Prescription medication use after congenital heart surgery

Background: Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. Methods: Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. Results: Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7–2.1; severe hazard ratio 6.5, 95% confidence interval 5.3–8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8–3.7; severe hazard ratio 38.8, 95% CI 27.5–54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. Conclusions: The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.

Sex-Specific Differences in the Association Between Race/Ethnicity and NAFLD Among US Population

Non-alcoholic fatty liver disease (NAFLD) is spreading worldwide, with a racial/ethnic disparity. We examined the gender role in the racial/ethnic difference in NAFLD in the US population. We analyzed data for 3,292 individuals ≥18 years old from NHANES 2017–2018, a representative sample of the non-institutionalized adult population in the US. Exclusions were subjects with elevated transferrin level, chronic hepatitis B or C, excessive alcohol use, or prescription medications that might cause hepatic steatosis. NAFLD was diagnosed by FibroScan® using controlled attenuation parameter (CAP) values: S0 &lt;238, S1 = 238–259, S2 = 260–290, S3 &gt;290. Data were analyzed using Chi square and multinomial regression. The overall prevalence of NAFLD was 47.9% [S2 = 16.1%, and S3 = 31.8%]. The prevalence of S3 was highest among Mexican Americans (46%), lowest among Blacks (22.7%), 29.9% in other Hispanics and 32.1% in Whites (p &lt; 0.05). It was higher among Mexican American males (54.1%) compared to Mexican American females (37.7%) (p &lt; 0.05). In the adjusted model, Mexican Americans were two times more likely than Whites to have S2 and S3 (p &lt; 0.05). Only male Mexican Americans had higher odds of S2 and S3 relative to male White (p &lt; 0.05). Males had higher odds of S3 relative to non-menopausal females (p &lt; 0.05). There was no difference in the odds of S2 or S3 NAFLD among the menopausal females with or without hormone therapy relative to non-menopausal females (p &gt; 0.05). While Mexican Americans had the highest prevalence of severe NAFLD relative to the other racial/ethnic groups, only male Mexican Americans, but not females, had higher likelihood of both moderate and severe NAFLD relative to Whites. Interventions that specifically target Mexican American males are needed to increase awareness about NAFLD and its prevention.

Treating Erectile Dysfunction with Prescription Medications & Natural Products: A Pharmacist’s Guide

Stigma surrounding erectile dysfunction creates a difficult environment for appropriate management. Knowledge of the condition and treatment options presents a unique opportunity for pharmacists to optimize a safe and affordable plan that meets patient needs.

Prevalence of Musculoskeletal Pain and Analgesic Treatment Among Home-Dwelling Older Adults: Changes 1999–2019

Pain has been shown to be undertreated in the older population. At the same time, the increased opioid use is of concern in the Western world. This study analyzes temporal trends in pain management among home-dwelling people aged 75 to 95 using cross-sectional cohort data spanning 20 years. The Helsinki Aging Study recruited random samples aged 75, 80, 85, 90, and 95 in 1999, 2009, and 2019. In total, 5,707 community-dwelling people participated in the questionnaire survey. Participants reported their medical diagnoses, regular prescription medications, and the presence of back pain or joint pain within the last 2 weeks (never, sometimes, or daily). We compared analgesics use in people reporting musculoskeletal pain and in people not reporting pain in 1999, 2009, and 2019. Of participants, 57–61% reported intermittent or daily musculoskeletal pain. The percentage of people taking a daily analgesic increased from 9% in 1999 to 16% in 2019. The use of NSAIDs decreased from 1999 to 2019, while the use of paracetamol increased from 2% to 11%. Of participants, 3% took daily opioids in 2019. Of those reporting daily musculoskeletal pain, 20% in 1999, 35% in 2009 and 32% in 2019 took regular pain medication. Pain remains undertreated in the older population, although the use of regular prescribed analgesics increased from 1999. The use of NSAIDs diminished, while the use of paracetamol increased. Daily opioid use remained modest from 1999 to 2019.

Cannabis Use Among Veterans: It Should be Easier to Get Some

and PTSD. From December 2020 – February 2021 we conducted 32 semi-structured interviews with Veterans who responded to our initial and follow-up surveys and agreed to discuss their cannabis use. We coded and themed the interviews using inductive thematic analysis. We found that many Veterans are using cannabis in place of other medications such as opioids and benzodiazepines and often do so to avoid the negative side effects. However, barriers such as Veterans Administration policies and cost of medical cannabis affect Veterans ability to obtain medical cannabis. Our results inform clinicians and policy makers on the use of cannabis as an alternative to prescription medications for treating chronic pain and other conditions in older Veterans.

Medication Management and the Role of the Geriatric Pharmacist in Interdisciplinary Care Teams

Among adults 65 and older, 30% are taking at least five medications to treat acute and chronic health conditions (Gavin, 2020). As the number of medications increases, the more complex the regimen tends to be, which increases risks with proper management and unwanted side effects. Our interdisciplinary geriatric assessment team has been conducting medication reviews for individuals living with dementia, where geriatric pharmacists meet with these individuals and their family caregiver. These sessions build a trusting relationship, where older adults are able to receive education about their prescription and over-the-counter medications, address any concerns and reach shared goals. Pharmacists routinely recommend deprescribing, and all recommendations are sent to the older adults’ primary care provider. After the initial appointment, a follow-up takes place six months later to re-examine adherence to recommendations and assess outcomes. Since April 2019, our pharmacists have served over 300 individuals, where nearly 90% would recommend this review to others. Pharmacists have recommended over 250 medication changes, averaging 2.53 per person. A statistically significant decrease in prescription medications (from 12.48 to 12.16) has been identified, in addition to a trending decline for over-the-counter medications (3.91 to 3.79). Medication reviews have successfully reduced the overall number of medications, as 36% of recommendations have been accepted by the patient and their healthcare provider. Comprehensive medication review programs, where pharmacists are integrated into an interdisciplinary care team, offer high quality, best practice healthcare, where safety and quality of life is improved for older adults.

Adulteration of Weight Loss Supplements by the Illegal Addition of Synthetic Pharmaceuticals

Weight loss supplements that have illegal additives of pharmaceutical drugs or analogues have additional health risks, and customers may not be aware of what they are taking. This research is an essential investigation and quantification of illegally added pharmaceuticals or prescription medications, specifically fluoxetine, phenolphthalein, and sibutramine, in herbal weight loss supplements offered for sale in the United Arab Emirates (UAE). In this case, 137 weight loss supplements were collected and analyzed in this study. Reversed-phase high-performance liquid chromatography with UV absorption detection coupled to tandem mass spectrometry (RP-HPLC-MS/MS) analyses were used to determine the presence of the pharmaceutical chemicals. Among the weight loss supplements, 15.3% (95% CI: 9.2–21.4) contained undeclared sibutramine, 13.9% (95% CI: 8.01–19.7) contained undeclared phenolphthalein, and 5.1% (95% CI: 1.4–8.8) contained undeclared fluoxetine. Amongst all weight loss supplements, 17.5% (95% CI: 11.07–24) contained significant concentrations of either sibutramine, phenolphthalein, or fluoxetine. Whilst weight loss herbal supplements offered for sale in the UAE have relatively low percentages of undeclared pharmaceuticals, many people take several different supplements daily and may encounter quite high levels of combined exposure to toxic compounds.