Pharmacy Technicians are "legally" NOT able to do consultation?

[paul25]

So I know "by law" that techs are not supposed to do patient counseling or even "recommend" any OTC or Rx. Could someone confirm this please?

Also, I have been looking into Title 16 of California Code of Regulations and California Business and Professions Code section 4202 anything that pertains to patient consultation, to no avail.

Where is it exactly? Any input will be much appreciated. Thanks.

EDIT: Thanks, pharmddreams, found it: California Business and Professions Code Section 4115

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[erin0522]

So I know "by law" that techs are not supposed to do patient counseling or even "recommend" any OTC or Rx. Could someone confirm this please?

Also, I have been looking into Title 16 of California Code of Regulations and California Business and Professions Code section 4202 anything that pertains to patient consultation, to no avail.

Where is it exactly? Any input will be much appreciated. Thanks.

This is correct. Technicians do not have the license or training to be able to make ANY sort of recommendations. Now, the pharmacist may allow this to be done with techs who have been working a very long time but it's up to their discretion. Nonetheless, it is illegal.

 

[tungsten87]

interns may also counsel, but as always the pharmacist is responsible for their actions.

 

[paul25]

Thanks. So do you guys know where under state or federal law says that it is indeed prohibited or otherwise illegal? Or is it the notion, only licensed *doctors* may prescribe / recommend medication, apply?

 

[erin0522]

Not sure exactly where. May I ask why you are looking for this?

 

[paul25]

Just being anal tonight is all, because I don't want to be paranoid and accidentally recommend a generic Ibu or Advil in lieu of Motrin.

 

[phathead]

Just being anal tonight is all, because I don't want to be paranoid and accidentally recommend a generic Ibu or Advil in lieu of Motrin.

I'm not going to dig through various laws, but I can for sure tell you that in the last two states I worked the law states that a technician may not give out or suggest medical advice.

Company regulations are often even more strict than that in lieu of getting sued. Check with whoever you're working with, they would know better than we do.

 

[paul25]

I'm not going to dig through various laws, but I can for sure tell you that in the last two states I worked the law states that a technician may not give out or suggest medical advice.

Company regulations are often even more strict than that in lieu of getting sued. Check with whoever you're working with, they would know better than we do.

What if I get asked about this in an interview? I've been searching and searching to no avail. So this is not some federal law or regulation, or is it?

 

[pharmddreams]

You will not be asked what you would recommend as a tech during the interview since any medical questions should be answered only by the pharmacist. If you are a tech and are looking to recommend medications or counsel the answer is no you cannot.

 

[paul25]

You will not be asked what you would recommend as a tech during the interview since any medical questions should be answered only by the pharmacist.

No, I was referring to whether or not they would ask the applicant to cite where under the law is it stated that either techs are prohibited, or that only doctors/pharmacists are allowed. It's always good to know what you are claiming.

 

[Neebs9]

Thanks. So do you guys know where under state or federal law says that it is indeed prohibited or otherwise illegal? Or is it the notion, only licensed *doctors* may prescribe / recommend medication, apply?

It doesn't necessary state the counseling of a patient is prohibited or illegal by CPhT, but theres a section in the policy for Pharmacy Technician that states: "a pharmacy technician or trainee should not perform a function reserved for a pharmacist, or graduate intern." This is in the Arizona State Board of Pharmacy Codes, but in the California it should probability be along the lines of that. So it's basically prohibited.

If you know answer to a recommendation you can say the answer, but just say to the patient let me double check with the pharmacist. If you do that it should be ok.

 

[pharmddreams]

I don't see why you would be asked to cite where in the law that techs cannot recommend medications or provide medical advice since this is commonly known knowledge.

Anyways, in California
"A pharmacy technician may perform packaging, manipulative, repetitive, or other nondiscretionary tasks, only while assisting, and while under the direct supervision and control of a pharmacist."
This is under section 4115 of the pharmacy law book.

 

[erin0522]

No, I was referring to whether or not they would ask the applicant to cite where under the law is it stated that either techs are prohibited, or that only doctors/pharmacists are allowed. It's always good to know what you are claiming.

I'm almost positive that you're not going to be asked where.

In training, they will TELL you not to make any sort of recommendations. Then it will become habit. We had a tech who tried to make recommendations and the pharmacist stopped him. So don't worry, you will be trained.

 

[phathead]

What if I get asked about this in an interview? I've been searching and searching to no avail. So this is not some federal law or regulation, or is it?

It's common sense. What right do you have to suggest medical treatment to a patient? Have you gone through years of schooling studying the various medications that are on the market to know the intricacies between when to suggest something like an NSAID and when not to?

