Preethi S Samuel, Folake Olaleye, Maria Longo, Leonard Berkowitz
{"title":"Real World Data of Viral Suppression With Darunavir/Cobicistat and Dolutegravir/Rilpivirine Among Treatment-Experienced Patients Living With Multidrug-Resistant HIV.","authors":"Preethi S Samuel, Folake Olaleye, Maria Longo, Leonard Berkowitz","doi":"10.1177/08971900241247618","DOIUrl":"10.1177/08971900241247618","url":null,"abstract":"<p><p><b>Background:</b> Despite the effectiveness of the TRIO regimen in maintaining viral suppression, as seen in the ANRS 139 TRIO trial, one drawback is the high pill burden. However, with the development of newer antiretrovirals, this regimen can be simplified. The combination of both co-formulated darunavir/cobicistat and dolutegravir/rilpivirine keeps the integrity of the TRIO regimen while decreasing daily pill count from 12 to 2 tablets daily. The purpose of this case series is to demonstrate the efficacy of this regimen as there is a current lack of data. <b>Methods:</b> This case series included patients with no resistance to dolutegravir, rilpivirine, or darunavir, who were switched to the modified TRIO regimen between June 1st 2018 to June 1st 2022. The primary outcome was the proportion of patients with plasma HIV-RNA levels <50 copies/mL by 24 weeks. <b>Results:</b> At week 24, all patients (n = 9) had a HIV-RNA <50 copies/mL. At week 48, one patient did not have a VL available. However, out of the remaining 8 patients, all maintained an HIV-RNA of <50 copies/mL at week 48. <b>Conclusion:</b> HIV-RNA levels remained suppressed when patients were switched to the modified TRIO regimen. In addition, the pill burden was reduced which can add to overall patient satisfaction.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha J Leatham, Karl R Winckel, Keshia R De Guzman
{"title":"Management and Pharmacological Treatment of Peripheral Arterial Disease.","authors":"Samantha J Leatham, Karl R Winckel, Keshia R De Guzman","doi":"10.1177/08971900241250084","DOIUrl":"10.1177/08971900241250084","url":null,"abstract":"<p><p><b>Background:</b> Peripheral arterial disease (PAD) is a complex, heterogeneous condition that has become a leading health concern globally. Peripheral arterial disease often co-exists with other vascular disease states, including cerebrovascular and cardiovascular disease. Optimal therapy for managing symptoms and progression of disease employs non-pharmacological, pharmacological, and contemporary revascularisation techniques to improve clinical outcomes and quality of life. However, large well-designed randomised control trials (RCT) and corresponding evidence-based guidelines for management of PAD are lacking, with current practice standards often extrapolated from evidence in coronary artery disease. <b>Purpose:</b> This review article aims to discuss currently accepted best pharmacological practice for PAD. <b>Method:</b> Relevant articles were searched between May 2023 and January 2024 through PubMed, Cochrane Library, Google Scholar and international guidelines, focusing on pharmacological management for PAD. <b>Results:</b> This narrative review discusses holistic pharmacological treatments for PAD.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie Greer, Joanna Q Hudson, Anna Jacobs, Drew A Wells
{"title":"The Use of Intraperitoneal Ampicillin in a Patient With <i>Enterococcus faecalis</i> Peritonitis.","authors":"Natalie Greer, Joanna Q Hudson, Anna Jacobs, Drew A Wells","doi":"10.1177/08971900241256726","DOIUrl":"10.1177/08971900241256726","url":null,"abstract":"<p><p><b>Introduction:</b> Peritoneal dialysis (PD) - associated peritonitis is a serious complication of peritoneal dialysis (PD). The 2022 International Society of Peritoneal Dialysis (ISPD) guidelines do not recommend intraperitoneal (IP) ampicillin for treatment of Enterococcal PD - associated peritonitis. To date, there is no in vivo data to support use of IP ampicillin for the treatment of <i>Enterococcus faecalis</i>. <b>Case Description:</b> A 69-year-old man with a past medical history of end stage kidney disease (ESKD) requiring continuous cycling peritoneal dialysis (CCPD) was admitted to the hospital and treated for peritonitis with <i>E. faecalis</i>. The patient's CCPD prescription was 2.5% Dianeal with 5 total exchanges. IP ampicillin was added to the first 4 exchanges and additional ampicillin was added to the last fill. The patient successfully completed the treatment course with clinical cure. <b>Discussion:</b> The use of IP ampicillin for <i>E</i>. <i>faecalis</i> peritonitis is controversial and previously lacked compelling clinical evidence for or against its use. This case demonstrates treatment of peritonitis using a modified dosing strategy with ampicillin added to each CCPD exchange and last fill. The loss of ampicillin antimicrobial activity reported in vitro with <i>E. faecalis</i> was not supported by this case.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mackenzie Stout, Carly Giavatto, Nicholas McDonald, Lauren Bryant, Casey Ross, Casey Fitzpatrick, Jessica Mourani, Ana I Lopez-Medina
