Pub Date : 2023-12-29DOI: 10.1177/87551225231220221
Soon Hye Yang, Neha Mittal, Amanda L. Bell, Christian E. Bell
Objective: The objective of the study is to highlight the role and safety of romosozumab in patients at high risk of fractures in primary care. Data Sources: A systemic database search of PubMed/MEDLINE, ClinicalTrials.gov, and Cochrane Library was conducted for articles with keywords romosozumab, osteoporosis, and safety between inception and July 2022. Study Selection and Data Extraction: Phase 3 trials in patients with osteoporosis were included. Data results from these trials were utilized for assessment. Data Synthesis: Romosozumab decreased vertebral fracture incidence by 73% at 12 months ( P < 0.001) in osteoporotic postmenopausal women compared with placebo. In an active-controlled fracture study in postmenopausal women with osteoporosis at high risk of fracture, a 48% lower risk of new vertebral fracture was observed at 24 months in the romosozumab-alendronate group ( P < 0.001) compared with alendronate group. In a study comparing romosozumab with teriparatide in postmenopausal women with osteoporosis at high risk of fracture, 2.6% of the mean percentage change from baseline in the total hip (TH) areal bone mineral density (BMD) was observed with romosozumab, while teriparatide led –0.6% of change ( P < 0.0001). Romosozumab significantly increased the mean percentage change from baseline in the lumbar spine (LS) and total hip (TH) BMD than placebo in men with osteoporosis (LS, 12.1% vs 1.2%; TH, 2.5% vs –0.5%; P < 0.001). Serious cardiovascular events were observed in the romosozumab compared with alendronate (2.5% vs 1.9%; odds ratio [OR] = 1.31; 95% confidence interval [CI] = 0.85-2.00) in postmenopausal women, and placebo (4.9% vs 2.5%) in men with osteoporosis. Relevance to Patient Care and Clinical Practice: This review discusses the role of romosozumab in patients with high fracture risk and its safety in primary care. Conclusions: Primary care physicians should consider romosozumab for patients at high fracture risk who are intolerant or have not responded to other pharmacological treatment. Further studies are needed to clarify the safety of cardiovascular events.
{"title":"Utilization of Romosozumab in Primary Care","authors":"Soon Hye Yang, Neha Mittal, Amanda L. Bell, Christian E. Bell","doi":"10.1177/87551225231220221","DOIUrl":"https://doi.org/10.1177/87551225231220221","url":null,"abstract":"Objective: The objective of the study is to highlight the role and safety of romosozumab in patients at high risk of fractures in primary care. Data Sources: A systemic database search of PubMed/MEDLINE, ClinicalTrials.gov, and Cochrane Library was conducted for articles with keywords romosozumab, osteoporosis, and safety between inception and July 2022. Study Selection and Data Extraction: Phase 3 trials in patients with osteoporosis were included. Data results from these trials were utilized for assessment. Data Synthesis: Romosozumab decreased vertebral fracture incidence by 73% at 12 months ( P < 0.001) in osteoporotic postmenopausal women compared with placebo. In an active-controlled fracture study in postmenopausal women with osteoporosis at high risk of fracture, a 48% lower risk of new vertebral fracture was observed at 24 months in the romosozumab-alendronate group ( P < 0.001) compared with alendronate group. In a study comparing romosozumab with teriparatide in postmenopausal women with osteoporosis at high risk of fracture, 2.6% of the mean percentage change from baseline in the total hip (TH) areal bone mineral density (BMD) was observed with romosozumab, while teriparatide led –0.6% of change ( P < 0.0001). Romosozumab significantly increased the mean percentage change from baseline in the lumbar spine (LS) and total hip (TH) BMD than placebo in men with osteoporosis (LS, 12.1% vs 1.2%; TH, 2.5% vs –0.5%; P < 0.001). Serious cardiovascular events were observed in the romosozumab compared with alendronate (2.5% vs 1.9%; odds ratio [OR] = 1.31; 95% confidence interval [CI] = 0.85-2.00) in postmenopausal women, and placebo (4.9% vs 2.5%) in men with osteoporosis. Relevance to Patient Care and Clinical Practice: This review discusses the role of romosozumab in patients with high fracture risk and its safety in primary care. Conclusions: Primary care physicians should consider romosozumab for patients at high fracture risk who are intolerant or have not responded to other pharmacological treatment. Further studies are needed to clarify the safety of cardiovascular events.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":" 23","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139142538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29DOI: 10.1177/87551225231220214
Silas Contaifer, Barbara Exum, D. Wijesinghe, Lauren M. Caldas