Even if they did ask this on whatever type of interview you're speaking of, and I wouldn't imagine they would, just use common sense and say no. There's no need to scour through the internet and various state and federal codes to find the answer to the question. We're all telling you the same thing from our various points of expertise.

 

[Neebs9]

I don't see why you would be asked to cite where in the law that techs cannot recommend medications or provide medical advice since this is commonly known knowledge.

Anyways, in California
"A pharmacy technician may perform packaging, manipulative, repetitive, or other nondiscretionary tasks, only while assisting, and while under the direct supervision and control of a pharmacist."
This is under section 4115 of the pharmacy law book.

Actually, take a look under Pharmacist, Graduate Intern, and Pharmacy intern: "only a pharmacist, graduate intern, and pharmacy intern shall provide oral consultation about a prescription medication to a patient or patient-care giver..." I don't want to list, but it does say recommendation for me. Double check under the intern section.

Like others are saying, its just common sense, and it is prohibited. I'm not sure why they would ask you that question...?

EDIT:

I was looking at the California Code book and its nothing compared to the Arizona which is more specific. But speaking about the nondiscretionary tasks, its states in the CA code book about those tasks for the technician.

 

[paul25]

Thanks, pharmddreams, found it: California Business and Professions Code Section 4115

Thanks everyone for the the great exchange of ideas.

 

[amox]

I've been a CPHT for 2 years...

If a patient asks for any zantac/motrin/aleve I recommend ranitidine/ibuprofen/naproxen respectivly to save the patient money.

If a patient asks what a zocor is for, I reply, cholesterol. Same with other medications.

If a patient asks if their antibiotic is "strong". I reply, antibiotics are not "strong," they work depending on the type of bacteria that they inhibit or kill. The antibiotic was prescribed because it is what kills the bug thats in/on you.

If they want ear wax remover, I simply tell them what aisle to go down, its location, and the name of a product within the aisle so they can locate. For example, Debrox and other products are down aisle 15 on the right midway down.

If a patient wants a cough medication, I ask who its for, and if they have high blood pressure, or are on bloodpressure medication. If they are not on medication, I send them to the RPh, if they are on medication, I tell them about Coricidin.

If a patient is buying tylenol and dayquil for their cold, I tell them to ONLY use one or the other, as they both contain tylenol, and they must limit their intake of APAP.

If the patient brings in a prescription for Levaquin (levofloxacin) and they are on coumadin/warfarin/jantoven then advise the patient that there is a drug interaction and get the pharmacist. (MD will have to monitor blood closely, or prescribe different antibiotic)

Theres many others, but I never directly recommend ANYTHING, and the pharmacists usally listen in and will butt in if they have something to say.

All information above is very basic for a CPHT and I don't see why they can screen the majority of the questions and resolve the easy ones. Less work for the RPh!

 

[phathead]

I've been a CPHT for 2 years...

If a patient asks for any zantac/motrin/aleve I recommend ranitidine/ibuprofen/naproxen respectivly to save the patient money.

If a patient asks what a zocor is for, I reply, cholesterol. Same with other medications.

If a patient asks if their antibiotic is "strong". I reply, antibiotics are not "strong," they work depending on the type of bacteria that they inhibit or kill. The antibiotic was prescribed because it is what kills the bug thats in/on you.

If they want ear wax remover, I simply tell them what aisle to go down, its location, and the name of a product within the aisle so they can locate. For example, Debrox and other products are down aisle 15 on the right midway down.

If a patient wants a cough medication, I ask who its for, and if they have high blood pressure, or are on bloodpressure medication. If they are not on medication, I send them to the RPh, if they are on medication, I tell them about Coricidin.

If a patient is buying tylenol and dayquil for their cold, I tell them to ONLY use one or the other, as they both contain tylenol, and they must limit their intake of APAP.

If the patient brings in a prescription for Levaquin (levofloxacin) and they are on coumadin/warfarin/jantoven then advise the patient that there is a drug interaction and get the pharmacist. (MD will have to monitor blood closely, or prescribe different antibiotic)

Theres many others, but I never directly recommend ANYTHING, and the pharmacists usally listen in and will butt in if they have something to say.

All information above is very basic for a CPHT and I don't see why they can screen the majority of the questions and resolve the easy ones. Less work for the RPh!

The bolded areas are illegal for a tech to do per state law in the four states I have worked in, ESPECIALLY the first one. In those cases you are providing medical advice which is against the law, even if it is as simple as naming what a drug is used for. There are many uses for drugs that you may be unaware of.

For instance Cymbalta is often used for mental disorders, but with certain dosing it can be used for certain types of nerve pain. You tell someone that they're on an "anti-depressant", you're liable to upset or offend someone. Do it to the wrong person, and they'll notify the state about what you've done.

