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An accurate medication history prevents medication errors during transitions of care, whereas an inaccurate medication history may lead to unnecessary tests or prolonged hospitalization. We describe the case of a patient with chronic hypothyroidism who presented to the hospital with severe hypothyroidism and reported strict adherence to her home levothyroxine.

Background: Specialty infusion and self-injectable biologic drugs for the treatment of inflammatory bowel disease (IBD) are high-cost medications. When administered to hospital-admitted patients, these medications are not reimbursed on an individual basis but rolled into a per diem payment by most payers in the United States (US). Therefore, choosing to administer these medications in the inpatient setting may reveal negative financial implications for some health care institutions. Selecting an alternative site of care to administer these medications during the clinical management process may lead to cost savings. Objective: Review the clinical necessity of inpatient specialty biologic administrations for the treatment of IBD to identify and quantify potential cost saving opportunities. Methods: Using patient medical records at a US academic medical center, we retrospectively identified inpatient administrations of specialty infusion and self-injectable biologic medications for IBD treatment from June 1, 2016 to May 31, 2017. Guided by a standardized form, an evaluation team consisting of 3 of the investigators determined the clinical necessity of each specialty biologic medication administration within the inpatient setting. Costs and reimbursement rates for administration in both the inpatient and outpatient settings were procured and tabulated. Results: Seventeen inpatient specialty biologic administrations for IBD during the 12 month study period were identified. Of these, 11 administrations were given for the treatment of Crohn's disease (CD) and 6 for ulcerative colitis (UC). The evaluation team determined that 65% of these administrations were clinically necessary as inpatient administrations, and that 35% were not. The sum of the wholesale acquisition costs (WAC) for clinically necessary inpatient biologic administrations totaled $54 737, and the WAC for those administrations deemed not clinically necessary totaled $43 702. Further analysis of administration events revealed that the institution could have realized an estimated $13817 in additional revenue above the cost of the drug if eligible inpatient biologic administrations had been received in the institution's outpatient clinic setting instead. Conclusion: Administering specialty biologic drugs for the treatment of IBD in the care setting best aligned with existing reimbursement structures may lead to institutional cost savings.

Almost 15 years have passed since the Joint Commission updated its National Patient Safety Goals to include a focus on medication reconciliation.1 Since then, a number of publications have addressed the topic. Authors have explored the frequency and relevance of medication errors detected by taking comprehensive medication histories,2 harm reduction when accurate medication histories are completed,3,4 potential cost savings to health systems resulting from newly designed or revised medication reconciliation processes,5 and the pharmacist’s role in the medication reconciliation process.1 Comparatively less evidenced-based information on methods of medication reconciliation—specifically on hospital admission medication history practice—has been disseminated. Sharing anecdotal evidence and experience is valuable to those seeking to improve their admission medication history practices. The admission medication history is the “cornerstone of the [inpatient] medication reconciliation process.” 6 The following tips aim to enhance the accuracy and scope of institutionally compiled preadmission medication lists to enable providers to make decisions based on reliable information, ultimately contributing to the safe and effective use of medications. When applicable, the reader is encouraged to consider incorporation of these tips into daily practice, training documents, and institutional policies and procedures.

Fluoroquinolones are a widely-prescribed, broad-spectrum class of antibiotics with several oral formulations notable for their high bioavailability. For certain infections, fluoroquinolones are the first line or only treatment choice. When administered orally, fluoroquinolones require proper administration to ensure adequate systemic absorption and, thereby, protect patients from treatment failure. Oral drug preparations that contain multivalent cations are well known to chelate with fluoroquinolones in the gastrointestinal tract; co-administration may lead to clinically significant decreases in oral fluoroquinolone bioavailability and an overall increase in fluoroquinolone-resistant bacteria. Based on a search and evaluation of the literature, this focused review describes oral fluoroquinolone-multivalent cation drug-drug interactions and their magnitude and offers several clinical management strategies for these potentially clinically significant interactions.

