Hospital Pharmacy最新文献

{"title":"How Reclassification of Hydrocodone Combination Products Affects Dispensing.","authors":"Jonah J Stulberg, Lan Vu, Reiping Huang, Salva N Balbale, Phillip Yoo, Phiyen Tra, Leanne N Metcalfe","doi":"10.1177/00185787231155839","DOIUrl":"10.1177/00185787231155839","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"323-325"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073208","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":"Materiovigilance in Intensive Care Units: An Active Surveillance.","authors":"Lakshay Kumar Attri, Ballaekere Jayaram Subhash Chandra, Madhan Ramesh, Sri Harsha Chalasani, Jehath Syed, Nikita Pal","doi":"10.1177/00185787221144931","DOIUrl":"10.1177/00185787221144931","url":null,"abstract":"<p><p><b>Background:</b> Medical devices are the vital part of healthcare system. The use of medical devices is higher in the intensive care units leading to increased exposure rendering the exponential rise in incidence of medical device associated adverse events (MDAEs). Timely detection and reporting of MDAEs can help reduce the disease and associated liabilities. <b>Objective:</b> To determine the rate, patterns, and predictors of MDAEs. <b>Methods:</b> An active surveillance was carried out in the intensive care units (ICUs) of a tertiary care teaching hospital located in southern India. The patients were monitored for MDAEs which were reported based on MvPI guidance document 1.2. The predictors were calculated using an odds ratio at 95% confidence interval. <b>Results:</b> A total of 185 MDAEs were reported amongst 116 patients, of which the majority [74 (63.7%)] were males. Most of the MDAEs were attributed to urethral-catheters [42 (22.7%)] among which a high majority of 34 were associated with urinary tract infections (UTI), followed by ventilators [35 (18.9%)] with all events causing pneumonia. Urethral catheters and ventilators are both classified as categories B and C respectively based on device risk classification provided by the Indian Pharmacopoeia Commission (IPC). Over 58% of MDAEs were reported among the elderly. The causality assessment was possible for 90 (48.6%) MDAEs whereas 86 (46.4%) were probable. The majority of the MDAEs reported were serious [165 (89.2%)] and only [20 (10.8%)] were found to be non-serious on the severity scale. Most [104 (56.2%)] of the devices attributed to MDAEs were single-use devices, of which [103 (55.6%)] were destroyed and only [81 (43.7%)] were retained in healthcare facilities. <b>Conclusions:</b> Despite the best possible care in the intensive care units (ICUs), MDAEs are inevitable, adding to the burden of patients in terms of suffering, disease, extended hospital stay, and increased costs. MDAEs require rigorous monitoring of patients, especially in the elderly population and patients with increased exposure to multiple devices.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"382-388"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10091872","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":"Successful Provision of a New York State Pharmacy Technician Certification Examination Review Program.","authors":"Matthew Li, Jamie Chin-Hon, Rafael Roman, Adrian Chatham","doi":"10.1177/00185787231152411","DOIUrl":"10.1177/00185787231152411","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"321-322"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10166591","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":"Supraventricular Tachycardia Associated With Ondansetron.","authors":"Evangelia Samara, Agathi Karakosta, Paraskevas Tseniklidis, Petros Tzimas","doi":"10.1177/00185787231158772","DOIUrl":"10.1177/00185787231158772","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"327-328"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9715208","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":"Paracetamol During COVID-19, a Matter of Concern.","authors":"Salvatore Chirumbolo","doi":"10.1177/00185787231158752","DOIUrl":"https://doi.org/10.1177/00185787231158752","url":null,"abstract":"To the Editor, The recent contribution by Mattiuzzi and Lippi on this Journal reappraised the great concern of paracetamol consumption during COVID-19, as the authors highlighted, in their infodemiological survey, the need for monitoring pharmaceutical prescription in order to prevent any potential drug shortage.1 Yet, the majority of paracetamol packages were abused by home resident patients during pandemic. The consumption of paracetamol dropped down by 13.3% respect to 2020, because of a reduction in symptomatic individuals with SARS-CoV2 infections and due to controversial debates about the role of paracetamol in causing glutatione (GSH) depletion and increase in the COVID-19 hospitalization rate.2 Recent pharmaco-surveillance data from the Italian Agency of Medicines (AIFA) reported that while paracetamol has the 254th rank position in Germany, in Italy has the first position for expenditure in 2020. Moreover, as paracetamol is a pain relief drug, used to relieve symptoms, and is endowed with a slight anti-inflammatory potential, people recurring to paracetamol to treat SARS-CoV2 early symptomatology not necessarily undergo a proper therapy against COVID-19, so enhancing the overall number of packages used in the first treatment line of caregiving against COVID-19. A way to reduce the consumption of paracetamol packages may be suggested by improving its ability in working as a pain relief pharmaceutical. It is widely known that paracetamol lowers both plasma and intracellular availability of GSH in patients with fever, yet GSH depletion can be prevented by associating