Background: Virtual reality (VR) has not been used in pharmacy education when teaching sterile compounding. Objective: The objective of this study was to describe the development of a VR 360 video for second-year student pharmacists. The secondary objective was to assess the VR experience, specifically on participants’ knowledge and performance in sterile compounding, as well as the VR video demands and efforts. Methods: This cross-sectional, open-label randomized study developed a VR 360 video introducing sterile compounding, created with Insta360 Pro and GoPro cameras. The video creation required two individuals to record and one individual to edit for approximately 12 hours of creation time. Participants’ knowledge and performance were assessed through ten knowledge questions and the class activity rubric. The NASA Task Load Index (TLX) measured the VR experience demands and efforts for the VR sterile compounding introduction. Results: Of the 98 second-year student pharmacists, 19 consented to the study with 7 in the VR group and 12 controls. Student knowledge increased from 6.33 (0.8) to 8 (1.2) for the VR group and 7 (0.7) to 8 (0.7) for the control group. Performance for the classroom activity was 23.71 (0.3) for the VR group and 22.96 (0.9) for the control group. The NASA TLX values demonstrated positive findings for the VR experience. Conclusion: With the limited study enrollment, comparative analysis between standard materials and the VR 360 video could not be determined. This article describes the creation of a VR sterile compounding 360 video with excerpts included. Future studies to compare traditional materials to VR will be completed in the future.
{"title":"A Virtual Reality 360 Video to Introduce Second-Year Student Pharmacists to Sterile Compounding Prior to Course Activity","authors":"Silas Contaifer, Barbara Exum, D. Wijesinghe, Lauren M. Caldas","doi":"10.1177/87551225231220214","DOIUrl":"https://doi.org/10.1177/87551225231220214","url":null,"abstract":"Background: Virtual reality (VR) has not been used in pharmacy education when teaching sterile compounding. Objective: The objective of this study was to describe the development of a VR 360 video for second-year student pharmacists. The secondary objective was to assess the VR experience, specifically on participants’ knowledge and performance in sterile compounding, as well as the VR video demands and efforts. Methods: This cross-sectional, open-label randomized study developed a VR 360 video introducing sterile compounding, created with Insta360 Pro and GoPro cameras. The video creation required two individuals to record and one individual to edit for approximately 12 hours of creation time. Participants’ knowledge and performance were assessed through ten knowledge questions and the class activity rubric. The NASA Task Load Index (TLX) measured the VR experience demands and efforts for the VR sterile compounding introduction. Results: Of the 98 second-year student pharmacists, 19 consented to the study with 7 in the VR group and 12 controls. Student knowledge increased from 6.33 (0.8) to 8 (1.2) for the VR group and 7 (0.7) to 8 (0.7) for the control group. Performance for the classroom activity was 23.71 (0.3) for the VR group and 22.96 (0.9) for the control group. The NASA TLX values demonstrated positive findings for the VR experience. Conclusion: With the limited study enrollment, comparative analysis between standard materials and the VR 360 video could not be determined. This article describes the creation of a VR sterile compounding 360 video with excerpts included. Future studies to compare traditional materials to VR will be completed in the future.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"81 6","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139146735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-23DOI: 10.1177/87551225231217903
Astrid Marie Sant, Stephanie Portelli, Clive Ballard, Maria Bezzina-Xuereb, Charles Scerri, Janet Sultana
Background: Despite global concerns of an opioid epidemic, there is no systematic literature review on how frequently these drugs are used in nursing home (NH) populations, including those living with dementia. Objective: This systematic review aims to describe the prevalence and incidence of opioid use in NHs. A secondary objective is to describe the use of these drugs in a subset of NH residents, namely among persons living with dementia. Methods: A systematic literature review was carried out using MEDLINE and Scopus (PROSPERO registration number CRD42021254210). Screening of title and abstract was carried out by 2 persons independently for studies published between January 1, 2011 and May 19, 2021. The main outcomes were annual prevalence, period prevalence, and duration of opioid use. Results: From a total of 178 identified studies, 29 were considered eligible for inclusion. The annual prevalence of any opioid use among all NH residents without any selection criteria ranged from 6.3% to 50% with a median annual prevalence of 22.9% (Q25-Q75: 19.5%-30.2%), based on 17 studies. Five studies measured the annual prevalence in NH residents living with dementia, finding that this ranged from 10% to 39.6%. Conclusions: More evidence is needed quantifying opioid use in NH, especially among persons living with dementia. Given that opioid use in NH is still a problem, implementation of a pain management protocol in NH or nationally would help improve clinical outcomes.
