Jerry Fahrni

Pharmacy Informatics and Technology

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Category Archives: Therapeutics

Pharmaceuticals from crab shells

Posted on February 14, 2012 by Jerry Fahrni
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This is pretty cool stuff.

Vienna University of Technology: “Fungi with additional foreign genes have been created at the Vienna University of Technology. They can now turn chitin into pharmaceuticals.

Usually, mould fungi are nothing to cheer about – but now they can be used as “chemical factories”. Scientists at the Vienna University of Technology have succeeded in introducing bacterial genes into the fungus Trichoderma, so that the fungus can now produce important chemicals for the pharmaceutical industry. The raw material used by the fungus is abundant – it is chitin, which makes up the shells of crustaceans."

N-Acetylneuraminic acid (sialic acid or Neu5Ac) is a naturally widespread carbohydrate with several biological functions, including blood protein half-life regulation, variety of toxin neutralization, cellular adhesion and glycoprotein lytic protection. Neu5Ac is also the starting reagent of biochemical derivatives for the synthesis of pharmaceuticals, including antivirals. Basically it’s pretty important, but it’s also very expensive, running about $2600 per gram.

Fortunately the team at Vienna UT uses a genetically altered form of the fungus Trichoderma to help create Neu5Ac from Chitin, which is readily and abundantly available, thus making it a much more cost effective pharmaceutical substrate. Ta-da!

Categories: Therapeutics | Tags: Cool Stuff

Android app updates for Medscape Mobile

Posted on February 1, 2012 by Jerry Fahrni
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Taken from an email I received informing me of the changes. Overall it looks like a pretty solid update.

Read more …

Categories: Mobile Computing, Therapeutics | Tags: Android, Drug information, mobile pharmacy

Med Adherence – Difference between prescribed and dosing histories [Article]

Posted on January 28, 2012 by Jerry Fahrni
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Annual Review of Pharmacology and Toxicology (2012 Feb 10;52:275-301. Epub 2011 Sep 19) – No big surprise here, but check out the graphs (posted below), especially the second one where you can see the effect poor compliance/adherence has on therapeutic concentration. Crazy.

Abstract

Satisfactory adherence to aptly prescribed medications is essential for good outcomes of patient care and reliable evaluation of competing modes of drug treatment. The measure of satisfactory adherence is a dosing history that includes timely initiation of dosing plus punctual and persistent execution of the dosing regimen throughout the specified duration of treatment. Standardized terminology for initiation, execution, and persistence of drug dosing is essential for clarity of communication and scientific progress. Electronic methods for compiling drug dosing histories are now the recognized standard for quantifying adherence, the parameters of which support model-based, continuous projections of drug actions and concentrations in plasma that are confirmable by intermittent, direct measurements at single time points. The frequency of inadequate adherence is usually underestimated by pre-electronic methods and thus is clinically unrecognized as a frequent cause of failed treatment or underestimated effectiveness. Intermittent lapses in dosing are potential sources of toxicity through hazardous rebound effects or recurrent first-dose effects.

Read more …

Categories: Therapeutics | Tags: Medication Safety, Pharmacy Practice

Surprise! Pharma says their “digital resources” are good for consumers

Posted on January 27, 2012 by Jerry Fahrni
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Sirensong

Reliance on pharma-sponsored digital resources among online U.S. adults is significant. The research found “51% of online U.S. adults (ages 18+) use pharma-sponsored digital resources, such as condition and treatment information, disease management tools, doctor discussion guides, or mobile apps or websites.” This validates that the interactive information and tools produced by biopharma are being utilized and appreciated.

Use of these materials results in action: a conversation about a prescription drug. The study learned “43% of consumers using pharma-sponsored digital resources have discussed prescription drugs with a doctor, nurse, or pharmacist as a result.” This data point supports the business objective behind providing these interactive resources: generating a conversation with a healthcare professional. Note that the study was fielded online among 6,634 U.S. adults, ages 18+ during Q4 2011.

For comparison, Prevention Magazine’s Direct to Consumer Study 2011 found that as a result of seeing an advertisement – not necessarily online – 77% of survey respondents talked to a doctor and 23% asked for a prescription.

How scary is this! Getting consumers to talk about their medication with their physician is a good thing; talking with their pharmacist even better. However, many times this type of advertising (“digital resource”) results in consumers asking about something completely inappropriate. Which, as we all know, can lead to  a physician prescribing an unnecessary medication, using something that they’re not familiar with or prescribing something they wouldn’t consider first line.

All you have to do is look at the top 5 “patient and caregiver groups to agree that pharma should be involved in online health consumer communities” to understand why this is such a bad idea.

1. ADD/ADHD Caregivers
2. Bipolar Disorder Caregivers
3. Epilepsy Caregivers
4. Cystic Fibrosis Patients
5. Rheumatoid Arthritis Patients

Yikes! Choosing drug therapy is quite a bit different than picking out a book on Amazon and it should be treated that way.

