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Pharmacotherapy

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https://www.readbyqxmd.com/read/29160945/lacosamide-pharmacokinetics-in-a-critically-ill-patient-receiving-continuous-venovenous-hemofiltration
#1
Miguel J Franquiz, Shamir N Kalaria, Michael J Armahizer, Mathangi Gopalakrishnan, Paul J McCarthy, Neeraj Badjatia
OBJECTIVE: Lacosamide is a new generation antiepileptic drug (AED) that is eliminated by both hepatic and renal mechanisms. Lacosamide elimination by Continuous Renal Replacement Therapy (CRRT) has never been studied. The objective of this case report was to describe lacosamide pharmacokinetics in the setting of CRRT. METHODS: Case report of a single patient admitted to the study center with status epilepticus and multi-organ failure. The patient required both continuous venovenous hemofiltration (CVVH) and several AEDs...
November 21, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29155443/the-philosophy-of-practice-for-comprehensive-medication-management-evaluating-its-meaning-and-application-by-practitioners
#2
Deborah L Pestka, Lindsay A Sorge, Mary Roth McClurg, Todd D Sorensen
OBJECTIVE: Philosophy of practice is the foundation to any patient care practice as it provides a set of professional values and beliefs that guide actions and decisions in practice. Study objectives were to understand how pharmacists providing comprehensive medication management (CMM) describe their philosophy of practice and compare how participants' philosophies align with predefined tenets of a CMM philosophy of practice. METHODS: An instrument with closed and open-ended items was developed and administered online to the lead pharmacist at 36 clinics participating in a large CMM study...
November 20, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29155440/severe-hypoglycemia-caused-by-lenalidomide
#3
Daniel J Przybylski, Ruemu Birhiray, David J Reeves
Lenalidomide is commonly used for multiple myeloma as either induction or maintenance therapy. The agent is associated with a host of adverse effects, but hypoglycemia has only been reported in one phase I trial in patients with solid tumors. We describe a 74-year-old woman who experienced grade 3 hypoglycemia (blood glucose level 35 mg/dL) likely related to lenalidomide. Her medical history was significant for refractory myeloma and type 2 diabetes mellitus. Lenalidomide was started as maintenance therapy following autologous bone marrow transplantation...
November 20, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#4
Kyle A Weant, Lauren M Linder, Clint A Ross
BACKGROUND: Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
November 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29136299/malignancy-in-renal-transplant-recipients-exposed-to-cyclophosphamide-prior-to-transplantation-for-the-treatment-of-native-glomerular-disease
#5
M R Jorgenson, J L Descourouez, T Singh, Brad C Astor, Sarah E Panzer
STUDY OBJECTIVE: To evaluate the risk of post-transplantation malignancy in renal transplant recipients exposed to pre-transplantation cyclophosphamide for treatment of glomerular nephropathy (GN). DESIGN: Retrospective cohort study. SETTING: Tertiary academic medical center. PATIENTS: Six hundred adult renal transplant recipients transplanted between 1993 and 2014; 54 patients were exposed to pre-transplantation cyclophosphamide for treatment of GN (GN-CYC group), and 546 patients with polycystic kidney disease were not exposed to pre-transplantation cyclophosphamide (PKD group)...
November 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29121410/medication-management-of-patients-undergoing-transcatheter-aortic-valve-replacement
#6
Bethany A Kalich, J Erin Ledford, Ian B Hollis
Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine the optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression. Surgical aortic valve replacement (SAVR) is curative but has significant limitations for some patient populations. A newer option, transcatheter aortic valve replacement (TAVR), has become more widely available to patients with intermediate- or high-operative risk...
November 9, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29121408/community-health-workers-supporting-clinical-pharmacists-in-diabetes-management-a-randomized-controlled-trial
#7
Lisa K Sharp, Jessica J Tilton, Daniel R Touchette, Yinglin Xia, Daniel Mihailescu, Michael L Berbaum, Ben S Gerber
OBJECTIVES: To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income, ethnic minority population. METHODS: In a two-arm, 2-year, crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A1c [HbA1c] ≥ 8%) were randomized to CHW support either during the first or second year of the study. All participants received clinical pharmacist support for both years of the study...
November 9, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29121395/multiple-dose-oritavancin-evaluation-in-a-retrospective-cohort-of-patients-with-complicated-infections
#8
Lucas T Schulz, Emily Dworkin, Jennifer Dela-Pena, Warren E Rose
OBJECTIVE: Oritavancin is a lipoglycopeptide antibiotic approved for use in acute bacterial skin and skin structure infections as a single 1200 mg parenteral dose. Because of oritavancin's long half-life and broad gram-positive activity, interest in its use for other infections is high. METHODS: This study is a retrospective cohort evaluation of patients receiving oritavancin at a single academic medical center. All patients receiving more than one dose of oritavancin were included...
