Journal of Pharmacy Technology最新文献

Background: There is currently a lack of evidence on the optimal loop diuretic dosing strategy in cases of acute decompensated heart failure (ADHF). Current consensus recommendations suggest starting with a dose of at least 2 times the patient's home loop diuretic dose. Objective: This study assessed whether higher initial loop diuretic doses are associated with faster time to decongestion in hospitalized ADHF patients. Methods: This was a retrospective, single-center cohort of patients ≥19 years of age with ADHF who received intravenous (IV) loop diuretics between September 2022 and August 2023. Patients were separated into groups based on receipt of greater than or equal to 2.5 times their home loop diuretic dose (high-dose) and <2.5 times their home loop diuretic dose (low-dose). Results: In total, 114 patients were included with 74 patients in the high-dose group and 40 patients in the low-dose group. For the primary outcome of time to decongestion, there was no difference between the high-dose and the low-dose -0.37 (95% confidence interval [CI] = -1.32 to 0.58), P = 0.44. There was a difference in the need for diuretic intensification beyond 24 hours in favor of the high-dose group (P = 0.0001). Conclusion: Higher initial doses of loop diuretics did not lead to a more rapid time to decongestion. The high-dose group did require less diuretic intensification beyond 24 hours, but this was not associated with a shorter hospital length of stay (LOS).

Objective: Itraconazole is recommended as the first-line oral treatment for pulmonary histoplasmosis. There is a paucity of data describing hypersensitivity reactions to itraconazole and lack of clarity on triazole antifungal cross-reactivity. Case: Approximately 9 hours after an initial dose of itraconazole 200 mg for treatment of chronic cavitary pulmonary histoplasmosis, a 72-year immunocompetent patient developed anaphylactic symptoms that abated with intervention. To resume histoplasmosis treatment in the setting of limited treatment options following nephrotoxicity that occurred while receiving amphotericin B, a single posaconazole 100 mg tablet was given and well tolerated by the patient. Subsequently a treatment course of posaconazole 300 mg began with confirmation of therapeutic drug levels prior to hospital discharge. Imaging after 2 months of posaconazole showed improvement in cavitation size. Conclusion: Posaconazole was a safe and effective alternative to itraconazole for chronic cavitary pulmonary histoplasmosis in this case. Further evaluation of mechanisms and management of triazole hypersensitivity reactions are warranted.

Background: Agitation in hospitalized older adults is common and can increase the risk of harm, mechanical ventilation duration, and prolonged hospital stays. Diagnosing and managing agitation in geriatric patients is especially complex due to overlapping symptoms with other conditions, altered pharmacokinetics, and increased sensitivity to adverse effects. This study aimed to evaluate the appropriateness of pharmacologic interventions for acute agitation in elderly inpatients and identify areas for improvement. Methods: A retrospective chart review was conducted at a public hospital in South Florida for patients ≥65 years old admitted between January 1 and June 30, 2024, who received medications for agitation management. Appropriateness was determined using Sedation-Agitation Scale (SAS) scores, medication administration patterns, and restraint use. Effectiveness, documentation quality, and adverse events were also assessed. Results: Among 72 encounters from 54 patients, 50% were classified as appropriate based on alignment with SAS scores and clinical restraint use. Effectiveness, defined as ≤1 as-needed dose per day, was observed in 68.1% of cases. Restraint use was significantly associated with appropriateness (χ² = 23.63, P < 0.0001), and although paradoxical, inappropriate regimens were more often effective (χ² = 5.39, P = 0.0203). Adverse effects were documented in only 6.9% of cases, and complete documentation was present in 27.8% of encounters. Conclusion: Findings reveal inconsistencies in agitation management and documentation, with frequent overtreatment and underreporting. There is a clear need for standardized, geriatric-focused treatment protocols and improved documentation practices to optimize safety and effectiveness.

