Traci Aladeen

Introduction: Older patients with dementia or mild cognitive impairment (MCI) are particularly vulnerable to adverse effects from potentially inappropriate medications (PIMs). Previous studies demonstrated that pharmacist interventions may reduce PIMs, but the impact of pharmacists embedded in an outpatient memory care clinic has not been adequately studied.Objective: To determine the impact of pharmacist recommendations on PIM reduction in older adults with dementia or MCI.Methods: This prospective observational study within an outpatient neurology center included patients at least 65 years old diagnosed with dementia or MCI. Pharmacists utilized the American Geriatrics Society Beers Criteria, the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions, and the Anticholinergic Burden Scale (ACB) to identify PIMs and reviewed patient charts to make pharmacologic and nonpharmacologic recommendations to prescribers when appropriate per clinical judgment. Primary outcomes included frequency and prevalence of PIMs before versus after pharmacist intervention and rate of acceptance of pharmacy recommendations. Additional outcomes included ACB scores before versus after intervention.Results: A total of 180 patients were included. Pharmacists made recommendations for 49% of patients, most commonly laboratory monitoring recommendations and medication discontinuations or substitutions. Out of 192 total pharmacist recommendations, 61 (32%) were accepted by providers within the memory clinic. After pharmacist intervention, the frequency and prevalence of PIMs were reduced from average 1.8 to 1.7 PIMs per patient and from 78% to 74% of patients with at least one PIM (p < 0.05). ACB scores were reduced from average 1.5 to 1.3 (p < 0.01).Conclusion: Pharmacist intervention resulted in a reduction in PIMs and ACB scores in patients with dementia or MCI. Future studies should incorporate a controlled prospective design with scheduled clinical outcomes assessments such as cognitive testing to examine the clinical benefit of pharmacist intervention and explore methods to improve multidisciplinary collaboration between pharmacists and prescribers.

BACKGROUND: Patients diagnosed as having multiple sclerosis (MS) experience a wide range of symptoms requiring pharmacologic management, and many do not achieve adequate symptom control. The purpose of this study was to evaluate the role of medical cannabis (MC) as part of a comprehensive treatment plan for patients with MS.METHODS: A retrospective medical record review of 141 patients with MS receiving MC for symptom management was conducted. Data were collected for up to 4 follow-up appointments after initiation of MC. Outcomes included changes in MS symptoms, medication changes, adverse events, and changes in cognition and mobility.RESULTS: Patients experienced extensive MS symptom improvement after initiation of MC, with alleviation of pain (72% of patients) and spasticity (48% of patients) and improvement in sleep (40% of patients) the most common. There was a significant reduction in concomitant opioid use after initiating MC as evidenced by a significant decrease in daily morphine milligram equivalents among patients prescribed opioid analgesics (P = .01). Decreases in muscle relaxant use and benzodiazepine use did not reach significance (P > .05). The most common adverse reaction to MC was fatigue (11% of patients).CONCLUSIONS: In many patients with MS, MC was well tolerated, eased pain and spasticity, improved sleep and other symptoms, and reduced use of concomitant opioid analgesics. Prospective studies are needed to further investigate the role of MC in the treatment of patients with MS.

Introduction: Aspirin and clopidogrel are mainstays in secondary stroke prevention; however, some patients do not demonstrate optimal antiplatelet effects from these therapies.Objectives: The primary objective of this study was to determine if pharmacist medication intervention paired with anti‐platelet medication monitoring with whole blood aggregometry improved responsiveness to antiplatelet treatment when compared with standard‐of‐care, alone in patients at risk of recurrent stroke or transient ischemic attack (TIA).Methods: This retrospective chart review at an outpatient neurology practice examined patients treated post‐stroke or post‐TIA between 2005 and 2017. Patients were categorized as either having undergone platelet function testing (PFT) with pharmacist intervention and standard‐of‐care or standard‐of‐care alone. Patient populations for each group were matched based on age, sex, and ABCD² risk scores. Pharmacotherapeutic management and interventions were assessed in each group.Results: A total of 342 patients were included as two matched groups (n = 171 for each group) with parallel baseline characteristics. Drug‐drug interactions were identified (P < .0001), and counseling on adherence (P = .0008) occurred statistically significantly more often with a pharmacist involved in patient care. After pharmacist intervention and PFT, 83% of patients were considered responsive to their antiplatelet therapy compared with 27% at baseline in the pharmacist intervention group (P < .0001).Conclusion: Pharmacist interventions optimized secondary stroke/TIA prophylaxis therapy, decreased drug‐drug interactions, and increased adherence counseling. Patients who underwent PFT and pharmacist intervention transitioned from nonresponsive to responsive to their antiplatelet therapy regimen.

Purpose/Background: Extensive research has been conducted comparing the metabolic characteristics of older second-generation antipsychotics (SGAs); minimal data exist comparing the long-term metabolic effects of SGAs approved in the last 10 years. Methods/Procedures: A retrospective chart review of patients treated with brexpiprazole, lurasidone, asenapine, cariprazine, and iloperidone (newer SGAs) for at least 6 weeks at an outpatient psychiatric practice was conducted. Patients treated with olanzapine, an older SGA, were included as a comparator. Metabolic characteristics were collected at baseline, approximately 6 weeks, 12 weeks, and for up to 12 months. Findings/Results: Of the newer SGAs, there were statistically significant increases in patients' average weight at 12 weeks and 1 year or less with brexpiprazole (2.48 lb, P = 0.02; 5.97 lb, P = 0.01) and iloperidone (4.54 lb, P < 0.01; 5.13 lb, P = 0.02). Brexpiprazole and iloperidone resulted in significant increases in body mass index, up to a 0.90-kg/m² average increase in patients taking brexpiprazole at 1 year or less. Minimal weight gain was seen with cariprazine (4.25 lb, P = 0.42) and asenapine (1.80 lb, P = 0.62) at 1 year or less after treatment initiation. Although not statistically significant, lurasidone showed an average weight loss of up to 0.60 lb at 1 year or less (P = 0.56). Implications/Conclusions: Although some weight gain was seen with the newer SGAs, all demonstrated significantly favorable metabolic characteristics compared with olanzapine. Monitoring of weight and metabolic parameters remain important in patients treated with SGAs.

Purpose/aim: A targeted questionnaire may help increase rates of reporting Parkinson’s disease psychosis (PDP) symptoms. Despite the need for a rapid patient- and/or caregiver-administered screening tool for PDP symptoms, an appropriate tool is not yet available. This study developed a targeted PDP questionnaire and examined rates of reporting psychosis symptoms in response to the questionnaire compared to rates of reporting symptoms to healthcare providers during a routine visit. Materials and methods: This was a single-center, cross-sectional observational study of patients at an outpatient neurology practice. Medical charts were screened for eligibility, and patients were contacted by telephone for informed consent. Results: A total of 25 patients (24%, N = 104) newly reported PDP symptoms in response to the targeted questionnaire. The frequency of reporting new symptoms in response to the questionnaire was statistically significantly greater compared to frequency of reporting symptoms without use of a targeted questionnaire (p < 0.0001). Conclusions: A targeted questionnaire increases rates of reporting PDP symptoms, and based on frequency, severity, and distress ratings, may allow for capture of PDP symptoms earlier in the course of the disease. By using a questionnaire, patients reported symptom onset an average of 1.4 years earlier than patients who reported symptoms to their providers according to patient medical records.