The Role and Responsibility of Clinical Pharmacists in Rheumatology Clinic: An exploratory study in Hong Kong

In Hong Kong, arthritis is the third leading chronic disorder among the older people. It could create a huge amount of burden on the health care system if patients cannot achieve good diseases control and have recurrent flare up of diseases. To maintain stable control and minimize acute flare up, medication adherence is essential. Studies revealed that drug education has the highest evidence in improving medication adherence. Pharmacists who are expert in drugs can provide counseling to arthritis patients, improving their drug adherence and disease activities. As a result, research evaluating the effectiveness of pharmacist counseling service on improving arthritis patients’ medication adherence and disease activities in Hong Kong has been initiated in a specialist out-patient clinic of a local acute hospital. This research aims to improve patient medication adherence and enhance medication safety. A validated Compliance Questionnaire on Rheumatology (CQR-19) is used to measure the medication adherence. From the preliminary data, over 90% of the recruited subjects are non-adherence at baseline and thus, detailed drug counseling is necessary. During the first visit, pharmacists will provide a 20 minutes drug counseling service to the referred patients. This includes discussion on drug administration schedule, importance of drug adherence, side effects management and pain management. Besides, pharmacists also have different roles in other aspects such as drug information and procurement. Pharmacists would assist in providing evidence-based information and recommendations to physicians and nurses for drug-related enquiries. These attempts to improve therapeutic outcomes and minimize medication errors, enhance medication safety and reduce hospitalization. Design of the multidisciplinary care model and results of this study would provide a reference for the future development of clinical pharmacist service in rheumatology.

1H NMR-Based Metabonomic Study of Functional Dyspepsia in Stressed Rats Treated with Chinese Medicine Weikangning

1H NMR-based metabolic profiling combined with multivariate data analysis was used to explore the metabolic phenotype of functional dyspepsia (FD) in stressed rats and evaluate the intervention effects of the Chinese medicine Weikangning (WKN). After a 7-day period of model establishment, a 14-day drug administration schedule was conducted in a WKN-treated group of rats, with the model and normal control groups serving as negative controls. Based on1H NMR spectra of urine and serum from rats, PCA, PLS-DA, and OPLS-DA were performed to identify changing metabolic profiles. According to the key metabolites determined by OPLS-DA, alterations in energy metabolism, stress-related metabolism, and gut microbiota were found in FD model rats after stress stimulation, and these alterations were restored to normal after WKN administration. This study may provide new insights into the relationship between FD and psychological stress and assist in research into the metabolic mechanisms involved in Chinese medicine.

Terlipressin Induced Severe Hyponatremia

Terlipressin is a vasopressin analogue used for its vasoconstrictor effect in the treatment of variceal bleeding. Despite its good safety profile compared to vasopressin, some adverse reactions may occur during its use – e.g. hyponatremia. We describe a case of a cirrhotic patient with active variceal bleeding treated during two separate hospitalizations with terlipressin. In both drug treatment periods, severe laboratory hyponatremia developed. After terlipressin discontinuation, mineral disbalance corrected rapidly. Positive dechallenge and rechallenge corresponding to the drug administration schedule confirms the causality between terlipressin administration and hyponatremia. Hyponatremia was preceded with substantial fluid retention in both episodes. In this case report we want to highlight the need for fluid balance monitoring immediately after first terlipressin dose, which may individually predict the patient risk for the development of hyponatremia as other risk factors have rather limited predictive value in real clinical settings.

Toxicological evaluation of long-term intravenous administration of amitraz in horses

With the aim of determining the possible toxicity of amitraz after its prolonged use in horses, six English Thoroughbred horses received intravenous injections of amitraz (0.05, 0.10 or 0.15 mg/kg) weekly for four months, constituting the experimental group. Eight other animals (control group), via the same route following the same drug administration schedule and period of time, received the vehicle, dimethylformamide. At the end of this period, blood was collected from all the animals, and a comparison was made of the means of the values obtained for the various blood analyses: complete hemogram, alkaline phosphatase, gamma-glutamyltransferase, blood urea nitrogen, lactate dehydrogenase, aspartate aminotransferase, creatine phosphokinase, glucose, albumin, total protein, creatinine, Na+ , K+, Cl- and CO2. The results for the biochemical characteristics showed that only the mean value for urea of the animals submitted to treatment with amitraz was significantly different than the mean value obtained for the control group. The analyses of the hematological characteristics showed that no significant differences between groups were observed. Similarly, the measurement of blood electrolyte levels demonstrated that long-term treatment with amitraz did not cause significant changes in the variables analyzed. The results indicate that amitraz, given in the doses employed in this study, did not show signs of inducing toxic effects in vital organs, even after prolonged administration.

Chronobiology and Clinical Activity of Dation 500 mg in Chronic Venous Insufficiency

Objective: To assess the chronobiological effect on therapeutic activity of Daflon 500 mg and to determine the optimum method of administration. Design: Multicentre, randomized, double-blind, controlled trial. Setting: Hospital outpatient clinics for vascular diseases in Hungary. Patients: Three hundred and twenty ambulatory patients with symptoms of chronic venous insufficiency randomized to three groups. Interventions: Oral administration daily of 1000 mg of Daflon 500 mg for 2 months in three different ways (morning or evening or morning and evening). Main outcome measures: Symptoms and clinical signs of chronic venous insufficiency. Results: In each group, a statistically significant improve ment was observed between the first (DO) and the last visit (D60) concerning all symptoms. Oedema disappeared in a mean percentage of patients ranging between 26% and 43%, according to the group and the side affected ( p <0.001). For the most affected leg, a significant decrease ( p <0.001) of ankle and calf circumferences was observed in each group. The first significant improvement, in comparison to DO, occurred between D15 and D30 for all symptoms and ankle circumference. The comparison between the groups did not disclose any difference concerning the improvement of symptoms and signs. Conclusion: In this study, Daflon 500 mg demonstrated its therapeutic activity in chronic venous insufficiency, irrespective of the daily drug administration schedule.

Chemo-Radiotherapeutic Management of Advanced Head and Neck Cancer

Stage III and IV head and neck cancer patients usually achieve poor therapeutic results after radiotherapy. The search for more effective treatment modalities is justified, provided that tolerance is not lower than that of the usual radiation therapy schedules. Chemotherapy has been shown to be effective, and cisplatinum and bleomycin based treatments are reported to result in objective remissions in a substantial proportion of cases. There is also experimental evidence of a radiosensitizing activity of cisplatinum. Thirty-five locally advanced head and neck cancer patients were given combined chemo-radiotherapeutic treatment consisting of a cisplatinum and bleomycin induction followed by a standard radiotherapy course integrated with weekly administrations of cisplatinum. Before radiotherapy, an overall 48.5 % objective remission rate was achieved, that rose to 85.8 % after completion of the entire treatment, with a 31.5 % complete response rate. Incidence and severity of radiation mucositis seem not to be increased, and systemic toxicity is very low, with the adopted drug administration schedule. Overall results do not show any obvious superiority over those of radiotherapy alone.