Papers by Candice Garwood
American Journal of Health-system Pharmacy, Jul 15, 2017
American Journal of Health-system Pharmacy, 2011
American Journal of Health-system Pharmacy, Aug 15, 2007
The neurobiology of tobacco dependence and the efficacy and safety of emerging pharmacotherapies ... more The neurobiology of tobacco dependence and the efficacy and safety of emerging pharmacotherapies for smoking cessation are reviewed. Dopamine is pivotal to the major addictive properties of nicotine. The neurotransmitters that influence dopamine activity include gamma-aminobutyric acid, acetylcholine, glutamate, norepinephrine, and serotonin. Opioids and endocannabinoids can also affect dopamine activity. Research on pharmacologic treatments for nicotine dependence has targeted the modulation of these neurotransmitter systems. Current pharmacotherapies for smoking cessation include bupropion and varenicline, both of which target the neurotransmitters involved in nicotine addiction. Several new therapies are emerging as possible treatment options for smoking cessation. Rimonabant, a selective cannabinoid antagonist, blocks dopamine release in the nucleus accumbens, a primary reward center for the brain. Studies have found that rimonabant may not only be effective as a smoking-cessation aid but may also assist in the maintenance of nicotine abstinence. Rimonabant has also demonstrated a weight-loss benefit, which may be attractive to smokers concerned with weight gain associated with smoking cessation. Three nicotine vaccines are currently in development, each acting to sequester nicotine from the bloodstream, thereby preventing its penetration of the central nervous system. Ongoing studies will evaluate their use as established therapies for smoking cessation. New nicotine-replacement formulations are also being developed. There are several promising products in development targeting the mechanisms of tobacco dependence. As failure rates are high and relapse is common, these emerging therapies would offer more therapeutic options for smoking cessation and solutions to the problem of relapse.
Medical Teacher, Dec 21, 2021
INTRODUCTION Interprofessional education (IPE) about patient safety positively impacts safety and... more INTRODUCTION Interprofessional education (IPE) about patient safety positively impacts safety and reduces errors but is challenging to deliver. We aimed to determine if a synchronous virtual IPE program using storytelling and interactive learning impacted student perceptions about patient safety. METHODS An IPE patient safety program involving medical and pharmacy students was synchronously delivered virtually due to the COVID-19 pandemic. The program was framed using storytelling about a medication error told by a family member. Post-program survey data, exploring participants' perspectives on the program, collected between July 2020 and November 2020 was retrospectively reviewed. Quantitative results were grouped by the five components of the program. Responses within each category were averaged to generate a summary measure of each student's experience. Qualitative feedback from two survey questions was evaluated. RESULTS There were 236 (96.7% of participants) completed surveys included in the analysis. High proportions of participants responded favorably across all five components of the survey. Qualitative responses were largely positive, with themes of increased empathy, behavior, and attitude change, and meaning making. CONCLUSION An interactive IPE patient safety program using storytelling about a real-life medication error to frame activities and utilizing a virtual platform was a favorable and impactful method to educate students.
American Journal of Health-system Pharmacy, Jun 1, 2013
Purpose. The literature surrounding health literacy and its importance in everyday practice are r... more Purpose. The literature surrounding health literacy and its importance in everyday practice are reviewed. Summary. Health literacy includes a patient's reading, writing, and numeracy skills, as well as his or her cultural experiences, understanding of health concepts and pathophysiology, and basic communication skills. Over one third of the American population lack the skills necessary to understand health information, make health care decisions, or follow medication instructions. Independent risk factors for low health literacy include poor socioeconomic status, ethnicity, older age, and limited education. Mounting evidence suggests that low health literacy leads to poor health outcomes, increased mortality, increases in health care costs, and poorly self-managed chronic diseases. Communication with a pharmacist to gain clarification of medication instructions is often the last opportunity to ensure that patients understand how to use their
Pharmacotherapy, Sep 6, 2017
Anticoagulation clinics emerged as a means to optimize warfarin effectiveness and minimize bleedi... more Anticoagulation clinics emerged as a means to optimize warfarin effectiveness and minimize bleeding risks. Anticoagulation clinics have traditionally been warfarin‐based models due to the need for frequent blood‐level monitoring, drug interactions, dietary considerations, and periprocedural management with warfarin. These models have demonstrated improved anticoagulation control and reduced bleeding complications for patients taking warfarin. Direct oral anticoagulants (DOACs) emerged with the perception of improved convenience due to the lack of blood‐level monitoring and lack of dietary considerations. Despite the advantages of DOAC therapy, new challenges exist with their management, warranting ongoing monitoring. Such challenges include prescribing and dosing issues, drug adherence, drug interactions, and high drug cost. Comprehensive anticoagulation centers are needed to manage and monitor all oral anticoagulants including DOACs. The objectives of this review are to describe the challenges and opportunities that exist in the management of DOACs and to describe a practice model that integrates a DOAC management service into the traditional anticoagulation clinic.
