Aldosterone Antagonist Utilization In A Nationally Representative Heart Failure With Reduced Ejection Fraction Outpatient Population: Prevalence And Predictors
Pharmacology & Pharmacy
Joyner K; Soric M; Boyle J; Moorman J; Fredrickson M E; Turosky J
Pharmacotherapy
2017
2017-12
Journal Article or Conference Abstract Publication
n/a
Genetic Ablation Of Mitoneet Alleviates Alcoholic Steatosis/steahepatitis In Mice
Gastroenterology & Hepatology
Jogasuria A; Geldenhuys W J; Wang J Y; Hu X D; Lee K; Sadana P; Wu J S; You M
Hepatology
2015
2015-10
Journal Article or Conference Abstract Publication
n/a
Neuromuscular Blocking Agents Use And Controversy In The Hospital Setting
Anesthesia; blockade; cardiac-arrest; intubation; management; meperidine; metaanalysis; paralysis; Pharmacology & Pharmacy; respiratory-distress syndrome; vecuronium
Neuromuscular blocking agents (NMBAs) play an important role in the management of a large number of hospital patients. The pharmacology of NMBAs is well understood, but the use of these agents can be controversial. NMBAs are common in surgical situations and rapid sequence intubation, but other indications, such as acute respiratory distress syndrome, therapeutic hypothermia, and elevated intracranial pressure, are somewhat divisive. It is essential for pharmacists to be familiar with clinical implications and outcomes associated with the use of NMBAs. In addition, it is important to understand concurrent considerations such as sedation, monitoring, and reversal. Pharmacists in the hospital setting should be familiar with the recently approved novel direct-reversal agent sugammadex (Bridion).
Gustafson K A; Brown A S
Us Pharmacist
2017
2017-01
Journal Article or Conference Abstract Publication
n/a
Survey Of Psychiatric Pharmacy Education At U.S. Schools Of Pharmacy
education; Education & Educational Research; health professional shortage; Pharmacy; Psychiatry; Survey
Martello J L; Kreys T J; Paxos C; Thornton A
Currents in Pharmacy Teaching and Learning
2016
2016-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.cptl.2016.08.020" target="_blank" rel="noreferrer noopener">10.1016/j.cptl.2016.08.020</a>
Misdiagnosis And Mistreatment Of Chronic Obstructive Pulmonary Disease In An Underserved Patient Population
General & Internal Medicine; Respiratory System
Ghattas C; Dai A; Awad M H
American Journal of Respiratory and Critical Care Medicine
2013
2013
Journal Article or Conference Abstract Publication
n/a
Serial Monitoring Of Brain Natriuretic Peptide Concentrations For Drug Therapy Management In Patients With Chronic Heart Failure
B-type natriuretic peptide; BNP; brain natriuretic peptide; cardiac-disease; converting enzyme-inhibitor; emergency diagnosis; functional-capacity; heart failure treatment; hospital discharge; left-ventricular dysfunction; N-terminal; NT-proBNP; NT-proBNP; obese-patients; Pharmacology & Pharmacy; practice guidelines; pro-BNP; trial; val-heft
Gallegos P J; MacLaughlin E J; Haase K K
Pharmacotherapy
2008
2008-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1592/phco.28.3.343" target="_blank" rel="noreferrer noopener">10.1592/phco.28.3.343</a>
Student College Of Clinical Pharmacy Provides Education About Medications And Fall Risk For Akron Area Agency On Aging Care Managers
Pharmacology & Pharmacy
Fredrickson M E; Smith A; Gallegos P; Soric M; Fosnight S
Pharmacotherapy
2012
2012-10
Journal Article or Conference Abstract Publication
n/a
Student College Of Clinical Pharmacy (sccp) Provides Education Regarding Counseling Of Patients With Copd For Akron Area Agency On Aging Care Managers
Pharmacology & Pharmacy
Fredrickson M E; Gallegos P J; Soric M; Fosnight S; Legros E; Smithbauer A
Pharmacotherapy
2013
2013-10
Journal Article or Conference Abstract Publication
n/a
The Role Of Pharmacists In Delirium Prevention And Treatment In The Acute Care Setting
delirium; Geriatrics & Gerontology; interdisciplinary care; pharmacist
Fosnight S; Moss K; Sabo A; Holder C; Hazelett S; Benedict L; Germano S; Allen K
