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Pharmacotherapy

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https://www.readbyqxmd.com/read/28895177/a-novel-use-for-olaparib-for-treatment-of-metastatic-castration-recurrent-prostate-cancer
#1
Grace A Martin, Adrienne H Chen, Kinjal Parikh
Although mortality from prostate cancer has declined over the past 20 years as a result of early detection and treatment, the 5-year survival rate for men with prostate cancer who develop metastatic disease is only 29%. Current treatment options for metastatic castration-recurrent prostate cancer (mCRPC) are associated with toxicity and a limited durable response; therefore, additional lines of efficacious and minimally toxic therapy are needed. Olaparib, a poly(adenosine 5'-diphosphate) ribose polymerase (PARP) inhibitor, received United States Food and Drug Administration breakthrough therapy designation in January 2016 for the treatment of patients with BRCA1/2 or ATM gene-mutated mCRPC based on results of a compelling phase II trial of olaparib in patients with advanced castration resistant prostate cancer (TOPARP-A)...
September 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28891099/opioid-and-benzodiazepine-weaning-in-pediatric-patients-review-of-current-literature
#2
Norman E Fenn, Kimberly S Plake
Pediatric opioid and benzodiazepine withdrawal are avoidable complications of pain and sedation management that is well described in the literature. To prevent withdrawal from occurring, practitioners regularly employ a steady decrease of pain and sedation medications, also known as a weaning or tapering schedule. The weaning schedule is highly variable based on clinician preference and is usually dependent on the clinician. The purpose of this review is to evaluate the current literature on the process of opioid and benzodiazepine weaning in pediatric patients and to assess the various standardized protocols used to decrease withdrawal occurrences...
September 11, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28891082/thrombolysis-for-massive-pulmonary-embolism-in-pregnancy
#3
Mojdeh S Heavner, Min Zhang, Chelsea E Bast, Lindsey Parker, Rachel F Eyler
Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism (PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Non-pregnant patients who develop PE with hypotension or showing signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics and all data available in this population is published as case reports or case series...
September 11, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28869666/comprehensive-guidance-for-antibiotic-dosing-in-obese-adults
#4
Lina Meng, Emily Mui, Marisa K Holubar, Stan C Deresinski
BACKGROUND: Physiologic alterations seen in obesity commonly impact the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogenous results that, in some cases, are contradictory. In the last 10 years, additional antimicrobial PK/PD and clinical data encompassing prolonged infusion strategies and examination of critically ill populations has emerged to inform antimicrobial dosing in obesity...
September 4, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28869655/intravenous-only-or-intravenous-transitioned-to-oral-antimicrobials-for-enterobacteriaceae-associated-bacteremic-urinary-tract-infection
#5
Krista L Rieger, John A Bosso, Shawn H MacVane, Zachary Temple, Amy Wahlquist, Nicole Bohm
Limited evidence supports use of oral antibiotics for Enterobacteriaceae-associated bacteremic urinary tract infection. This retrospective cohort study found no statistically significant difference in the composite outcome of treatment failure in patients who received exclusively intravenous versus intravenous/oral antibiotics for the treatment of bacteremic urinary tract infections. This article is protected by copyright. All rights reserved.
September 4, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28845902/persistence-of-delirium-after-cessation-of-sedatives-and-analgesics-and-impact-on-clinical-outcomes-in-critically-ill-patients
#6
Michael T Kenes, Joanna L Stollings, Li Wang, Timothy D Girard, E Wesley Ely, Pratik P Pandharipande
STUDY OBJECTIVE: As delirium is a common manifestation in critically ill patients and is associated with worse clinical outcomes, we sought to characterize the reversibility of delirium after discontinuation of sedation and to determine whether sedation-associated delirium that rapidly reverses impacts clinical outcomes. DESIGN: Post hoc subgroup analysis of prospectively collected data from a previously published study. PATIENTS: Seventy adults admitted to a medical intensive care unit (ICU) between March and July 2012 who required mechanical ventilation with continuous analgesia and/or sedation and underwent a spontaneous awakening trial (SAT)...
August 28, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28845898/comparison-of-bioavailability-of-single-dose-extended-release-venlafaxine-capsules-in-obese-patients-before-and-after-gastric-bypass-surgery
#7
Carrie A Krieger, Julie L Cunningham, Karen B Grothe, Joel M Reid, Loralie J Langman, Matthew M Clark, Ross A Dierkhising
STUDY OBJECTIVE: The extended-release (ER) form of venlafaxine is preferred because of improved patient adherence, but the immediate-release form is frequently used after Roux-en-Y gastric bypass surgery (RYGB) because of concerns for malabsorption. The objective of this study was to determine whether a statistically significant and predictable change in the bioavailability of venlafaxine ER capsules occurs after RYGB. DESIGN: Prospective, nonblinded, single-dose pharmacokinetic study...