Sounds far-fetched, but I've seen it happen before.

The red part is above the call of a tech and is not to be expected of them. The pharmacists will do this on their own with a proper patient chart. It's not bad to do though.

 

[erin0522]

I agree with phathead.

When things like that are asked, I ask the pharmacist no matter what. You cannot give ANY sort of advice because if you are wrong, it's on the pharmacist's head. The pharmacist should be able to answer these questions and still get his or her work done.

 

[delano2000]

Check this link out:

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=15&ch=297&rl=2


It states:

Pharmacy technician--An individual who is registered with the Board as a pharmacy technician and whose responsibility in a pharmacy is to provide technical services that do not require professional judgment regarding preparing and distributing drugs and who works under the direct supervision of and is responsible to a pharmacist.

Hope that answers your question. At least this is how it is in Texas.

 

[R2pharmD2]

The bolded areas are illegal for a tech to do per state law in the four states I have worked in, ESPECIALLY the first one. In those cases you are providing medical advice which is against the law, even if it is as simple as naming what a drug is used for. There are many uses for drugs that you may be unaware of.

Everything you said might technically be correct, but it doesn't seem terribly practical to refuse to tell a patient what their drug is for. I typically will say something along the lines of "This is commonly used to treat x, but there are other potential uses that I may not be familiar with. Would you like to speak with our pharmacist about it?" That typically answers their question, but if not I've made it clear that they can speak with a pharmacist if they so desire.

In some circumstances, I think it would be pretty irresponsible to NOT say anything to a patient, particularly in the example where they're getting multiple products with tylenol. I wouldn't go so far as to tell them not to take something, but I would strongly suggest to them that they don't take both and should definitely talk to a pharmacist about it.

When I get a question I know the answer to, but know I'm not legally supposed to answer, I'll often go ahead and answer it but then ask the pharmacist if they have anything to add. That way if I've said something they disagree with or left anything out they have the opportunity to correct me. This is really just like most everything else a tech does. We enter rxs, count them out, label them, and then a pharmacist checks our work. Obviously, we couldn't do any one of those things without a pharmacist checking over our work, but as long as they do it's all kosher. How is counseling over simple issues any different?

 

[KCflacpht]

I agree with others above- it's better to ask the pharmacist if it has anything to do with how a drug works, or what it's for specifically.
Now, I have had the pharmacist tell me to go ahead if a patient asks questions about certain things- Head lice treatments comes to mind ( because I've had 3 kids go through all that and he hasn't!) or something similar. But I've also been a Cpht for 20 years and they know that I'm not going to step over "that line".

If you have even the slightest bit of doubt about whether to answer a patient's question- then ask your pharmacist first. Err on the side of caution always!

 

[Farmacist2011]

I agree with others above- it's better to ask the pharmacist if it has anything to do with how a drug works, or what it's for specifically.
Now, I have had the pharmacist tell me to go ahead if a patient asks questions about certain things- Head lice treatments comes to mind ( because I've had 3 kids go through all that and he hasn't!) or something similar. But I've also been a Cpht for 20 years and they know that I'm not going to step over "that line".

If you have even the slightest bit of doubt about whether to answer a patient's question- then ask your pharmacist first. Err on the side of caution always!

Why haven't you gone to pharmacy school?

 

[phathead]

Everything you said might technically be correct, but it doesn't seem terribly practical to refuse to tell a patient what their drug is for. I typically will say something along the lines of "This is commonly used to treat x, but there are other potential uses that I may not be familiar with. Would you like to speak with our pharmacist about it?" That typically answers their question, but if not I've made it clear that they can speak with a pharmacist if they so desire.

In some circumstances, I think it would be pretty irresponsible to NOT say anything to a patient, particularly in the example where they're getting multiple products with tylenol. I wouldn't go so far as to tell them not to take something, but I would strongly suggest to them that they don't take both and should definitely talk to a pharmacist about it.

When I get a question I know the answer to, but know I'm not legally supposed to answer, I'll often go ahead and answer it but then ask the pharmacist if they have anything to add. That way if I've said something they disagree with or left anything out they have the opportunity to correct me. This is really just like most everything else a tech does. We enter rxs, count them out, label them, and then a pharmacist checks our work. Obviously, we couldn't do any one of those things without a pharmacist checking over our work, but as long as they do it's all kosher. How is counseling over simple issues any different?

I once saw a tech tell a patient that warfarin is for 'blood pressure'. Simple fact is, a tech is not authorized or trained properly to state what something is for. CPhT's are better, but that still doesn't make it okay. One state I worked in, if you do that they'll revoke your tech license.

