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Addiction Pharmacy Presented by the Student College of Clinical Pharmacy — UGA College of Pharmacy, a student chapter of ACCP Clinical Pharmacist Spotlight: Addiction Pharmacy What is the role of a pharmacist in addiction pharmacy? Addiction Pharmacy is the study of three separate distinct, but closely connected areas of pharmacotherapy in a patient that is diagnosed with an addictive disease and the co-occurring disease states of mental illness and/or acute/chronic pain. This patient is particularly difficult to manage due to the vast complexities of the multiple disease states and needs continual evaluation of pharmacotherapies and other treatment modalities (psychotherapy, pain management, etc.). What types of things do you do at your practice site? I encounter a variety of disease states in this clinic so I provide evaluation, assessment, intervention and treatment strategies to the patient’s treatment team for the following: Substance Use Disorders (Chemical and Behavioral) - ambulatory detoxification of alcohol Dr. Merrill Norton, and withdrawal, benzodiazepine withdrawal, and opioid withdrawal; PharmD, PhD, ICCDP-D Anxiety (assessment and screening); Bipolar Disorder (assessment and screening); Depression (assessment and screening) Inside this issue: Tobacco Use Disorder (interventions and pharmacotherapy); Acute/chronic pain (assessment and follow-up); Clinical Pharmacist 1 I also provide ongoing drug information lectures on the neurobiology and Spotlight pharmacogenomics of addiction, and the appropriate use of medications in recovery to patients and their families. Other disease states that are commonly encountered are Levaquin ADR 2 metabolic syndrome, insomnia, liver disease, and GERD. Update New Rheumatoid What do you think should change in the field of addiction pharmacy? 2 Arthritis Treatment Simply to educate all pharmacists to the basics of addiction pharmacy. I have spent over 25 years of my career as an international clinical pharmacist consultant assisting Andexanet: Factor Xa 3 physicians and psychiatric institutions with drug information about addiction, psychiatric, and Inhibitor Reversal pain management medications. Addiction pharmacy requires an understanding of drug New App for information and how to communicate this information to patients, family members, and 3 Pharmacy treatment teams- both of these skill sets are NOT a part of the current Pharm.D. curriculum nationally. My plan is to develop a two year addiction pharmacy residency at the University of Georgia College of Pharmacy. Topicals for Sunburn 4 Idiopathic Why is it important for the student pharmacist to understand addiction? 4 There are two reasons for student pharmacists to understand addiction: 1.) Over 40-50% of the Pulmonary Fibrosis patients the student pharmacist will treat in their careers will have experienced an addiction or be affected by a loved one’s addiction; 2.) The student pharmacist may also be high risk for Travel Vaccinations 5 developing addiction, anxiety, and depression. The pharmacy profession has been somewhat slow Avycanz Drug in appropriately training the student pharmacist to these risks and outcomes. 6 Monograph continued on page 3... Page 2 Student Clinical Digest Dangers of Mislabeling: Levaquin Use and the Increased Risk for Peripheral Neuropathy In 2014, a lawsuit was filed by a woman in California after being Levaquin, can lead to a 30% increased risk of peripheral diagnosed with peripheral neuropathy caused by her use of neuropathy2. It was discovered that the risk of peripheral Levaquin (levofloxacin), a popular antibiotic and fluoroquinolone1. neuropathy development was highest among new users of Peripheral neuropathy is a serious condition that can be described fluoroquinolones. This case emphasized the necessary change of as damage to the peripheral nervous system resulting in warning labels by the drug manufacturers to highlight the increased miscommunication between the central nervous system and the prevalence of peripheral neuropathy occurrence in patients who remaining parts of the body. Patients who suffer from peripheral are taking fluoroquinolones in hopes to increase patient awareness neuropathy could experience symptoms such as numbness, burning and safety. pain, paresthesia, muscle weakness, and allodynia. Extreme cases By: Ashni Patel, PharmD Candidate & Justin Moore, PharmD can result in complications including rhabdomyolysis, paralysis, and Candidate organ dysfunction. The patient complained that the warning label mislead her to believe that peripheral neuropathy associated with Levaquin and other fluoroquinolones was rare. In addition, the lawsuit stated peripheral neuropathy cannot always be avoided by discontinuing the use of Levaquin. The patient also alleged that this debilitating side effect was “buried at a long list of adverse reactions1”. In 2013, the Federal Food and Drug Administration (FDA) issued References: a label change for all oral fluoroquinolones based on published case 1. Grossman v. Johnson & Johnson. United States Northern District of reports and reports from the Adverse Event Reporting System in California. 