Journal of the American Geriatrics Society
2010
2010-04
Journal Article or Conference Abstract Publication
n/a
Impact Of Pharmacy Contribution To Interprofessional Transitions Intervention On Patient Outcomes
Pharmacology & Pharmacy
Fosnight S; King P; Dittmer A; Grzybowski G; Shah M; Worthington J
Pharmacotherapy
2017
2017-12
Journal Article or Conference Abstract Publication
n/a
Interprofessional Geriatric Stewardship Program: Medication Focused Outcomes
Geriatrics & Gerontology
Fosnight S; Drost J; Kayani N; Oravec M; Cunningham J; Hovsepyan H; Paintsil A
Journal of the American Geriatrics Society
2017
2017-05
Journal Article or Conference Abstract Publication
n/a
Stability Of Extemporaneously Prepared Acetylcysteine 1% And 10% Solutions For Treatment Of Meconium Ileus
Acetylcysteine; Chromatography; Color; Compounding; Concentration; cystic fibrosis; Diluents; edta; equivalent; Hydrogen ion concentration; Hydrogen sulfide; Ileus; Infant; liquid; management; Mucolytic agents; n-acetylcysteine; nonoperative treatment; obstruction; Odors; Pharmacology & Pharmacy; Sodium chloride; Stability; Storage
Fohl A L; Johnson C E; Cober M P
American Journal of Health-System Pharmacy
2011
2011-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.2146/ajhp100214" target="_blank" rel="noreferrer noopener">10.2146/ajhp100214</a>
Interprofessional Education Campaign On Improving Medication Adherence
Pharmacology & Pharmacy
Elavasky M; Dai A; Fredrickson M E; Poole M; Sherritt M; Fosnight S
Pharmacotherapy
2013
2013-10
Journal Article or Conference Abstract Publication
n/a
Assessment And Revision Of Clinical Pharmacy Practice Internet Web Sites
cancer; clinical pharmacy; information; Internet; osteoporosis; pharmacist; Pharmacology & Pharmacy; quality; Web site; websites
Edwards K L; Salvo M C; Ward K E; Attridge R T; Kiser K; Pinner N A; Gallegos P J; Kesteloot L L; Hylton A; Bookstaver P B
Annals of Pharmacotherapy
2014
2014-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/1060028013510899" target="_blank" rel="noreferrer noopener">10.1177/1060028013510899</a>
Stability of extemporaneously prepared glycopyrrolate oral suspensions
Color; Chromatography; Suspensions; Taste; Pharmacology & Pharmacy; liquid; Stability; Compounding; Concentration; Contamination; Glycopyrrolate; Hydrogen ion concentration; Parasympatholytic agents; sialorrhea; Storage; Vehicles
Purpose. The stability of extemporaneously prepared glycopyrrolate 0.5-mg/mL suspensions was evaluated. Methods. An oral suspension of glycopyrrolate 0.5 mg/mL was prepared by thoroughly grinding 30 1-mg tablets of glycopyrrolate in a glass mortar. Thirty milliliters of Ora-Plus and 30 mL of either Ora-Sweet or Ora-Sweet SF were mixed and added to the powder to make a final volume of 60 mL. Three identical samples of the formulation were prepared and placed in 2-oz amber plastic bottles with child-resistant caps and stored at room temperature (23-25 degrees C). A 1-mL sample was withdrawn from each of the three bottles with a micropipette immediately after preparation and 7, 15, 30, 60, and 90 days afterward. After further dilution to an expected concentration of 50 mu g/mL with sample diluent, the samples were assayed in duplicate by stability-indicating high-performance liquid chromatography. The samples were visually examined for any color change and evaluated for pH on each day of analysis. Taste evaluations were performed at the beginning and end of the study. Stability was defined as the retention of at least 90% of the initial concentration. Results. At least 95% of the initial glycopyrrolate remained throughout the 90-day study period in both preparations. There were no detectable changes in color, odor, taste, and pH, and no visible microbial growth was observed in any sample. Conclusion. Extemporaneously compounded suspensions of glycopyrrolate 0.5 mg/mL in a 1:1 mixture of Ora-Plus/Ora-Sweet or Ora-Plus/Ora-Sweet SF were stable for at least 90 days when stored in amber plastic bottles at room temperature.
