American Journal of Health-System Pharmacy最新文献

{"title":"Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 1: Patient presentation through revascularization.","authors":"Sara J Hyland, Rachael E Eaton, Marion E Max, Susan B Egbert, Stephanie A Wong, Danielle M Blais","doi":"10.1093/ajhp/zxae303","DOIUrl":"10.1093/ajhp/zxae303","url":null,"abstract":"<p><strong>Purpose: </strong>Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical initial phases of care are reviewed.</p><p><strong>Summary: </strong>Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes.</p><p><strong>Conclusion: </strong>Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e578-e595"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating pharmacoequity in the formulary review and evaluation process: Opportunities for health-system P&T committees to address health disparities and inequities.","authors":"Donald C Moore, Angela Colella, Janine S Douglas, Elizabeth A Shlom, Joshua P Vanderloo, Folashade Alabi","doi":"10.1093/ajhp/zxae370","DOIUrl":"10.1093/ajhp/zxae370","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e637-e640"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clearing the air: Assessing inhaler usage and associated greenhouse gas emissions in a health system.","authors":"Keaton S Smetana, Jake Girardot, Samantha Hopton, Adam Trimble, Beth Eckl, Allegra Wiesler","doi":"10.1093/ajhp/zxae384","DOIUrl":"10.1093/ajhp/zxae384","url":null,"abstract":"<p><strong>Purpose: </strong>The transition from chlorofluorocarbons (CFCs) to hydrofluoroalkanes (HFAs) has significantly reduced the greenhouse gas (GHG) emissions associated with metered-dose inhalers (MDIs). However, HFAs still have a high global warming potential (GWP) compared to other alternatives such as dry powder inhalers (DPIs) and soft mist inhalers (SMIs). This transition has significantly impacted GHG emissions, underscoring a need to evaluate the environmental impact of medication delivery via MDIs.</p><p><strong>Objectives: </strong>This study quantifies the GHG emissions, expressed as carbon dioxide equivalents (CO2e), from the use of HFAs in MDIs within our health system. The healthcare system includes 13 hospitals with over 2,000 staffed beds and approximately 100,000 annual patient admissions. It also examines the broader environmental impacts of the packaging materials associated with these inhalers.</p><p><strong>Methods: </strong>A retrospective analysis of the use of albuterol and inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) MDIs over a 1-year period, assessing their CO2e emissions and the environmental impact of their packaging. The total weight of propellant was determined by calculating the difference in canister weight before use and after all contents were expelled.</p><p><strong>Results: </strong>A total of 17,589 albuterol and 20,563 ICS/LABA MDIs were dispensed during the study. The total propellant weight led to CO2e emissions of 212 metric tons (MT) for albuterol MDIs and 506 MT for ICS/LABA MDIs. Including resource use and emissions from inhaler components led to an environmental impact that totaled 213 MT of CO2e for albuterol MDIs and 512.5 MT for ICS/LABA MDIs.</p><p><strong>Conclusion: </strong>Our study emphasizes the necessity of integrating environmental stewardship into healthcare practices. By fostering awareness and initiating discussions on sustainable practices, particularly in the context of pharmacy operations, we can contribute to a more environmentally responsible healthcare system while continuing to meet the clinical needs of our patients.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e607-e614"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent and anticipated novel drug approvals (1Q 2025 through 4Q 2025).","authors":"Matthew H Rim, Brittany L Karas, Farah Barada, Mary Golf, Vishal Prakash, Andrew M Levitsky","doi":"10.1093/ajhp/zxaf030","DOIUrl":"10.1093/ajhp/zxaf030","url":null,"abstract":"<p><strong>Purpose: </strong>Health-system pharmacists play a crucial role in monitoring the pharmaceutical pipeline to manage formularies, allocate resources, and optimize clinical programs for new therapies. This article aims to support pharmacists by providing updates on new and anticipated novel drug approvals.</p><p><strong>Summary: </strong>Selected drug approvals anticipated in the 12-month period covering each quarter of 2025 are reviewed. The analysis emphasizes drugs expected to have significant clinical and financial impact in hospitals and clinics, as selected from 60 novel drugs awaiting US Food and Drug Administration approval. This year's pipeline features gene and cell therapies for rare diseases, agents for neurological disorders, and several novel treatments for cancers and various disease states.