{"title":"Impact of Risk Stratification in Patients With Diabetes Mellitus in a Health System Specialty Pharmacy Setting.","authors":"Mackenzie Stout, Carly Giavatto, Nicholas McDonald, Lauren Bryant, Casey Ross, Casey Fitzpatrick, Jessica Mourani, Ana I Lopez-Medina","doi":"10.1177/08971900241257293","DOIUrl":"10.1177/08971900241257293","url":null,"abstract":"<p><p><b>Background:</b> Integrated pharmacist care into health systems results in significant A1c reduction and improved outcomes in patients with diabetes. However, little is known about the adoption of Health System Specialty Pharmacy (HSSP) chronic disease management (CDM) services within diabetes clinics. Risk stratification is proven to enhance care in various patient populations. <b>Objective:</b> The objective of this study is to describe how the implementation of risk stratification in the HSSP setting results in optimized patient outcomes in diabetes. <b>Method:</b> This is a retrospective descriptive study reporting the results of expanding the HSSP care model to implement risk stratified CDM services for patients with diabetes. A total of 285 patients were enrolled in the HSSP CDM pharmacy services and were stratified into high- or low-risk groups. <b>Results:</b> Eighty-eight patients were stratified as high-risk with an average baseline A1c of 11.47% and a most recent average of 8.84%. The remaining 285 patients were stratified into the low-risk group. Their average baseline A1c was 7.48% and the last recorded average A1c was 7.15%. Patients not enrolled in HSSP CDM services (N = 100) had a lower reduction in average A1c compared to patients enrolled in the program. <b>Conclusion:</b> Patients stratified into high- and low-risk groups had greater reductions in A1c compared to patients who did not use HSSP CDM services. These results showcase the success of risk stratification and demonstrate the impact HSSP has on patients needing CDM services and outlines a strategy to provide the greatest impact in a high-volume patient population.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141159831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily Wo, Cara Trulli, Jessica Wilczynski, Jimmy Gonzalez
{"title":"Evaluation of Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitor Prescribing Patterns in Heart Failure Patients at Hospital Discharge.","authors":"Emily Wo, Cara Trulli, Jessica Wilczynski, Jimmy Gonzalez","doi":"10.1177/08971900241256772","DOIUrl":"10.1177/08971900241256772","url":null,"abstract":"<p><p><b>Background:</b> Sodium-glucose cotransporter-2 inhibitors (SGLT2i) dapagliflozin and empagliflozin are indicated for heart failure with reduced ejection fraction (HFrEF) for cardiovascular death and heart failure hospitalization risk reduction. Due to the recent nature of these data, prescribing of SGLT2is may be suboptimal. <b>Objective:</b> This study sought to assess the prevalence of SGLT2i prescriptions at hospital discharge for HFrEF. <b>Methods:</b> A retrospective chart review was conducted on HFrEF patients discharged from April 1st to December 31st, 2021 from one academic medical center in the United States. The primary objective was to determine the percentage of eligible patients prescribed SGLT2i at discharge and the secondary objective was to characterize covariates impacting prescription. <b>Results:</b> Overall, 115 patients were included. The mean age was 72 ± 14.25 years. The majority were male (73.9%) and Caucasian (74.8%). At discharge, 15.7% of patients were prescribed an SGLT2i, although 94.8% were eligible. Baseline characteristics and concomitant medications did not differ significantly, although the mean number of discharge medications differed significantly between those prescribed an SGLT2i (15.78 ± 6.77) and those not (12.05 ± 5.28) (<i>P</i> = 0.023). <b>Conclusions:</b> SGLT2is are under-prescribed at discharge for HFrEF patients, despite many being eligible. Further studies should be done to elucidate factors that influence the under-prescription of SGLT2is.