Fostering cultural sensitivity amongst students of pharmacy through an interprofessional book club activity.

BACKGROUND AND PURPOSE: To describe a large-scale, cultural sensitivity-focused interprofessional book club activity that is required in the first-professional year of an accelerated pharmacy curriculum. EDUCATIONAL ACTIVITY AND SETTING: An interprofessional book club activity, focusing on the need for cultural sensitivity in health care, is conducted annually for students in the acupuncture, pharmacy, physical therapy, physician assistant, and sonography programs. Each year over 400 students are required to attend and are assigned to interprofessional groups to discuss guided questions pertaining to the book written by Anne Fadiman, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Pharmacy students complete multiple assignments before and after the activity. Students are administered a post-survey to collect student feedback and self-assessment data. The book club has been run in both synchronous and asynchronous formats. FINDINGS: Student survey responses have consistently revealed that the majority of students agreed or strongly agreed that they were better prepared for culturally-diverse patient interactions, the activity allowed for interprofessional learning, and the activity should continue for future students. SUMMARY: A book club activity is an effective strategy for delivering content related to cultural sensitivity in an interprofessional format. This activity model can be used to support interactions with multiple professions in different schools within the same university or with multiple professions located at different universities/institutions.

Deoxycholic Acid (ATX-101) for Reduction of Submental Fat.

OBJECTIVE: To review trials evaluating purified synthetic deoxycholic acid (DCA; ATX-101) for the reduction of submental fat (SMF). DATA SOURCES: A literature search was conducted using MEDLINE (1946 to week 4 of April 2016) and Evidence Based Medicine Database (1974 to 6 May, 2016). Keywords searched included deoxycholic acid, ATX-101, and submental fat. STUDY SELECTION AND DATA EXTRACTION: All human studies published in English that addressed the effects of DCA for the reduction of SMF were selected for analysis. DATA SYNTHESIS: Five phase III, multicenter, randomized, double-blinded clinical trials enrolling more than 1700 patients have demonstrated the efficacy of ATX-101 in the reduction of SMF via a variety of validated scales as well as objective measurements. Purified synthetic DCA 2 mg/cm(2) injected monthly for 4 to 6 treatment sessions demonstrated improvement in scales evaluated by both clinicians and patients. Improvement in skin caliper measurements of SMF and Magnetic Resonance Imaging (MRI) provide objective evidence of the efficacy of ATX-101. Adverse events (AEs) are very common but are transient and localized to the treatment area. Pain at the injection site is the most common AE, occurring in more than 80% of patients treated. Other common AEs include swelling, bruising, numbness, and induration. Appropriate injection technique is patient specific and requires detailed knowledge of the submental anatomy to minimize AEs. CONCLUSIONS: ATX-101 is the first pharmacological intervention approved for the reduction of SMF and offers an alternative to invasive measures to improve the submental profile and positively affect patient self-image.

An update in options for the treatment of pain: a review of new opioid formulations.

In the past 2 decades, there has been a significant increase in the use of opioids for the management of chronic nonmalignant pain. This increase in usage has led to concerns of misuse and abuse of opioids. Also, many of the available opioid options were previously only available as oral tablets or capsules, further limiting treatment options for health care providers. Several new opioid formulations have been developed to address and prevent the misuse and abuse of opioids via tampering in the United States. In addition, alternative delivery systems have been developed to provide physicians with more options to provide adequate pain management for those with chronic pain. This article reviews new opioid options for the treatment of pain management and requirements of the Risk Evaluation and Mitigation Strategies program.

Considerations for the use of proton-pump inhibitors in older adults.