</p><p><strong>Conclusion: </strong>Novel therapies continue to strengthen the current drug pipeline.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e600-e606"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial stewardship in the Federal Bureau of Prisons: Combining prospective audit and feedback with formulary changes to reduce inappropriate fluoroquinolone use.","authors":"Alexander Brorby, Holly Herring, Evan Williams","doi":"10.1093/ajhp/zxae394","DOIUrl":"10.1093/ajhp/zxae394","url":null,"abstract":"<p><strong>Purpose: </strong>Antimicrobial stewardship programs have been widely implemented with positive results in the inpatient healthcare delivery model. However, data supporting these interventions is limited in other care settings.</p><p><strong>Summary: </strong>Formulary restrictions and conducting prospective audit and feedback (PAF) are mainstays of antimicrobial stewardship. A PAF program targeted specifically at fluoroquinolone use was implemented in the Federal Bureau of Prisons (FBOP), in addition to exclusionary formulary restrictions on ciprofloxacin and levofloxacin. After implementation of these interventions, overall fluoroquinolone orders per 1,000 adults in custody (AICs) were reduced by 46.4% (P < 0.0001). The majority of PAF interventions addressed situations in which an antibiotic was unnecessary or a fluoroquinolone was not the recommended first-line agent. Over the same time period, nonformulary approval rates for ciprofloxacin and levofloxacin averaged 62%.</p><p><strong>Conclusion: </strong>The interventions from this program provide data supporting the effectiveness of formulary changes and PAF for antimicrobial stewardship in a nontraditional care setting.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e632-e638"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and potential predictors of SGLT2 inhibitor initiation in acutely hospitalized patients with heart failure.","authors":"Cameron Lanier, Jessica C Brumit, Jennifer Tharp, Jacquelyn Crawford, Kathleen M White, Vera Wilson, Kelly Covert","doi":"10.1093/ajhp/zxaf025","DOIUrl":"10.1093/ajhp/zxaf025","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the incidence of sodium-glucose cotransporter 2 (SGLT2) inhibitor initiation in hospitalized patients with heart failure and determine what potential factors may influence use.</p><p><strong>Methods: </strong>A single-center, retrospective cohort analysis was conducted of hospitalized patients with heart failure. The primary outcome was the incidence of SGLT2 inhibitor initiation. Secondary outcomes included the rates of use of other guideline-directed medical therapy, identification of factors associated with initiation of SGLT2 inhibitors, and reasons why SGLT2 inhibitors were not initiated.</p><p><strong>Results: </strong>A total of 503 patients were included. The overall incidence of SGLT2 inhibitor initiation was 18% across all heart failure types, with 30% incidence in heart failure with reduced ejection fraction, 2.2% incidence in heart failure with mildly reduced ejection fraction (HFmrEF), and 5.7% incidence in heart failure with preserved ejection fraction (HFpEF). Logistic regression analysis showed that older age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-0.99; P = 0.009) and the presence of HFpEF (OR, 0.37; 95% CI, 0.17-0.77; P = 0.007) or HFmrEF (OR, 0.22; 95% CI, 0.05-0.69; P = 0.02) were negatively associated with SGLT2 inhibitor initiation. Presence of an angiotensin-converting enzyme inhibitor, angiotensin 2 receptor blocker, or angiotensin receptor/neprilysin inhibitor (OR, 2.14; 95% CI, 1.16-4.05; P = 0.017) or a β-blocker (OR, 3.78; 95% CI, 1.62-10.37; P = 0.004) was positively associated with the addition of an SGLT2 inhibitor, as was a cardiology consult (OR, 8.29; 95% CI, 2.36-52.83; P = 0.005). Providers rarely documented the reason for not prescribing an SGLT2 inhibitor, but the most commonly cited reasons were deferral to the outpatient setting (5.6%) and concern for renal function (4.6%).</p><p><strong>Conclusion: </strong>Use of SGLT2 inhibitors remains low despite recommendations advocating for their use in heart failure, with these agents specifically underutilized in HFpEF and HFmrEF at this institution.