Optimizing Medication Therapy & Improving Outcomes

December 16, 2016

Drug-Induced Liver Injury: An Overview

Drug-induced liver injury (DILI) is an uncommon, but potentially fatal, cause of liver disease that is associated with prescription medications, OTC drugs, and herbal and dietary supplements (HDS). DILI has two types: intrinsic and idiosyncratic. Patient, environmental, and drug-related factors may play a role in the pathogenesis of DILI. In the United States, antibiotics and antiepileptic drugs are the most common drug classes associated with DILI, but HDS are on the rise as a cause. Management of DILI involves the removal of the offending agent and the use of N-acetylcysteine for acetaminophen-induced liver injury. Outcomes vary depending on the drug used and type of liver injury sustained. Pharmacists can play an essential role in the evaluation of DILI, especially in patients taking multiple medications and supplements. Read more.

Acute Opioid Withdrawal: Identification and Treatment Strategies

Opioid use—encompassing prescription opioids received via the legitimate healthcare system and illegal substances (e.g., heroin) obtained through illicit distribution—in the United States has increased dramatically since 2002. Abrupt discontinuation of opioids can result in acute opioid withdrawal. Symptoms of opioid withdrawal are often managed in the inpatient setting. Methadone and buprenorphine are the two medications that are FDA-approved for use in treating opioid withdrawal. Morphine is typically used to treat infants with neonatal abstinence syndrome. Several different scoring systems have been used to quantify opioid-withdrawal symptoms and to guide therapy. Pharmacists can play an essential role in identifying the appropriate use of pharmacotherapy in acute opioid withdrawal. Read more.

Cannabinoid Hyperemesis Syndrome

Marijuana, or cannabis, is commonly thought to be a benign substance without adverse effects; however, cannabinoid hyperemesis syndrome (CHS) is a sequela of chronic cannabis use. Clinicians should strongly suspect CHS in long-term users of cannabis who present with intractable nausea and vomiting and whose symptoms are relieved by bathing in hot water. A lack of response to antiemetics should assist in the diagnosis of CHS. The only treatment to successfully resolve CHS is abstinence from cannabis, although haloperidol is being studied as a potential treatment option. A patient experiencing CHS should be counseled to avoid cannabis because continued use will trigger further symptoms. Read more.

Medication Therapy Management in the News

LAMA/LABA Therapy Plays Bigger Role in New GOLD Strategy

The updated 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Strategy, a major revision of the GOLD document since 2011, focuses on individualized COPD management. Read more.

Ritalin Combined With Cognitive Therapy Shows Promise in TBI Treatment

Methylphenidate combined with cognitive-behavioral rehabilitation shows promise for traumatic brain injury patients with persistent cognitive problems, according to Indiana University School of Medicine researchers. Read more

Thiazide Diuretics Present Lower Risk of Hip, Pelvic Fractures

According to Kaiser Permanente researchers, thiazide diuretics to treat hypertension appear to be associated with a 21% lower risk of hip and pelvic fractures, as compared with some other antihypertensive medications. Read more.

Crohn’s Disease Improved by Human Antibody Used to Treat Arthritis

Ustekinumab significantly induces response and remission in patients with moderate-to-severe Crohn’s disease, according to University of California San Diego School of Medicine researchers. Read more.