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Medicine Use in Chronic Disease

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A special issue of Pharmacy (ISSN 2226-4787). This special issue belongs to the section "Pharmacy Practice and Practice-Based Research".

Deadline for manuscript submissions: closed (15 October 2022) | Viewed by 41659

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Dr. Elizabeth Unni

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Department of Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York, NY 10027, USA
Interests: self-management of chronic disease conditions; medication adherence; health literacy; beliefs in medicines and illnesses; medication adherence measurement; scholarship of teaching and learning

Special Issue Information

Dear Colleagues,

A chronic disease, as defined by the Centers for Disease Control and Prevention, is a condition that lasts 1 year or more and requires ongoing medical attention or limits activities of daily living or both. Globally, approximately one in three adults suffer from multiple chronic conditions. One way to manage chronic conditions is by using medicines as prescribed.

Medicine use in chronic diseases can be defined in several ways: the individual’s experience with taking medicines, the healthcare provider’s perspectives on how medicines are used by patients, impact of quality, access, and cost on medicine use, patterns of medicine use, impact of medicine use on healthcare utilization, factors that influence medication use, challenges in medication use, interventions that promote medication use, and ways to measure medicine use.

We invite you to share your research on medicine use in chronic diseases in the form of articles, reviews, meta-analyses, commentaries, and opinion pieces. We invite research papers that are both qualitative and quantitative in nature. We also invite papers that are theoretical with no empirical data. In addition to medicine use in common chronic diseases, any condition where medicine use is complicated, such as cancer, CKD, and rare conditions, is also of interest.

Dr. Elizabeth Unni
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Chronic diseases
Medicine use
Adherence
Patterns
Measures
Interventions
Experiences
Challenges
Quality
Access
Cost

Published Papers (14 papers)

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Editorial

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3 pages, 181 KiB

Open AccessEditorial

Medicine Use in Chronic Diseases

by Elizabeth Unni

Pharmacy 2023, 11(3), 100; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy11030100 - 12 Jun 2023

Viewed by 1364

Abstract

Welcome to this Special Issue on “Medicine Use in Chronic Disease” in Pharmacy, an open-access journal focusing on pharmacy education and practice [...] Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

Research

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7 pages, 875 KiB

Open AccessArticle

Enhancing Outcomes: Acceptability of Medication Formulations for the Treatment of Acute Agitation in a Psychiatric Population

by Rachel E. Walker, Leigh Anne Nelson, Carrie Kriz, Courtney A. Iuppa, Yifei Liu, Lauren A. Diefenderfer, Ellie S. R. Elliott and Roger W. Sommi

Pharmacy 2023, 11(1), 4; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy11010004 - 23 Dec 2022

Cited by 1 | Viewed by 1176

Abstract

BACKGROUND: There is limited research evaluating patient acceptability of medication formulations in the treatment of acute agitation. This study assessed patient acceptability of medication formulations (tablet, orally-dissolving-tablet [ODT], liquid, intramuscular injection [IM], inhaled device [INH]) for the treatment of acute agitation and examined correlating factors. METHODS: Adults with psychotic illness or bipolar disorder receiving emergency or inpatient services at an inpatient psychiatric facility in Kansas City, Missouri were included. Participants viewed a presentation on medication formulations for acute agitation and were surveyed on acceptability (measured on a five-point Likert scale). The primary outcome variable was the attitudinal measurement of acceptability of each formulation in correlation with the severity of agitation for use in themselves and other patients. RESULTS: One hundred participants completed the survey. Participants rated the following: (1) This medication formulation would be acceptable to treat mild agitation in themselves and others (oral tablet 85% and 48%; ODT 82% and 55%; liquid 74% and 51%; IM 53% and 74%; INH 78% and 72%); and (2) This medication formulation would be acceptable to treat severe agitation in themselves and others (oral tablet 75% and 52%; ODT 74% and 53%; liquid 66% and 53%; IM 61% and 67%; INH 77% and 72%). For treating mild agitation, participants preferred tablets and ODTs to the IM (p < 0.05) and the INH to liquid or IM (p < 0.05), for themselves; and oral formulations were preferred to the IM (p < 0.05) for other patients. For severe agitation in themselves and others, preference for the INH and IM versus oral formulations (p < 0.05) was significant, with no difference between the INH and IM (p > 0.05). CONCLUSIONS: The proportion of responses preferring oral formulations was higher than IM and INH. Dosage formulation acceptability differed depending on the severity of agitation and intended recipient of the medication. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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9 pages, 554 KiB

