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Pharmacotherapy

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https://www.readbyqxmd.com/read/28654205/driving-toward-precision-medicine-for-acute-leukemias-are-we-there-yet
#1
Clement Chung, Hilary Ma
Despite recent progress in the understanding of the molecular basis of acute leukemias, treatment options for these diseases have not shown significant changes over the last few decades. In this review, we present a nonexhaustive key summary of the current cytogenetic and molecular changes associated with acute leukemias in disease prognostication and potential targeted therapies. An emerging paradigm is that many genetic or molecular alterations target similar signal transduction, transcriptional, and epigenetic pathways...
June 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28654193/serotonin-transporter-gene-polymorphisms-and-ssri-tolerability-review-of-pharmacogenetic-evidence
#2
Jing Zhu, Michele Klein-Fedyshin, James M Stevenson
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy for mood and anxiety disorders. The common mechanism of drugs in this class is antagonism of the serotonin transporter. Within the serotonin transporter gene SLC6A4, two polymorphic sites termed 5-HTTLPR and STin2 are proposed to have functional consequences and thus have been attractive candidates for pharmacogenetic studies of SSRI efficacy and tolerability studies. OBJECTIVE: This review summarizes approximately 15 years of study of these polymorphisms as they relate to SSRI tolerability phenotypes...
June 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28654165/using-personalized-medicine-in-the-management-of-diabetes-mellitus
#3
Nina Elk, Otito F Iwuchukwu
Diabetes mellitus is a worldwide problem of immense pharmacoeconomic burden. The multifactorial and complex nature of the disease lends itself to personalized pharmacotherapeutic approaches to treatment. Variability in individual risk and subsequent development of diabetes have been reported, in addition to differences in response to the many oral glucose lowering therapies currently available for diabetes pharmacotherapy. Pharmacogenomic studies have attempted to uncover the heritable components of individual variability in risk susceptibility and response to pharmacotherapy...
June 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28654154/commentary-should-pharmacogenomic-evidence-be-considered-in-clinical-decision-making-focus-on-select-cardiovascular-drugs
#4
Michael B Bottorff, David R Bright, David F Kisor
Despite advances in technology and guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC) that focus on how to utilize pharmacogene test results, hurdles remain that have delayed the widespread application of pharmacogenomics in clinical practice. These hurdles include a lack of prospective randomized controlled trials to address the utility of pharmacogenomics on clinical outcomes, what the clinical algorithm for pharmacogenomics should be, and whether or not pharmacogenomics is cost-effective...
June 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28632968/perspective-on-precision-medicine-in-oncology
#5
Tali M Johnson
The topic of precision medicine is increasingly more prevalent in the general medical literature with oncology research leading the way. Many factors, such as, availability of targeted drugs, advances in laboratory science, and improved information systems, converged to make precision medicine research possible on a large scale at the National Cancer Institute. The resultant big data will spur new kinds of research in the decades to come, but until then, all clinicians are challenged to make sense of an overabundance of information when managing individual patients...
June 20, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28632946/emerging-biomarkers-of-illness-severity-urinary-metabolites-associated-with-sepsis-and-necrotizing-methicillin-resistant-staphylococcus-aureus-pneumonia
#6
Lilliam Ambroggio, Todd A Florin, Samir S Shah, Richard Ruddy, Larisa Yeomans, Julie Trexel, Kathleen A Stringer
STUDY OBJECTIVE: To illustrate the potential of metabolomics to identify novel biomarkers of illness severity in a child with fatal necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: Case report with two control groups and a metabolomics analysis. PATIENTS: An infant with fatal MRSA pneumonia, four children with influenza pneumonia (pneumonia control group), and seven healthy children with no known infections (healthy control group)...
June 20, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28632924/metabolomics-as-a-driver-in-advancing-precision-medicine-in-sepsis
#7
Michelle Eckerle, Lilliam Ambroggio, Michael Puskarich, Brent Winston, Alan E Jones, Theodore J Standiford, Kathleen A Stringer
OBJECTIVE: The objective of this review is to explain the science of metabolomics-a science of systems biology that measures and studies endogenous small molecules (metabolites) that are present in a single biological sample-and its application to the diagnosis and treatment of sepsis. In addition, we discuss how discovery through metabolomics can contribute to the development of precision medicine targets for this complex disease state and the potential avenues for those new discoveries to be applied in the clinical environment...
