Hospital Pharmacy最新文献

Background: Doravirine (DOR) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) approved for use in combination antiretroviral therapy (cART) for treatment of human immunodeficiency virus (HIV) in treatment-naive patients. Doravirine-based regimens are an option for patients with limited alternatives due to drug-drug interactions, toxicities, or resistance. A paucity of data exists for use of two-drug DOR-based regimens in treatment-experienced individuals. Methods: This is a retrospective case series of two treatment-experienced HIV-1 infected patients switched to two-drug doravirine-based regimens. Baseline HIV-RNA and CD4 cell count were measured at the time of switch to the DOR-based regimen. HIV-RNA and CD4 cell count were measured again more than a month after initiating therapy to determine efficacy of the DOR-based regimens. Results: Patient 1 was transitioned to once daily DOR and darunavir with cobicistat (DRV/c). The baseline HIV-RNA was 370,070 copies/mL and CD4 cell count was 196 cells/mm³. After 2 years of treatment, the viral load was less than 30 copies/mL and the CD4 cell count was 239 cells/mm³. Patient 2 was transitioned to once daily DOR and dolutegravir (DTG). The baseline HIV-RNA was <30 copies/mL and CD4 cell count was 229 cells/mm³. After 11 months of therapy, the patient's HIV viral load remained <30 copies/mL and the CD4 cell count was stable at 236 cells/mm³. Conclusions: Two-drug cART including DOR appears to be an acceptable option for patients who may be limited to alternative ART regimens due to drug-drug interactions, resistance mutations, or toxicities. Additional evidence from case reports or clinical trials are needed to further evaluate the long-term efficacy and safety of DOR as part of a two-drug cART regimen.

Beta-blockers are recommended in the first 24 hours after ST-segment elevation myocardial infarction (STEMI) except in those at risk of cardiogenic shock. This retrospective cohort study aimed to assess if early beta-blocker use was associated with cardiogenic shock development in STEMI patients. Cardiogenic shock was assessed in adult patients with STEMI undergoing percutaneous coronary intervention (PCI) with guideline defined risk factors for shock (age above 70 years, systolic blood pressure below 120 mmHg, and heart rate above 120 bpm or below 60 bpm) who did or did not receive a beta-blocker within 24 hours of PCI. Multivariable logistic regression was used to assess the association between cardiogenic shock development and early beta-blocker administration. A total of 216 patients were included, 85 with early beta-blocker administration and 131 without. Patients who received an early beta-blocker versus those who did not had a median (interquartile range) age of 63 (52-71) versus 66 (54-76; P = .2260) and peak troponin of 58.3 (15.0-132.4) ng/mL versus 51.6 (16.6-139.5; P = .9884). Cardiogenic shock occurred in 4.7% (n = 4) patients with early beta-blocker use versus 12.2% (n = 16; P = .0909) without. After backward stepwise logistic regression, early beta-blocker use was not associated with cardiogenic shock (adjusted odd ratio [aOR] 0.334, 95% confidence interval (CI) 0.106-1.047; P = .0599), but those with a peak troponin over 56 ng/mL had an over three-fold increased risk of developing cardiogenic shock (aOR 3.434, 95% CI 1.191-9.902; P = .0224) regardless of beta blocker administration. Early beta-blocker administration in STEMI patients may not be associated with shock development.

Background: Patients in neurocritical care units are particularly vulnerable to medication errors and adverse drug events, necessitating specialized care and comprehensive pharmacological management. Despite this need, the scarcity of clinical pharmacist specialists in South Korean hospitals results in limited direct patient care within multidisciplinary teams. Objective: This study aimed to evaluate the impact of a dedicated pharmacy service program in the neurocritical care intensive care unit (neuro-ICU) on patient outcomes and to propose a clinical pharmacy service model tailored for resource-limited settings. Methods: We conducted a retrospective cohort study comparing neuro-ICU mortality rates and length of stay between periods with and without the presence of a dedicated neurocritical care pharmacist (d-NCP) from May 1, 2016, to December 31, 2017. The study also assessed the frequency and nature of pharmacy interventions alongside factors associated with patient outcomes. Results: The analysis included 769 patients in the group with d-NCP and 676 patients in the group without d-NCP. The presence of a d-NCP was associated with significantly shorter neuro-ICU stays (3.4 ± 8 days vs 3.5 ± 6.4 days, P = .012). Multivariate analysis indicated that the involvement of a d-NCP correlated with reduced length of neuro-ICU stay (β coefficient -0.077, 95% CI: -0.148 to -0.006, P = .033), whereas the number of prescribed medications was linked to longer stays (β coefficient 0.004, 95% CI: 0.014 to 0.005, P < .001). Conclusion: The implementation of a dedicated pharmacy service program in the neuro-ICU leads to improved patient outcomes and mitigates drug-related complications. This model offers a feasible and effective approach for enhancing care in hospitals with limited resources.

