O calcium supplements increase cardiovascular risk?

Drug Information Consult Project
The title of this project is: Do calcium supplements increase cardiovascular risk?


This project consists of three components to be turned in separate times: Total page the project is 6 pages. 2 pages for tertiary literature review, 1 page for secondary literature review and finally 3 page of primary literature review. Primary literatures review the most important part of the project. Total pages: about 6 pages:
The detail information of the project is as follow: Look carefully the example and instruction that I give the bottom of this instruction.

1. Tertiary literature review
a? Obtain your Drug Information Consult question from the requestor.
a? Search tertiary literature for background information on your drug(s) and topic. Should include at least the following information as it relates to the question:
a? Drug name(s)
a? Uses/Indications of drug(s)
a? Mechanism of action of drug(s)
a? Pharmacokinetic drug data
a? Pharmacodynamic drug data
a? Disease state information (What, Who, When, How, and Why)
a? Pathophysiology of the disease
a? Any other relevant information
Do NOT simply recite information found from Drug Databases (i.e., Micromedex, Lexi-Comp, etc.) ONLY relevant information should be SUMMARIZED to provide an adequate background for the proposed question


2. Secondary literature search
a) Navigate the secondary literature using OVID and/or PubMed
b) Record search strategy (i.e., what process did you use in your search?)
c) Include any MeSH terms, limits, etc. used to find the studies relevant to the topic
-Record your search strategy and your thought process while searching for primary literature to answer your drug information question
-Provide documentation of your search results


3. Primary literature search and drug information response: This is the most important step of final work.
a) Find primary literature that will give the most up-to-date information (not review articles) in answering the initial question
i. Pull and read at least 2 primary literature references (i.e. clinical trials, case reports/series, cohort studies, case-control, etc.) that you consider the best based on what you learned in lectures entitled a?Overview of Literature Evaluation.a?
ii. Use 2 to 4 of these studies as the basis for conclusions of the consult question.
b) Answer the Drug Information Consult question
i. Use Information gathered from tertiary and primary literature to give the most complete and up-to-date answers. Include all information the physician would need to read your consult and write the order if applicable, i.e. dose, directions, route, etc.
ii. Cite all tertiary and primary literature
a? Additional information: Answer to the drug information consult as specified above. Be sure to include the initial question on the paper. Answers to the question should be no longer than 2 double-spaced typed pages with 1 inch margins.
The hard-copies of the 2-4 primary literature articles cited in your drug information response.
One paragraph for each study cited as to why you chose this study a pros & cons of study, study design, confounders, etc.



Example Final Drug Consult Project Response
QUESTION: Can Atorvastatin be used to treat plaque-type psoriasis?

Psoriasis is an autoimmune condition that affects the skin, scalp, nails and occasionally the joints, with periods of exacerbation and remission.2 Inflammatory cells and mediators, particularly T-cells, cytokines and chemokines are involved in psoriatic lesion development. In addition to lowering cholesterol, it is thought that statins have nona lipid-lowering benefits including, but not limited to: Anti-inflammatory effects, improving endothelial function, and promotion of angiogenesis. The ability of statins to reduce inflammation is thought to occur partly due to T-cell activation suppression & regulation.4 As a result of the proposed pleiotropic effects on inflammation; it is believed that statin use may be beneficial in treatment of plaque-type psoriasis.
A randomized, double-blind, placebo-controlled study was conducted in 2010 by Faghihi et al. to explore the efficacy and safety of Atorvastatin for plaque-type psoriasis treatment. Forty-two patients aged 16a 60 years with a diagnosis of acute or chronic plaque-type psoriasis with BSA involvement > 10% were enrolled; 40 completed the study. In addition to topical corticosteroids, patients were randomized to add either atorvastatin 40 mg/day or placebo for 12 weeks. No statistically significant differences were found between the two treatment groups in regards to the primary outcome. 3
A case-control analysis study was conducted by Brauchli et al in 2010 to examine the risk of first-time psoriasis diagnosis in patients on statin therapy. 36,702 psoriasis cases between 1994 -2005 were identified. The study did not provide evidence that long term statin therapy alters the risk of developing psoriasis. This study, however, did not provide any evidence about statin therapy in preexisting psoriasis.1
Although there is evidence that statin use has pleiotropic effects on inflammation, there is currently no evidence to support the use of Atorvastatin in the treatment of plaque-type psoriasis. The study population in the Faghihi was too small to detect a significant difference between the two treatment groups. In addition, this study only used a singular dose of atorvastatin 40mg daily. It is also unclear if the inflammatory effects of statin therapy differ between long term & short term use. Further randomized, large controlled trials studying different treatment doses would need to be conducted to provide more conclusive evidence. Based on current evidence it is not recommended that healthcare providers utilize Atorvastatin as a primary treatment or prevention method for plaque-type psoriasis.
References:
1. Brauchli Y, Jick S, Meier C. Statin use and risk of first-time psoriasis diagnosis. Journal of the American Academy of Dermatology 2011:65(1);77-83
2. Dipiro JT, Talbert RL, Yee GC, et al. Pharmacotherapy: A Pathophysiologic Approach. 7th Edition. McGraw-Hill Medical Publishing Division. 2008. p.977-987.
3. Faghihi T, Radfar M, Mehrabian Z. Atorvastatin for the Treatment of Plaque-Type Psoriasis. Pharmacotherapy 2011:31(11);1045-1050
4. Spah F, Krefeld H, Klinik M et al. Inflammation in atherosclerosis and psoriasis: common pathogenic mechanisms and the potential for an integrated treatment approach. British Journal of Dermatology 2008:159;10a 17