June 20, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28609563/bayesian-forecasting-tool-to-predict-the-need-for-antidote-in-acute-acetaminophen-overdose
#8
Julie Desrochers, Jessica Wojciechowski, Wendy Klein-Schwartz, Jogarao V S Gobburu, Mathangi Gopalakrishnan
STUDY OBJECTIVE: Acetaminophen (APAP) overdose is the leading cause of acute liver injury in the United States. Patients with elevated plasma acetaminophen concentrations (PAC) require hepatoprotective treatment with N-acetylcysteine (NAC). These patients have been primarily risk-stratified using the Rumack-Matthew nomogram. Previous studies of acute APAP overdoses found that the nomogram failed to accurately predict the need for the antidote. The objectives of this study were to develop a population pharmacokinetic (PK) model for APAP following acute overdose and evaluate the utility of population PK model-based Bayesian forecasting in NAC administration decisions...
June 13, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28605058/cardiovascular-pharmacogenomics-and-cognitive-function-in-patients-with-schizophrenia
#9
Kristen M Ward, A Zarina Kraal, Stephanie A Flowers, Vicki L Ellingrod
STUDY OBJECTIVE: To examine the impact of multiple risk alleles for cognitive dysfunction and cardiovascular disease risk on cognitive function, and to determine if these relationships varied by cognitive reserve (CR) or concomitant medication use in patients with schizophrenia. DESIGN: Cross-sectional study. SETTING: Ambulatory mental health centers. PATIENTS: A total of 122 adults with a schizophrenia spectrum diagnosis who were maintained on a stable antipsychotic regimen for at least 6 months prior to study enrollment; patients were divided into three CR groups based on years of formal education: no high school completion or equivalent (low-education group [18 patients]); completion of high school or equivalent (moderate-education group [36 patients]; or any degree of post-high school education (high-education group [68 patients])...
June 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28605053/prevalence-of-cyp3a5-genomic-variances-and-their-impact-on-tacrolimus-dosing-requirements-among-kidney-transplant-recipients-in-eastern-north-carolina
#10
Angela Q Maldonado, Tomefa Asempa, Suzanne Hudson, Lorita M Rebellato
STUDY OBJECTIVE: To assess the prevalence of CYP3A5 genomic variances and their impact on tacrolimus dosing requirements among kidney transplant recipients in eastern North Carolina. DESIGN: Single-center, retrospective cohort study. SETTING: Large tertiary care medical center. PATIENTS: A total of 162 adults who received a kidney transplant between March 1, 2013, and February 28, 2015, and received oral tacrolimus as part of their maintenance immunosuppression; of these patients, 85 patients expressed a genotype with a CYP3A5*1 variant (CYP3A5*1 group), and 77 patients expressed genotypes with other CYP3A5 variants (nonexpressor group)...
June 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28605049/clinical-trial-designs-to-support-clinical-utility-of-pharmacogenomic-testing
#11
Katarzyna Drozda, Michael A Pacanowski
Advancing the use of biomarkers and pharmacogenomics has been a key priority area for the Food and Drug Administration (FDA). The FDA offers prescribing recommendations to manage approximately 100 gene-drug interactions, and multiple institutions around the United States and abroad have incorporated genomic testing into patient care. However, the penetration of pharmacogenomic testing remains incomplete. In this perspective, we summarize the evidence streams to support the clinical utility of pharmacogenomic testing and its transition into clinical practice...
June 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28600867/reply-to-the-hematology-oncology-pharmacy-association-alternative-viewpoint-on-the-2016-accp-pharmacotherapy-didactic-curriculum-toolkit
#12
Terry L Schwinghammer, Drayton A Hammond, Andrew J Crannage
On behalf of the 2016 ACCP Educational Affairs Committee, we appreciate the thoughtful Alternative Viewpoint of the Hematology/Oncology Pharmacy Association (HOPA) Task Force(1) to the 2016 ACCP Pharmacotherapy Didactic Curriculum Toolkit. The Toolkit(2) and its accompanying Commentary(3) are published online with the expectation that there will be periodic updates. ACCP plans to review the Toolkit every two to three years and will empanel a Task Force in fall 2017 to conduct the next review, anticipating an update in 2018...
June 10, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28594450/evaluation-of-the-effectiveness-of-two-morphine-protocols-to-treat-neonatal-abstinence-syndrome-in-a-level-ii-nursery-in-a-community-hospital
#13
Heather N DeAtley, Amanda Burton, Michelle DeLuca Fraley, Joan Haltom
STUDY OBJECTIVE: To evaluate the impact on length of hospital stay and treatment duration of morphine after implementation of a change in the institutional protocol for managing neonatal abstinence syndrome (NAS) in an effort to improve patient outcomes. DESIGN: Single-center, retrospective chart review. SETTING: Level II nursery in a community hospital in Kentucky. PATIENTS: Fifty-nine neonates born between January 1, 2014, and December 31, 2015, who were diagnosed with NAS and received morphine for treatment were included...
June 8, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28585720/optimizing-specialty-drug-use
#14
Samuel G Johnson, Keri A Sims
No abstract text is available yet for this article.