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation of ChatGPT as a Tool for Answering Clinical Questions in Pharmacy Practice.","authors":"Faria Munir, Anna Gehres, David Wai, Leah Song","doi":"10.1177/08971900241256731","DOIUrl":"10.1177/08971900241256731","url":null,"abstract":"<p><p><b>Background:</b> In the healthcare field, there has been a growing interest in using artificial intelligence (AI)-powered tools to assist healthcare professionals, including pharmacists, in their daily tasks. <b>Objectives:</b> To provide commentary and insight into the potential for generative AI language models such as ChatGPT as a tool for answering practice-based, clinical questions and the challenges that need to be addressed before implementation in pharmacy practice settings. <b>Methods:</b> To assess ChatGPT, pharmacy-based questions were prompted to ChatGPT (Version 3.5; free version) and responses were recorded. Question types included 6 drug information questions, 6 enhanced prompt drug information questions, 5 patient case questions, 5 calculations questions, and 10 drug knowledge questions (e.g., top 200 drugs). After all responses were collected, ChatGPT responses were assessed for appropriateness. <b>Results:</b> ChatGPT responses were generated from 32 questions in 5 categories and evaluated on a total of 44 possible points. Among all ChatGPT responses and categories, the overall score was 21 of 44 points (47.73%). ChatGPT scored higher in pharmacy calculation (100%), drug information (83%), and top 200 drugs (80%) categories and lower in drug information enhanced prompt (33%) and patient case (20%) categories. <b>Conclusion:</b> This study suggests that ChatGPT has limited success as a tool to answer pharmacy-based questions. ChatGPT scored higher in calculation and multiple-choice questions but scored lower in drug information and patient case questions, generating misleading or fictional answers and citations.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Updates in Chronic Kidney Disease.","authors":"Haley N Johnson, Lalita Prasad-Reddy","doi":"10.1177/08971900241262381","DOIUrl":"10.1177/08971900241262381","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) affects approximately 14% of adults in the United States and is present in at least 10% of the population worldwide. Blood glucose and blood pressure control are imperative to adequately manage CKD as they are the only primary prevention measures for the condition. Recent changes in CKD evaluation and medication therapies that modify disease progression and aid in managing complications such as anemia of CKD have emerged, including a newly approved mineralocorticoid receptor antagonist and hypoxia-inducible factor-prolyl hydroxylase inhibitor, respectively. This focused update on CKD evaluation and management will review the most recent evidence and approved agents to support patients with CKD, including a review of glomerular filtration rate measurement methods such as CKD-EPI 2021 and utilization of cystatin C, Kidney Disease Improving Global Outcomes (KDIGO) guidelines, American Diabetes Association (ADA) guidelines, and primary literature supporting the use of newer agents in CKD. Checklists for managing blood pressure and blood glucose, CKD-mineral bone disorder, and anemia of CKD targeted for pharmacists are also provided. Additionally, a discussion of Centers for Medicare & Medicaid (CMS) coverage of agents approved for managing complications of CKD is included.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Navigating Glucagon-Like Peptide Receptor Agonist Reinitiation Amid Access Barriers: An Adverse Drug Event Case Report.","authors":"Olivia Denny, Jeffrey Baron, Nicole P Albanese","doi":"10.1177/08971900241256775","DOIUrl":"10.1177/08971900241256775","url":null,"abstract":"<p><p><b>Background:</b> The expanding roles and popularity of glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists has created access barriers to medication use. We sought to describe an adverse drug event which occurred after reinitiation of a GLP-1 receptor agonist following a prolonged lapse in therapy due to poor medication access. <b>Case Summary</b>: Once-weekly injectable semaglutide was prescribed to an outpatient 33-year-old male for chronic weight management. After a delayed initiation due to global shortage, semaglutide was initiated and titrated over five months before a seven week lapse in therapy due to prior authorization interruption. Despite the extended treatment gap, the patient was directed to reinitiate semaglutide at the target dose rather than starting dose, which was followed by recurrent, symptomatic nausea and vomiting requiring medical intervention. <b>Practice Implications:</b> A prolonged lapse in GLP-1 receptor agonist therapy, typically defined as missing three or more doses of a once-weekly injectable, warrants consideration of reinitiation at a reduced dose, personalized to the patient's prior gastrointestinal tolerability, efficacy goals, and therapy lapse duration. Therapy lapses with GLP-1 receptor agonists may be prevented by utilizing a multi-modal approach including extended dosing intervals, intermediate doses, agent interchange, efficient prior authorization communication, and cautious initiation of GLP-1 recent agonists while supply cannot meet demand.