Open AccessArticle

Knowledge of Saudi Patients with Autoimmune Diseases about Hydroxychloroquine Toxicity: The Role of Physician–Patient Communication

by Amal Aldarwesh, Ali Almustanyir, Mazoon Alharthi and Duja Alhayan

Pharmacy 2022, 10(6), 152; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10060152 - 17 Nov 2022

Cited by 2 | Viewed by 1509

Abstract

This cross-sectional internet-based questionnaire aimed to assess the knowledge and experience of autoimmune disease patients in Saudi Arabia of the ocular effects of hydroxychloroquine (HCQ). Among the 245 respondents, discontinuation of the drug was linked to its ocular toxicity in approximately 7.3%. Most patients had taken HCQ for a period longer than five years, exceeding a dose of 5 mg/Kg. A lack of education and physician communication about medication toxicity was reported by approximately 40.8% of the participants. Despite the knowledge about HCQ retinopathy, the drug is prescribed to autoimmune disease patients at an inappropriate dosage. Knowledge obtained from physicians’ communication may improve the health outcomes of chronically ill patients. Rheumatologists and ophthalmologists should work together to recognize patients at risk of hydroxychloroquine toxicity and ensure they receive proper education and adhere to periodic follow-up. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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19 pages, 1096 KiB

Open AccessArticle

Generating Practice-Based Evidence in the Use of Guideline-Recommended Combination Therapy for Secondary Prevention of Acute Myocardial Infarction

by Mary C. Schroeder, Cole G. Chapman, Elizabeth A. Chrischilles, June Wilwert, Kathleen M. Schneider, Jennifer G. Robinson and John M. Brooks

Pharmacy 2022, 10(6), 147; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10060147 - 03 Nov 2022

Cited by 1 | Viewed by 1700

Abstract

Background: Clinical guidelines recommend beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and statins for the secondary prevention of acute myocardial infarction (AMI). It is not clear whether variation in real-world practice reflects poor quality-of-care or a balance of outcome tradeoffs across patients. Methods: The study cohort included Medicare fee-for-service beneficiaries hospitalized 2007–2008 for AMI. Treatment within 30-days post-discharge was grouped into one of eight possible combinations for the three drug classes. Outcomes included one-year overall survival, one-year cardiovascular-event-free survival, and 90-day adverse events. Treatment effects were estimated using an Instrumental Variables (IV) approach with instruments based on measures of local-area practice style. Pre-specified data elements were abstracted from hospital medical records for a stratified, random sample to create “unmeasured confounders” (per claims data) and assess model assumptions. Results: Each drug combination was observed in the final sample (N = 124,695), with 35.7% having all three, and 13.5% having none. Higher rates of guideline-recommended treatment were associated with both better survival and more adverse events. Unmeasured confounders were not associated with instrumental variable values. Conclusions: The results from this study suggest that providers consider both treatment benefits and harms in patients with AMIs. The investigation of estimator assumptions support the validity of the estimates. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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15 pages, 1997 KiB

Open AccessArticle

Effects of Adjuvant Medications on A1C, Body Mass Index, and Insulin Requirements among Patients with Type 1 Diabetes

by Armando Silva Almodóvar, Jonathan Clevenger and Milap C. Nahata

Pharmacy 2022, 10(4), 97; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10040097 - 08 Aug 2022

