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Dyslipidaemia describes the condition of abnormal lipid levels in a person's bloodstream. Since the 1980s, statin medications have been used to treat dyslipidaemia and other comorbidities, such as stroke risk and atherosclerosis. Statin medications were initially synthesised from fungal metabolites, but many synthetic statin drugs have been manufactured since then. Statin medication is quite effective in reducing total cholesterol levels in the bloodstream, but it has limitations. Due to their poor water solubility, statin drugs possess poor oral bioavailability, which hinders their therapeutic efficacy. Nanoparticle drug delivery technology has been shown to improve the pharmacokinetic profiles of many drug classes, and statins have great potential to benefit from this. This paper reviewed the currently available literature on nanoparticle statin medication and evaluated the possible improvements that can be made to the pharmacokinetic profile and efficacy of conventional statin medication. It was found that the oral bioavailability of nanoparticle medication consistently outperformed conventional medication by up to 400% in some cases. Substantial improvements in time to peak plasma concentration and plasma concentration peaks were also found, and increased periods in circulation before excretion were shown. It was concluded that nanoparticle technology has the potential to completely replace conventional statin medication as it offers more significant benefits with minimal drawbacks. Upon further study and development, the manufacture of nanoparticle statin medication should become feasible enough for large-scale application, which will significantly benefit patients and unburden healthcare systems.

Biosimilars are biological medicines highly similar to a previously licensed reference product and their licensing is expected to improve access to biological therapies. This study aims to present an overview of biosimilars approval by thirteen regulatory authorities (RA). The study is a cross-national comparison of regulatory decisions involving biosimilars in Argentina, Australia, Brazil, Chile, Canada, Colombia, Europe, Hungary, Guatemala, Italy, Mexico, Peru and United States. We examined publicly available documents containing information regarding the approval of biosimilars and investigated the publication of public assessment reports for registration applications, guidelines for biosimilars licensing, and products approved. Data extraction was conducted by a network of researchers and regulatory experts. All the RA had issued guidance documents establishing the requirements for the licensing of biosimilars. However, only three RA had published public assessment reports for registration applications. In total, the investigated jurisdictions had from 19 to 78 biosimilars approved, most of them licensed from 2018 to 2020. In spite of the advance in the number of products in recent years, some challenges still persist. Limited access to information regarding the assessment of biosimilars by RA can affect confidence, which may ultimately impact adoption of these products in practice.

The pharmacokinetics of propranolol were investigated in obese and healthy weight groups. Research studies in relation to the presented topic were gathered, evaluated, and compared to distinguish variabilities involved amongst different lipophilic drugs and how they impacted the clinical effectiveness. Propranolol is a lipophilic drug so it was predicted that the pharmacokinetics would differ between obese and ideal-weight individuals. Previous research in other lipophilic drugs shows a trend to increase the volume of distribution and half-life in obese compared to ideal weight individuals. However, the majority of both clinical and preclinical studies gathered in this review, found a decrease in the volume of distribution (VD) and clearance, and minimal significant difference in the half-life, in the obese group when compared with the ideal weight group. Different explanations for this comparison have been theorised including differing tissue blood flow, plasma protein binding, or hepatic clearance in obese compared with ideal weight populations; though the exact reasoning as to why propranolol does not follow the general trend for lipophilic drugs is yet to be determined. These findings regarding propranolol pharmacokinetics can be utilised towards further research and development in personalised medicine for patients with obesity and comorbid cardiovascular disease. The comparative studies highlighted the pharmacokinetic parameters which demonstrated a need for personalised dosage regimes for propranolol and a proposed research direction to understand why the difference exists between these population groups. With the prevalence of obesity continuing to rise, the relative pharmacokinetics of drugs must be evaluated in obese patient groups in order to inform drug dosing regimens and improve current clinical practice.

AIMS: The aim of this systematic review is to assess the effects of community pharmacist-led interventions to optimise the use of antibiotics and identify which interventions are most effective. METHODS: This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context, and be pharmacist-led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient-reported outcomes. Risk of bias was assessed using the 'Cochrane suggested risk of bias criteria' and narrative synthesis of primary outcomes conducted. RESULTS: Seventeen studies were included covering in total 3822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, 12 on secondary outcomes and two on both. Three studies reported improvements in quality of dispensing, interventions led to more intensive symptom assessment (up to 30% more advice given) and a reduction of over-the-counter supply up to 53%. Three studies led to higher consumer satisfaction, effects on adherence from nine studies were mixed (risk difference 0.04 [-0.02, 0.10]). All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies. CONCLUSIONS: Our review suggests some positive results from pharmacist-led interventions, but the interventions do not seem sufficiently effective as currently implemented. This review should be interpreted as exploratory research, as more high-quality research is needed.

