Journal of pharmacy practice
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Annually there are 500 000 preventable deaths in the United States caused by smoking; as health care professionals, pharmacists have a unique opportunity to advise, assess, and assist patients to quit smoking. This review article provides pharmacists with a "toolbox" containing an overview of pharmacologic and nonpharmacologic methods for smoking cessation. Currently approved over-the-counter (OTC) and prescription medications (nicotine replacement therapy, varenicline, and bupropion) are summarized, and nonpharmacologic therapies discussed include cognitive therapy and hypnosis. In addition to traditional therapies some potential approaches to smoking cessation are addressed, including nicotine immunizations and electronic cigarettes.
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Evaluate the impact of replacing hydroxyethyl starch (HES) 670/0.75 with lower molecular weight HES 130/0.4 on albumin utilization in cardiac surgery, as well as any impact on renal function and bleeding. ⋯ Change to a lower molecular weight HES decreased intraoperative albumin utilization and increased HES utilization with no detected difference in renal function or bleeding complications.
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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality across the globe and within the United States. Although several medication classes are used for COPD treatment, none of these medications have been shown to significantly improve long-term lung function or mitigate overall disease progression. ⋯ Additionally, indacaterol and roflumilast, 2 new COPD treatment agents approved by the Food and Drug Administration in 2011, are discussed. Pharmacists play an important role in managing and educating patients with COPD and should utilize new evidence to make recommendations.
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Electronic cigarettes have gained popularity among patients as a smoking cessation aid despite not being approved or supported for this purpose by the United States Food and Drug Administration due to concerns with poor manufacturing practices and the presence of known carcinogens in the limited products that they tested. A few studies have evaluated the effects of electronic cigarettes on plasma nicotine levels and heart rate but found negligible effects. Safety data are mainly limited to surveys in which patients report only minor side effects, such as mouth and throat irritation, headache, vertigo, and nausea. ⋯ However, many of these studies introduce bias due to recruiting on e-cigarette Web sites and having tobacco cigarette use self-reported by the participant rather than objectively tested. A few studies have formally evaluated nicotine craving when using electronic cigarettes with mixed results. Although patients support the use of electronic cigarettes in smoking cessation, more formal studies on safety and efficacy should be completed in order to determine whether these products have a role in smoking cessation.