{"title":"Prevalence of Opioid Use in Nursing Homes Over the Last Decade: A Systematic Literature Review","authors":"Astrid Marie Sant, Stephanie Portelli, Clive Ballard, Maria Bezzina-Xuereb, Charles Scerri, Janet Sultana","doi":"10.1177/87551225231217903","DOIUrl":"https://doi.org/10.1177/87551225231217903","url":null,"abstract":"Background: Despite global concerns of an opioid epidemic, there is no systematic literature review on how frequently these drugs are used in nursing home (NH) populations, including those living with dementia. Objective: This systematic review aims to describe the prevalence and incidence of opioid use in NHs. A secondary objective is to describe the use of these drugs in a subset of NH residents, namely among persons living with dementia. Methods: A systematic literature review was carried out using MEDLINE and Scopus (PROSPERO registration number CRD42021254210). Screening of title and abstract was carried out by 2 persons independently for studies published between January 1, 2011 and May 19, 2021. The main outcomes were annual prevalence, period prevalence, and duration of opioid use. Results: From a total of 178 identified studies, 29 were considered eligible for inclusion. The annual prevalence of any opioid use among all NH residents without any selection criteria ranged from 6.3% to 50% with a median annual prevalence of 22.9% (Q25-Q75: 19.5%-30.2%), based on 17 studies. Five studies measured the annual prevalence in NH residents living with dementia, finding that this ranged from 10% to 39.6%. Conclusions: More evidence is needed quantifying opioid use in NH, especially among persons living with dementia. Given that opioid use in NH is still a problem, implementation of a pain management protocol in NH or nationally would help improve clinical outcomes.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"48 S1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139162757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1177/87551225231217906
Gwendolyn M. Knowles, Grace E. LaFleur, Mariann D. Churchwell
Background: Gabapentin and pregabalin are well-tolerated medications primarily cleared by the kidney. Patients receiving higher gabapentinoid doses with decreased kidney function may be at an increased risk of adverse effects (AEs), but limited evidence exists evaluating gabapentinoid dosing and AEs in this population. Objective: To determine whether patients with decreased creatinine clearance (CrCl) experienced increased frequency of AEs related to gabapentinoid dose at hospital admission. Methods: Single-center retrospective cohort study in adults with a gabapentinoid prescription and serum creatinine measurement documented on hospital admission. The primary outcome was the appropriateness of gabapentinoid prescription based on CrCl (stratified by CrCl ≥60 mL/min, <60 mL/min, 15-29 mL/min, and <15 mL/min) at admission. Secondary outcomes included the incidence of AEs related to gabapentinoids and concomitant opioid and psychiatric prescriptions. Results: A total of 286 patients were included in this study (gabapentin n = 234, pregabalin n = 52). Patients with a CrCl <60 mL/min and doses above the manufacturer’s recommendation were prescribed gabapentin (34%) and pregabalin (22.7%). For patients with a CrCl of 15 to 29 mL/min and <15 mL/min groups, inappropriately high doses were prescribed for gabapentin (48.8%) and pregabalin (45%). A significant increase in recorded falls ( P = 0.029) was identified in patients with a CrCl <60 mL/min. Concomitant opioid and psychiatric medications contributed to a higher prevalence of AEs regardless of CrCl. Conclusions: Patients with a CrCl <60 mL/min were frequently prescribed inappropriately high doses of gabapentinoids. The relationship between gabapentinoid dosing, kidney function, and the incidence of gabapentinoid-related AEs at hospital admission requires larger, multicentre studies.