Medication management for older persons can be complex. With over 50% of all hospital admissions being for people aged over 65 years, understanding age-related functional, cognitive and social factor changes and their impact on medication use is critical for pharmacists working in most adult medicine areas. This paper provides an overview of critical elements of medication management for older persons for pharmacists. Key elements include age-related changes impacting medication effectiveness and safety, frailty, geriatric syndromes, polypharmacy and deprescribing, minimising medication-related harm at transitions of care, dose administration aids and other strategies to support individuals in medication management and multidisciplinary comprehensive geriatric assessment.

BACKGROUND: The lack of interoperable IT systems between residential aged care facilities (RACF) and general practitioners (GP) in primary care settings in Australia introduces the potential for medication discrepancies and other medication errors. The aim of the GRACEMED study is to determine the extent and potential severity of medication discrepancies between general practice and RACFs, and identify factors associated with medication discrepancies. METHODS: A cross sectional study of medication discrepancies between RACF medication orders and GP medication lists was conducted in the Sydney North Health Network, Australia. A random sample of RACF residents was included from practice lists provided by the general practices. RACF medication orders and GP medication lists for the included residents were compared, and medication discrepancies between the two sources were identified and characterised in terms of discrepancy type, potential for harm and associated factors. RESULTS: 31 GPs and 203 residents were included in the study. A total of 1777 discrepancies were identified giving an overall discrepancy rate of 72.6 discrepancies for every 100 medications. Omissions were the most common discrepancy type (35.2%,) followed by dose discrepancies (34.4%) and additions (30.4%). 48.5% of residents had a discrepancy with the potential to result in moderate harm and 9.8% had a discrepancy with the potential for severe harm. Number of medications prescribed was the only factor associated with medication discrepancies. CONCLUSION: Increased use of systems that allow information sharing and improved interoperability of clinical information is urgently needed to address medication safety issues experienced by RACF residents.

© 2017 The Authors Context: Dying patients commonly experience potentially distressing symptoms. Palliative care guidelines recommend opioids, anticholinergics, antipsychotics, and benzodiazepines for symptom relief. Objectives: The objective of this study was to systematically review the effectiveness and safety of palliative drug treatment in the last days of life of adult patients, focusing on the management of pain, dyspnea, anxiety, restlessness, and death rattle. Methods: A systematic search of the literature was published before December 2016 in PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Cochrane, ClinicalTrials.gov, and SveMed+. Studies on safety or effectiveness of drug therapy in dying adults with at least one outcome on symptom control, adverse effects, or survival were included. Data for included studies were extracted. Study quality was assessed using the Effective Public Health Practice Quality assessment tool for quantitative studies. Results: Of the 5940 unique titles identified, 12 studies met the inclusion criteria. Five studies assessed anticholinergics for death rattle, providing no evidence that scopolamine hydrobromide and atropine were superior to placebo. Five studies examined drugs for dyspnea, anxiety, or terminal restlessness, providing some evidence supporting the use of morphine and midazolam. Two studies examined opioids for pain, providing some support for morphine, diamorphine, and fentanyl. Eight studies included safety outcomes, revealing no important differences in adverse effects between the interventions and no evidence for midazolam shortening survival. Conclusion: There is a lack of evidence concerning the effectiveness and safety of palliative drug treatment in dying patients, and the reviewed evidence provides limited guidance for clinicians to assist in a distinct and significant phase of life.

