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Bryan Dotson, Patrick Larabell, Jasmine U Patel, Kristoffer Wong, Lina Qasem, William Arthur, Chaim Leiberman, Peter Whittaker, Steven D Tennenberg
STUDY OBJECTIVE: Parenteral calcium is frequently administered to critically ill patients. However, animal studies demonstrate that calcium administration during critical illness heightens inflammation and leads to shock, organ dysfunction, and mortality. We sought to evaluate the association between calcium administration and adverse outcomes in critically ill patients receiving parenteral nutrition (PN). DESIGN: Retrospective cohort examined before and during a calcium gluconate shortage...
October 12, 2016: Pharmacotherapy
A Shaun Rowe, Pinky S Mahbubani, Mason H Bucklin, Christopher T Clark, Leslie A Hamilton
STUDY OBJECTIVE: To evaluate the efficacy and safety of an activated 4-factor prothrombin complex concentrate (aPCC) versus plasma for the reversal of warfarin-associated hemorrhage. DESIGN: Single-center, retrospective cohort analysis of adult patients with warfarin-associated hemorrhage treated with either aPCC or plasma. PATIENTS: Patients received either aPCC or plasma as treatment for warfarin-associated hemorrhage between January 1, 2011 and July 1, 2013...
October 11, 2016: Pharmacotherapy
Sarah E Petite, Seth R Bauer, Jessica E Bollinger, Christine L Ahrens, Lisa M Harinstein
STUDY OBJECTIVE: It is unknown if beta-lactam monotherapy is sufficient for complicated intra-abdominal infections or if broader coverage is required, such as with vancomycin. This study sought to determine the clinical outcomes of piperacillin/tazobactam monotherapy compared to combination therapy with vancomycin and piperacillin/tazobactam for complicated intra-abdominal infections among patients within a surgical intensive care unit. DESIGN: Retrospective cohort study...
October 11, 2016: Pharmacotherapy
Sara R Britnell, Amy E Willets, Adam J Vanderman, Catherine L Woodard, Rachel B Britt
STUDY OBJECTIVE: To describe international normalized ratio (INR) trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis C virus (HCV) with ledipasvir/sofosbuvir with or without ribavirin. DESIGN: Case series. SETTING: Pharmacist-led anticoagulation clinic at a Veterans Affairs medical center. PATIENTS: Four patients aged 59-66 years who were receiving warfarin and had stable, therapeutic INRs and started ledipasvir/sofosbuvir therapy with or without ribavirin for HCV infection...
October 7, 2016: Pharmacotherapy
Neil J Turco
I would like to thank Joy et al for their recent article, "Safety and Efficacy of High-dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients," which contributed more to the body of literature in VTE prophylaxis for patients with obesity.(1) This study provided evidence against the use of high-dose unfractionated heparin (UFH) thromboprophylaxis for obese patients. These results differ from those of a previous study by Wang et al, which found a lower incidence of VTE for patients on high-dose UFH...
October 7, 2016: Pharmacotherapy
Lisa M Potter, Eric M Tichy, Timothy A Horwedel, Michael A Shullo, Christopher R Ensor, Nicole A Pilch, Adam B Cochrane, Angela Q Maldonado
The American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) aims to develop and disseminate pharmacy practice models that optimize the use of pharmacists as direct care providers.(1) In their commentary, Jacobi and colleagues highlight opportunities and challenges presented through the PPMI, and draw attention to potential negative consequences for clinical pharmacy specialists.(2) We present the transplant specialist perspective. This article is protected by copyright. All rights reserved...
October 7, 2016: Pharmacotherapy
Noll L Campbell, Anthony J Perkins, Pamela Bradt, Sinem Perk, Ronald C Wielage, Malaz A Boustani, Daniel B Ng
STUDY OBJECTIVE: To determine the association between Anticholinergic Cognitive Burden (ACB) score and both cognitive impairment and health care utilization among a diverse ambulatory older adult population. DESIGN: Retrospective cohort study. DATA SOURCE: Medication exposure and other clinical data were extracted from the Regenstrief Medical Record System (RMRS), and cognitive diagnosis derived from a dementia screening and diagnosis study...