{"title":"Evaluation of Gabapentin and Pregabalin Use in Hospitalized Patients With Decreased Kidney Function","authors":"Gwendolyn M. Knowles, Grace E. LaFleur, Mariann D. Churchwell","doi":"10.1177/87551225231217906","DOIUrl":"https://doi.org/10.1177/87551225231217906","url":null,"abstract":"Background: Gabapentin and pregabalin are well-tolerated medications primarily cleared by the kidney. Patients receiving higher gabapentinoid doses with decreased kidney function may be at an increased risk of adverse effects (AEs), but limited evidence exists evaluating gabapentinoid dosing and AEs in this population. Objective: To determine whether patients with decreased creatinine clearance (CrCl) experienced increased frequency of AEs related to gabapentinoid dose at hospital admission. Methods: Single-center retrospective cohort study in adults with a gabapentinoid prescription and serum creatinine measurement documented on hospital admission. The primary outcome was the appropriateness of gabapentinoid prescription based on CrCl (stratified by CrCl ≥60 mL/min, <60 mL/min, 15-29 mL/min, and <15 mL/min) at admission. Secondary outcomes included the incidence of AEs related to gabapentinoids and concomitant opioid and psychiatric prescriptions. Results: A total of 286 patients were included in this study (gabapentin n = 234, pregabalin n = 52). Patients with a CrCl <60 mL/min and doses above the manufacturer’s recommendation were prescribed gabapentin (34%) and pregabalin (22.7%). For patients with a CrCl of 15 to 29 mL/min and <15 mL/min groups, inappropriately high doses were prescribed for gabapentin (48.8%) and pregabalin (45%). A significant increase in recorded falls ( P = 0.029) was identified in patients with a CrCl <60 mL/min. Concomitant opioid and psychiatric medications contributed to a higher prevalence of AEs regardless of CrCl. Conclusions: Patients with a CrCl <60 mL/min were frequently prescribed inappropriately high doses of gabapentinoids. The relationship between gabapentinoid dosing, kidney function, and the incidence of gabapentinoid-related AEs at hospital admission requires larger, multicentre studies.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":" 44","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138964341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-15DOI: 10.1177/87551225231218164
James Debono, D. Balzan, John-Joseph Borg, Stephen Falzon, Dania al-Haddad, Benjamin Micallef, Janet Sultana
Nivolumab is used to treat several different types of cancers. Although it is generally considered to be effective and well-tolerated, it has been associated with adverse effects requiring discontinuation of treatment, like many other drugs used for cancer. A 70-year-old male was switched from sunitinib to nivolumab for renal cell carcinoma. The patient developed persistent hypothyroidism, onycholysis, and pneumonitis at nivolumab cycle 6, 10, and 11, respectively. Using the Naranjo causality method, the likelihood of causality was deemed “probable” for pneumonitis and hypothyroidism and “possible” for onycholysis. Nivolumab was eventually discontinued due to disease progression, rather than safety concerns. Eudravigilance, the European pharmacovigilance database, was searched for all nivolumab-related individual case safety reports from Malta, up to September 4, 2023. Six reports were identified in Malta, although the 3 events identified in this case report were not reported, suggesting under-reporting in Malta. This case report identified an uncommon nivolumab adverse drug reaction (ADR), onycholysis and showed how, despite the occurrence of 3 ADRs, it was its lack of efficacy rather than its safety which led to its discontinuation in this particular patient.
