Hospital Pharmacy最新文献

Purpose: Optimal dosing of VTE prophylaxis for specific patient populations remains an area of concern as insufficient evidence exists regarding dosing for underweight patients. The purpose of this study is to compare the incidence of major bleeding events in underweight patients given different prophylactic doses of enoxaparin. Methods: This is a retrospective analysis performed at multiple hospitals within a single health care system. Patients with a BMI < 18.5 kg/m² were divided into 2 groups depending on whether they received at least 1 prophylactic dose of enoxaparin 30 mg subcutaneously once daily or enoxaparin 40 mg subcutaneously once daily. Underweight adult patients were included if they were admitted to an ICU for at least 48 hours and received at least 1 dose of enoxaparin for VTE prophylaxis during their ICU admission. The primary aim was to compare the incidence of clinically significant bleeding between dosing strategies. Secondary aims included the incidence of VTE during admission, ICU length of stay, overall hospital length of stay, and all-cause mortality 30 days post-discharge. Results: A total of 310 patients met inclusion criteria for this study, with 80 patients in the 30 mg group and 230 patients in the 40 mg group. There was no significant difference in major bleeding events between the 2 groups (P = .61). No significant differences in incidence of VTE (P = .455 ), ICU length of stay (P = .466), overall hospital stay (P = .502), or all-cause mortality (P = .925) were found between groups. Conclusions: No difference was found in clinically significant bleeding between underweight critically ill patients receiving VTE prophylaxis with enoxaparin 30 mg once daily or 40 mg once daily. Further studies are needed to evaluate the optimal dosing of VTE prophylaxis with enoxaparin in underweight patients.

We describe a case of a 67-year-old man with bioprosthetic aortic valve endocarditis secondary to Rhizobium radiobacter, a rare Gram-negative plant pathogen. The initial source was assumed to be due to soil exposure. The patient was successfully managed with ceftriaxone following aortic valve replacement. Upon review of the literature, failure to recover R. radiobacter from blood cultures occurred in 57% (4/7) of reported endocarditis cases and 86% (6/7) were managed with antimicrobial monotherapy. Notably, all the published case reports to date of R. radiobacter endocarditis have reported survival following treatment.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy and Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.

Background: Opioids are often part of the post-operative pain regimen after orthopaedic surgery. Novel multimodal post-operative pain control regimens have been developed to decrease the amount of opioid usage due to their negative side effects including nausea, constipation, and addiction. The purpose of this study was to compare the cost of postoperative pain management treatment methods after orthopaedic surgery between opioid/acetaminophen therapy and an opioid-free, multidrug, multimodal pathway. Methods: This is a secondary analysis of data collected from 2 IRB approved prospective studies that evaluated pain control after elective orthopaedic surgery from a single institution. The first study analyzed the use of opioid medication after hallux valgus surgery and calculated the total cost of opioid pain medication consumed. The second study assessed the pain of patients after elective foot and ankle surgery utilizing a novel opioid-free multimodal pain pathway that included 5 medications. The postoperative prescription costs of these 2 pain management groups were totaled, analyzed, and compared. A paired t-test was used to compare the means of these 2 groups and to evaluate whether significant differences might exist between them. Results: We noted that the opioid group had an average cost of $8.92 (SD $5.74), while the opioid-free multimodal group had an average total cost of $25.60 (SD $10.49), P < .001. The average difference in cost between the 2 regimens was $16.68. Conclusion: There was a statistically significant difference between the costs of an opioid-free multimodal post-operative pain regimen when compared to an opioid/acetaminophen therapy, irrespective of public vs private insurance. This 17-dollar cost difference may or may not be clinically significant depending on the financial situation of the patient, but it may be important for the clinician to consider to provide appropriate individualized patient care after orthopaedic surgery. Level of Evidence: II.

Amid the early 2020 SARS-CoV-2 crisis, severe hand sanitizer shortages led to OMS local production recommendations, inviting a diverse array of alcohol producers to contribute. However, not all followed mandatory controls for API-grade alcohol. We conducted a study to ensure the safety of the received alcohols, focusing on methanol and acetaldehyde levels. All samples were well below Ph. Eur guidelines, affirming their safety for use. Furthermore, no additional impurities were detected, reinforcing the quality and safety of the assessed hand sanitizers. Our findings, amidst the scarcity of the SARS-CoV-2 era, highlight the importance of rigorous safety assessments during local hand sanitizer production.

Background: Enteral vasopressor therapies have been used to facilitate the weaning of intravenous (IV) vasopressors in critically ill patients. Studies have shown mixed results in the medically critically ill population; however, this practice is still common. The use of enteral vasopressors in the acute traumatic spinal cord injury is less well-described. Methods: This was a retrospective review of adult patients at a Level 1 trauma center. Adult patients were included if they were admitted to the trauma and surgical ICU for acute traumatic spinal cord injury; required hemodynamic support for more than 24 hours; and received concomitant administration of IV vasopressor(s) and midodrine. The primary endpoint was overall success in weaning of IV vasopressors and successful weaning at <24 and <48 hours after midodrine initiation. Secondary endpoints were bradycardic events and IV vasopressor-free days in patients with a defined mean arterial pressure (MAP) augmentation duration. Results: Out of 48 patients evaluated, 79.2% successfully weaned off IV vasopressors after the addition of midodrine, with 22.9% and 43.8% discontinuing IV vasopressors at <24 and <48 hours, respectively. Bradycardia occurred in 50% of patients, but only 8.3% required treatment. Among patients with a defined MAP goal duration, midodrine was associated with a median of 3 IV vasopressor-free days (interquartile range: 1-5). Conclusion: Enteral vasopressor therapy with midodrine can be used to facilitate weaning of IV vasopressor therapy in critically ill, acute traumatic spinal cord injury patients. Midodrine may also be beneficial in reducing IV vasopressor days in patients with MAP augmentation. Future prospective studies are needed to confirm this finding.

