J. of the Am. Pharmacists Association: September/October 2004

Newswise — In addition to the below featured peer-reviewed articles, the current issue of JAPhA contains updates from APhA2004, the annual meeting and exposition held this past March in Seattle. In a special section are this year's presidential address, Remington Lecture, House of Delegates report, and listings of awards and honors.

Full-text articles are available as PDF files on the journal's Web site (http://www.japha.org)

Research

National Survey of Pharmacists About Coronary Heart Disease, Hypercholesterolemia, Nonprescription Statin Therapy, and Pharmacists' Services

James M. McKenney, J. Chris Bradberry, Robert L. Talbert, Edward Cahill, and W. Virgil Brown

James M. McKenney, PharmD, is President and CEO, National Clinical Research, Richmond, Va. J. Chris Bradberry, PharmD, is Dean, School of Pharmacy, Creighton University, Omaha, Nebr. Robert L. Talbert, PharmD, is Professor of Pharmacy, University of Texas at Austin, Austin, Tex. Edward Cahill, PhD, is Director, Applied Research & Consulting LLC, New York, N.Y. W. Virgil Brown, MD, is Charles Howard Chandler Professor of Medicine, Emory University, Atlanta, Ga.

Synopsis: A nationwide survey of 275 community pharmacists reflects general support of and interest in the availability of statins for nonprescription therapy. Most pharmacists recognized the importance of coronary heart disease (CHD) and high blood cholesterol levels to public health, and most reported that they regularly counseled patients about prescription and nonprescription treatments and encourage treatment adherence. Pharmacists also expressed concern about nonprescription statins, particularly safety, patients' ability to self-manage therapy, and out-of-pocket costs for consumers, effectiveness of low-dose statins, and patients distancing themselves from the health care system. Pharmacists were also very interested in providing a wide range of services to support patients in the use of nonprescription statins, including advising and answering questions, assisting with selection of the therapy, monitoring patients' response, and encouraging adherence.

Analysis: CHD is the most common cause of mortality in Americans. Although considerable progress in reducing CHD events has come with the introduction of statins, about 36 million patients are candidates for lipid-lowering medications but fewer than 15 million people are receiving these treatments. Could nonprescription availability of statins help address this treatment gap? Might the availability of such a tool enable the pharmacist to provide a more effective interface between consumers and their physicians? As APhA's Project ImPACT: Hyperlipidemia demonstrates, when pharmacists become actively involved in providing collaborative services to patients with high blood cholesterol, patients' persistence and adherence with therapy improves, as does the proportion of patients who achieve treatment goals. Nonprescription statins would provide pharmacists with a useful tool for enhancing such services.

Research

Men's Health Initiative Risk Assessment Study: Effect of Community Pharmacy Based Screening

Thomas C. Boyle, Jack Coffey, and Tony Palmer

Thomas C. Boyle, MBA, is Chief Operating Officer of United Pharmacy Resources, Houston, Tex. Jack Coffey, DPh, is Assistant Dean for External and Professional Affairs and Clinical Associate Professor at College of Pharmacy, University of Oklahoma, Tulsa, Okla. Tony Palmer, MBA, is Director, Continuing Education, and Clinical Associate Professor, College of Pharmacy, University of Oklahoma, Tulsa, Okla.

Synopsis: Community pharmacists encouraged men with health risks to visit physicians through screenings, counseling, and follow-up telephone calls. Men were identified for the intervention using the Men's Health Risk Assessment Tool, which screens for health issues ranging from hypertension to depression to the need for vaccination. The nearly 400 patients screened had about three significant health risks each, and 69% had not had a physical examination by a physician for periods ranging from 1 year to more than 22 years. Nearly 70% of patients who were recommended to visit a physician either did so or had scheduled an appointment within 12 weeks of the intervention. Telephone follow-up by pharmacists slightly increased the percentage of men who had examinations or made appointments for them but not significantly so. A return on investment analysis indicated that pharmacies would require payment for such services, as the number of prescriptions generated by physical examinations was insufficient to cover the cost of providing the screening and patient interventions.

Analysis: Life expectancy for men lags behind that of women. Research consistently demonstrates that men engage in fewer health-promoting behaviors and are less likely to have regular physical examinations than are women. The National Community Pharmacists Association established the Men's Health Initiative, which identified health risk assessment and interventions by pharmacists as offering a potential mechanism for helping men change their behaviors and obtain physical examinations. If pharmacists' health screening services can be funded—by patients, health plans, or employers—an enormous opportunity exists for community pharmacists to raise awareness of men's health, influence men's health behaviors, and have a positive impact on the public health of Americans.

