Lipid management practices

The nature of the practice may be influenced by the availability of space in which to provide patient care. For example, the lack of facilities in which to meet privately with the patient may result in a telephone-based practice. Offering lipid management in the community pharmacy may require an investment in infrastructure. Some remodeling of the pharmacy may be needed to provide an area where confidential communications can occur. A lipid analyzer, as well as a dedicated clean area, must be supplied if blood lipid monitoring is to be offered. 

Pharmacists who practice lipid management should be familiar with dietary factors that influence lipids. If referrals to a dietician are allowed by law, the pharmacist should have a referral base from which to guide the patient. Handouts that describe the goals of fat content, specific foods to choose and avoid, and how to read and interpret food labels should be available for distribution. These are available from a variety of sources. Patients may be referred to the AHA web site, which offers information about recommended diets as well as recipes. Drug companies that market cholesterol-lowering medications often provide free patient information materials that may... 

Whatever the reason for insufficient sleep, the sleepiness and neurobehav-ioral consequences seem inevitable. Prevention of sleep deprivation through lifestyle management, and perhaps with hypnotics, would be first- and second-line recommendations for most situations. However, there are instances in which sleepiness cannot be managed with those approaches. Wake-promoting agents would seem very appropriate for use in some of these situations. It should be noted that the use of medications to modulate the effects of lifestyle is not unique to sleep medicine. The use of artificial sweeteners or lipid-lowering agents, often to correct the effect of inappropriate nutritional choices, has become an acceptable part of daily food selection as well as medical practice. 

Once it is determined which service is to be implemented, it is important to put some thought into what the service will look like and how it will be delivered at the practice. As discussed previously, regardless of the type of service (i.e., diabetes, lipids, asthma, etc.), the medication management processes used by pharmacists remain relatively the same. Some component of the service will require the pharmacist to collect patient clinical information, including laboratory data. The pharmacist also needs to assess the patient information that has been collected and make a clinical decision regarding the appropriateness of the therapy. Patient education is a component of each type of service but may be emphasized more so with certain services (e.g.,... 

Cardiovascular diseases are a major cause of death in developed countries, making prevention a priority for public health policy. Research evidence over years has shown that cardiovascular diseases can be managed and even prevented by healthful eating practices involving a resveratrol-enriched diet of whole plant foods such as offered by superfruits. For more than fifty years, research has shown that a healthful, active lifestyle combined with the dietary benefit of high fruit and vegetable intake may lower blood lipid levels, blood pressure, and risk of coronary heart disease and stroke. 

The next frontier is cardiology clinical practice in community pharmacy settings. It is hoped that the progress made in ambulatory practice can be extrapolated into these environments. This possibility has been fueled by demonstration projects where pharmacists receive financial payments for cognitive services. Noteworthy is that some of these initial disease state management efforts (e.g., management of hypertension, lipid disorders, and thrombosis) require practice skills and specialized knowledge in cardiovascular pharmacotherapy. 

Management of adverse reactions Administration of amphotericin B lipid complex (ABLC) may be associated with infusion-related reactions, such as fever, rigors, and chills. Premedication with hydrocortisone may reduce the incidence of these reactions, but there are currently limited confirmatory data from clinical practice [7 ]. In a prospective 18-month study, patients with cancers were given intravenous hydrocortisone 100 mg 15-30 minutes before each infusion of ABLC (275 cycles mean dose per cycle 931 mg) [14. There were 44 infusion-related reactions (16%), most of which followed the first infusion of a cycle (15% subsequent infusions 2.9%). The most common reactions were rigors (15%) and fever (13). There was no significant difference in the rates or types of reactions between ABLC-naive and previously treated patients. The dose of ABLC had no effect on the rate of reactions, but female sex, neutropenia, and being younger were predictive. 

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