Asthma Review for Pharmacists Providing Asthma Education.

Asthma is the most common pediatric illness affecting more than 6 million children in the United States. Children with asthma have more frequent office visits and hospitalizations compared with adults. Despite advances in therapies, asthma still has a significant effect on the health care system. Regardless of the setting, pharmacists are uniquely equipped with an intimate knowledge of medications. With this knowledge, they can provide education to patients at various points throughout the health care system, from hospitalization to office visits to point of pick up at the pharmacy. The goal of this article is to equip the pharmacist with the necessary knowledge to provide education to these patients in a variety of practice settings, including community pharmacies, ambulatory care settings, and during transitions in care.

Treatment Options and Considerations for Intestinal Helminthic Infections.

Objective: To review the literature regarding the epidemiology and treatment of intestinal helminthic infections. Data Sources: A literature search of MEDLINE (1946-January 2014), EMBASE (1980-January 2014), International Pharmaceutical Abstracts (1970-January 2014), and the Cochrane Library (1996-January 2014) was performed using the following terms: intestinal, helminthic, humans, United States, and individual drug names (albendazole, ivermectin, mebendazole, nitazoxanide, praziquantel, pyrantel pamoate). Secondary and tertiary references were obtained by reviewing related articles. Study Selection and Data Extraction: All English-language articles identified from the data sources and clinical studies using anthelmintic agents were included. Data Synthesis: The 2011 removal and continued absence of mebendazole from the market has left limited options for helminth infections. For hookworm, albendazole has a 72% cure rate compared to 32% for pyrantel pamoate. Albendazole, ivermectin, and nitazoxanide appear to be effective for Ascaris with cure rates of 88%, 100%, and 91%, respectively. Both albendazole and pyrantel pamoate have been evaluated for pinworm with cure rates of 94.1% and 96.3%, respectively. Combination therapy with ivermectin and albendazole produces cure rates of 38% to 80% for whipworm. For Strongyloides stercoralis, ivermectin cure rates are 93.1% to 96.8% compared with 63.3% for albendazole. Praziquantel is effective for intestinal trematode infections with cure rates of 97% to 100% while its efficacy against tapeworm ranges from 75% to 85%. Conclusions: Albendazole is the drug of choice for hookworm, Ascaris lumbricoides, and pinworm. In combination with ivermectin, it is the first-line agent for whipworm. Ivermectin is preferred for Strongyloides stercoralis, and praziquantel is effective against most nematodes and trematodes.

A comparison of heart rate changes associated with levalbuterol and racemic albuterol in pediatric cardiology patients.

BACKGROUND: To our knowledge, no data exist regarding the effect of levalbuterol and racemic albuterol on heart rate in pediatric cardiology patients. OBJECTIVE: To compare heart rate change in pediatric cardiology patients receiving levalbuterol and/or racemic albuterol. The secondary objective was to identify characteristics associated with heart rate changes observed with these drugs. METHODS: A review of electronic medical records at a pediatric academic hospital was conducted to determine the equivalence of heart rate change in patients receiving levalbuterol or racemic albuterol. Patients receiving at least 3 doses of levalbuterol and/or racemic albuterol during the study period were included if they were younger than 18 years and had a diagnosis of congenital heart disease (CHD), cardiomyopathy, or supraventricular tachycardia. Patients were excluded if they received a ß-blocker or continuous racemic albuterol or did not have documented pre- and postdose heart rates. RESULTS: One hundred ninety-two patients were included. One hundred forty-two received racemic albuterol, 40 received levalbuterol, and 10 received both racemic albuterol and levalbuterol. The mean increase in heart rate for patients receiving racemic albuterol and levalbuterol was 6.8 beats/min and 6.2 beats/min, respectively (p = 0.01). In patients with CHD, the racemic albuterol group experienced a mean heart rate increase of 6.6 beats/min compared to 6.3 beats/min in the levalbuterol group (p = 0.01). Equivalence was also determined in patients without surgical intervention and patients receiving concomitant cardiac and respiratory medications. Equivalence was not established in other analyzed subgroups secondary to insufficient sample sizes. CONCLUSIONS: Racemic albuterol and levalbuterol were associated with increased heart rate in pediatric cardiology patients. This increase was found to be equivalent.

Prescribing errors in a pediatric clinic.

OBJECTIVE: This project was completed to determine the frequency and type of prescribing errors occurring in a pediatric clinic. STUDY DESIGN: Records for all patient encounters in the pediatric acute care clinic from February through April 2007 were reviewed. Prescriptions entered into the electronic medical records (EMR) were reviewed the day after they were written. RESULTS: A total of 3523 records containing 1802 new prescriptions were reviewed. Prescribing errors were found in 175 prescriptions (9.7%). The most common type of error was an incomplete prescription (42%), followed by dosing errors (34%). Anti-infectives were most commonly written in error followed by anti-inflammatories. CONCLUSIONS: Prescribing errors were commonly identified in a pediatric clinic utilizing electronic medical records. Incomplete prescriptions and dosing errors were the most commonly occurring errors. Recognizing the types of errors has been beneficial for developing educational programs intended to decrease prescribing errors and recommending improvements to the EMR system and its utilization.