Cited by 1 | Viewed by 1801

Abstract

Randomized controlled trials have demonstrated that noninsulin medications used to treat type 2 diabetes can improve health outcomes among patients with type 1 diabetes (T1D). This study assessed the effects of adjuvant diabetes medications on glycated hemoglobin (A1C), body mass index (BMI), or total daily insulin (TDI) among patients with T1D in a real-world setting. This was an analysis of the T1D Exchange Clinic Registry, using the study periods of 2010–2012, 2015–2016, and 2016–2017, to assess differences in A1C, BMI, and TDI between patients with and without adjuvant medications. The relationships between characteristics and A1C in 2015–2016 and 2016–2017 were determined. Analysis included 517 patients in the adjuvant medication cohort and 4968 in the insulin-only cohort. No significant improvement in A1C was observed. A significant difference in BMI and TDI between the insulin-only (median BMI: 25.5, 26.2, 26.4 and median TDI: 45, 44 units) and adjuvant medication cohorts (median BMI: 29.8, 30.5, 30.5 and median TDI: 51, 52 units) (p < 0.001) was observed. Patients with a continuous glucose monitor (CGM), higher education level, higher annual income, and older age were associated with lower A1C (p ≤ 0.001). Higher BMI and self-description as African American/Black were associated with higher A1C (p ≤ 0.01). Insulin pump use was associated with lower A1C (p < 0.01) in 2015–2016. Patients who used adjuvant medications did not demonstrate significant improvement in disease control. These data suggest that findings from well-designed research studies may not be consistently reproducible in real-world settings, due to patient-specific factors. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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12 pages, 265 KiB

Open AccessArticle

Barriers Associated with Access to Prescription Medications in Patients Diagnosed with Type 2 Diabetes Mellitus Treated at Federally Qualified Health Centers

by Asma M. Ali, Ewan K. Cobran and Henry N. Young

Pharmacy 2022, 10(4), 79; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10040079 - 08 Jul 2022

Cited by 3 | Viewed by 1784

Abstract

This study describes access to prescription medications and examines personal, financial, and structural barriers associated with access to prescription medications in patients with type 2 diabetes treated at Federally Qualified Health Centers. We used a cross-sectional design to analyze data retrieved from the 2014 Health Center Patient Survey. Adult participants who self-reported having type 2 diabetes were included in this study. Predictor variables were categorized into personal, financial, and structural barriers. Outcomes include being unable to get and delayed in getting prescription medications. Chi-square and multivariable regression models were conducted to examine associations between predictor and outcome variables. A total of 1097 participants with type 2 diabetes were included in analyses. Approximately 29% of participants were delayed, and 24% were unable to get medications. Multivariable regression results showed that personal barriers, such as federal poverty level, health status, and psychological distress were associated with being unable to get medications. Financial barriers including out-of-pocket medication cost and employment were associated with access to prescription medications. Type of health center funding program as a structural barrier was associated with access to medications. In conclusion, multi-level tailored strategies and policy changes are needed to address these barriers to improve access to prescription medications and health outcomes in underserved patient populations. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

11 pages, 238 KiB

Open AccessArticle

Engaging Patient Advisory Boards of African American Community Members with Type 2 Diabetes in Implementing and Refining a Peer-Led Medication Adherence Intervention

by Martha A. Maurer, Olayinka O. Shiyanbola, Mattigan L. Mott and Julia Means

Pharmacy 2022, 10(2), 37; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10020037 - 10 Mar 2022

Cited by 8 | Viewed by 3505

Abstract

African Americans are more likely than non-Hispanic whites to be diagnosed with and die from diabetes. A contributing factor to these health disparities is African Americans’ poor diabetes medication adherence that is due in part to sociocultural barriers (e.g., medicine and illness misperceptions), which negatively affect diabetes management. In our prior work, we engaged with community stakeholders to develop and test a brief version of a culturally adapted intervention to address these barriers to medication adherence. The objective of this study was to elicit feedback to inform the refinement of the full 8-week intervention. We utilized a community-engaged study design to conduct a series of meetings with two cohorts of patient advisory boards of African Americans with type 2 diabetes who were adherent to their diabetes medicines (i.e., peer ambassadors). In total, 15 peer ambassadors were paired with 21 African American participants (i.e., peer buddies) to provide specific intervention support as peers and serve in an advisory role as a board member. Data were collected during nine board meetings with the patient stakeholders. A qualitative thematic analysis of the data was conducted to synthesize the findings. Feedback from the patient advisory board contributed to refining the intervention in the immediate-term, short-term, and long-term. The inclusion of African American community members living with type 2 diabetes on the advisory board contributed to further tailoring the intervention to the specific needs of African Americans with type 2 diabetes in the community. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

