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Kathryn E Smith, Caitlin S Brown, Bridget M Manning, Teresa May, Richard R Riker, Patricia A Lerwick, Timothy L Hayes, Gilles L Fraser
STUDY OBJECTIVE: High-dose intravenous vitamin C is a potential treatment option for patients with sepsis and may interfere with point-of-care (POC) blood glucose testing. This study aimed to determine if vitamin C dosing used for sepsis affected POC blood glucose level results. DESIGN: Prospective observational pilot study. SETTING: Intensive care unit in a large, academic, tertiary care medical center. PATIENTS: Five consecutive critically ill adults hospitalized between April 1 and June 1, 2017, who received two or more doses of intravenous vitamin C 1500 mg for treatment of sepsis and had at least two paired POC blood glucose levels and laboratory venous blood glucose levels measured within 1 hour of each other during vitamin C therapy...
September 19, 2018: Pharmacotherapy
Jimin Lee, Sukhyang Lee
STUDY OBJECTIVE: Patients with coronary heart disease (CHD) frequently use the combination of a statin and renin-angiotensin-aldosterone system (RAAS) blocker- an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB)-to control lipid levels and blood pressure, respectively, and the use of ARBs is increasing in Korean patients. Few studies are available, however, that have compared combination therapy with statin-ACEIs versus statin-ARBs. The objective of this study was to evaluate whether ARBs are associated with a reduced risk of major adverse cardiovascular and cerebrovascular events (MACCEs) compared with ACEIs when used in combination with statins in patients with established CHD...
September 17, 2018: Pharmacotherapy
Zach R Click, Amanda N Seddon, Young R Bae, Justin D Fisher, Adebayo Ogunniyi
Advancements in the treatment of acute myeloid leukemia (AML) have been sparse over the last several decades, and the disease continues to have a poor prognosis. However, in 2017 alone, four new medications approved by the United States Food and Drug Administration (FDA) for the treatment of AML reached the market. Midostaurin, liposomal cytarabine and daunorubicin, enasidenib, and gemtuzumab ogozamicin all showed benefit in respective clinical trials to gain approval for the treatment of AML in various patient populations...
September 16, 2018: Pharmacotherapy
Amy D Robertson, Chenghui Li, Drayton Hammond, Tiffany A Dickey
INTRODUCTION: Vancomycin (VAN) is associated with an increased risk of acute kidney injury (AKI). There is conflicting evidence regarding the risk of AKI when VAN is combined with an anti-pseudomonal beta-lactam. OBJECTIVES: To determine the comparative incidence of AKI when VAN is combined with piperacillin-tazobactam (PTZ) or meropenem (MER). METHODS: This was a retrospective cohort study of acutely ill adults receiving the combination of VAN and PTZ or MER for at least 48 hours between November 1, 2014 and October 31, 2016 in a tertiary care hospital...
September 2, 2018: Pharmacotherapy
Ralph C Ward, David J Taber, Robert Neal Axon, Mulugeta Gebregziabher
STUDY OBJECTIVE: Summary measures of medication adherence, such as the proportion of days covered (PDC), are often used to analyze the association between medication adherence and various health outcomes. We hypothesized that PDC and similar measures may lead to biased results in some situations when used to estimate the association between adherence and the outcome event (e.g., mortality). Thus, the objective was to determine the conditions under which PDC and similar measures might produce biased estimates of the association between adherence and mortality, and to review methods to avoid such bias...
August 24, 2018: Pharmacotherapy
James R Krenz, Yaman Kaakeh
Both calcium-channel blockers (CCB) and beta blockers (BB) have been associated with fatal substance exposures within the United States. Cases of overdose with these agents have the potential to be both complex and difficult to manage. There are a variety of pharmacologic treatment options clinicians may employ to help mitigate harm from these poisonings. Hyperinsulinemic-euglycemic therapy (HIET) was once regarded as a last-ditch effort to treat patients in highly refractory cases. In recent years, this therapy has become a routine therapy in the treatment of CCB/BB overdose...
