Therapeutic Classes Of Medications Research Articles

Chronic Medication Use and Factors Associated With Polypharmacy Among Outpatient Pediatric Patients.

This study aimed to determine the prevalence and predictors of chronic polypharmacy among pediatric patients in an outpatient setting. We conducted a review of medications dispensed to patients from an outpatient pediatric facility during a 12-month period. Patients who received chronic medications (≥30 days' supply), which contained at least 1 active pharmaceutical ingredient were included in the study. Descriptive analysis was used to determine prevalence of polypharmacy while predictive factors for polypharmacy were evaluated using logistic regression. Our study included 3920 patients (median age, 9.9 years; IQR, 9.4) and 16,401 medications. The median number of chronic medications used among our study cohort was 2.0 (IQR, 1) with polypharmacy identified in 309 (7.9%) patients. Predictors for polypharmacy were age and the use of certain therapeutic class of medications. Patients 12 to <19 years old (OR, 6.95; 95% CI, 4.1-10.1) were more likely to require ≥5 concurrent medications compared with patients younger than 2 years of age. Use of calcium supplements (OR, 21.2; 95% CI, 11.3-39.6), Vitamin D analogues (OR, 14.3; 95% CI, 8.0-25.8), and systemic glucocorticoids (OR, 18.8; 95% CI, 10.7-33.2) were also highly associated with polypharmacy. Adolescents and children with chronic medical conditions who require prolonged systemic glucocorticoids, calcium, and Vitamin D supplements are at higher risk of incurring long-term polypharmacy. This subgroup of pediatric patients may be more vulnerable to the occurrence of negative outcomes resulting from the use of multiple chronic medications.

Medical cannabis in multiple sclerosis

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating and neurodegenerative disease of the central nervous system that affects over 100 000 individuals in the UK. The symptoms of MS are heterogenous and correspond to the location of demyelination. However, common symptoms include sensory, motor, cognitive and affective disturbances. While the cornerstone of medical therapy is disease modifying agents, there is an ongoing need to develop symptomatic treatments. Cannabis-based medicinal products (CBMPs), which were partially legalised in the UK in November 2018, have been touted as a potential management option for the associated sequelae of MS. Nabiximols, an oromucosal spray containing cannabidiol and (−)-trans-Δ9-tetrahydrocannabinol, has been extensively evaluated for the treatment of MS-related spasticity. However, unlicensed CBMP formulations are a novel therapeutic class of medications, of which the clinical effects are less well known. Yet, there are promising indications for the use of CBMP in the symptomatic treatment of MS. This article reviews the literature on efficacy and safety of medical cannabis for people with MS.

Analyses of HIV-1 integrase gene sequences among treatment-naive patients in the Eastern Cape, South Africa.

Drug resistance has been recognized in all available therapeutic classof medications for the management of human immunodeficiency virus-1 (HIV-1) infected patients. This makes the continuous study of HIV drug resistance and new treatment options pertinent to patients and researchers globally. The aim of this study is to analyze the complete HIV-1 integrase gene for the possible occurrence of resistance mutations or polymorphisms. We performed genetic analyses on 48 treatment-naive HIV-1-infected patients using nested polymerase chain reaction. Integrase drug-related resistance mutation (DRMs) analysis was performed on all generated sequences according to Stanford HIV drug interpretation program and the International AIDS Society-USA guidelines while phylogenetic analysis was inferred using MEGA 6. The study revealed no major resistance-associated mutation. However, E157Q (2.1%), L74M/I (4.2%), and P142T (2.1%) were the observed accessory and polymorphic mutations. Naturally occurring polymorphism observed were E11D, K14R, D25E, V31I, M50I, V72I, P90T, F100Y, L101I, T124A, T125A, K136Q, D167E, V201I, L234I, A265V, A269K, D278A, and S283G. Phylogenetic analysis delineated all the sequences as HIV-1 subtype C. The study revealed the absence of major integrase inhibitors associated resistance mutations in a setting where integrase inhibitor is administered as salvage therapy in patients developing resistance to first and second-line antiretroviral treatment. However minor and natural polymorphisms were observed and thus may influence the outcome of each treatment regimen. However, additional studies are required to precisely evaluate the impact of these mutations on integrase inhibitors in the Eastern Cape of South Africa.

Initial study of clinical pharmacy work prioritization tools.

The development, implementation, and validity of clinical pharmacy work prioritization tools (CPWPTs) were analyzed. Informatics pharmacists were contacted and asked to participate in 30-minute teleconference interviews, as they have primary responsibility for the technical configuration of CPWPTs. A total of 19 respondents participated in the survey. The qualitative data collected encompassed the thoughts and ideas of practicing informatics pharmacists who are knowledgeable about the design, configuration, management, and use of CPWPTs. In addition to capturing their thoughts and ideas with open-ended questions, demographic data were collected, as was information about the sites where respondents worked and the CPWPTs they used. Most of the CPWPTs were built into existing electronic health record platforms. There was considerable variation among the prioritization factors used at each site. The most commonly identified categories of prioritization factors were patient-specific factors, therapeutic classes of medications, and potential pharmacist interventions. All respondents reported that the prioritized tasks generated by their CPWPTs were examined for face validity. Of the 19 respondents, only 4 reported that the priorities generated by their CPWPT had been empirically validated in some way. Qualitative data analysis revealed that informatics pharmacists have 5 general perceptions about CPWPT factors, validation, and use in practice: (1) mirroring practice, (2) pharmacist consensus-based design, (3) complexity of logic, (4) tension between task-oriented and patient-centric approaches to practice, and (5) comfort from tracking tasks to completion. Early CPWPTs vary significantly in their prioritization factors. These tools partially reflect the scope of clinical pharmacy practice at the sites where they are used.

