Journal of pharmacy practice最新文献

Purpose: A case of enoxaparin-induced bullous hemorrhagic dermatosis is reported. Summary: A 69-year-old male with past medical history including chronic atrial fibrillation and a re-do aortic valve replacement, anticoagulated on warfarin, received an enoxaparin bridge for a molar extraction. On day 7 after restarting enoxaparin post-procedure at a therapeutic dose of 90 mg every 12 hours, the patient noticed multiple small, dark, raised lesions on his forearm and ankle. The patient denied pain, itchiness, or initiation of new medications other than enoxaparin. The patient had never experienced this side effect in the past, although he had two prior exposures to enoxaparin. A review of the available literature on cutaneous side effects from enoxaparin was performed and it was determined that the patient experienced enoxaparin-induced bullous hemorrhagic dermatosis. There is currently limited guidance on management of this rare side effect and whether enoxaparin rechallenge is safe. As benefit outweighed risk for the patient, the enoxaparin bridge was continued for an additional 3 doses, until the patient completed his supply of enoxaparin at home. Approximately within 1 week after enoxaparin was discontinued, the hemorrhagic bullae disappeared. The patient was re-exposed to enoxaparin 6 months later for a colonoscopy and the side effect did not reoccur. Conclusion: It may be safe to continue enoxaparin while experiencing enoxaparin-induced bullous hemorrhagic dermatosis as the condition is typically self-limiting. This case report shows that re-exposure to enoxaparin may be safe as it may not result in reoccurrence of the side effect.

Purpose: To provide a summarization of the most significant infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2023. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated notable articles providing significant contributions to ID pharmacotherapy in 2023. Article nominations included those pertaining to general ID and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. Out of the 31 articles nominated by HIDN members, 22 pertained to general ID pharmacotherapy, and 9 pertained to HIV/AIDS pharmacotherapy. To aid selection of the most notable articles of 2023, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 153 SIDP members who participated in the survey, there were 118 recorded votes for the top 10 general ID pharmacotherapy articles and 55 votes were recorded for the top HIV/AIDS article. The most notable publications are summarized. Conclusion: Advances in antimicrobial stewardship and infectious disease states continue to occur. Sustained growth in the publication of ID-related articles over the past year contributed to this review's aim to aid clinicians in remaining current on potentially practice-changing ID pharmacotherapy publications from 2023. This review provides a summary of recently published ID literature, including emphasis on antimicrobial stewardship, appropriate treatment durations, new antimicrobials, and drug-resistant organisms.

Background: Ceftriaxone is a third-generation cephalosporin commonly used for treating bacteremia caused by gram-positive organisms such as Streptococcus spp. and gram-negative organisms such as Enterobacterales. The typical doses for treating bacteremia are either 1 gram or 2 grams daily. Despite its widespread use, there are limited data on the optimal treatment dose for bacteremia. Methods: This IRB-approved retrospective cohort study evaluated the difference in the clinical failure rate among patients who received 1 gram or 2 grams of ceftriaxone once daily for documented bacteremia. Clinical failure was defined as a composite of the following: antibiotic escalation, escalation to intensive care, and 30-day readmission due to an infectious cause. Adult patients admitted to Long Island Jewish (LIJ) Valley Stream, LIJ Forest Hills, or LIJ Medical Center in 2022 who received ceftriaxone were reviewed for inclusion. Patients were excluded if they received ceftriaxone for endocarditis or meningitis, had a positive blood culture with a ceftriaxone-resistant pathogen, or received ceftriaxone for less than 72 hours. Results: A total of 128 patients were included in this study. Approximately 46.9% of the participants received a 1 gram dose, while 53.2% received a 2 gram dose. 35.4% of patients in the 2 gram group experienced clinical failure compared to 21.7% in the 1 gram group (P = .08, OR 0.51; 95% CI 0.23-1.11). Conclusion: Our findings indicate that the primary outcome of clinical failure did not significantly differ between the 1 gram and 2 gram doses.

The objective of this systematic review was to characterize the literature regarding the risk factors associated with the development of toxic shock syndrome (TSS) secondary to the use of intrauterine contraceptives (IUCs), as well as patient outcomes. A literature search was conducted spanning origin through December 12, 2022, using Embase and MEDLINE ALL. Primary literature that discussed development of TSS along with the presence of an IUC were included. Extracted data included study and participant demographics, IUC data, and infection data. Reports were evaluated for risk-of-bias using the Joanna Briggs Institute critical appraisal tool for case reports. Thirteen reports met the eligibility criteria, all of which were case reports involving one patient per case who developed TSS following the insertion of an IUC or in the presence of an IUC. The patients included in the review were women aged 23 to 50 years old. Major outcomes reported included time of IUD insertion, bacteria cultured, and antibiotic therapies administered. A minority of the reports (n = 5) provided data related to recent or prior childbirth, miscarriages, or abortions, some of which were proposed to have contributed to development of TSS. Risk-of-bias assessments identified potential concerns in four domains. This systematic review characterized literature pertaining to IUC use and TSS. There may be a low but possible risk of TSS when using an IUC; generalizability is limited given the low quality of available studies. This study was neither registered nor funded.