Cober M P; Johnson C E; Sudekum D; Penprase K
American Journal of Health-System Pharmacy
2011
2011-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.2146/100247" target="_blank" rel="noreferrer noopener">10.2146/100247</a>
Promoting clinical pharmacy: the past, present, and future of the student College of Clinical Pharmacy Organization at Northeast Ohio Medical University
Pharmacology & Pharmacy
Carneal D; Legros E; Gallegos P J
Pharmacotherapy
2014
2014-10
Journal Article or Conference Abstract Publication
n/a
Evaluation of preoperative antimicrobial prophylaxis in select neonatal intensive care unit surgeries
Pharmacology & Pharmacy
Byrne A; Cober M P
Pharmacotherapy
2014
2014-10
Journal Article or Conference Abstract Publication
n/a
Denosumab in Osteoporosis and Oncology
Prostate cancer; breast-cancer; osteoporosis; Pharmacology & Pharmacy; postmenopausal women; breast-cancer; bone-mineral density; tumor; metastases; ligand; biochemical markers; bisphosphonate therapy; bone metastases; denosumab; monoclonal antibody; multiple; myeloma; necrosis factor; phase-ii; RANKL; solid tumor; turnover; zoledronic acid
OBJECTIVE: To review the pharmacology, pharmacokinetics, pharmacodynamics, safety, efficacy, and use of denosumab in osteoporosis, breast cancer, prostate cancer, and multiple myeloma. DATA SOURCES: Studies and abstracts were identified through MEDLINE and International Pharmaceutical Abstracts (1966-July 2009). Key search terms include denosumab, AMG-162, and receptor activator of nuclear factor-kappa B ligand system. Information available in abstract form was retrieved from major oncology and bone metabolism meetings. Additional data were obtained from the manufacturer. STUDY SELECTION AND DATA EXTRACTION: All available studies in humans were included except for studies in rheumatoid arthritis and giant cell tumor of the bone. DATA SYNTHESIS: In patients with osteoporosis, denosumab significantly reduces bone resorption and fractures. Studies of denosumab in the prevention and treatment of osteoporosis have demonstrated significantly increased bone mineral density and reduced bone turnover markers. Studies of denosumab versus placebo in the treatment of osteoporosis have demonstrated reductions in vertebral, hip, and nonvertebral fractures. In oncology, positive results from clinical trials in patients receiving endocrine therapy for breast and prostate cancer demonstrated decreases in bone loss and skeletal-related events. Denosumab seems to be at least as effective in reducing bone turnover markers as intravenous bisphosphonates in the oncology setting. The most common adverse effects in patients with osteoporosis were arthralgia, nasopharyngitis, back pain, and headache. The most common adverse effects in patients with cancer were infection, pain in the extremities, arthralgia, bone pain, fatigue, and pain. Serious adverse effects include infections requiring hospitalization. CONCLUSIONS: Denosumab has documented efficacy and safety in patients with osteoporosis, breast cancer, and prostate cancer. Additional clinical trial data are needed to more completely establish the effectiveness of denosumab in the treatment of osteoporosis and neoplastic disease as well as its cost-effectiveness and long-term safety.
