P and T最新文献

We report on sessions on the dapagliflozin effect on cardiovascular events; angiotensin receptor-neprilysin inhibition for acute decompensated heart failure; rivaroxaban's effect on thromboembolic events with heart failure, sinus rhythm, and coronary disease; trial results on the withdrawal of pharmacological heart failure therapy in recovered dilated cardiomyopathy; and more from AHA's November meeting.

Approvals, new indications, drug safety issues, and more.

Background: Children with sickle cell disease experience vaso-occlusive crises (VOC) that requires opioid pharmacotherapy. Multimodal analgesic therapy may reduce pain and opioid-induced adverse effects.

Objective: The primary objective was to examine the effectiveness of intravenous (IV) acetaminophen in children presenting with pain from VOC. Secondary objectives were to document the safety and opioid-sparing effects of IV acetaminophen during VOC in pediatric patients.

Setting: Children's Medical Center, NYU-Winthrop Hospital.

Method: This retrospective study had two groups of patients, those who received opioids alone (group O) and those who received acetaminophen with opioids (group OA). Children two to 19 years of age who were admitted to the children's medical center for VOC were eligible for inclusion.

Main outcome measure: A reduction in pain by at least 1 out of 10. With every analgesic dose, we documented pain scales and pain scores before and after each dose, the number of doses administered per day, and mg/kg/day. Data were analyzed using the mixed effect model. All opioids administered to patients were converted to morphine equivalents. We documented length of stay and adverse events.

Results: We had a total of 46 children: 28 in group O and 18 in group OA. Acetaminophen reduced the pain from VOC by 2.3/10. There were trends in different assessments of opioid-sparing effects, in reducing opioid dosage (-0.5 mg/kg morphine equivalent; P = 0.45), reducing overall morphine equivalent doses (-18.5 mg; P = 0.066), and opioid-related adverse effects.

Conclusion: This is the first study to demonstrate the effectiveness of IV acetaminophen in treating VOC pain in children, supporting multimodal analgesic therapy in this setting. Opioid-sparing effects were also encouraging.

Approvals, new indications, regulatory activities, and more.

Purpose: To provide medication safety tips to optimize the management of patients receiving treatment for chronic hepatitis C virus (HCV) infection.

Summary: Ensuring safe medication use in patients who receive treatment for HCV infection is a crucial component in providing optimal patient care. Because of the complexity of available treatment options, numerous challenges exist in preventing medication errors with HCV therapies. This article will focus on the selection of appropriate treatment options along with proper dosing and duration, awareness of concomitant disease states and drug interactions, identifying adverse drug reactions (ADRs) and patient counseling points, the provision of adherence counseling and prevention of treatment interruptions, improving communication with patients and between pharmacies, and recognizing the importance of a multidisciplinary approach.

Conclusion: Maintaining awareness of medication safety strategies geared toward HCV pharmacotherapy is critical for providing optimal care for patients while minimizing the opportunity for errors.

As the door opens to more step therapy and indication-based formularies, P&T committees must walk a fine line between managing treatment costs and providing access to critical drugs.

The authors underscore the importance of understanding standards and procedures as they discuss two lawsuits that arose from drug injury.