In Australia, the nurse practitioner (NP) obtained prescriptive authority in some jurisdictions in 2001. One of the key aspects in which the scope of NPs differs from Registered Nurses (RNs) relates to the legal privilege to prescribe medications. Although NPs have had prescriptive authority in Australia since 2001, with access to the Commonwealth subsidy scheme (PBS) since 2010, little is known about NPs prescriptive patterns or outcomes of prescriptive practice.The aim of this scoping review was to examine the extent, range and nature of research conducted in relation to NP prescribing in the Australian health context as well as identify gaps in the existing literature. Whilst considerable research has been undertaken on medical prescribing, to date there is no published review of studies regarding NP prescribing in the Australian context.A structured search of the literature was undertaken using permutations of the following key words ’nurse practitioner prescribing Australia’, ’nurse practitioner and prescribing’, ’advanced practice nurse and prescribing’, ’nurse practitioner and Australia’. Databases where searched from January 2000 to January 2016. Databases searched include PsycInfo, Pubmed, CINAHL and Medline.There are a number of distinguishing features of NP prescribing practices in the Australian context. Little is known about the prescribing behaviours of critical care NPs in both the international and Australian context. Key themes identified were: barriers to prescribing, attitudes to NP prescribing, frequency of prescribing, types of medications prescribed, prescribing practice behaviours and confidence in prescribing.The impact of legislative changes on Australian NPs clinical practice and service delivery is still evolving. This review should create impetus for further research to determine the outcomes of NP prescribing on both patient and health service outcomes in the Australian healthcare context including critical care settings.

The prevalence of hypertension increases with age making it a significant health concern for older persons. Aging involves a range of physiological changes such as increases in arterial stiffness, widening pulse pressure, changes in renin and aldosterone levels, decreases in renal salt excretion, declining in renal function, changes in the autonomic nervous system sensitivity and function and changes to endothelial function all of which may not only affect blood pressure but may also affect individual response to pharmacotherapy used to manage hypertension and prevent end organ damage and other complications associated with poor blood pressure control.Unlike many chronic conditions where there is limited evidence for management in older populations, there is good evidence regarding the management of hypertension in the elderly. The findings from multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults, showing that reduction of blood pressure in older hypertensive populations is associated with reduced mortality and morbidity. Diuretics, agents action on the renin angiotensin system, beta blockers and calcium channel blockers have all been well studied in older populations both in view of the benefits associated with blood pressure lowering and the risks associated with associated adverse events. While all antihypertensive agents will lower blood pressure, when managing hypertension in older persons the choice of agent is dependent not only on the ability to lower blood pressure but also on the potential for harm with older persons. Understanding such potential harms in older populations is essential with older persons experiencing increased sensitivity to many of the adverse effects such as dizziness associated with the use of antihypertensive agents.Despite the wealth of evidence regarding the benefits of managing hypertension in the old and very old, a significant proportion of older individuals wi

The aim of this study was to assess the effect of Play Up humour therapy on antipsychotic, benzodiazepine and antidepressant use in Australian nursing homes.Play Up is a humour therapy program that has been implemented in Australian nursing homes. This study was an uncontrolled retrospective review of psychotropic medication charts of 406 residents in thirty-three nursing homes before and after 12 weeks of participation in Play Up. Prevalence and mean daily equivalent doses of psychotropic medication use were analysed.There were significant reductions from before to after the Play Up program in the prevalence of any psychotropic medication use, antipsychotic use and benzodiazepine use (P = 0.001, 0.02, 0.007, respectively). Mean daily dose equivalents of pro re nata (PRN) antipsychotics and PRN benzodiazepines significantly reduced over time (P = 0.007; P = 0.001).Play Up was associated with an overall decline in the use of psychotropic medications. Further trials are required to confirm and better define this association.

In the end stages of life, drug treatment goals shift to symptom control and quality of life and as such changes in drug utilization are expected. The aim of this paper is to review the extent to which costs are considered in drug utilization research at the end of life, with a particular focus on the outcome measures being used. This systematic review identified seven studies across varied settings studies reporting both drug utilization and medication cost outcome measures. The main factors identified that impacted medication use and cost were the time period considered and the provision of specialist palliative care services. Combining drug utilization and medication cost outcomes is critical for the allocation of healthcare resources and the development of a sound health policy.

Profession-derived competency standards are key determinants for curriculum and assessment in many professional university programmes. An Australian Learning and Teaching Council funded project used a participatory action research approach to enable the collaborative development of a graduated (or incremental) descriptors tool related to competencies, applicable to Australian pharmacy students at various stages within their university programmes. Consultations with pharmacy professional/registration organisations, students, preceptors and academics throughout Australia were undertaken. Recording of key themes of discussions and progressive development of the tool occurred. Initial trialling of the tool in pharmacy programmes at two different Australian universities has indicated that students were ambivalent regarding the tool and, for example, its usefulness for self-assessment against competencies and its role in supporting learning. Preceptors, supporting students on placements, were however very positive about the tool, its usefulness in supporting learning and in supporting discussions between preceptors and students. © 2012 Copyright Taylor and Francis Group, LLC.