American Journal of Health-system Pharmacy, Jul 1, 2007
The pharmacology, pharmacokinetics, clinical efficacy, safety, dosage and administration, and pla... more The pharmacology, pharmacokinetics, clinical efficacy, safety, dosage and administration, and place in therapy of varenicline are reviewed. Summary. Varenicline is the newest therapy approved by the Food and Drug Administration for smoking cessation and the first in its class targeting the neurobiology of nicotine addiction. Varenicline is selective
JACCP: journal of the American College of Clinical Pharmacy, Nov 21, 2018
Over the last three decades, a host of structured models of oral anticoagulation management has e... more Over the last three decades, a host of structured models of oral anticoagulation management has evolved. There are an estimated 3000 anticoagulation management services (AMS) in existence in the United States, providing care to approximately 30% to 40% of the patients receiving oral anticoagulation therapy. 1 Historically, most anticoagulation clinics have focused on management of warfarin therapy alone. After all, warfarin was the lone oral anticoagulant in the United States for over 50 years.
American Journal of Health-system Pharmacy, 2011
Epilepsy & Behavior, Mar 1, 2023
Journal of the American Pharmacists Association, Nov 1, 2021
BACKGROUND Antiseizure medications are commonly associated with adverse effects including behavio... more BACKGROUND Antiseizure medications are commonly associated with adverse effects including behavioral and cognitive issues, drug interactions, idiosyncratic reactions, and long-term complications, which can lead to non-adherence. At the same time, there are limited reports describing multidisciplinary models of epilepsy care that include pharmacists. OBJECTIVE To describe the pharmacist services in an epilepsy clinic for older adults and document the patient care delivered using this design. PRACTICE DESCRIPTION A subspecialty older adult epilepsy clinic, embedded within a neurology clinic, in an urban academic medical center. PRACTICE INNOVATION Integration of pharmacy services to document medication history, provide medication reconciliation, identify medication-related problems, and make interventions. EVALUATION METHODS Data were retrospectively evaluated for the patients seen by the pharmacist and epilepsy team between July 2019 and January 2021. Data were summarized with descriptive statistics. RESULTS Fifty-eight patients with a total of 94 encounters (70.7% of all specialty clinic visits) were seen collaboratively by the physician and the pharmacist. The majority of patients were African American (87.9%), aged 63.7 ± 8.2 years, and more frequently male (58.6%), and a high proportion had some baseline memory loss or diagnosis of dementia (53.4%). Medication reconciliation occurred in 94 (100%) encounters. More than half the encounters required reconciliation to the existing medication list by adding medication (55.3 % of encounters) or deleting mediations (53.2% of encounters). Presence of adverse effects was the most common medication-related problem identified (23.4%). Resolutions to the medication-related problems were also reported. CONCLUSION The population of older adults with epilepsy is expected to increase in prevalence. Pharmacists are able to impact medication-related problems in a vulnerable, high-risk patient population. The multidisciplinary model we describe here can be used as a template to provide care in ambulatory care practices involving other neurology specialties with a high proportion of older adult patients.
Annals of Pharmacotherapy, Jun 17, 2021
March of 2020, the World Health Organization declared COVID-19 resulting from the severe acute re... more March of 2020, the World Health Organization declared COVID-19 resulting from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic. Approximately 15% to 20% of COVID-19 patients progress to severe viral disease. 1 In severe COVID-19 infection, a proinflammatory cytokine response occurs with subsequent increased expression of tissue factor and coagulation activation. The concurrent suppression of fibrinolysis, platelet activation, and endothelial injury all contribute to COVID hypercoagulability. Thrombotic complications from COVID-19 include venous thromboembolism (VTE), arterial thrombosis, thrombosis of extracorporeal circuits, and microvascular clot formation in the lungs, potentially leading to acute respiratory distress syndrome. 2 Rates of VTE from retrospective cohort studies of COVID-19 patients vary widely and range from 0% to 85.4%. 3 Variability can be attributed to differences in study design, including the use of VTE screening, pharmacological prophylaxis, the intensity of anticoagulation, acuity of illness, thrombotic outcomes reported, and varying duration of hospitalization. Microvascular and macrovascular thrombosis in various organs has also been reported in autopsies of COVID-19 patients. 4 With the heightened concern for thromboinflammation, anticoagulant management is an important component of care for patients with severe COVID-19 infection. Numerous organizations have put forth guidance for anticoagulation management for hospitalized patients with COVID-19 infection. 5-10 Current guidance is limited by the 1025042A OPXXX10.
Pharmacotherapy, Jun 1, 2006
A 47-year-old Caucasian woman had a 3.5-year history of primary hypothyroidism treated with levot... more A 47-year-old Caucasian woman had a 3.5-year history of primary hypothyroidism treated with levothyroxine. Her levothyroxine dosage of 0.05 mg/day had been stable for the past 15 months. She was then prescribed raloxifene for prevention of osteoporosis secondary to early menopause. During the next 30 months, her levothyroxine dosage had to be gradually increased. The patient had been taking levothyroxine and raloxifene at the same time each day on an empty stomach. During the months of her levothyroxine dosage changes, however, she separated administration of levothyroxine and raloxifene by 12 hours; the patient then became hyperthyroid. Eventually, her levothyroxine needs decreased, and she returned to the same levothyroxine dosage she had taken before separating administration of the two drugs. These findings suggest that raloxifene decreased the absorption of levothyroxine when the two agents were coadministered. Assessment of causality using the Naranjo adverse drug reaction probability scale resulted in a possible association for this adverse event. Another published case report provides findings similar to our patient' s experience. The possibility of a malabsorption interaction between levothyroxine and raloxifene is significant, as hypothyroidism is common among postmenopausal women-the same population that is the target of osteoporosis therapy with agents such as raloxifene. The mechanism by which raloxifene decreases levothyroxine absorption is unknown. Further investigation of this potential interaction is warranted. Until then, clinicians should be alert to the potential for an interaction between raloxifene and levothyroxine.