Why haven't you gone to pharmacy school?

Some people, believe it or not, do not wish to go to pharmacy school.

 

[rxlea]

I remember when I interviewed at the hospital I work at, they asked me what I should do if a nurse or patient called and asked, "What is amoxicillin for?". I, of course, know it is an antibiotic but I replied that even though I had that knowledge, the pharmacist was the one authorized to answer the question. Your pharmacist clearly trusts you and is comfortable with you stepping outside the (legal) boundary. Just be careful and please, please don't let pharm hopefuls think that what you're doing is legal or the norm.

 

[KCflacpht]

Why haven't you gone to pharmacy school?

2 reasons really. First- I had started out in Management, and moved to pharmacy because I was sick and tired of not having a life. And while I do have a degree ( history/education- but no jobs there when I graduated!) I basically suck at science so I know I would not do well in pharmacy school.
( Plus-any money we had for schooling went to my husband getting his license in his field, since I already had my degree).

And quite frankly- after all the pressure/crap/tension I dealt with in management- I didn't want that kind of responsibility. I still gladly step back and let the Rph deal. I don't have that kind of ambition. I'm good at what I do- and that's good enough for me believe it or not.

 

[amox]

I remember when I interviewed at the hospital I work at, they asked me what I should do if a nurse or patient called and asked, "What is amoxicillin for?". I, of course, know it is an antibiotic but I replied that even though I had that knowledge, the pharmacist was the one authorized to answer the question. Your pharmacist clearly trusts you and is comfortable with you stepping outside the (legal) boundary. Just be careful and please, please don't let pharm hopefuls think that what you're doing is legal or the norm.

Good point! In my position, I train other techs aswell. My first rule is, if you don't know what your doing, or what the answer is... ASK the pharmacist. Don't complete a task, or tell a patient something unless your 110% confident, and the pharmacist approves, or is listening in on the conversation.

The main reason I handle situations like I posted above is that I work in a slower pharmacy... 100-200 Rxs a day, the pharmacist and I work together on all tasks, and he/she listens to what I am saying.

Also since they know I want to be a pharmacist, they teach me about all medications so that I can counsel patients. Plus they know I am taking this job very seriously since it's my future career, and I want to learn as much as I can.

-AmoX

 

[phathead]

Good point! In my position, I train other techs aswell. My first rule is, if you don't know what your doing, or what the answer is... ASK the pharmacist. Don't complete a task, or tell a patient something unless your 110% confident, and the pharmacist approves, or is listening in on the conversation.

The main reason I handle situations like I posted above is that I work in a slower pharmacy... 100-200 Rxs a day, the pharmacist and I work together on all tasks, and he/she listens to what I am saying.

Also since they know I want to be a pharmacist, they teach me about all medications so that I can counsel patients. Plus they know I am taking this job very seriously since it's my future career, and I want to learn as much as I can.

-AmoX

Honestly, that's scary if you're training other techs with what you have posted. It doesn't matter if you work in a slow pharmacy. It doesn't matter how much your pharmacist 'trusts' you.

What you've described doing is illegal and unethical. There's a difference between skirting frivolous laws and skirting ones that actually have a purpose. You have no right to dispense information regarding drugs. I don't care how much your pharmacist 'teaches' you, that is not your job.

You mention what you're doing during your interviews, and I promise you that will be an immediate red flag for AdCom

 

[ucrx]

I've been a CPHT for 2 years...

If a patient asks for any zantac/motrin/aleve I recommend ranitidine/ibuprofen/naproxen respectivly to save the patient money.

If a patient asks what a zocor is for, I reply, cholesterol. Same with other medications.

If a patient asks if their antibiotic is "strong". I reply, antibiotics are not "strong," they work depending on the type of bacteria that they inhibit or kill. The antibiotic was prescribed because it is what kills the bug thats in/on you.

If they want ear wax remover, I simply tell them what aisle to go down, its location, and the name of a product within the aisle so they can locate. For example, Debrox and other products are down aisle 15 on the right midway down.

If a patient wants a cough medication, I ask who its for, and if they have high blood pressure, or are on bloodpressure medication. If they are not on medication, I send them to the RPh, if they are on medication, I tell them about Coricidin.

If a patient is buying tylenol and dayquil for their cold, I tell them to ONLY use one or the other, as they both contain tylenol, and they must limit their intake of APAP.

If the patient brings in a prescription for Levaquin (levofloxacin) and they are on coumadin/warfarin/jantoven then advise the patient that there is a drug interaction and get the pharmacist. (MD will have to monitor blood closely, or prescribe different antibiotic)

Theres many others, but I never directly recommend ANYTHING, and the pharmacists usally listen in and will butt in if they have something to say.

