What lies behind the growth of rising hospital prices? Many factors-including the impact of hospital mergers and the industry's complicated relationship with Congress.
What lies behind the growth of rising hospital prices? Many factors-including the impact of hospital mergers and the industry's complicated relationship with Congress.
Perseris: A new, long-acting, atypical antipsychotic drug-delivery system.
Chronic obstructive pulmonary disease can be attributed to genetic conditions and predispositions, among other factors. Alpha-1 antitrypsin deficiency (AATD) is a significant risk factor for COPD development and progression, and aggressive screening for all patients with COPD or adult-onset asthma is encouraged.
Neuromuscular blockers have been inadvertently administered to patients who were not receiving proper ventilatory assistance, causing death or permanent injuries.
Thrombocytosis is defined as a platelet count greater than 400,000/mcL. We report the case of a patient who developed thrombocytosis after receiving ciprofloxacin and ceftriaxone therapy. A 73-year-old African-American female presented to the hospital with altered mental status attributed to sepsis and urinary tract infection. Patient was initiated on multiple empiric antibiotic therapy and was subsequently transitioned to ciprofloxacin and ceftriaxone at different times as definitive therapy for treatment of Escherichia coli bacteremia and Escherichia coli urinary tract infection. The patient developed thrombocytosis during and/or proximally to the administration of ciprofloxacin and ceftriaxone. A myeloproliferative source for the thrombocytosis was ruled out by the hematology/oncology team with a negative Janus kinase 2 V617F mutation assay result. In addition, other nondrug reactive sources of thrombocytosis (infection and anemia) were generally ruled out because the thrombocytosis was proximally linked with ciprofloxacin and ceftriaxone administration. The Naranjo Adverse Drug Reaction Probability Scale assigned a score of 5, indicating ciprofloxacin or ceftriaxone independently or in combination as a probable cause of thrombocytosis. This case report suggests that ciprofloxacin in combination with ceftriaxone (a beta-lactam antibiotic) may be a probable cause of thrombocytosis.
Historically, coagulopathy related to cirrhosis has been managed primarily as a bleeding disorder. However, several recent studies have shown that patients with cirrhosis have an increased risk of both bleeding and clotting. These coagulopathic changes are a result of the decreased synthetic capabilities of the cirrhotic liver. Vitamin K is often given to correct prolonged prothrombin times (PT) in patients with cirrhosis. However, this practice is not well defined and its effectiveness is questionable. The objective of our literature review is to determine the effectiveness of vitamin K to correct coagulopathy in cirrhosis. This report evaluates data published between 1981 and 2017. Published articles relevant to vitamin K use in cirrhotic patients were reviewed and summarized. The available literature regarding the use of vitamin K in cirrhosis is limited, and the research published so far does not appear to support its use. The routine uses of vitamin K to correct PT/international normalized ratio in hepatic cirrhosis should be avoided unless further studies can demonstrate true clinical benefit.
PURPOSE:Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. The economic effect of COPD management is substantial, and the prevalence of the disease continues to rise with the growth of older populations. The purpose of this study was to evaluate the clinical and financial impact of a comprehensive therapeutic interchange program (CTIP) in hospitalized patients with COPD. The primary outcome was a 30-day readmission rate, with the following secondary outcomes: 30-day mortality and pharmacy-inhaled medication cost per patient.METHODS:This study was a multi-center, retrospective, electronic chart review of patients with a diagnosis of COPD admitted to two hospitals from July 1, 2016 to June 30, 2017. Our intervention group was admitted to a 550-bed tertiary care hospital and was managed with a pharmacist-led CTIP for inhaled products used in COPD. Our control group was admitted to a 545-bed tertiary care hospital, which did not have a CTIP in place.RESULTS:2,885 hospitalized patients with a diagnosis of COPD were included in the analysis (1,350 in the intervention group and 1,535 in the control group). Univariable analysis demonstrated that the intervention group was associated with a lower 30-day readmission rate (5.8% vs. 8.3%; P = 0.012) and a lower average pharmacy-inhaled medication cost ($221 vs. $311; P = < 0.01). There was no statistical difference in 30-day mortality.CONCLUSION:This study demonstrates that the use of a pharmacist-led CTIP of COPD inhalers does not worsen patient outcomes and may provide pharmacy cost savings. The cohort managed with a CTIP was statistically associated with a lower 30-day readmission rate and lower pharmacy-inhaled medication costs without any difference in 30-day mortality.
