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Therapeutic Advances in Drug Safety

Ian A Scott, Peter I Pillans, Michael Barras, Christopher Morris
Prescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment and formulary restrictions. With the increasing uptake of electronic medical records (EMRs) across hospitals, clinics and residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) and e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at the point of care...
September 2018: Therapeutic Advances in Drug Safety
Maire O'Dwyer, Philip McCallion, Mary McCarron, Martin Henman
It is known that for all adults, prevalence of potentially inappropriate prescribing (PIP) and polypharmacy increases with advancing age and morbidity. This has been associated with adverse drug reactions and poor outcomes. As a result, screening tools have been developed to identify PIP and to improve prescribing and health outcomes. A growing body of evidence supports the fact that there are even greater concerns among older adults with intellectual disability (ID) who are living longer than before but still have premature mortality and poorer health outcomes compared with the general population...
September 2018: Therapeutic Advances in Drug Safety
Alec W Petersen, Avantika S Shah, Sandra F Simmons, Matthew S Shotwell, J Mary Lou Jacobsen, Amy P Myers, Amanda S Mixon, Susan P Bell, Sunil Kripalani, John F Schnelle, Eduard E Vasilevskis
Background: Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. Methods: This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications...
September 2018: Therapeutic Advances in Drug Safety
Rikke Mie Rishoej, Anna Birna Almarsdóttir, Henrik Thybo Christesen, Jesper Hallas, Lene Juel Kjeldsen
Background: Hospitalized children are prone to experience harm from medication errors (MEs). Strategies to prevent MEs can be developed from identified malfunctioning practices and conditions in the medication use process. In this study, we aimed to identify MEs and potentially unsafe medication practices (PUMPs) in hospitalized children, and to assess the potential harm of these, using raters of different professions. Methods: A 1-week observation using an undisguised technique was conducted on four paediatric hospital wards...
September 2018: Therapeutic Advances in Drug Safety
Angela N Migowa, William M Macharia, Pauline Samia, John Tole, Alfred K Keter
Background: Medication-related errors account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths. The risk is threefold greater in the pediatric population. In sub-Saharan Africa, research on medication-related errors has been obscured by other health priorities and poor recognition of harm attributable to such errors.Our primary objective was to assess the effect of introduction of a voice recognition system (VRS) on the prevalence of medication errors. The secondary objective was to describe characteristics of observed medication errors and determine acceptability of VRS by clinical service providers...
September 2018: Therapeutic Advances in Drug Safety
Jerald V Felipe, Danielle R Fixen, Sunny A Linnebur
An 84-year-old woman presented to her primary care physician with an unexplained 4-month history of weight and appetite loss after initiation of dofetilide 125 mcg orally twice daily for atrial fibrillation. She was noted to have lost 2.5 kg, which was a 3.6% decrease from her initial body weight of 69.4 kg. After excluding other etiologies for her anorexia, such as medication changes or changes in other diseases or conditions, her primary care physician and cardiologists elected to continue dofetilide but monitor the patient's appetite and body weight...
July 2018: Therapeutic Advances in Drug Safety
Greg Scutt, Andrew Overall, Railton Scott, Bhavik Patel, Lamia Hachoumi, Mark Yeoman, Juliet Wright
Major depressive disorder (MDD) in older people is a relatively common, yet hard to treat problem. In this study, we aimed to establish if a single nucleotide polymorphism in the 5-HT1A receptor gene (rs6295) determines antidepressant response in patients aged > 80 years (the oldest old) with MDD. Nineteen patients aged at least 80 years with a new diagnosis of MDD were monitored for response to citalopram 20 mg daily over 4 weeks and genotyped for the rs6295 allele. Both a frequentist and Bayesian analysis was performed on the data...