Categories: Therapeutics | Tags: Patient Safety, Pharmacy Practice

Impact of Anti-infective Drug Shortages [Article]

Posted on January 26, 2012 by Jerry Fahrni
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Clinical Infectious Disease (online January 19):

Abstract

Anti-infective shortages pose significant logistical and clinical challenges to hospitals and may be considered a public health emergency. Anti-infectives often represent irreplaceable life-saving treatments. Furthermore, few new agents are available to treat increasingly prevalent multidrug-resistant pathogens. Frequent anti-infective shortages have substantially altered patient care and may lead to inferior patient outcomes. Because many of the shortages stem from problems with manufacturing and distribution, federal legislation has been introduced but not yet enacted to provide oversight for the adequate supply of critical medications. At the local level, hospitals should develop strategies to anticipate the impact and extent of shortages, to identify therapeutic alternatives, and to mitigate potential adverse outcomes. Here we describe the scope of recent anti-infective shortages in the United States and explore the reasons for inadequate drug supply.

Unfortunately the abstract doesn’t say much and a subscription is required to read the full article [grrr!]. The authors of the article basically evaluate the shortage of anti-infective agents over a multi-year period (2005-2010) and conclude that “anti-infective drug shortages continue to pose significant problems for clinicians and are a rapidly evolving public health emergency.” In addition they call for further research “regarding the clinical impact of drug shortages on patient outcomes”. How would one perform such a study?

Drug shortages have received a lot of attention lately. Shortages are certainly nothing new, but they seem to have become a bigger issue lately as the sheer number of unavailable medications is staggering. Areas like oncology and infectious disease are particularly hard hit as the number of treatment options in these specialties are limited to start with.

While there is no doubt that the shortages have impacted healthcare, I tend to agree with the authors of a commentary piece on the article that conclude that " it is difficult to systematically measure the resulting clinical problem or draw quantitative conclusions about differences in outcomes." Sounds overly simplified, but it’s true.

For more information on drug shortages make sure to visit the ASHP Drug Shortages Resource Center. Over 200 drugs and counting…

Categories: Therapeutics | Tags: Pharmacy Practice

The e-patient movement, panacea or barrier to care?

Posted on January 1, 2012 by Jerry Fahrni
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I haven’t really paid much attention to the e-patient movement, but recently it’s become a subject of interest.

I Googled “epatient”, and here’s what I found: “e-Patients are health consumers who use the Internet to gather information about a medical condition of particular interest to them, and who use electronic communication tools in coping with medical conditions The term encompasses both those who seek online guidance for their own ailments and the friends and family members who go online on their behalf. e-Patients report two effects of their online health research: “better health information and services, and different (but not always better) relationships with their doctors.”” This definition comes from Wikipedia. I’m not a big fan of Wikipedia, but in this case it seems appropriate.
Read more …

Categories: Therapeutics | Tags: Random thought

Safety, privacy and UCSF Med Center’s failure to do the right thing

Posted on December 31, 2011 by Jerry Fahrni
1 Comment

I am a UCSF School of Pharmacy alum. I consider UCSF Medical Center, along with many other people, to be one of the best medical centers in the country. And, UCSF Medical Center saved my mother’s life with a liver transplant earlier this year. However, I am frustrated with UCSF Medical Center this morning.

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Categories: Therapeutics | Tags: Bad, Random thought

Medscape mobile acknowledges problem with iOS 5

Posted on December 22, 2011 by Jerry Fahrni
1 Comment

Apparently some Medscape mobile users with iOS 5 have had some issues. Below is the content from an email I received earlier today. Not exactly sure what the problem is as the email didn’t actually say. I’d be leery of the application until the fix is applied, which according to the email will be sometime in the first week of January. I’d recommend using something else in the meantime.

image

Categories: Mobile Computing, Therapeutics | Tags: Apple, mobile pharmacy

Fun with Lugol’s solution…not really

Posted on December 12, 2011 by Jerry Fahrni
1 Comment

A recent ISMP Medication Safety Alert shared various errors that have occurred with Lugol’s solution over the ages. Lugol’s solution is a concentrated liquid form of potassium iodide and iodine known for its use in the treatment of hyperthyroidism. It’s also a dangerous drug because it’s typically dosed in drops, not mL’s.

Anyway, the ISMP alert shared several examples of oral overdoses with Lugol’s solution secondary to confusion between drops and mL’s. However, mixed in with all the “typical” errors, was the little gem below. Even though the error is more than a decade old, I can’t help but wonder “what the heck were they thinking!”. By the way, my initial read through had me thinking cursive “OS” (oculus sinister, i.e. LEFT eye). With that said, I wouldn’t have actually dispensed it because nothing else on the prescription fits.

image

One of the errors reported more than a decade ago involved an order to administer 10 drops of Lugol’s solution mixed with "OJ" (orange juice), but nurses misinterpreted "OJ" as OD (right eye). The patient received several doses of Lugol’s solution in his right eye. The error was identified when the patient complained to the physician about how painful the eye drops were.

Categories: Therapeutics | Tags: Bad, Medication Safety, Patient Safety

National Influenza Vaccination Week December 4-10

Posted on November 29, 2011 by Jerry Fahrni
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imageApparently National Influenza Vaccination Week (NIVW) is next week. Who knew?

The CDC has additional information on NIVW here, and a whole lot more information on seasonal influenza (Flu) as well. Need to know more about types of influenza viruses? No problem, you can find that at the CDC site too. The most common form of influenza is Type A. For most healthy people the flu is self-limiting. Sure you feel like crap for a few days, but you get over it and truck on. With that said, influenza can be quite dangerous to elderly and those with compromised immune systems. Get vaccinated.

Read more …

Categories: Therapeutics | Tags: Random thought
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