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Alejandro Arana, Andrea V Margulis, Lisa J McQuay, Ryan Ziemiecki, Jennifer L Bartsch, Kenneth J Rothman, Billy Franks, Milbhor D Silva, Kwame Appenteng, Cristina Varas-Lorenzo, Susana Perez-Gutthann
BACKGROUND: Blocking muscarinic receptors could have an effect upon cardiac function, especially among elderly patients with overactive bladder (OAB). STUDY OBJECTIVE: To investigate the risk of cardiovascular events in users of antimuscarinic drugs to treat OAB. DESIGN, SETTING AND PARTICIPANTS: Cohort study of new users of darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium, aged ≥18 years old in the United Kingdom's Clinical Practice Research Datalink (CPRD), 2004-2012...
May 3, 2018: Pharmacotherapy
Meredith L Howard, Taylor D Steuber, Sarah A Nisly
Obesity is a worldwide epidemic often complicated by multiple comorbidities, including type 2 diabetes mellitus (T2DM). Bariatric surgery is an increasingly common and effective weight loss strategy for obese patients that may result in resolution of metabolic related disease states, such as T2DM. Although bariatric surgery has many positive outcomes for patients, dietary and pathophysiologic changes can create difficult to control blood glucose, especially in the immediate perioperative setting. Depending on oral antidiabetic agent and insulin needs preoperatively, many patients require cessation of oral agents and reduction or cessation of insulin...
May 3, 2018: Pharmacotherapy
Kristen M Ward, Larisa Yeomans, Cora McHugh, A Zarina Kraal, Stephanie A Flowers, Amy E Rothberg, Alla Karnovsky, Arun Das, Vicki L Ellingrod, Kathleen A Stringer
STUDY OBJECTIVE: Patients with schizophrenia are known to have higher rates of metabolic disease than the general population. Contributing factors likely include lifestyle and atypical antipsychotic (AAP) use, but the underlying mechanisms are unknown. The objective of this study was to identify metabolomic variability in adult patients with schizophrenia who were taking AAPs and grouped by fasting insulin concentration, our surrogate marker for metabolic risk. DESIGN: Metabolomics analysis...
May 3, 2018: Pharmacotherapy
Uvaraj Uddayasankar, Colin Lee, Curtis Oleschuk, Gregg Eschun, Robert E Ariano
Carfentanil and related fentanyl analogues have been linked to a number of overdose deaths from drug users in several cities across North America. Diagnosis of carfentanil exposure requires a very high index of clinical suspicion, especially because available laboratory narcotic screens do not detect this agent. We describe a 34-year-old male admitted with depressed level of consciousness and in respiratory failure after recreational exposure to a white powder later inferred to contain carfentanil. Urine and whole blood samples were obtained for conventional preliminary drug screen immunoassays for unknown exposures; in addition to utilizing high pressure liquid chromatography tandem mass spectrometry assay for quantification of carfentanil and its metabolite...
April 20, 2018: Pharmacotherapy
Alexandra M Hanretty, Jason C Gallagher
BACKGROUND: Commonly prescribed durations of therapy for many, if not most, bacterial infections are not evidence-based. Misunderstandings by clinicians and patients alike influence perspectives on antibiotic use, including duration of therapy and its role in antibiotic resistance. OBJECTIVE: To demonstrate that shorter durations of antibiotic therapy are as efficacious as longer durations for many infections. DATA SOURCES: A systematic review of English language articles using PubMed were identified for inclusion...
April 20, 2018: Pharmacotherapy
Alexandra N Varga, David Johnson, Deirdre L Sawinski, Mary Ann Lim, Roy D Bloom, Peter L Abt, Simin Goral, Melissa Bleicher, Matthew H Levine, Ali Naji, Susanna Nazarian, Paige Porrett, Jennifer Trofe-Clark
BACKGROUND: Kidney transplant induction therapy often includes inpatient administration of rabbit antithymocyte globulin (rATG) over multiple days. To reduce hospital length of stay (LOS) and drug expenditures, the rATG induction course was completed in the outpatient setting via peripheral intravenous administration. The present study assesses early readmission trends ascribable to an outpatient rATG administration protocol to assure initial reduction in hospital LOS is sustained early after discharge...
April 17, 2018: Pharmacotherapy
Jerry L Bauman
No abstract text is available yet for this article.
April 16, 2018: Pharmacotherapy
E Alfonso Romero-Sandoval, Jack E Fincham, Ashley L Kolano, Brandi N Sharpe, P Abigail Alvarado-Vázquez
The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped...
April 10, 2018: Pharmacotherapy
Melanie Livet, Stuart T Haines, Geoff M Curran, Terry Seaton, Caryn Ward, Todd Sorensen, Mary Roth McClurg
There is increasing pressure within healthcare to implement evidence-based interventions that improve quality, control costs, and maximize value. Unfortunately, many clinical services and interventions to optimize medication use do not consistently produce the intended humanistic, clinical, and economic outcomes. The lack of conclusive results is believed to stem from the widely recognized research-to-practice gap. The field of implementation science seeks to discover and apply strategies designed to accelerate successful integration of interventions into routine practice...
April 6, 2018: Pharmacotherapy
Elizabeth W Covington, Megan Z Roberts, Jenny Dong
Effective antimicrobial stewardship practices are increasingly essential to best utilize the current arsenal of antimicrobials for the shortest necessary duration to minimize the development of antimicrobial resistance, secondary infections, and health care costs. Monitoring of serum procalcitonin (PCT) levels represents an effective antimicrobial stewardship strategy to differentiate bacterial infections from viral infections and noninfectious inflammatory conditions. Current literature illustrates the merits of PCT monitoring in reducing duration of antibiotic therapy without detrimental effects on mortality or infection relapses...
