Title: What you dont know can hurt your patients
1What you dont know can hurt your patients
- Ben ORourke
- Ted Williams
- Christine Wood
- Samantha Woodhouse
- Brian Zacher
- Atanaz Zargarizadeh
2Presentation Outline
- Patient Care Team/ Site Description
- Christine Wood
- Alternative Hormone Replacement Therapy
- Brian Zacher
- Alternative Anti-Infective Agents
- Samantha Woodhouse
- Alternative Pain Treatments
- Atanaz Zargarizadeh
- Alternative Anti-Emetics
- Ted Williams
- Conclusion
- Ben ORourke
3Lloyd Center Pharmacy
- Compounding Pharmacy
- Provides specialty products for animals and
humans - Major focus is on hormone replacement therapy
4Compounding
- Compounding is the process of preparing a
specialized medication for an individual patient
when the standard Rx does not fill the bill.
Nordenberg, Tamar. Pharmacy compounding
customizing prescription drugs. FDA Consumer
magazine. 2000.
5Why Compound?
- Patient may be allergic to inactive ingredients
of manufactured drug - Right dose may not be available
- Patient may need drug in a powder, liquid,
lozenge, suppository, or other form - Drugs for certain conditions are not made
6Alternative Hormone Replacement Therapy
- Large portion of business
- Help meet the individual patients specific
needs - Indications
Siglers Prescription Drug Cards. 21st Ed. SFI Med
Publishing Guyton A, Hall J. Textbook of Medical
Physiology 10th Ed. WB Saunders Co.
Pennsylvania. 2000
7Alternative Hormone Replacement Therapy
- Men thyroid deficiency, loss of strength/
endurance/ libido/ hair, prostate cancer - Women atrophic vaginitis, osteoporosis,
hypoestrogenism, breast cancer
Siglers Prescription Drug Cards. 21st Ed. SFI Med
Publishing Guyton A, Hall J. Textbook of Medical
Physiology 10th Ed. WB Saunders Co.
Pennsylvania. 2000
8Hormones
- Progesterone
- EstrogensE1, E2, E3
- Premarin
- Testosterone
- Soy
- Wild Yams
www.hormoneprofile.comGuyton A, Hall J. Textbook
of Medical Physiology 10th Ed. WB Saunders Co.
Pennsylvania. 2000
9(No Transcript)
10Chrysin
- Stabilizes Testoserone
- Induces UDP-Glucoronosyltransferase (UGT)
http//toxsci.oxfordjournals.org/cgi/content/full/
82/1/70http//dmd.aspetjournals.org/cgi/content/f
ull/28/9/1077Lacy, J LexiComp Drug Information
Handbook 13th Ed. 2005
11Baquacil polyhexamethylene biguanide (PHMB)
- A compound having a broad spectrum activity and
low toxicity - Ophthalmology
- A common swimming pool biocide
- Protection against bacteria and algae without
the harsh effects of chlorine
12Acanthamoeba Keratitis
- Acanthamoeba
- Small, free-living protozoa commonly found in
water - Lives in two forms
- Trophozoite
- Cyst form
- Patients notice pain, photophobia, and irritation
- Clinical characteristics include stromal ring
infiltrate, epithelial haze, and radial
keratoneuritis - Combination therapy is used to treat
- PHMB for trophozoites
- Eye Drop that is made at Lloyd Center Pharmacy
- Chlorhexidine for cysts
Radial Keratoneuritis
Hassanlou, M et.al. Bilteral acanthamoeba
ketatitis and treatment strategy based on lesion
depth. Can J Ophthalmol, Vol. 41, No 1, 2006.
13Other Uses
- Bacterial Vaginosis
- Most common vulvovaginal infection
- Mouth Rinses
- Inhibits re-growth of plaque
- Reduces oral bacterial counts
- HIV
Rosin, M et. al. Effect of a polyhexamethylene
biguanide mouthrinse on bacterial counts and
plaque. J Clin Periodontol. 2001 Dec 28
(12) 1121-6. Gerli, S, Rossetti, D, and Di
Renzo GC. A new approach for the treatment of
bacterial vaginosis use of polyhexamethylene
biguanide. A prospective, randomized study.