Objective: To assess the clinical utility of clesrovimab-cfor (Enflonsia^®), a newly Food and Drug Administration (FDA)-approved monoclonal antibody, for the prevention of respiratory syncytial virus (RSV) lower respiratory tract infections in infants. Data Sources: A literature search was conducted using the key words clesrovimab, RSV, pediatric, infant, and nirsevimab. Data were also extracted from Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), FDA prescribing information, and manufacturer data were reviewed. Study Selection and Data Extraction: English-language studies assessing the pharmacokinetics, pharmacodynamics, efficacy, and safety of clesrovimab were included. Key clinical trials (CLEVER and SMART) and cost-effectiveness models were reviewed. Data Synthesis: Clesrovimab binds to a conserved site on the RSV F protein, targeting both pre- and postfusion forms. In the CLEVER trial, it reduced RSV-associated medical visits by 60.4% and hospitalizations by 84.2%. The SMART trial showed comparable efficacy and safety to palivizumab. Adverse events were mild and injection-site related. No cross-resistance was observed with variants resistant to other monoclonal antibodies. Pharmacokinetics support single-dose administration with a half-life of 44 days. Conclusion: Clesrovimab offers simplified dosing, favorable safety, and potential cost savings compared with palivizumab and nirsevimab. While nirsevimab has a longer half-life, clesrovimab's unique binding site and room-temperature stability offer practical advantages. Lack of head-to-head comparisons and limited second-season data warrant further study. Clesrovimab is a promising addition to RSV prevention strategies, offering effective, safe, and accessible immunization for infants. Ongoing research will clarify its role in high-risk populations and broader clinical use.

Background: Pharmacists play a vital role in diabetes education, including continuous glucose monitors (CGMs). However, formal CGM training within pharmacy education remains limited. To address this, a CGM wear activity using the FreeStyle Libre 3 system was integrated into a third-year (P3) pharmacy elective. Objective: To evaluate how a week-long educational CGM wear experience affects P3 students' knowledge and confidence in using CGMs and influences their empathy toward patients with diabetes. Methods: This was a prospective, single-center study. Students enrolled in the course attended a lecture on CGMs and were invited to wear a FreeStyle Libre 3 sensor for 1 week. During the sensor-wear period, students completed daily tasks simulating the management of a patient with diabetes. Preactivity and postactivity surveys were administered to evaluate changes in knowledge (9 items), confidence (5 items), and empathy (6 items) related to CGMs and diabetes care. Change in knowledge was assessed using a paired t test while change in confidence and empathy were assessed using Wilcoxon signed-rank test. Results: Seventeen students participated in the wear experience, completed the presurvey and postsurvey, and were included in the analysis. Statistically significant increases were noted in the knowledge assessment scores (54.4% vs 70%, P < 0.005), all self-reported confidence items (P < 0.05), and 2 empathy items related to wearing the CGM sensor (P < 0.05). Students reported being woken up by the alarms as the biggest challenge. Conclusions: Following this week-long CGM wear activity, students demonstrated improved knowledge, confidence, and empathy related to CGMs and diabetes care.

Background: Among health care professionals, burnout is of growing concern, affecting both personal well-being and professional performance. Burnout poses significant risks to patient care with diminished work quality and increased staff turnover. Factors contributing to burnout have been identified although specific preventative resources and accessibility data remain limited. Objective: This study aimed to evaluate burnout among emergency medicine and critical care pharmacists, and identify the availability and impact of employer-provided resources on burnout. Methods: This national survey aimed to describe burnout and preventative resource utilization among emergency medicine and critical care pharmacists. Responses were collected from December 20, 2024 to February 14, 2025 from self-identified critical care and emergency medicine pharmacists that accessed the survey from professional listserv posts or email invitations. Demographic information was collected, and burnout was assessed using the Oldenburg Burnout Inventory (range 16-64, with higher scores indicating more burnout). Descriptive statistics, Student's t tests, and analysis of variance (ANOVA) were used with statistical significance defined as P < 0.05. Multivariable linear regression models were used to understand the relationships among variables and burnout. Free text survey responses were reviewed and coded based on themes. Results: Among 346 completed surveys, 72.1% were submitted by female pharmacists, and 50% of respondents practice in emergency medicine. Moderate burnout was observed with a mean score of 39.1 (SD = 7.1). 46.4% of participants indicated using resources at least monthly with clinical support during shifts the most common. All multivariate models demonstrated an association between lack of peer support and burnout. The top resources pharmacists suggested for reducing burnout included improved scheduling, improved staffing ratios, and scheduled nonclinical time. Conclusions: Moderate burnout was observed among critical care and emergency medicine pharmacists with a strong desire for increased leadership support within staffing indicated. In addition, leaders should consider creating formal peer support programs to prevent or address burnout.

