Journal of Pharmacy Technology最新文献

Background: Levetiracetam is a soluble ethyl analogue of the nootropic agent piracetam that is utilized primarily for epilepsy treatment. Studies have shown levetiracetam has preferred pharmacokinetic and pharmacodynamic properties compared to phenytoin, however, limited data exist regarding neuropsychiatric side effects. Purpose: To evaluate the incidence of neuropsychiatric events in patients under the age of 75 and over the age 75 years receiving levetiracetam for seizure prophylaxis following traumatic brain injury (TBI). Methods: This study was a retrospective cohort analysis conducted at the University of Toledo Medical Center (UTMC) between January 1, 2023, and March 15, 2025. Inclusion criteria required adults aged >18 years old who had been admitted to the surgical intensive care unit (SICU) and received levetiracetam for seizure prophylaxis following a TBI. The primary study outcome was to assess the incidence of neuropsychiatric events attributed to levetiracetam. Secondary outcomes included levetiracetam dose/route, seizure occurrence, time to onset of neuropsychiatric event, SICU length of stay and duration of levetiracetam treatment. Results: There were 55 patients included in the study. For the primary endpoint, two patients (3.6%) experienced a neuropsychiatric event. There were 14 patients (25.5%) with a history of psychiatric disorders, and just 1 of those patients experienced a neuropsychiatric event while receiving levetiracetam. Conclusions: Levetiracetam is a well-tolerated antiepileptic agent for patients requiring seizure prophylaxis post TBI and did not demonstrate a significant incidence of neuropsychiatric events in this evaluation.

Background: Normal saline (NS) is a vital resource used to care for patients with febrile neutropenia (FN). A 2017 shortage in NS driven by Hurricane Maria raised concerns about patient outcomes. Objective: This study aimed to evaluate the impact of this shortage on in-hospital mortality and the length of stay (LOS) among adults with FN. Methods: The National Inpatient Sample database was used to identify adult FN encounters. Two cohorts were defined: a pre-shortage group (November 2016-March 2017) and a shortage group (November 2017-March 2018). In-hospital mortality was the primary outcome, and LOS was secondary. Results: We identified 19 425 encounters with FN in the dataset, 9584 occurring pre-shortage and 9841 occurring during the shortage. Cohorts were similar in age, sex, and race. Small but statistically significant differences were observed in primary payer distribution (P = 0.022) and hospital size (P = 0.037). In-hospital mortality was similar between cohorts (7.1% vs 6.9). Mean LOS was also similar during the pre-shortage vs shortage periods (10.1 ± 12.7 vs 10.2 ± 13.0 days). Adjusted analyses demonstrated no differences in mortality (aOR = 1.01; 95% CI = 0.90-1.13) or LOS (mean difference = 0.1 days; 95% CI = -0.14 to 0.38). Conclusion: Mortality and LOS were stable across pre-shortage and shortage periods in patients with FN despite the national NS shortage. While such shortages may disproportionately affect patients with conditions that rely heavily on supportive fluids and rapid intravenous medication administration, this study did not observe statistically significant negative impacts on patient outcomes.

Objective: To review the efficacy, safety, and tolerability of a sublingual formulation of cyclobenzaprine for the treatment of fibromyalgia. Data Sources: A literature search was conducted through PubMed and DrugBank using the following terms: cyclobenzaprine, fibromyalgia, sublingual, Tonmya, and TNX-102 SL. Study Selection and Data Extraction: Articles describing the pharmacology, pharmacokinetics, efficacy, safety, and/or tolerability of sublingual cyclobenzaprine were included in this review. Data Synthesis: Cyclobenzaprine is a tricyclic antidepressant like agent which exhibits sedative and muscle relaxant effects in the treatment of fibromyalgia. Clinical trials have demonstrated improvements in daily pain scores compared with placebo. Common adverse events associated with this agent include oral hypoesthesia, oral paresthesia, and abnormal taste. Conclusions: Pharmacologic agents receive a weak recommendation for use in the treatment guidelines and include agents such as duloxetine, pregabalin, tramadol, amitriptyline, and a nonsublingual formulation of cyclobenzaprine. Tonmya, the newest agent approved for fibromyalgia, provides clinicians with an additional treatment option in a convenient dosage form for this potentially debilitating condition.

