Journal of pharmacy practice最新文献

Coronary artery disease (CAD) is a major problem in the United States, impacting 5% of American adults. Ensuring medication adherence is of vital importance, as lower adherence to cardiovascular medications is associated with higher risk of cardiovascular events and mortality in patients with CAD. Many adults in the United States have poor health literacy, contributing to difficulty comprehending their conditions and potentially the importance of medication adherence. While the EPA recommended grade level for patient education materials (PEMs) is below an eighth grade level, most are written at a much higher level than this, which may cause disparity in patients' level of understanding. The purpose of our review was to benchmark the reading levels of several widely used PEMs to determine if they fell within the recommended guidelines and to discuss the potential role of pharmacists in medication education and adherence. Twenty PEMs relevant to CAD were gathered and their readability was analyzed using the software on Microsoft Word to determine the Flesch-Kincaid Grade Level (FKGL) of each PEM. It was determined that 85% of the PEMs ranked higher than the current recommendation, indicating that work needs to be done to ensure adequate patient understanding and adherence. Through pharmacist involvement, industry-wide awareness, and collaborative efforts, adherence to the readability standard can be achieved, improving health outcomes and medication adherence in patients with CAD.

BackgroundAvailable evidence for many prescription drugs comes from clinical trials that often exclude older patients. Real-world evidence (RWE) generated post-approval can provide new evidence on effectiveness and safety for these populations. We sought to understand physicians' perceptions of clinical trial and RWE for prescribing decisions. To frame the study, we used examples of drugs for heart failure and anticoagulation, which are more like to be prescribed to older adults.MethodsWe conducted an interview study of 15 US physicians specializing in geriatrics, cardiology, or primary care and affiliated with academic medical centers. Interviews were coded using a qualitative thematic analysis approach to construct themes and identify patterns in responses.ResultsAll participants described limitations in current believed real-world evidence could help inform patient care and their practice. However, they had concerns about the data. If clinical trial and RWE findings diverged, all would need more information to determine which findings to follow.ConclusionsPhysicians who routinely prescribe to older patients are optimistically cautious about RWE for drugs but would rely on trusted sources, like professional society guidelines, for incorporating it into practice. Therefore, RWE researchers should identify opportunities to work alongside guideline developers and database editors on the practice-relevant interpretation and dissemination of the evidence.

Background: Patients receiving mechanical circulatory support (MCS) devices should receive anticoagulation to avoid clotting of the circuit and to lower risk of acute thrombosis. Patients at our institution are initiated on UFH at 12 units/kg/h; however, patients weighing > 83 kg are weight-capped (WC) at an initial rate of 1000 units/h, which equates to < 12 units/kg/h. Objective: The objective of this study was to compare time to goal anticoagulation in patients receiving MCS who were WC compared to those who were not. Methods: A retrospective cohort study was completed of patients who received UFH during admission for an MCS device and monitored by activated partial thromboplastin time (aPTT) or anti-Xa levels. The primary outcome was the percentage of patients between groups who achieved goal anti-Xa or aPTT within 48 h of UFH initiation. Results: A total of 56 patients were included, with 27 not weight-capped (NWC) and 29 WC. There was no significant difference between groups in percentage of patients who achieved goal anti-Xa or aPTT within 48 h (88.9% NWC vs 89.7% WC, P = 0.93). There was no significant difference in time to goal between groups. The NWC group had more bleeding events (4 vs 0, P = 0.031), with no difference in thrombosis. Conclusion: There was no difference in the percentage of patients reaching goal aPTT or anti-Xa within 48 h when UFH was WC. However, future studies should compare differences in time to goal anticoagulation between different UFH intensity protocols.

Background: Direct oral anticoagulants (DOACs) are commonly used for the treatment/prevention of thromboembolism. Data supporting the best practices for anticoagulation management, specifically with DOACs, at the time of solid organ transplant is limited. This study was designed to compare the perioperative bleeding risk of warfarin vs DOACs in kidney transplant recipients. Methods: This was a single center, retrospective, cohort study evaluating patients on either a DOAC or warfarin prior to kidney transplant. The primary outcome compared a composite of perioperative bleeding risk at 30 days of major bleeding and clinically relevant non-major bleeding. Secondary outcomes evaluated the incidence of type of bleeds, thromboembolism, hospital length of stay, blood product receipt, and patient/graft survival. Results: 67 kidney transplant recipients were included (n = 39 warfarin and n = 28 DOAC). The primary outcome of the composite of incidence of bleeding was no different between groups (21.4% vs 28.2% in DOAC vs warfarin groups, P = 0.52). More warfarin patients met criteria for major bleeding (20.5% vs 14.3%, P = 0.13) but this was not statistically significant. Minor bleeds were similar between DOAC vs warfarin groups (7.7% vs 7.1%, P = 0.99). Hospital length of stay was longer for warfarin patients (median [IQR] days 8 [5-12.3] vs 5 [4-6], P < 0.0001). There was no difference in the other outcomes. Conclusions: This study found no difference in risk of bleeding between groups, however warfarin patients required higher volumes of blood products and had longer hospital length of stays. This study supports DOAC use in the perioperative setting for kidney transplant recipients.

Peripheral neuropathy is a common neurological condition with diverse etiologies, including metabolic, infectious, and toxic exposures. While isopropyl alcohol (IPA) toxicity is well-documented in ingestion cases, transdermal exposure leading to neuropathy is rare. IPA is readily absorbed through intact skin and metabolized to acetone, which may exert neurotoxic effects. Chronic dermal exposure can lead to peripheral nerve damage via oxidative stress, mitochondrial dysfunction, and local inflammation. We report an 80-year-old male who developed left lower extremity numbness following topical application of IPA multiple times daily for 3 months for pain relief. After differential diagnoses were ruled out, cessation of the IPA led to complete resolution after 3 weeks.