November 9, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29105160/strength-in-amalgamation-newer-combination-agents-for-hiv-and-implications-for-practice
#9
Christopher McCoy, Melissa Badowski, Elizabeth Sherman, Rustin Crutchley, Ethan Smith, Daniel B Chastain
Antiretroviral (ART) therapy for treatment of human immunodeficiency virus (HIV) infection has undergone significant changes over the past 30 years. Many single tablet regimens (STR), including newer fixed dose combination (FDC) tablets, are available, offering patients several options for choosing a treatment regimen that works best for them. Given these changes, patients are more likely to adhere to treatment, achieve better clinical outcomes, and experience both fewer side effects and drug-drug interactions...
November 3, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29105102/impact-of-penicillin-allergy-on-empirical-carbapenem-use-in-gram-negative-bloodstream-infections-an-antimicrobial-stewardship-opportunity
#10
Majdi N Al-Hasan, Emily C Acker, Joseph E Kohn, P Brandon Bookstaver, Julie Ann Justo
OBJECTIVES: Retrospective matched cohort study evaluating association between penicillin allergy and empirical carbapenem use in gram-negative bloodstream infections (BSI) and utility of antimicrobial stewardship interventions in reducing carbapenem utilization. METHODS: Hospitalized adults with community-onset gram-negative BSI from January 1, 2010 to June 30, 2015 at two large community hospitals in Columbia, SC were identified. Antimicrobial stewardship interventions targeting penicillin allergy and carbapenem utilization were fully implemented in January 1, 2014...
November 3, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29059475/incidence-of-and-risk-factors-for-severe-adverse-events-in-elderly-patients-taking-angiotensin-converting-enzyme-inhibitors-or-angiotensin-ii-receptor-blockers-after-an-acute-myocardial-infarction
#11
Gang Fang, Izabela E Annis, Joel F Farley, Nirosha Mahendraratnam, Ryan P Hickson, Til Stürmer, Jennifer G Robinson
STUDY OBJECTIVE: To assess the incidence of and risk factors associated with severe adverse events in elderly patients who used angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) after an acute myocardial infarction (AMI). DESIGN: Retrospective cohort study. DATA SOURCES: Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse (Medicare service claims database), American Community Survey of the U...
October 23, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29059465/what-is-old-is-new-again-delafloxacin-a-modern-fluoroquinolone
#12
Jonathan C Cho, Matthew P Crotty, Bryan P White, Marylee V Worley
Delafloxacin is a new fluoroquinolone antimicrobial approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in adults using dosage regimens of 300 mg intravenously every 12 hours, 450 mg orally every 12 hours, or switching from intravenous to oral regimens for a 5 to 14 day treatment duration. Dosage adjustments in patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] = 15-29 ml/min/1.73m(2) ) are not required for oral doses but should be decreased to 200 mg intravenously every 12 hours in patients requiring parenteral therapy...
October 23, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29044720/observational-comparative-effectiveness-of-pharmaceutical-treatments-for-obesity-within-the-veterans-health-administration
#13
Ted R Grabarczyk
STUDY OBJECTIVE: To compare the effectiveness of weight-management medications used to assist with weight loss in real-world clinical practice in the Veterans Health Administration (VHA). DESIGN: Retrospective, multicenter, observational cohort study. DATA SOURCE: National VA Corporate Data Warehouse. PATIENTS: A total of 66,035 VA patients aged 18 years or older with a body mass index of 25 kg/m(2) or greater who had an initial fill for a study medication (orlistat [6153 patients], phentermine [304 patients], lorcaserin [298 patients], or phentermine-topiramate extended release [233 patients]) or participation in the VA's MOVE! weight management program with at least three total visits in a clinic coded as a MOVE clinic in the subsequent 24 weeks (59,047 patients) between January 1, 2012 and July 1, 2016...
October 17, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29044643/fidaxomicin-versus-vancomycin-as-a-first-line-treatment-for-clostridium-difficile-associated-diarrhea-cdad-in-specific-patient-populations-a-pharmacoeconomic-evaluation
#14
Kelly R Reveles, Jennifer L Backo, Frank A Corvino, Marko Zivkovic, Kelly C Broderick
OBJECTIVES: The reduction in recurrent Clostridium difficile-associated diarrhea (CDAD) with fidaxomicin therapy may reduce hospital readmissions and lead to lower overall CDAD costs. However, studies assessing the cost-effectiveness of fidaxomicin as first-line therapy from the United States (US) hospital perspective are lacking. This study evaluated the costs associated with utilizing fidaxomicin or vancomycin as a first-line therapy for CDAD in specific patient populations from a US hospital perspective...