OBJECTIVE: To investigate current concerns regarding the use of proton-pump inhibitors (PPIs) in older adults. DATA SOURCES: A literature search was conducted in MEDLINE (1948 to April week 3 2011) to identify relevant publications. Key words searched included proton-pump inhibitor, safety, adverse events, elderly, and older adults. Additional data sources were obtained through a bibliographic review of selected articles. DATA SELECTION: Relevant studies conducted in older adults published in English that examined risks associated with the use of PPIs were included in this review. DATA SYNTHESIS: The older adult population in the United States is growing at an astounding rate. With the increase in age, there are many factors that make the elderly susceptible to acid-related gastrointestinal disorders that require treatment with PPIs. However, PPI use in the elderly has been shown to lead to a number of health concerns. Recent data have shown that PPI use is associated with an increased risk of fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin and mineral deficiencies, and drug interactions. These concerns will be further investigated and weighed against the benefits of PPI use in this population. CONCLUSIONS: Patient-specific characteristics must be taken into consideration when recommending and/or prescribing PPIs to older adults.

Special considerations for the use of insulin in older adults.

OBJECTIVE: The goal of this article is to provide guidance in prescribing insulin for older adults. BACKGROUND: The prevalence of diabetes increases with age, with almost 30% of the elderly population diagnosed with this metabolic disorder. Along with the well-documented microvascular and microvascular complications of diabetes, older adults are at increased risk of numerous other complications, such as dementia, risk of falling, frailty, and incontinence. DATA SYNTHESIS: Whether designing a new insulin regimen or adjusting an existing regimen, many factors must be considered; these include advantages and disadvantages of each insulin option; adverse events, particularly hypoglycemia and increased risk of falls; and comorbid conditions. When assessing insulin options for older adults, a thorough evaluation of key features, such as the pharmacokinetics and timing of administration in relation to meals, along with cost, will assist clinicians in selecting an appropriate regimen. Hypoglycemia and risk of falls are increased in older adults; tight glycemic goals must be weighed against the risk of these adverse events. The presence of comorbid conditions may interfere with older adults' ability to inject insulin and monitor their blood sugar appropriately. Specialized devices, such as insulin pens, may offer a means to assist older adults with their insulin therapy. CONCLUSION: Prescribing insulin to older patients must be individualized and tailored to meet the needs of each individual.

Treatment options for osteoarthritis: considerations for older adults.

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of disability among older adults in the United States. Treatment options such as acetaminophen and nonsteroidal anti-inflammatory drugs are the most widely used agents to manage mild-to-moderate pain. Treatment with tramadol or opioids is usually reserved for severe pain associated with OA. These agents do not come without risk, especially for older adults. Patient-specific parameters and comorbid conditions must be considered when evaluating treatment options for older adults. This article reviews pharmacological and nonpharmacological approaches to the management of OA in older adults.

The role of pramlintide for weight loss.

OBJECTIVE: To evaluate the weight-loss effects of pramlintide. DATA SOURCES: A literature search was conducted in MEDLINE (1950-October week 4, 2009), International Pharmaceutical Abstracts (1970-October 2009), and Evidence Based Medicine Database (1991-2009 week 44) to identify relevant publications. Key words searched included pramlintide, weight loss, obesity, and overweight. Additional data sources were obtained through a bibliographic review of selected articles. STUDY SELECTION/DATA EXTRACTION: All studies conducted on humans and published in English that examined the effects of pramlintide on body weight as a primary or secondary endpoint were selected for analysis. DATA SYNTHESIS: Pramlintide is a human amylin analog approved by the Food and Drug Administration for use in conjunction with insulin therapy in patients with type 1 or 2 diabetes. In addition to its glucoregulatory actions, pramlintide has been shown to increase satiety and, therefore, decrease caloric intake via a central mechanism. Several studies show that this translates into statistically significant weight loss in overweight or obese patients with type 1 or 2 diabetes; patients with type 1 diabetes lost up to 1.7 kg over 1 year with pramlintide 60 microg 3 times daily, while patients with type 2 diabetes experienced a placebo-subtracted weight loss of up to 3.7 kg after 16 weeks of pramlintide 120-240 microg administered 3 times daily. Preliminary trials assessing the use of pramlintide for weight loss in obese patients without diabetes have demonstrated weight loss of up to 8 kg after 1 year. In all studies, the drug was generally well tolerated, with nausea being the most commonly reported adverse effect. CONCLUSIONS: Based on preliminary evidence, pramlintide facilitates modest weight loss in obese or overweight patients with and without diabetes. However, current trials were limited by inconsistent study design, dosing, and patient population.