Introduction: As artificial intelligence (AI) becomes increasingly integrated into various professional fields, understanding its impact on pharmacy education is crucial. This study explores pharmacists' perceptions of AI's role in enhancing educational and professional practices, particularly focusing on the generation of educational content and analytical tasks. Objectives: The primary objective was to assess pharmacists' concerns and perceived benefits regarding the use of AI in pharmacy education, examining variations across different age groups and years of practice. Methods: A cross-sectional survey was completed by 446 pharmacists who actively precept pharmacy residents and students. Respondents practiced across 35 states with over half (53.4%) being in Ohio. The survey included items on concerns about AI's quality and accuracy, human interaction, plagiarism, and its potential benefits in data analysis and research literature summarization. Responses were analyzed to identify trends across demographic categories, including age and years in practice. Results: Of the respondents, 67.9% expressed concerns about the quality and accuracy of AI-generated content, while 50.9% were concerned about plagiarism. Younger pharmacists (73.8% of those aged 20-29) showed heightened concern about accuracy compared to older groups (56.8% of those aged 60+). In contrast, 57.8% of respondents recognized AI's potential benefits for data analysis, with experienced pharmacists (>20 years in practice) being more likely to see these advantages (62.2%). Conclusion: The findings indicate a need for targeted educational strategies to address AI literacy and ethical use in pharmacy education. Integrating AI tools that support educational objectives while addressing these concerns could enhance the efficacy and acceptance of AI in pharmacy practice. Further research should explore the development of training programs that align with the evolving expectations and technological competencies of different pharmacist demographics.

Introduction: Glycemic management in the intensive care unit is an evolving practice area. This evolution has included the refinement of blood glucose targets, matching glycemic management to premorbid status, and investigations into the impact of glycemic variability and relative hypoglycemia on ICU outcomes. The interplay between these phenomena and absolute hypoglycemia has yet to be investigated in hyperglycemic emergencies. Objectives: To examine the incidence of and risk factors for relative hypoglycemia and absolute hypoglycemia in patients admitted to an intensive care unit for the management of hyperglycemic emergencies. Methods: This was a retrospective, single-center, exploratory analysis of adults admitted to the medical intensive care unit for diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome. The primary outcome was the incidence of relative hypoglycemia, defined as a blood glucose level 30% lower than baseline. The baseline was determined by the estimated average blood glucose calculated from hemoglobin A1c within 3 months of index admission. Secondary outcomes were ICU length of stay, glycemic variability, and incidence of absolute hypoglycemia.Results: Relative hypoglycemia was observed in 60% of patients in the cohort. Longer insulin infusion duration and higher hemoglobin A1c levels were found to statistically increase the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU length of stay were associated with the risk of developing absolute hypoglycemia. Conclusions: Relative hypoglycemia is a frequent occurrence in this patient population. Hemoglobin A1c and duration of the insulin infusion statistically influenced the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU stay were significantly associated with developing absolute hypoglycemia. While relative hypoglycemia is common in hyperglycemic emergencies, the clinical impact remains uncertain and warrants additional investigation.

Purpose: Direct oral anticoagulants (DOACs) are the preferred choice of anticoagulation therapy for nonvalvular atrial fibrillation and venous thromboembolism. Inadequate monitoring of patients on DOACs may lead to suboptimal outcomes and safety concerns. This project aimed to implement a standardized telemedicine-based DOAC monitoring service and track pharmacist-based interventions. Methods: This project was conducted at a safety-net hospital over 6 months. Anticoagulation pharmacists developed a scheduling process for telemedicine DOAC follow-up appointments, integrated them into the electronic health record, and implemented standardized protocols and documentation tools. Outcomes of interest included the average number of pharmacist interventions per encounter and per patient. Results: One hundred sixty-four encounters involving 120 patients were included in the analysis. 92.7% of encounters resulted in at least 1 intervention, with 73.8% involving an education intervention. The average number of interventions per patient was 2.0, with 37.2% of encounters having multiple interventions. Conclusion: Implementation of a standardized telemedicine-based monitoring service allowed for pharmacist identification and management of issues related to DOAC therapy. These findings emphasize the importance of pharmacist-led interventions and telemedicine-based follow-up of DOAC therapy.

Donepezil and memantine are second-generation antipsychotics widely used in the management of mild to moderate Alzheimer's disease. These drugs are highly selective for the central nervous system, targeting different neural pathways to mitigate cognitive decline. Donepezil is a reversible and specific acetylcholinesterase inhibitor, while memantine is an NMDA receptor antagonist which modulates glutamatergic activity. Although these medications are safe, they are associated with adverse effects, and cardiovascular complications are rare. The reported cardiac adverse drug reactions include bradycardia, atrioventricular block, and prolonged QT interval. We are reporting a case of an 81-year-old male patient with schizophrenia, Alzheimer's disease and bilateral sensorineural deafness receiving oral donepezil and memantine presented with second-degree atrioventricular block. The patient's atrioventricular block recovered completely in 2 to 3 weeks after the discontinuation of donepezil-memantine and with a short course of sympathomimetic drugs.