therapy with a sulfydryl donor such as N-acetyl-cysteine (NAC), even in case of paracetamol abuse.3 Ameliorating the efficacy of paracetamol, by accelerating the patient’s ability in restoring its health, may result in a reduced consumption of paracetamol packages. Moreover, the association with NSAIDs able to prevent the effect of paracetamol on glutathione, such as indomethacin, enhances the antipyretic effect of paracetamol and reduces the need to recur to further doses of the pharmaceutical.4 The rationalization of NSAIDs purchase and consumption, greatly depends on the optimal use of pharmaceuticals in home therapy and in hospitals. Pharmaceutical sciences should strengthen any effort to ameliorate the different therapy protocols used for inflammatory and infectious diseases, in order to reduce pharmaceutical abuse and promote a more sustainability also in pharmacy.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"326"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988618/pdf/10.1177_00185787231158752.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10091869","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":"Seizures Following Self-Medication With Colloidal Silver: A Case Report.","authors":"Daniel Hu, Cary Yuen","doi":"10.1177/00185787231151862","DOIUrl":"10.1177/00185787231151862","url":null,"abstract":"<p><p>Silver-containing products have been used for medicinal purposes since antiquity. Throughout the ages and indeed up until the present time, silver has been employed with the hopes of treating a myriad of diseases including the common cold, skin problems, infections, and even cancer. However, silver has no known biological role in human physiology, and taking silver may lead to adverse reactions. The better-known adverse reactions of silver include argyria, or a gray-blue cutaneous discoloration, which is a known effect of silver accumulation. Additionally renal or hepatic injury may also be experienced. Reports of neurological adverse reactions are rare, however, and the extant medical literature contains very few descriptions of such cases. We report herein a case of a 70 year old man who presented with seizures as the sole manifestation of silver toxicity after self-medicating with colloidal silver.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"350-352"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10091871","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 Multifaceted Intervention on Antibiotic Prescribing for Cystitis and Asymptomatic Bacteriuria in 23 Community Hospital Emergency Departments.","authors":"Emily M Ingalls, John J Veillette, Jared Olson, Stephanie S May, C Dustin Waters, Stephanie S Gelman, George Vargyas, Mary Hutton, Nick Tinker, Gabriel V Fontaine, Rachel A Foster, Jena Stallsmith, Ali Earl, Whitney R Buckel, Todd J Vento","doi":"10.1177/00185787231159578","DOIUrl":"10.1177/00185787231159578","url":null,"abstract":"<p><p><b>Background:</b> Urinary tract infections (UTIs) are over-diagnosed and over-treated in the emergency department (ED) leading to unnecessary antibiotic exposure and avoidable side effects. However, data describing effective large-scale antimicrobial stewardship program (ASP) interventions to improve UTI and asymptomatic bacteriuria (ASB) management in the ED are lacking. <b>Methods:</b> We implemented a multifaceted intervention across 23 community hospital EDs in Utah and Idaho consisting of in-person education for ED prescribers, updated electronic order sets, and implementation/dissemination of UTI guidelines for our healthcare system. We compared ED UTI antibiotic prescribing in 2021 (post-intervention) to baseline data from 2017 (pre-intervention). The primary outcomes were the percent of cystitis patients prescribed fluoroquinolones or prolonged antibiotic durations (>7 days). Secondary outcomes included the percent of patients treated for UTI who met ASB criteria, and 14-day UTI-related readmissions. <b>Results:</b> There was a significant decrease in prolonged treatment duration for cystitis (29% vs 12%, <i>P</i> < .01) and treatment of cystitis with a fluoroquinolone (32% vs 7%, <i>P</i> < .01). The percent of patients treated for UTI who met ASB criteria did not change following the intervention (28% pre-intervention versus 29% post-intervention, <i>P</i> <i>=</i> .97). A subgroup analysis indicated that ASB prescriptions were highly variable by facility (range 11%-53%) and provider (range 0%-71%) and were driven by a few high prescribers. <b>Conclusions:</b> The intervention was associated with improved antibiotic selection and duration for cystitis, but future interventions to improve urine testing and provide individualized prescriber feedback are likely needed to improve ASB prescribing practice.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"401-407"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9714428","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":"Managing the Drug-Drug Interaction With Apixaban and Primidone: A Case Report.","authors":"Melanie M Manis, Kat Petersen, Megan Z Roberts, Jeffrey A Kyle","doi":"10.1177/00185787221150928","DOIUrl":"10.1177/00185787221150928","url":null,"abstract":"<p><p>The management of the drug-drug interaction (DDI) between primidone, a moderate to strong cytochrome P-450 (CYP) 3A4 inducer, and apixaban, a direct oral anticoagulant (DOAC) and CYP3A4 substrate is complex and limited evidence exists to guide management. This case report describes a 65-year-old male, receiving primidone for essential tremor who developed an acute venous thromboembolism (VTE) requiring oral anticoagulation. DOACs are preferred over vitamin K