All information above is very basic for a CPHT and I don't see why they can screen the majority of the questions and resolve the easy ones. Less work for the RPh!

These may all technically be right, but there are some situations when they might not be. Statins aren't always for cholesterol; if someone has had a heart attack they get put on one even if their cholesterol is great. Patients with hypertension that is adequately controlled on medication can actually take pseudoephedrine, but with more monitoring. These are things I thought I knew even in my first year of pharmacy school but have since discovered almost nothing is black and white.

I like what someone else said about "This drug is commonly used for this condition, but sometimes it is used for others. Do you want to talk to the pharmacist?" I think that's a great way to handle "what is this for" questions- even as a pharmacist (skipping the last part of course).

 

[paul25]

Statins aren't always for cholesterol; if someone has had a heart attack they get put on one even if their cholesterol is great.

OK since the thread has gone a bit off tangent, may I just say that statins / HMG-CoA rI's are not the best way to alleviate atherosclerosis. It's just too broad and high in the pathway and affects CoQ10 synthesis. Why would you want to block production of CoQ10 as well? That's a crucial part in ATP production. In theory it does make sense that the adverse effect of statins (i.e., rhabdomyolysis, other myalgia, myopathies) is brought by CoQ10 depletion, one way or another.

Secondly, mortality rate did not improve with statin usage. AT ALL. I'll pull out the decades long pubmed study on this. And also, Re: Vytorin study!

and Re: Taubes, Gary.

 

[Tenor CS]

In an 8-hour shift, I'll say, "Unfortunately, I can't give medical advice, but let me get the pharmacist for you" at least 6 times. But sometimes, just from a customer service aspect, I have to do SOMETHING to at least acknowledge the person standing at the consultation window, drumming his fingers, wondering why the pharmacist is gabbing away on the telephone.

The guideline I was always given was that, as a tech, I should only answer questions that have one correct factual answer and don't require "professional judgment."

 

[R2pharmD2]

I remember when I interviewed at the hospital I work at, they asked me what I should do if a nurse or patient called and asked, "What is amoxicillin for?". I, of course, know it is an antibiotic but I replied that even though I had that knowledge, the pharmacist was the one authorized to answer the question. Your pharmacist clearly trusts you and is comfortable with you stepping outside the (legal) boundary. Just be careful and please, please don't let pharm hopefuls think that what you're doing is legal or the norm.

Not sure if this was directed at me or one of the other posters, but I'll offer up a response anyway. Since this is the pre-pharmacy forum, I want to make it very clear that I think technicians should always rely solely on the judgement of the pharmacist(s) they work under and follow their guidance and interpretation of the law when it comes to figuring out what they can and can't do as techs. Laws vary from state to state and are subject to some level of interpretation (what exactly is considered a nondiscretionary task, for example). It's their license on the line, so the pharmacist should be the one to establish boundaries as to what's acceptable in their pharmacy using their knowledge of the law, bottom line.

Honestly, that's scary if you're training other techs with what you have posted. It doesn't matter if you work in a slow pharmacy. It doesn't matter how much your pharmacist 'trusts' you.

What you've described doing is illegal and unethical. There's a difference between skirting frivolous laws and skirting ones that actually have a purpose. You have no right to dispense information regarding drugs. I don't care how much your pharmacist 'teaches' you, that is not your job.

You mention what you're doing during your interviews, and I promise you that will be an immediate red flag for AdCom

I don't know if there's a federal guideline outlining technician responsibilities in detail, but my understanding is that the laws can vary widely from state to state. What you're saying generally sounds correct based on my own experience but may not be true everywhere. Again, I think it's best for each tech to rely on their pharmacist for legal guidance, and if they green light a specific behavior (at least where there's a gray area subject to interpretation) then you do as they say.

 

[group_theory]

OK since the thread has gone a bit off tangent, may I just say that statins / HMG-CoA rI's are not the best way to alleviate atherosclerosis. It's just too broad and high in the pathway and affects CoQ10 synthesis. Why would you want to block production of CoQ10 as well? That's a crucial part in ATP production. In theory it does make sense that the adverse effect of statins (i.e., rhabdomyolysis, other myalgia, myopathies) is brought by CoQ10 depletion, one way or another.

Secondly, mortality rate did not improve with statin usage. AT ALL. I'll pull out the decades long pubmed study on this. And also, Re: Vytorin study!

and Re: Taubes, Gary.

Early statin treatment following acute myocardial infarction and 1-year survival.
Stenestrand U, Wallentin L; Swedish Register of Cardiac Intensive Care (RIKS-HIA)
JAMA 2001 Jan 24-31;285(4):430-6.

