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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
Daniel C Jupiter, Xiao Fang, Zachary Ashmore, Naohiro Shibuya, Hemalkumar B Mehta
OBJECTIVE: To examine the association between quinolone use and Achilles tendon injury, comparing well matched cohorts of users of quinolone and non-quinolone antibiotics, and well matched cohorts of quinolone users and patients not using any non-quinolone antibiotics. PATIENTS AND METHODS: This retrospective cohort study used Clinformatics data from 2008 to 2014. Using propensity score, we matched quinolone users with other antibiotic users, and quinolone users with non-users...
July 4, 2018: Pharmacotherapy
Vaughn L Culbertson, Shaikh Emdadur Rahman, Grayson C Bosen, Matthew L Caylor, Megan M Echevarria, Dong Xu
STUDY OBJECTIVE: Serotonergic adverse drug events (ADEs) are caused by enhanced intra-synaptic 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) employing a molecular bioinformatics, poly-pharmacologic approach for assessing the participation of individual 5-HT drugs in serotonin syndrome (SS) reports...
July 4, 2018: Pharmacotherapy
Tzu-Yun McDowell, John Lawrence, Jeffry Florian, Mary Ross Southworth, Stephen Grant, Norman Stockbridge
A target international normalized ratio (INR) of 2-3 has been recommended for patients with atrial fibrillation (AF) and risk factors for thromboembolism. This recommendation is largely based on evidence from observational studies a decade ago. This study utilized collective data from modern trials with warfarin controls to examine the relationship of warfarin anticoagulation, as assessed by INR, on the clinical outcome events of interest. METHODS: Data on warfarin-treated patients from 3 clinical studies supporting the approval of dabigatran (Pradaxa® ), apixaban (Eliquis® ), and edoxaban (Savaysa® ) were pooled...
June 19, 2018: Pharmacotherapy
Kailynn J DeRonde, Jennifer E Girotto, David P Nicolau
Acute hematogenous osteomyelitis (AHO), often occurring in young children, is the most frequently diagnosed type of osteomyelitis in pediatric patients. Optimizing antibiotics is essential as delays to receipt of appropriate therapy can lead to chronic osteomyelitis, as well as impairments in bone growth and development. Antimicrobial Stewardship Programs (ASPs) are in a key position to help improve the care of patients with AHO as they contain a pharmacist with expertise in antibiotic drug selection, optimization of dosing, and microbiologic test review...
June 19, 2018: Pharmacotherapy
Junya Zhu, G Caleb Alexander, Saman Nazarian, Jodi B Segal, Albert W Wu
OBJECTIVE: Since 2010, several non-vitamin K antagonist oral anticoagulants (NOACs) have been brought to the U.S. market, yet little is known regarding their evolving adoption for prophylaxis of atrial fibrillation (AF) related stroke. We examined temporal trends in choice of oral anticoagulants (OACs) among incident OAC users with AF and its association with patient demographic and clinical characteristics. METHODS: We conducted a serial cross-sectional analysis of medical and pharmacy claims for commercial and Medicare Advantage enrollees in a large, private, U...
June 19, 2018: Pharmacotherapy
Jill M Butterfield-Cowper, Thomas P Lodise, Manjunath P Pai
OBJECTIVES: To compare daptomycin exposures and predicted safety outcomes with a simulated weight-based and fixed dose in morbidly-obese and non-obese subjects METHODS: We performed a nonparametric population pharmacokinetic analysis of daptomycin concentration-time data from a prior obese and non-obese kidney function matched cohort of healthy adult volunteers. Monte Carlo simulations were performed to compare the maximum concentrations (Cmax ), minimum concentrations (Cmin ), and area under the curve (AUC) with the standard daptomycin 6-mg/kg/day dose or a 500-mg daily fixed dose in obese and non-obese subjects...
June 15, 2018: Pharmacotherapy
Lynn E Kassel, Edward T Van Matre, Charles J Foster, Douglas N Fish, Scott W Mueller, Deb S Sherman, Michael F Wempe, Robert MacLaren, Robert T Neumann, Tyree H Kiser
PURPOSE: Neurocritically-ill patients have clinically significant alterations in pharmacokinetic parameters of renally-eliminated medications, which may result in subtherapeutic plasma and cerebrospinal fluid antibiotic concentrations. METHODS: Prospective, randomized, open-label study of adult neurocritically-ill patients treated with vancomycin and cefepime. Vancomycin 15 mg/kg and cefepime 2 g were dosed at every 8 or 12-hour intervals. The primary outcomes were the achievement of pharmacodynamic targets related to time of unbound drug above minimum inhibitory concentrations (MIC) for 60% or more of the dosing interval (fT>MIC ≥60%) for β-lactams and ratio of 24-hour area under the curve (AUC):MIC of 400 or greater for vancomycin...
June 15, 2018: Pharmacotherapy
Nicole J Brandt, Chad Worz, Sharon F Clackum
Skilled nursing facilities and nursing homes are care settings that offer increasing opportunities for pharmacists to take the lead when addressing the new updated Centers for Medicare and Medicaid Services (CMS) requirements coupled with enhanced quality measures reporting. In addition, the complexity of the medication-related needs and comorbidities of the patients served in long-term care facilities promotes pharmacists practicing to the top of their license. Medication stewardship needs to be an interdisciplinary team activity led by the pharmacist...