August 28, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28836287/precision-pharmacotherapy-enables-precision-medicine
#8
EDITORIAL
Jeffrey R Bishop, Vicki L Ellingrod
No abstract text is available yet for this article.
August 23, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28833385/empiric-vancomycin-dosing-in-pediatric-patients-with-congenital-heart-disease-and-the-impact-of-cardiopulmonary-bypass-on-trough-concentrations
#9
Christopher A Thomas, Amy Picone, Sharad Menon, Brigham C Willis
OBJECTIVES: To determine the optimal vancomycin dosing regimen to achieve empiric goal trough concentrations in pediatric patients with congenital heart disease and to examine the impact of cardiopulmonary bypass on vancomycin dosing requirements. METHODS: Patients younger than 18 years of age admitted to the pediatric cardiovascular intensive care unit (CVICU) at our institution from 10/1/2012 - 12/31/2014 who received at least one dose of vancomycin were retrospectively reviewed...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28833362/evaluation-of-progesterone-utilization-and-birth-outcomes-in-a-state-medicaid-plan
#10
Tasmina Hydery, Mylissa K Price, Bonnie C Greenwood, Mito Takeshita, Parag S Kunte, Rose P Mauro, Kimberly Lenz, Paul L Jeffrey
OBJECTIVES: Progesterone (hydroxyprogesterone caproate injection and vaginal progesterone) has been shown to reduce preterm birth (PTB) rates by one-third among pregnant women at high risk. The purpose of this analysis is to report birth outcomes and medication adherence among Massachusetts Medicaid (MassHealth) members receiving progesterone, evaluate the association between member characteristics and birth outcomes and medication adherence, and compare cost of care to a prior preterm pregnancy...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28833357/prothrombin-complex-concentrate-reduces-blood-product-utilization-in-heart-transplantation
#11
Daniel H Enter, Anthony L Zaki, Megan Marsh, Nikki Cool, Jane Kruse, Zhi Li, Adin-Cristian Andrei, Adam Iddriss, Patrick M McCarthy, S Chris Malaisrie, Allen Anderson, Jonathan D Rich, Duc Thinh Pham
BACKGROUND: Current practices for the reversal of warfarin prior to cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of PCC (Prothrombin Complex Concentrate), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of 4-factor Prothrombin Complex Concentrate (4-F PCC) administration in patients requiring warfarin reversal prior to heart transplantation by determining blood product utilization perioperatively...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28833353/assessment-of-an-extended-interval-fondaparinux-dosing-regimen-for-venous-thromboembolism-prophylaxis-in-critically-ill-patients-with-severe-renal-dysfunction-using-antifactor-xa-levels
#12
Krista A Wahby, Lauren K Riley, Steven D Tennenberg
OBJECTIVE: Pharmacologic options for venous thromboembolism (VTE) prophylaxis are often limited in critically ill patients due to thrombocytopenia and multisystem organ dysfunction. Fondaparinux offers potential advantages in the critically ill; however, it is currently contraindicated in severe renal dysfunction (SRD). We evaluated antifactor Xa levels in critically ill patients with SRD who were receiving an extended interval dosing regimen of fondaparinux for VTE prophylaxis. METHODS: A prospective, single arm, interventional study was conducted at two academic hospitals of the Detroit Medical Center...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28833346/repurposing-valproate-enteral-clonidine-and-phenobarbital-for-comfort-in-adult-icu-patients-a-literature-review-with-practical-considerations
#13
David J Gagnon, Gabriel V Fontaine, Richard R Riker, Gilles L Fraser
Provision of adequate sedation is a fundamental part of caring for critically ill patients. Propofol, dexmedetomidine, and benzodiazepines are the most commonly administered sedative medications for adult patients in the intensive care unit (ICU). These agents are limited by adverse effects, need for a monitored environment for safe administration, and lack of universal effectiveness. Recently, there has been increased interest in repurposing older pharmacologic agents for patient comfort in the intensive care unit...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28833345/contemporary-time-trends-in-use-of-antiplatelet-agents-among-patients-with-acute-coronary-syndrome-and-comorbid-diabetes-mellitus-or-chronic-kidney-disease
#14
Rishi J Desai, Julia Spoendlin, Helen Mogun, Joshua J Gagne
STUDY OBJECTIVE: To describe contemporary trends of P2Y12 inhibitor use in patients with acute coronary syndrome (ACS) and comorbid diabetes mellitus (DM) and/or chronic kidney disease (CKD) who have higher risk of recurring ACS and may benefit from treatment with higher efficacy third generation agents (prasugrel and ticagrelor). DESIGN: Observational cohort study. SETTING: A large US commercial insurance program (2009-2015). PATIENTS: P2Y12 inhibitor initiatored within 2 weeks after an ACS event...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28833332/pharmacotherapeutic-management-of-gastrointestinal-bleeding-in-patients-with-continuous-flow-left-ventricular-assist-devices