{"title":"Nivolumab Safety in Renal Cell Carcinoma: A Case Report","authors":"James Debono, D. Balzan, John-Joseph Borg, Stephen Falzon, Dania al-Haddad, Benjamin Micallef, Janet Sultana","doi":"10.1177/87551225231218164","DOIUrl":"https://doi.org/10.1177/87551225231218164","url":null,"abstract":"Nivolumab is used to treat several different types of cancers. Although it is generally considered to be effective and well-tolerated, it has been associated with adverse effects requiring discontinuation of treatment, like many other drugs used for cancer. A 70-year-old male was switched from sunitinib to nivolumab for renal cell carcinoma. The patient developed persistent hypothyroidism, onycholysis, and pneumonitis at nivolumab cycle 6, 10, and 11, respectively. Using the Naranjo causality method, the likelihood of causality was deemed “probable” for pneumonitis and hypothyroidism and “possible” for onycholysis. Nivolumab was eventually discontinued due to disease progression, rather than safety concerns. Eudravigilance, the European pharmacovigilance database, was searched for all nivolumab-related individual case safety reports from Malta, up to September 4, 2023. Six reports were identified in Malta, although the 3 events identified in this case report were not reported, suggesting under-reporting in Malta. This case report identified an uncommon nivolumab adverse drug reaction (ADR), onycholysis and showed how, despite the occurrence of 3 ADRs, it was its lack of efficacy rather than its safety which led to its discontinuation in this particular patient.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"93 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-15DOI: 10.1177/87551225231217905
Laurie DeMillard, Michael Thuyns
Background: Vasopressors, including norepinephrine, epinephrine, and phenylephrine are commonly used to maintain mean arterial pressure (MAP) in critically ill patients. Despite their frequent use, the optimal dosing strategy for vasopressors remains understudied. Objective: The purpose of this study is to evaluate the implementation of a weight-based (WB) dosing strategy using ideal body weight compared to a non-weight-based (NWB) dosing strategy for vasopressors in critically ill patients. Methods: This is a retrospective chart review of patients admitted to intensive care units receiving vasopressor medications for greater than or equal to 4 hours. Patients received either an NWB or a WB vasopressor dosing strategy. The primary endpoint was the time to achieve goal MAP. Results: This study included 153 patients in the NWB vasopressor dosing group and 183 in the WB dosing group. The median time to achieve goal MAP in the NWB group was 24 minutes versus 21 minutes in the WB group ( P = 0.1713). There were no significant differences in secondary outcomes including number of vasoactive agents required, hospital length of stay, and duration of mechanical ventilation. Subgroup analysis of patients with extremes of body mass index did not show a difference in time to achieve goal MAP. In a subgroup analysis of patients with septic shock, a higher percentage of patients in the WB group received corticosteroids than the NWB group patients (14% vs. 54%; P ≤ 0.001). Conclusion and relevance: There was no difference in time to achieve goal MAP when using a WB or NWB vasopressor dosing approach. Institutions should employ a consistent dosing strategy for vasopressors with either an NWB or WB approach.
{"title":"Implementation and Evaluation of Weight-Based Vasopressors in Intensive Care Units","authors":"Laurie DeMillard, Michael Thuyns","doi":"10.1177/87551225231217905","DOIUrl":"https://doi.org/10.1177/87551225231217905","url":null,"abstract":"Background: Vasopressors, including norepinephrine, epinephrine, and phenylephrine are commonly used to maintain mean arterial pressure (MAP) in critically ill patients. Despite their frequent use, the optimal dosing strategy for vasopressors remains understudied. Objective: The purpose of this study is to evaluate the implementation of a weight-based (WB) dosing strategy using ideal body weight compared to a non-weight-based (NWB) dosing strategy for vasopressors in critically ill patients. Methods: This is a retrospective chart review of patients admitted to intensive care units receiving vasopressor medications for greater than or equal to 4 hours. Patients received either an NWB or a WB vasopressor dosing strategy. The primary endpoint was the time to achieve goal MAP. Results: This study included 153 patients in the NWB vasopressor dosing group and 183 in the WB dosing group. The median time to achieve goal MAP in the NWB group was 24 minutes versus 21 minutes in the WB group ( P = 0.1713). There were no significant differences in secondary outcomes including number of vasoactive agents required, hospital length of stay, and duration of mechanical ventilation. Subgroup analysis of patients with extremes of body mass index did not show a difference in time to achieve goal MAP. In a subgroup analysis of patients with septic shock, a higher percentage of patients in the WB group received corticosteroids than the NWB group patients (14% vs. 54%; P ≤ 0.001). Conclusion and relevance: There was no difference in time to achieve goal MAP when using a WB or NWB vasopressor dosing approach. Institutions should employ a consistent dosing strategy for vasopressors with either an NWB or WB approach.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"29 5","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1177/87551225231216638
Sarah Casella, Katelyn Galli
Introduction: While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become increasingly prescribed, use is often inhibited by the gastrointestinal adverse effects that patients must endure. Nausea, vomiting, and cholelithiasis are most commonly associated with use, with little to no data or labeling reflecting risk of appendicitis or associated symptoms. Appendicitis etiology is theorized to develop secondary to obstruction of the vermiform via infection or fecalith causing an increase in intraluminal pressure. It is hypothesized that given the aforementioned gastrointestinal effects associated with GLP-1 RAs, patients taking such agents may be more at risk for developing this acute condition. Patient Case: We describe a case of a 48-year-old woman who presented to the emergency department several months after being initiated on Ozempic (semaglutide). This report aims to analyze the potential secondary adverse effects that may result from GLP-1 RA use. Her examination was positive for focal abdominal tenderness and leukocytosis along with imaging suggestive of appendicitis. Her acute condition ultimately required an appendectomy. Discussion: While minimal data are available to suggest significant causation between GLP-1 RAs and appendicitis, a literature and database search revealed that instances may be more common than previously thought. Conclusion: Trial results and adverse event reporting systems report an infrequent incidence in patients using these medications, but this report aims to contribute to the literature describing this potential adverse event.