Prescribing d-penicillamine for Wilson's disease must be accompanied by vigilant monitoring, including a complete blood cell count with differential. For most, this should occur once or twice weekly during the first month of therapy and during periods of dose escalation, then every two weeks for six additional months, then monthly.

Medication reconciliation is a focus of national quality mandates,1,2 with research demonstrating value in obtaining accurate medication histories.3,4 At the University of Iowa Hospitals and Clinics (UIHC), a 729-bed academic medical center, pharmacists are responsible for components of the medication reconciliation process, including the compilation of patient preadmission medication histories. Pharmacy student involvement in the inpatient medication reconciliation process has been previously described, typically in the context of a doctor of pharmacy program’s experiential education component.5 We describe an in-process improvement and educational strategy to involve volunteer pharmacy students in medication reconciliation. Under UIHC’s Visiting Pharmacy Student Agreement (VPSA), volunteer pharmacy students help pharmacists compile medication histories on select patient care units. Before the fall, spring, and summer academic terms, the VPSA program coordinator, a UIHC clinical pharmacy specialist with a faculty appointment at the University of Iowa College of Pharmacy (UICOP), recruits first-, second-, and third-year pharmacy students. To be eligible to enroll, students must complete several online institutional-compliance training-course modules, including one on the Health Insurance Portability and Accountability Act, shadow a designated individual, often a current VPSA enrollee, as he or she compiles one or more patient medication histories, and complete onsite computer-based electronic-medical-record (EMR) training.

Introduction: Morbidity and mortality associated with invasive fungal infections (IFIs) remains unacceptably high. Such diseases represent a substantial burden to the healthcare system. New options are needed to address antifungal resistance in existing and emerging pathogens and improve treatment outcomes while minimizing drug-related toxicities and interactions. Awareness of new and potential future options is of great value for those healthcare professionals who care for patients with IFIs.Areas covered: A search of PubMed, infectious diseases conference abstracts and reference lists from relevant publications was conducted and relevant information abstracted. This review describes the limitations of existing systemic antifungal therapies (e. g., resistance, drug-drug interactions, drug-related toxicities) and summarizes data regarding several emerging antifungal compounds including (but not limited to) new triazoles (e. g. isavuconazole, ravuconazole), echinocandins (e. g., aminocandin) and nikkomycin Z. Agents in clinical trials such as (but not limited to) new triazoles (e. g., isavuconazole, ravuconazole), echinocandins (e. g., aminocandin) and nikkomycin are included. New formulations of existing drugs including reformulations of miconazole, posaconazole and amphotericin B are also reviewed. Finally, new or novel administration strategies for existing drugs such as combination antifungal therapy, antifungal dose escalation, adjunctive use of iron chelators and preemptive therapy are discussed.Expert opinion: All present antifungal agents have some deficiencies in antifungal spectra, toxicity, pharmacokinetics and/or drug-drug interactions, making them less than ideal for some fungal infections. Therefore, there remains an urgent need to find safe, effective, rapidly fungicidal, broad-spectrum antifungal agents with excellent pharmacodynamics to effectively eliminate the fungus from the body with short antifungal courses.

OBJECTIVE To analyze the most common active ingredients in ambulatory prescription and nonprescription products to provide evidence for contemporary pharmacotherapeutics curricula development. METHODS Content analysis was performed to code commonly dispensed prescription ingredients into American Hospital Formulary Service Pharmacologic-Therapeutic categories and commonly sold nonprescription products into self-care categories. This study used data from Drug Topics' 2007 "top 200" lists. RESULTS For prescription drugs, when tallying the ingredients assigned to the AHFS categories "Cardiovascular Drugs" and "Central Nervous Systems Agents," more than 50% of the total dispensed ingredients from the brand and generic top 200 lists were represented. For nonprescription products, over 75% of the commonly sold nonprescription products were categorized within 4 of the possible 11 self-care categories. CONCLUSIONS This analysis provides a method for educators to use when collecting curricula-refining evidence and specific findings for evaluating therapeutics curricula.