Journal of pharmacy practice
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Acute kidney insufficiency (AKI), or injury, is common in the critically ill patient. Minimal increases in serum creatinine (Scr) have been associated with greater morbidity, mortality, and hospital cost. In 2002, the Acute Dialysis Quality Initiative (ADQI) proposed a consensus definition (the RIFLE classification) which was modified after continuing evidence suggested that small changes in Scr (≥0.3 mg/dL) led to worsening outcomes. ⋯ Such definitions may aid in identifying patients at greatest risk and further the development of preventive strategies. This review will focus on the epidemiology and etiology of AKI as well as provide a mechanistic description of drug-induced AKI. In addition, a brief review of continuous renal replacement therapies is provided.
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Qualitative urine drug assays are frequently used in conjunction with opioid contracts as a means of monitoring use of prescribed controlled substances as well as concurrent use of illicit substances in patients receiving opioids for chronic nonmalignant pain (CNMP) management. Appropriate use of these screening tests, in conjunction with opioid contracts, may provide the health care provider with additional information needed to safely prescribe opioids for selected individuals with CNMP. It is important for the practitioner caring for patients subject to random urine drug screening to understand interferences with the commonly used urine drug assays, as well as knowing options to confirm contested test results. We reviewed the literature on urine drug assay test interferences and present a summary of this information in this article.
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Shock states have multiple etiologies, but all result in hypoperfusion to vital organs, which can lead to organ failure and death if not quickly and appropriately managed. Pharmacists should be familiar with cardiogenic, distributive, and hypovolemic shock and should be involved in providing safe and effective medical therapies. An accurate diagnosis is necessary to initiate appropriate lifesaving interventions and target therapeutic goals specific to the type of shock. ⋯ Rapid therapeutic intervention has been proven to decrease morbidity and mortality and is crucial to providing the best patient outcomes. Pharmacists can provide their expertise in medication selection, titration, monitoring, and dose adjustment in these critically ill patients. This review will focus on parameters used to assess hemodynamic status, the major causes of shock, pathophysiologic factors that cause shock, and therapeutic interventions that should be employed to improve patient outcomes.
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The production and distribution of counterfeit medications has become a significant global public health issue and though not as rampant in the United States as in other parts of the world, the Food and Drug Administration (FDA) has seen a 10-fold increase in the number of cases investigated. The purpose of this study was to examine California pharmacist knowledge of counterfeit medications, impact of technology and barriers to pharmacist involvement, and potential roles pharmacists can undertake. Our results showed that 59.3% of respondents believe counterfeit drugs pose a problem to the profession, but most had little to no experience with counterfeit medications. ⋯ Pharmacist agreed lack of knowledge (46.8%) and resources (82.5%) were barriers to detecting the presence of counterfeits. Half of respondents were award of the CA board of pharmacy's (BOP) future use of Radio Frequency Identification (RFID) technology, but 43% did not believe RFID would be effective. Most pharmacists indicated lack of knowledge regarding new technologies but seemed willing to learn.