antagonists for acute VTE treatment. Based on patient-specific variables, provider preference, and the avoidance of other DDIs, apixaban was selected. Apixaban's package insert recommends avoiding use with concomitant strong P-gp and CYP3A4 inducers due to the decreased exposure to apixaban; however, no recommendations are available for drugs that are moderate to strong CYP3A4 inducers and lack P-gp effects. Given that phenobarbital is an active metabolite of primidone, extrapolation of evidence from such literature is theoretical but provides insight into the management of this multi-faceted DDI. In the absence of the ability to monitor plasma apixaban levels, a management strategy of avoidance with a washout period of primidone based on pharmacokinetic parameters was used in this case. Additional evidence is needed to clearly understand the degree of impact and clinical significance of the DDI between apixaban and primidone.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"345-349"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9715206","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":"Use of Intravenous Anakinra for Management of Pediatric Cytokine Storm Syndromes at an Academic Medical Center.","authors":"Lirong Yang,&nbsp;Sandra Lowry,&nbsp;Travis Heath","doi":"10.1177/00185787221142470","DOIUrl":"https://doi.org/10.1177/00185787221142470","url":null,"abstract":"<p><p><b>Background:</b> Off-label intravenous (IV) route of anakinra is increasingly recognized to enable higher and faster maximal plasma concentrations than subcutaneous route for treatment of cytokine storm syndromes. <b>Objective:</b> To describe off-label indications of IV anakinra, corresponding dosing and safety profiles, particularly during the coronavirus disease 19 (COVID-19) pandemic. <b>Methods:</b> A retrospective, single-cohort study was conducted at an academic medical center to evaluate use of IV anakinra in hospitalized pediatric patients (age ≤21 years). Institutional Review Board review was considered exempt. The primary endpoint was the primary indication(s) for IV anakinra. The key secondary endpoints were dosing of IV anakinra, previous immunomodulatory therapies, and adverse events. <b>Results:</b> Of 14 pediatric patients, 8 (57.1%) received IV anakinra for treatment of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, whereas 3 and 2 were treated for hemophagocytic lymphohistiocytosis (HLH) and flares of systemic onset juvenile idiopathic arthritis (SoJIA), respectively. The initial dosing regimen of IV anakinra for MIS-C associated with COVID-19 was a median dose of 2.25 mg/kg/dose with a median dosing interval of 12 hours for a median initial treatment duration of 3.5 days. Eleven (78.6%) patients received previous immunomodulatory therapies (IV immune globulin [n = 10; 71.4%] and steroids [n = 9; 64.3%]). No adverse drug events were documented. <b>Conclusion:</b> IV anakinra was used off-label for treatment of MIS-C associated with COVID-19, HLH and SoJIA flares in critically ill patients with no adverse drug events documented. This study helped ascertain the off-label indications of IV anakinra and corresponding patient characteristics.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"376-381"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10091873","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 Impact of Pharmacist-Led Antimicrobial Stewardship Review of Cultures in the Ambulatory Setting at a Comprehensive Cancer Center.","authors":"Deema H Abdelrahman, Aseel K AbuSara, Dina S Khabour","doi":"10.1177/00185787221150920","DOIUrl":"10.1177/00185787221150920","url":null,"abstract":"<p><p><b>Background:</b> Several antimicrobial stewardship interventions have demonstrated improved clinical outcomes. Though the impact of a pharmacist-led antimicrobial stewardship review of cultures has been described, studies have not evaluated such an intervention in institutions that primarily serve cancer patients. <b>Aim:</b> To describe the impact of the antimicrobial stewardship pharmacist's review of microbiological cultures from adult cancer patients in the ambulatory setting. <b>Method:</b> A retrospective study at a comprehensive cancer center that included adult cancer patients with positive microbiological cultures treated in the ambulatory setting, between August 2020 and February 2021. The cultures were reviewed in real time by the antimicrobial stewardship pharmacist, and were assessed for appropriateness of treatment. The number of antimicrobial modifications made, type of modifications, and physicians' acceptance rate were recorded. <b>Results:</b> A total of 661 cultures from 504 patients were reviewed by the pharmacist. The mean age of patients was 58 years ± 16 (SD); most had solid tumors (95%), and 34% were recent recipients of chemotherapy. Among the reviewed cultures, 175 (26%) required antimicrobial therapy modification, with an acceptance rate of 86%. The modifications consisted of changing from non-susceptible to susceptible antimicrobials (n = 95, 54%), initiation (n = 61, 35%), discontinuation (n = 10, 6%), de-escalation (n = 7, 4%), and dose modification (n = 2, 1%) of antimicrobials. <b>Conclusion:</b> Around one fourth of the cultures reviewed by the antimicrobial stewardship pharmacist in the ambulatory setting required interventions to optimize therapy. Future studies should evaluate the impact of these interventions on clinical outcomes.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 4","pages":"392-395"},"PeriodicalIF":0.8,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9769373","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}