8 pages, 703 KiB

Open AccessArticle

Optimization of Medication Regimens in Patients with Type 2 Diabetes and Clinical Atherosclerotic Cardiovascular Disease

by Jarred Prudencio, Paige Cajudoy and Donald Waddell

Pharmacy 2021, 9(4), 186; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy9040186 - 17 Nov 2021

Cited by 2 | Viewed by 2526

Abstract

The American Diabetes Association recommends that patients with type II diabetes and atherosclerotic cardiovascular disease be prescribed an SGLT-2 inhibitor or GLP-1 agonist for cardioprotective benefit. This project assessed the use of these medications in this patient population in a rural clinic by measuring prescribing rates of SGLT-2/GLP-1 therapy before and after pharmacist interventions. Of the 60 patients identified at baseline, 39.39% (13/33) managed by a pharmacist were prescribed SGLT-2/GLP-1 therapy compared to the 14.81% (4/27) who had not seen a pharmacist (p = 0.025). Of the 43 patients that were not on SGLT-2/GLP-1 therapy at baseline, 13 were lost to follow-up and 13 had contraindications. For the 17 remaining patients, pharmacists recommended initiating SGLT-2/GLP-1 therapy and were able to successfully initiate therapy for 9 patients (52.94%). Pharmacist interventions improved the prescription rates from a baseline of 36.17% (17/47) to 55.3% (26/47) (p = 0.002), with SGLT-2/GLP-1 therapy contraindicated in 27.66% (13/47) of patients. This suggests that patients managed by a pharmacist have medication regimens that were optimized at a greater rate and pharmacists can have a positive impact on the appropriate medication usage in this population. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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Review

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15 pages, 285 KiB

Open AccessReview

The Role of Sodium-Glucose Cotransporter-2 Inhibition in Heart Failure with Preserved Ejection Fraction

by Lindsay Brust-Sisti, Nicole Rudawsky, Jimmy Gonzalez and Luigi Brunetti

Pharmacy 2022, 10(6), 166; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10060166 - 30 Nov 2022

Cited by 2 | Viewed by 2507

Abstract

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic mediations found to also reduce cardiovascular morbidity and mortality and hospitalization for heart failure. Positive results from the EMPEROR-Preserved (empagliflozin) and PRESERVED-HF (dapagliflozin) studies led to recommendations for SGLT2 inhibitors in HFpEF within major international heart failure guidelines. However, studies of ipragliflozin and luseogliflozin, agents approved outside the United States (U.S.), reported different outcomes relative to pivotal trials and failed to realize benefits in the HFpEF population. Varying definitions of HFpEF and outcomes studied complicate the interpretation of study results. SGLT2 inhibitors may cause common adverse events (genital mycotic infections, volume depletion) in addition to rare but severe sequela, including euglycemic diabetic ketoacidosis, Fournier’s gangrene, and lower limb amputation. While evidence of CV benefits grows, SGLT2 inhibitor prescribing has lagged, particularly among patients without diabetes. In the U.S., high cost and administrative hurdles may contribute to decreased patient and clinician uptake of this drug class. Future trial results and clinical experience with SGLT2 inhibitors may lead to expanded use and greater uptake among patients with heart failure. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

19 pages, 964 KiB

Open AccessReview

Recent Advances in Sickle-Cell Disease Therapies: A Review of Voxelotor, Crizanlizumab, and L-glutamine

by Michael Migotsky, Molly Beestrum and Sherif M. Badawy

Pharmacy 2022, 10(5), 123; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10050123 - 26 Sep 2022

