Journal Article Impact of pharmacist home visits on drug therapy Get access Michele A. Schrecengost-Kibbey, B.S.Pharm., Michele A. Schrecengost-Kibbey, B.S.Pharm. Pharmacist Rx Partners Long Term Care, Inc. (a division of UPMC Health System) 500 Old Pond Road, Suite 400 Bridgeville, PA 15017 Search for other works by this author on: Oxford Academic Google Scholar Richard J. Ptachcinski, Pharm.D., Richard J. Ptachcinski, Pharm.D. Chief Executive Officer American Pharmacotherapy, Inc. Pittsburgh, PA 15237 Search for other works by this author on: Oxford Academic Google Scholar Amy L. Tuttle, M.B.A., Amy L. Tuttle, M.B.A. Manager Living-at-Home Program UPMC Health System Pittsburgh, PA 15213 Search for other works by this author on: Oxford Academic Google Scholar Teresa P. McKaveney, B.S. Teresa P. McKaveney, B.S. Research Assistant Department of Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh Pittsburgh, PA 15261 Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 59, Issue 13, 1 July 2002, Pages 1293–1294, https://doi.org/10.1093/ajhp/59.13.1293 Published: 01 July 2002
Purpose. The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, and role in therapy of vildagliptin for the treatment of type 2 diabetes mellitus were reviewed. Summary. Vildagliptin is an agent in a new class of medications called dipeptidyl peptidase IV (DPP4) inhibitors. By inhibiting DPP4, vildagliptin causes an increase in glucagon like peptide-1 (GLP-1), an intestinal hormone that aids in glucose homeostasis and insulin secretion. The manufacturer of vildagliptin received an approvable letter from the Food and Drug Administration in late February 2007. Vildagliptin has a halflife of about 90 minutes; however, ≥50% of DPP4 inhibition continues for more than 10 hours, allowing for once- or twice-daily dosing. Clinical trials have shown that vildagliptin is effective in significantly lowering glycosylated hemoglobin (HbA1c), fasting plasma glucose, and prandial glucose levels. Beta-cell function may also be improved. The most common adverse effects in patients receiving vildagliptin included headache, nasopharyngitis, cough, constipation, dizziness, and increased sweating. In most studies, the rate of hypoglycemia appeared to be similar to that of placebo. Conclusion. In clinical trials of patients with type 2 diabetes mellitus, vildagliptin has been shown to reduce HbA1c, fasting plasma glucose levels, prandial glucose levels, and prandial glucagon secretion and to improve β-cell function. If vildagliptin is approved for marketing, it will add to the available treatment options for diabetes and will provide patients and health care providers with another noninjectable therapy option.
555 The inclusion of older transplant recipients and donors may affect drug metabolism following orthotopic liver transplantation (OLTx). The purpose of this study was to characterize the activity of five drug-metabolizing cytochrome P450 enzymes (CYP) in liver transplant patients in comparison to healthy normal subjects. Methods: Stable tacrolimus-treated OLTx patients were given a 5-drug cocktail with the following agents: chlorzoxazone (CYP2E1), mephenytoin (CYP2C19), caffeine (CYP1A2), debrisoquine (CYP2D6), and dapsone (CYP3A). Drug/metabolite concentrations were determined in blood or urine and used to calculate standard measures of enzyme activity. A healthy group of normal subjects aged 67-91 years were studied as controls. The median age of the OLTx patients was 51 years (range 25-72 years), so the group was assessed as Old-OLTx (>51 years) and Young-OLTx (≤ 51 years). Studies were also divided to those greater than and less than 30 days postoperatively. Results: The measures of enzyme activity are listed below: (Table)TableDifferences were only observed in the early postoperative period, and demonstrated induced 2E1 and depressed 2C19 and 3A4. After 30 days, no significant differences between the Old-OLTx and the old normal subjects were observed. Donor age (15-68 years) by itself did not explain variability in CYP enzyme activity. However, in the Old-OLTx >30 day group, the two highest values for CYP2C19 (approximately 1.5 X mean) were for 15 and 16 year old donors. Conclusions: (1) stable older OLTx patients metabolize drugs similarly to older normal subjects, (2) Old-OLTx patients have similar postoperative changes in metabolism as Young-OLTx patients, and (3) donor age may selectively influence drug metabolizing enzymes and warrants further study.
Study Objectives. To determine the prevalence of hyperlipidemia and the effectiveness of hyperlipidemia management in a large population of transplant recipients. A secondary objective was to assess the effect of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III guidelines on hyperlipidemia management compared with the effect from earlier guidelines. Design. Retrospective review of computerized records. Setting. University-affiliated transplantation center. Patients. Three thousand four hundred fourteen patients with liver, kidney, or pancreas transplants. Measurements and Main Results. To determine a diagnosis of hyperlipidemia and the effectiveness of treatment, we assessed the patients' lipid levels. Hyperlipidemia was defined as a total cholesterol level above 200 mg/dl and/or the use of antihyperlipidemic drugs. Of the 3414 patients in the study, 1638 (48%) had hyperlipidemia. Of these, 711 (43%) were receiving antihyperlipidemic drugs; 227 (32%) of the 711 patients had achieved the total cholesterol goal of 200 mg/dl or below. Low-density lipoprotein cholesterol (LDL) levels were available for 1953 (57%) patients. Of these, 537 patients were receiving cholesterol-lowering drugs, and 384 (72%) of the 537 patients achieved the LDL goal of less than 130 mg/dl. Conclusion. Although NCEP guidelines recommend monitoring LDL, only slightly more than half of these transplant recipients were monitored. In addition, the patients identified as having hyperlipidemia were not effectively treated to lower their cholesterol levels. Clinicians must be aggressive in diagnosing, monitoring, and treating hyperlipidemia to decrease the rate of cardiovascular disease and to prolong patient survival after transplantation.
Study Objective. To determine the long‐term tolerability of prophylactic administration of pyrazinamide and levofloxacin in patients possibly exposed to multidrug‐resistant tuberculosis (MDRTB) after undergoing solid organ transplantation. Design. Retrospective analysis. Setting. Community outpatient clinic. Patients. Forty‐eight recipients of solid organ transplants beginning prophylaxis for MDRTB during August 1999 after possible exposure to a single index case of multidrug‐resistant Mycobacterium tuberculosis within our community. Intervention. Prophylaxis consisted of pyrazinamide 30 mg/kg/day plus levofloxacin 500 mg/day, administered for 1 year. Measurements and Main Results. Thirteen (27.1%) of the 48 patients completed therapy; 27 (56.3%) discontinued therapy within 4 months due to adverse drug events. Gastrointestinal intolerance was the major adverse event resulting in early discontinuation. Conclusion. Prophylaxis of MDRTB with levofloxacin and pyrazinamide was associated with limited tolerability due to the high frequency of adverse events. While we search for a better tolerated prophylactic regimen, close monitoring for adverse reactions is recommended.