Background: Most antibiotics administered via intermittent IV infusion are diluted in 50 to 100 ml of diluent. The primary infusion set for the BD Alaris^® pumps can hold 25 ml of volume in its tubing, potentially contributing up to a 50% drug loss if residual volume is present after administration is complete. In the case of antibiotics, this may lead to significant underdosing, potentially contributing to reduced therapeutic response and emergence of antimicrobial resistance. Many organizations lack departmental policies and procedures for the administration of small-volume intermittent infusions. Developing a clear policy and procedure can increase drug delivery efficiency. Previous studies propose several recommendations, such as using a secondary infusion set, adding carrier fluids, and flushing the line to account for overfill. Objective: Our aim was to implement pilot new guidance in 2 patient units (an ICU and a non-ICU) to address the administration of small-volume intermittent infusions and determine if this results in more complete medication administration. Methods: This was an observational quality improvement initiative assessing the new guidance established for the administration of small-volume intermittent infusions to current practices. The primary outcome of this study was the incidence of residual drug volume in the IV line before the air-detector, IV bag, or IV vial. This was done through observation, and data collected through a survey. Results: In total, 203 IV administrations were observed, 86% of which were antibiotics. There were 124 IV administrations being observed before policy guidance initiation and 79 after initiation. The results showed a statistically significant reduction in the incidence of fluid remaining in the IV line before the air-detector (85% vs 27%; P < .001), the IV bag (59% vs 7.6%; P < .001), and in the IV vial (47% vs 24%; P < .001.). Conclusion: The proposed interventions significantly decreased the incidence of fluid remaining in the IV line before the air detector in the BD Alaris Pump, IV bag, and IV vial, presumably decreasing medication loss.

Lipid-lowering therapy (LLT) includes a diverse group of pharmaceuticals designed to reduce blood levels of cholesterol and triglyceride (TG), helping to prevent cardiovascular diseases like myocardial infarction and stroke. LLT includes treatment with several lipid-lowering drugs (LLD), including hydroxymethylglutaryl (HMG-CoA) reductase inhibitors (statin), PCSK9 Inhibitors, cholesterol-absorbing inhibitors (Ezetimibe), Bile Acid Sequestrants, Fibrates, Niacin (Vitamin B3), Omega-3 Fatty Acids, Bempedoic Acid, and combination therapy. The efficacy and safety of these molecules vary widely. Statins are the first-line LLD for treating hypercholesterolemia and are widely used for cardiovascular disease prevention. Common side effects include muscle-related issues such as myalgia, muscle atrophy, and, rarely, rhabdomyolysis. However, adverse effects on male reproductive health are infrequent and often underreported. Other medication classes employed in LLT mostly share many of the ADRs seen with statins, although individual classes may have unique ADRs depending on the pharmacokinetics and pharmacodynamics. Here, we are reporting a unique case of a 50-year-old male patient with no prior history of sexual dysfunction or testicular issues and other comorbidities or habits, who developed loss of libido, erectile dysfunction (ED) and testicular pain with most of the LLD, which promptly resolved on discontinuation of the LLT. This case highlights the importance of considering potential reproductive side effects when prescribing LLT and monitoring male patients for symptoms of sexual dysfunction.

Background: Hypersalivation, or excessive production and secretion of saliva, can result from associated disorders or adverse drug reactions. It significantly impacts physical health, psychosocial well-being, and quality of life. Clozapine, a gold standard for treatment-resistant schizophrenia, is known to cause hypersalivation in some patients. Objectives: This study aimed to determine the prevalence of hypersalivation and identify factors associated with its occurrence in patients with schizophrenia treated with clozapine, either as monotherapy or in combination with other antipsychotics. Methods: This retrospective cohort study was conducted using medical records from inpatients diagnosed with schizophrenia at a tertiary psychiatric hospital. Data were collected from patients treated with clozapine between June 1, 2020, and December 31, 2020. Descriptive statistics were used to describe the prevalence of hypersalivation, and multiple logistic regression was performed to assess the association between hypersalivation and patient characteristics. Results: A total of 96 patients were included in the study, with a mean age of 44.03 years (SD = 13.27); 72.9% of the patients were male. The overall prevalence of hypersalivation was 14.6%, with 19.51% of patients on clozapine monotherapy and 10.91% of those on clozapine combined with other antipsychotics experiencing hypersalivation. Male sex appeared to reduce the risk for hypersalivation (adjusted OR: 0.36, 95% CI: 0.10-1.33, P = .13), while the use of electroconvulsive therapy (ECT) significantly increased the risk of hypersalivation (adjusted OR: 5.40, 95% CI: 1.22-24.02, P = .03). Other variables, including age, Body Mass Index (BMI), smoking status, alcohol consumption, clozapine dosage, and use of anticholinergics, were not significantly associated with hypersalivation. Conclusion: The prevalence of hypersalivation in schizophrenia inpatients treated with clozapine was 14.6%. Male sex was associated with a reduced risk of hypersalivation, while ECT use significantly increased the risk. These findings provide valuable insights for clinicians managing patients on clozapine, highlighting the need for careful monitoring, particularly in patients undergoing ECT.