I thought it would have been higher

Almost a Third of Patients Don’t Take Drugs as Directed” says a new study out of Canada, and if that many Canadians aren’t taking their meds, can you imagine what it’s like here?

In a study that examined more than 200,000 patients and 91,000 unique prescriptions, overall nonadherence rates ranged from 13.7% for patients prescribed antidepressants to 30.3% for patients prescribed antihypertensive therapies.

What’s the problem? It might be cost (Canadians’ healthcare is paid for by the government, but not prescriptions), but the researchers say that they just don’t know. “We assume that people are following our instructions. We’re often giving people second and third prescriptions before we even check if they’re taking their first one.”

Pharmacists: Your hot immunization date is coming

Get 20 hours of CE (!), the world’s best update on immunization skills, and a certificate to impress your patients — all from GPhA, starting August 21, with APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists.

This ever-popular certificate training program prepares pharmacists with comprehensive knowledge, skills, and resources necessary to provide immunization services to patients across their lifespan — skills you need now more than ever.

Sunday, August 21, 2022 8:00 am – 5:00 pm Georgia Pharmacy Association Classroom

CLICK HERE for more information and to register!

SimStomach

When a drug maker tests a drug, one thing it probably doesn’t consider is the patients’ posture. And yet (Johns Hopkins researchers realized), all those fluids churning around the stomach must have an effect.

“When the pill reaches the stomach, the motion of the stomach walls and the flow of contents inside determine the rate at which it dissolves. The properties of the pill and the stomach contents also play a major role.

So they built … StomachSim, a stomach-simulation computer program. (Sorry, “a biomimetic in-silico simulator based on the realistic anatomy and morphology of the stomach.”) Their goal is to use it to figure out how the position of the stomach might affect the absorption of medication — “unique insights into the complex physiological processes behind the oral administration of pills.”

Teaching technique

When it comes to improving how asthma patients use their inhalers, who do you think is a good choice? Why yes, as a matter of fact it is pharmacists.

Granted, the folks at the Cleveland Clinic did more case studies than study-studies, but their conclusion sure makes sense. They tested the effect of having a pharmacist demonstrate and check inhaler technique before hospital discharge, then again at a follow-up visit.

Result: Fewer errors and fewer problems.

Fun facts: “exhalation before inhalation” was the most common error, followed by patients not holding their breath after inhalation.

Something to look forward to in an upcoming season

A new international study found that “a median of about 66,000 people are infected with [SARS-related coronaviruses] each year in Southeast Asia,” and that “suggests that bat-to-human SARSr-CoV spillover is common in the region, and is undetected by surveillance programs and clinical studies.”

The good news: Many of those strains that infect humans “may not be able to replicate well in people, cause illness, or be transmitted sufficiently among people to cause an outbreak.”

The bad news: “Many.”

(Above link goes to the paper in Nature Communications. For the short news story, click here.)

Fluoroquinolone risks

Giving fluoroquinolone to patients with chronic kidney disease increases their risk of an “adverse event” — and higher doses lead to higher chances.

What kind of adverse event? We’re talking hospital visits for “nervous system and psychiatric disorders, hypoglycemia, or […] collagen-associated events.”

The rate isn’t high, thankfully — around 0.9% on a low dose or 1.2% on a higher one, but still, that’s 1 out of 100 patients being hospitalized, and it’s not considering fluoroquinolone’s other possible side effects: aortopathy, arrhythmia, hyper- or hypoglycemia, neuropathy, or tendinopathy.

This suggests, say the Canadian researchers who did the study, “that fluoroquinolones should be prescribed cautiously and at lower doses among older adults with advanced CKD.”

Hitting asthma at its source

British bioscientists say they’ve found a way to treat a cause of asthma, rather than just its symptoms, and it could lead to long-term treatments.

The target: pericytes, stem cells in the lining of blood vessels. During an asthma attack, they move to the airway walls and then do what stem cells do — they turn into other cells. Like, for example, muscle cells, which tend to block the airways.

What the Brits found is that 1) pericytes get the signal to move to the airways via a protein called CXCL12* and 2) a molecule called LIT-927 can block that signal.

Asthmatic mice that were treated with LIT-927 had a reduction in symptoms within one week and their symptoms virtually disappeared within two weeks. The researchers also found that the airway walls in mice treated with LIT-927 were much thinner than those in untreated mice, closer to those of healthy controls.

The usual mantra: “[F]urther research is needed before we can begin to test this in people,” including determining dosage, timing, what other effects LIT-927 might have, and what cool name they can give it.

* Also a droid in the upcoming series, “Star Wars: Random Background Characters” on Disney+

Drug combo equation

Combining drugs to treat osteoporosis (especially the postmenopausal kind) is often the best treatment. But which drugs? There’s no clear answer.

Why not? Maybe because no one thought to ask the computer. Until a group of German researchers, that is.

Using evidence of how bone is broken down and renewed, and how different kinds of osteoporosis medications work, they “built a mathematical model of bone renewal that predicts the effects of various osteoporosis medications in postmenopausal women.”

They literally created an equation for osteoporosis:

Then they tested it on various med combinations — and even the order those combinations were given. And that led to a surprising (and useful) finding:

They […] found that combinations that cause the most rapid increases in bone density do not always strengthen bone in the long term and can instead cause a rebound of accelerated bone loss after the treatment stops.

The end result wasn’t The Answer for the best meds combo for osteoporosis. The goal is to inform clinical trials that can confirm what the computer came up with, and hopefully design personalized treatment plans.

The Long Read: The Spread of Monkeypox edition

Is prolonged skin-to-skin contact the only way it spreads? (Not exactly.) And how did the virus change to make this outbreak different? (It didn’t.) The details are in “What scientists know — and don’t know — about how monkeypox spreads” from Stat.