Journal of pharmacy practice
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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.
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Antimicrobial stewardship is an important process proven to combat antimicrobial resistance, improve patient outcomes, and reduce costs. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have provided guidelines for the provision of antimicrobial stewardship. According to these recommendations, antimicrobial stewardship teams should be multidisciplinary in nature, with core members consisting of an infectious disease physician and an infectious disease-trained clinical pharmacist. ⋯ This clinical pharmacist was not trained in infectious disease specialty, and stewardship activities were only one part of his daily activities. Pharmacy residents and students were extensively utilized to assist in the stewardship process. Approximately two thirds of stewardship recommendations were accepted using primarily a prospective audit and feedback approach.