ABSTRACT
Care for people with cystic fibrosis (PWCF) is highly complex and requires a multidisciplinary approach where the pharmacist plays a vital role. The purpose of this manuscript is to serve as a guideline for pharmacists and pharmacy technicians who provide care for PWCF by providing background and current recommendations for the use of cystic fibrosis (CF)-specific medications in both the acute and ambulatory care settings. The article explores current literature surrounding the role of pharmacists and pharmacy technicians, proven pharmacy models to emulate, and pharmacokinetic idiosyncrasies unique to the CF population while also identifying areas of future research. Clinical recommendations for the use of CF-specific medications are broken down by organ system including mechanism of action, adverse events, dosages, and monitoring parameters. The article also includes quick reference tables essential to the acute and chronic medication therapy management of PWCF.
Subject(s)
Cystic Fibrosis , Pharmaceutical Services , Cystic Fibrosis/drug therapy , Humans , Medication Therapy Management , Pharmacists , Pharmacy Technicians , Professional RoleABSTRACT
Individuals with cystic fibrosis (CF) have an increased risk for gallbladder abnormalities and biliary tract disease, but the reported incidence of these manifestations of CF varies widely in the literature. With the approval of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA), increasing numbers of CF patients have been initiated on highly effective cystic fibrosis transmembrane regulator (CFTR) modulator therapy. While elevations in hepatic panel are known potential side effects of CFTR modulators, there have been no published cases of biliary disease or acute cholecystitis attributed to these medications. In this case series, we describe seven patients at two adult CF centers with biliary colic shortly after initiation with ELX/TEZ/IVA, six of whom required cholecystectomy.
Subject(s)
Biliary Tract Diseases/chemically induced , Biliary Tract Diseases/surgery , Chloride Channel Agonists/adverse effects , Cholecystectomy , Cystic Fibrosis/drug therapy , Adult , Aminophenols/adverse effects , Benzodioxoles/adverse effects , Drug Combinations , Female , Humans , Indoles/adverse effects , Male , Pyrazoles/adverse effects , Pyridines/adverse effects , Pyrrolidines/adverse effects , Quinolones/adverse effectsABSTRACT
OBJECTIVES: To describe the percentage of pediatric outpatient pharmacy prescriptions with inappropriate prescribing identified by a pharmacist that resulted in a change to the prescription. Secondary objectives include describing types of inappropriate prescribing errors, prevalence of Institute of Safe Medication Practices high-alert medications, patient demographics, prescriber origin, and prescription origin. METHODS: This retrospective outpatient prescription record review was approved by an institutional review board and performed at an outpatient pharmacy located in an academic teaching hospital. The study reviewed pediatric outpatient prescriptions for a 6-month period. Prescriptions with prescribing errors were identified from pediatric prescriptions sent to the problem queue and documented with appropriate pharmacist notes. RESULTS: This study demonstrated the impact of a dose checking procedure and pharmacist interventions on pediatric prescriptions. Initial results show that 3% of all pediatric prescriptions required a pharmacist intervention. Of these prescriptions, 50% resulted in a change to the original prescription. CONCLUSION: Weight-based dose checking in a pediatric outpatient pharmacy proactively prevents potential adverse events among the pediatric population. Despite this study's limitations, we believe that a pediatric dose checking procedure in community pharmacies will reduce adverse events. Further study is warranted in this field.