Objectives: A commonly applied analgesic therapy for patients with severe abdominal pain due to cancer-related pain in the upper abdomen, is coeliac plexus neurolysis (CPN). Herein, a combination product of phenol and an iodine contrast agent are injected simultaneously. The chemical stability of such a combination product is unknown, and no chromatographic method is yet available that describes the simultaneous quantification of phenol and iomeprol. The aim of this study was to develop and validate a stability-indicating UPLC method for the simultaneous quantification of both phenol and iomeprol and to determine the chemical stability of a sterile 100 mg/mL phenol in 350 mg I/mL iomeprol solution for injection during shelf life. Methods: The product was compounded and sterilized in a GMP certified facility. The pharmaceutical analysis was validated by determination of the accuracy, precision, specificity, selectivity, carry-over and linearity. Pharmaceutical product stability was determined before and after sterilization, and during shelf life of 36 months at 25°C ± 2°C. Results: The accuracy for phenol and iomeprol was 97.1% to 99.3% and 100.0% to 100.2%, respectively. The RSD for repeatability and reproducibility for phenol were 0.65% and 1.17%, and for iomeprol 0.61% and 1.49%, respectively. All other tested parameters met the predefined validation criteria. All concentrations at all tested time points remained within ±2% of the initial concentrations for phenol and ±4% for iomeprol. No additional peaks were visible on the chromatograms. Conclusion: A stability-indicating method for the simultaneous quantification of phenol and iomeprol in a parental pharmaceutical preparation was developed and validated. This method was used to demonstrate the chemical stability of a newly developed sterile solution of 100 mg/mL phenol and 350 mg I/mL iomeprol. Chemical product stability was demonstrated during shelf life of up to 36 months.

Background: Recent literature demonstrated a 24-hour reduction in vancomycin duration of therapy (DOT) for skin and soft tissue infections (SSTIs) with a negative methicillin-resistant staphylococcus aureus (MRSA) nasal screening versus a positive nasal screening. Objective of this study was to investigate vancomycin DOT in patients with SSTIs who received MRSA nasal polymerase chain reaction (PCR) screening versus those who did not receive MRSA nasal PCR screening. Methods: A retrospective, multi-center, cohort study was completed in admitted adult patients on vancomycin for SSTI from 01/01/2020 to 09/30/2022. Hospital policy permits any clinician to order a MRSA nasal PCR screening test for various indications, including SSTIs, pneumonia and sepsis. Results: One-hundred-fifty-one patients were included, of which 71 had MRSA nasal PCR screening tests obtained, and 80 did not. The median vancomycin DOT in patients with MRSA nasal PCR screening tests was 19.9 versus 36.7 hours (P = .014) in patients without screening tests. Conclusion: Patients with SSTIs who receive MRSA nasal PCR screening tests have a shortened vancomycin DOT. These results contribute to current data in support of the efficacy and clinical utility of obtaining MRSA nasal PCR screening tests for SSTIs.

Background: Major trauma is a risk factor for venous thromboembolism (VTE). Trauma guidelines recommend prompt initiation of pharmacologic VTE prophylaxis. While early initiation is recommended, delays in therapy can occur. Objective: The aim of this study was to evaluate the compliance of pharmacologic VTE prophylaxis initiation timing with trauma guidelines and impact on rates of VTE, bleeding and in-hospital mortality. Methods: This retrospective cohort study included patients admitted to a trauma unit between January 1, 2020 and December 1, 2021. Patients were stratified by injury type and categorized as either compliant or non-compliant based on timing of initiation. Rates of VTE, bleeding, and in-hospital mortality were collected. Results: Of the 300 patients, 259 (86.3%) were compliant. Reasons for non-compliance included bleeding (19.5%) and pending evaluation for intervention such as nerve block procedure (12.2%) and surgical operation (4.9%). There were no differences in VTE (4.8% vs 1.2%, P = .139) or bleeding (4.6% vs 0%, P = N/A) between groups. There was a higher rate of in-hospital mortality in the non-compliant group (12.2% vs 2.3%, P = .009). Upon multivariate logistic regression, the ICU setting was identified as a risk factor for noncompliance (P = .020, OR = .45). Conclusion: Initiating pharmacologic VTE prophylaxis in concordance with trauma guidelines led to low observed rates of VTE and bleeding. In evaluating reasons for noncompliance, we identified areas of improvement for initiation including minimizing inappropriate delays in therapy.