Role of huperzine a in the treatment of Alzheimer's disease.

OBJECTIVE: To review the role of huperzine A in the treatment of Alzheimer's disease (AD). DATA SOURCES: A literature search was conducted through MEDLINE (1950-September week 2, 2008), EMBASE (all years), Google Scholar, International Pharmaceutical Abstracts, and a bibliographic review of relevant articles. Key words included huperzine, huperin, Huperzia serrata, and Alzheimer's disease. STUDY SELECTION AND DATA EXTRACTION: All clinical trials published in the English language that evaluated huperzine A in patients with AD were included in this review. Articles published in Chinese were included when English abstracts or electronic translation technology were available. DATA SYNTHESIS: AD is a progressive neurodegenerative brain disorder for which there is no cure; available therapies only decrease cognitive decline. Huperzine A, an alkaloid derived from Chinese club moss (H. serrata), acts as a selective inhibitor of acetylcholinesterase and may also display neuroprotective properties. Preliminary data suggest that huperzine A may improve cognition; studies ranging from 8 to 12 weeks have found improvements in the Mini-Mental State Examination score of 1-5 points. CONCLUSIONS: Although use of huperzine A has shown promising results in patients with AD, data supporting its use are limited by weak study design. Largescale, randomized, placebo-controlled trials are necessary to establish the role of huperzine A in the treatment of AD.

Osteoarthritis: a review of treatment options.

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of disability in the United States, especially among older adults. Treatment options have primarily focused on alleviating the pain often associated with this condition. Acetaminophen and nonsteroidal anti inflammatory drugs (NSAIDs) are often employed for relief of mild-to moderate pain associated with OA. NSAIDs are typically more effective than acetaminophen; however, because of adverse effects associated with long-term use of NSAIDS, acetaminophen is considered first-line therapy. Safety concerns of traditional pharmacotherapeutic agents used in the management of OA, such as NSAIDs and opioids, have led healthcare professionals to seek other options. Trials of disease modulating agents that focus on preventing further damage to the joints have the potential to change how this disease state is managed. This article reviews nonpharmacologic and pharmacologic approaches to management of OA of the knee and hip.

Role of metformin for weight management in patients without type 2 diabetes.

OBJECTIVE: To evaluate the efficacy and safety of metformin for weight management in overweight and obese patients without type 2 diabetes. DATA SOURCES: Literature was obtained through MEDLINE Ovid (1950-February week 3, 2008), EMBASE (all years), and a bibliographic review of relevant articles. Key words included metformin, obesity, overweight, and weight loss. STUDY SELECTION/DATA EXTRACTION: All studies published in the English language that evaluated the effects of metformin on weight in obese or overweight individuals were critically analyzed. Relevant articles were selected for inclusion in this review. DATA SYNTHESIS: Metformin is first-line pharmacotherapy in the treatment of overweight or obese patients with type 2 diabetes, with beneficial effects on weight in this population. Multiple trials have evaluated the effect of metformin on weight and other metabolic parameters in adults and adolescents without diabetes. Five of 12 trials in adults evaluated weight loss as a primary endpoint. Significant weight reduction was found in 4 of these studies; however, the trials were small and of weak design. Weight reduction was significant in 5 of the 6 adolescent trials; similarly, these studies were limited by weak study design and small patient population. Metabolic parameters (blood pressure, waist circumference, cholesterol parameters, insulin/glucose levels) often showed varying results. Metformin was well tolerated; gastrointestinal effects were the most frequently reported adverse effects. CONCLUSIONS: The weight loss effects of metformin in overweight or obese adults and adolescents without diabetes appear promising; however, trials have been limited by small patient populations and weak design. Metformin may also have a positive effect on metabolic parameters such as waist circumference, fasting insulin and glucose levels, and triglycerides. Further research involving large-scale trials that evaluate weight loss as a primary outcome is necessary to firmly establish the role of metformin in this population.