Background: Piperacillin-tazobactam (PTZ) demonstrates time-dependent bactericidal activity, potentially increasing the need for higher dosing in obese and critically ill patients. However, limited information is available on the safety of higher dosing strategies. Objective: To evaluate the safety and clinical impact of high dose 6.75 g IV PTZ for the treatment of pneumonia in critically ill, obese (≥120 kg) patients vs standard dose 4.5 g IV PTZ. Methods: Retrospective, cohort study, multicenter in health-system consisting of four acute-care teaching hospitals. Adult patients weighing at least 120 kg on PTZ for pneumonia in the intensive care unit (ICU) from January 2013 to September 2018 were included. The primary outcome of the study was acute nephrotoxicity defined as initiation of renal replacement therapy and/or serum creatinine increase within 48 hours of last PTZ dose. Secondary outcomes included thrombocytopenia, 14-day all-cause mortality, and ICU length of stay (LOS). Results: One hundred thirty-six patients were included with 52 and 84 in 4.5 g PTZ and 6.75 g PTZ respectively. The rate of acute nephrotoxicity was comparable between cohorts (50% 4.5 g vs 40.5% 6.75 g, P = 0.277). High dose PTZ was not independently associated with acute nephrotoxicity after control for selected confounders. All secondary outcomes were similar. Concomitant vancomycin and calculated supratherapeutic vancomycin area under curve were not independently associated with increased nephrotoxicity. Conclusions: High dose PTZ was not associated with increased acute nephrotoxicity, thrombocytopenia, 14-day all-cause mortality, or ICU LOS. Additionally, more robust trials are needed to fully assess the clinical impact of 6.75 g PTZ dosing for critically ill, obese patients, for pneumonia.

IntroductionSeveral studies have illustrated value in early patient contact following oral anticancer medication (OAM) initiation, particularly within the first 14 days of therapy, as adverse effects may lead to early discontinuation or poor adherence. Health-system specialty pharmacies (HSSPs) are optimally positioned to adopt this best practice through formalized protocols designed to identify and mitigate medication-related issues.ObjectiveTo outline an HSSP-led early check-in protocol for patients taking OAMs and to describe the subsequent interventions conducted by the HSSP team and their acceptance rate.ResultsHSSPs enacted a protocol in January 2021 requiring oncology pharmacists - to contact patients within 14 days of OAM initiation, aiming to optimize adverse effect management, offer supportive care, address adherence, and provide education. To evaluate the impact of the early check-in protocol, we conducted a retrospective, multicenter, observational study across CPS's health system clients from January 2022 to November 2023. HSSP pharmacists created 1698 interventions for 1184 patients from the early check-in. The cancer types most frequently associated with an intervention were breast (n = 431, 25.4%), gastrointestinal (n = 245, 14.4%), and prostate (n = 206, 12.1%). The most frequent intervention categories were adverse drug reactions (ADRs) (n = 1,548, 91.2%) and adherence (n = 55, 3.2%). Overall, 95.5% of pharmacist recommendations were accepted by patients and/or providers.ConclusionImplementing an early check-in protocol allows HSSP pharmacists to mitigate barriers to OAM adherence. This study emphasizes the importance of early check-in and illustrates the scope of the oncology pharmacist's role by evaluating critically meaningful interventions and quantifying pharmacist recommendations and acceptance rate.

Background: Buprenorphine is an opioid that has recently gained interest for acute pain management in post-operative patients. It has theoretical advantages due to its unique mechanism and favorable adverse effect profile. Currently, no studies have evaluated intravenous buprenorphine for acute pain management in a critically ill medical patient population.

Objective: The objective of this study was to compare the use of intravenous buprenorphine with or without a full agonist IV opioid vs a full agonist IV opioid alone for acute pain in non-ventilated, non-surgical critically ill patients.

Methods: A retrospective cohort study was completed of patients who received IV buprenorphine or full-agonist opioids while admitted to the medical intensive care unit at an academic medical center and community hospital.

Results: The median DVPRS difference in the buprenorphine group compared to the control group was 5 vs 6. The non-inferiority t-test showed buprenorphine was not significantly non-inferior with mean DVPRS score at day 3 for the buprenorphine group was 5.02 and the control group was 5.07 (P = 0.85). Respiratory depression within 7 days occurred less in the buprenorphine group (20.6% vs 42.9%, P = 0.004). Oversedation occurred less in the buprenorphine group (27% vs 46.8%, P = 0.01. The ICU LOS was longer in the buprenorphine group (8 vs 5 days, P = 0.01). The median daily OME on day 1 was less in the buprenorphine group (29 vs 42.5, P = 0.03).