Results At 1 year, unadjusted mortality was 9.3% (1307 deaths) in the no-statin group and 4.0% (219 deaths) in the statin treatment group. In regression analysis adjusting for confounding factors and propensity score for statin use, early statin treatment was associated with a reduction in 1-year mortality (relative risk, 0.75; 95% confidence interval, 0.63-0.89; P = .001) in hospital survivors of AMI. This reduction in mortality was similar among all subgroups based on age, sex, baseline characteristics, previous disease manifestations, and medications.

Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes (PROVE IT-TIMI 22)
N Engl J Med 2004;350:1495-504.​

Conclusions
Among patients who have recently had an acute coronary syndrome, an intensive lipid lowering statin regimen provides greater protection against death or major cardiovascular events than does a standard regimen. These findings indicate that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels.​

Discontinuation of statin therapy following an acute myocardial infarction: a population-based study
Daskalopoulou et al.
Eur Heart J (2008) 29 (17): 2083-2091.


Conclusion Discontinuation of statins in survivors of a first AMI was relatively rare in this cohort. However, statin discontinuation was associated with higher total mortality and this may represent a biological rebound or/and a risk-treatment mismatch phenomenon, where treatment is withdrawn from very ill patients. While awaiting further research, at present statin use should only be withdrawn under judicious clinical supervision.

 

[Sparda29]

Early statin treatment following acute myocardial infarction and 1-year survival.
Stenestrand U, Wallentin L; Swedish Register of Cardiac Intensive Care (RIKS-HIA)
JAMA 2001 Jan 24-31;285(4):430-6.

Results At 1 year, unadjusted mortality was 9.3% (1307 deaths) in the no-statin group and 4.0% (219 deaths) in the statin treatment group. In regression analysis adjusting for confounding factors and propensity score for statin use, early statin treatment was associated with a reduction in 1-year mortality (relative risk, 0.75; 95% confidence interval, 0.63-0.89; P = .001) in hospital survivors of AMI. This reduction in mortality was similar among all subgroups based on age, sex, baseline characteristics, previous disease manifestations, and medications.

Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes (PROVE IT-TIMI 22)
N Engl J Med 2004;350:1495-504.​

Conclusions
Among patients who have recently had an acute coronary syndrome, an intensive lipid lowering statin regimen provides greater protection against death or major cardiovascular events than does a standard regimen. These findings indicate that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels.​

Discontinuation of statin therapy following an acute myocardial infarction: a population-based study
Daskalopoulou et al.
Eur Heart J (2008) 29 (17): 2083-2091.


Conclusion Discontinuation of statins in survivors of a first AMI was relatively rare in this cohort. However, statin discontinuation was associated with higher total mortality and this may represent a biological rebound or/and a risk-treatment mismatch phenomenon, where treatment is withdrawn from very ill patients. While awaiting further research, at present statin use should only be withdrawn under judicious clinical supervision.

 

[armorking]

Early statin treatment following acute myocardial infarction and 1-year survival.
Stenestrand U, Wallentin L; Swedish Register of Cardiac Intensive Care (RIKS-HIA)
JAMA 2001 Jan 24-31;285(4):430-6.

Results At 1 year, unadjusted mortality was 9.3% (1307 deaths) in the no-statin group and 4.0% (219 deaths) in the statin treatment group. In regression analysis adjusting for confounding factors and propensity score for statin use, early statin treatment was associated with a reduction in 1-year mortality (relative risk, 0.75; 95% confidence interval, 0.63-0.89; P = .001) in hospital survivors of AMI. This reduction in mortality was similar among all subgroups based on age, sex, baseline characteristics, previous disease manifestations, and medications.

Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes (PROVE IT-TIMI 22)
N Engl J Med 2004;350:1495-504.​

Conclusions
Among patients who have recently had an acute coronary syndrome, an intensive lipid lowering statin regimen provides greater protection against death or major cardiovascular events than does a standard regimen. These findings indicate that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels.​

Discontinuation of statin therapy following an acute myocardial infarction: a population-based study
Daskalopoulou et al.
Eur Heart J (2008) 29 (17): 2083-2091.


Conclusion Discontinuation of statins in survivors of a first AMI was relatively rare in this cohort. However, statin discontinuation was associated with higher total mortality and this may represent a biological rebound or/and a risk-treatment mismatch phenomenon, where treatment is withdrawn from very ill patients. While awaiting further research, at present statin use should only be withdrawn under judicious clinical supervision.

@group_theory: The facts don't lie/btw nice reply...where did you go to school if you don't mind me asking?

