BACKGROUND: Osteoporosis is underdiagnosed, and rural communities often have limited technical resources for the assessment of osteoporosis. OBJECTIVE: To evaluate the impact of a pharmacist, trained in the use of a portable heel ultrasound device, in screening elderly rural women for risk of osteoporosis and determine whether those found to be at risk seek further help and treatment from their general practitioner (GP) following screening. METHODS: Following promotion of the service, 345 women were recruited from 6 rural community pharmacies in Tasmania, Australia, and underwent quantitative heel ultrasound screening. Women were comprehensively educated on risk factors for osteoporosis and completed a calcium intake questionnaire. Results were forwarded to each woman's GP, and the participants were followed up 3 months later to assess outcomes from the screening procedure. RESULTS: Approximately 20% of women were shown to be at high risk for osteoporosis; 201 (58%) of these were referred to their GP for further assessment. Sixty-eight percent of women who were screened discussed their results with their GP, and 11% underwent further investigation. Over one-third of women screened began medication (30% calcium, 6% bisphosphonate, 6% vitamin D) for osteoporosis. CONCLUSIONS: Pharmacist-provided screening for osteoporosis in rural areas is a potentially useful method to identify women at risk for fracture and a convenient time point for discussion of preventive therapy.

Absorptiometry, Photon↗

PubMed2005

Thalidomide-associated thrombocytopenia.

OBJECTIVE: To report thrombocytopenia in a patient prescribed thalidomide for multiple myeloma (MM). CASE SUMMARY: A 70-year-old woman was diagnosed in 2003 with MM. At diagnosis, melphalan 0.25 mg/kg/day and prednisolone 2 mg/kg/day were started; however, the patient became refractory to therapy. Melphalan and prednisolone were discontinued, and monotherapy with dexamethasone 40 mg for 12 days per month was started. The patient's hematologic condition deteriorated again after about one year; dexamethasone was discontinued, and treatment with oral thalidomide 200 mg/day was initiated. About 2 weeks after thalidomide administration, the woman developed disabling adverse effects (flu-like symptoms, swollen fingers, rash and hematoma on her legs, shortness of breath, dry mouth, multiple petechiae). Laboratory testing showed neutropenia (neutrophils 0.4 x 10(9)/L) and thrombocytopenia (platelets 58 x 10(9)/L). Thalidomide was promptly discontinued; within 3 weeks, the laboratory values returned to pretreatment levels (1.3 x 10(9)/L and 267 x 10(9)/L, respectively) and her symptoms disappeared. DISCUSSION: Thrombocytopenia is a rarely reported hematologic adverse consequence of thalidomide therapy. A recent report identified 5 patients who developed thrombocytopenia while undergoing monotherapy with thalidomide for MM. According to the Naranjo probability scale, thalidomide was classified as the probable cause of thrombocytopenia in our patient. CONCLUSIONS: Unlike other antineoplastic drugs, thalidomide is rarely reported to cause severe hematologic toxicity. We present this case to increase clinicians' awareness for the potential of thalidomide to adversely affect platelet counts, particularly because its effectiveness in MM will likely result in expansion of its clinical use.

Administration, Oral↗

PubMed2005

Drug costs developments after patent expiry of enalapril, fluoxetine and ranitidine: a study conducted for the Netherlands.

BACKGROUND: In order to increase price competition, government regulations focus on controlling drug costs. Drug costs after patent expiry are an area of particular interest because the substitution of branded medication with generics represents an opportunity for lowering drug costs. However, drug costs may not decrease after patent expiry, because of a lack of price competition and different national pricing systems. AIM: The aim of this study was to investigate the trends in the use of generics after patent expiry for enalapril, fluoxetine and ranitidine and the subsequent changes, if any, in the costs of these medications. METHODS: A drug-utilisation study was performed using data from a large sample of Dutch pharmacies. Both volumes (measured as defined daily doses [DDD] per 1000 population) as well as drug costs (calculated per DDD) prior to and after patent expiry were calculated. Costs per DDD were compared using trend-line analysis. In addition, the relative market shares of the different trade channels (branded, parallel imported and generic) were compared before and after patent expiry. RESULTS: The costs per DDD decreased for all three drugs and, as expected, these costs decrease more rapidly after patent expiry. Significant differences in the trend lines were found for enalapril and fluoxetine. CONCLUSIONS: Despite relatively high reimbursement prices for generics in the Netherlands, this example from the Dutch pharmaceutical market demonstrates the benefit of generic substitution for containing pharmaceutical costs, which contrasts with concerns raised by the Dutch government.

Anti-Ulcer Agents↗

PubMed2004

Addressing information needs in the management of osteoporosis.

Explore the source record for details and available documents.

Adrenal Cortex Hormones↗

PubMed2004

Multifaceted educational program increases prescribing of preventive medication for corticosteroid induced osteoporosis.

OBJECTIVE: Despite evidence that oral corticosteroids increase fracture risk and the existence of guidelines for the prevention of corticosteroid induced osteoporosis, few patients prescribed longterm corticosteroids receive osteoporosis prevention. We performed a controlled trial of a comprehensive educational program aimed at increasing the use of osteoporosis preventive therapy in patients prescribed longterm oral corticosteroids. METHODS: The intervention was conducted in Southern Tasmania, Australia, using Northern Tasmania as a control area. All general practitioners and community pharmacies were sent educational material and locally produced guidelines on the prevention of corticosteroid induced osteoporosis. This was followed by academic detailing visits and reminders. Pharmacists were provided with supplies of an educational refrigerator magnet, intended for patients. Outcomes were measured using evaluation feedback from the general practitioners and pharmacists, and drug utilization data provided by (1). a series of patients presenting to hospital and taking oral corticosteroids for at least 3 consecutive months; and (2). dispensing of osteoporosis preventive therapy under the Australian Pharmaceutical Benefits Scheme. RESULTS: The prevalence of osteoporosis preventive therapy increased from 31% of admitted hospital patients taking longterm oral corticosteroids to 57% postintervention (p < 0.0001). The use of bisphosphonates (6% to 24% of patients), calcium (5% to 19%), and vitamin D (3% to 11%) all increased significantly. Prescription data also indicated a significant (p < 0.01) increase in the use of osteoporosis preventive therapy in the intervention region. CONCLUSION: A multifaceted education program, incorporating academic detailing of general practitioners and community pharmacists, increased the use of osteoporosis prevention strategies in longterm oral corticosteroid users.

Adult↗

PubMedDate not supplied

Estradiol gel: review of the pharmacology, pharmacokinetics, efficacy, and safety in menopausal women.

OBJECTIVE: To review the pharmacology, pharmacokinetics, safety, and efficacy of a gel containing estradiol that is applied to the skin. DESIGN: MEDLINE and EMBASE searches were conducted from 1966 to March 2005. Additional references were identified from bibliographies from selected studies in addition to approved product information. RESULTS: Estradiol gel is indicated for the relief of moderate to severe vasomotor symptoms in menopausal women, and moderate to severe symptoms of vulvar and vaginal atrophy. Women who are intolerant of the oral route, have had previous hypersensitivity skin reactions, or have had difficulties with adhesive patches are ideal candidates for estradiol gel. CONCLUSIONS: Estradiol gel can effectively reduce menopause symptoms with minimal side effects. Long-term safety data of estradiol gel are required.

Administration, Cutaneous↗