Objective: Acute pancreatitis is an inflammatory disorder of the pancreas with diverse etiologies, including rare drug-induced causes such as propofol. Propofol-associated acute pancreatitis has been linked to hypertriglyceridemia; however, causal attribution is particularly challenging in patients with chronic kidney disease, due to metabolic disturbances and overlapping clinical features. Case: We report the case of a 49-year-old female with end-stage chronic kidney disease admitted with septic shock requiring mechanical ventilation and continuous sedation with propofol infused at 70 mg/h. After 8 days of therapy, she developed progressive hypertriglyceridemia followed by clinical and biochemical findings consistent with acute pancreatitis. Common etiologies were excluded, and the temporal relationship supported a probable adverse drug reaction. Discussion/Conclusions: This case highlights the diagnostic and causal complexity of acute pancreatitis in critically ill patients with advanced chronic kidney disease and underscores the importance of vigilant metabolic monitoring and multidisciplinary medication review during propofol therapy.

Objective: To describe a mixed anticholinergic-type syndrome not previously associated with vancomycin in a patient with end-stage renal disease on hemodialysis, highlighting the impact of dosing and infusion rate errors. Case: A 61-year-old man with stage 5 chronic kidney disease on hemodialysis was admitted to the internal medicine unit for a catheter-related infection. Vancomycin was initiated at 1 g every 12 hours, infused at 16.6 mg/min. After four doses, the patient developed transient amaurosis, tachycardia, hyperthermia, xerostomia, xeroderma, confusion, agitation, and panic, consistent with a mixed anticholinergic-type syndrome. Symptoms resolved after discontinuation of vancomycin and subsequent hemodialysis. Discussion/Conclusions: This case demonstrates a definite association between vancomycin overdose with rapid infusion and the development of a mixed anticholinergic-type syndrome in a patient on hemodialysis. These findings underscore the importance of careful dose adjustment and strict control of infusion rates in advanced renal disease.

Introduction: Overuse of carbapenem antibiotics can lead to patient harm through adverse effects and further development of bacterial resistance. The purpose of this study was to investigate the sustained impact of meropenem restriction criteria on utilization volume and appropriateness. Methods: A retrospective observational study was conducted to evaluate meropenem restriction criteria among 5 adult hospitals (1 academic hospital and 4 community hospitals) in a single health system. Total meropenem days of therapy/1000 patient days (DOT/1000 PDs) and drug spending was compared before (January 2022) and after implementation (July 2023) were reviewed to investigate total impact of restriction criteria in the first year after implementation. Statistical comparisons used t tests or Mann-Whitney U tests for continuous data and chi square or Fisher's exact tests for categorical data; significance was defined as P < 0.05. Results: A total of 161 meropenem orders were included in this study, with 61 (39%) found to be inappropriate based on approved restriction criteria. The top 3 reasons for inappropriate meropenem use were undocumented or non-anaphylactic penicillin allergies (31%), lack of qualifying resistant organism within 3 months (26%), and starting meropenem prior to completing 48 hours of empiric therapy with cefepime or piperacillin/tazobactam (23%). The median meropenem DOT/1000 PD decreased from 40.5 to 20 (P < 0.001). Median monthly drug spend on meropenem across the hospital system decreased by 42% during the study period (P = 0.001). Conclusions: Meropenem restriction criteria across a multi-site health system can sustainably reduce carbapenem use and associated costs, supporting their continued adoption in antimicrobial stewardship policy.

