Hospital Pharmacy最新文献

{"title":"Women and Hyponatremia: An Analysis of Sex Differences in Adverse Drug Reactions.","authors":"Eleonora Castellana, Patricia Madalina Budau, Maria Rachele Chiappetta","doi":"10.1177/00185787251337618","DOIUrl":"https://doi.org/10.1177/00185787251337618","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337618"},"PeriodicalIF":0.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077423","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":"The Relation Between Polypharmacy, Potentially Inappropriate Medications, Organ Function, and Quality of Life in Elderly Patients with Type 2 Diabetes.","authors":"Hozan Jaza Hama Salh, Tavga Ahmed Aziz, Taha Othman Mahwi, Narmin Hamaamin Hussen, Dlivan Fattah Aziz","doi":"10.1177/00185787251337592","DOIUrl":"https://doi.org/10.1177/00185787251337592","url":null,"abstract":"<p><p><b>Objective:</b> To determine the prevalence of polypharmacy, potentially inappropriate medications (PIMs) and potentially serious clinically relevant DDIs and to determine the association of polypharmacy with PIMs, potentially serious clinically relevant DDI, kidney function, liver function, serum electrolytes, and quality of life (QoL) in old patients with type 2 diabetes mellitus (T2DM). <b>Methods:</b> A cross-sectional study was performed among 136 patients (aged ≥ 65) with T2DM in the Center of Diabetes and Endocrine Diseases in Sulaimani, Iraq. A clinical pharmacist used an interview-based questionnaire to collect data. Blood samples were obtained to measure HbA1c, fasting blood glucose, creatinine, urea, AST, ALT, and potassium. STOPP criteria version 3 was used to identify PIMs, while, DDIs were checked using the Medscape interaction database. <b>Results:</b> In this study, the prevalence of polypharmacy was 55.88%. Patients on polypharmacy exhibited higher BMI 29.60 ± 4.220 (<i>P</i>-value = 0.037), longer diabetes duration 14.24 ± 6.464 (<i>P</i>-value = 0.0001), more comorbidities 100% (<i>P</i>-value = 0.0001), more diabetes complications 93.4% (<i>P</i>-value = 0.006), and greater use of chronic medications 100% (<i>P</i>-value = 0.0001) compared to those without polypharmacy. Among the participants, 64.7% had PIMs, with 64% linked to the endocrine system. Additionally, 14% experienced potentially serious clinically relevant DDIs, mostly due to interaction between aspirin and ACE inhibitors 47.8%. The prevalence of PIMs 73.7% (<i>P</i>-value = 0.019) and potentially serious clinically relevant DDIs 25% (<i>P</i>-value = 0.0001) respectively were higher in patients with polypharmacy compared to those without polypharmacy. Furthermore, polypharmacy was correlated with lower QoL index scores 0.221 ± 0.411 (<i>P</i>-value = 0.002), lower mean VAS scores 59.54 ± 7.83 (<i>P</i>-value = 0.028), and high serum K⁺ 4.81 ± 0.545 (<i>P</i>-value = 0.022). However, no significant differences in kidney function tests (GFR and urea) and liver function tests (AST and ALT), were seen between the two groups. <b>Conclusion:</b> The findings highlight a high prevalence of PIMs and potentially serious DDIs in patients on polypharmacy. Furthermore, polypharmacy is associated with poorer QoL outcomes in older patients with T2DM, emphasizing the need for careful medication review and management in this population.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337592"},"PeriodicalIF":0.8,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077420","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":"Unpacking Oral Challenge Protocols: A Descriptive Epidemiologic Study of Reactions, Predictors, and Practices for Delabeling Low-Risk Penicillin Allergies Leveraging Data from a Systematic Review and Meta-Analysis.","authors":"Mira Maximos, Ryan Pelletier, Sameer Elsayed, Colleen J Maxwell, Sherilyn K D Houle, Brie McConnell, John-Michael Gamble","doi":"10.1177/00185787251337626","DOIUrl":"https://doi.org/10.1177/00185787251337626","url":null,"abstract":"<p><p><b>Background:</b> Oral challenges with amoxicillin or other penicillins are safe and effective for delabeling low-risk penicillin allergy histories. While approximately 90% of reported penicillin allergies can be safely delabeled, detailed data on reaction frequency, types, and timing during and after delabeling interventions remain limited. Such data are crucial to optimizing protocols and integrating oral challenges into routine practice. This study aims to characterize the interventions commonly used for oral challenge, classify reported reactions, and identify reported predictors of hypersensitivity reactions in randomized controlled trials and quasi-experimental studies involving an oral challenge for patients with low-risk penicillin allergies. <b>Methods:</b> This study leverages data from a systematic review and meta-analysis assessing the effectiveness of oral