Pharmacotherapeutic options for overweight adolescents.

OBJECTIVE: To evaluate the safety and efficacy of current pharmacotherapeutic options for weight loss in overweight adolescents. DATA SOURCES: Literature was obtained through MEDLINE Ovid (1996-April 2007) and EMBASE Drugs and Pharmacology (1991-2nd quarter 2007) searches and a bibliographic review of published articles. Key words included adolescents, overweight, obesity, anti-obesity agents, drug therapy, orlistat, sibutramine, and metformin. STUDY SELECTION AND DATA EXTRACTION: All studies published in the English language that evaluated the use of pharmacotherapy for the treatment of overweight adolescents were critically analyzed; pertinent articles were selected for this review. DATA SYNTHESIS: Orlistat has been approved for use in adolescents between the ages of 12 and 16 years. The most frequently reported adverse effects of orlistat were gastrointestinal; reduced concentrations of fat-soluble vitamins were also observed. Of the 6 clinical trials published, 5 have shown statistically significant reductions in body mass index (BMI) from baseline, ranging from 0.55 to 4.09 kg/m2; one small trial failed to demonstrate significant weight reduction compared with placebo. Sibutramine has also been evaluated for use in overweight adolescents in 6 trials. Trials demonstrated a statistically significant reduction in BMI up to 5.6 kg/m2 (from baseline). Of concern is evidence indicating that sibutramine therapy may be associated with elevated blood pressure, increased pulse rate, depression, and suicidal ideations. Lastly, metformin has recently been evaluated for weight loss in overweight adolescents; small, short-term trials demonstrate modest reductions in weight and BMI. CONCLUSIONS: Orlistat has been proven both safe and effective for weight reduction in overweight adolescents. Sibutramine has also been proven effective in reducing weight in this population; however, the potential for severe adverse effects requires further investigation. Metformin has demonstrated promising results in small trials; its role in the treatment of overweight adolescents will remain investigational until further research is conducted.

The role of olanzapine in the treatment of anorexia nervosa.

OBJECTIVE: To evaluate the role of olanzapine in the treatment of anorexia nervosa. DATA SOURCES: Literature was obtained through searches of MEDLINE (1966-December 2006), EMBASE (1980-4th Quarter 2006), and PsycINFO (1985-December 2006) and a bibliographic review of published articles. Key terms used in the searches included anorexia nervosa, antipsychotics, eating disorders, olanzapine, and Zyprexa. STUDY SELECTION AND DATA EXTRACTION: All English language articles that were identified from the search were evaluated. All primary literature was included in the review. DATA SYNTHESIS: In several case reports and most clinical trials, patients with anorexia nervosa successfully gained weight while being treated with olanzapine. Moreover, many patients treated with olanzapine achieved a healthy body weight. Case reports and trials identified additional benefits of olanzapine, including reduction in delusional thinking; improvement in body image, sleep, depressive symptoms, adherence to treatment, and eating-disorder symptoms; and decreased agitation and premeal anxiety. CONCLUSIONS: Preliminary evidence supports the use of olanzapine for treatment of anorexia nervosa by demonstrating that olanzapine 2.5-15 mg daily promotes weight gain and has positive effects on associated psychological symptoms. Limitations of the reported data include small sample size, low completion rate in clinical trials, and open-label trial design. Although olanzapine appears to have a potential role in the treatment of anorexia nervosa that has been unresponsive to other therapy, randomized, placebo-controlled studies with larger sample sizes are necessary to establish its role in therapy.