{"title":"Appendicitis: A Hidden Danger of GLP-1 Receptor Agonists?","authors":"Sarah Casella, Katelyn Galli","doi":"10.1177/87551225231216638","DOIUrl":"https://doi.org/10.1177/87551225231216638","url":null,"abstract":"Introduction: While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become increasingly prescribed, use is often inhibited by the gastrointestinal adverse effects that patients must endure. Nausea, vomiting, and cholelithiasis are most commonly associated with use, with little to no data or labeling reflecting risk of appendicitis or associated symptoms. Appendicitis etiology is theorized to develop secondary to obstruction of the vermiform via infection or fecalith causing an increase in intraluminal pressure. It is hypothesized that given the aforementioned gastrointestinal effects associated with GLP-1 RAs, patients taking such agents may be more at risk for developing this acute condition. Patient Case: We describe a case of a 48-year-old woman who presented to the emergency department several months after being initiated on Ozempic (semaglutide). This report aims to analyze the potential secondary adverse effects that may result from GLP-1 RA use. Her examination was positive for focal abdominal tenderness and leukocytosis along with imaging suggestive of appendicitis. Her acute condition ultimately required an appendectomy. Discussion: While minimal data are available to suggest significant causation between GLP-1 RAs and appendicitis, a literature and database search revealed that instances may be more common than previously thought. Conclusion: Trial results and adverse event reporting systems report an infrequent incidence in patients using these medications, but this report aims to contribute to the literature describing this potential adverse event.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"15 10","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138591284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-06DOI: 10.1177/87551225231216328
Gaidaa M. Dogheim, Rehab H. Werida
Background: Antimicrobial resistance is a global health crisis threatening optimal management of infectious diseases. Ciprofloxacin is a widely used fluoroquinolone in various disease conditions. Resistance against ciprofloxacin is increasing, leading to nonoptimal management of patients. Thus, the aim of this study was to assess ciprofloxacin use in the community setting in terms of appropriate prescribing, dosing, frequency, and duration of use. Methods: A cross-sectional, retrospective study was conducted by community pharmacists in 5 community pharmacies in Egypt from September 2021 to February 2022. Patients prescribed oral ciprofloxacin during the period of the study were included. Data on demographics, indications for ciprofloxacin, dosing regimen, adverse events, and drug interactions were collected. Results: A total of 151 patients’ record indicated for ciprofloxacin were included in the study, of whom 44.4% were men and 55.6% were women who were neither pregnant nor lactating. Based on international guidelines, 96.69% ciprofloxacin prescriptions were appropriate; 96.03% contained correct ciprofloxacin dosing whereas 3.97% were overdose. A total of 90. 73% had correct frequency of administration and 96.03% records had correct durations. Only 1.99% of patients were ≤18 years of age, which is an absolute contraindication. Interacting drugs with ciprofloxacin were 28.5% with acetaminophen, 31.1% with ibuprofen, 16.6% with antacids, 21.2% with chlorpheniramine, and 7.9% with prednisolone. Adverse events included 1.32% hypoglycemia, 0.66% hyperglycemia, 3.97% tendinitis, and 2.65% QTc (heart rate–corrected QT interval) prolongation. Conclusion and relevance: Ciprofloxacin use in community pharmacies is appropriate according to international guidelines. Ongoing drug utilization evaluation is necessary to ensure rational drug use, which in turn can decrease resistance rates.