@Sparda29: Absolutely hilarious!!!

 

[paul25]

Early statin treatment following acute myocardial infarction and 1-year survival.
Stenestrand U, Wallentin L; Swedish Register of Cardiac Intensive Care (RIKS-HIA)
JAMA 2001 Jan 24-31;285(4):430-6.

Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes (PROVE IT-TIMI 22)
N Engl J Med 2004;350:1495-504.​

Discontinuation of statin therapy following an acute myocardial infarction: a population-based study
Daskalopoulou et al.
Eur Heart J (2008) 29 (17): 2083-2091.

Thanks, group it really is an interesting subject and am passionate about it since my mom also had to take statins until her lipid profile has normalized. Please know that I am not against statin administration per se but a CoQ10 adjunct would be a great supplement AND prophylactic.

Hey guys please don't misconstrue this as some competition. I would love to share ideas with you all too as I am really hoping to be a PharmD someday. I know I need to learn a lot more.

Here is the 20 year study:

Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program, a 20 Year Study. The Lancet
Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD.
Lancet. 2001 Aug 4;358(9279):351-5.

"Our data accords with previous findings of increased mortality in elderly people with low serum cholesterol, and show that long-term persistence of low cholesterol concentration actually increases risk of death. Thus, the earlier that patients start to have lower cholesterol concentrations, the greater the risk of death. . . The most striking findings were related to changes in cholesterol between examination three (1971-74) and examination four (1991-93). There are few studies that have cholesterol concentrations from the same patients at both middle age and old age. Although our results lend support to previous findings that low serum cholesterol imparts a poor outlook when compared with higher concentrations of cholesterol in elderly people, our data also suggest that those individuals with a low serum cholesterol maintained over a 20-year period will have the worst outlook for all-cause mortality."

Here is the largest North American cholesterol-lowering trial ever:
ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)
Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin vs Usual Care
Link: http://jama.ama-assn.org/content/288/23/2998.full
JAMA. 2002 Dec 18;288(23):2998-3007. Curt D. Furberg, MD, PhD; Jackson T. Wright, Jr, MD, PhD; Barry R. Davis, MD, PhD; Jeffrey A. Cutler, MD, MPH; Michael Alderman, MD et al

Heart failure rate: SAME for statin and non-statin taking groups.
The 6-year incident cancer rates (Table 4) were similar in the 2 groups.

The results were similar when the unconfirmed deaths (27 pravastatin vs 28 usual care) were included. Numbers of cardiovascular deaths were similar in the 2 groups. There were more cancer deaths and slightly fewer other medical deaths with pravastatin than usual care.

http://jama.ama-assn.org/content/288/23/2998.full

FDA
The clinical use of HMG CoA-reductase inhibitors (statins) and the associated depletion of the essential co-factor coenzyme Qlo; a review of pertinent human and animal data.
Peter H. Langsjoen, M.D., F.A.C.C.
LINK: http://www.fda.gov/ohrms/dockets/dailys/02/May02/052902/02p-0244-cp00001-02-Exhibit_A-vol1.pdf

Fifteen animal studies in six different animal species have documented statin-induced Co-Q10 depletion leading to decreased ATP production, increased injury from heart failure, skeletal muscle injury and increased mortality. Of the nine controlled trials on statin-induced Co-Q10 depletion in humans, eight showed significant Co-Q10 depletion leading to decline in left ventricular function and biochemical imbalances.

2009
Serum lipids and their association with mortality in the elderly: a prospective cohort study. (Finland)
Upmeier E, Lavonius S, Lehtonen A, Viitanen M, Isoaho H, Arve S.
Aging Clin Exp Res. 2009 Dec;21(6):424-30. Department of Geriatrics, Turku City Hospital and University of Turku, 20700 Turku, Finland.

RESULTS: Low levels of serum total cholesterol and HDL-c were associated with a greater risk of death over a follow-up of 12 years. After adjustment for several cardiovascular risk factors, the association between total cholesterol and survival changed. All-cause mortality seemed to be highest in the highest quartile of total cholesterol and nearly as high in the lowest quartile of total cholesterol, suggesting a U-shaped connection, but the differences were not statistically significant. However, cardiovascular mortality was significantly lowest in the lowest quartile of total cholesterol and significantly highest in the lowest quartile of HDL-c.

