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Biomedical subjects

Michael B Bottorff

Publications and source records attributed to Michael B Bottorff.

7 recordsLinked to original sources
PubMed2006

Statin safety and drug interactions: clinical implications.

The risks of muscle adverse events related to use of the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, increase significantly with the addition of interacting drugs to a patient's therapy. The mechanism for most statin drug interactions involves the cytochrome P-450 system, which provides an indication of which drugs may interact. However, it is difficult to predict the probability of a drug interaction in a given patient because there are individual differences in sensitivity to increased statin drug levels. Drug metabolism studies show simvastatin and lovastatin to be especially sensitive to the inhibiting effects of other drugs on the cytochrome P-450 3A4 (CYP3A4) isoenzyme. Atorvastatin metabolism is less affected by inhibitors of this isoenzyme. Case reports, postmarketing surveillance, and clinical trial data demonstrate the clinical effect of CYP3A4 inhibitors on statins. Also, through possible inhibition of statin biliary excretion and glucuronidation, gemfibrozil given concomitantly with rosuvastatin, lovastatin, and simvastatin significantly increases the risk of myopathy and rhabdomyolysis, a potentially life-threatening consequence of statin drug interactions.

Cytochrome P-450 Enzyme System↗
PubMed2004

Quality improvement in the continuum of care: impact of atherothrombosis in managed care pharmacy.

OBJECTIVE: To review the clinical and economic impact of atherothrombosis, the use of antiplatelet therapy for patients with atherothrombosis, and the impact of disease management programs on quality improvement and health care costs. SUMMARY: Atherothrombosis is a new term that describes the formation of a thrombus on an existing atherosclerotic plaque. While simple, this pathophysiologic mechanism underlies a vast array of vascular diseases, including myocardial infarction, ischemia, peripheral arterial disease, vascular death, and many forms of stroke. In fact, atherothrombosis is the leading cause of death worldwide. Treatment approaches include lifestyle modification and the use of pharmacologic agents such as lipid-lowering therapy, antihypertensive agents, hypoglycemic therapy, ACE inhibitors, and beta-blockers. Despite these treatments, studies have indicated that not all patients receive recommended therapies. The continuing upward spiral in health care costs in the United States has spurred numerous initiatives aimed at improving the quality of care while maintaining or reducing costs. Among these approaches to quality improvement are programs that promote adherence to evidence-based clinical data, including published guidelines, and improve the appropriate use of pharmaceuticals. Although expenditures for prescription drugs are rising, they remain a minority of overall health care expenditures, and evidence suggests that improved usage of medications can reduce other direct costs, such as hospitalizations and inpatient care, which may account for a far greater proportion of total costs. CONCLUSION: The utilization of quality improvement techniques and disease management tools can be used to improve the quality of care of patients with atherothrombosis. A key component of this strategy is pharmacologic therapy. The appropriate use of prescription drugs involves several key factors, including the proper selection of the agent based on available clinical evidence, choosing regimens that enhance patient compliance, and sound methodologies to evaluate outcomes. Improvements in the quality of care for patients with atherothrombosis can have a significant impact on the overall quality of health care as well as total costs.

Arteriosclerosis↗
PubMed2002

Combination antiplatelet therapy: implications for pharmacists.

OBJECTIVES: To present two case reports of patients who received suboptimal oral antiplatelet therapy and to review recent changes in national guidelines for management of acute coronary syndromes. DATA SOURCES: Personal observation by the authors, and clinical practice guidelines and related clinical trials of the American Heart Association and the American College of Cardiology. SUMMARY: The American College of Cardiology and the American Heart Association revised the guidelines for administration of antiplatelet and anticoagulant therapy in patients with unstable angina and non-ST-segment elevation myocardial infarction in March 2002. Two cases observed by the authors illustrate the consequences of suboptimal antiplatelet therapy when a combination of two antiplatelet drugs should have been administered. CONCLUSION: Evidence from recent randomized controlled trials led to changes in the national guidelines for administration of oral antiplatelet therapy in patients with acute coronary syndromes. Pharmacists should be aware of these changes and counsel patients about appropriate administration of antiplatelet drugs.

Adult↗
PubMedDate not supplied

Combination antiplatelet therapy: implications for pharmacists.

OBJECTIVES: To present two case reports of patients who received suboptimal oral antiplatelet therapy and to review recent changes in national guidelines for management of acute coronary syndromes. DATA SOURCES: Personal observation by the authors, and clinical practice guidelines and related clinical trials of the American Heart Association and the American College of Cardiology. SUMMARY: The American College of Cardiology and the American Heart Association revised the guidelines for administration of antiplatelet and anticoagulant therapy in patients with unstable angina and non-ST-segment elevation myocardial infarction in March 2002. Two cases observed by the authors illustrate the consequences of suboptimal antiplatelet therapy when a combination of two antiplatelet drugs should have been administered. CONCLUSION: Evidence from recent randomized, controlled trials led to changes in the national guidelines for administration of oral antiplatelet therapy in patients with acute coronary syndromes. Pharmacists should be aware of these changes and counsel patients about appropriate administration of antiplatelet drugs.

Adult↗
PubMedDate not supplied

Underidentification and undertreatment issues.

Despite the Adult Treatment Panel (ATP) guidelines and strong evidence that reduction of blood cholesterol levels favorably decreases the morbidity and mortality associated with coronary heart disease (CHD), a significant number of patients remain undiagnosed and untreated. With the aggressive detection and evaluation methods ATP III advocates, more than 65 million Americans are now eligible for lipid modification through lifestyle changes and/or drug therapy. Recent data suggest, however, that as many as 50% of all patients do not have their cholesterol assessed and less than 45% receive lipid-modifying therapy. Additionally, more than 75% of patients who receive therapy fail to achieve their National Cholesterol Education Program (NCEP) target low-density lipoprotein cholesterol goal. Persistence with therapy is another challenge, as less than 30% of patients continue with therapy beyond one year. If a realistic attempt is to be made to reduce the CHD risk among Americans, diagnosis of dyslipidemia and treatment to therapeutic targets must be improved.

Anticholesteremic Agents↗