Treating Hypertension in the Very Elderly (September).
Ann Pharmacother. 2011 Aug 18;
Authors: Charpentier MM, Bundeff A
Abstract
OBJECTIVE: To review the evidence for strict blood pressure (BP) management in t…

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Intensity of Anticoagulation with Warfarin and Risk of Adverse Events in Patients Presenting to the Emergency Department (July/August).
Ann Pharmacother. 2011 Jul 12;
Authors: Anthony CJ, Karim S, Ackroyd-Stolarz S, Fry A, Mur…

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Activated Partial Thromboplastin Time Versus Antifactor Xa Heparin Assay in Monitoring Unfractionated Heparin by Continuous Intravenous Infusion (July/August).
Ann Pharmacother. 2011 Jun 28;
Authors: Guervil DJ, Rosenberg AF, …

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Evaluation of a Simplified N-Acetylcysteine Dosing Regimen for the Treatment of Acetaminophen Toxicity (June).
Ann Pharmacother. 2011 May 17;
Authors: Johnson MT, McCammon CA, Mullins ME, Halcomb SE
BACKGROUND: Acetami…

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Pancreatic Enzyme Products: Digesting the Changes (May).
Ann Pharmacother. 2011 May 3;
Authors: Giuliano CA, Dehoorne-Smith ML, Kale-Pradhan PB
OBJECTIVE: To review the pharmacology, dosage regimens, efficacy, and safe…

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Dabigatran Etexilate: A Novel Oral Thrombin Inhibitor for Thromboembolic Disease (May).
Ann Pharmacother. 2011 May 3;
Authors: Bovio JA, Smith SM, Gums JG
OBJECTIVE: To evaluate the efficacy and safety of dabigatran et…

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Efficacy of Agents to Prevent and Treat Enteral Feeding Tube Clogs (May).
Ann Pharmacother. 2011 Apr 26;
Authors: Dandeles LM, Lodolce AE
OBJECTIVE: To review the efficacy and safety of agents used to prevent and treat…

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Vancomycin-Induced Neutropenia: Is it Dose- or Duration-Related? (May).
Ann Pharmacother. 2011 Apr 26;
Authors: Black E, Lau TT, Ensom MH
OBJECTIVE: To systematically evaluate the literature to determine whether vancom…

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Role of {alpha}2-Agonists in the Treatment of Acute Alcohol Withdrawal (May).
Ann Pharmacother. 2011 Apr 26;
Authors: Muzyk AJ, Fowler JA, Norwood DK, Chilipko A
OBJECTIVE: To evaluate literature reporting on the role …

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Terlipressin in Hepatorenal Syndrome (March).

Ann Pharmacother. 2011 Mar 8;

Authors: Mazur JE, Cooper TB, Dasta JF

OBJECTIVE: To compare the pharmacology, dosing, and adverse reactions of vasopressin and terlipressin for the treatment of hepatorenal syndrome (HRS) and assess the efficacy of the investigational drug terlipressin for HRS. DATA SOURCES: Articles evaluating prospective studies for vasopressin and terlipressin were discussed after being identified through PubMed (1966-November 2010), International Pharmaceutical Abstracts (1970-November 2010), and EMBASE (1985-November 2010) with combinations of the following terms: vasopressin, terlipressin, and hepatorenal syndrome. In addition, reference citations from publications identified were reviewed. Thirteen studies were identified for terlipressin, along with 4 meta-analyses and 1 case report. For vasopressin, 2 studies were identified. STUDY SELECTION AND DATA EXTRACTION: Prospective clinical studies directly comparing terlipressin and vasopressin were evaluated, as well as prospective clinical studies and meta-analyses for terlipressin in HRS. DATA SYNTHESIS: No randomized, placebo-controlled trials using vasopressin for the treatment of type I HRS have been published, and 4 randomized studies involving 197 patients provide the most current outcome data for use of terlipressin in HRS. Terlipressin differs significantly from vasopressin with regard to its pharmacology, dosing, and adverse drug reaction profile. There is a paucity of data on vasopressin for HRS. CONCLUSIONS: No definitive recommendations can be made for the use of terlipressin for this indication until further, well-conducted studies are performed.

PMID: 21386023 [PubMed - as supplied by publisher]

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Evaluation of Contraindicated Drug-Drug Interaction Alerts in a Hospital Setting (March).

Ann Pharmacother. 2011 Mar 8;

Authors: Hatton RC, Rosenberg AF, Morris CT, McKelvey RP, Lewis JR

BACKGROUND: Risks associated with contraindicated drug-drug interaction alerts (CDDIAs) should always outweigh benefits. Misclassified CDDIAs should be eliminated. OBJECTIVE: To review CDDIAs and determine if they are contraindicated according to Food and Drug Administration-approved product labeling and if there are circumstances in which contraindicated interactions are acceptable. METHODS: A cross-sectional observational and quality improvement study was conducted over two 1-year periods. The 20 most common CDDIAs from May 2007 to May 2008 and all CDDIAs from April 2008 to April 2009 were collected at a large teaching hospital. Horizon Meds Manager used First DataBank as the knowledge base for decision support. Interactions were deemed truly contraindicated if listed in the contraindications section of the labeling of at least one of the interacting drugs. Alerts were grouped by drug and pharmacologic class to evaluate the evidence supporting the relevance of these interactions. An expert panel determined when an alert was misclassified. A medical advisory committee determined whether a contraindicated drug-drug combination was acceptable. RESULTS: Twelve (60%) of the most common 20 contraindicated interaction pairs from 2007 to 2008 were inappropriately classified. Half of the alerts were not truly contraindicated. The 8 truly contraindicated drug-drug pairs were ketorolac and other nonsteroidal antiinflammatory drugs or oral solid potassium products and anticholinergics. Half of these interactions were subsequently deemed acceptable under specific circumstances. Similar results were found in the second year, with only 55.1% of all CDDIAs being truly contraindicated despite eliminating some of the alerts that were misclassified in the first year. Nearly three fourths of legitimate CDDIAs were deemed acceptable under specific circumstances. CONCLUSIONS: Most contraindicated drug-drug interaction alerts from a commercial knowledge base were inappropriately categorized and could be downgraded. Some contraindicated drug combinations are permissible under specific circumstances. Alerts suggesting that certain drugs should never be used together, but their use together is sometimes acceptable, contribute to alert fatigue.