Medication discrepancies in late-stage chronic kidney disease.

BackgroundLate-stage chronic kidney disease (LS-CKD) can be defined by glomerular filtration rate (GFR) 0–30 mL/min. It is a period of risk for medication discrepancies because of frequent hospitalizations, fragmented medical care, inadequate communication and polypharmacy. In this study, we sought to characterize medication discrepancies in LS-CKD.MethodsWe analyzed all patients enrolled in Northwell Health’s Healthy Transitions in LS-CKD program. All patients had estimated GFR 0–30 mL/min, not on dialysis. Medications were reviewed by a nurse at a home visit. Patients’ medication usage and practice were compared with nephrologists’ medication lists, and discrepancies were characterized. Patients were categorized as having either no discrepancies or one or more. Associations between patient characteristics and number of medication discrepancies were evaluated by chi-square or Fisher’s exact test for categorical variables, and two-sample t-test or Wilcoxon text for continuous variables.ResultsSeven hundred and thirteen patients with a median age of 70 (interquartile range 58–79) years were studied. There were 392 patients (55.0% of the study population) with at least one medication discrepancy. The therapeutic classes of medications with most frequently occurring medication discrepancies were cardiovascular, vitamins, bone and mineral disease agents, diuretics, analgesics and diabetes medications. In multivariable analysis, factors associated with higher risk of discrepancies were congestive heart failure [odds ratio (OR) 2.13; 95% confidence interval (CI) 1.44–3.16; P = 0.0002] and number of medications (OR 1.29; 95% CI 1.21–1.37; P < 0.0001).ConclusionsMedication discrepancies are common in LS-CKD, affect the majority of patients and include high-risk medication classes. Congestive heart failure and total number of medications are independently associated with greater risk for multiple drug discrepancies. The frequency of medication discrepancies indicates a need for great care in medication management of these patients.

Deprescribing in Older Nursing Home Patients: Focus on Innovative Composite Measures for Dosage Deintensification.

Deprescribing, which includes stopping or reducing the dosage of medications, is designed to improve safety and prevent adverse drug reactions in older patients. To date, there has been limited work on measuring decreases in dosage intensity, or deintensification, across therapeutic classes of medications. Given the ongoing focus on central nervous system (CNS) medications and the frequency with which providers encounter hypertension and diabetes in older nursing home patients, the objective of this expert review is to describe and critique innovative composite dosage intensity measures that have been, or could be, applied to quantify deintensification within three therapeutic medication targets commonly encountered in nursing home patients: CNS agents, antihypertensive therapy, and antidiabetic therapy and the extent to which they are associated with health outcomes. Composite measures for CNS medication intensity considered dividing a patient's daily dose by defined daily dosage (DDD), or the minimum effective adult or geriatric daily dosage. In contrast, composite measures for antihypertensives used either DDD or maximum recommended daily dosage in the denominator. We were not able to identify any composite measure of intensity for antidiabetic classes. There was a paucity of interventional studies that showed reducing the dosage intensity resulted in improved health outcomes. In conclusion, we identified several innovative composite measures of dosage intensity for CNS and antihypertensive medications, and discussed possible approaches for developing an antidiabetic regimen composite measure. It is critical for future research to compare and contrast various measures and to determine their impact on important clinical outcomes.

Medicaid Prescription Drug Utilization and Expenditures Following Part D

Although much attention has been paid to examining the impact of Medicare Part D on Medicare, few studies have examined its influence on Medicaid. This study uses an interrupted time series design to examine the impact of Part D on prescription drug expenditures and utilization among different therapeutic classes of medication across 44 Medicaid programs. In overall reductions in Medicaid prescription expenditures and utilization, our study finds evidence of greater reductions among medications used to treat chronic conditions. Our results provide a glimpse of the impact of Part D on long-term growth in the Medicaid prescription drug benefit.

