American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists最新文献

{"title":"Pharmacy technicians find influence, acceptance as pharmacy board members.","authors":"Kate Traynor","doi":"10.1093/ajhp/zxac174","DOIUrl":"https://doi.org/10.1093/ajhp/zxac174","url":null,"abstract":"","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1221-1222"},"PeriodicalIF":2.7,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405797","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":"Implications of obesity for drug administration and absorption from subcutaneous and intramuscular injections: A primer.","authors":"Brian L Erstad,&nbsp;Jeffrey F Barletta","doi":"10.1093/ajhp/zxac058","DOIUrl":"https://doi.org/10.1093/ajhp/zxac058","url":null,"abstract":"<p><strong>Purpose: </strong>To discuss the potential implications of obesity for drug administration and absorption from subcutaneous (SC) and intramuscular (IM) injection sites.</p><p><strong>Summary: </strong>The SC and IM routes are useful for the parenteral administration of medications to optimize pharmacokinetic properties such as time to onset and duration of effect, for cost considerations, or for ease of administration, such as when intravenous access is unavailable. The choice of SC or IM injection depends on the specific medication, with SC administration preferred for products such as insulin where a slower and more sustained response is desirable, while IM administration is usually preferred for products such as vaccines where more rapid absorption leads to a more rapid antibody response. Obesity has the potential to influence the rate and extent of absorption, as well as adverse effects, of medications administered by the SC or IM route through changes in SC tissue composition and depth or by inadvertent administration of IM medications into SC tissue because of improper needle length. Potential adverse effects associated with IM or SC injections in addition to pain, bruising, and hematoma formation include sciatic nerve injury, particularly with IM injection in the upper outer quadrant of the buttock; bone contusion or rarely osteonecrosis if the IM injection is excessively deep; and granulomas, fat necrosis, and calcification with SC injection.</p><p><strong>Conclusion: </strong>Issues related to medication absorption in obese patients are likely to become more prominent in the future with increasing approvals of a wide range of biotherapeutic agents administered by SC injection. Studies should be directed toward these and other agents to assist with dosing decisions in this challenging population.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1236-1244"},"PeriodicalIF":2.7,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39933081","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":"ASHP Pharmacy Technician Forum Executive Committee.","authors":"David Wild","doi":"10.1093/ajhp/zxac173","DOIUrl":"https://doi.org/10.1093/ajhp/zxac173","url":null,"abstract":"","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1222-1223"},"PeriodicalIF":2.7,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405076","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":"Acute elevation of liver function test values following concomitant administration of dabigatran and primidone.","authors":"Lisa A Caviness,&nbsp;Katelyn M Wassell,&nbsp;Amanda Howard-Thompson","doi":"10.1093/ajhp/zxac054","DOIUrl":"https://doi.org/10.1093/ajhp/zxac054","url":null,"abstract":"<p><strong>Purpose: </strong>We report a unique case of transiently elevated liver function test (LFT) values associated with concurrent use of dabigatran and primidone, which has not previously been described in the scientific literature.</p><p><strong>Summary: </strong>Management of drug-drug interactions requires a fundamental understanding of pharmacodynamic and pharmacokinetic parameters. Despite the use of available best predictive models, idiosyncratic drug reactions may still occur when a newly approved medication begins to be used in the general population. We report a case of a possible interaction (Naranjo adverse drug reaction probability score of 3, Roussel Uclaf causality assessment method score of 3) between dabigatran and primidone in a 70-year-old Caucasian male resulting in a transient elevation of LFT values. The patient was transitioned from warfarin to dabigatran in the setting of persistently subtherapeutic international normalized ratio values. During a routine outpatient follow-up appointment approximately 1 month after dabigatran initiation, the patient was discovered to have LFT values greater than 5 times the upper limit of normal. Dabigatran was thus discontinued; the patient was returned to warfarin therapy and their LFT values returned to baseline.</p><p><strong>Conclusion: </strong>Studies have indicated a potential for reduced dabigatran efficacy with concurrent use of primidone due to P-glycoprotein induction, thereby potentiating the risk for thrombosis. To date, reports of this interaction resulting in hepatic injury are lacking. The present case suggests that this interaction may be clinically significant with regard to selection of antithrombotic medication therapy in patients on primidone therapy.