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Changes in Time in Therapeutic Range Within a Warfarin Anticoagulation Clinic Following Introduction of Direct Oral Anticoagulants.","authors":"Preethi Samuel, Kaitlyn Cassidy, Pauletta Lazarevskiy, Rebecca Cope","doi":"10.1177/08971900241256779","DOIUrl":"10.1177/08971900241256779","url":null,"abstract":"<p><p><b>Background:</b> As direct oral anticoagulants (DOACs) have become widely recommended as first-line anticoagulation therapy, patients who remain on warfarin are likely those unable to afford, adhere to, or utilize DOAC therapy due to the presence of a contraindication. It is currently unknown how availability of DOACs have affected populations being managed at warfarin (VKA) anticoagulation clinics. <b>Methods:</b> This was a retrospective chart review assessing warfarin-treated patients at an outpatient anticoagulation clinic. The primary endpoint was the 6-month time in therapeutic range (TTR) before and after DOACs were recommended as first-line therapy by clinical guidelines. Study periods were January to June 2015, before DOACs were recommended over VKA, and January to June 2022, when DOACs were often recommended over VKA. TTR, demographic changes, and the presence of contraindications to DOAC therapy in the clinic population between the two time periods were assessed. <b>Results:</b> No difference in 6-month TTR was observed between study periods (59% in 2015 vs 63% in 2022; <i>P</i> = .45). Patient demographics did not significantly vary, which may be due to the clinic retaining 45% of patients between both time periods. Contraindications to DOAC therapy were identified in 39% of the 2015 group and 49% of the 2022 group (<i>P</i> = .18). The most common contraindication was indication for anticoagulation. <b>Conclusion:</b> Availability of DOACs did not seem to significantly affect the population or management of warfarin-treated patients at an outpatient anticoagulation clinic, however, contraindications and potential challenges to use of DOAC therapy are present in many patients.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141154155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cassidy H Padgett, G Shawn King, R Ethan Hughes, Megan N Hull, Eliseo A Colon
{"title":"Evaluation of Empiric Coverage of Previously Cultured Multidrug Resistant Organisms in Critically Ill Patients Admitted for Sepsis.","authors":"Cassidy H Padgett, G Shawn King, R Ethan Hughes, Megan N Hull, Eliseo A Colon","doi":"10.1177/08971900241262359","DOIUrl":"10.1177/08971900241262359","url":null,"abstract":"<p><p><b>Purpose</b>: Multidrug-resistant organisms (MDROs) are associated with an increased length of stay and a higher risk of mortality in hospitalized patients. A lack of literature exists that evaluates the need to empirically cover patients for historic MDROs upon readmission. <b>Methods</b>: A retrospective, single-center, cohort study was conducted to evaluate the impact of empiric MDRO antibiotic coverage in patients with a history of MDROs. Differences in length of stay were assessed between two groups of patients: those empirically treated for their historic MDRO and those not. Secondary outcomes included in-hospital mortality, ICU length of stay, need for antibiotic escalation, need for antibiotic de-escalation, and antibiotic duration. <b>Results:</b> Seventy-two patients with historic MDRO(s) were readmitted to the hospital and met inclusion criteria for this study. Hospital length of stay was similar between those empirically covered and those not (11 days vs 15.1 days; <i>P = 0.149</i>). When analyzed in a population only including Gram-negative MDROs, hospital length of stay was shorter in those who received empiric coverage (10.7 days vs 17.2 days; <i>P = 0.032</i>). <b>Conclusion:</b> In the total study population, empiric coverage of historic MDROs failed to significantly reduce hospital length of stay. When analyzed in a population of only Gram-negative MDROs, empiric coverage of historic organisms reduced hospital length of stay by 6.5 days. This suggests that in patients readmitted to the ICU for sepsis, empiric coverage of historic Gram-negative MDROs may be beneficial.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}