Objective: We report a unique case of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) possibly related to administering daptomycin and ceftaroline for persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. We describe treatment strategies and challenges of determining drug causality when multiple antimicrobials are administered. Case: A 78-year-old male developed SJS/TEN during week 6 of daptomycin and ceftaroline therapy. Other antimicrobials administered within the previous 8 weeks included vancomycin, meropenem, piperacillin/tazobactam, levofloxacin, and fluconazole. Causality was assessed using the Algorithm of Drug Causality for Epidermal Necrolysis, which indicated probable association with ceftaroline and possible association with daptomycin. Management included discontinuing both agents, transferring to a burn intensive care unit, wound care, and treatment with intravenous immunoglobulin. Discussion/Conclusion: Stevens-Johnson syndrome and toxic epidermal necrolysis associated with the use of daptomycin and ceftaroline is rare. Appropriate and timely diagnosis and management by a multidisciplinary team led to favorable clinical outcomes.

Objective: Diabetes mellitus encompasses chronic metabolic disorders marked by impaired insulin secretion, action, or both, with type 1 and type 2 diabetes presenting distinct mechanisms and therapeutic needs. Achieving durable glycemic control remains essential to preventing microvascular and macrovascular complications. Data Sources: The growing prevalence of obesity among people with diabetes-driven by insulin resistance, lifestyle factors, and, in type 1 diabetes, insulin-associated weight gain-has increased the demand for therapies targeting both glycemia and body weight. Study Selection and Data Extraction: Traditional agents such as insulin, metformin, sulfonylureas, and thiazolidinediones have long served as treatment foundations but are limited by risks like hypoglycemia and weight gain. Incretin-based therapies, particularly glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT-2) inhibitors, have reshaped diabetes care by improving glycemic control, promoting weight loss, and offering cardiovascular and renal protection. Data Synthesis: Newer dual and multiagonists, including tirzepatide and emerging triple agonists, show unprecedented reductions in HbA_1c and body weight, approaching outcomes seen with bariatric surgery. However, rising off-label use of antidiabetic drugs for weight loss raises safety concerns, including gastrointestinal effects and rare motility disorders, underscoring the need for careful patient selection and pharmacovigilance. Conclusion: Ongoing challenges include high costs, inequities in access, medication shortages, and the need for sustained pharmacovigilance. Future directions involve oral non-peptide incretin mimetics, broader indications for multiagonists, and deeper understanding of long-term safety, particularly in off-label contexts.

Background: Beta blockers are no longer recommended as first-line agents for hypertension (HTN) without compelling indications; however, evidence suggests that there is still frequent inappropriate prescribing of beta blockers to many US adults with HTN. Objective: To determine rate of prescribing of beta blockers for HTN without concurrent use of other first line antihypertensive agents. Methods: To analyze the validity of these claims, we utilized National Ambulatory Medical Care Survey data from 2013 to 2018 (excluding 2017). This data represented office visits related to adults receiving treatment for HTN. The data in the study encompasses 5191 unweighted visits representing 247 million visits nationally. Results: The data from these visits showed the prevalence of beta blocker prescribing to be 21.8% with 93.6% of beta blocker prescriptions considered inappropriate based on current guideline recommendations. This determination was made based on whether the patient had all first-line HTN treatment options prescribed prior to receiving beta blockade. Factors such as older age (≥65 years; odds ratio [OR] = 1.48, 95% CI = 1.11-1.97) and elevated blood pressure at the visit (OR = 1.43, 95% CI = 1.06-1.92) were associated with an increased likelihood of beta blocker prescribing, while depression (OR = 0.42, 95% CI = 0.24-0.73) and diabetes (OR = 0.70, 95% CI = 0.55-0.90) were associated with decreased likelihood. Conclusion: Inappropriate beta blocker prescribing for HTN without compelling indications remains highly prevalent in US outpatient practice. Older adults and patients with elevated blood pressure are particularly at risk. Targeted provider education and clinical decision support interventions are warranted to improve hypertension management.