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1250-1254"},"PeriodicalIF":2.7,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959720","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":"New and emerging pharmacotherapies for the management of multiple myeloma.","authors":"Donald C Moore,&nbsp;Carolyn J Oxencis,&nbsp;Brandon R Shank","doi":"10.1093/ajhp/zxac091","DOIUrl":"https://doi.org/10.1093/ajhp/zxac091","url":null,"abstract":"<p><strong>Purpose: </strong>The pharmacology, efficacy, safety, and dosing/administration of new and emerging therapies for the treatment of multiple myeloma are summarized.</p><p><strong>Summary: </strong>There have been significant advancements in the treatment of multiple myeloma in recent years, with an expansion of available drug therapies. Newer therapies for multiple myeloma include the anti-CD38 monoclonal antibodies daratumumab and isatuximab, the exportin 1 inhibitor selinexor, the anti-B-cell maturation antigen (BCMA) antibody-drug conjugate belantamab mafodotin, and the chimeric antigen receptor (CAR) T-cell therapy idecabtagene vicleucel. These agents have unique toxicity profiles, specific monitoring parameters, and operational considerations that clinicians treating multiple myeloma should be aware of. There is likely to be continued rapid expansion of new agents for patients with multiple myeloma, as there are many novel investigational agents in the drug development pipeline, such as bispecific antibodies and additional CAR T-cell therapies.</p><p><strong>Conclusion: </strong>Several therapeutic agents have been recently approved by the Food and Drug Administration for the treatment of multiple myeloma. There are many novel agents in the pipeline, including bispecific antibodies and CAR T-cell therapies that have the potential to continue to change the treatment landscape of multiple myeloma.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1137-1145"},"PeriodicalIF":2.7,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40328264","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":"Impact of an electronic health record alert on inappropriate prescribing of high-risk medications to patients with concurrent \"do not give\" orders.","authors":"Kirsten Smith,&nbsp;Karin M Durant,&nbsp;Chris Zimmerman","doi":"10.1093/ajhp/zxac092","DOIUrl":"https://doi.org/10.1093/ajhp/zxac092","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of clinical decision support (CDS) alerts tied to high-risk medications at a Michigan health system by determining the true prescriber action rate in response to select \"do not give\" (DNG) alerts.</p><p><strong>Methods: </strong>A retrospective review of prescriber actions in response to CDS alerts was conducted to evaluate the effectiveness of alerts designed to prevent prescribing of high-risk medications to patients with concurrent DNG orders. The primary endpoint was the overall action rate, determined by totaling orders cancelled within the alert display and orders modified shortly after an alert. The overall action rate was hypothesized to significantly exceed the action rate estimated on the basis of alert overrides alone. Following the initial review, changes were made to the alert format and preset documentation choices (\"acknowledgement comments\"), and it was hypothesized that these changes would increase the overall action rate. A repeat analysis was conducted to evaluate the impact of these changes.</p><p><strong>Results: </strong>Across a total of 506 CDS alerts over 14 months, 78% resulted in prescribers modifying orders to comply with alert recommendations. Prescribers cancelled orders in response to only 26% of alerts, often overriding alerts prior to modifying orders. Documentation of rationale or approval for overrides was inconsistent, and while requiring acknowledgement comments facilitated documentation of prescriber rationale, it did not consistently improve overall action rates.</p><p><strong>Conclusion: </strong>These findings demonstrate that override rates alone are not good markers for the true effectiveness of CDS alerts and support the need for frequent evaluation of alerts at the institutional level. CDS alerts remain a valuable tool to prevent inappropriate prescribing of high-risk medications and for promoting patient safety.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1198-1204"},"PeriodicalIF":2.7,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40326866","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":"Extremely hypo-osmolar intravenous solutions to treat hypernatremia: The time has come to stop.","authors":"Brian L Erstad,&nbsp;Yvonne C Huckleberry","doi":"10.1093/ajhp/zxab480","DOIUrl":"https://doi.org/10.1093/ajhp/zxab480","url":null,"abstract":"In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1122-1125"},"PeriodicalIF":2.7,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39848449","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":"Home infusion pharmacy quality improvement for central venous access devices using anti-reflux needleless connectors to reduce occlusions, emergency room visits, and alteplase costs.","authors":"Bob Buzas,&nbsp;Julie Smith,&nbsp;Gregory E Gilbert,&nbsp;Nancy Moureau","doi":"10.1093/ajhp/zxac083","DOIUrl":"https://doi.org/10.1093/ajhp/zxac083","url":null,"abstract":"<p><strong>Purpose: </strong>The study's purpose was to measure the impact of anti-reflux needleless connector usage in prevention of intraluminal thrombotic occlusions among central venous catheters, as represented by alteplase usage, in a home infusion patient population.