{"title":"Drug Utilization Evaluation Study of Ciprofloxacin Use and Adverse Events Occurrence: Role of Community Pharmacists","authors":"Gaidaa M. Dogheim, Rehab H. Werida","doi":"10.1177/87551225231216328","DOIUrl":"https://doi.org/10.1177/87551225231216328","url":null,"abstract":"Background: Antimicrobial resistance is a global health crisis threatening optimal management of infectious diseases. Ciprofloxacin is a widely used fluoroquinolone in various disease conditions. Resistance against ciprofloxacin is increasing, leading to nonoptimal management of patients. Thus, the aim of this study was to assess ciprofloxacin use in the community setting in terms of appropriate prescribing, dosing, frequency, and duration of use. Methods: A cross-sectional, retrospective study was conducted by community pharmacists in 5 community pharmacies in Egypt from September 2021 to February 2022. Patients prescribed oral ciprofloxacin during the period of the study were included. Data on demographics, indications for ciprofloxacin, dosing regimen, adverse events, and drug interactions were collected. Results: A total of 151 patients’ record indicated for ciprofloxacin were included in the study, of whom 44.4% were men and 55.6% were women who were neither pregnant nor lactating. Based on international guidelines, 96.69% ciprofloxacin prescriptions were appropriate; 96.03% contained correct ciprofloxacin dosing whereas 3.97% were overdose. A total of 90. 73% had correct frequency of administration and 96.03% records had correct durations. Only 1.99% of patients were ≤18 years of age, which is an absolute contraindication. Interacting drugs with ciprofloxacin were 28.5% with acetaminophen, 31.1% with ibuprofen, 16.6% with antacids, 21.2% with chlorpheniramine, and 7.9% with prednisolone. Adverse events included 1.32% hypoglycemia, 0.66% hyperglycemia, 3.97% tendinitis, and 2.65% QTc (heart rate–corrected QT interval) prolongation. Conclusion and relevance: Ciprofloxacin use in community pharmacies is appropriate according to international guidelines. Ongoing drug utilization evaluation is necessary to ensure rational drug use, which in turn can decrease resistance rates.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"12 6","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138596916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-18DOI: 10.1177/87551225231211737
Hakeam A. Hakeam, Khadija A. Sarkhi, Alla Iansavichene
Objective: To describe the clinical characteristics of hypoglycemia that develop with tigecycline therapy and to review and summarize the current evidence of this uncommonly occurring metabolic adverse effect of tigecycline therapy. Underlying risk factors and potential mechanisms are also discussed. Data source: A 3-phase literature search was performed. In phase 1, the Cochrane Central Register of Controlled Trials (CENTRAL) Library, MEDLINE, and Embase electronic databases were searched for hypoglycemia and tigecycline, published from inception until August 2023. In phase 2, MEDLINE was searched for tigecycline randomized controlled trials and results were manually screened for hypoglycemia. In phase 3, the US Food and Drug Administration Adverse Event Reporting System public dashboard was searched for reports on tigecycline and hypoglycemia from June 2005 until July 2023. Study selection and data extraction: Relevant English-language citations and those conducted in humans were considered. Relevance to patient care and clinical practice: Hypoglycemia of various causes is an independent mortality risk. This review raises awareness among clinicians about the possibility of hypoglycemia with tigecycline therapy. Conclusion: Data on tigecycline-related hypoglycemia are scarce. Hypoglycemia may occur at any time during tigecycline therapy and can be severe and persist for days after tigecycline cessation. Renal dysfunction or renal replacement therapy may predispose to severe hypoglycemia during tigecycline therapy. Tigecycline-related hypoglycemia may develop in patients with or without diabetes mellitus and appears independent of insulin or antidiabetic agents. Intravenous dextrose showed efficacy in the restoration of euglycemia. Studies are needed to determine whether tigecycline-related hypoglycemia is iatrogenic or spontaneous.