July 2018: Therapeutic Advances in Drug Safety
Rikke Mie Rishoej, Henriette Lai Nielsen, Stina Maria Strzelec, Jane Fritsdal Refer, Sanne Allermann Beck, Hanne Marie Gramstrup, Henrik Thybo Christesen, Lene Juel Kjeldsen, Jesper Hallas, Anna Birna Almarsdóttir
Background: Medication errors (MEs) in neonates are frequent and associated with increased potential for harm compared with adults. The effect of learning from reported MEs is potentially lacking due to underreporting, lack of feedback and missing actions to improve medication safety. A new approach involving positive recognition of current and future strategies may facilitate greater exploration of how to improve medication safety in neonates. We aimed to explore current and potential future practices to prevent MEs in neonatal intensive care units (NICUs)...
July 2018: Therapeutic Advances in Drug Safety
Craig S Jabaley, Francis A Wolf, Grant C Lynde, Vikas N O'Reilly-Shah
Background: Mobile applications (apps) have become a ubiquitous source of clinical decision support. We sought to ascertain the feasibility of using an app platform to obtain a crowdsourced measure of adverse drug reaction reporting rates associated with sugammadex administration and compare it with traditionally-derived estimates. Methods: Using the widely-distributed anesthesia calculator app, 'Anesthesiologist', we surveyed anesthesia providers regarding their experience with adverse drug reactions associated with sugammadex administration...
July 2018: Therapeutic Advances in Drug Safety
Nicholas Farina, Christopher Anderson
Background: Hyperkalemia is an electrolyte abnormality that may cause ventricular dysrhythmias and cardiac arrest. The presence of hyperkalemia may necessitate prompt treatment via intravenous insulin and dextrose. One notable complication of this therapy is the development of hypoglycemia. Previous trials have examined the impact of altering the insulin dose administered on hypoglycemia development; no trials to date however, have examined the impact of altering the dextrose dose. Methods: This was a multicenter, retrospective, matched cohort study of patients who received intravenous insulin and dextrose for reversal of hyperkalemia...
June 2018: Therapeutic Advances in Drug Safety
Toke Vanwesemael, Koen Boussery, Patricia van den Bemt, Tinne Dilles
Background: Literature suggests a positive impact of self-administration of medication during hospitalization on medication adherence and safety, and on patient satisfaction. However, self-administration is not a common practice in Belgian hospitals. The aim of this study was to describe patients' willingness towards self-administration of medication while in hospital. Methods: A cross-sectional observational study was conducted in three Belgian hospitals in November and December 2015...
June 2018: Therapeutic Advances in Drug Safety
Matthew P Rochester, Allison M Kane, Sunny Anne Linnebur, Danielle R Fixen
Antidepressants are widely used medications for a range of medical conditions such as mood disorders and chronic pain in older adults. A vast body of evidence exists concerning the risks of QT interval prolongation associated with these agents and healthcare providers should critically evaluate the potential for QT prolongation when selecting antidepressant agents. Long QT syndrome is a disorder of myocardial repolarization that manifests as a prolonged QT interval on an electrocardiogram (ECG) and has been demonstrated to increase with age...
June 2018: Therapeutic Advances in Drug Safety
Thomas M Polasek, Matthew P Doogue, Tilenka R J Thynne
With the increasing prevalence of type 2 diabetes mellitus (T2DM) in women of childbearing age, prescribing antidiabetic medications in first-trimester pregnancy is becoming more common. Metformin treatment during this time is usually avoided in countries with well-resourced healthcare. This is based on historical concerns about safety to the foetus and the widespread availability of insulin. However, there is now increasing interest in the potential benefits of metformin in pregnant women with T2DM. In this commentary, the main evidence supporting metformin safety in pregnancy is summarized, with an emphasis on the first trimester...
June 2018: Therapeutic Advances in Drug Safety
Jose Ramon Gonzalez-Porras, Jose Maria Bastida
Immune thrombocytopenia (ITP) is an autoimmune disorder that induces a decrease in the number of circulating platelets due to spleen destruction and inability of megakaryocytes to restore normal counts. Immunosuppressive therapy with glucocorticoid drugs constitutes the first line of treatment. However, lack of response to these agents is not uncommon, and the management of refractory patients is a matter of controversy. In fact, day-to-day clinical practice shows that, in spite of the current guidelines, splenectomy, which is currently considered a suitable second-choice therapy, is being replaced by treatment with thrombopoietin receptor agonists...