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e624-e631"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a pharmacist-driven ketogenic diet protocol at an academic, quaternary pediatric referral center.","authors":"Anthony Vecchione, Philip Carpiniello, Corey A Fowler","doi":"10.1093/ajhp/zxae399","DOIUrl":"10.1093/ajhp/zxae399","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e573"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a pharmacy residency research program educational series: A review of the literature and considerations for implementation.","authors":"Kyle A Weant, Nicole M Acquisto, Mandy Brown, Jennifer Iuppa, Stephen Rappaport, Erin Weeda","doi":"10.1093/ajhp/zxae382","DOIUrl":"10.1093/ajhp/zxae382","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e641-e647"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion of health equity language in recruitment materials for postgraduate pharmacy residencies.","authors":"Sarah Vas, Akshara Kumar, Jessica Schowe, Jasmine Reyes, Taylor Krout, Monica L Miller, Rakhi Karwa","doi":"10.1093/ajhp/zxae393","DOIUrl":"10.1093/ajhp/zxae393","url":null,"abstract":"<p><strong>Purpose: </strong>The study objective was to analyze the use of health equity (HE)- and social determinants of health (SDOH)-related language within pharmacy residency websites and recruitment materials.</p><p><strong>Methods: </strong>Using the ASHP residency directory of 2022, a randomly selected sample of postgraduate year 1 (PGY1) and PGY1/PGY2 programs from each state were analyzed. After search terms were selected from HE/SDOH resources, each program's residency-specific webpages (RSWs) and institution-specific webpages (ISWs) were searched and given a score based on the frequency of identified terms. The primary outcome was the number of programs with at least one identified instance of HE/SDOH terms. Additional outcomes included the frequency of HE/SDOH terms on ISWs or RSWs and program score distribution. Outcomes were also evaluated among programs in medically underserved areas (MUAs).</p><p><strong>Results: </strong>Three hundred eighteen programs were included, of which 205 (64%) included HE/SDOH language within RSWs, ISWs, or both. Of these 205 programs, 126 programs (61%) included language only on ISWs. The number of programs that only had one instance of HE/SDOH terms on either category of webpages, or had a score of 1, was 128 programs (40.2% of the total of 318 programs). Of the 111 programs in MUAs (35%), 66 (59.5%) included HE/SDOH language within the ISWs.</p><p><strong>Conclusion: </strong>Most evaluated programs, including those in MUAs, lacked language specifically identifying their focus and work around HE/SDOH within their residency promotional materials.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e615-e623"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cabotegravir/rilpivirine resistance in a patient living with HIV despite on-time administration: A case report.","authors":"Trent G Towne, Travis R Hays","doi":"10.1093/ajhp/zxaf078","DOIUrl":"10.1093/ajhp/zxaf078","url":null,"abstract":"<p><strong>Purpose: </strong>Cabotegravir/rilpivirine (CAB/RPV) is the first long-acting antiretroviral therapy for patients with human immunodeficiency virus (HIV). It is administered via intramuscular injection into the gluteal muscle, requiring precise technique. We report the case of a patient living with HIV who developed resistance to CAB despite on-time administration of all doses.</p><p><strong>Summary: </strong>A 34-year-old man with a body mass index (BMI) of 38.42 kg/m2 who received therapy with CAB/RPV 600 mg/900 mg intramuscularly every other month for 15 months presented to the clinic for routine HIV care. An HIV viral load obtained just before the visit demonstrated a significant elevation in his viral load, which was previously undetectable. Further testing demonstrated the development of a G118R resistance-associated mutation in the virus with a class-wide effect on integrase inhibitors. Upon review, it was determined that the patient had received all doses of his medication with a 1.5-inch needle rather than the recommended 2-inch needle based on his BMI. He was subsequently switched to darunavir/cobicistat/emtricitabine/tenofovir alafenamide and quickly achieved viral suppression.</p><p><strong>Conclusion: </strong>This case demonstrates the potential for patients living with HIV to develop resistance to CAB/RPV despite on-time administration of the medication. Proper administration and timing of antiretroviral therapy for these patients is essential to ensure efficacy and safety in the management of HIV but does not completely prevent development of resistance.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e596-e599"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}