challenge interventions in patients with low-risk penicillin allergies. This descriptive analysis summarizes the adverse reactions experienced among patients in published studies who received oral challenge. Participant demographics, intervention protocols, frequency, type, and timing of post-challenge adverse reactions are reported. Reactions are categorized as immediate, delayed, or other, with frequencies summarized using descriptive statistics. A random effects meta-analysis quantifies a pooled adverse reaction rate. Predictors of hypersensitivity reactions were synthesized narratively. <b>Results:</b> Across 26 studies (2 randomized trials, 24 quasi-experimental studies) evaluating an oral challenge for patients with a low-risk penicillin allergy, the average participant age was 56 years, with a predominance of females (61%) and limited ethnic diversity with 88% reported or identifying as White. Amoxicillin was the most frequenty used oral challenge agent, typically administered as a single 250 mg oral dose. The incidence of reaction or non-delabeling was 4% (95% Confidence Interval 3%, 6%), <i>I</i> ² = 43%, <i>P</i> = .0001. Cutaneous manifestations, such as rashes, were the most frequent reactions. Delayed reactions, primarily mild maculopapular rashes, were uncommon and managed with antihistamines or topical steroids. Risk factors for oral challenge reactions included higher baseline allergy burden and shorter intervals to oral challenge since the index reaction. <b>Conclusion:</b> Oral challenge strategies to delabel low-risk penicillin allergies can involve single doses of amoxicillin or other penicillins with monitoring protocols that can be managed in ambulatory settings. However, although these delabeling strategies are becoming more prevalent, continued study of standardized protocols and follow-up are essential for effective and replicable delabeling strategies. Future research should prioritize diverse populations and equity-driven frameworks to improve generalizability to all individuals and to resource limited settings.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337626"},"PeriodicalIF":0.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984336","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":"Agnostic Drugs: A New Paradigm in Pharmacological Therapy.","authors":"Eleonora Castellana, Maria Rachele Chiappetta","doi":"10.1177/00185787251340598","DOIUrl":"https://doi.org/10.1177/00185787251340598","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251340598"},"PeriodicalIF":0.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017347","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":"Efficacy, Safety, and Cost-Effectiveness of N-Acetylcysteine in Preventing Amphotericin B Nephrotoxicity in Egyptian Patients with Hematological Malignancies: A Randomized Controlled Trial.","authors":"Abdel-Hameed Ibrahim Mohamed Ebid, Haydi Sayed Mohamed, Yasmin Medhat Monir Mohammed, Sara Mohamed Mohamed Abdel Motaleb","doi":"10.1177/00185787251337615","DOIUrl":"https://doi.org/10.1177/00185787251337615","url":null,"abstract":"<p><p><b>Introduction:</b> Amphotericin B (AmB-d) is one of the most common agents for treating fatal systemic fungal infections in patients with hematologic malignancies. However, its severe adverse effects, especially nephrotoxicity, limited its use. This study evaluated the efficacy, safety, and cost-effectiveness of oral N-acetylcysteine (NAC) in preventing AmB-d nephrotoxicity and promoting renal recovery in Egyptian hematological malignancy patients. <b>Methods:</b> A prospective open-label randomized controlled trial was conducted. Patients were randomized to receive AmB-d plus 600 mg NAC twice daily (intervention group) or AmB-d alone (control group). The primary outcome was the incidence of acute kidney injury (AKI), with secondary outcomes including electrolyte imbalances (hypokalemia, hypomagnesemia) and renal recovery from AKI. A cost-effectiveness analysis was performed, supported by one-way and probabilistic sensitivity analyses (PSA). <b>Results:</b> NAC co-treatment significantly reduced AmB-d-induced AKI (odds ratio = 0.415, 95% CI: 0.174-0.992, <i>P</i> = .041). Renal recovery rates were higher in the NAC group (73.33% vs 53.85%), though not statistically significant (<i>P</i> = .322); the number needed to treat (NNT) was 6, indicating clinical relevance. No significant differences were observed in hypokalemia (<i>P</i> = .547) or hypomagnesemia (<i>P</i> = .768). NAC was cost-effective, with an effectiveness gain of 0.22 and cost savings of 2742.678 EGP per patient. Sensitivity analyses confirmed robustness, with NAC being dominant in 942 out of 1000 PSA scenarios. NAC was well-tolerated, with only mild gastrointestinal side effects reported. <b>Conclusion:</b> NAC co-administration with AmB-d effectively prevents nephrotoxicity, reduces costs, and may promote renal recovery in Egyptian hematological malignancy patients. The favorable NNT for renal recovery suggests clinical relevance, warranting further investigation in larger studies. <b>Trial registration:</b> ClinicalTrials.gov identifier, NCT06122311.