The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
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To review symptom awareness, diagnostic techniques, and therapeutic interventions for the recognition and treatment of transient ischemic attack (TIA) and to discuss secondary stroke prevention after TIA. ⋯ TIA and stroke must be recognized and treated urgently. Through public education, readily available information, access to diagnostic imaging devices, and aggressive preventive strategies and treatments, the frequency and severity of secondary cerebrovascular events, as well as the economic burden of secondary stroke, could be substantially reduced.
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To test the feasibility and reliability of a tool and methodology for evaluating expert clinicians' perceptions about the application of the Beers criteria in hospice. ⋯ We established a viable methodology for evaluating clinician judgment about medication inappropriateness in older hospice patients. Some medications routinely considered to be inappropriate may be appropriate at end of life; different criteria may be needed to determine medication inappropriateness in hospice care.
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The number of hip fractures increases substantially with age, and they often become life threatening. Fractures can increase postsurgical incidences of deep venous thrombosis, delirium, persistent pain, wounds, and urinary tract infections. ⋯ Rehabilitation is patient-specific and focuses on maximizing functional status and minimizing future risks. Ongoing medication review and assessment are important components in preventing fractures.
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A 67-year-old patient presented to the community pharmacy with poorly controlled postherpetic neuralgia (PHN) pain following an episode of herpes zoster. The clinical pharmacist did a medication review and found that, although the patient was receiving medications proven effective in the treatment of PHN, she was not receiving optimal therapy. ⋯ Managing PHN pain requires practitioners to be vigilant in titrating pain regimens and trying various combinations of therapies with different mechanisms of action. Such an approach is one that tailors medication therapy to each individual patient, provides the most relief, and restores a patient's quality of life.
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To review the pharmacodynamics, pharmacokinetics, efficacy, tolerability, dosing, and role of oral oxymorphone immediate-release (IR) and extended-release (ER). ⋯ Oxymorphone is the newest oral opioid to enter a crowded marketplace now totaling 12 Schedule 2 opioids. It does not appear to have any unique assets or liabilities and should be considered as one of many oral opioids for the management of acute and persistent pain of moderate-to-severe intensity.