Hospital Pharmacy最新文献

Background: Acute ischemic stroke is a leading cause of death and long-term disability. To improve patient outcomes, timely restoration of blood flow to the ischemic brain tissue is vital. One reperfusion strategy includes the administration of thrombolytics. Historically, alteplase has been the thrombolytic of choice for acute ischemic stroke; however, given recent safety and efficacy data, tenecteplase has gained popularity due to its optimal pharmacokinetic profile. Objectives: This study compares outcomes between adult patients with acute ischemic stroke who received tenecteplase as the preferred thrombolytic versus alteplase. Methods: This was a single center, retrospective cohort study that included adult patients who received intravenous thrombolytic therapy, either tenecteplase 0.25 mg/kg or alteplase 0.9 mg/kg, for acute ischemic stroke from May 2021 to December 2023. The primary outcome was door-to-needle time. Secondary safety outcomes included the incidence of symptomatic intracerebral hemorrhage (ICH), any ICH on 24-hour follow-up imaging, major extracranial bleeding, and angioedema. Secondary efficacy outcomes included discharge with a favorable neurological outcome, discharge disposition, ICU length of stay, and overall length of stay. Secondary stroke metric times evaluated include door-to-computed tomography (CT) time, CT-to-needle time, neurologist notification-to-needle time, and thrombolytic decision-to-needle time. Results: Fifty patients were included in the alteplase group and 50 patients were included in the tenecteplase group. The primary outcome, door-to-needle time, was significantly shorter in the tenecteplase group (36 vs 30 minutes, P = .006). There were no statistically significant differences found in the secondary safety and efficacy outcomes. Patients who received tenecteplase experienced significantly faster CT-to-needle times (17 vs 11 minutes, P = .006), neurologist notification-to-needle times (32 vs 25 minutes, P = .001), and thrombolytic decision-to-needle times (9 vs 5 minutes, P < .001). Conclusions: In this retrospective, observational study, there was a statistically significant decrease in door-to-needle time with tenecteplase compared to alteplase. No significant differences in secondary safety and efficacy outcomes were observed.

Comparison of monotherapy sodium zirconium cyclosilicate (SZC) versus sodium polystyrene sulfonate (SPS) is lacking. We aimed to evaluate the effectiveness of SZC versus SPS for acute potassium lowering. This retrospective cohort study included hospitalized adult patients with acute hyperkalemia treated with SZC or SPS monotherapy. The primary outcome was time to normalization of serum potassium. Secondary outcomes included necessity of additional treatment, achievement of normokalemia at 1, 2, 4, 8, and 24 hours, and change in serum potassium from baseline to 1, 2, 4, 8, and 24 hours. Fifty-one patients received SZC and 50 received SPS. Mean baseline potassium was 5.4 mmol/L for both groups. Median time to normokalemia was 14 (IQR 8-20) hours in the SZC group versus 17 (IQR 10-21) hours in the SPS group (P = .26). Normokalemia was achieved at 24 hours in 80% versus 77% in each group, respectively (P = .56). Six patients per group required additional treatment (P = .97). Mean serum potassium at all time points was numerically lower with SZC, but statistical significance was only observed at hour 8 (4.6 vs 5.0 mmol/L, P = .005), which was associated with a -0.77 versus -0.51 mmol/L decrease in serum potassium from baseline in each group, respectively (P = .026). SZC monotherapy is at least as effective as SPS in treating mild hyperkalemia and may reduce serum potassium more quickly and to a greater degree than SPS. Future research in more severe hyperkalemia and with monitoring of potassium at regular intervals is needed to better understand the role and potential advantages of SZC over SPS.

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several board-certified nutrition support pharmacists aggregated a list of articles relevant to pharmacy nutrition support published in 2023. The list was compiled into a spreadsheet whereby the authors were asked to assess whether the article was considered important. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the article to be important for pharmacists practicing in nutrition support. Guideline and consensus papers, important to practice but not ranked, were also included. Results: A total of 133 articles were identified; 9 from the primary literature were voted by the group to be of high importance. Fourteen guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.