June 11, 2018: Pharmacotherapy
Scott M Sutherland
Nephrotoxin-associated acute kidney injury (NTx-AKI) has become one of the most common causes of AKI among hospitalized adults and children; across acute and intensive care populations, exposure to nephrotoxins accounts for 15-25% of AKI cases. Although some interventions have shown promise in observational studies, no treatments currently exist for NTx-AKI once it occurs. Thus, nearly all effective strategies are aimed at prevention. The primary obstacle to prevention is risk prediction and the determination of which patients are more likely to develop NTx-AKI when exposed to medications with nephrotoxic potential...
June 9, 2018: Pharmacotherapy
Adrian Wong, Joseph M Plasek, Steven P Montecalvo, Li Zhou
The safety of medication use has been a priority in the United States since the late 1930s. Recently, it has gained prominence due to the increasing amount of data suggesting that a large amount of patient harm is preventable and can be mitigated with effective risk strategies that have not been sufficiently adopted. Adverse events from medications are part of clinical practice, but the ability to identify a patient's risk and to minimize that risk must be a priority. The ability to identify adverse events has been a challenge due to limitations of available data sources, which are often free text...
June 9, 2018: Pharmacotherapy
Parth K Shah, Jamie Irizarry, Sean O'Neill
Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically insignificant alarms and alerts create the potential for alert and alarm fatigue. We searched the PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for peer-reviewed literature (January 1, 2004-August 31, 2017) on managing smart pump alerts, alarms, and related fatigue. Twenty-nine articles that met the inclusion criteria were reviewed and organized into themes...
June 8, 2018: Pharmacotherapy
Erin F Barreto, Andrew D Rule, Stacy A Voils, Sandra L Kane-Gill
Over the last decade, the discovery of novel renal biomarkers and research on their use to improve medication effectiveness and safety has expanded considerably. Pharmacists are uniquely positioned to leverage this new technology for renal assessment to improve medication dosing and monitoring. Serum cystatin C is a relatively new, inexpensive, functional renal biomarker that responds more quickly to changing renal function than creatinine and is not meaningfully affected by age, sex, skeletal muscle mass, dietary intake, or deconditioning...
June 8, 2018: Pharmacotherapy
Hanna K Welch, John A Kellum, Sandra L Kane-Gill
STUDY OBJECTIVE: Acute kidney injury (AKI) is a common condition associated with both short-term and long-term consequences including dialysis, chronic kidney disease, and mortality. Although the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database is a powerful tool to examine drug-associated events, to our knowledge, no study has analyzed this database to identify the most common drugs reported with AKI. The objective of this study was to analyze AKI reports and associated medications in the FAERS database...
June 8, 2018: Pharmacotherapy
Elena Tomaselli Muensterman, James E Tisdale
Prolongation of the heart rate-corrected QT (QTc) interval increases the risk for torsades de pointes (TdP), a potentially fatal arrhythmia. The likelihood of TdP is higher in patients with risk factors, which include female sex, older age, heart failure with reduced ejection fraction, hypokalemia, hypomagnesemia, concomitant administration of ≥ 2 QTc interval-prolonging medications, among others. Assessment and quantification of risk factors may facilitate prediction of patients at highest risk for developing QTc interval prolongation and TdP...
June 8, 2018: Pharmacotherapy
Seth R Bauer, Gretchen L Sacha, Simon W Lam
Circulatory shock is a medical emergency that requires rapid intervention to optimize patient outcomes. Although catecholamine vasopressors are considered life-sustaining therapy, they are associated with adverse reactions, and vasopressin and angiotensin II may be used to minimize these adverse effects. However, vasopressin and angiotensin II are also associated with adverse reactions that must be known to the clinician to mitigate risk for patients. This review focuses on the known adverse drug effects of vasopressin and angiotensin II while offering potential solutions to minimize harm with these agents...
June 7, 2018: Pharmacotherapy
Jennifer L Bacci, Lucas A Berenbrok
The scope of community pharmacy practice has expanded beyond the provision of drug product to include the provision of patient care services. Likewise, the community pharmacist's approach to patient safety must also expand beyond prevention of errors during medication dispensing to include optimization of medications and prevention of adverse events throughout the entire medication use process. Connectivity to patient data and other health care providers has been a long-standing challenge in community pharmacy with implications for the delivery and safety of patient care...
June 7, 2018: Pharmacotherapy
Carlos D Flombaum, Dazhi Liu, Shirley Qiong Yan, Amelia Chan, Sherry Mathew, Paul A Meyers, Ilya G Glezerman, Thangamani Muthukumar
BACKGROUND: Acute kidney injury complicating high-dose methotrexate (HDMTX) therapy increases the risk for severe mucositis, myelosuppression, and death. It is unclear whether high-dose leucovorin and supportive therapy without the use of glucarpidase can reduce toxicity from HDMTX. STUDY DESIGN: The charts of all patients at Memorial Sloan Kettering Cancer Center whose methotrexate (MTX) drug levels at 48 or 72 hours after administration were 10 times or more the toxic level were reviewed between January 2000 and December 2011...
June 4, 2018: Pharmacotherapy
Margaret R Jorgenson, Jillian L Descourouez, Magdalena Siodlak, Shelby Tjugum, John P Rice, Luis A Fernandez
This article summarizes available literature regarding the utilization of probiotic and synbiotics in liver transplant (LTX) recipients, reviewing efficacy in both decreasing infectious complications and immunomodulation, as well as exploring safety concerns. Data suggest that the use of probiotics containing Lactobacillus spp, either alone or in combination with prebiotics (referred to as synbiotics), may be effective in reducing infectious complications after LTX, a major contributor to graft loss, hospital length of stay, and mortality...
May 26, 2018: Pharmacotherapy
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