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Journal of Pharmacy Practice

Eric R Gregory, Donna R Burgess, Sarah E Cotner, Jeremy D VanHoose, Alexander H Flannery, Brian Gardner, Elizabeth B Autry, Derek W Forster, David S Burgess, Katie L Wallace
Due to the inconsistent correlation of vancomycin trough concentrations with 24-hour area under the curve (AUC) and a desire to reduce rates of vancomycin-associated acute kidney injury, an institutional guideline was implemented by the Antimicrobial Stewardship Team in September 2017 to monitor vancomycin using AUC. Three stages were utilized to organize the process: preparation, implementation, and evaluation. The preparation stage was used to present literature to key stakeholders, and pharmacy meetings focused on the development of a dosing and monitoring guideline...
March 10, 2019: Journal of Pharmacy Practice
Aubrey A Defayette, Lisa M Voigt, Kimberly T Zammit, Jamie N Nadler, Brian P Kersten
PURPOSE: Computerized insulin dosing tools (CIDT) have been shown to improve the care of critically ill patients with hyperglycemia. Application of a CIDT in addition to a diabetic ketoacidosis (DKA) order set for the treatment of DKA has not been evaluated. Our goal was to determine the effects the CIDT would have on the treatment of a patient with DKA. METHODS: In this retrospective, pre-post chart review, a provider-driven insulin dosing strategy (pregroup) was compared to the CIDT (postgroup) with 24-hour pharmacist monitoring...
March 10, 2019: Journal of Pharmacy Practice
Judith Jacobi
Endocrine emergencies are frequent in critically ill patients and may be the cause of admission or can be secondary to other critical illness. The ability to anticipate endocrine abnormalities such as adrenal excess or , hypothyroidism, can mitigate their duration and severity. Hyperglycemic crisis may trigger hospital and intensive care unit (ICU) admission and may be life threatening. Recognition and safe treatment of severe conditions such as acute adrenal insufficiency, thyroid crisis, and hypoglycemia and hyperglycemic crisis may be lifesaving...
March 10, 2019: Journal of Pharmacy Practice
Chelsea R Wampole, Kathryn E Smith
Critically ill patients commonly experience pain, and the provision of analgesia is an essential component of intensive care unit (ICU) care. Opioids are the mainstay of pain management in the ICU but are limited by their adverse effects, risk of addiction and abuse, and recent drug shortages of injectable formulations. A multimodal analgesia approach, utilizing nonopioid analgesics as adjuncts to opioid therapy, is recommended since they may modulate the pain response and reduce opioid requirements by acting on multiple pain mediators...
March 7, 2019: Journal of Pharmacy Practice
Nicole Lynn Kovacic, David J Gagnon, Richard R Riker, Sijin Wen, Gilles L Fraser
BACKGROUND: Psychoactive medications (PM) are frequently administered in the intensive care unit (ICU) to provide comfort. Interventions focused on preventing their continuation after the acute phase of illness are needed. OBJECTIVE: To determine the frequency that patients with ICU-initiated PM are continued upon ICU and hospital discharge. METHODS: This single-center, prospective, observational study assessed consecutive adult ICU patients who received scheduled PM...
February 27, 2019: Journal of Pharmacy Practice
Julie A Murphy, Michelle N Schroeder, Anita T Ridner, Megan E Gregory, Jangus B Whitner, Sean G Hackett
BACKGROUND: In October 2012, a pharmacy-driven Inpatient Diabetes Patient Education (IDPE) program was implemented at the University of Toledo Medical Center (UTMC). OBJECTIVE: To determine the difference in 30-day hospital readmission rates for patients who receive IDPE compared to those who do not. METHODS: This retrospective cohort was completed at UTMC. Patients admitted between October 1, 2012, and September 30, 2013, were included if they were ≥18 years and had one of the following: (1) diagnosis of diabetes mellitus, (2) blood glucose >200 mg/dL (>11...
February 27, 2019: Journal of Pharmacy Practice
William B Hays, Emma Tillman
BACKGROUND: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. OBJECTIVE: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. METHODS: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit...