August 23, 2018: Pharmacotherapy
Raymond J Yost, Bradley J Haan, Kyle C Mangan
Dosing of enoxaparin for deep vein thrombosis (DVT) prophylaxis in acutely burned patients has been shown to result in antifactor-Xa (anti-Xa) levels below target range. We describe the first case report, to our knowledge, of a severely burned patient who, despite prophylactic dosing of enoxaparin 30 mg subcutaneously twice daily, developed an acute DVT that required high-dose enoxaparin (100 mg [1.5 mg/kg] subcutaneously every 8 hours) to maintain anti-Xa levels within the therapeutic range (0.6-1 IU/mL). Pharmacokinetic evaluations were performed using anti-Xa levels measured throughout the patient's hospital stay to validate the appropriateness of this high-dose regimen based on established therapeutic anti-Xa level ranges...
August 20, 2018: Pharmacotherapy
Laura A Tang, Brianne N Dixon, Kathryn T Maples, Kristen M Poppiti, Tim J Peterson
Prevalent molecular alterations of the phosphoinositide 3-kinase (PI3K) pathway are found on solid tumors and are expressed in leukocytes, making it a desirable target in both solid and hematologic malignancies. In recent years, two agents targeting this pathway have been approved by the United States Food and Drug Administration, idelalisib and copanlisib, with many others under investigation. Due to the off-target effects seen with these agents, those under development have varying isoform specificity that mitigate toxicity...
August 18, 2018: Pharmacotherapy
Bradley J Peters, Andrew D Rule, Kianoush B Kashani, John C Lieske, Kristin C Mara, Ross A Dierkhising, Erin F Barreto
STUDY OBJECTIVE: Serum creatinine (Sc r ) concentration is used to calculate estimated glomerular filtration rate (eGFR) for medication dosing. Serum cystatin C (CysC) concentration has been proposed as an adjunct or alternative to Scr . This study sought to evaluate the possible impact of using CysC in eGFR equations on drug dose recommendations in hospitalized patients with infections. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Large academic tertiary care medical center...
August 18, 2018: Pharmacotherapy
Lindsey M Childs-Kean, Eric F Egelund, Jacqueline Jourjy
Tenofovir alafenamide (TAF) is indicated for adult patients with chronic hepatitis B virus (HBV) infection with compensated liver disease at an oral dose of 25 mg/day. TAF is a more stable prodrug in the plasma than tenofovir disoproxil fumarate (TDF), leading to decreased plasma exposure of tenofovir. Decreased exposure is thought to reduce the risk of long-term TDF toxicities, such as nephrotoxicity and decreased bone mineral density (BMD). TAF, a nucleotide reverse transcriptase inhibitor, has the same mechanism of action as TDF...
August 18, 2018: Pharmacotherapy
Paul M Reynolds, Robert MacLaren
STUDY OBJECTIVE: Because recent studies have challenged the efficacy of stress ulcer prophylaxis (SUP) in the critically ill patient, our objective was to evaluate the efficacy of SUP with proton pump inhibitors (PPIs) or histamine2 -receptor antagonists (H2 RAs) against placebo, control, no therapy, or enteral nutrition alone in critically ill adults. DESIGN: Meta-analysis with trial sequential analysis (TSA) of 34 randomized controlled trials. PATIENTS: A total of 3220 critically ill adults who received PPIs or H2 RAs versus placebo, control, no therapy, or enteral nutrition...
August 13, 2018: Pharmacotherapy
Ishaq Lat, Mitchell J Daley, Anand Shewale, Mark H Pangrazzi, Drayton Hammond, Keith M Olsen
OBJECTIVE: This study was conducted to describe the prevalence, epidemiology, and clinical outcomes of multidrug resistant (MDR) organism (MDRO) pneumonia in critically ill patients. METHODS: A multicenter, prospective, observational study of patients admitted to 60 intensive care units (ICUs), from 34 hospitals, in the United States from November-December 2016. Adults (>18 years) receiving antimicrobial therapy at least 5 days for pneumonia were included. Patients were classified into 2 categories, with or without MDRO, and subcategorized by pneumonia type...
August 12, 2018: Pharmacotherapy
Rosa Camila Lucchetta, Barbara Paes Miglioli da Mata, Patricia de Carvalho Mastroianni
STUDY OBJECTIVE: The use of benzodiazepines and the development of dementia is controversial, with studies indicating that benzodiazepines could be either a protective factor or a risk factor for dementia, or no association may exist between the two. Our objective was to identify whether such an association exists. DESIGN: Systematic review and meta-analysis of 12 prospective and retrospective cohort studies and case-control studies. PARTICIPANTS: A total of 981,133 (in the systematic review) and 980,860 (in the meta-analysis) adults or elderly individuals...