Background: Immune Thrombocytopenia Purpura (ITP) is a hematological disorder, where its primary cause is unknown. This can be triggered through any secondary underlying diseases or other environmental agents such as drugs, vaccination, natural viral infections etc. After the introduction of COVID-19 vaccines, a 4-fold increase in ITP cases was observed globally. Many of the COVID-19 vaccines such as m-RNA and viral-vector vaccines already demonstrated a cause-effect relationship between the event of ITP and immunization. Case presentation: A 54 year old diabetic patient presented to the hospital with complaints of gum bleeding and fatigue. He was diagnosed with severe ITP following COVID-19 vaccination with a platelet count of 5000 cumm. Initially his condition was considered as idiopathic and the COVID-19 vaccine exposure (13 days prior to the clinical presentation) was not suspected. Later the immunization timeline and onset of the reaction was traced by his hematologist. The patient underwent multiple platelet transfusions and was given corticosteroid therapy. The patient was followed for a period of 1 year and throughout the follow-up period the patient had fluctuating platelets count, especially after tapering steroids. Conclusion: ITP in this case is found to have a consistent causal association to COVID-19 vaccination as per the World Health Organization Causality assessment algorithm and is categorized under vaccine product related reactions. One year follow-up conducted showed that the thrombocytopenia following COVID-19 vaccine may be prolonged.

During a general anesthetic case, a patient was administered a 400 µg/mL infusion of phenylephrine as opposed to the 40 µg/mL solution typically used in most operating rooms. The patient experienced iatrogenic hypertension, which resolved once the cause was discovered and the phenylephrine was discontinued. A root cause analysis was performed, with multiple factors contributing to the error. The Department of Pharmacy advocated switching to one concentration of phenylephrine hospital-wide. After performing a literature review regarding the safety of using 400 µg/mL phenylephrine peripherally, the decision was made to switch the operating room to this concentration of phenylephrine. The switch has been successful, with only one known medication error and no adverse events occurring since implementation. This quality improvement initiative demonstrates that 400 µg/mL phenylephrine can be used as an infusion in the operating room, which has potential implications for patient safety and efficiency. This safety initiative may serve as an example for other operating rooms.

Background: Medications requiring refrigeration for stability are commonly used across hospitals. Temperature-sensitive medications may not have their temperature requirements maintained due to breaches in the cold chain, especially refrigerator failure. This is usually caused by malfunction of the refrigerator unit or by power outage. After multiple power outages at our institution involving refrigerators with temperature probes located in different areas of the refrigerator, we hypothesised that the fixed temperature probe may not accurately reflect the temperature of the medications themselves. Methods: We conducted simulations of power outages in a commonly used medication refrigerator, using additional temperature data loggers, placed on the refrigerator shelf and inside a cardboard box to replicate the temperature inside medication containers to determine if there was a difference in the time to breach cold chain conditions (>8°C) and to return to appropriate refrigerated temperatures (<8°C) when power was restored. Results: All data loggers took a longer time to breach cold chain conditions than the refrigerator probe (12.5 minutes vs 23-26 minutes) but took longer to return to acceptable temperature after power was restored (17.5 minutes vs 70.5-89 minutes). Conclusion: This exploratory research suggests that temperatures vary within a refrigerator depending on the type and location of probe and that medications within may take longer to breach cold chain conditions but also take longer to return to cold chain conditions compared with fixed refrigerator temperature probes. Further research is required to determine whether these variations occur across different sizes/brands of refrigerators and the effect on stability on refrigerated medications.

Interprofessional education (IPE) is an educational technique in which tutors and students from several healthcare disciplines, such as pharmacy and physiotherapy, collaborate to achieve a common goal. IPE has been shown to increase patient outcomes and professional growth among healthcare teams. Pharmacists and physiotherapists have different knowledge bases and skills, both of which are integral to the effectiveness of a collaborative healthcare team. By bringing their respective expertise together in an interprofessional context these healthcare professionals can work to develop increased understanding, respect for each other's roles, and the ability to collaborate more effectively.