Burkiewicz J S; Scarpace S L; Bruce S P
Annals of Pharmacotherapy
2009
2009-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1345/aph.1M102" target="_blank" rel="noreferrer noopener">10.1345/aph.1M102</a>
A Multi-center, Open-label Study to Evaluate the Safety and Efficacy of a Sequential Treatment Regimen of Clobetasol Propionate 0.05% Spray Followed by Calcitriol 3 mg/g Ointment in the Management of Plaque Psoriasis
Dermatology; quality-of-life
Background: Psoriasis is a hyperproliferative and inflammatory skin disorder that affects roughly 2 percent of the worldwide population. Clobetasol propionate is the most common corticosteroid used to treat moderate-to-severe psoriasis but the potential for side effects limits its long-term use. Topical vitamin D, which is used to treat mild-to-moderate psoriasis, has been shown to be safe when used daily for up to 52 weeks. To date, very few studies exist evaluating the use of clobetasol propionate in a regimen with calcitriol to manage moderate-to-severe disease over time. Objectives: To evaluate the efficacy and assess safety of a regimen of sequential topical treatments with clobetasol propionate 0.05% spray for up to four weeks followed by calcitriol 3 mu g/g ointment for eight weeks in the management of moderate-to-severe plaque psoriasis. Methods: This was a multi-center, open-label study in subjects aged 18-80 years with moderate-to-severe plaque psoriasis at baseline. Subjects applied clobetasol propionate 0.05% spray twice daily for up to four weeks. At the end of four weeks, if the subject's overall disease severity (ODS) was assessed as clear, almost clear, mild or moderate, subjects started treatment with calcitriol 3 mu g/g ointment twice daily. Twice-daily treatment with calcitriol 3 mu g/g ointment continued for eight weeks (until week 12) or unless the subject's ODS was assessed as severe or returned to the baseline score, at which time it was discontinued. Subjects were evaluated at baseline and at weeks 2, 4, 8 and 12. Results: Of the 305 subjects enrolled, 170 subjects completed the full 12-week study with no major protocol deviations and comprised the per-protocol (PP) study population. Treatment success, defined as at least one grade improvement in ODS at week 12 compared to baseline, was achieved in 84.1 percent of subjects. The percent body surface area affected (% BSA) decreased from 7.1 percent at baseline to 3.9 percent at week 12 (P<0.001). The sequential treatment regimen was well tolerated with no unexpected adverse events. Most reported adverse events and cutaneous irritations were mild in severity. Conclusions: The results of this study indicate that the 12-week regimen of clobetasol propionate 0.05% spray treatment for four weeks immediately followed by an eight-week treatment phase with calcitriol 3 mu g/g ointment is efficacious and safe for the management of moderate-to-severe plaque psoriasis.
Brodell R T; Bruce S; Hudson C P; Weiss J S; Colon L E; Johnson L A; Gottschalk R W
Journal of Drugs in Dermatology
2011
2011-02
Journal Article or Conference Abstract Publication
n/a
Safety and efficacy of two regimens involving clobetasol spray, 0.05% and calcitriol ointment, 3 mu g/g for moderate plaque psoriasis
Dermatology
Brodell R; Goffe B S; Weiss J S; Bruce S
Journal of the American Academy of Dermatology
2011
2011-02
Journal Article or Conference Abstract Publication
n/a
ETHANOL LOCKS THERAPY FOR RESOLUTION OF FUNGAL CATHETER INFECTIONS
Pediatrics; Infectious Diseases; Immunology; blood-stream infections; fungal infections; catheter infections; ethanol locks
Ethanol locks have been used to treat catheter infections and to decrease the rate at which they occur. Catheter-related infections caused by Candida spp. are especially difficult to manage medically and usually require catheter removal. We report 3 consecutive patients whose catheter infections caused by Candida were successfully treated with a combination of ethanol lock therapy and systemic antifungals.
Blackwood R A; Klein K C; Micel L N; Willers M L; Mody R J; Teitelbaum D H; Cober M P
Pediatric Infectious Disease Journal
2011
2011-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/INF.0b013e31822c84a4" target="_blank" rel="noreferrer noopener">10.1097/INF.0b013e31822c84a4</a>
The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic
medical education; clinical; medications; pharmacy; interventions; Pharmacology & Pharmacy; impact; academic detailing; ambulatory care; community practice; prescribing patterns; prior authorization
Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of beta-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's chi(2) and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and beta-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.