The validity of self-reported prescription medication use among adolescents varied by therapeutic class

Objective Validation studies of self-reported medication use in adolescents have been scarce. The objective of this study was to estimate the sensitivity and specificity of self-reported use of medication using a prescription database as reference standard. Study Design and Setting The study population consisted of a cohort of 2,613 adolescents aged 15–16 years from the Norwegian youth health survey in 2004 and 2005. Self-reported data on medication use were compared with data from the Norwegian Prescription Database which contains information from all prescription dispensed at Norwegian pharmacies. Results Sensitivity for self-reported questions on medication use was highest for contraceptive pills 99.2% (95% CI 97.7–100) compared to antiasthmatics 79.1% (66.9–91.2), painkillers 48.5% (36.7–60.4), and psychotropic drugs 75.0% (35.6–95.6). Specificity values of self-reported information of psychotropic drugs 89.6% (87.8–91.5) and antiasthmatics 87.4% (85.4–89.5) were higher than for painkillers 80.0% (77.5–82.4) and contraceptive pills 76.2% (72.3–80.1). Conclusion Validity of self-reported previous medication use among adolescents differed by the therapeutic classes of medication. The highest sensitivity was observed for contraceptive pills and lowest for prescribed painkillers.

Emerging drugs for eating disorder treatment

Anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) comprise the currently recognised eating disorders. Although distinct diagnostic entities, they share certain forms of comorbid psychopathology, particularly anxiety and mood disorders. BN and BED have been studied most intensively as targets for pharmacotherapy. The list of drugs tested in eating disorders is substantial; however, the number of therapeutic classes of medications tested in these conditions is relatively modest. Antidepressant medications, including tricyclic antidepressants, selective serotonin re-uptake inhibitors, as well as some of the novel antidepressants, have shown evidence of some therapeutic value in both BN and BED. Their efficacy in AN, however, has been disappointing. The pharmacological options for AN are very limited. The number of controlled trials that have been conducted is small, and the research that has been successfully completed has generally failed to demonstrate medication efficacy. Patients with BN typically show reduced binge eating and purging frequency in medication trials, but rarely attain abstinence. In BED, patients often measure the value of their medication therapy by its ability to stimulate weight loss, which is another area on which future pharmacotherapy may improve. Novel pharmacological interventions are needed for each of these conditions. Peptide hormones are increasingly being evaluated for eating disorder treatment, including ghrelin agonists, neuropeptide Y1 and -5 antagonists, orexin receptor antagonists, corticotropin-releasing factor receptor 2 antagonists, histamine 3 antagonists, melanocortin 4 receptor antagonists, β3-adrenoceptor agonists, 5-hydroxytryptamine-2A antagonists and growth hormone agonists. Although these compounds are in early phases of clinical testing for eating disorder treatments, data from these studies will be instructive in the quest for effective pharmacotherapy for these conditions. An overview of the current pharmacotherapy options for eating disorders is presented with a discussion of the emerging potential treatments.

Raloxifene: A Review

women can now expect to live up to one-third of their lives in the post-menopausal state. This low estrogen state is a major risk factor for the development of osteoporosis and cardiovascular disease. The Osteoporosis Society of Canada currently recommends estrogen as the treatment of choice for preventing post-menopausal osteoporosis. Sustained unopposed estrogen use is associated with an increased risk of endometrial hyperplasia and endometrial cancer, necessitating the concomitant use of a progestin in those with an intact uterus. Recent large cohort studies suggest that estrogen and estrogen/progestin therapy may also be associated with an increased risk of breast cancer thus diminishing the beneficial effects of estrogen on overall mortality. Bisphosphonates are also available for the treatment and prevention of osteoporosis. They do not have the other beneficial effects that estrogen may provide. Selective estrogen receptor modulators (SERMs) represent a new therapeutic class of medications that have been developed to act as estrogen agonists in some tissues and estrogen antagonists in others. Raloxifene (Evista®) is a selective estrogen receptor modulator that, in pre-clinical and clinical studies, demonstrates estrogen agonist activity on bone and lipid metabolism, and shows estrogen antagonist activity on uterine and breast tissue. It is the first estrogen receptor active agent that has been shown in adequately powered, placebo-controlled, randomized clinical trials, to reduce the risk of new vertebral fractures in post-menopausal women with osteoporosis.

Prescribed Medication Use among Troops Deploying to Somalia: Pharmacoepidemiologic Analysis

To describe the frequency of chronic ambulatory prescriptions dispensed to troops, pharmacists analyzed records of soldiers deploying to Somalia for Operation Restore Hope. Prescriptions recorded in the Fort Drum pharmacy data base for soldiers deploying between November 24, 1992, and January 12, 1993, were compared to the roster of troops deployed. Among 3,701 deploying soldiers, 273 patients (7.4%) received 425 prescriptions. For each 1,000 troops, 114.8 prescriptions were dispensed. Of 333 presumptive diagnoses, the most common diagnostic groups were contraceptive, musculoskeletal, dermatologic, respiratory, and cardiovascular. Of 425 prescriptions, the most common therapeutic classes of medication dispensed were oral contraceptives, anti-inflammatory drugs, acne treatments, and beta-adrenergic agonists. Generically, the common prescribed substances were contraceptives, ibuprofen, pirbuterol, temazepam, piroxicam, and beclomethasone. Although women represented 6.8% of troops, women represented 31.5% of prescription recipients and received 29.4% of prescriptions. Women were 6.5 times as likely to receive a prescription as men (p < 0.0001); this relative risk was 3.4 if contraceptives were omitted from analysis (p < 0.0001). Two hospitalizations in Somalia may have been related to medication use.