Cited by 8 | Viewed by 4266

Abstract

Sickle-cell disease (SCD) is an inherited hemoglobinopathy, causing lifelong complications such as painful vaso-occlusive episodes, acute chest syndrome, stroke, chronic anemia, and end-organ damage, with negative effects on quality of life and life expectancy. Within the last five years, three new treatments have been approved: L-glutamine in 2017 and crizanlizumab and voxelotor in 2019. We conducted a literature search of these three medications, and of the 31 articles meeting inclusion criteria, 6 studied L-glutamine, 9 crizanlizumab, and 16 voxelotor. Treatment with L-glutamine was associated with decrease in pain crises, hospitalizations, and time to first and second crises, with a decrease in RBC transfusion rate. Barriers to filling and taking L-glutamine included insurance denial, high deductible, and intolerability, especially abdominal pain. Crizanlizumab was associated with a reduction in pain crises and time to first crisis, with reduction in need for opioid use. Adverse effects of crizanlizumab include headache, nausea, insurance difficulty, and infusion reactions. Voxelotor was associated with increased hemoglobin and decreased markers of hemolysis. Barriers for voxelotor use included insurance denial and side effects such as headache, rash, and diarrhea. These three medications represent exciting new therapies and are generally well-tolerated though price and insurance approval remain potential barriers to access. Other studies are ongoing, particularly in the pediatric population, and more real-world studies are needed. The objective of this article is to evaluate post-approval studies of crizanlizumab, voxelotor, and L-glutamine in SCD, with a focus on real-world efficacy, side effects, and prescribing data. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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10 pages, 427 KiB

Open AccessReview

Exploring a New Theoretical Model to Explain the Behavior of Medication Adherence

by Elizabeth Unni and Sun Bae

Pharmacy 2022, 10(2), 43; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10020043 - 01 Apr 2022

Cited by 7 | Viewed by 8071

Abstract

Medication adherence is essential for optimal therapeutic outcomes. However, non-adherence with long-term therapy is at 50%. Several theoretical models have identified several key factors that could explain medication adherence. Though numerous interventions have been developed based on these theoretical models, the success rates with interventions are not the best. This paper proposes a new Hierarchical Model for Medication Adherence. In this model, we propose medication adherence as a five-tier model with medication adherence as the desirable behavior on the top of the pyramid. From the bottom of the hierarchy upwards, the skills/beliefs/behaviors to be achieved are: health literacy, belief in illness (impacted by perceived susceptibility and severity of illness), belief in medicines (impacted by treatment satisfaction), and self-efficacy (impacted by social support). The model further proposes that each individual will achieve or already have these skills/beliefs/behaviors at various levels. Screening patients for these benchmarks will enable providers to decide where to target interventions. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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Other

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16 pages, 629 KiB

Open AccessProtocol

Protocol for a Pilot Randomized Controlled Mixed Methods Feasibility Trial of a Culturally Adapted Peer Support and Self-Management Intervention for African Americans

by Olayinka O. Shiyanbola, Martha Maurer and Meng-Jung Wen

Pharmacy 2023, 11(1), 2; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy11010002 - 21 Dec 2022

Cited by 1 | Viewed by 1743

Abstract

Background: Due to diabetes disparities commonly seen among African Americans, it is important to address psychosocial and sociocultural barriers to medication adherence among African Americans with diabetes. Building on our prior work testing a culturally adapted peer supported diabetes self-management intervention for African Americans, this study will conduct a pilot randomized controlled feasibility trial that compares the culturally adapted intervention with a standard diabetes self-management program. Methods: Using an intervention mixed-methods design, the six-month trial will be conducted at two sites. Twenty-four African Americans with uncontrolled type 2 diabetes will be randomized to the intervention or control arm. Feasibility and acceptability outcomes in four domains (recruitment, intervention acceptability, intervention adherence, retention) will be collected. Primary clinical outcome (A1C), secondary outcome (medication adherence) and patient-specific psychosocial measures will be collected at baseline, 2 months, and 6 months. Document review, interview and focus groups will be used to gather qualitative data on feasibility and acceptability. Results: Expected results are that the trial protocol will be feasible to implement and acceptable for participants, and there will be a signal of clinically meaningful reduction in A1C and improvements in medication adherence. Conclusions: The results of this trial will inform a future powered large-scale randomized controlled trial testing the effectiveness of the culturally tailored intervention. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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14 pages, 1001 KiB