Awad M H; Ulbrich T R; Furdich K M; Schneider S R; Gothard M D
Journal of Pharmacy Technology
2019
2019-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/8755122518818826" target="_blank" rel="noreferrer noopener">10.1177/8755122518818826</a>
The PEACE Pilot Study: Convergence of Geriatrics and Palliative Care
Geriatrics & Gerontology
Allen K R; Radwany S M; Kropp D J; Ertle D; Fosnight S; Moore P; Hazelett S E
Journal of the American Geriatrics Society
2012
2012-04
Journal Article or Conference Abstract Publication
n/a
Awareness of an American College of Clinical Pharmacy state affiliate chapter
Pharmacology & Pharmacy
Vest T A; Delabar C M; Furnish C J; Kim K Y; Gallegos P J; Komorny K M; Pallotta A M
Pharmacotherapy
2014
2014-10
Journal Article
n/a
Thyroid hormone (T3) regulates lipoprotein metabolism via induction of Angiopoeitin-like 4 (ANGPTL4) in human hepatoma cell line
Biochemistry & Molecular Biology; Cell Biology; Life Sciences & Biomedicine - Other; Topics
Talasila P K; Sadana P
Faseb Journal
2012
2012-04
Journal Article
n/a
Predictors of metformin prescribing in adult type II diabetes mellitus patients: a national cross sectional study
Pharmacology & Pharmacy
Soric M M; Boyle J; Moorman J
Pharmacotherapy
2015
2015-11
Journal Article
n/a
The effects of melatonin and trazodone on delirium in hospitalized patients
Pharmacology & Pharmacy
Shumate L; Fosnight S; DiNuoscio D; Wilford R
Pharmacotherapy
2013
2013-10
Journal Article
n/a
Clarifying Confusion: Educational Intervention to Improve Delirium Recognition
Geriatrics & Gerontology
Scott E; Baum E; Benedict L; Sabo A; Apolonia F; Hazelett S; Fosnight S
Journal of the American Geriatrics Society
2010
2010-04
Journal Article
n/a
Identification and characterization of a novel small molecule agonist of lipoprotein lipase by random screening
Biochemistry & Molecular Biology; Cell Biology; Life Sciences & Biomedicine - Other; Topics
Sadana P; Aring D; Burke J; Geldenhuys W
Faseb Journal
2014
2014-04
Journal Article
n/a
Alcohol Induces Angiopoeitin like-3 (ANGPTL3) in the Liver: Implications for Alcohol Induced Hypertriglyceridemia
Biochemistry & Molecular Biology; Cell Biology; Life Sciences & Biomedicine - Other; Topics
Sadana P; Burke J; Jogasuria A; Darvesh A; Geldenhuys W; Wu J S; You M
Faseb Journal
2015
2015-04
Journal Article
n/a
Student College of Clinical Pharmacy (SCCP) members provide student driven diabetes education to behavioral health care case managers
Pharmacology & Pharmacy
Reale M C; Burchett S; Mansour T; Shifrin D A; Soric M M; Gallegos P J; Dugan S
Pharmacotherapy
2012
2012-10
Journal Article
n/a
Wikis and Open-Access Education?
Education & Educational Research; Pharmacology & Pharmacy
Peeters M J; Gallegos P J
American Journal of Pharmaceutical Education
2010
2010
Journal Article
n/a
Effect of daily vitamin D supplementation on HbA1c in patients with uncontrolled type 2 diabetes mellitus: A pilot study
adults; cholecalciferol; Endocrinology & Metabolism; HbA1c; human; type-2 diabetes-mellitus
Soric M M; Renner E T; Smith S R
Journal of Diabetes
2012
2012-03
Journal Article
<a href="http://doi.org/10.1111/j.1753-0407.2011.00164.x" target="_blank" rel="noreferrer noopener">10.1111/j.1753-0407.2011.00164.x</a>
Economic and patient satisfaction outcomes of a layered learning model in a small community hospital
Pharmacology & Pharmacy
Purpose. Results of a study of economic and patient satisfaction outcomes of implementing a "layered learning model" (LLM) in a community hospital are presented. Methods. An LLM consisting of a clinical pharmacist, two postgraduate year 1 pharmacy residents, and pharmacy students participating in rounds and providing patient education was implemented at a small community hospital. The primary endpoint was the difference in mean total drug cost per discharge in cases managed by physicians who rounded with pharmacy representatives (the intervention group) and cases managed by physicians who rounded with no pharmacist present (the control group). Secondary outcomes were drug expenditures associated with eight common diagnoses and patient satisfaction scores in medication education domains of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Statistical analysis was performed using Student's t test and chi-square tests. Results. The intervention-group data comprised 2737 hospital discharges, as compared with 3983 discharges for the control group. The geometric mean total drug cost per discharge was $161.52 for the intervention group, as compared with $210.15 for the control,group (difference, $48.63; p < 0.001); drug costs for pneumonia and urinary tract infection were significantly lower for the intervention group. Patient satisfaction scores were significantly improved in the intervention group relative to baseline scores (8th percentile versus 39th percentile, p < 0.0010. Conclusion. Implementation of the LLM in a small community hospital reduced medication costs and improved HCAHPS patient satisfaction scores.