06 Aug. 2014. order to emphasize that peripheral neuropathy can occur rapidly 2. Etminan M, Brophy JM, Samii A. Oral fluoroquinolone use and risk of while using Levaquin. According to a study at the University of peripheral neuropathy: A pharmacoepidemiologic study. Neurology 2014; Washington Seattle, the use of fluoroquinolones, including Epub 2014 Aug. 22. Ache No More! New Drug Therapy for Rheumatoid Arthritis Rheumatoid arthritis (RA) is an monotherapy.4,5 Sarilumab is the first fully fully human antibodies is a revolutionary autoimmune disease in which the body’s human monoclonal antibody targeting IL-6 concept that is expected to continue immune system mistakenly attacks the receptors, thereby inhibiting the cytokine- throughout future drug developments for joints, causing inflammation and joint mediated inflammatory pathway.3 RA and other autoimmune disease damage. RA typically affects women ages 30 Historically, non-human antibodies, which treatments. to 60. Patients experience symptoms such typically come from mouse cells, have By: Allyson Cox, PharmD Candidate as pain, fatigue, morning joint stiffness, and elicited immune responses since the mouse 1 red swollen joints. Based on the guidelines cells are seen as foreign. Therefore, the References: by the American College of Rheumatology, advantage of administering fully human 1Rheumatoid Arthritis. Arthritis Foundation web site. there are different treatment options monoclonal antibodies is having a decreased http://www.arthritis.org/arthritis-facts/disease- contingent upon disease activity and risk of patient rejection of the drug both center/rheumatoid-arthritis.php Updated 2015. features of poor prognosis, such as short and long term.6 Accessed April 4, 2015. 2Singh, J.A., et al. 2012 Update of the 2008 American functional limitations or rheumatoid Based on the original study, patients College of Rheumatology Recommendations for the nodules. If a patient does not have features receiving a dose of sarilumab 150 mg or 200 Use of Disease-Modifying Antirheumatic Drugs and of poor prognosis, a typical starting regimen mg subcutaneously every two weeks proved Biologic Agents in the Treatment of Rheumatoid is DMARD (disease-modifying antirheumatic to have the most favorable safety and Arthritis. American College of Rheumatology 2012; drug) monotherapy, such as methotrexate. efficacy profiles after 12 weeks of therapy.4 64: 625-639. 3Sanofi and Regeneron Announce New, Detailed Data If features of poor prognosis appear, an The most common side effect seen thus far from Positive Sarilumab Phase 3 Rheumatoid option is to start the patient on a biologic is infection. However, further studies are Arthritis Trial at EULAR. Regeneron. http:// agent in combination with the DMARD. An underway to determine additional adverse investor.regeneron.com/releasedetail.cfm? example of this regimen would be the effects. Although this is the first fully releaseid=854328. Published June 12, 2014. Accessed addition of Humira to methotrexate.2 human antibody, there are other IL-6 April 2, 2015. 4Huizinga, T.W., et. al. Sarilumab, a fully human In June 2014, Sanofi announced positive receptor inhibitors on the market for monoclonal antibody against IL-6Rα in patients with phase 3 trial results of sarilumab for the treatment in RA. Side effects for these rheumatoid arthritis and an inadequate response to treatment of RA in combination with medications, such as tocilizumab, include methotrexate: efficacy and safety results from the methotrexate.3 The study was randomized, increased cholesterol and LFTs, randomised SARIL-RA-MOBILITY Part A trial. Ann double-blinded, and placebo controlled. The neutropenia, and hypersensitivity reactions. Rheum Dis 2014; 73: 1626-34. sample size consisted of Japanese patients Therefore, these are some adverse effects ages 20 to 65 with moderate to severe RA, researchers might expect to see in future already taking methotrexate as studies.7 Transitioning from mouse cell to Page 3 Reversal Agent for Direct Factor Xa Inhibitors In the scope of anti-coagulation therapy, warfarin has performed on healthy historically been the drug of choice for oral therapy. However, due volunteers ages 50 to 75. The to its high drug interaction profile and high demand for blood patients were given Xarelto® monitoring there has been a push to see new drugs for anti- 20mg for four days to reach coagulation therapy. In recent years,
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