Community Practice

Arformoterol (Brovana, Sepracor) inhalation solution, 15 mcg, is the first inhaled long-acting beta2-adrenergic agonist to be approved for use with a nebulizer. It was approved for long-term, twice-daily (morning and evening) maintenance treatment of bronchoconstriction in chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. The company plans to launch the product during the second quarter of 2007.

Over the years, long-term use of immunosuppressive medications has shown that they reduce morbidity and mortality in transplant patients. One of physicians' challenges is to balance the risk of organ rejection caused by underimmunosuppression with the risk of drug toxicity, secondary infections, and posttransplant lymphoproliferative disorders caused by overimmunosuppressing the patient.

Fungal infections are on the increase, but not for all the usual reasons. Increasing rates of bacterial and viral infections are due in large part to growing resistance to antimicrobials, but fungi and antifungals are different.

The International Society for Heart & Lung Transplantation (ISHLT) has released the first international guidelines for managing heart failure (HF) patients prior to heart transplantation. HF is a serious condition in which the heart is unable to pump blood at a rate sufficient to meet the needs of the body. "The new guidelines will enhance the effectiveness of patient care, optimize patient outcomes, and improve overall cost by focusing resources on the most effective strategies," said Mariell Jessup, M.D., ISHLT task force chair and professor of medicine at the University of Pennsylvania Medical Center.

A 20-year-old patient, T.C., managed in your hospital's asthma clinic has recently been diagnosed with paroxysmal supraventricular tachycardia (SVT). To control his asthma, T.C. uses a fluticasone 250 mcg/salmeterol 50 mcg inhaler (Advair Diskus, GlaxoSmithKline) regularly plus an albuterol inhaler as needed. T.C.'s physician suspects the beta agonists used to control asthma could be a factor in T.C.'s episodes of SVT. He requests a pharmacist consult about how best to deal with the asthma to prevent episodes of heart arrhythmia. What do you suggest?

Diabetes is undertreated among inpatients, especially acute care patients, sometimes with devastating results. "Blood glucose levels are too often not treated as intensively as other medical conditions among floor patients," said Almut G. Winterstein, Ph.D., assistant professor of pharmacy health care administration at the University of Florida College of Pharmacy. "If hospitals made a more aggressive effort, it could save quite a significant number of lives."

Dasatinib (Sprycel, Bristol-Myers Squibb) is a new tyrosine kinase inhibitor for chronic myelogenous leukemia (CML). The Food & Drug Administration approved the drug in June, and now the National Comprehensive Cancer Network (NCCN) has added dasatinib to its CML guidelines.

Drug-eluting stents (DESs) greatly reduce the chances of restenosis, a gradual growth of abnormal cells within the stent. However, the results of a new study reveal that DESs may also put patients at a higher risk for a sudden and potentially fatal thrombosis.

The Food & Drug Administration recently approved fentanyl buccal tablets (Fentora, Cephalon) for the management of breakthrough pain in cancer patients who are already receiving and who are tolerant to opioids for their underlying persistent cancer pain. Fentora is the first and only buccal tablet approved for this indication and is the first tablet formulation of the opioid fentanyl. It is also the first new medication approved for the treatment of breakthrough pain in opioid-tolerant patients with cancer since 1998.

Manufacturers are churning out yet another barrage of OTCs. Here's a peek.

It's not a death sentence anymore, but drug resistance is a rising concern as research continues on a preventive vaccine

The position of pharmacy technician has grown and evolved dramatically over the past 11 years. And, as technicians grow in importance at many chain and independent pharmacies, so too has the technician certification exam.

Do you provide exemplary care to Alzheimer's disease patients or their caregivers? Do you have a special program in place to manage their care? If you answered yes to either of these questions, you may be eligible to win a prestigious award from Eisai Inc.

A pharmacy technician from Seattle has created a disposable, single-use tray and spatula to eliminate the risk of cross-contamination during pill counting in pharmacies.

In an extension of cooperation begun earlier this year, health insurance plans and pharmacist groups have created a booklet and a Web site to guide Medicare beneficiaries through choosing a 2007 Part D plan, just as open enrollment is set to begin on Nov. 15.

The Infectious Diseases Society of America (IDSA) recently updated its guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (HGA, formerly known as human granulocytic ehrlichiosis), and babesiosis. Gary Wormser, M.D., lead author, said the guidelines were updated in response to mounting concern and confusion regarding Lyme disease. Wormser, who is also the chief of the division of infectious disease and vice-chairman of the department of medicine at the New York Medical College in Valhalla, went on to point out that the updated document differs from the previous guidelines, released in 2000, in several ways.

