The essential research curriculum for doctor of pharmacy degree programs.

In 2008, the American College of Clinical Pharmacy appointed the Task Force on Research in the Professional Curriculum to review and make recommendations on the essential research curriculum that should be part of doctor of pharmacy (Pharm.D.) degree programs. The essential research curriculum provides all students with critical and analytical thinking and lifelong learning skills, which will apply to current and future practice and stimulate some students to pursue a career in this field. Eight key curricular competencies are as follows: identifying relevant problems and gaps in pharmacotherapeutic knowledge; generating a research hypothesis; designing a study to test the hypothesis; analyzing data results using appropriate statistical tests; interpreting and applying the results of a research study to practice; effectively communicating research and clinical findings to pharmacy, medical, and basic science audiences; interpreting and effectively communicating research and clinical findings to patients and caregivers; and applying regulatory and ethical principles when conducting research or using research results. Faculty are encouraged to use research-related examples across the curriculum in nonresearch courses and to employ interactive teaching methods to promote student engagement. Examples of successful strategies used by Pharm.D. degree programs to integrate research content into the curriculum are provided. Current pharmacy school curricula allow variable amounts of time for instructional content in research, which may or may not include hands-on experiences for students to develop research-related skills. Therefore, an important opportunity exists for schools to incorporate the essential research curriculum. Despite the challenges of implementing these recommendations, the essential research curriculum will position pharmacy school graduates to understand the importance of research and its applications to practice. This perspective is provided as an aid and a challenge to those in leadership and teaching positions within schools and colleges of pharmacy.

Rivastigmine-induced dystonia.

PURPOSE: A case of acute dystonia related to rivastigmine use is reported. SUMMARY: A 61-year-old Caucasian woman who had suffered from bipolar II disorder with rapid cycling for over 30 years was admitted to an inpatient psychiatry unit. In addition to bipolar II disorder, the patient had been previously diagnosed with early-stage Alzheimer's disease, posttraumatic stress disorder, and various anxiety disorders. During the current hospitalization, she was taking clonazepam, dextroamphetamine, lamotrigine, lansoprazole, levothyroxine, memantine, quetiapine, risperidone, rivastigmine, tranylcypromine, trazodone, and zolpidem. Soon after hospital admission, she began to complain of a tightening in her chest. A review of her records revealed similar complaints during previous hospitalizations. Rivastigmine was discontinued due to concerns of interactions with her antipsychotic regimen. Although these symptoms were previously attributed to anxiety, they appeared worse during this hospitalization. During these events she would be witnessed lying in bed in a supine position with her head canted posteriorly. Benztropine was given to help determine if she was having a dystonic reaction. Within 30 minutes, her chest discomfort began to resolve, and her symptoms resolved completely over the next 48 hours. Three days later, rivastigmine was restarted by the attending psychiatrist because of concerns about the patient's memory, and the dystonia-like symptoms returned within 2 hours of her morning dose. Rivastigmine was discontinued, and benztropine was given and then discontinued, with no return of symptoms for the remainder of her two-week hospitalization. CONCLUSION: A patient with bipolar II disorder and mild-to-moderate Alzheimer's disease developed dystonia, possibly caused by rivastigmine. However, the patient was taking various other medications that could have lowered the threshold for extrapyramidal syndromes.

Clozapine-induced leukopenia successfully treated with lithium.

PURPOSE: A case of clozapine-induced leukopenia successfully treated with lithium is reported. SUMMARY: A 55-year-old man with paranoid schizophrenia who had been stable on clozapine for more than 10 years was admitted to an inpatient behavioral health unit with leukopenia associated with clozapine use. This patient's history was significant for four previous hospitalizations for psychiatric issues, none of which occurred while he was using clozapine. On admission, the patient's clozapine was discontinued and he was started on olanzapine. On hospital day 4, his white blood cell (WBC) count had risen to 3400/mm(3) and clozapine was resumed due to increasing auditory hallucinations and suicidal ideation. On hospital day 5, his WBC count decreased to 2900/mm(3) and clozapine was again stopped. The patient was given lithium carbonate 300 mg at bedtime, and olanzapine was discontinued. The next day, clozapine was restarted at 12.5 mg daily at bedtime. On hospital day 11, his WBC count had risen to 5400/mm(3). The patient was discharged on clozapine 25 mg at bedtime, with a WBC count of 3400/mm(3). The patient has not been rehospitalized and has not had significant changes in his WBC count or absolute neutrophil count (ANC) for more than 14 months. CONCLUSION: A 55-year-old man with schizophrenia developed clozapine- induced leukopenia after more than 10 years of treatment. Lithium was used to stimulate leukocyte production, and clozapine was restarted successfully. The patient was maintained on clozapine and lithium without significant changes in his WBC count or ANC.