Hepatitis B virus (HBV) infection can lead to severe complications, including cirrhosis, hepatocellular carcinoma, and death. Entecavir, a guanosine nucleoside analogue, is recommended for chronic hepatitis B virus (CHB) and is rarely associated with myopathy. This report presents a 65-year-old woman with CHB who developed suspected entecavir-associated myopathy. The patient, with a history of hypertension, systemic lupus erythematosus, rheumatoid arthritis, seizures, stroke, polyneuropathy, cervical and lumbar myelopathy, bilateral lumbar radiculopathy, and alcohol use, was admitted for chest pain. Acute pathologies were ruled out; however, acute reactivation of CHB was identified. Entecavir was initiated, but the patient developed significant fatigue and muscle weakness within days, in the absence of acute liver failure. On discontinuation of entecavir and initiation of tenofovir disoproxil fumarate, the patient's symptoms improved. This case highlights the rare but serious adverse effects of entecavir, emphasizing the need for careful monitoring and consideration of alternative treatments in patients with CHB.

Objective: To evaluate the potential for drug interactions with pharmacotherapy for central hypersomnolence (modafinil, armodafinil, solriamfetol, pitolisant, sodium oxybate, methylphenidate, amphetamine, lithium, clarithromycin). Data Sources: A systemic literature search (1980 to June 2025) was performed using PUBMED, SCOPUS, and EMBASE to locate relevant articles. The MeSH terms included specific medication and "drug interactions." DAILYMED was used for product-specific interactions. Study Selection and Data Extraction: The search was conducted to identify drug interactions with excessive daytime sleepiness treatments. The search was limited to those articles studying humans and publications using the English language. Case reports, clinical trials, review articles, treatment guidelines, and package labeling were selected for inclusion. Data Synthesis: Primary literature and package labeling indicate that pharmacotherapy for central hypersomnolence is subject to both pharmacokinetic and pharmacodynamic interactions. While some interactions can be clinically significant, much of the data available for potential drug interactions was found in the package labeling and not from the primary literature. Conclusions: Available literature indicates that pharmacotherapy for central hypersomnolence is associated with clinically significant drug interventions and subsequent possible adverse reactions. Clinicians in all practice settings should be mindful of the potential to minimize drug interactions and optimize pharmacotherapy for hypersomnolence.

Background: In patients with acute ischemic stroke (AIS), tenecteplase and alteplase help preserve brain tissue. The 2019 American Heart Association/American Stroke Association guidelines designate alteplase as the first-line therapy for AIS, listing tenecteplase as a reasonable alternative for patients eligible for mechanical thrombectomy. The 2023 European Stroke Organisation recommends tenecteplase in patients with AIS due to large vessel occlusion prior to thrombectomy. Our institution adopted tenecteplase as the formulary fibrinolytic for AIS due to emerging clinical data, reduced cost, and operational benefits. Objective: The objective was to compare outcomes associated with tenecteplase versus alteplase in AIS. Methods: This multicenter, retrospective study included adults treated with tenecteplase or alteplase for AIS between April 1, 2022 and April 1, 2023. The primary outcome was intracranial hemorrhage (ICH) within 36 hours. Secondary outcomes included hospital and intensive care unit length of stay, in-hospital all-cause mortality, door-to-needle time, time to reperfusion, and adverse events. A subgroup analysis was performed to assess ICH that required reversal therapies. Results: There was no significant difference in the incidence of ICH between the tenecteplase and alteplase groups (20.4% vs 11.7%; P = 0.09). Within the subgroup analysis, a higher proportion of patients in the tenecteplase group required reversal therapies for ICH compared with the alteplase group (35.0% vs 8.3%; P = 0.09). Secondary outcomes were similar between groups. Conclusion: There was no significant difference in the incidence of ICH after tenecteplase or alteplase administration. Further studies are warranted to clarify the comparative safety profiles of tenecteplase and alteplase.

Universal Licensing Recognition (ULR) laws have emerged as a key policy tool to improve license mobility by allowing licensure obtained in one state to be more easily recognized in another. While these reforms have increased access to licensure and employment opportunities, they generally apply only to initial licensure, not to renewal. Nearly all state boards of pharmacy require continuing education (CE) for license renewal, yet CE requirements vary significantly across states in terms of hours, topics, formats, reporting frequency, and approved providers. These discrepancies create substantial administrative burdens for pharmacists maintaining active licenses in multiple jurisdictions. This article examines the implications of extending ULR principles to license renewal, using a case study of a pharmacist licensed in West Virginia and neighboring states. The analysis suggests that pharmacists working across state lines often default to the most restrictive CE standards to ensure compliance, incurring unnecessary cost and complexity. We highlight Idaho's 2024 reform to its ULR statute, which exempts multistate licensees from duplicative CE requirements if they comply with their home state's CE standards and limits overall CE burdens based on regional averages. These reforms offer a promising model for pharmacy regulators seeking to reduce administrative friction, support workforce flexibility, and enhance access to care without compromising professional standards.