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Cynthia K Kirkwood

Publications and source records attributed to Cynthia K Kirkwood.

5 recordsLinked to original sources
PubMed2006

Development of a competency-based assessment process for advanced pharmacy practice experiences.

OBJECTIVES: To develop and implement a competency-based assessment process for the experiential component of a pharmacy education curriculum. DESIGN: A consultative process was used in the development of new assessment forms and policies, and a survey regarding student and faculty satisfaction was conducted. Information received from the survey and from consultations with faculty preceptors resulted in revision of the forms in subsequent years. ASSESSMENT: Faculty and student perceptions of the assessment process were generally positive. We were moderately successful in reducing grade inflation. The new process also provides the school with data that can be used to evaluate the effectiveness of our curriculum in preparing students for practice. CONCLUSIONS: Development and implementation of a competency-based assessment process require a considerable amount of work from dedicated faculty members. With health professions schools under pressure to provide evidence of their graduates' clinical competence, this is a worthwhile investment.

Competency-Based Education↗
PubMed2006

Polypharmacy in a 75-year-old patient with schizoaffective disorder.

A 75-year-old white female with schizoaffective disorder was admitted to an inpatient psychiatry unit for uncooperativeness in refusing to take scheduled medications. She complained of anticholinergic adverse effects and had abnormal involuntary movements in the oral/buccal region. The patient had been prescribed six psychotropic medications (i.e., thiothixene, lithium, divalproex sodium, amitriptyline, benztropine, and trazodone effects. The treatment team determined that the patient was noncompliant and experienced the effects of polypharmacy. She had been prescribed two mood stabilizers and suffered from anticholinergic adverse effects and the movement disorder tardive dyskinesia (TD). Four medications were discontinued: thiothixene, amitriptyline, lithium, and benztropine. Quetiapine, a second-generation antipsychotic, was recommended, with a daily titration schedule to reach a target dose of 600 mg per day in divided doses. This agent has less propensity to cause movement disorders compared with first-generation antipsychotics. All medications with additive anticholinergic properties also were discontinued. Lithium was stopped secondary to subtherapeutic levels and potential drug interactions. The pharmacist educated the inpatient team on the additive anticholinergic effects of each medication, reduced the total number of medications prescribed, and assisted in appropriate conversion to quetiapine to reduce TD symptoms.

Aged↗
PubMed2005

Eszopiclone for insomnia.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy data, and adverse effects of eszopiclone in the treatment of transient and chronic insomnia in adult and geriatric patients. DATA SOURCES: A MEDLINE literature search (1966-May 2005) was conducted to retrieve articles and abstracts involving eszopiclone. The manufacturer of the drug provided a general summary of clinical data and abstracts of unpublished Phase III clinical trials. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were reviewed, and information deemed relevant was included for this review. DATA SYNTHESIS: Food and Drug Administration approval of eszopiclone was based on 6 double-blind, placebo-controlled trials. Five trials published in abstract or study form were reviewed. The sixth trial was not available for evaluation. An open-label continuation trial was also reviewed. All studies showed statistically significant improvements in sleep parameters in adult and elderly patients treated for insomnia with eszopiclone. CONCLUSIONS: The results of the 5 available double-blind, placebo-controlled studies (and 1 open-label, 6-month extension) showed that eszopiclone was safe and effective in the treatment of transient and chronic insomnia in adult and geriatric patients. Tolerance with long-term exposure (6 mo) and rebound insomnia were not observed. The results of the 6-month, open-label extension trial demonstrated that improvements in sleep parameters were sustained. Future studies comparing eszopiclone with other non benzodiazepine sedative-hypnotics (eg, zolpidem, zaleplon) are needed with cost data to clearly define the role of eszopiclone in the pharmacotherapy of chronic insomnia.

Azabicyclo Compounds↗
PubMed2003

Advances in pharmacotherapy of psychotic disorders in the elderly.

OBJECTIVE: To evaluate the literature on the pharmacotherapy of psychosis in the elderly. DATA SOURCES: Searches of MEDLINE (1996-April 2002) and the Cochrane Database using the terms psychosis, elderly, geriatric, dementia, Alzheimer's disease, Parkinson's disease, antipsychotics, atypical antipsychotics, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and haloperidol were performed. An updated search of psychosis, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole occurred in April 2003. STUDY SELECTION: Reviews, case reports, and open-labeled and controlled trials were selected. DATA SYNTHESIS: Psychotic symptoms in the elderly can occur in the context of psychiatric disorders, medical conditions, or as a medication complication. Behavioral problems (e.g., agitation, aggression) can accompany psychosis and may not respond to nonpharmacological strategies. Pharmacological management of psychosis in the elderly with typical antipsychotics (e.g., haloperidol, chlorpromazine) can result in intolerable adverse effects (e.g., sedation, anticholinergic effects, extrapyramidal symptoms, tardive dyskinesia, and orthostatic hypotension). The atypical antipsychotic agents (e.g., risperidone, olanzapine, quetiapine, ziprasidone) and the dopamine-serotonin system stabilizer aripiprazole offer more tolerable adverse effects profiles. Most information supporting the use of the atypical antipsychotics is derived from open-label trials involving patients with dementia or Parkinson's disease; however, data from large randomized, controlled trials is emerging. In general, psychosis in elderly patients responds to low doses of antipsychotics. Patients must be monitored closely for adverse effects, especially in light of the new information associating cerebrovascular adverse events with risperidone in patients with dementia. Further trials are required to determine if this is a disease- or drug-specific phenomenon. CONCLUSION: Psychosis in elderly patients can be managed with antipsychotic agents. The atypical antipsychotics are effective and offer advantages over typical antipsychotics with regard to a reduced rate of adverse effects.

Journal Article↗