Gender-specific issues in the treatment of migraine.

Migraine is approximately three times more common in women than in men. Women tend to have longer attacks and are more likely than men to experience aura with migraine, but both sexes can experience frequent and severe attacks. Treatment principles for migraine and guidelines for the use of prophylactic and abortive therapies are generally consistent between males and females. However, due to hormonal changes induced in the female during menstruation, oral contraceptive use, pregnancy, and menopause, gender-specific therapeutic strategies are often necessary when treating migraine in females.

Building a year-round immunization program.

Each year, an estimated 55,000 to 80,000 people die from vaccine-preventable diseases. More pharmacists are needed to advocate, facilitate, and deliver immunizations throughout the year. Pharmacists who want to develop a year-round immunization program should begin by developing a comprehensive business plan. By implementing a successful year-round immunization program, pharmacists can reduce morbidity and mortality from a range of vaccine-preventable infections.

Implementation of a pharmacy-based immunization program in a supermarket chain.

OBJECTIVE: To describe procedures for implementing a pharmacy-based immunization program in a supermarket chain. SETTING: Supermarket chain pharmacy. PRACTICE DESCRIPTION: Ukrop's is a local supermarket chain with 27 stores in the greater area of Richmond, Fredericksburg, and Williamsburg, Virginia, 19 of which have pharmacies. Ukrop's offers enhanced patient care services including immunizations, diabetes, asthma, hypertension, hyperlipidemia monitoring, and smoking cessation. All pharmacies offer adult immunizations and host periodic diabetes, hypertension, and hyperlipidemia screening events. PRACTICE INNOVATION: Adult immunization program. INTERVENTIONS: Each pharmacy offered influenza and pneumococcal vaccinations on a walk-up basis during pharmacy hours and during clinics held at least 3 days per week. Immunizations were also offered periodically at off-site locations. Distribution of letters and chart stickers to patients' physicians, and even partnership with a physician to establish the immunization protocol, helped increase awareness of the pharmacy immunization services. This service involved a core group of immunizing pharmacists who developed a policies and procedures manual, distributed the vaccine, and handled additional staffing requirements. MAIN OUTCOME MEASURES: Number of adult influenza and pneumococcal vaccinations administered by pharmacists. RESULTS: Between September and December 1998, Ukrop's pharmacists administered 5,137 influenza vaccinations and 613 pneumococcal vaccinations. Between September 1999 and January 2000, Ukrop's pharmacists administered 18,000 influenza vaccinations and 1,200 pneumococcal vaccinations. CONCLUSION: In addition to immunizing thousands of people in its first year, the program served as a successful marketing tool to increase awareness of enhanced pharmacy services in the community and among local physicians. Administration of vaccines increased pharmacists involvement with and enthusiasm for enhanced patient care services and generated a revenue stream for the pharmacies.

Role of anagrelide in the treatment of thrombocytosis.

OBJECTIVE: To review the role of anagrelide in the management of essential thrombocythemia. DATA SOURCES: A MEDLINE search (January 1966-August 1998) was performed using the key terms anagrelide, thrombocytosis, and essential thrombocythemia. In addition, the package insert, product monograph, and patient information pamphlets were reviewed. DATA SYNTHESIS: Recently, there has been a trend toward the use of anagrelide in the management of thrombocythemia. Anagrelide lacks leukemogenic and mutagenic potential and possesses a more favorable adverse effect profile compared with other therapeutic agents. At recommended doses, anagrelide induces thrombocytopenia in thrombocythemic patients with a concomitant reduction in the incidence of disease-related symptoms. CONCLUSIONS: Although the treatment of choice for thrombocythemia is still an area of debate, anagrelide has distinct advantages over alternative therapies. Anagrelide represents an important therapeutic option in the treatment of patients with thrombocythemia.

Migraine: a comprehensive review of new treatment options.

Headaches are among the most common complaints reported to health care professionals and are classified by the International Headache Society as migraine, tension-type, or cluster, with additional subtypes. Classification and etiology of headache should be determined after thorough review of the patient's history. Once diagnosed, migraine can be treated by preventive or abortive measures. Recent developments add new options, including availability of drugs for intranasal administration (sumatriptan, dihydroergotamine) and 5-HT1B/1D agonists (rizatriptan, zolmitriptan, naratriptan, eletriptan). Although placebo-controlled trials are available, few comparative clinical trials of these agents have been conducted; however, important pharmacologic, pharmacokinetic, and clinical differences exist among the drugs.

Home blood glucose monitoring.

OBJECTIVE: To provide a review of self-monitoring blood glucose including home blood glucose meters and patient education. DATA SOURCES: A MEDLINE search (January 1966-January 1998) was conducted to identify original and review articles. Search terms included self-monitoring blood glucose and blood glucose monitoring. Owner's manuals and package inserts were reviewed to determine specific characteristics for each glucose meter. DATA EXTRACTION: All current original and review articles about self-monitoring blood glucose and home blood glucose meters were included if they contained information about benefits of self-monitoring blood glucose, technology and performance of blood glucose meters, quality control, selection characteristics of blood glucose meters, and patient education. DATA SYNTHESIS: Self-monitoring of blood glucose has become an increasingly vital component of the care of the diabetic patient. Many glucose monitors are available with various features that may be confusing to pharmacists. Pharmacists need to be able to aid patients in the selection of an appropriate glucose meter and provide the education necessary for proper use and follow-up. Patient education is a key component in optimizing the potential benefits of self-monitoring. CONCLUSIONS: Self-monitoring of blood glucose, if used properly, can have a positive effect by increasing patient involvement in overall diabetes care. Pharmacists are accessible and can teach patients necessary skills that will enhance their ability to self-manage blood glucose.

The role of academia in community-based pharmaceutical care.

Developing models of pharmaceutical care (PC) for educating students and practitioners represents a fundamental role for schools of pharmacy. Virginia Commonwealth University has sought to facilitate the implementation of PC in the community by hiring faculty to practice in this setting. The mission of the faculty is to implement PC in a community pharmacy practice, to develop clerkship sites for Pharm.D. students, and to evaluate the impact of PC services in the community. Examples of an independent pharmacy model, a grocery chain model, and a retail chain model of care may serve a dual purpose for faculty members, that is, define responsibilities for the academic institution and for the community practice environment.

Evaluation of the total cost of treating elderly hypertensive patients with ACE inhibitors: a comparison of older and newer agents.

We compared total costs and adherence to the regimen of older versus newer angiotensin-converting enzyme (ACE) inhibitors for the treatment of elderly patients with hypertension. A computer search using the data base of a health care insurer identified 6176 subjects age 65 years or older who had ICD-9 coding for hypertension only and had a new prescription for an ACE inhibitor dispensed between April 1, 1992, and January 31, 1993. Subjects receiving concurrent antihypertensive drugs were included. Total cost of therapy included acquisition costs for the ACE inhibitors and concurrent antihypertensive agents, and nondrug costs. Other costs were laboratory tests, hospitalization, and clinic visits associated with monitoring outcomes of antihypertensive therapy. Total median cost per month was greater for older than for newer agents, $59.82 versus $53.09 (p<0.0009). The mean percentage of patients complying with therapy as determined by refill data was greater with newer than with older agents, 66% versus 58% (p<0.0001). Based on our results, newer ACE inhibitors should be first-line antihypertensive therapy in elderly patients. They also should be considered for elderly patients who are unresponsive to older ACE inhibitors.