Eur Rev Med Pharmacol Sci. 2003 Sep-Oct 7 (5)
127-30. Krebs, FC et.al. Polybiguanides,
particularly polyethylene hexamethylene
biguanide, have activity against human
immunodeficiency virus type 1. Biomed
Pharmacother. 2005 Sep 59 (8) 438-45.
14COMPUNDING FOR PAIN MANAGEMENT
- Chronic Pain and Compounding Pharmacy
- Different strength of mixed of compounds
including - Morphin
- Hydromorphone
- Which is five times more potent than morphin with
lower incidence of side effects - Bupivicaine
- Local anesthetics block the generation and the
conduction of nerve impulses, presumably by
increasing the threshold for electrical
excitation in the nerve, by slowing the
propagation of the nerve impulse, and by reducing
the rate of rise of the action potential
Department of Neurological Surgery. Spinal cord
stimulators and Spinal Pumps.http//www.cumc.colu
mbia.edu/dept/nsg/NSGCPMC/specialties/spinestim.ht
mlPain Management Compounding http//www.bbpharma
cy.com/paincompounding.html
15METHOD OF DELIVERY
- Small doses of the opioid are delivered close to
their receptors in the dorsal horn of the spinal
cord, resulting in high local concentration. - Fine catheters are placed within the epidural
space or within the cerebrospinal fluid in the
subarachnoid space. - Catheters may be tunnelled subcutaneously to exit
under the skin at an accessible site. They are
attached to a bacterial filter for intermittent
or continuous drug administration or,
alternatively, may be connected to a
subcutaneously implanted reservoir or pump
delivery system, which can function for weeks or
months.
Department of Neurological Surgery. Spinal cord
stimulators and Spinal Pumps.http//www.cumc.colu
mbia.edu/dept/nsg/NSGCPMC/specialties/spinestim.ht
mlPain Management Compounding http//www.bbpharma
cy.com/paincompounding.html
16Alternative Pain Management
- Most important of all, different dosages are
prepared in these compounding pharmacies to fit
with the patients pain characteristics, also
with reduce of side effects of opioids in
previous form of usage ( non-compounding pills
and dosages). Compounding pharmacies prepare the
pain medication for effective response that has
not been achieved with previous treatments.
Department of Neurological Surgery. Spinal cord
stimulators and Spinal Pumps.http//www.cumc.colu
mbia.edu/dept/nsg/NSGCPMC/specialties/spinestim.ht
mlPain Management Compounding http//www.bbpharma
cy.com/paincompounding.html
17Case Study Introduction
- 63 yr old male
- Avid deep sea fisherman
- Has used Transderm Scop (scopolamine) patch every
summer weekend for nearly 20 years - Has developed a severe, persistent, painful rash
behind both ears due to the adhesive - Has tried various other motion sickness
treatments with no comparable effect
18Case Study Conundrum
- Would rather endure the pain and rash (and
possible longer term effects) rather than not use
the patch - The patient is a pharmacist
19Alternative Solution
- Scopolamine Hydrobromide compounded with Pluronic
Lecithin Organogel (PLO) - Provides sustained drug delivery similar to the
patch - No adhesives
- Demonstrated effect in as far back as 1992
20Pluronic Lecithin Organogel (PLO)
- Liquid a refrigeration temperatures
- Easy to mix and measure
- Cream at room/body temperatures
- Easy to apply
- Very little mess
21Conclusions
- Mass manufactured products target the masses
- Not all drugs are right for all patients
- Not all drug combinations are right for all
patient - Not all delivery modes are right for all patients
- Know what you dont know
- Even an experienced pharmacist can be oblivious
to an established solution to a problem
22Additional References