February 26, 2019: Journal of Pharmacy Practice
Tram Tran, Heather Miller, Delaney Ivy
PURPOSE: To evaluate the difference in the number of drug therapy interventions between patients seen by pharmacists and patients seen by nonpharmacist providers during Medicare Annual Wellness Visits (AWVs). METHODS: Pharmacists completed the medication history portion of AWVs at a primary care, interdisciplinary clinic in Central Texas. Drug therapy problems were collected and compared to those identified by physicians conducting AWVs. Drug therapy problems were grouped into 4 categories: indication, effectiveness, safety, and adherence...
February 26, 2019: Journal of Pharmacy Practice
Simon W Lam, Stephanie N Bass
Treatment of suspected infections in critically ill patients requires the timely initiation of appropriate antimicrobials and rapid de-escalation of unnecessary broad-spectrum coverage. New advances in rapid diagnostic tests can now offer earlier detection of pathogen and potential resistance mechanisms within hours of initial culture growth. These technologies, combined with pharmacist antimicrobial stewardship efforts, may result in shorten time to adequate coverage or earlier de-escalation of unnecessary broad spectrum antimicrobials, which could improve patient outcomes and lower overall treatment cost...
February 26, 2019: Journal of Pharmacy Practice
Lindsey E Wiegmann, Matthew S Belisle, Kristin S Alvarez, Neelima J Kale
Previous studies have shown pharmacists positively impact 30-day readmission rates. However, there is limited data regarding the effect of clinical pharmacist (CP) follow-up on 90-day readmission or evaluation of disease-specific goals after hospitalization. Investigators analyzed the impact of postdischarge extended CP follow-up within a family medicine service (FMS). The primary end point was all-cause 90-day readmission rates. Secondary end points included all-cause 30- and 60-day readmission rates and the achievement of disease-specific goals postdischarge...
February 25, 2019: Journal of Pharmacy Practice
Mitchell S Buckley, Amy L Dzierba, Justin Muir, Jeffrey P Gonzales
Acute respiratory distress syndrome (ARDS) remains a common complication associated with significant negative outcomes in critically ill patients. Lung-protective mechanical ventilation strategies remain the cornerstone in the management of ARDS. Several therapeutic options are currently available including fluid management, neuromuscular blocking agents, prone positioning, extracorporeal membrane oxygenation, corticosteroids, and inhaled pulmonary vasodilating agents (prostacyclins and nitric oxide). Unfortunately, an evidence-based, standard-of-care approach in managing ARDS beyond lung-protective ventilation remains elusive, contributing to significant variability in clinical practice...
February 21, 2019: Journal of Pharmacy Practice
Karly Berquist, Sunny A Linnebur, Danielle R Fixen
Transitional care management (TCM) programs have been shown to decrease hospital readmission rates, health-care costs, and medication-related errors and adverse drug events. Pharmacists have been utilized during the medication reconciliation process, during admission, and after hospital discharge to prevent readmission and identify medication discrepancies. There is a lack of data utilizing clinical pharmacists in the geriatric patient population transitional care process after hospital discharge. Less is known about the depth of professional services a pharmacist can perform in the geriatric setting...
February 21, 2019: Journal of Pharmacy Practice
Michael W Nagy, Stephanie Gruber, Macy McConnell
BACKGROUND: Recent literature findings suggest that opportunities exist to optimize testosterone replacement therapy management. OBJECTIVE: To evaluate the impact of a pilot clinical pharmacist testosterone therapy management service in a Veterans Affairs primary care setting. METHODS: A 6-month, single-clinic, prospective cohort quality improvement project included male patients with an active prescription for testosterone. Patients were excluded if they switched primary care providers or were managed by a specialty clinic...
February 21, 2019: Journal of Pharmacy Practice
George C Leef, Alexander C Perino, Mariam Askari, Jun Fan, P Michael Ho, Christoph B Olivier, Lisa Longo, Kenneth W Mahaffey, Mintu P Turakhia
BACKGROUND: Direct oral anticoagulants (DOACs) have strict dosing guidelines, but recent studies indicate that inappropriate dosing is common, particularly in chronic kidney disease (CKD), for which it has been reported to be as high as 43%. Since 2011, the Veterans Health Administration (VA) has implemented anticoagulation management programs for DOACs, generally led by pharmacists, which has previously been shown to improve medication adherence. OBJECTIVE: We investigated the prevalence of overdosing and underdosing of DOACs in the VA...