The recently approved Zolinza (vorinostat), the first anticancer drug to be developed by Merck & Co. in 20 years, targets a little-known malignancy that's often mistaken for eczema or psoriasis. Vorinostat, also known as suberoylanilide hydroxamic acid (SAHA), is indicated for the treatment of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL), a rare form of non-Hodgkin's lymphoma, who have progressive, persistent, or recurrent disease on or following two systemic therapies.

The long-awaited first dipeptidyl peptidase-4 (DPP-4) inhibitor will soon make its debut. Januvia (sitagliptin), from Merck & Co., has been approved by the Food & Drug Administration as both a monotherapy and an add-on treatment to improve glycemic control in Type 2 diabetes.

The Food & Drug Administration recently approved ciclesonide (Omnaris, Altana Pharma) for the treatment of nasal symptoms associated with seasonal and perennial allergic rhinitis in adults and children 12 years and older.

Although jaw osteonecrosis is a rare complication of bisphosphonate therapy, the sheer numbers of bisphonphonate Rxs filled annually suggest this rare side effect may affect thousands of patients. Bisphosphonates are indicated for treating hypercalcemia of malignancy, multiple myeloma, bone metastases of solid tumors and Paget's disease, and for the treatment and prevention of osteoporosis.

Public and private payers seemingly intent on wringing the last bit of profit from drug distribution have forced pharmacy to a "critical juncture," according to Bruce Roberts, R.Ph., executive VP/CEO, National Community Pharmacists Association. He believes that if the profession is going to survive, let alone thrive, it must erect a new model built around paying pharmacists for providing face-to-face medication therapy management (MTM) services.

Recent years have seen dramatic growth in the specialty pharmacy market, a segment of the industry addressing the needs of patients with chronic illnesses such as cancer and HIV. Sales of specialty medications-though expensive, often injectable, and typically requiring more patient education-have trended upward at more than 25% annually for the past five years. Industry experts forecast annual increases of more than 30% through the rest of this decade, according to Armada Health Care, a specialty pharmacy group purchasing organization in Short Hills, N.J.

One of the benefits of using targeted therapies such as imatinib (Gleevec, Novartis) in treating cancer is that they seem to be fairly well tolerated. Indeed, it may be beneficial to investigate combining them with cytotoxic chemotherapy, or even other targeted therapies, to see if patients' clinical outcomes can be improved, said B. Douglas Smith, M.D., an assistant professor of oncology at the Johns Hopkins University School of Medicine in Baltimore.

Very few drug plan providers left the Medicare market in 2007, but their offerings have shifted. There are fewer plans offering basic coverage and more offering enhanced coverage. Beneficiaries in most states have 50-60 prescription drug plans to consider including 15 or 16 that offer partial or complete coverage in the donut hole.

Even as pharmacists are still divided on whether the profession should have moved to the Pharm.D. degree, there are some industry insiders who believe that an eight-year entry-level degree is in the offing. Fueling this belief is the fact that a majority of students today enter pharmacy schools with several years of undergraduate education and many expect that a prior B.S. (or B.A.) degree will be a requirement in another 10 years.

Patients infected with gram-negative organisms are in trouble. "Drugs that used to be very effective against gram-negative infections no longer work," Johnson & Johnson research fellow Karen Bush, Ph.D., warned the 46th Interscience Conference on Antimicrobial Agents & Chemotherapeutics, held recently in San Francisco.

A diagnosis of metastatic colorectal cancer is not one that a patient wants to hear. It has historically been one of the most difficult cancers to treat, associated with mediocre responses and short survival periods. According to 2006 estimates from the American Cancer Society, colorectal cancer is now the second- and third-leading cause of cancer deaths in men and women, respectively, in the United States. Now a new treatment option is available for patients with metastatic cases that are refractory or intolerant to traditional agents. Enter panitumumab (Vectibix, Amgen).

The quivering and ineffective pumping of the heart during atrial fibrillation (AF) is associated with twice the mortality of persons with normal sinus rhythm. This statistic is one reason revised guidelines on how to treat the condition were recently released by the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC). "Guidelines for the Management of Patients with Atrial Fibrillation" was published in the Aug. 15 issue of Circulation. While the 2001 guide placed greater emphasis on using patient characteristics such as age, gender, and heart disease risk, the new guidelines highlight stroke risk as the primary means to determine the need for anticoagulants.

Squeezed by low and slow reimbursement from Medicare Part D, independent pharmacists have certainly taken their lumps this past year. But they still managed to eke out some victories, according to leaders of the National Community Pharmacists Association, which held its annual meeting in Las Vegas last month.