</p><p><strong>Methods: </strong>An18-month before-and-after cohort study of a single home infusion intervention was conducted to compare occlusion outcomes with use of two types of needleless connectors-neutral and anti-reflux-in preventing catheter occlusions, which have been reported to occur in 28% of home infusion patients, resulting in treatment delays, increased nursing encounters and emergency room visits, and higher overall pharmacy costs for supplies and alteplase.</p><p><strong>Results: </strong>A total of 552,707 patient therapy days were studied: 42.5% in the neutral needleless connector group (n = 235,004 therapy days) and 57.5% in the anti-reflux needleless connector group (n = 317,703 therapy days). The rate of alteplase usage with neutral versus anti-reflux needleless connectors was 4.4% versus 2.2% per 1,000 therapy days, with median alteplase use of 112 (95% CI, 89-169) units versus 82 (95% CI, 68-109) units (P < 0.001). Implementation of anti-reflux connectors reduced occlusions and alteplase usage by 48%.</p><p><strong>Conclusion: </strong>Statistical evidence demonstrated that use of anti-reflux needleless connectors with central venous access devices reduced the need for alteplase in the study population. Since 10% of patient occlusions were within 7 days after home infusion admission, future research may indicate that placement of anti-reflux needleless connectors at the time of in-hospital insertion can improve patient outcomes. This quality improvement measure reduced central catheter occlusions, alteplase costs, and the number of required nursing and emergency room visits.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1079-1085"},"PeriodicalIF":2.7,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40319593","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":"Panacea or oversimplification: Relating AUC and troughs.","authors":"Nicholas Rebold,&nbsp;Thomas Lodise,&nbsp;Michael J Rybak","doi":"10.1093/ajhp/zxac031","DOIUrl":"https://doi.org/10.1093/ajhp/zxac031","url":null,"abstract":"In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1019-1021"},"PeriodicalIF":2.7,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39605984","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":"Stability of Captisol-enabled versus propylene glycol-based melphalan at room temperature and after refrigeration.","authors":"Jitesh D Kawedia,&nbsp;Sumankalai Ramchandran,&nbsp;Xiaoqian Liu,&nbsp;Alison M Gulbis,&nbsp;Mark Titus,&nbsp;Qaiser Bashir,&nbsp;Muzaffar H Qazilbash,&nbsp;Richard E Champlin,&nbsp;Stefan O Ciurea","doi":"10.1093/ajhp/zxac055","DOIUrl":"https://doi.org/10.1093/ajhp/zxac055","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the chemical stability of Captisol-enabled (CE) melphalan (\"CE-melphalan\"; Evomela, Acrotech Biopharma LLC) and propylene glycol (PG)-based melphalan (\"PG-melphalan\"; Alkeran, GlaxoSmithKline) admixtures prepared with 0.9% sodium chloride injection in polyvinyl chloride (PVC) bags or reconstituted vials stored at room temperature (RT) and under refrigeration.</p><p><strong>Methods: </strong>Lyophilized CE-melphalan and generic PG-melphalan were reconstituted to 5 mg/mL with 0.9% sodium chloride injection or manufacturer-supplied diluent, respectively. The reconstituted vials were then diluted to the desired concentrations with 0.9% sodium chloride injection in PVC bags and were stored at RT (23oC) or under refrigeration (4oC). Aliquots were withdrawn from the bags and reconstituted vials of CE-melphalan and PG-melphalan immediately after preparation and at predetermined time intervals. Melphalan concentrations were measured using a validated high-performance liquid chromatography method.</p><p><strong>Results: </strong>CE-melphalan reconstituted in PVC bags at concentrations of 1 and 2 mg/mL was stable for 6 and 24 hours, respectively, at RT and for 8 and 24 hours, respectively, at 4oC. PG-melphalan reconstituted in bags at 1, 1.5, and 2 mg/mL was stable for 1, 2, and 2 hours, respectively, at RT and for 2, 4, and 4 hours, respectively, at 4oC. Reconstituted CE-melphalan vials were stable for 48 hours at both RT and 4oC, whereas PG-melphalan vials were stable for 6 hours at RT but formed precipitate within 2 hours at 4oC.</p><p><strong>Conclusion: </strong>CE-melphalan remained stable longer than generic PG-melphalan under the test conditions. CE-melphalan at 2 mg/mL has 24-hour stability at RT and can be used for extended infusion times or may be compounded ahead of time. Reconstituted CE-melphalan vials are stable for 48 hours at both RT and 4oC.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":"1011-1018"},"PeriodicalIF":2.7,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39933079","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}