February 21, 2019: Journal of Pharmacy Practice
Brandon J Opitz, Marissa L Ostroff, Arin C Whitman
The objective of this review was to identify and examine the pharmacokinetic and pharmacodynamic interactions between cannabidiol (CBD)-only products, such as CBD oil, and anticancer agents. A literature search of PubMed (1980 to September 2018) and the Cochrane Collection (1980 to September 2018) was performed using the following search terms: "cannabidiol," "cancer," "cannabis," "marijuana," and "interaction," as well as any combination of these terms. Literature was excluded if it did not appear in the search when limited to the "full text" filter on PubMed, if it was not published in the English language, or if it did not explore potential pharmacodynamic or pharmacokinetic interactions of CBD and anticancer agents...
February 18, 2019: Journal of Pharmacy Practice
Ilana Fuzaylova, Chester Lam, Om Talreja, Amgad N Makaryus, Deborah Ahern, Manouchkathe Cassagnol
Sacubitril/valsartan (Entresto®) is the first commercially available angiotensin receptor neprilysin inhibitor (ARNI) approved for use in heart failure patients with a reduced ejection fraction. It is a combination drug that contains sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin II receptor blocker. Our report outlines a case of probable ARNI-induced hyponatremia occurring in an elderly woman with heart failure with a reduced ejection fraction. According to Naranjo Adverse Drug Reaction Assessment, score indicated a likely association between patient's hyponatremia and her use of sacubitril/valsartan...
February 18, 2019: Journal of Pharmacy Practice
Yotsaya Kunlamas, Nutthada Areepium, Aekarach Ariyachaipanich, Krittin Bunditanukul
Although high-intensity statins are recommended for atherosclerotic cardiovascular disease, evidence has shown that Asians may need lower dose statins to achieve similar effect when compared to Caucasians. Moreover, awareness of adverse effects leads physicians to initiate moderate-intensity statins. Comparative of high versus moderate-intensive statins on LDL-C among patients who had undergone primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) are less established in Thailand...
February 18, 2019: Journal of Pharmacy Practice
Emmanuel M Knight, Daryl S Schiller, Magda K Fulman, Rupangi Rastogi
BACKGROUND: Limited evidence suggests that prophylactic oral vancomycin may be beneficial in preventing Clostridium difficile infection (CDI) recurrence, but long-term efficacy is unknown. OBJECTIVE: To evaluate the long-term efficacy of oral vancomycin prophylaxis (OVP) in preventing CDI recurrence in subjects who require subsequent antibiotic exposure. METHODS: A retrospective cohort study was conducted at a community hospital. A total of 91 subjects with a history of CDI between January 2013 and December 2015 who had a subsequent hospitalization requiring systemic antibiotics within 12 months were evaluated...
February 11, 2019: Journal of Pharmacy Practice
Andrew M Sam, Ila M Saunders, Randy Taplitz, Divya Koura
Metronidazole is a nitroimidazole antibacterial agent that is highly effective for the treatment of protozoal and anaerobic infections. Metronidazole is known to cause hematologic adverse effects, including a reversible mild neutropenia; in rare circumstances, thrombocytopenia has been associated with metronidazole treatment. We present a case of aplastic anemia related to the extended use of metronidazole.
February 6, 2019: Journal of Pharmacy Practice
Simon W Lam, Erick Sokn
BACKGROUND: Previous studies demonstrated that transitions of care bundles, which include bedside discharge medication delivery (BDMD), may be helpful in decreasing hospital readmissions. OBJECTIVE: To evaluate the effects of BDMD alone on day 30 readmission rates. METHODS: Retrospective, cohort study comparing those who received pharmacy-driven BDMD to usual discharge. Primary outcome was day 30 readmission rates. Multivariable logistic regression was used to account for baseline differences between groups...
February 6, 2019: Journal of Pharmacy Practice
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