger

-Unusual weight loss

-Extreme fatigue and irritability

Symptoms of Type 2 diabetes are:

-Any of the Type 1 symptoms

-Frequent infections

-Blurred vision

-Cuts/bruises that are slow to heal

-Tingling/numbness in the hands or feet

-Recurring skin, gum, or bladder infections

Often people with Type 2 diabetes show no symptoms.

You can prevent or delay the onset of Type 2 diabetes through a heathy lifestyle.  Here are some tips:

1. Get more physical activity.  Exercise can help you lose weight, lower blood sugar, and boost your sensitivity to insulin.
2. Get plenty of fiber.  Foods high in fiber including fruits, vegetables, beans, whole grains, nuts and seeds.
3. Eat whole grains.  Whole grains may reduce your risk of diabetes and help maintain blood sugar levels.
4. Lose extra weight.  If you are overweight, prevention will depend on weight loss.
5. Healthy diet. Eat a variety of fruits and vegetables.  Skip the fad diets.

Make sure you share your diabetes concerns with your doctor.  Early detection is key.

How do you obtain enough Vitamin D?  The easiest way is to get adequate sun exposure.  As little as 10 minutes per day of sun exposure is thought to be enough to prevent deficiencies.  Skin cancer is always a concern, so it is a fine line to obtain adequate vitamin D from the sun and to avoid some of the sun’s harmful effects.  Vitamin D is also found in dietary sources such as fortified milk, eggs, fish and cod liver oil.

Even with adequate sun and daily dietary sources, deficiencies can be found.  Recommendations for vitamin D are as follows and can usually be found in a multivitamin:

All individuals under the age of 50 years- 5 mg or 200 IU

Individuals aged 51-70 years- 10 mg or 400 IU

Individuals aged 71 and older- 15 mg or 600 IU

The upper limit for vitamin D is recommended at 2000 IU to avoid toxicities.

There are some groups that are more prone to vitamin D deficiency.

Breastfed infants. Infants who are breastfed cannot meet intake needs by human milk alone.

Americans aged 50 years and older.  With age comes a decreased ability to synthesize vitamin D as efficientls

Those with limited sun exposure. Most often those in northern latitudes or individuals with occupations that prevent any sun exposure.

People with dark skin. The pigment melanin that is present in greater amounts in darker skin, reduces the skin’s ability to produce vitamin D form sunlight exposure.

Any individual with fat malabsorption. Vitamin D is a fat soluble vitamin that requires fat to be absorbed in the gut.

As always, check with your doctor about your risk of vitamin D deficiency and appropriate doses for you.

Tea:

A recent study showed that tea reduces the levels of cortisol, the stress hormone.

This can greatly affect digestive health.  Tea has long been recommended in treating gas, indigestion, diarrhea, and bloating.

Best bets- Ginger, peppermint, and chamomile.

Spices:

Ayurvedic and Chinese medicine have long touted the benefits of spices.  Promising ones include cinnamon to aid in constipation and relieve abdominal spasms caused by gas.

Ginger is used for treating diarrhea and nausea.

Best bets- Use ginger root extract from pills or fresh ginger in cooking or hot water.  Do avoid ginger in pills if you are on blood thinning meds or on blood pressure medication.

Fiber:

Fiber promotes regularity, removes toxins and promotes regularity.  Fiber has also been shown to help in lowering glucose and cholesterol levels.

Best bets-Fruits and vegetables with skins on, bran flakes, and legumes.  Try to eat 25-35 grams of fiber per day and make sure to increase your water intake if you are increasing your fiber.  Increasing your fiber and not increasing your fluid can cause constipation.

Fruits and Vegetables:

Some fruits and vegetables contain digestive enzymes that aid in breaking down protein, carbohydrates and starches.  Bloating, gas, cramps and indigestion all decrease due to these digestive enzymes.

Best bets- romaine lettuce, spinach, papaya, pineapple and seaweed are all high in digestive enzymes.  Stick to fresh as canning can make these enzymes inactive.

Probiotics and Prebiotics:

Probiotics can help treat gastrointestinal illnesses and keep the bad bacteria in your stomach from causing problems.  Prebiotics help probiotics work.  Combining prebiotics and probiotics will provide the most benefit for your stomach.

Best bets for prebiotics- bananas, flax, honey, oats, garlic, legumes, berries, almonds, artichokes.

Best bets for probiotics- cottage cheese, yogurt, and buttermilk.  Look for the National Yogurt Association’s Live and Active Cultures seal check out aboutyogurt.com to ensure that there are enough probiotics for a health benefit.

