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Brandon Cave, Augustus Hough, Paul P Dobesh
Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with the majority of events occurring within 30 days of hospital discharge. Therefore, the 30-day time period post discharge has been identified as a stage in which patients are still at high-risk of developing VTE...
March 15, 2018: Pharmacotherapy
Sara C Keller, Kathryn Dzintars, Lisa A Gorski, Deborah Williams, Sara E Cosgrove
OBJECTIVES: Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home-based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (such as midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home-based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications...
March 1, 2018: Pharmacotherapy
C J Michaud, Brian Trethowan
When aortic dissections extend to the renal arteries, the reductions in renal blood flow can cause marked increases in renin production. The resultant rise in angiotensin II can lead to difficult-to-control blood pressure, despite normal post-dissection antihypertensive agents. Herein, we highlight a case of a post-dissection patient with malignant hypertension refractory to eight different enteral antihypertensives. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers had been held due to post-operative acute kidney injury...
February 28, 2018: Pharmacotherapy
Alyssa M Peckham, Kirk E Evoy, Jordan R Covvey, Leslie Ochs, Kathleen A Fairman, David A Sclar
OBJECTIVE: Research suggests medical consequences of gabapentin overuse depends on whether gabapentin is abused alone or with opioids to potentiate an opioid "high." The objective of this study was to assess predictors of gabapentin overuse with or without concomitant opioids. METHODS: Data were obtained from the Truven Health MarketScan® Commercial Claims and Encounters database for years 2013 to 2015. Eligibility criteria were gabapentin utilization, with or without opioids, for 120 days or longer throughout a 12-month observation period...
February 27, 2018: Pharmacotherapy
Kyle J Burghardt, Berhane Seyoum, Sabrina Dass, Elani Sanders, Abdullah Mallisho, Zhengping Yi
STUDY OBJECTIVE: Atypical antipsychotics cause insulin resistance that leads to an increased risk of diabetes mellitus and cardiovascular disease. Skeletal muscle is the primary tissue for uptake of glucose, and its dysfunction is considered one of the primary defects in the development of insulin resistance. Protein kinase B (AKT) plays an important role in overall skeletal muscle health and glucose uptake into the muscle. The objective of this study was to measure AKT isoform-specific gene methylation differences in the skeletal muscle of patients with bipolar disorder treated with atypical antipsychotic or mood stabilizer maintenance therapy...
February 27, 2018: Pharmacotherapy
Nimisha Sulejmani, Shunji Nagai, Mohamed Safwan, Michael D Rizzari, Mohammad Raoufi, Marwan S Abouljoud, Mayur Ramesh
Adenoviruses are double-stranded DNA viruses that typically cause mild self-limiting respiratory, ocular, and gastrointestinal infections. In immunocompromised patients, especially transplant recipients, the infection can be severe, with dissemination and multiorgan failure. In intestinal transplant recipients, the incidence is as high as 57%. To our knowledge, no standardized guidelines or United States Food and Drug Administration-approved medications exist for the treatment of adenovirus disease. We describe two isolated intestinal transplant recipients who developed adenovirus disease (viremia with viral enteritis) that was managed with a new experimental drug, brincidofovir (an oral lipid conjugate prodrug of cidofovir), as salvage therapy...
February 19, 2018: Pharmacotherapy
Shiyin Jiao, Irene B Murimi, Randall S Stafford, Ramin Mojtabai, G Caleb Alexander
OBJECTIVE: Nurse practitioners (NPs) and physician assistants (PAs) have increasingly broad prescribing authority in the United States, yet little is known regarding how the quality of their prescribing practices compares to that of physicians. The objective of this study was to compare the quality of prescribing practices of physicians and non-physician providers. METHODS: A serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) was performed...
February 19, 2018: Pharmacotherapy
Heather Torbic, Abhijit Duggal
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, long-term cognitive impairment, and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidly and mortality...
