On the horizon for multiple myeloma.

Treatment of multiple myeloma (MM) remains highly individualized, with multiple factors that play a role in determining the best course of therapy. Patient-specific criteria such as age of onset, whether the patient is symptomatic at the time of diagnosis, and any detected high-risk cytogenic abnormalities are all considerations when selecting a regimen. Newer agents such as bortezomib and lenalidomide in combination with low-dose steroids have replaced more toxic chemotherapeutic regimens for primary induction and have led to significant increases in progression-free survival. Depending on duration of response prior to relapse, patients may be rechallenged with the same regimen, switched to an alternative, or may undergo hematopoietic cell transplant (HCT), which remains a highly effective treatment option for patients who are candidates. However, the cost of transplantation remains high and some patients may require a second transplantation if the initial response is incomplete. With the availability of newer agents for salvage therapies in refractory or relapsed patients, the reliance on HCT may decrease, potentially lowering healthcare costs. In addition, the availability of orally active agents may decrease the need for outpatient infusions, thus decreasing the overall costs associated with treatment and improving patient satisfaction. Finally, combination regimens that use lower doses may prove to be less toxic as well as more effective. Even though MM only accounts for approximately 1% of all cancers in the United States, with 75 million "baby boomers" now reaching the median age of diagnosis, the increased number of cases could have a substantial impact on healthcare costs.

Role of student pharmacists in the identification and prevention of medication-related problems.

OBJECTIVES: To measure the total rate of attending physician, medical resident, and medical student acceptance of interventions recommended by third-year student pharmacists supervised by a licensed pharmacist and to determine the type of health care provider group that accepted the most interventions, type of interventions provided, and number of patients counseled on medication use. METHODS: This prospective unblinded pilot study followed single interventions documented by nine third-year student pharmacists enrolled at the University of Louisiana at Monroe College of Pharmacy. Success rates of suggested interventions made to family medicine attending physicians, pharmacists, medical residents, and medical students in three Louisiana outpatient clinics were documented. Student pharmacists performed medication histories, identified potential medication-related problems, discussed interventions with health care providers, and counseled patients on medication use. Outcomes assessed were intervention type and number, intervention acceptance rate, and number of patients counseled. RESULTS: Student pharmacists communicated with attending physicians, medical residents, and/or medical students regarding 32 patients. A total of 48 interventions were documented. Of these interventions, 34 were potential medication-related problems, 8 were pharmacotherapeutic recommendations for a new problem, 4 were responses to a health care provider's drug information requests, and 2 were referrals to a diabetes education class. The acceptance rate of student pharmacists' recommendations was 86%. Attending physicians accepted 93.8% of recommended interventions, medical residents 70%, and medical students 87.5%, Student pharmacists counseled 29 patients on medication use. CONCLUSION: Student pharmacists were able to recommend new drug regimens and discuss changes in therapy with health care providers. Attending physicians, medical residents, and medical students accepted the majority of students' recommendations. Third-year student pharmacists have the potential to serve an important role in the identification and prevention of medication-related problems by suggesting interventions to health care providers.

Clinical inquiries. Which drugs are best when aggressive Alzheimer's patients need medication?

Atypical antipsychotics are effective; so are selective serotonin reuptake inhibitors (SSRIs), and they may be safer. Atypical antipsychotics are an effective short-term (6-12 weeks) treatment for aggressive behavior in patients with Alzheimer's disease because they consistently decrease aggression scores (strength of recommendation [SOR]: A, multiple randomized controlled trials [RCTs]). However, evidence of drug-related deaths in patients taking these drugs mandates weighing the benefits against the risks. SSRIs may be a safer, effective alternative (SOR: B, limited studies).