What you don’t know can hurt your patients Ben O’Rourke Ted Williams Christine Wood Samantha...
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Transcript of What you don’t know can hurt your patients Ben O’Rourke Ted Williams Christine Wood Samantha...
What you don’t know can hurt your patientsBen O’RourkeTed WilliamsChristine Wood Samantha WoodhouseBrian ZacherAtanaz Zargarizadeh
Presentation Outline Patient Care Team/ Site Description
Christine Wood Alternative Hormone Replacement Therapy
Brian Zacher Alternative Anti-Infective Agents
Samantha Woodhouse Alternative Pain Treatments
Atanaz Zargarizadeh Alternative Anti-Emetics
Ted Williams Conclusion
Ben O’Rourke
Lloyd Center Pharmacy
Compounding Pharmacy Provides specialty products for animals
and humans Major focus is on hormone replacement
therapy
Compounding
Compounding is the process of preparing a specialized medication for an individual patient when the standard Rx does not fill the bill.
Nordenberg, Tamar. Pharmacy compounding: customizing prescription drugs. FDA Consumer magazine. 2000.
Why Compound?
Patient may be allergic to inactive ingredients of manufactured drug
Right dose may not be available Patient may need drug in a powder, liquid,
lozenge, suppository, or other form Drugs for certain conditions are not made
Alternative Hormone Replacement Therapy
Large portion of business Help meet the individual patients’
specific needs Indications
Siglers Prescription Drug Cards. 21st Ed. SFI Med Publishing Guyton A, Hall J. Textbook of Medical Physiology 10th Ed. WB Saunders Co. Pennsylvania. 2000
Alternative Hormone Replacement Therapy Men: thyroid deficiency, loss of strength/
endurance/ libido/ hair, prostate cancer Women: atrophic vaginitis, osteoporosis,
hypoestrogenism, breast cancer
Siglers Prescription Drug Cards. 21st Ed. SFI Med Publishing Guyton A, Hall J. Textbook of Medical Physiology 10th Ed. WB Saunders Co. Pennsylvania. 2000
Hormones
Progesterone Estrogens:E1, E2, E3
Premarin Testosterone:
SoyWild Yams
www.hormoneprofile.comGuyton A, Hall J. Textbook of Medical Physiology 10th Ed. WB Saunders Co. Pennsylvania. 2000
Chrysin
Stabilizes Testoserone Induces UDP-Glucoronosyltransferase
(UGT)
http://toxsci.oxfordjournals.org/cgi/content/full/82/1/70http://dmd.aspetjournals.org/cgi/content/full/28/9/1077Lacy, J LexiComp Drug Information Handbook 13th Ed. 2005
Baquacil polyhexamethylene biguanide (PHMB) A common swimming
pool biocide Protection against
bacteria and algae without the harsh effects of chlorine
A compound having a broad spectrum activity and low toxicity Ophthalmology
Acanthamoeba Keratitis
Acanthamoeba Small, free-living protozoa
commonly found in water Lives in two forms
Trophozoite Cyst form
Patients notice pain, photophobia, and irritation
Clinical characteristics include stromal ring infiltrate, epithelial haze, and radial keratoneuritis
Combination therapy is used to treat
PHMB for trophozoites Eye Drop that is made at
Lloyd Center Pharmacy Chlorhexidine for cysts
Radial Keratoneuritis
Hassanlou, M et.al. Bilteral acanthamoeba ketatitis and treatment strategy based on lesion depth. Can J Ophthalmol, Vol. 41, No 1, 2006.
Other Uses
Bacterial VaginosisMost common vulvovaginal infection
Mouth Rinses Inhibits re-growth of plaqueReduces oral bacterial counts
HIV
Rosin, M et. al. “Effect of a polyhexamethylene biguanide mouthrinse on bacterial counts and plaque.” J Clin Periodontol. 2001 Dec; 28 (12): 1121-6.
Gerli, S, Rossetti, D, and Di Renzo GC. “A new approach for the treatment of bacterial vaginosis: use of polyhexamethylene biguanide. A prospective, randomized study.” Eur Rev Med Pharmacol Sci. 2003 Sep-Oct; 7 (5): 127-30.
Krebs, FC et.al. “Polybiguanides, particularly polyethylene hexamethylene biguanide, have activity against human immunodeficiency virus type 1.” Biomed Pharmacother. 2005 Sep; 59 (8): 438-45.
COMPUNDING FOR PAIN MANAGEMENT Chronic Pain and Compounding Pharmacy Different strength of mixed of compounds including
Morphin Hydromorphone
Which is five times more potent than morphin with lower incidence of side effects
Bupivicaine Local anesthetics block the generation and the conduction of
nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential
Department of Neurological Surgery. Spinal cord stimulators and Spinal Pumps.http://www.cumc.columbia.edu/dept/nsg/NSGCPMC/specialties/spinestim.htmlPain Management Compounding http://www.bbpharmacy.com/paincompounding.html
METHOD OF DELIVERY Small doses of the opioid are delivered close to their
receptors in the dorsal horn of the spinal cord, resulting in high local concentration.
Fine catheters are placed within the epidural space or within the cerebrospinal fluid in the subarachnoid space.
Catheters may be tunnelled subcutaneously to exit under the skin at an accessible site. They are attached to a bacterial filter for intermittent or continuous drug administration or, alternatively, may be connected to a subcutaneously implanted reservoir or pump delivery system, which can function for weeks or months.
Department of Neurological Surgery. Spinal cord stimulators and Spinal Pumps.http://www.cumc.columbia.edu/dept/nsg/NSGCPMC/specialties/spinestim.htmlPain Management Compounding http://www.bbpharmacy.com/paincompounding.html
Alternative Pain Management
Most important of all, different dosages are prepared in these compounding pharmacies to fit with the patient’s pain characteristics, also with reduce of side effects of opioids in previous form of usage ( non-compounding pills and dosages). Compounding pharmacies prepare the pain medication for effective response that has not been achieved with previous treatments.
Department of Neurological Surgery. Spinal cord stimulators and Spinal Pumps.http://www.cumc.columbia.edu/dept/nsg/NSGCPMC/specialties/spinestim.htmlPain Management Compounding http://www.bbpharmacy.com/paincompounding.html
Case Study Introduction 63 yr old male Avid deep sea fisherman Has used Transderm Scop (scopolamine) patch
every summer weekend for nearly 20 years Has developed a severe, persistent, painful rash
behind both ears due to the adhesive Has tried various other motion sickness
treatments with no comparable effect
Case Study Conundrum
Would rather endure the pain and rash (and possible longer term effects) rather than not use the patch
The patient is a pharmacist
Alternative Solution
Scopolamine Hydrobromide compounded with Pluronic Lecithin Organogel (PLO)
Provides sustained drug delivery similar to the patch
No adhesives Demonstrated effect in as far back as
1992
Pluronic Lecithin Organogel (PLO)
Liquid a refrigeration temperaturesEasy to mix and measure
Cream at room/body temperaturesEasy to applyVery little mess
Conclusions Mass manufactured products target the masses
Not all drugs are right for all patients Not all drug combinations are right for all patient Not all delivery modes are right for all patients
Know what you don’t know Even an experienced pharmacist can be oblivious to
an established solution to a problem
Additional References Student Site Evaluation