Soric M M; Glowczewski J E; Lerman R M
American Journal of Health-System Pharmacy
2016
2016-04
Journal Article
<a href="http://doi.org/10.2146/ajhp150359" target="_blank" rel="noreferrer noopener">10.2146/ajhp150359</a>
Similarities and Differences between Two Modes of Antagonism of the Thyroid Hormone Receptor
androgen receptor; Biochemistry & Molecular Biology; coactivator binding; estrogen receptor; gene-expression; growth-hormone; hepatoma-cell line; hepg2; liver; nuclear receptor; small-molecule inhibitors
Thyroid hormone (T3) mediates diverse physiological functions including growth, differentiation, and energy homeostasis through the thyroid hormone receptors (TR). The TR binds DNA at specific recognition sequences in the promoter regions of their target genes known as the thyroid, hormone response elements (TREs). Gene expression at TREs regulated by TRs is mediated by coregulator recruitment to the DNA bound receptor. This TR-coregulator interaction controls transcription of target genes by multiple mechanisms including covalent histone modifications and chromatin remodeling. Our previous studies identified a beta-aminoketone as a potent inhibitor of the TR-coactivator interaction. We describe here the activity of one of these inhibitors in modulating effects of T3 signaling in comparison to an established ligand-competitive inhibitor of TR, NH-3. The beta-aminoketone was found to reverse thyroid hormone induced gene expression by inhibiting coactivator recruitment at target gene promoters, thereby regulating downstream effects of thyroid hormone. While mimicking the downstream effects of NH-3 at the molecular level, the beta-aminoketone affects only a subset of the thyroid responsive signaling network. Thus antagonists directed to the coregulator binding site have distinct pharmacological properties relative to ligand-based antagonists and may provide complementary activity in vivo.
Sadana P; Hwang J Y; Attia R R; Arnold L A; Neale G; Guy R K
Acs Chemical Biology
2011
2011-10
Journal Article
<a href="http://doi.org/10.1021/cb200092v" target="_blank" rel="noreferrer noopener">10.1021/cb200092v</a>
Effect of Intravenous Versus Subcutaneous Phytonadione on Length of Stay for Patients in Need of Urgent Warfarin Reversal
coagulopathy; controlled trial; excessive anticoagulation; Length of Stay; Pharmacology & Pharmacy; phytonadione; vitamin-k; warfarin
This institutional review board-approved retrospective cohort study evaluated the impact of intravenous versus subcutaneous phytonadione on length of stay in hospitalized patients requiring urgent warfarin reversal. All patients were 18 years or older, on warfarin therapy with an international normalized ratio (INR) between 3.1 and 10.0, and had warfarin therapy restarted at discharge. Patients who received intramuscular or oral phytonadione, phytonadione by more than 1 route, fresh frozen plasma, or any other blood products containing clotting factors, patients with active or severe liver disease, and patients who received other forms of anticoagulation were excluded. A total of 4425 patients receiving phytonadione were evaluated and 79 patients were included. Baseline characteristics were similar between the intravenous and subcutaneous groups, including mean age, gender, warfarin indication, Charlson comorbidity index, and indication for phytonadione. Geometric mean length of stay in the intravenous group was 211.7 hours compared with 191.0 hours in the subcutaneous group (P = 0.47). Though intravenous phytonadione administration resulted in significantly lower INRs at all time points <36 hours, geometric mean time to restart of warfarin therapy was not impacted (66.3 hours vs. 64.1 hours, P = 0.72). Despite demonstrating significantly greater INR reductions, hospital length of stay and time to restart of warfarin therapy were not improved with the administration of intravenous over subcutaneous phytonadione.
Mottice B L; Soric M M; Legros E
American Journal of Therapeutics
2016
2016-03
Journal Article
<a href="http://doi.org/10.1097/mjt.0000000000000170" target="_blank" rel="noreferrer noopener">10.1097/mjt.0000000000000170</a>
Enteral and parenteral nutrition considerations in pediatric patients
compounding; enteral; neonatal; nutrition; parenteral; pediatric; stability
October 2019 Update
PURPOSE: Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. SUMMARY: The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. CONCLUSION: The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.
Cober Mary Petrea; Gura Kathleen M
American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists
2019
2019-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ajhp/zxz174" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxz174</a>
A need for a holistic residency application review process.