Mavenclad (cladribine) tablets for relapsing MS forms; Duaklir Pressair (aclidinium bromide/formoterol fumarate) inhalant for COPD; Evenity (romosozumab-aqqg) injection for osteoporosis.
Alpelisib (Piqray) for HR-positive/HER2-negative, PIK3CA-mutated, advanced/ metastatic breast cancer; polatuzumab vedotin-piiq (Polivy) for diffuse large B-cell lymphoma; and eculizumab (Soliris) for neuromyelitis optica spectrum disorder.
The familiar but ambiguous sigs on prescriptions are often of limited help to patients and pharmacists. Sometimes, the instruction to "use as directed" has resulted in serious errors.
Sunosi (solriamfetol) tablets for excessive daytime sleepiness with narcolepsy or obstructive sleep apnea; Zulresso (brexanolone) injection for postpartum depression in adults; Mayzent (siponimod) tablets for adults with relapsing forms of MS.
Cablivi (caplacizumab-yhdp) for acquired thrombotic thrombocytopenic purpura; Egaten (triclabendazole) for fascioliasis; and Spravato (esketamine) for treatment-resistant depression.
PURPOSE:To provide a guide to interpreting bacterial culture results.METHODS:Studies were identified via a PubMed literature search (from 1966 to January 2018). Search terms included microbial sensitivity tests, microbial drug resistance, and anti-infective agents/pharmacology. Articles were included if they were published in English. References within identified articles were also reviewed.RESULTS:This paper reviewed core concepts of interpreting bacterial culture results, including timing of cultures, common culture sites, potential for contamination, interpreting the Gram stain, role of rapid diagnostic tests, conventional antibiotic susceptibility testing, and automated testing.CONCLUSION:This guide can assist pharmacists in their role as integral members of the antimicrobial stewardship team in an effort to improve patient care.
From ASCO, we report on metastatic castrate-resistant prostate cancer and locally advanced/metastatic renal cell carcinoma. From IHS, we report on complementary and alternative medicine use by patients and practitioners, the effects of biological hemp-derived cannabidiol on PTSD in military veterans, and more.
We report on two presentations on β-thalassemia and myelodysplastic syndromes, three presentations on chronic lymphocytic leukemia, and others on perioperative oral anticoagulation, sickle-cell anemia, diffuse large B-cell lymphoma, and multiple myeloma.
Orthostatic hypotension is defined as a decrease in systolic blood pressure of at least 20 mmHg or a decrease in diastolic blood pressure of at least 10 mmHg (or both), within three minutes of moving from a supine to an upright or standing position. Droxidopa is a synthetic amino acid analog that is directly metabolized to norepinephrine by dopa-decarboxylase, subsequently providing alpha and beta-agonist effects to increase blood pressure. It is indicated in the treatment of neurogenic orthostatic hypotension caused by primary autonomic failure that is associated with Parkinson disease, multi-system atrophy, pure autonomic failure, dopamine beta-hydroxylase deficiency, and/or non-diabetic autonomic neuropathy. In addition, it has been studied in other disease states, such as diabetic autonomic neuropathy-associated orthostatic hypotension and supine hypotension. We report on two cases of off-label droxidopa use. The first case was for diabetic autonomic neuropathy-associated orthostatic hypotension, and the second case was for hypotension due to autonomic dysfunction associated with rheumatoid arthritis. Although the outcomes differed in each case, this article contributes to the literature demonstrating that droxidopa may have varying effects in treating orthostatic hypotension of non-neurogenic etiology.