October 6, 2016: Pharmacotherapy
Kirollos S Hanna
PURPOSE: Pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor, is a humanized monoclonal antibody used in the treatment of metastatic or unresectable melanoma and advanced non-small cell lung cancer (NSCLC). We hereby report a case of pembrolizumab-induced uveitis to increase practitioner awareness. CASE REPORT: A 78-year-old female presented with onset of panuveitis after initiation of pembrolizumab therapy for metastatic melanoma. The patient received three cycles of therapy every 21 days during which her symptoms progressively worsened...
September 26, 2016: Pharmacotherapy
Christine E Vaudo, Brigitte Gil, Kari Galuski, Corinne Zarwan, Francis W Nugent
5-fluorouracil (5-FU) is an antimetabolite pyridine analogue used for the treatment of solid tumors. Early toxicities may occur at standard doses of 5-FU due to dihydropyrimidine dehydrogenase (DPD) deficiency. Uridine triacetate, approved by the FDA in 2015, is an oral prodrug of uridine, a pharmacologic antidote for 5-FU toxicity. To our knowledge, this is the first case report that documents the clinical course of a patient treated with uridine triacetate for the reversal of early-onset 5-FU toxicity negative for DPD mutations...
September 26, 2016: Pharmacotherapy
John J Veillette, James Truong, Steven C Forland
Limited data exist regarding optimal dosing of ceftazidime/avibactam (C/A) in patients with unique physiology, who were excluded from published clinical trials. Data are also lacking regarding clinical efficacy of C/A in patients with infections due to multidrug-resistant Gram-negative pathogens. To expand knowledge in these areas, we present pharmacokinetic data from two patients with KPC-producing Klebsiella pneumoniae bloodstream infections, both of whom had renal impairment, and one of whom was morbidly obese...
September 26, 2016: Pharmacotherapy
Michael Guo, Balraj Heran, Ryan Flannigan, Abbas Kezouh, Mahyar Etminan
PURPOSE: To examine the risk of persistent sexual dysfunction (PSD) with finasteride 1mg. METHODS: We conducted a retrospective cohort study using the IMS U.S. health claims database. From an original cohort of 6,110,723 patients, we identified 1390 men who had stopped using finasteride 1mg and 20,000 randomly selected age- and calendar time-matched users of omeprazole from 2006 to 2014. First PSD event was defined as 1) the first PSD diagnosis through the first International Classification for Diseases, Ninth Revision Clinical Modification [ICD-9-CM]) code for sexual dysfunction and 2) use of a phosphodiesterase inhibitor (sildenafil, tadalafil, or vardenafil) RESULTS: In the primary analysis, we identified 1,390 men taking finasteride 1mg and 20,000 omeprazole users...
September 19, 2016: Pharmacotherapy
Wesley D Kufel, Adam S Zayac, David F Lehmann, Christopher D Miller
Despite prescribing guidance, limited data exist to describe the use of apixaban in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD). Current apixaban dosing recommendations for this patient population are based largely on a single-dose pharmacokinetic study of eight patients. We describe the clinical application and pharmacodynamic monitoring of apixaban in a 62-year-old 156-kg African-American woman with nonvalvular atrial fibrillation and ESRD requiring hemodialysis who developed calciphylaxis while receiving warfarin therapy...
September 19, 2016: Pharmacotherapy
Jin Han, Shubha Bhat, Michel Gowhari, Victor R Gordeuk, Santosh L Saraf
Ambulatory care clinical pharmacy services have expanded beyond primary care settings, but literature supporting the benefits of clinical pharmacy involvement with patients who have rare diseases such as sickle cell disease (SCD) is lacking. Hydroxyurea is the only agent approved by the U.S. Food and Drug Administration for the treatment of SCD; full benefit in controlling pain episodes and other complications is achieved through monitored escalation to a maximum tolerated dose. The primary objective of this analysis was to evaluate the impact of a newly implemented clinical pharmacy service on the management of patients with SCD...
September 16, 2016: Pharmacotherapy
Emily Huesgen, Kathryn E DeSear, Eric F Egelund, Renata Smith, Blake Max, Jennifer Janelle
Selection of an appropriate antiretroviral regimen for the patient infected with human immunodeficiency virus can be challenging, as various considerations must be taken into account including viral resistance mutations, patient comorbidities, drug interactions, and the potential for drug-related adverse effects and toxicities. Treatment is further complicated when a clinical scenario arises requiring an alteration in the dosage form. Factors ranging from dysphagia to administration through an enteral feeding tube can affect decisions regarding antiretroviral dosage forms...