Open AccessBrief Report

Improving Asthma Management: Patient–Pharmacist Partnership Program in Enhancing Therapy Adherence

by Tatiana Makhinova, Jamie C. Barner, Carolyn M. Brown, Kristin M. Richards, Karen L. Rascati and Arpita Nag

Pharmacy 2022, 10(1), 34; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10010034 - 17 Feb 2022

Cited by 2 | Viewed by 5458

Abstract

Community pharmacist interventions can assist in improving adherence in patients with asthma. The objective of the study was to assess the feasibility of patient-centered counseling using the developed asthma-specific tools to identify barriers to adherence and identify their preliminary effect on adherence barrier score and asthma control. Adult patients with persistent asthma were invited to participate in a 3-month pre–post intervention study involving community pharmacist-provided patient-centered counseling. Bivariate analyses were conducted to determine whether there were changes in outcomes from the pre to post period. Of 36 recruited patients, 17 completed both pre and post surveys. At baseline, patients had a mean ACT score of 15.1 ± 3.5, with 94% having uncontrolled asthma, and an average of 4.2 ± 2.5 reported barriers. The following barriers were most common: not having an Asthma Action Plan (52.9%), use of inhaler more or less often than prescribed (47.1%) and forgetfulness (41.2%). The ACT score increased by 2.7 ± 5.4, which was not statistically significant; however, it might be clinically significant. Two barrier scores improved as a result of the intervention. Preliminary evidence on the feasibility of identifying and addressing patient-specific barriers to adherence delivered by pharmacists showed that it has the potential to resolve barriers and improve asthma outcomes. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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8 pages, 218 KiB

Open AccessCase Report

Respecting the Patient’s Choice: A Case of Possible Drug-Induced Parkinsonism

by Megan R. Undeberg, Kimberly C. McKeirnan and David Easley

Pharmacy 2022, 10(1), 10; https://0-doi-org.brum.beds.ac.uk/10.3390/pharmacy10010010 - 04 Jan 2022

Cited by 3 | Viewed by 2836

Abstract

This report describes a case of likely drug-induced Parkinsonism (DIP) identified by the pharmacist. A 54-year-old female patient was referred by a physician to the pharmacist in a rural, integrated care team for a comprehensive medication review (CMR) to address the patient’s concerns of possible Parkinson’s disease (PD). While PD may occur over the progression of age, medications that affect dopamine transport can also cause DIP, a secondary form of Parkinson’s disease. Although PD and DIP may be clinically indistinguishable, differentiation may be possible by reviewing a patient’s medication history for any potential causative drugs correlating to the timeline of the onset of symptoms. In this case, the pharmacist reviewed the medication profile and identified medications that could be responsible for causing DIP, specifically bupropion. The pharmacist suggested discontinuing bupropion and identifying another option for treating depression. The patient appreciated the suggestion and education, but ultimately preferred continuing her bupropion therapy instead of discontinuing therapy or changing to an alternative agent. At a follow-up meeting with the pharmacist, not only was the patient still experiencing tremors despite taking carbidopa/levodopa, but additional medications known to be potential inducers of tremors were added to her regimen. Although the pharmacist repeatedly discussed DIP with the patient and believed stopping bupropion would determine whether her Parkinsonism was PD or DIP, ultimately the patient continued taking bupropion because of concerns related to depression severity and the impact on her well-being. The patient’s wishes were respected. Full article

(This article belongs to the Special Issue Medicine Use in Chronic Disease)

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