PMID: 21386026 [PubMed - as supplied by publisher]

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Subcutaneous unfractionated heparin for treatment of venous thromboembolism in end-stage renal disease.

Ann Pharmacother. 2010 Dec;44(12):2023-7

Authors: Metzger NL, Chesson MM

To report 3 cases of venous thromboembolism (VTE) in patients with end-stage renal disease (ESRD) treated with subcutaneous unfractionated heparin (UFH) bridged with warfarin.

PMID: 21098749 [PubMed - indexed for MEDLINE]

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Medication reconciliation during internal hospital transfer and impact of computerized prescriber order entry.

Ann Pharmacother. 2010 Dec;44(12):1887-95

Authors: Lee JY, Leblanc K, Fernandes OA, Huh JH, Wong GG, Hamandi B, Lazar NM, Morra D, Bajcar JM, Harrison J

Internal hospital transfer is a vulnerable time during which patients are at high risk of medication discrepancies that can result in clinically significant harm, medication errors, and adverse drug events.

PMID: 21098753 [PubMed - indexed for MEDLINE]

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Impact of a Pharmacist-Directed Anticoagulation Service on the Quality and Safety of Heparin-Induced Thrombocytopenia Management (February).

Ann Pharmacother. 2011 Feb 8;

Authors: To L, Schillig JM, Desmet BD, Kuriakose P, Szandzik EG, Kalus JS

BACKGROUND: The use of anticoagulant medications is complex and prone to error in the inpatient setting. Patients with heparin-induced thrombocytopenia (HIT) must receive treatment with alternative anticoagulant agents to ensure optimal patient outcomes. OBJECTIVE: To evaluate the impact of an inpatient pharmacist-directed anticoagulation service (PDAS) on the safety and efficiency of direct thrombin inhibitor use in patients with HIT. METHODS: This was a quasi-experimental pre/postintervention study comparing patients with HIT managed with usual care to patients managed with a focused inpatient anticoagulation service. The primary endpoints of the study were the percent of time that the activated partial thromboplastin time (aPTT) remained within the therapeutic range and time to achievement of a therapeutic aPTT. Bleeding and appropriateness of warfarin initiation were evaluated as secondary endpoints. RESULTS: A total of 193 patients were included in the study. Percent of time that aPTT was in the therapeutic range was 32% higher with the PDAS (p < 0.001) and time to therapeutic aPTT was shortened by approximately 12.5 hours in patients managed by the PDAS (p < 0.001). There was a trend for more bleeding events, regardless of severity, among control patients (p = 0.130). Rate of TIMI (Thrombolysis in Myocardial Infarction) major bleeding was lower in the PDAS group (p = 0.006), but there was no significant difference between groups in GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) moderate/severe bleeding (p = 0.679). Appropriateness of warfarin initiation was also similar between groups. CONCLUSIONS: Implementation of a focused inpatient PDAS was associated with improved efficiency of dosing, improved monitoring, and low bleeding risk.

PMID: 21304024 [PubMed - as supplied by publisher]

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A Comparative Look at the Safety Profiles of Intravenous Iron Products Used in the Hemodialysis Population (February).

Ann Pharmacother. 2011 Feb 8;

Authors: Coppol E, Shelly J, Cheng S, Kaakeh Y, Shepler B

OBJECTIVE: To review clinical trials conducted in hemodialysis patients of the 4 intravenous iron products available in the US in an attempt to discern strengths and inferiorities between products and evaluate current safety data that can be used to assist the clinician in selecting the most appropriate agent. DATA SOURCES: Literature was accessed through PubMed (January 2000-October 2010). In some cases, reference citations from selected review articles were evaluated as well. STUDY SELECTION AND DATA EXTRACTION: Clinical trials published in the English language were selected using the search terms iron dextran, iron sucrose, sodium ferric gluconate, and ferumoxytol. Studies were further pared down to include only those enrolling hemodialysis patients. DATA SYNTHESIS: There are currently 4 intravenous iron formulations in the US used to treat iron-deficiency anemia in hemodialysis patients. Ferumoxytol has not yet been directly compared to the other 3 agents. Eight studies have been conducted in hemodialysis patients directly comparing iron dextran, iron sucrose, and/or sodium ferric gluconate. These studies were further categorized for evaluation based on iron products compared. Four studies directly compared iron dextran to iron sucrose, 1 study compared iron dextran to sodium ferric gluconate, 1 study compared iron sucrose to sodium ferric gluconate, and 2 studies compared all 3 agents. Of the 3 agents, iron dextran appears to have the least favorable safety profile, while iron sucrose appears most favorable. CONCLUSIONS: The newest intravenous iron product, ferumoxytol, has not been directly compared to the other 3 agents. Large well-controlled studies of these products specifically in the hemodialysis population would further help clinicians determine appropriate therapy. Iron sucrose appears to offer the most favorable safety profile when compared to iron dextran and sodium ferric gluconate in treating hemodialysis patients. Oxidative stress and hypersensitivity reactions are common problems encountered when administering intravenous iron.

PMID: 21304025 [PubMed - as supplied by publisher]

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