September 16, 2016: Pharmacotherapy
Matthew Daubresse, Martin Andersen, Kevin R Riggs, G Caleb Alexander
IMPORTANCE: Drug coupons are widely used, but their effects are not well understood. OBJECTIVE: To quantify the effect of coupons on statin use and expenditures. DESIGN: Retrospective cohort analysis of IMS Health LRx LifeLink database. SETTING: U.S. retail pharmacy transactions. PARTICIPANTS: Incident statin users who initiated branded atorvastatin or rosuvastatin between June 2006 and February 2013...
July 25, 2016: Pharmacotherapy
Iman A Basheti, Odate K I Tadros, Salah Aburuz
STUDY OBJECTIVE: To assess the impact of a medication management review (MMR) service on treatment-related problems (TRPs) and certain clinical outcomes in outpatients. DESIGN: Prospective randomized controlled study. SETTING: Two community pharmacies in Amman, Jordan. PATIENTS: A total of 160 people who visited the two community pharmacies between September 2009 and June 2010. INTERVENTION: Patients were randomized into two groups: intervention (82 patients) and control (78 patients) groups...
October 2016: Pharmacotherapy
Kevin W McConeghy, Melinda M Soriano, Larry H Danziger
BACKGROUND: Studies have shown associations between Clostridium difficile infection (CDI) and non-antimicrobial medications including proton pump inhibitors, osteoporosis medications, and antidepressants. OBJECTIVES: Our primary objective was to evaluate oral bisphosphonates and reported CDI adverse drug reactions in the United States using the Food and Drug Administration Adverse Event Reporting System data (FAERS). METHODS: We performed a disproportionality analysis evaluating the proportion of reports with bisphosphonates and CDI compared with other adverse drug reactions in the database...
October 2016: Pharmacotherapy
David F Blackburn, Charity D Evans, Dean T Eurich, Kerry D Mansell, Derek J Jorgenson, Jeff G Taylor, William M Semchuk, Yvonne M Shevchuk, Alfred J Remillard, David A Tran, Anne P Champagne
STUDY OBJECTIVE: To test a brief intervention for preventing statin nonadherence among community pharmacy patrons. DESIGN: Prospective, cluster-randomized, controlled trial (the Community Pharmacists Assisting in Total Cardiovascular Health [CPATCH] trial). SETTING: Thirty community pharmacies in Saskatchewan, Canada. PATIENTS: Participating pharmacies were randomized to 15 intervention pharmacies where a brief statin adherence intervention was delivered by pharmacists (intervention group [907 patients]) or 15 usual care pharmacies where no statin adherence intervention was delivered (usual care group [999 patients]) to new users of statins (defined as less than 1 yr of statin therapy)...
October 2016: Pharmacotherapy
Kaylee K Marino, Raul A Santiago, Richard B Dew, Nancy Berliner, Jean M Connors, Nathan T Connell, John Kevin Tucker
Vitamin K antagonists have been a mainstay of treatment for patients requiring anticoagulation for atrial fibrillation, but direct oral anticoagulants, such as dabigatran, have become increasingly prescribed. Compared with warfarin, dabigatran has a significantly lower risk of life-threatening bleeding; however, bleeding events can still occur, supporting the need for effective reversal strategies. Idarucizumab was recently approved by the U.S. Food and Drug Administration to reverse the anticoagulant effects of dabigatran when life-threatening bleeding occurs or an urgent need for an invasive medical procedure exists...
October 2016: Pharmacotherapy
Tracy N Zembles, Nathan E Thompson, Peter L Havens, Bruce A Kaufman, Anna R Huppler
STUDY OBJECTIVE: To describe our experience with voriconazole in three patients younger than 2 years using an optimized dosing strategy for voriconazole that incorporates intensive therapeutic drug monitoring (TDM). DESIGN: Case series. SETTING: Large pediatric hospital. PATIENTS: Three patients younger than 2 years who received voriconazole therapy and had serum trough concentrations measured between January 1, 2010, and October 31, 2015...
October 2016: Pharmacotherapy
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