March 31, 2018: Pharmacotherapy
Brandon K Martinez, Jit Sheth, Nishi Patel, William L Baker, Craig I Coleman
INTRODUCTION: While not designated as guideline-recommended first-line anticoagulation therapy, about one in five patients in the United States receive rivaroxaban for the treatment of cancer-associated venous thrombosis (CAT). METHODS: A systematic review and meta-analysis were performed to evaluate the incidences of recurrent venous thromboembolism (VTE), major bleeding, and all-cause mortality in rivaroxaban patients treated for CAT in routine practice. Literature searches of MEDLINE and SCOPUS were performed through September 2017 to identify real-world studies of ≥ 20 patients evaluating the incidence of recurrent VTE, major bleeding, or all-cause mortality in CAT patients anticoagulated with rivaroxaban...
March 31, 2018: Pharmacotherapy
Jenny Hong, Arden R Barry
Beta-blockers are recommended as standard of care for patients who experience a myocardial infarction (MI). However, evidence to support this recommendation is primarily derived from the pre-reperfusion era. In the reperfusion era, short-term (≤30 days) beta-blocker therapy has been demonstrated to reduce recurrent MI and angina, but not mortality. The objective of this review was to evaluate the evidence for long-term (≥1 year) beta-blocker therapy in patients post-MI without left ventricular dysfunction in the reperfusion era...
March 30, 2018: Pharmacotherapy
Wan-Chen Shen, Chia-Hwa Lee, El-Wui Loh, An-Tsz Hsieh, Lawrence Chen, Ka-Wai Tam
STUDY OBJECTIVE: To investigate the efficacy and safety of rituximab in patients with Graves' orbitopathy (GO). DESIGN: Systematic review and meta-analysis of four randomized controlled trials. PATIENTS: A total of 293 patients with GO who received rituximab or control (either glucocorticoids, the established first-line therapy [three trials], or saline [one trial]). MEASUREMENTS AND RESULTS: Relevant studies published before February 2018 were identified from the PubMed, Embase, Cochrane Library, and Scopus databases, and the ClinicalTrials...
March 30, 2018: Pharmacotherapy
Patrick M Zueger, Varun M Kumar, Rachel L Harrington, Gianna C Rigoni, Alicia Atwood, Robert J DiDomenico, Daniel R Touchette
OBJECTIVE: Sacubitril/valsartan (SAC/VAL) has been shown to reduce mortality and hospitalization in patients with heart failure with reduced ejection fraction (HFrEF) compared with enalapril but at a substantially higher cost. This study evaluates the cost-effectiveness of SAC/VAL versus enalapril in patients with HFrEF over a 5-year time horizon from the U.S. payer perspective. METHODS: A cohort-based Markov model was developed to compare costs and quality-adjusted life years (QALYs) between SAC/VAL and enalapril in patients with HFrEF over a 5-year time horizon...
March 30, 2018: Pharmacotherapy
Drayton A Hammond, Oktawia A Ficek, Jacob T Painter, Kelsey McCain, Julia Cullen, Amy L Brotherton, Krishna Kakkera, Divyan Chopra, Nikhil Meena
PURPOSE: Delays in achieving target mean arterial pressure (MAP) are associated with increased morbidity and mortality in patients with septic shock. This trial was conducted to test the hypothesis that early concomitant treatment with vasopressin and norepinephrine reduces the time to achieve and maintain target MAP compared with initial norepinephrine monotherapy. METHODS: A single-center prospective open-label trial was conducted in patients with septic shock between November 2015 and June 2016 at a medical intensive care unit in an academic medical center...
March 30, 2018: Pharmacotherapy
Sarah R Hood, Anthony J Giazzon, Gwen Seamon, Kathleen A Lane, Jane Wang, George J Eckert, Wanzhu Tu, Michael D Murray
BACKGROUND: Previous studies of heart failure patients demonstrated an association between cardiovascular medication adherence and hospitalizations or a composite end point of hospitalization and death. Few studies have assessed the impact of treatment adherence within large general medical populations that distinguish the health outcomes of emergency department visits, hospitalization, and death. OBJECTIVE: To determine the association of incremental cardiovascular medication adherence on emergency department visits, hospitalization, and death in adult heart failure patients in Indiana...
March 30, 2018: Pharmacotherapy
Noll L Campbell, Kathleen A Lane, Sujuan Gao, Malaz A Boustani, Fred Unverzagt
STUDY OBJECTIVE: To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care. DESIGN: This observational cohort study was conducted over a mean follow-up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to four years. DATA SOURCE: Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC), while the cognitive diagnosis was derived from a cognitive screening and diagnosis study...
March 30, 2018: Pharmacotherapy
Andrea S Franks, Karen Sando, Sarah McBane
Tobacco use continues to be a major cause of morbidity and mortality. Even with behavioral and pharmacologic treatment, long-term tobacco cessation rates are low. Electronic nicotine delivery systems, commonly referred to as electronic cigarettes or e-cigarettes, are increasingly used for tobacco cessation. Because e-cigarettes are widely used in this setting, health care professionals need to know if they are safe and effective. The purpose of this article is to review literature regarding use of e-cigarettes as a tool for tobacco cessation in patients who are ready to quit, as well as those who are not ready to quit, along with some selected patient populations...
March 24, 2018: Pharmacotherapy
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 most events occurring within 30 days of hospital discharge. Therefore, the 30-day time period postdischarge 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 (e.g., 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...
April 2018: Pharmacotherapy
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