]]> http://www.pharmacytechniciancertification.com/blog/2010/first-defense-for-gi-ailments/feed/ 1 http://www.pharmacytechniciancertification.com/blog/2010/prescription-errors-decimal-points/ http://www.pharmacytechniciancertification.com/blog/2010/prescription-errors-decimal-points/#comments Fri, 23 Jul 2010 11:04:59 +0000 Pharmacist http://www.pharmacytechniciancertification.com/?p=294 The small decimal point has the power of providing the precise medication for someone or wreaking havoc by providing too much or too little medication to patients.  Proper decimal point placement cannot be overstated.  Prescriptions that are faxed, written or typed on no carbon-required forms, or written on lined paper all carry the risk of a decimal point being missed.

Decimal points should never be left alone, but always preceded by a zero.  This will ensure that the decimal point is more visable.  For example, with no leading zero, “Haldol .5 mg” could easily be misinterpreted as “Haldol 5 mg” or “Risperdal .5 mg” easily interpreted as “Risperdal 5 mg”.

Conversely, a whole number should never be followed with a decimal point and a zero.  This can easily cause 10 fold overdose.  For example, “Coumadin 1.0 mg” can easily be misinterpreted as “Coumadin 10 mg”.

To avoid errors in decimal point placement, the following rules should be in place:

-Any concentrations or strengths less than zero should have a leading zero in front of the decimal point.

-A decimal point and a trailing zero should never follow a whole number.

-Educate staff about the dangers or using naked decimal points and trailing zeros.

-Do not allow staff members to omit leading zeros or trailing zeros when reducing oral prescriptions to writing.

-Ensure that pharmacy and prescriber electronic order entry screens, preprinted prescriptions, and computer generated labels do not use any dangerous decimal dose expressions.

-If a satisfactory alternative is available, eliminate the use of decimal points.  For example, use 125 mcg instead of 0.125 mg , 500 mg instead of 0.5 g, and 2 ½ mg instead of 2.5 mg.

-Identify any drugs with 10 fold differences in dosage strength, such as Coumadin 1 mg and 10 mg, Levothyroxine 25 mcg and 250 mcg, and Cytomel 5 mcg and 50 mg.  Make sure that any drugs on this list are double checked to ensure correct dosage strength.

-Decimal points can be easily missed when prescriptions are faxed.  Have the pharmacist check and verify all faxed prescriptions.

-Eliminate lines on NCR forms so that decimal points are more clearly distinguished.

More information concerning decimal point placement as well as a listing of the ISMP (Institute for Safe Medicine Practices) List of Error-Prone Abbreviations can be found by clicking the following link.

Institute for Safe Medicine Practices

Be realistic. Healthy weight loss is around 1-2 pounds per week.  Much more than that is going to be water weight.  One pound is equal to 3,500 calories.  So, you need to eat 500-1000 calories less a day or exercise to equal that amount.  The best way is a combination of both diet and exercise to equal 500- 1000 calories per day.

Avoid drastic diet changes. Think of this as a lifestyle change, not a diet.  If you plan to go on a diet and then go back to eating the way you were after you lose the weight, you are setting yourself up for failure.  The weight you lost will come right back on when you resume the eating habits that got you there in the first place.  Stick with an eating plan that you could see yourself doing 10 weeks and 10 months down the road.

Eat breakfast. Study after study has shown that breakfast eaters tend to lose weight, while breakfast skippers tend to gain weight.  Mealsmatter.org

Avoid diet foods. Just because it says “light” or “fat free” does not mean that it is calorie free.  All calories add up at the end of the day and many diet foods are not as satisfying as the real thing.  Have the real thing if you must, just in smaller amounts.

Eat in. You have control over what you are putting in your mouth.  Restaurants tend to go heavier on fat and sugar, therefore calories.

Check your portions. Keep your portion sizes under control will keep your calories under control.  A bakery size bagel or muffin can be 4 servings of bread.  Check out Allina.com to see what appropriate portion sizes should be.

Count your drinks also. Many fluids that you drink will contain calories also.  Make sure that you check the label of what you are drinking to see how many calories your favorite beverages contain.  I would personally rather eat my calories, so I avoid any beverages except milk and water. Dietbites.com

Exercise. Even something as simple as a 30 minute walk a day is going to go a long way toward helping you meet your weight loss goal.  Exercise increases your metabolism and increases muscle, which burns more fat.

Keep a journal. Writing down what you eat can be a real eye opener in helping you see all the little extras that can pack on the pounds.

Everything in moderation. You can still have the occasional dessert and snack, just make sure to keep the portions small.  Try to buy a single portion of your favorite treat so that you do not go overboard.