Soric Mate M; Robinson Jennifer D; Ulbrich Timothy R
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-06
<a href="http://doi.org/10.1002/jac5.1119" target="_blank" rel="noreferrer noopener">10.1002/jac5.1119</a>
AMPK‐SIRT1‐independent inhibition of ANGPTL3 gene expression is a potential lipid‐lowering mechanism of metformin.
angiopoietin‐like 3; diabetes; dyslipidaemia; lipoprotein lipase; metformin
Objectives: Hypertriglyceridaemia enhances cardiovascular disease risk in patients with diabetes. Lipoprotein lipase (LPL) regulates plasma triglyceride levels by hydrolysing chylomicrons and very‐low‐density lipoprotein (VLDL). Metformin, an antidiabetic drug, improves plasma lipids including triglycerides. We examined metformin's regulation of angiopoietin‐like 3 (ANGPTL3), a liver‐derived secretory protein with LPL inhibitory property. Methods: Using HepG2 cells, a human hepatocyte cell line, the effects of metformin on ANGPTL3 gene and protein expression were determined. The role of AMPK‐SIRT1 pathway in metformin regulation of ANGPTL3 was determined using pharmacological, RNAi and reporter assays. Metformin regulation of ANGPTL3 expression was also examined in sodium palmitate‐induced insulin resistance. Key findings: Metformin and pharmacological activators of AMPK and SIRT1 inhibited the expression of ANGPTL3 in HepG2 cells. Pharmacological or RNAi‐based antagonism of AMPK or SIRT1 failed to affect metformin inhibition of ANGPTL3. AMPK‐SIRT1 activators and metformin exhibited distinct effects on the expression of ANGPTL3 gene luciferase reporter. Sodium palmitate‐induced insulin resistance in cells resulted in increased ANGPTL3 gene expression which was suppressed by pretreatment with metformin. Conclusions: Metformin inhibits ANGPTL3 expression in the liver in an AMPK‐SIRT1‐independent manner as a potential mechanism to regulate LPL and lower plasma lipids. [ABSTRACT FROM AUTHOR]
Lin Li; Burke Jamie; Venkatesh Sahana; Sadana Prabodh
Journal of Pharmacy & Pharmacology
2019
2019-09
<a href="http://doi.org/10.1111/jphp.13138" target="_blank" rel="noreferrer noopener">10.1111/jphp.13138</a>
National Trends in Statin Medication Prescribing in Patients With a History of Stroke or Transient Ischemic Attack
statin; stroke; transient ischemic attack
BACKGROUND: Guidelines support statin therapy post-stroke or transient ischemic attack (TIA); however, previously reported utilization rates are suboptimal. OBJECTIVE: This study investigates the incidence of statin usage in patients with a documented stroke or TIA while identifying predictors of statin use. METHODS: A retrospective, cross-sectional study utilizing data from the National Ambulatory Medical Care Survey. RESULTS: A total of 2963 unweighted visits were included in the analysis, representing a total of 52 645 000 office visits when weighted. Statin therapy was initiated or continued in 35.7% (95% confidence interval [CI]: 32.4-39.0%) of office visits. Upon multivariate analysis, positive predictors of statin therapy included a diagnosis of hyperlipidemia (odds ratio [OR]: 3.60; 95% CI: 2.40-5.41), angiotensin-converting enzyme inhibitor (ACE-I) therapy (OR: 2.52; 95% CI: 1.69-3.76), aspirin therapy (OR: 2.02; 95% CI: 1.40-2.93), and clopidogrel therapy (OR: 2.60; 95% CI: 1.69-4.02). Negative predictors of statin therapy included office visits with neurologists when compared to visits with primary care practitioners (OR: 0.55; 95% CI: 0.33-0.90) and office visits in rural areas when compared to office visits in urban areas (OR: 0.64; 95% CI: 0.41-0.99). CONCLUSION: Various factors impact statin therapy use with overall utilization being suboptimal, highlighting an opportunity for medication optimization.
Snyder Brittany M; Soric Mate M
Journal of Pharmacy Practice
2019
2019-07
<a href="http://doi.org/10.1177/0897190019865147" target="_blank" rel="noreferrer noopener">10.1177/0897190019865147</a>