(Vytorin)
Extended-Release Niacin or Ezetimibe and Carotid Intima–Media Thickness
Allen J. Taylor, M.D., Todd C. Villines, M.D., Eric J. Stanek, Pharm.D., Patrick J. Devine, M.D., Len Griffen, M.D., Michael Miller, M.D., Neil J. Weissman, M.D., and Mark Turco, M.D. N Engl J Med 2009; 361:2113-2122November 26, 2009

Dr. Allen Taylor, who was at the Walter Reed Army Medical Center in Bethesda, Md., reported at a news conference Sunday that Niaspan shrank plaque in carotid arteries by about 2%, while Ezetemibe had no effect, even though it reduced cholesterol. There were two heart attacks or heart-related deaths in the 160 people given Niaspan, but nine among the 165 given Zetia. About a third of those who received Niaspan did suffer flushing, however.

http://latimesblogs.latimes.com/boo...ttle-or-no-benefit-against-heart-disease.html

** Niacin, IMHO, is not a good option either, as it also raises liver ALT/AST, along with the above effects

Which Cholesterol Level Is Related to the Lowest Mortality in a Population with Low Mean Cholesterol Level: A 6.4-Year Follow-up Study of 482,472 Korean Men

To evaluate the relation between low cholesterol level and mortality, the authors followed 482,472 Korean men aged 30-65 years from 1990 to 1996 after a baseline health examination. The mean cholesterol level of the men was 189.1 mg/100 ml at the baseline measurement. There were 7,894 deaths during the follow-up period. A low cholesterol level (<165 mg/100 ml) was associated with increased risk of total mortality, even after eliminating deaths that occurred in the first 5 years of follow-up. The risk of death from coronary heart disease increased significantly in men with the highest cholesterol level (>=252 mg/100 ml). There were various relations between cholesterol level and cancer mortality by site. Mortality from liver and colon cancer was significantly associated with a very low cholesterol level (<135 mg/100 ml) without any evidence of a preclinical cholesterol-lowering effect. With lengthening follow-up, the significant relation between a very low cholesterol level (<135 mg/100 ml) and mortality from stomach and esophageal cancer disappeared. The cholesterol level related with the lowest mortality ranged from 211 to 251 mg/100 ml, which was higher than the mean cholesterol level of study subjects.
Am J Epidemiol 2000; 151:739-47

So some thoughts

> Why is Calcium CT scoring vital in diagnosing Atherosclerosis?

> Is it really the calcification more so than a high serum LDL? (re: fatty streak formation... wbc/calcium/lipids ... arterial plaque)

> Is saturated fat bad, or is it the lipid peroxidation of PUFAs + trans fats thereby == Advanced Glycation End products?

> Is it really LDL, or VLDL, along with trans fats and calcium that we REALLY need to look out for as markers of CVD/ atherosclerosis?

> So are there any other options, without compromising sales? Menatetrenone (mk4)/menaquinone administration - for calcium binding via carboxylation?

 

[delano2000]

 

[ucrx]

Thanks, group it really is an interesting subject and am passionate about it since my mom also had to take statins until her lipid profile has normalized. Please know that I am not against statin administration per se but a CoQ10 adjunct would be a great supplement AND prophylactic.

Hey guys please don't misconstrue this as some competition. I would love to share ideas with you all too as I am really hoping to be a PharmD someday. I know I need to learn a lot more.

I'd like to point out that your studies pretty much aren't related to statins given after MI. Many aren't related to either statins or MI. Statins effects post MI are believed to be related to its other effects on the body in addition to its effects on cholesterol.

 

[paul25]

I'd like to point out that your studies pretty much aren't related to statins given after MI. Many aren't related to either statins or MI. Statins effects post MI are believed to be related to its other effects on the body in addition to its effects on cholesterol.

I think I was clear enough to point out that my premise is about long-term statin administration and mortality rate. I tried to establish that these cohort studies are long term trials to see the effect of statin prescription on patients AND the justification of decreasing plasma LDL and TC, especially now that this class of drugs is being used as prophylactic! Then there's that FDA link above that CoQ10 depletion is a health risk in the long term. I mean, my goodness, the food source highest in CoQ10 is beef HEARTs! And then we are going to deplete the patient's heart with ubiquinone, so we can treat athero and then risk the patient of CHF / cardiac arrest (in theory of course)? If statins are being used as prophylactic, why not CoQ10 too, *if* statin administration is indeed inevitable and since we don't want to lose market anyway.

Statin + CoQ10 (with closed monitoring) = happy richer retail pharmacy + healthy patient = everybody happy

The problem is not one pharma would make enough studies on CoQ10 + HMG-CoA rI's and their effect on myopathy, myalgia, rhabdo, since there are no monopolized incentives, but that's another issue.

Otherwise, find other action mechanisms to alleviate atheromatous plaque formation to begin with, like menatetrenone (drug interactions coumadin warfarin classes), re: recent Johns Hopkins talk on Calcium, and statin links to depression.