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337615"},"PeriodicalIF":0.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006033","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":"Impact of a Pharmacist Driven Penicillin Allergy De-labeling Protocol on Rates of Reported Allergy in the Intensive Care Unit.","authors":"Mujtaba Mahmud, Shahristan R Kokoy, Joanna L Stollings, Allison B McCoy, Grace Koo, Mary Lynn Dear, Todd W Rice, Elizabeth J Phillips, Cosby A Stone","doi":"10.1177/00185787251337625","DOIUrl":"https://doi.org/10.1177/00185787251337625","url":null,"abstract":"<p><p>Inaccurate penicillin allergy labels (PALs) results in use of broader, less optimized antibiotics. Studies have shown challenging low-risk PALs is safe and effective. We assessed the proportion of PALs among critically ill patients after a pharmacist driven allergy de-labeling program was implemented in the medical intensive care unit (MICU) between November 2017 and March 2023. There was a notable reduction in the proportion of PALs pre-intervention (14.0%) and post-intervention (12.8%). Persistent reductions in the proportion of PALs among readmitted patients was seen in both MICU (21.4% to 15.9%) and non-MICU patients (13.8% to 11.1%). This study further emphasizes the potential for proactive surveillance and intervention on low-risk PALs by pharmacists to reduce the burden of broad-spectrum antibiotics, which may optimize antibiotic usage and possibly impact institutional antimicrobial spectrum.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337625"},"PeriodicalIF":0.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963357","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":"Pharmacovigilance and Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN): 55 Years of Retrospective Analysis of the FDA Adverse Event Reporting System (FAERS) Database.","authors":"Eleonora Castellana, Patricia Madalina Budau, Maria Rachele Chiappetta","doi":"10.1177/00185787251337610","DOIUrl":"https://doi.org/10.1177/00185787251337610","url":null,"abstract":"<p><p><b>Purpose:</b> This study investigates Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), severe and rare cutaneous adverse reactions often linked to drug use, utilizing data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database collected between 1969 and 2024. The objective is to identify the drugs most frequently associated with these conditions and to analyze trends in reporting over time. <b>Methods:</b> A retrospective analysis was conducted on 29 661 136 total adverse event reports, including 39 398 cases (0.13%) related to SJS/TEN. The drugs most commonly associated were classified using the Anatomical Therapeutic Chemical (ATC) system. The analysis included the severity, outcomes, gender, and age distribution of affected patients, focusing on drugs with the highest number of reports and their association with SJS/TEN. Regarding outcomes, their total number exceeds the number of SJS/TEN cases, as a single adverse drug reaction (ADR) can be associated with multiple outcomes. <b>Results:</b> Of the SJS/TEN cases, 97.79% were classified as severe, and 20.86% were fatal. Reports of SJS/TEN have increased significantly over the decades, peaking during the 2018 to 2020 period. The most frequently implicated drugs were Lamotrigine (9.17% of cases), Sulfamethoxazole/Trimethoprim (6.12%), and Allopurinol (5.88%). Other significant drugs included Phenytoin (5.05%), Acetaminophen (4.97%), and Ibuprofen (4.13%). Valdecoxib showed the highest percentage of SJS/TEN cases relative to its total adverse event reports (10.71%). Women were slightly more affected (51.03%) than men (39.30%). The most impacted age group was 18 to 64 years (45.12%), followed by 65 to 85 years (23.16%). Most reports were submitted by healthcare professionals (70.38%). <b>Conclusion:</b> The 55-year retrospective analysis highlights a rising trend in SJS/TEN reporting, attributed to increased awareness and vigilance in pharmacovigilance. These findings emphasize the importance of monitoring high-risk drugs, such as antiepileptics, analgesics, and antibacterials, and implementing strategies to mitigate associated risks. This study underscores the need for ongoing surveillance and education to enhance patient safety.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337610"},"PeriodicalIF":0.