目的描述替加环素治疗过程中出现的低血糖症的临床特征，回顾并总结替加环素治疗过程中这种罕见代谢不良反应的现有证据。此外，还讨论了潜在的风险因素和机制。数据来源：进行了三个阶段的文献检索。在第 1 阶段，在 Cochrane 对照试验中央注册库 (CENTRAL) 图书馆、MEDLINE 和 Embase 电子数据库中检索了从开始到 2023 年 8 月发表的有关低血糖和替加环素的文献。第 2 阶段，在 MEDLINE 中检索替加环素随机对照试验，并对结果进行人工低血糖筛查。第三阶段，在美国食品和药物管理局不良事件报告系统（US Food and Drug Administration Adverse Event Reporting System public dashboard）中搜索自 2005 年 6 月至 2023 年 7 月有关替加环素和低血糖症的报告。研究选择和数据提取：考虑相关的英文引文和在人体中进行的研究。与患者护理和临床实践的相关性：各种原因导致的低血糖是一种独立的死亡风险。本综述提高了临床医生对替加环素治疗低血糖可能性的认识。结论有关替加环素相关低血糖症的数据很少。低血糖可能在替加环素治疗期间的任何时候发生，严重的低血糖可能在停用替加环素后持续数天。肾功能不全或肾脏替代疗法可能导致在替加环素治疗期间出现严重低血糖。无论患者是否患有糖尿病，都可能出现与替加环素相关的低血糖症，且与胰岛素或抗糖尿病药物无关。静脉注射葡萄糖对恢复优格血症有效。需要进行研究以确定与替加环素相关的低血糖症是先天性的还是自发性的。
{"title":"Tigecycline and Hypoglycemia, When and How?","authors":"Hakeam A. Hakeam, Khadija A. Sarkhi, Alla Iansavichene","doi":"10.1177/87551225231211737","DOIUrl":"https://doi.org/10.1177/87551225231211737","url":null,"abstract":"Objective: To describe the clinical characteristics of hypoglycemia that develop with tigecycline therapy and to review and summarize the current evidence of this uncommonly occurring metabolic adverse effect of tigecycline therapy. Underlying risk factors and potential mechanisms are also discussed. Data source: A 3-phase literature search was performed. In phase 1, the Cochrane Central Register of Controlled Trials (CENTRAL) Library, MEDLINE, and Embase electronic databases were searched for hypoglycemia and tigecycline, published from inception until August 2023. In phase 2, MEDLINE was searched for tigecycline randomized controlled trials and results were manually screened for hypoglycemia. In phase 3, the US Food and Drug Administration Adverse Event Reporting System public dashboard was searched for reports on tigecycline and hypoglycemia from June 2005 until July 2023. Study selection and data extraction: Relevant English-language citations and those conducted in humans were considered. Relevance to patient care and clinical practice: Hypoglycemia of various causes is an independent mortality risk. This review raises awareness among clinicians about the possibility of hypoglycemia with tigecycline therapy. Conclusion: Data on tigecycline-related hypoglycemia are scarce. Hypoglycemia may occur at any time during tigecycline therapy and can be severe and persist for days after tigecycline cessation. Renal dysfunction or renal replacement therapy may predispose to severe hypoglycemia during tigecycline therapy. Tigecycline-related hypoglycemia may develop in patients with or without diabetes mellitus and appears independent of insulin or antidiabetic agents. Intravenous dextrose showed efficacy in the restoration of euglycemia. Studies are needed to determine whether tigecycline-related hypoglycemia is iatrogenic or spontaneous.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"15 3","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139261601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-15DOI: 10.1177/87551225231213259
Jessica H. Williams, Savannah Young, Kaitlyn Wallace, E. Weeda
{"title":"Annual Wholesale Acquisition Costs of Novel Drugs Relative to US County-Level House Prices","authors":"Jessica H. Williams, Savannah Young, Kaitlyn Wallace, E. Weeda","doi":"10.1177/87551225231213259","DOIUrl":"https://doi.org/10.1177/87551225231213259","url":null,"abstract":"","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"23 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139273642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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