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Pharmacotherapy

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https://www.readbyqxmd.com/read/27888542/clinical-outcomes-of-extended-versus-intermittent-infusion-of-piperacillin-tazobactam-in-critically-ill-patients-a-prospective-clinical-trial
#1
Sheung-Yin Fan, Hoi-Ping Shum, Wing-Yee Cheng, Yat-Hei Chan, Sik-Yin McShirley Leung, Wing-Wa Yan
STUDY OBJECTIVE: To determine whether critically ill patients receiving extended-infusion (EI) piperacillin/tazobactam would have improved clinical outcomes compared with patients receiving intermittent infusions. DESIGN: Single-center, open-label, prospective study. SETTING: Twenty-two-bed intensive care unit (ICU) in a regional hospital in Hong Kong. PATIENTS: A total of 367 adults who had a diagnosis of either bacterial infection or neutropenic fever and had received treatment with piperacillin/tazobactam for at least 48 hours between December 1, 2013, and August 31, 2015...
November 26, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27888528/hormone-related-migraine-headaches-and-mood-disorders-treatment-with-estrogen-stabilization
#2
Julia K Warnock, Lawrence J Cohen, Harvey Blumenthal, Jordan E Hammond
Since estrogens and the trigeminal system are inherently linked, prescribers who are treating a woman with a hormonally-related mood disorder and migraine headachesshould consider hormonal options to optimize the patient's treatment. This paper will discuss the interrelationships of estrogen, serotonin, and the trigeminal system as they relate to menstrual migraine occurrence and hormone-related mood symptoms. In addition, clinical examples are provided to facilitate the prescribers treating women during reproductive transitions in which declining estrogens are related to their suffering...
November 26, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27885711/the-importance-of-research-and-scholarly-activity-in-pharmacy-training
#3
Eli N Deal, Paul M Stranges, Whitney D Maxwell, Jennifer Bacci, Emily J Ashjian, David L DeRemer, Sandra L Kane-Gill, Nicholas B Norgard, Lauren Dombrowski, Robert B Parker
Regardless of practice setting, it is imperative that pharmacists be able to either participate in generating new knowledge or use the ever-expanding body of literature to guide patient care. However, competing priorities in Pharm.D. curricula and residency training programs have resulted in limited emphasis on acquiring research and scholarly skills. Factors likely contributing to this reduced focus include the lack of curricular and postgraduate training standards emphasizing the development of research skills, time to commit to scholarly activity, and accessibility to experienced mentors...
November 25, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27870104/clinical-experience-with-daptomycin-in-pediatrics
#4
Katie C Namtu, Julianna C Crain, Allison F Messina, Juan A Dumois, David M Berman
INTRODUCTION: The management of Gram-positive infections has been complicated in recent years by the emergence of antimicrobial resistance, leaving fewer options for therapy. Daptomycin is a lipopeptide antibiotic used for the systemic treatment of Gram-positive infections and has a distinct mechanism of action, favorable side effect profile, and requires once daily dosing. Unfortunately, there is a paucity of safety, efficacy, and pharmacokinetic data in neonatal and pediatric patients...
November 21, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27870103/role-of-immunotherapy-in-targeting-the-bone-marrow-microenvironment-in-multiple-myeloma-an-evolving-therapeutic-strategy
#5
Clement Chung
Multiple myeloma (referred to henceforth as myeloma) is a B-cell malignancy characterized by unregulated growth of plasma cells in the bone marrow. The treatment paradigm for myeloma underwent significant evolution in the last decade, with an improved understanding of the pathogenesis of the disease as well as the development of therapeutic agents that target not only the tumor cells but also their microenvironment. Despite these therapeutic advances, the prognosis of patients with relapsed or refractory myeloma remains poor...
November 21, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27870079/cost-effectiveness-analysis-of-second-line-chemotherapy-agents-for-advanced-gastric-cancer
#6
Simon W Lam, Maya Wai, Jessica E Lau, Michael McNamara, Marc Earl, Belinda Udeh
STUDY OBJECTIVE: Gastric cancer is the fifth most common malignancy and second leading cause of cancer-related mortality. Chemotherapy options for patients who fail first-line treatment are limited. Thus, the objective of this study was to assess the cost-effectiveness of second-line treatment options for patients with advanced or metastatic gastric cancer. DESIGN: Cost-effectiveness analysis using a Markov model to compare the cost-effectiveness of six possible second-line treatment options for patients with advanced gastric cancer who have failed previous chemotherapy: irinotecan, docetaxel, paclitaxel, ramucirumab, paclitaxel plus ramucirumab, and palliative care...
November 21, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27862122/rising-cost-of-cancer-pharmaceuticals-cost-issues-and-interventions-to-control-costs
#7
Ashley E Glode, Megan Brafford May
The rising cost of pharmaceuticals and, in particular, cancer drugs has made headline news in recent years. Several factors contribute to increasing costs and the burden this places on the health care system and patients. Some of these factors include costly cancer pharmaceutical research and development, longer clinical trials required to achieve drug approval, manufacturing costs for complex compounds, and the economic principles surrounding oncology drug pricing. Strategies to control costs have been proposed, and some have already been implemented to mitigate cancer drug costs such as the use of clinical treatment pathways and tools to facilitate cost discussions with patients...