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005546","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":"Implementation of a Self-Service Data Exploration Tool Within an Academic Medical Center Department of Pharmacy.","authors":"Thomas S Achey, Holly R Griffin","doi":"10.1177/00185787251337613","DOIUrl":"https://doi.org/10.1177/00185787251337613","url":null,"abstract":"<p><p><b>Purpose:</b> The validation and implementation of a self-service data exploration and reporting tool in an academic medical center is described. <b>Summary:</b> Macro-level data is abundant within hospitals and health systems. In the absence of a data scientist, other solutions were explored within Medical University of South Carolina (MUSC) Health pharmacy's technology. A data exploration tool within the electronic health record was validated for widespread use. Based on limited experiences, an educational session was conducted to satisfy Practice Advancement Initiative (PAI) 2030 recommendations for staff competence and personnel professional development desires. Epic SlicerDicer was leveraged by frontline staff for data-driven decision-making in operational and clinical arenas. The MUSC Health Department of Pharmacy incorporated the tool into a data-driven culture. The tool had widespread use upon implementation. After disseminating the tool, impact was measured and evaluated. Its utility impacted operations, drug distribution, formulary management, resident research, quality improvement, and staff satisfaction. There now exists an accessible tool for staff to utilize on-demand for data-driven recommendations and interventions. <b>Conclusion:</b> A data exploration tool within the electronic health record improved operational efficiency, cost savings, and research productivity. It offers elevated decision-making and enhanced professional development for staff.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337613"},"PeriodicalIF":0.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984346","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":"Optimization of Pharmacist Resources at a Community Internal Medicine Teaching Hospital: Development of a Tool Through Pharmacist and Physician Expert Panels.","authors":"Rachel K Russ, Marjorie V Neidecker, Ariane Schieber, Robert J Weber, Charlotte Forshay","doi":"10.1177/00185787251337599","DOIUrl":"https://doi.org/10.1177/00185787251337599","url":null,"abstract":"<p><p><b>Purpose:</b> Expansion of acute care clinical pharmacist roles requires pharmacy departments to optimize allocation of pharmacist resources. This study aimed to develop an objective resource optimization tool to rank clinical service needs to assign internal medicine pharmacist resources at a community hospital within an academic medical center health system. Additionally, this study aimed to collect and analyze physician expert opinion to supplement the pharmacist-developed tool. <b>Method:</b> A pharmacist expert panel was convened to determine patient characteristics necessitating additional pharmacist services. Retrospective electronic health record data were aggregated by patient characteristic categories and ranked by clinical services. Separately, a survey of attending physicians rated patient cases on the need for additional pharmacy services and provided rationale. Results of both panels were analyzed and compared to develop and strengthen the tool. <b>Results:</b> The pharmacist-developed tool included three patient characteristic categories: Patient Acuity, Critical Drug Monitoring, and Transitions of Care. An internal medicine teaching service scored highest for needing additional pharmacy services; surgery and urology resulted in lowest scores. Highest ranked cases surveyed by physicians were patients with more complex transitions of care, inpatient medication management, and disease state optimization. Comparing panels, 92.5% of physician comments were related to one of the three categories included in the pharmacist developed tool. Remaining comments fell within a new category, Patient Allergies. <b>Conclusion:</b> Pharmacists and physicians identified similar patient characteristic categories requiring more robust pharmacist services across internal medicine patients. Alignment of the two panels confirms the inputs used to develop the tool and increases confidence in its application for pharmacist resource optimization.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337599"},"PeriodicalIF":0.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962958","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":"Pharmacist Preparation of 4F-PCC in the Emergency Department: Implications for Hemorrhage Management.","authors":"Yalcin Golcuk","doi":"10.1177/00185787251337593","DOIUrl":"https://doi.org/10.1177/00185787251337593","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251337593"},"PeriodicalIF":0.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984184","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}