February 14, 2018: Pharmacotherapy
Sarah Christina Jane Jorgensen, Michael Joseph Rybak
Vaborbactam (VAB; formerly RPX7009) is a novel beta-lactamase inhibitor based on a cyclic boronic acid pharmacophore with potent inhibitory activity against Ambler class A and C beta-lactamases. It has been co-formulated with meropenem to restore its activity against Klebsiella pneumoniae carbapenemases (KPC). VAB does not inhibit class B or D carbapenemases, nor does it improve the activity of meropenem against multidrug-resistant non-fermenting Gram-negative bacilli, notably Acinetobacter spp. and Pseudomonas aeruginosa...
February 10, 2018: Pharmacotherapy
Richard H Tran, Ahmed Aldemerdash, Patricia Chang, Carla A Sueta, Brystana Kaufman, Josephine Asafu-Adjei, Orly Vardeny, Eliza Daubert, Khalid A Alburikan, Anna M Kucharska-Newton, Sally C Stearns, Jo E Rodgers
BACKGROUND: Modification of guideline-directed medical therapy (GDMT) in hospitalized patients with heart failure (HF) has not been extensively evaluated. METHODS: The community surveillance arm of the Atherosclerosis Risk in Communities Study identified 6959 HF hospitalizations from 2005 to 2011. Predictors of GDMT modification and survival were assessed using multivariable logistic regression and Cox proportional hazards models. RESULTS: For 5091 hospitalizations, patient mean age was 75 years old, 53% were female, 69% were Caucasian, and 81% had acute decompensated HF (ADHF)...
February 9, 2018: Pharmacotherapy
Vinita Singh, Theresa W Gillespie, R Donald Harvey
Cancer-related pain continues to be a significant therapeutic challenge, made more difficult by contemporary opioid use and diversion concerns. Conventional treatment utilizing a tiered approach of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant agents is limited; and alternatives are needed for patients with rapidly progressing pain and those who develop hyperalgesia and tolerance to opioids. Ketamine, an N-methyl-D-aspartate (NMDA) selective antagonist, has historically been used for anesthesia in adult and pediatric populations, but has also been investigated for depression, bipolar disorder, and general and post-operative pain management...
February 3, 2018: Pharmacotherapy
Kelly R Reveles, Eric M Mortensen, Jim M Koeller, Kenneth A Lawson, Mary Jo V Pugh, Sarah A Rumbellow, Jacqueline R Argamany, Christopher R Frei
STUDY OBJECTIVE: Prior studies have identified risk factors for recurrent Clostridium difficile infection (CDI), but few studies have integrated these factors into a clinical prediction rule that can aid clinical decision making. The objective of this study was to derive and validate a CDI recurrence prediction rule to identify patients at risk for first recurrence in a national cohort of veterans. DESIGN: Retrospective cohort study. DATA SOURCE: Veterans Affairs Informatics and Computing Infrastructure...
February 2, 2018: Pharmacotherapy
Aditi Shendre, Gaurav M Parmar, Chrisly Dillon, T Mark Beasley, Nita A Limdi
OBJECTIVE: We assessed the influence of age on warfarin dose, percent time in target range (PTTR), and risk of major hemorrhage. DESIGN: Warfarin users recruited into a large prospective inception cohort study were categorized into three age groups: young (<50 years), middle-aged (50 -70 years), and elderly (>70 years). The influence of age on warfarin dose and PTTR was assessed using regression analysis and risk of major hemorrhage was assessed using the proportional hazards (PH) analysis...
February 2, 2018: Pharmacotherapy
David F Lehmann, William D Eggleston, Dongliang Wang
BACKGROUND: Use of the QT (QTc) interval on the electrocardiogram to predict torsades de pointes (TdP) risk from culprit drugs is neither sensitive nor specific. The ratio of the half-maximum inhibitory concentration of the hERG channel (hERG IC50) to the peak serum concentration of unbound drug (Cmax) is used during drug development to screen out chemical entities likely to cause TdP. PURPOSE: To validate the use of the hERG IC50/Cmax ratio to predict of TdP risk from a culprit drug by its correlation with TdP incidence...