November 12, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27859453/past-present-and-future-of-antibacterial-economics-increasing-bacterial-resistance-limited-antibiotic-pipeline-and-societal-implications
#8
Katherine H Luepke, Katie J Suda, Helen Boucher, Rene L Russo, Michael W Bonney, Timothy D Hunt, John F Mohr
Growing antimicrobial resistance and a dwindling antibiotic pipeline has resulted in an emerging postantibiotic era, as patients are now dying from bacterial infections that were once treatable. The fast-paced "Golden Age" of antibiotic development that started in the 1940s has lost momentum, as from the 1980s to the early 2000s, there was a 90% decline in approval of new antibiotics as well as discovery of few new novel classes. Many companies have shifted away from development due to scientific, regulatory, and economic hurdles that proved antibiotic development to be less attractive compared with more lucrative therapeutic areas...
November 12, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27862113/rethinking-strategies-to-select-antibiotic-therapy-in-cdi
#9
Teena Chopra, Ellie J C Goldstein, Sherwood L Gorbach
In recent years, Clostridium difficile infection (CDI) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. Current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. Furthermore, there is little evidence linking severity at onset to outcome. However, reducing the risk of recurrence may offer both a better outcome for the individual and decreased downstream economic impact...
November 9, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27862103/pharmacokinetics-of-imipenem-cilastatin-burn-intensive-care-unit-patients-undergoing-high-dose-continuous-venovenous-hemofiltation
#10
Bradley A Boucher, Joanna Q Hudson, David M Hill, Joseph M Swanson, G Christopher Wood, S Casey Laizure, Angela Arnold-Ross, Zhe-Yi Hu, William L Hickerson
STUDY OBJECTIVE: High dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently inpatients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I-C) we evaluated the systemic and extracorporeal clearances (CL) of I-C in patients with burns undergoing high dose CVVH. DESIGN: Prospective clinical pharmacokinetic study...
November 9, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27859444/spending-on-hepatitis-c-antivirals-in-the-united-states-2009-2015
#11
Katie J Suda, Drew J Halbur, Robert J Hunkler, Linda M Matusiak, Glen T Schumock
STUDY OBJECTIVE: New hepatitis C virus (HCV) antivirals have been shown to be highly effective with minimal adverse effects, but they are costly. Little is known, however, about the impact of the new HCV antivirals on expenditures to the overall U.S. health care system or by health care sector. Thus, the objective of this study was to describe HCV antiviral expenditures by agent, year, and health care sector. DESIGN: Retrospective, cross-sectional study. DATA SOURCE: QuintilesIMS National Sales Perspectives database...
November 9, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27891635/potential-association-between-drug-shortages-and-high-cost-medications
#12
Erin R Fox, Linda S Tyler
Shortages and sudden price increases of certain drugs may both occur emergently, with little to no warning, and they can have a dramatic impact on patient care. Little data are available linking drug shortages and price increases. Many of the same characteristics that may make medications susceptible to shortages can also place them at risk for sudden price increases. These characteristics include unapproved drugs, off-patent sole-source medications, and infrequently used medications. We reviewed drug shortage data from the University of Utah Drug Information Service to demonstrate how frequently these characteristics occurred and resulted in higher drug prices...
November 5, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27809338/cost-effectiveness-of-histamine2-receptor-antagonists-versus-proton-pump-inhibitors-for-stress-ulcer-prophylaxis-in-critically-ill-patients
#13
Drayton A Hammond, Niranjan Kathe, Anuj Shah, Bradley C Martin
STUDY OBJECTIVE: To determine the cost-effectiveness of stress ulcer prophylaxis with histamine2 receptor antagonists (H2RA) versus proton pump inhibitors (PPI) in critically ill and mechanically ventilated adults. DESIGN: A decision analytic model estimating the costs and effectiveness of stress ulcer prophylaxis (with H2RAs and PPIs) from a health care institutional perspective. PATIENTS: Adult, mixed intensive care unit (ICU) population who received an H2RA or PPI for up to 9 days...
November 3, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27809336/polymorphisms-in-cyp1a1-and-cyp3a5-genes-contribute-to-the-variability-in-granisetron-clearance-and-exposure-in-pregnant-women-with-nausea-and-vomiting
#14
Martha L Bustos, Yang Zhao, Huijun Chen, Steve N Caritis, Raman Venkataramanan
BACKGROUND: Nausea and vomiting affect up to 90% of pregnant women. Granisetron is a potent and highly selective serotonin receptor antagonist and is an effective antiemetic. Findings from a prior study in pregnant women demonstrated a large iner-individual variability in granisetron exposure. Granisetron is primarily metabolized by the cytochrome P450 (CYP) enzymes CYP1A1 and CYP3A and is likely a substrate of the ABCB1 transporter. Single-nucleotide polymorphisms (SNPs) in CYP3A, CYP1A1 and ABCB1 can alter drug metabolism...