Background: Historical trials of adjunctive dexamethasone for management of neurologic symptoms in malignant spinal cord compression (MSCC) utilized high doses of dexamethasone for 3 days then tapered over an additional 12 days. There is limited evidence on the current practice of adjunctive dexamethasone. Objective: The purpose of this study was to evaluate various dosing strategies of dexamethasone in MSCC. Methods: This was a retrospective, single-site, analysis of hospitalized patients presenting with MSCC and received dexamethasone. Patients were grouped into 2 cohorts; an acute course (AC, ≤3 days) and a prolonged course (PC, >3 days), based on length of high-dose dexamethasone therapy (16 mg/day). Primary outcome was cumulative dexamethasone dose between groups. Other additional outcomes evaluated safety and efficacy. Results: A total of 26 patients were included, with 14 patients in the AC group and 12 in the PC group. The median cumulative dexamethasone dose was significantly lower in the AC group compared to the PC group (117 mg vs 165 mg, P < 0.001). Time to IV-to-PO conversion was significantly delayed in the PC group (6 days vs 1 day, P < 0.001). There were no significant differences in additional outcomes. Conclusion: The findings of this study provide insights into consideration of early tapering strategies to decrease dexamethasone exposure and lessen the risk of adverse effects. Despite the retrospective nature of this small study, the findings of this study highlight the need for more standardized guidance to optimal dose, duration, and tapering strategy for dexamethasone use in patients with MSCC.

We present a case of ecthyma gangrenosum caused by Stenotrophomonas maltophilia in an immunocompromised patient with aplastic anemia and on antithymocyte globulin therapy, cyclosporine, and methylprednisolone treatment. We also conducted a brief literature review on ecthyma gangrenosum caused by Stenotrophomonas maltophilia to determine optimal treatment and expected duration of therapy for infection management. This report highlights the key clinical challenges in determining optimal treatment duration for this uncommon condition taking into account underlying host factors.

Background: The Society of Critical Care Medicine's 2025 update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption suggest the use of dexmedetomidine over propofol for sedation in critically-ill, mechanically ventilated patients. With widespread use of dexmedetomidine, reports have been published describing development of fever with its use. Drug-induced fevers are usually a diagnosis of exclusion, making them hard to recognize, and misdiagnosis can lead to utilization of additional medications and resources. The objective of this study was to identify risk factors associated with dexmedetomidine-related fever in critically-ill patients. Methods: This was a single-center retrospective study conducted at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients, admitted to the intensive care unit, who received at least 12 hours of continuous dexmedetomidine infusion were included. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for dexmedetomidine-related fever. Results: Eighty one patients were included, of whom 31 (38.3%) were febrile and 50 (61.7%) were afebrile while receiving dexmedetomidine infusion. Multivariate analysis showed higher likelihood of developing fever if patients received dexmedetomidine continuously for ≥72 hours (OR 5.97, 95% CI 1.90-18.75) and if dexmedetomidine rate was ≥1 mcg/kg/hr at Tmax (OR 6.16, 95% CI 1.80-21.09). Conclusion: Dexmedetomidine infusion for 72 hours or longer and dexmedetomidine infusion rate at 1 mcg/kg/hr or greater were risk factors for developing a fever in critically ill patients in a community teaching hospital.

Introduction: Heart failure is a leading cause of morbidity and mortality worldwide. Literature suggests that the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors can be beneficial to decrease hospitalizations and cardiac mortality in patients with heart failure with an ejection fraction >40%. Research Question: This study assessed the impact of a pharmacist monitoring program on the use of SGLT2 inhibitors for patients hospitalized with heart failure with an ejection fraction >40%, accounting for documented reasons for not prescribing. Study Design: This was a single-center, retrospective, pre/post interventional study. The pre-intervention cohort was assessed for usage prior to initiation of the pharmacist monitoring program, whereas the post-intervention group was assessed after initiation. Methods: Hospitalized patients were identified retrospectively through a report of intravenous diuretic use on the cardiology floor in conjunction with a documented diagnosis of heart failure and ejection fraction >40%. Data Analysis: Data was assessed via Chi-squared or student's t-test for comparison between the pre-intervention and post-intervention groups. Results: There was a statistically significant increase in documented appropriate use of SGLT2 inhibitors after implementation of pharmacist monitoring program (40.9% pre-intervention vs 62.7% post-intervention, P = <0.001). The most common reasons they were held was due to risk of infection and renal dysfunction. Conclusion: Implementation of a pharmacist monitoring program was associated with an increase in utilization of SGLT2 inhibitors in eligible patients, driven by an increase in documentation. There was an increase in prescribing in patients that were eligible for the medication.

We describe a 47-year-old treatment-experienced African-American man co-infected with human immunodeficiency virus (HIV) and chronic hepatitis C virus (HCV) who took sofosbuvir-velpatasvir-voxilaprevir (SOF/VEL/VOX) for approximately 4 weeks and achieved sustained virologic response 12 weeks post-treatment (SVR12). Prior to initiating SOF/VEL/VOX, the patient completed 10 weeks of treatment with SOF/VEL. After 1 month of SOF/VEL/VOX, the patient was lost to follow-up for 3 months. This case report illustrates that SVR12 may be achieved in treatment-experienced patients living with HIV/HCV who complete a shortened duration of triple-direct acting antiviral therapy. Healthcare professionals should consider obtaining an HCV-RNA to assess if SVR12 was achieved prior to re-initiating treatment in patients lost to follow-up or who did not complete therapy.