August 11, 2018: Pharmacotherapy
Renée Dagenais, Peter J Zed
Intranasal lidocaine has been studied and recommended as an alternative in the management of acute headache. The objective of this systematic review was to evaluate the efficacy and safety of intranasal lidocaine in the acute management of primary headaches. The MEDLINE (1946 to May 2018), EMBASE (1974 to May 2018), Cochrane Central Register of Controlled Trials (2008 to May 2018), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to May 2018), and ClincialTrials. gov online databases were searched...
August 11, 2018: Pharmacotherapy
Chi Nguyen, David R Lairson, Michael D Swartz, Xianglin L Du
STUDY OBJECTIVE: To examine the risks and compare the occurrences of major long-term side effects (sexual dysfunction, bone fractures, diabetes, cardiovascular morbidity, acute myocardial infarction [MI], and dementia) in patients with prostate cancer who received androgen-deprivation therapy (ADT) with those who did not. DESIGN: Propensity score-matched retrospective cohort study using Medicare claims data. DATA SOURCE: National Cancer Institute's Surveillance, Epidemiology, and End Results Program-Medicare linked database...
August 6, 2018: Pharmacotherapy
Boris Nogid, Melinda K Lacy, Micah Jacobs, Jon Bruss, Jamie Dwyer
STUDY OBJECTIVE: Telavancin and vancomycin are both approved for treatment of hospital-acquired and ventilator-associated bacterial pneumonias caused by Staphylococcus aureus, and both agents can cause renal dysfunction. The objective of this study was to assess renal function changes by performing renal shift table analyses of telavancin- and vancomycin-treated patients in phase III trials. DESIGN: Retrospective, descriptive analysis of data from the safety population from the Assessment of Telavancin for Treatment of Hospital-Acquired Pneumonia (ATTAIN) trials...
July 12, 2018: Pharmacotherapy
Kailynn J DeRonde, Jennifer E Girotto, David P Nicolau
Methicillin-resistant Staphylococcus aureus (MRSA) has become the most prevalent cause of acute hematogenous osteomyelitis (AHO) in pediatric patients. This increase in MRSA is due to the rise in community-acquired MRSA. Therefore, it is important that clinicians are aware of the various and upcoming therapies that cover this bacterium. A literature search of the Medline database was performed from creation through January 2018. Articles chosen for the review emphasize well-established MRSA treatment options for pediatric AHO, newer therapies on the horizon, and important pharmacokinetics and pharmacodynamic concepts for treatment...
July 10, 2018: Pharmacotherapy
Vaughn L Culbertson, Shaikh E Rahman, Grayson C Bosen, Matthew L Caylor, Megan M Echevarria, Dong Xu
STUDY OBJECTIVE: Serotonergic adverse drug events (ADEs) are caused by enhanced intrasynaptic concentrations of 5-hydroxytryptamine (5-HT). No systematic process currently exists for evaluating cumulative 5-HT and off-target toxicity of serotonergic drugs. The primary study aim was to create a Serotonergic Expanded Bioactivity Matrix (SEBM) by using a molecular bioinformatics, polypharmacologic approach for assessment of the participation of individual 5-HT drugs in serotonin syndrome (SS) reports...
July 4, 2018: Pharmacotherapy
Megan C Herink, Adriane N Irwin, Gregory M Zumach
The United States Food and Drug Administration (FDA) has created approval pathways and designations to accelerate access to medications indicated for serious or life-threatening conditions with limited treatment options. Implemented in 2012, the most recent of these is the breakthrough therapy designation (BTD). The purpose of this article was to review the evidence surrounding approval of medications with nononcology indications approved with the BTD designation from 2012 to 2016. Fifteen medications were identified for eight conditions, ranging from conditions that are relatively common, such as chronic hepatitis C infection, to those that are extremely rare, such as lysosomal acid lipase deficiency...
September 2018: Pharmacotherapy
Michael P Veve, Jamie L Wagner
The emergence and spread of antimicrobial resistance have led to a global public health emergency requiring development of new antimicrobial classes. Lefamulin (formally BC-3781) is a novel pleuromutilin antibiotic currently undergoing Food and Drug Administration review for community-acquired bacterial pneumonia (CABP) as intravenous (IV) and oral (PO) formulations. Although pleuromutilin antibiotics were first developed in the 1950s, lefamulin is the first to be used for systemic treatment of bacterial infections in humans...
September 2018: Pharmacotherapy
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