November 3, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27805728/is-the-combination-of-piperacillin-tazobactam-and-vancomycin-associated-with-development-of-acute-kidney-injury-a-meta-analysis
#15
Christopher A Giuliano, Chandni R Patel, Pramodini B Kale-Pradhan
STUDY OBJECTIVE: To evaluate the association of the development of acute kidney injury (AKI) when piperacillin-tazobactam is used in combination with vancomycin compared with vancomycin with or without a β-lactam. DESIGN: Meta-analysis of 15 observational cohort studies. PATIENTS: A total of 3258 adult inpatients who received vancomycin + piperacillin-tazobactam versus vancomycin alone (10 studies); vancomycin + piperacillin-tazobactam versus vancomycin + β-lactam (four studies); or vancomycin + piperacillin-tazobactam versus vancomycin alone or vancomycin + other antibiotics (one study)...
November 2, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27791276/the-2016-accp-pharmacotherapy-didactic-curriculum-toolkit
#16
Terry L Schwinghammer, Andrew J Crannage, Eric G Boyce, Bridget Bradley, Alyssa Christensen, Henry M Dunnenberger, Michelle Fravel, Holly Gurgle, Drayton A Hammond, Jennifer Kwon, Douglas Slain, Kurt A Wargo
The 2016 American College of Clinical Pharmacy (ACCP) Educational Affairs Committee was charged with updating and contemporizing ACCP's 2009 Pharmacotherapy Didactic Curriculum Toolkit. The toolkit has been designed to guide schools and colleges of pharmacy in developing, maintaining, and modifying their curricula. The 2016 committee reviewed the recent medical literature and other documents to identify disease states that are responsive to drug therapy. Diseases and content topics were organized by organ system, when feasible, and grouped into tiers as defined by practice competency...
October 28, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27785827/operational-and-clinical-strategies-to-address-drug-cost-containment-in-the-acute-care-setting
#17
Karen J McConnell, Oscar E Guzman, Nisha Pherwani, Dustin D Spencer, Jennifer D Van Cura, Katherine M Shea
OBJECTIVE: To provide clinical and operational strategies to generate drug cost savings in the hospital setting. METHODS: A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. MAIN RESULTS: Investigators reviewed 937 abstracts...
October 27, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27779789/role-of-cytochrome-p450-2b6-pharmacogenomics-in-determining-efavirenz-mediated-central-nervous-system-toxicity-treatment-outcomes-and-dosage-adjustments-in-patients-with-human-immunodeficiency-virus-infection
#18
Teresa T Vo, Sheeba Varghese Gupta
For treatment-naïve patients with human immunodeficiency virus infection, efavirenz (EFV) together with tenofovir and emtricitabine were once widely prescribed given its efficacy and ease of administration in a combination pill. However, the high rate of central nervous system toxicities from EFV prompted the United States Department of Health and Human Services to move the EFV-based regimen from the recommended to the alternative category. For patients who do meet the criteria for newer recommended antiretroviral treatments, EFV is a viable option and is often the mainstay of treatment outside the United States, as newer antiretroviral treatments are more expensive...
October 25, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27779786/positive-impact-of-continuous-flow-left-ventricular-assist-device-implantation-on-glycemic-control-in-patients-with-type-2-diabetes-mellitus-and-advanced-chronic-systolic-heart-failure
#19
Debbie C Yen, Mara H Watson, Lindsey D Burgess, Maragatha Kuchibhatla, Chetan B Patel, Kristen B Campbell, Alyssa K Vora
STUDY OBJECTIVE: To evaluate the impact of continuous-flow left ventricular assist device (LVAD) implantation on glycemic control in patients with type 2 diabetes mellitus and advanced chronic systolic heart failure. DESIGN: Retrospective medical record review. SETTING: Large, academic, tertiary and quaternary care hospital. PATIENTS: Eighty-three adults with type 2 diabetes mellitus and advanced chronic systolic heart failure who underwent implantation of a continuous-flow LVAD between July 1, 2008, and June 30, 2013...
October 25, 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/27779782/use-of-tumor-necrosis-factor-alpha-inhibitors-in-children-and-young-adults-with-juvenile-idiopathic-arthritis-or-rheumatoid-arthritis
#20
Wan-Ju Lee, Leslie Briars, Todd A Lee, Gregory S Calip, Katie J Suda, Glen T Schumock
OBJECTIVE: To characterize the use of tumor necrosis factor-alpha inhibitors (TNFI) in children with juvenile idiopathic arthritis (JIA) and young adults with rheumatoid arthritis (RA). METHODS: Patients with incident JIA or RA were identified using the Truven Health MarketScan Commercial Claims and Encounters database from 2009 to 2013. The incident diagnosis was defined as no prior claims with a JIA/RA code and no JIA/RA medications recorded during the previous 6 months...
October 25, 2016: Pharmacotherapy
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