New Cholesterol Guidelines: An Update for Pharmacists

The American College of Cardiology and American Heart Association published new blood cholesterol guidelines in November 2013. The new guidelines place an emphasis on evidence-based treatment of dyslipidemias and primarily use randomized controlled trials to create recommendations for health care providers. Major changes from the previous guidelines include eliminating low-density lipoprotein goals, the classification of statins by lipid-lowering potential and the creation of four major statin benefit groups. The new guidelines also establish the role of non-statins in dyslipidemias and use the Pooled Cohort Risk Assessment Equations to calculate patients\u27 risk for cardiovascular events and the need for cholesterol-lowering medications. Pharmacists play a vital role on the health care team and should be aware of the changes in the cholesterol guidelines in order to improve patient care

Neonatal Abstinence Syndrome: A Targeted Review for Pharmacists

Neonatal abstinence syndrome (NAS) is a disease that impacts drug-exposed infants and describes an array of issues that arise in newborns just hours after birth. Patient presentation and disease symptomatology vary widely based upon the specific substance utilized by the mother while pregnant and duration of exposure. Treatment is dependent on which symptoms are present and, assuming an opioid-derived abstinence syndrome, is based primarily on opioid supplementation to prevent symptoms of withdrawal. Treatment of non-opioid derived abstinence syndrome is often slightly more complex and involves the use of different agents depending on the drug of exposure. Due to the intricate nature of treating NAS, a team of health care professionals, including a pharmacist, should oversee management of the disease state. Pharmacists in both the inpatient and outpatient settings are in important locations to prevent and/or positively impact the outcomes for NAS

Answers About the Need for Vitamin D Supplementation

Vitamin D has a significant role in bone health, calcium homeostasis, immune function and other biological functions. In our bodies, the main source of vitamin D is linked to our skin\u27s exposure to sunlight. It can also be obtained through foods that contain vitamin D. Despite these two sources, vitamin D supplementation is often necessary. It is available in two forms, cholecalciferol and ergocalciferol as over-the-counter (OTC) products, as well as calcitriol as prescription only. Reasons for vitamin D deficiency include lack of sunlight, poor diet, malabsorption of vitamin D, liver and/or kidney disease. Vitamin D deficiencies lead to diseases such as rickets, osteomalacia and osteoporosis. During supplementation it is important to monitor for vitamin D toxicity. Pharmacists need to be aware of the various guidelines regarding vitamin D supplementation

Overview of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immunologic reactions that typically present due to drug hypersensitivity. These reactions present with serious mucocutaneous manifestations that can lead to significant morbidity and mortality. The pathogeneses of SJS and TEN have yet to be clearly elucidated, but three potential immunologic mechanisms have been defined in literature: granulysin, Fas-FasL, and perforin and granzyme B. Medications have been immunologically linked as the primary causative agents of SJS/TEN. Corticosteroids, intravenous immunoglobulin administration (IVIG) and cyclosporine have been employed as treatments; however, none have resulted in consistent positive outcomes. Pharmacists have a significant role in identifying and discontinuing the offending agent and recommending pharmacotherapy for treatment

A Review of the Guidelines and Treatment Options for Major Depressive Disorder in Adolescents

Major depressive disorder (MOD) is a disease often underdiagnosed in adolescents. For adolescents in particular, MOD can have far-reaching implications on developmental, social and emotional functioning. Unfortunately, few guidelines detail consistent means by which to evaluate and treat these patients; significantly more information exists that solely pertains to the adult population. Governing bodies such as the American Academy of Child and Adolescent Psychiatry (AACAP) and Resource for Advancing Children\u27s Health (REACH) recommend that primary care physicians be diligent in their psychiatric analyses and follow-ups with young patients who may be experiencing MOD. Both psychotherapy and medications, either as monotherapy or in combination, should be considered when treating MOD. Selective serotonin reuptake inhibitors (SSRis), particularly fluoxetine, are considered the anti-depressants of choice despite their black box warning pertaining to increased suicidality in children and adolescents. In all cases, benefits of therapy should always be assessed alongside potential risks. Pharmacists can play a significant role in counseling patients on these potential risks and benefits for both the pharmacological and nonpharmacologic aspects of MOD treatment