Research

Variability in Tablet Fragment Weights When Splitting Unscored Cyclobenzaprine 10 mg Tablets

Thomas J. Cook, Shanya Edwards, Charlene Gyemah, Manoj Shah, Indu Shah, and Tiziana Fox

Thomas J. Cook, PhD, is Assistant Professor, Department of Pharmaceutics, and Shanya Edwards and Charlene Gyemah are Doctor of Pharmacy candidates, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, N.J. Manoj Shah, PhD, is Senior Director, New Products Development, Indu Shah, PhD, is Manager, New Products Development, and Tiziana Fox, PharmD, is Director, Medical Information & Communications, McNeil Consumer & Specialty Pharmaceuticals, Fort Washington, Pa.

Synopsis: Generic 10 mg cyclobenzaprine tablets are not good candidates for tablet splitting because they are film-coated and unscored. However, when physicians prescribe the 5 mg dose of this agent, some patients might be tempted or required by payers to attempt to split the generic products. In the current study, using a tablet splitter or a kitchen knife to split generic 10 mg cyclobenzaprine tablets produced tablet fragments that often deviated from pharmaceutically acceptable and compendially mandated standards. Overall, 16% of tablet fragments produced by the tablet splitter were outside compendial standards, as were 58% of fragments produced with the knife.

Analysis: Cyclobenzaprine 5 mg is equally effective but better tolerated than 10 mg doses of this agent. However, the efficacy of cyclobenzaprine 2.5 mg has been shown to be no different from placebo, and some knife-produced fragments in this study contained about this much active drug. The results from this study suggest that dispensing the commercially available 5 mg tablets may result in more predictable dosing and therapeutic responses than splitting generic 10 mg tablets.

Reviews

Efficacy of Zinc Against Common Cold Viruses: An Overview

Darrell Hulisz

Darrell Hulisz, PharmD, is Associate Professor of Family Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio, and Associate Clinical Professor of Pharmacy Practice, Raabe College of Pharmacy, Ohio Northern University, Ada, Ohio.

Synopsis: Laboratory and clinical evidence supports the medicinal value of zinc for the treatment of the common cold. Early studies reported inconsistent findings, often because of design or lozenge content inconsistencies. Three recent clinical trials with similar study designs, methodologies, and efficacy assessments provided evidence that zinc can effectively and significantly shorten the duration of the common cold if it is administered within 24 hours of the onset of symptoms. In addition, reports of trials with zinc gluconate administered as a nasal gel have supported these findings.

Analysis: Zinc preparations are widely available and promoted for the treatment of the common cold. Pharmacists should advise patients to begin zinc treatment at the very first sign of cold symptoms, ideally within 24 hours of onset. Zinc products should be continued until symptoms resolve or until otherwise advised by a physician. Pharmacists should reassure patients that the use of zinc at dosages consistent with product labeling is safe. Adverse effects are mild and are generally confined to the gastrointestinal tract. Zinc formulations for the common cold have not been systematically studied in pregnant and lactating females.

Commentary

Advancing Pharmacy Practice Through Research: A 2004 Perspective

Pharmacy Practice Research Roundtable

Synopsis: Since 1998, the Pharmacy Practice Research Roundtable has challenged the profession and provided leadership on research and policy issues related to pharmacists' roles in the U.S. health care system. In this 2004 report, roundtable members focus on how trends in health care, population demographics, and the profession itself will blend with a Medicare prescription drug benefit in the coming months. Specific research priorities are provided, with emphasis on medication therapy management services, pharmacy practice models, and dealing with the pharmacist shortage through prioritization in selecting patients for pharmacists' interventions designed to improve medication use and avoid medication errors and adverse events.

Analysis: The Pharmacy Practice Research Roundtable, which meets twice yearly, brings together a cross section of practitioners, educators, researchers, association executives, and industry representatives to discuss current trends in health care, pertinent laws and regulations, and research. The roundtable identifies developments that may affect the practice of pharmacy and develops research questions and strategies.

The American Pharmacists Association is dedicated to improving medication use and advancing patient care. Founded in 1852 as the American Pharmaceutical Association, APhA is the first-established and largest professional association of pharmacists in the United States. Our more than 50,000 members include pharmacists, scientists, student pharmacists, pharmacy technicians and others interested in advancing the profession.

APhA's World Wide Web Site: http://www.aphanet.orgAPhA's Consumer Web Site: http://www.pharmacyandyou.orgAPhA Resources for Pharmacy Professionals: http://www.pharmacist.com