Idarucizumab is approved for patients treated with dabigatran when reversal of the anticoagulant effects is needed. Like dabigatran, idarucizumab is excreted in the urine. The effect of renal dysfunction on drug elimination is uncertain, as patients in the RE-VERSE AD trial had a median creatinine clearance of 58 mL/min. Also, dabigatran accumulation can occur if the international normalized ratio (INR) is greater than two. A 73-year-old female was admitted for lower extremity edema and increased abdominal girth. On admission, the patient was in acute kidney injury (AKI) with an estimated creatinine clearance of 34.5 mL/min. Her prothrombin time (PT) on admission was 17 seconds, her INR was 1.4, and her hemoglobin was 8.7 gm/dL (12-16 gm/dL). Throughout her admission, she was continued on her home regimen of dabigatran 150 mg twice daily for atrial fibrillation. On day 4, she had rectal bleeding and altered mental status. At this time, her PT was elevated to 25.6 seconds, her INR had increased to 2.3, and her hemoglobin had dropped to 6.8 gm/dL. Two doses of idarucizumab 2.5 gm were administered, and dabigatran was successfully reversed with cessation of bleeding and normalization of the INR to 1.5. An additional dose of idarucizumab was not required. The patient was discharged home two days later. Idarucizumab successfully reversed the bleeding and coagulopathy associated with dabigatran in a patient with AKI.
{"title":"Reversal of Dabigatran Bleeding and Coagulopathy Using Idarucizumab in a Patient With Acute Kidney Injury.","authors":"Jennifer Vidal, Richard DePalma, Leila Forouzan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Idarucizumab is approved for patients treated with dabigatran when reversal of the anticoagulant effects is needed. Like dabigatran, idarucizumab is excreted in the urine. The effect of renal dysfunction on drug elimination is uncertain, as patients in the RE-VERSE AD trial had a median creatinine clearance of 58 mL/min. Also, dabigatran accumulation can occur if the international normalized ratio (INR) is greater than two. A 73-year-old female was admitted for lower extremity edema and increased abdominal girth. On admission, the patient was in acute kidney injury (AKI) with an estimated creatinine clearance of 34.5 mL/min. Her prothrombin time (PT) on admission was 17 seconds, her INR was 1.4, and her hemoglobin was 8.7 gm/dL (12-16 gm/dL). Throughout her admission, she was continued on her home regimen of dabigatran 150 mg twice daily for atrial fibrillation. On day 4, she had rectal bleeding and altered mental status. At this time, her PT was elevated to 25.6 seconds, her INR had increased to 2.3, and her hemoglobin had dropped to 6.8 gm/dL. Two doses of idarucizumab 2.5 gm were administered, and dabigatran was successfully reversed with cessation of bleeding and normalization of the INR to 1.5. An additional dose of idarucizumab was not required. The patient was discharged home two days later. Idarucizumab successfully reversed the bleeding and coagulopathy associated with dabigatran in a patient with AKI.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 12","pages":"748-749"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281148/pdf/ptj4312748.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36780983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leftover or improperly discarded drugs are easy prey for diversion and are fueling the opioid abuse epidemic. ISMP offers safe practice recommendations to prevent drug misuse.
{"title":"Partially Filled Vials and Syringes in Sharps Containers Are a Key Source of Drug Diversion.","authors":"Matthew Grissinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Leftover or improperly discarded drugs are easy prey for diversion and are fueling the opioid abuse epidemic. ISMP offers safe practice recommendations to prevent drug misuse.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 12","pages":"714-717"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281145/pdf/ptj4312714.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36780976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
New sleep deprivation studies confirm the relationship between inadequate sleep and a wide range of disorders, such as hypertension, obesity and type-2 diabetes, cardiovascular disease, impaired immune functioning, and more.
{"title":"The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research.","authors":"Susan L Worley","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>New sleep deprivation studies confirm the relationship between inadequate sleep and a wide range of disorders, such as hypertension, obesity and type-2 diabetes, cardiovascular disease, impaired immune functioning, and more.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 12","pages":"758-763"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281147/pdf/ptj4312758.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36780985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmaceutical Approval Update.","authors":"Michele B Kaufman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Mulpleta (lusutrombopag) for thrombocytopenia; ajovy (fremenezumab-vfrm) for migraine; takhzyro (lanadelumab-flyo) for hereditary angioedema attacks.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 12","pages":"734-735"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281146/pdf/ptj4312734.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36780979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Americans worry more about the cost and availability of health care than any other major societal issue. Clarity in treatment costs could help alleviate stress.
与其他重大社会问题相比，美国人更担心医疗保健的成本和可获得性。明确治疗费用有助于缓解压力。
{"title":"Health Care Price Transparency Initiatives Are All the Rage: But Burgeoning Efforts Suffer from Myriad Shortcomings.","authors":"Stephen Barlas","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Americans worry more about the cost and availability of health care than any other major societal issue. Clarity in treatment costs could help alleviate stress.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 12","pages":"744-768"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281149/pdf/ptj4312744.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36780981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steglatro (ertugliflozin) for glycemic control in adults with type-2 diabetes mellitus.
Steglatro (ertuglilozin)用于成人2型糖尿病患者的血糖控制。
{"title":"Ertugliflozin (Steglatro): A New Option for SGLT2 Inhibition.","authors":"Nikolas Kovacich, Benjamin Chavez","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Steglatro (ertugliflozin) for glycemic control in adults with type-2 diabetes mellitus.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 12","pages":"736-742"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281144/pdf/ptj4312736.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36780980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Developing drugs with enhanced safety profiles and improving treatment affordability are vital for patients with MS. The author reviews some encouraging new agents in late-stage development.
{"title":"Promising Multiple Sclerosis Agents In Late-Stage Development.","authors":"Troy Kish","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Developing drugs with enhanced safety profiles and improving treatment affordability are vital for patients with MS. The author reviews some encouraging new agents in late-stage development.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 12","pages":"750-772"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281141/pdf/ptj4312750.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36780984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We review sessions on the association of diuretic use and amputations, albiglutide and cardiovascular outcomes with diabetes and cardiovascular disease, how lorcaserin affects diabetes in overweight patients, how testosterone therapy improves diabetes in hypogonadal men, the pros and cons of gastric bypass surgery, how low-calorie sweeteners affect the gut microbiome, and more.
{"title":"2018 European Association for the Study of Diabetes.","authors":"Walter Alexander","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We review sessions on the association of diuretic use and amputations, albiglutide and cardiovascular outcomes with diabetes and cardiovascular disease, how lorcaserin affects diabetes in overweight patients, how testosterone therapy improves diabetes in hypogonadal men, the pros and cons of gastric bypass surgery, how low-calorie sweeteners affect the gut microbiome, and more.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 11","pages":"689-693"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205117/pdf/ptj43011689.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36659734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The final part of a 3-part series discusses medication safety risks related to labeling, patient education, and medication storage.
3部分系列文章的最后一部分讨论了与标签、患者教育和药物储存相关的药物安全风险。
{"title":"Selected Medication Safety Risks That Can Easily Fall Off the Radar Screen-Part 3.","authors":"Matthew Grissinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The final part of a 3-part series discusses medication safety risks related to labeling, patient education, and medication storage.</p>","PeriodicalId":38773,"journal":{"name":"P and T","volume":"43 11","pages":"645-666"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205125/pdf/ptj43011645.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36708464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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