June 2018: Therapeutic Advances in Drug Safety
Roy L Soiza, Alison I C Donaldson, Phyo Kyaw Myint
No abstract text is available yet for this article.
June 2018: Therapeutic Advances in Drug Safety
Amir Sharifi-Sistani, Ali Tafazoli
No abstract text is available yet for this article.
May 2018: Therapeutic Advances in Drug Safety
Domenico De Berardis, Gabriella Rapini, Luigi Olivieri, Domenico Di Nicola, Carmine Tomasetti, Alessandro Valchera, Michele Fornaro, Fabio Di Fabio, Giampaolo Perna, Marco Di Nicola, Gianluca Serafini, Alessandro Carano, Maurizio Pompili, Federica Vellante, Laura Orsolini, Giovanni Martinotti, Massimo Di Giannantonio
Clozapine, a dibenzodiazepine developed in 1961, is a multireceptorial atypical antipsychotic approved for the treatment of resistant schizophrenia. Since its introduction, it has remained the drug of choice in treatment-resistant schizophrenia, despite a wide range of adverse effects, as it is a very effective drug in everyday clinical practice. However, clozapine is not considered as a top-of-the-line treatment because it may often be difficult for some patients to tolerate as some adverse effects can be particularly bothersome (i...
May 2018: Therapeutic Advances in Drug Safety
Deanna Mill, Jessica Dawson, Jacinta Lee Johnson
Lactose intolerance is exceedingly common, reportedly affecting up to 70% of the world's population, leading to both abdominal and systemic symptoms. Current treatment focuses predominantly on restricting dietary consumption of lactose. Given lactose is one of the most commonly used excipients in the pharmaceutical industry, consideration must be given to the lactose content and therefore safety of pharmaceutical preparations prescribed for patients with lactose intolerance. This article summarizes the current literature examining the likelihood of inducing adverse effects through the administration of lactose-containing pharmaceutical preparations in patients reporting lactose intolerance, describes how to assess this risk on an individual patient basis and reviews suitable analgesic options for this population...
May 2018: Therapeutic Advances in Drug Safety
Amber Onoh, Sunny A Linnebur, Danielle R Fixen
An increased risk of bacterial resistance toward fluoroquinolones and the increased risk of disabling and serious adverse effects prompted the US Food and Drug Administration to recommend limiting fluoroquinolone use to the treatment of community-acquired pneumonia, skin and skin-structure infections, bacterial sinusitis, plague, chronic bronchitis exacerbations, and complicated intra-abdominal infections. We report a case of moxifloxacin-induced tinnitus in an older adult prescribed oral moxifloxacin 400 mg for 5 days for the treatment of acute diverticulitis, due to allergies to nonfluoroquinolone preferred agents...
April 2018: Therapeutic Advances in Drug Safety
Mitchell S Buckley, Jeffrey R Rasmussen, Dale S Bikin, Emily C Richards, Andrew J Berry, Mark A Culver, Ryan M Rivosecchi, Sandra L Kane-Gill
Background: Medication safety strategies involving trigger alerts have demonstrated potential in identifying drug-related hazardous conditions (DRHCs) and preventing adverse drug events in hospitalized patients. However, trigger alert effectiveness between intensive care unit (ICU) and general ward patients remains unknown. The objective was to investigate trigger alert performance in accurately identifying DRHCs associated with laboratory abnormalities in ICU and non-ICU settings. Methods: This retrospective, observational study was conducted at a university hospital over a 1-year period involving 20 unique trigger alerts aimed at identifying possible drug-induced laboratory abnormalities...
April 2018: Therapeutic Advances in Drug Safety
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