October 17, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29028123/impact-of-insulin-detemir-administration-time-on-hypoglycemia-rates-in-hospitalized-patients
#15
Jennifer L Grelle, Sydney N Kutter, Megan E Giruzzi, John C Tawwater
STUDY OBJECTIVE: To determine if insulin detemir administration time affects the frequency of hypoglycemia (blood glucose level <70 mg/dL) in hospitalized patients. DESIGN: Retrospective cohort study. PATIENTS: A total of 357 adults (aged 18-89 yrs) who received insulin detemir for at least 48 hours while hospitalized between January 1, 2014, and December 31, 2015, were included. Patients were categorized into one of three groups according to insulin detemir administration time: detemir given once daily between 7 A...
October 13, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29028119/comparison-of-treatment-persistence-with-dabigatran-or-rivaroxaban-versus-vitamin-k-antagonist-oral-anticoagulants-in-atrial-fibrillation-patients-a-competing-risk-analysis-in-the-french-nationwide-healthcare-databases
#16
Géric Maura, Cécile Billionnet, François Alla, Joshua J Gagne, Antoine Pariente
BACKGROUND: Direct oral anticoagulants (DOACs) have been proposed as a more convenient alternative to vitamin K antagonists (VKAs), which are commonly associated with poor treatment persistence in nonvalvular atrial fibrillation (nv-AF). METHODS: Using data from the French National Healthcare databases (Régime Général, 50 million beneficiaries), a cohort study was conducted to compare the 1-year non-persistence rates in nv-AF patients initiating dabigatran (N=11,141) or rivaroxaban (N=11,126) versus VKA (N=11,998)...
October 13, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29028117/comparison-of-weight-based-dosing-strategies-for-intravenous-immunoglobulin-in-patients-with-hematologic-malignancies
#17
Sarah E Stump, Allison J Schepers, Alexis R Jones, Maurice D Alexander, Jessica J Auten
STUDY OBJECTIVE: Intravenous immunoglobulin (IVIG) is a weight-based therapy used to treat and prevent infections in patients with hematologic malignancies. Traditionally, IVIG doses have been calculated using actual body weight (ABW). However, limited pharmacokinetic (PK) data suggest dosing strategies using ideal body weight (IBW) or adjusted body weight (adjBW) may be appropriate given the small volume of distribution of IVIG. The objective of this study was to compare the effectiveness of using a precision-dosing strategy (IBW or adjBW) to a traditional-dosing strategy (ABW) for IVIG in patients with hematologic malignancies or those undergoing hematopoietic stem cell transplant, as well as to perform an IVIG drug use analysis...
October 13, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29023938/a-pharmacist-led-program-to-evaluate-and-reduce-polypharmacy-and-potentially-inappropriate-prescribing-in-older-hiv-positive-patients
#18
I R McNicholl, M Gandhi, C Bradley Hare, M Greene, E Pierluissi
OBJECTIVE: The goal of this pharmacist-led study was to utilize 2 validated instruments, Beers and Screening Tool of Older Persons' Potentially inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions. DESIGN: Prospective, randomized, interventional trial. SETTING: Large urban clinic providing interdisciplinary primary and HIV care for approximately 2700 HIV-positive, publically insured patients...
October 10, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29023930/evaluation-and-treatment-of-acute-and-subacute-hearing-loss-a-review-of-pharmacotherapy
#19
Maryam T Fazel, Patrick M Jedlowski, Robert B Cravens, Brian L Erstad
Among various forms of hearing loss, there are acute (within 72 hours) or sub-acute (weeks to months) presentations that may be reversible with early pharmacological intervention. The workup of a patient presenting with hypoacusia includes the usual history and physical examination in conjunction with an audiometric assessment in order to categorize the hearing loss as conductive, sensorineural, or mixed. Sudden sensorineural hearing loss (SSNHL) and autoimmune inner ear disease (AIED) are acute and subacute forms of sensorineural hypoacusia most likely to be reversed with prompt pharmacological intervention...
October 10, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29023898/impact-of-ketamine-use-on-adjunctive-analgesic-and-sedative-medications-in-critically-ill-trauma-patients
#20
Kaitlin A Pruskowski, Kelly Harbourt, Mehrnaz Pajoumand, Sai-Ho Jason Chui, H Neal Reynolds
BACKGROUND: Ketamine may be used to manage pain and agitation that is refractory to "traditional" agents such as fentanyl, propofol, benzodiazepines, and dexmedetomidine; however, literature describing the use of ketamine continuous infusions for this purpose in critically ill trauma patients is limited. OBJECTIVES: The primary objective of this study was to determine the impact of the initiation of a ketamine continuous infusion on sedative and analgesic use in critically ill trauma patients...
October 10, 2017: Pharmacotherapy
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