January 30, 2018: Pharmacotherapy
Denise K Patten, Bob G Schultz, Daniel J Berlau
Chronic inflammatory diseases are complex to treat and have an impact on a large number of patients. Due to the difficulty of treating these diseases and the great impact on quality of life, patients often seek off-label, complimentary, or alternative medicines to gain relief from symptoms. Low-dose naltrexone has been used off-label for treatment of pain and inflammation in multiple sclerosis, Crohn's disease, fibromyalgia, and other diseases. Naltrexone is a mu-opioid receptor antagonist indicated by the Food and Drug Administration for opioid and alcohol dependence...
January 27, 2018: Pharmacotherapy
Michael R Cobretti, Benjamin Bowman, Ted Grabarczyk, Emily Potter
OBJECTIVES: The dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) are effective modulators of fasting and postprandial hyperglycemia in patients with type 2 diabetes mellitus (T2DM). In 2013 the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) clinical trial found an increased risk of heart failure exacerbation, as a secondary outcome, among patients treated with saxagliptin. This study examines the safety of DPP-4 inhibitors as a class in T2DM in relation to risk of heart failure exacerbations...
January 24, 2018: Pharmacotherapy
Derek Wilke, Nikhilesh Patil, Helmut Hollenhorst, David Bowes, Robert Rutledge, Casely Ago
OBJECTIVES: To characterize the probability of testosterone escape during a course of radiotherapy and androgen deprivation (ADT) in patients with prostate cancer, and examine predictors of testosterone escape, the prostate specific antigen (PSA) levels during testosterone escape, and the impact of testosterone escape on outcome. PATIENTS AND METHODS: To participate in the database review, necessary data included: (i) type of luteinizing hormone-releasing hormone agonist (LHRHa) administered, date of initiation, and date of cessation or duration of therapy, (ii) radiotherapy information (start date and dose) with at least 6 months of follow-up after radiotherapy, (iii) radiotherapy to the prostate or prostate bed, and (iv) at least one serum testosterone and PSA measurement...
January 16, 2018: Pharmacotherapy
Maxwell D Anderegg, Tyler H Gums, Liz Uribe, Eric J MacLaughlin, James Hoehns, Oralia V Bazaldua, Timothy J Ives, David L Hahn, Christopher S Coffey, Barry L Carter
OBJECTIVES: The objectives of this study were to 1) determine if hypertensive patients with comorbid diabetes mellitus (DM) and/or chronic kidney disease (CKD) receiving a pharmacist intervention had a greater reduction in mean blood pressure (BP) and improved BP control at 9 months compared to those receiving usual care and 2) compare Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guideline and 2014 guideline (JNC-8) BP control rates in patients with DM and/or CKD...
January 13, 2018: Pharmacotherapy
Gretchen L Sacha, Simon W Lam, Abhijit Duggal, Heather Torbic, Anita J Reddy, Seth R Bauer
STUDY OBJECTIVES: Patients with septic shock often require vasoactive agents for hemodynamic support; however, the optimal approach to discontinuing these agents once patients reach the recovery phase is currently unknown. The objective of this evaluation was to compare the incidence of hypotension within 24 hours based on the discontinuation order of norepinephrine (NE) and vasopressin (AVP) in patients in the recovery phase of septic shock. DESIGN: Retrospective cohort study...
January 12, 2018: Pharmacotherapy
Diana X Cao, Rebecca J C Tran
Recent hypertension clinical trials and national guideline updates have created a debate on the most appropriate treatment goals in elderly patients with hypertension. In 2014, recommendations by the Eighth Joint National Committee (JNC 8) allowed a more lenient goal for patients 60 years and older compared with previous guidelines. Since then, several large clinical trials and meta-analyses have added more information regarding strict versus lenient treatment goals. Most recently, the American College of Cardiology and American Heart Association Task Force published their highly-anticipated hypertension guideline developed in conjunction with nine additional interdisciplinary organizations...
January 8, 2018: Pharmacotherapy
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