Davis\u27s drug guide for nurses

https://jdc.jefferson.edu/jeffersonfacultybooks/1014/thumbnail.jp

Clinical observations with the amiodarone/warfarin interaction: Dosing relationships with long-term therapy

Objectives: The interaction between amiodarone and warfarin has only been described in patients being followed up for relatively short time periods. The objectives of this study were to characterize the interaction between these two agents in a clinical situation over a longer period of time in a larger cohort of patients, and to determine the relationship between the maintenance dose of amiodarone and the resultant need to adjust the dose of warfarin. Design: This was an observational trial of a cohort of patients receiving a stable warfarin regimen in whom oral amiodarone was initiated. Patients received both amiodarone and warfarin for at least 1 year, and the dosage of warfarin was adjusted as clinically necessary to achieve an international normalized ratio of 2 to 3. Data from a total of 43 patients were analyzed. Results: At baseline, prior to initiation of amiodarone, the warfarin dose was 5.2 ± 2.6 mg/d. The magnitude of the interaction between these two agents peaked at 7 weeks, which resulted in a 44% mean maximum reduction in the warfarin dose. The warfarin dose inversely correlated with the maintenance dose of amiodarone (r2 = 0.94, p \u3c 0.005). Minor bleeding episodes occurred in five patients (12%). For patients receiving amiodarone maintenance doses of 400, 300, 200, or 100 mg/d, it is recommended that the daily warfarin dose be reduced by approximately 40%, 35%, 30%, or 25%, respectively. Conclusions: The magnitude of the amiodarone/warfarin interaction is highly dependent on the maintenance dose of amiodarone. This relationship can aid clinicians in adjusting the dose of warfarin patients receiving long-term amiodarone treatment

Interprofessional Education in Didactic and Experiential Settings at the Jefferson School of Pharmacy

Presented at: 2012 Annual Meeting of the American Association of Colleges of Pharmacy in Kissimmee, Florida. Objective: To evaluate the various IPE offerings at a new school of pharmacy at a large academic medical center

Torsades de pointes associated with methadone and voriconazole

This report concerns a case of torsades de pointes (TdP) associated with the concomitant administration of methadone and voriconazole in a patient with comorbid medical conditions. A 57-year-old man, with a medical history of human immunodeficiency virus, infective endocarditis, hepatitis C and orbital Aspergillus infection, was admitted to the intensive care unit following several episodes of TdP. The patient was being treated with methadone for opioid addiction and had started taking voriconazole 2 weeks prior for orbital Aspergillosis. He experienced multiple episodes of TdP with a prolonged QTc interval (>600 ms). The pronounced inhibitory impact of voriconazole on methadone metabolism via the cytochrome P450 (CYP)2B6 isoenzyme was identified as a probable cause of the arrhythmia. Voriconazole was subsequently temporarily withheld and the methadone dose was significantly reduced. The patient received an implantable cardioverter-defibrillator, did not experience additional episodes of TdP during hospitalisation, and was discharged from the hospital on day 13

Title: Student Readiness For Interprofessional Learning: Baseline and Midpoint in the Jefferson Health Mentor Program

Objectives: To measure pharmacy student readiness for interprofessional education (IPE) and compare the results to medical, nursing, occupational therapy (OT), and physical therapy (PT) student peers using the Readiness for Interprofessional Learning Scale (RIPLS). Methods: First-year medical, nursing, OT, pharmacy, and PT students (n=544) participate in a 2-year longitudinal, interdisciplinary curriculum where they are assigned to a team including a Health Mentor (patient volunteer with chronic condition). Aims include understanding team roles and patient-centered care. All students complete the RIPLS at baseline and after completing years 1 and 2. RIPLS contains 3 subscales related to readiness for IPE: 1.)teamwork and collaboration; 2.)professional identity; and 3.)roles and responsibilities. Results: At baseline, using the total RIPLS score, significant differences were observed between medicine and nursing, OT, and pharmacy (all p-values \u3c0.05) with the latter 3 disciplines appearing to be more ready for IPE. Pharmacy (n=70) scored significantly higher than medicine in subscale 1 (p=0.028), subscale 2 (p=0.003), and subscale 3 (p=0.005). The RIPLS results for this cohort at the end of year 1 will be collected and analyzed in April 2009. Implications: Identifying differences in baseline readiness for IPE allows all programs participating in the delivery of this longitudinal curriculum to recognize the strengths and areas of improvements. Information will be used in improving the orientation to and curricular components of the program

Workshop #3: Interprofessional Education Knowledge and Skills Development

Objectives: 1. Categorize the elements of successful interprofessional curricular design. 2. Produce an interprofessional action plan for existing courses