#15
Adam Sieg, Jeremy D Moretz, Edward Horn, Douglas L Jennings
Continuous-flow left ventricular assist devices (CF-LVADs) have become an integral component of the management in patients with advanced heart failure, serving as destination therapy or as a bridge to heart transplantation. Despite significant advances in the design and longevity of the device, the ongoing risk for bleeding remains a significant concern. The genesis of gastrointestinal bleeding (GIB) in patients with CF-LVADs is likely multifactorial and may include components of acquired von Willebrand disease, angiodysplasia, and gastrointestinal arteriovenous malformations, as well as additional risk factors such as history of GIB and increased age...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28805961/reducing-branded-prescription-drug-prices-a-review-of-policy-options
#16
G Caleb Alexander, Jeromie Ballreich, Mariana P Socal, Taruja Karmarkar, Antonio Trujillo, Jeremy Greene, Joshua Sharfstein, Gerard Anderson
The high prices of specialty pharmaceuticals are causing some public programs to ration care and many private insurers, including Medicare drug plans, to place specialty drugs on high cost sharing tiers. As a result, access to these drugs is severely restricted, and only a small portion of the population with the disease is receiving treatment. This concern has generated a wide range of proposed solutions. We conducted a literature review and identified fifty-two solutions in the peer reviewed literature that we classified into five broad categories: revising the patent system; encouraging research to increase development of new drugs; altering pharmaceutical regulation; decreasing market demand; and developing innovative pricing strategies...
August 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28801944/the-emergence-of-second-generation-lethal-injection-protocols-a-brief-history-and-review
#17
Daniel R Malcom, Frank Romanelli
The history of capital punishment in the United States is long and controversial. In many cases, lethal injection has brought medical personnel, ethically and professionally charged with preserving life, into the arena of assisting the state in taking life. Recent US Supreme Court decisions, including Baze v. Rees and Glossip v. Gross, have evaluated and condoned lethal injection protocols. Despite the judicial validation of some midazolam-containing protocols, controversy exists as to the level of unconsciousness provided due to the ceiling effects of the drug...
August 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28801938/factors-in-variability-of-serial-gabapentin-concentrations-in-elderly-patients-with-epilepsy
#18
Jeannine M Conway, Lynn E Eberly, Joseph F Collins, Flavia M Macias, R Eugene Ramsay, Ilo E Leppik, Angela K Birnbaum
OBJECTIVES: To characterize and quantify the variability of serial gabapentin concentrations in elderly patients with epilepsy. METHODS: This study included 83 patients (age ≥60 years) from an 18-center, randomized, double-blind, double dummy, parallel study from the Veterans Affairs Cooperative 428 Study. All patients were taking 1500 mg/day of gabapentin. Within-person coefficient of variation (CV) in gabapentin concentrations, measured weekly to bimonthly for up to 52 weeks, then quarterly, was computed...
August 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28752555/relationships-between-medication-adherence-and-cardiovascular-disease-risk-factor-control-in-elderly-patients-with-diabetes
#19
Marsha A Raebel, Wendy Dyer, Gregory A Nichols, Glenn K Goodrich, Julie A Schmittdiel
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) Medicare Star program provides incentives to health plans when their patients with diabetes meet adherence targets to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and statins. While a link between adherence and cardiovascular risk factor control is established, most studies included young patients with few comorbidities. Whether the Star adherence target is associated with reduced blood pressure or low-density lipoprotein cholesterol (LDL-C) in complex older patients is not well understood...
July 28, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28741848/pharmacologic-considerations-in-the-management-of-patients-receiving-left-ventricular-percutaneous-mechanical-circulatory-support
#20
J Erin Allender, Brent N Reed, Jenna L Foster, Jeremy D Moretz, Carrie S Oliphant, Douglas L Jennings, Robert J DiDomenico, James C Coons
Percutaneous mechanical circulatory support (MCS) devices, including the intra-aortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure...
July 25, 2017: Pharmacotherapy
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