June 6, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28574586/clinical-importance-of-monitoring-unbound-valproic-acid-concentration-in-patients-with-hypoalbuminemia
#15
Maxime Doré, Adriana E San Juan, Anne Julie Frenette, David Williamson
STUDY OBJECTIVE: As the pharmacokinetic evaluation of valproic acid (VPA) based on total drug concentration may be misleading in patients with hypoalbuminemia as a result of saturable protein binding and saturable metabolism, we sought to investigate the usefulness of therapeutic drug monitoring of unbound VPA concentration in a real-world clinical context, with a focus on clinically significant neurologic adverse outcomes. DESIGN: Retrospective analysis. SETTING: Large, academic, tertiary care hospital in Montréal, Canada...
June 2, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28556122/role-of-procalcitonin-in-differentiating-between-infectious-and-non-infectious-fevers-among-patients-with-lymphoma
#16
Xiao Jun Wang, Thuan Tong Tan, Soon Thye Lim, Mohamad Farid, Miriam Tao, Richard Quek, Alexandre Chan, Tiffany Tang
OBJECTIVE: The primary objective of this study is to prospectively evaluate the role of procalcitonin (PCT) in distinguishing infectious fever from non-infectious fever (NIF) among febrile lymphoma patients. The secondary objective is to evaluate the usefulness of PCT in distinguishing between bloodstream infections (BSI), local infections and unidentified infections (LIUI), and NIF. METHODS: Patients with lymphoma and fever were prospectively recruited between August 2014 and November 2015...
May 28, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28556353/decreased-absorption-of-dolutegravir-and-tenofovir-disoproxil-fumarate-but-not-emtricitabine-in-an-hiv-infected-patient-following-oral-and-jejunostomy-tube-administration
#17
Kristina M Brooks, Katy L Garrett, Safia S Kuriakose, Jomy M George, Gayle Balba, Bria Bailey, Megan Anderson, H Clifford Lane, Frank Maldarelli, Alice K Pau
The use of enteral feeding tubes to administer antiretroviral medication administration is necessary in certain patients with human immunodeficiency virus (HIV) infection. However, adequacy of drug exposures after these administration routes are largely unknown, making dosing recommendations and the attainment of viral suppression challenging in this patient population. This report describes a patient with advanced HIV infection and a complicated medical history, including long-term intractable nausea/vomiting necessitating antiretroviral medication administration via a Roux-en-Y jejunostomy (J)-tube...
May 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28556176/lixisenatide-a-once-daily-prandial-glucagon-like-peptide-1-receptor-agonist-for-the-treatment-of-adults-with-type-2-diabetes
#18
Jennifer M Trujillo, Jennifer Goldman
Lixisenatide, a short-acting glucagon-like peptide-1 receptor agonist (GLP-1 RA), has been available in Europe since 2013 and was recently approved in the United States for the treatment of type 2 diabetes (T2D) as an adjunct to diet and exercise. The objective of this systematic review is to describe the pharmacology, pharmacokinetics, safety, and efficacy of lixisenatide in patients with T2D. We conducted a search of the EMBASE database, limited to human studies with abstracts available in English. Published conference abstracts, limited to the American Diabetes Association (ADA) and the European Association for the Study of Diabetes meetings in 2015, as well as abstracts presented at the ADA meeting in 2016, were also screened...
May 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28555946/comparative-effectiveness-of-oral-antiplatelet-agents-in-patients-with-acute-coronary-syndrome
#19
Kibum Kim, Todd A Lee, Amer K Ardati, Robert J DiDomenico, Daniel R Touchette, Surrey M Walton
OBJECTIVE: In randomized controlled trials, prasugrel and ticagrelor reduced cardiovascular complications in patients with acute coronary syndrome (ACS) compared to clopidogrel. However, there have been limited head-to-head comparisons across the three anti-platelet agents using real-world data. The aim of this study was to compare clinical outcomes of three strategies during a 1-year post percutaneous coronary intervention (PCI) period. METHODS: Rates of all-cause and acute myocardial infarction (AMI) related hospitalizations were retrospectively compared using an insurance claims database...
May 27, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28543813/inhaled-pulmonary-vasodilator-therapy-for-management-of-right-ventricular-dysfunction-after-left-ventricular-assist-device-placement-and-cardiac-transplantation
#20
Leah A Sabato, David M Salerno, Jeremy D Moretz, Douglas L Jennings
Right ventricular failure (RVF) after cardiac transplant (CTX) or implantation of a continuous-flow left ventricular assist device (CF-LVAD) is associated with significant post-operative morbidity and mortality. A variety of modalities have been used to treat post-operative RVF, including management of volume status, intravenous inotropes and vasodilators, and right-sided mechanical support. Inhaled vasodilator agents are a unique treatment option aimed at minimizing systemic absorption by delivering therapy directly to the pulmonary vasculature...
May 24, 2017: Pharmacotherapy
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