Amiodarone to prevent recurrence of atrial fibrillation.
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Amiodarone↗
Biomedical subjects
E M Furmaga
Publications and source records attributed to E M Furmaga.
Ambulatory care certificate program for pharmacists.
An ambulatory care certificate program tailored to meet the educational needs of Department of Veterans Affairs (VA) and Navy pharmacists is described. In 1992, the College of pharmacy, University of Illinois at Chicago, worked with the VA and the Navy to design an ambulatory care certificate program for pharmacists in VA and Navy hospitals. The pilot course consisted of 103 hours of didactic and experiential education. The 10 didactic modules covered both disease management and clinical skills. The experiential component incorporated pharmaceutical care steps as applied to therapeutic areas taught in the course. Although the pilot course met most of the original objectives, several unanticipated problems emerged, including distance learning issues, the number of hours for completing the course requirements, learner variance, the impact of institutional support on participants' academic success, participants' difficulty in assimilating education into practice, and difficulty with the clinical evaluation tool developed for the course. The course was modified over the next year to address these problems. Now in its fourth year, the course is offered nationally to the VA and the Department of Defense. In the first three years, 72 of 99 enrolled pharmacists completed the course. An ambulatory care certificate program helps Navy and VA pharmacists develop patient care skills.
Ambulatory Care↗
Isolated systolic hypertension in older patients.
Pathophysiologic changes and risks associated with isolated systolic hypertension (ISH) are described, findings of clinical trials pertaining to ISH are summarized, and recommendations for management are provided. ISH is the most frequent type of hypertension in patients over 65 years of age and is associated with increased cardiovascular and cerebrovascular morbidity and mortality. Decreased arterial compliance, increased peripheral vascular resistance, changes in cardiac output, decreases in plasma renin activity, and reduced beta-adrenergic function are all possible mechanism contributing to hypertension in older patients. Environmental factors that may contribute to hypertension in this population include diet, exercise, and salt sensitivity. Currently, the Systolic Hypertension in the Elderly Program (SHEP) is the only study that has evaluated the efficacy of treating ISH. The risk of stroke was lowered in patients who received low doses of the diuretic chlorthalidone, which was well tolerated with minimal adverse effects. Thiazide diuretics, beta-blockers, angiotensin-converting-enzyme inhibitors, calcium antagonists, and isosorbide dinitrate have been shown to lower systolic blood pressure (SBP) in patients with ISH. Because the SHEP study is the only trial to document a decrease in morbidity, diuretics are considered firstline therapy for patients with a SBP of > or = 160 mm Hg. In older patients, it is prudent to initiate antihypertensive therapy at lower doses with a more gradual increase in dosage. The SHEP trial demonstrated a significant reduction in morbidity with a trend toward decreased mortality when patients with ISH received pharmacologic treatment. More studies are necessary to determine whether other antihypertensive agents will have similar effects on mortality in patients with ISH.
Aged↗
Pharmacist management of a hyperlipidemia clinic.
A hyperlipidemia clinic in which a pharmacist provides primary care is described. The clinic was established at a Veterans Affairs medical center in January 1990. A pharmacist performs limited physical assessments, refers patients to other clinics as necessary, orders laboratory and diagnostic tests, and selects and monitors the use of lipid-lowering medications. Interventions are performed according to the pharmacist's clinical judgment; there is no set protocol. Recommendations for patient management are approved by an attending physician, who prescribes the antilipemic drugs. The pharmacist teaches patients about hyperlipidemia, the impact of diet and life-style, and the mechanism of action, administration, and adverse effects of the antilipemics prescribed. The pharmacist also monitors compliance, laboratory test values, and the response to treatment. Treatment is modeled after the recommendations of the National Cholesterol Education Program. If a patient has not achieved the targeted cholesterol concentration after receiving dietary therapy for three months, further education about diet and lifestyle is provided. If, after three more months, the cholesterol level remains high, drug therapy is begun. Four antilipemic drugs--colestipol, gemfibrozil, lovastatin, and niacin--are used in the clinic. Since it began operating, the clinic has enrolled 284 patients. Compliance with the lipid-lowering agents has ranged from 43% to 100%. Adverse effects have accounted for the majority of cases of noncompliance. A pharmacist provides primary care for patients with hyperlipidemia in an ambulatory-care clinic.
Chicago↗