Innovations in pharmacy, Apr 27, 2021
Background: The purpose of this study was to implement and evaluate a pharmacist-led hypertension... more Background: The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for underresourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. Methods: This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. Results: There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of-23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). Conclusion: The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.
American Journal of Health-system Pharmacy, Dec 1, 2016
Quality management of complex chronic diseases requires ongoing medical care beyond a patient’s v... more Quality management of complex chronic diseases requires ongoing medical care beyond a patient’s visit with a primary care provider (PCP). Historically, under the Medicare fee-for-service model, reimbursement for non–face-to-face efforts has been limited.[1][1] However, as of January 1, 2015,
American Journal of Geriatric Pharmacotherapy, Mar 1, 2008
Background: There have been a number of published reports of central nervous system (CNS) adverse... more Background: There have been a number of published reports of central nervous system (CNS) adverse effects with statins. Case summary: A 79-year-old woman developed paranoia, anxiety, and behavioral changes-2.5 weeks after starting atorvastatin ] 0 mg/d. The patient had no other medication changes at this time. After 2 months of therapy, the patient discontinued atorvastatin, and her symptoms fully resolved after 4 days. Conclusions: This is the first case report, to out" knowledge, describing paranoia as one of the symptoms associated with statin therapy. Our report suggests an adverse reaction due to the initiation of" atorvastatin via the temporal relationship between the start of atorvastatin and symptom onset, as well as termination of therapy and subsequent s)q~lptom disappearance. Use of the Naranjo adverse drug reaction probability scale to assess causali b" revealed a "probable" association (score, 5) for this adverse event. This report emphasizes the possibility of paranoia as a CNS adverse effect due to statin therapy. Statins arc f}equently used in older populations and should therdbre be considered when such CNS adverse effects occur during therap> (Am ]
JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY
Journal of Interprofessional Care, 2022
Interprofessional education (IPE) activities are recommended to reflect current and future practi... more Interprofessional education (IPE) activities are recommended to reflect current and future practice. The opioid epidemic is one of the most significant current health challenges; recently declared a United States public health crisis. Thus, an IPE program centered on interprofessional roles in pain management during the opioid crisis was developed at the Eugene Applebaum College of Pharmacy and Health Sciences. Professional students from pharmacy, physical therapy, occupational therapy, physician assistant, and nurse anesthesia programs were included. The program included a lecture about each profession, small group case-based problem-solving sessions (group activity), and a panel discussion led by representative pain management experts from each profession. We conducted a retrospective review of data from 251 professional students attending the IPE program, and assessed students' knowledge of each profession and their respective roles in pain management. We evaluated interprofessional skills using the Interprofessional Collaborative Competency Attainment Survey and gathered qualitative student feedback. Participants gained knowledge about other professions. Each represented profession had improvements in five constructs related to interprofessional skills. Students found the most value from the group activity, which encouraged interaction among professions. Overall, the program design was effective in enhancing student knowledge and attitudes regarding collaborative interprofessional team skills.
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2019
Patients with atrial fibrillation (AF) who suffer an acute ischemic stroke are at risk for both h... more Patients with atrial fibrillation (AF) who suffer an acute ischemic stroke are at risk for both hemorrhagic transformation and recurrent ischemic stroke in the acute post‐stroke period. Oral anticoagulants are recommended for secondary stroke prevention in patients with AF. The optimal time to initiate anticoagulant therapy after acute ischemic stroke in patients with AF is uncertain. There is concern that early initiation increases the risk of hemorrhagic transformation, whereas delayed initiation leaves the patient at risk for recurrent ischemic stroke. In this article, we provide a review of the risk of hemorrhagic transformation of acute ischemic stroke as well as review the literature and major guidelines addressing the timing of anticoagulation initiation after an acute ischemic stroke in patients with AF. Relevant articles published from 1990 to the present were identified using the PubMed and Embase databases. The majority of available literature is observational data. Large...
Journal of the American College of Clinical Pharmacy, 2018
Over the last three decades, a host of structured models of oral anticoagulation management has e... more Over the last three decades, a host of structured models of oral anticoagulation management has evolved. There are an estimated 3000 anticoagulation management services (AMS) in existence in the United States, providing care to approximately 30% to 40% of the patients receiving oral anticoagulation therapy. 1 Historically, most anticoagulation clinics have focused on management of warfarin therapy alone. After all, warfarin was the lone oral anticoagulant in the United States for over 50 years.
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Papers by Candice Garwood