Conclusion: Intravenous buprenorphine may be a comparable alternative to full agonist intravenous opioids for pain control in the medical intensive care unit.

Olmesartan, an angiotensin II receptor blocker (ARB) approved in 2002, is used to treat hypertension, either alone or with other antihypertensive drugs. It has been frequently associated with sprue-like enteropathy, while few cases of colitis have been reported. Differentiating between sprue-like enteropathy and colitis is of clinical concern, since just the first condition is a well-documented adverse event of olmesartan. Diagnosis of these occurrences is difficult, as symptoms are unspecific namely diarrhoea, weight loss, fatigue, nausea, and abdominal discomfort, with laboratory findings showing anaemia, electrolyte imbalances, and vitamin deficiencies. Here, we report two cases of patients in treatment for hypertension with olmesartan in association with hydrochlorothiazide and amlodipine, who developed sprue-like enteropathy and colitis, respectively. We then conducted a disproportionality analysis of cases retrieved from the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) to assess the association level between these conditions and olmesartan. We found a strong association between olmesartan and sprue-like enteropathy (ROR 8499.53 (95% CI: 8402.05 - 16383.99)). Olmesartan resulted to be associated also with colitis (ROR 2.56 (95% CI: 2.28 - 2.88)). In light of the diagnostic challenges posed by nonspecific symptoms, these findings underscore the importance of distinguishing between the two conditions in patients exposed to olmesartan, to improve the spectrum of knowledge.

Background: Critically ill adults are more commonly being admitted to intensive care units (ICU) with a recent history of direct oral anticoagulant (DOAC) use. No consensus guidance exists on optimal anticoagulation strategies in critically ill adults with non-valvular atrial fibrillation (NVAF) on DOAC's prior to ICU admission, and there is considerable variability in clinical practice. Objective: To evaluate rates of major bleeding and thrombosis between 2 anticoagulation strategies for NVAF upon ICU admission: package insert (continuation of oral or parenteral anticoagulation per manufacturer recommendations) vs non-package insert (prophylactic dosing or delayed therapeutic anticoagulation). Study design: This was a retrospective cohort study conducted from January 2019 to August 2023. Patients with NVAF and objective evidence of DOAC exposure within 48 hours of ICU admission were included. Those admitted to the ICU for a bleeding event or who received anticoagulation for indications other than NVAF were excluded. Results: A total of 353 patients met inclusion criteria (122 vs 231 in the package insert and non-package insert groups, respectively). There was no significant difference in the composite incidence of major bleeding and stroke or systemic embolism between groups (4.1% in package insert vs 6.1% in non-package insert; P = 0.437). Conclusion: This study demonstrated no difference in the incidence of major bleeding, in-hospital stroke, or systemic embolism with a package insert vs a non-package insert approach to anticoagulation in critically ill patients receiving DOAC therapy for atrial fibrillation. However, more studies are needed to develop evidence-based guidance on anticoagulation management in this population.

Background: Telehealth in the ICU (Tele-ICU) may improve patient outcomes and optimize utilization of high acuity intensive care unit (ICU) beds. However, the relationship between tele-ICU and medication regimen complexity-ICU (MRC-ICU) score is unexplored. Objective: To assess the effect of tele-ICU on MRC-ICU score and describe pharmacists' work. Methods: Adult ICU encounters lasting at least 24 h were retrospectively compared pre- and post- implementation of tele-ICU services in a rural, five-hospital system. The primary outcome was MRC-ICU score 24 h after ICU admission. Prospectively, pharmacist interventions during ICU encounters were captured. Encounters were categorized on exposure to clinical pharmacist review. Results: The difference in mean MRC-ICU score between pre- and post-intervention encounters was -0.2032 (95% CI,-0.8253, 0.4188, P = 0.5217). Post-intervention encounters had a higher rate of thromboembolism prophylaxis (64.5% vs 54.9%, P = 0.001), higher adherence to stress-ulcer prophylaxis (74.1% vs 60.9%, P < 0.001), and a lower presence of glycemic control agent(s) (39.8% vs 46.2%, P = 0.017) 24 h after ICU admission. Tele-ICU services did not significantly change ICU LOS (3.261 vs 3.166 days, P = 0.536), nor ICU mortality (11.1% vs 12.7%, P = 0.377). In the prospective period (n = 196 encounters), 189 interventions were recorded on 80 encounters. There was no difference in median MRC-ICU score at 24 h in encounters with clinical pharmacist review and intervention vs without scheduled clinical pharmacist review (9 vs 8, P = 0.0596). Conclusion: Implementation of Tele-ICU did not change the MRC-ICU score at 24 h, although some ICU bundled care metrics improved. Many encounters lack opportunity for meaningful pharmacy interventions.