Seizure Occurring During Baclofen Monotherapy for Phenibut Withdrawal.

OBJECTIVE: Phenibut is a widely available gamma-aminobutyric acid B receptor agonist. When taken chronically, phenibut causes dependence and subsequent withdrawal if stopped. Baclofen, a gamma-aminobutyric acid B receptor agonist structurally related to phenibut, has been used to manage phenibut withdrawal (PW), although baclofen doses for PW are not well defined and may exceed Food and Drug Administration-approved doses. Little data described outcomes from baclofen use. METHODS: This case details a patient who experienced a seizure while on baclofen 10 mg thrice daily as monotherapy for PW and highlights a potential risk of underdosing baclofen as monotherapy in the management of PW. RESULTS: A man in his early 30s with anxiety, depression, and substance use disorder presented to the emergency department by family for lethargy and confusion starting earlier that day. He had been using 25-30 g of phenibut daily for the past 6 months. On arrival, he was hypertensive, tachycardic, tachypneic, and lethargic. The patient received 1 mg of intravenous lorazepam and was admitted to the hospital for presumed PW. His symptoms improved overnight, and he was discharged on 10 mg of baclofen thrice daily. He returned 28 hours later after having a seizure and required intensive care admission in addition to multimodal drug therapy. CONCLUSIONS: Phenibut use is rising, and treatment options for PW, such as baclofen, warrant additional study. Potential risks of underdosing baclofen if used as monotherapy in PW may include seizures as withdrawal progresses. Baclofen's role in therapy may be more appropriate as an adjunct than a cornerstone of therapy. Treatment done in consultation with providers experienced in managing withdrawal such as a toxicologist may help reduce this risk.

Relationship Between Mean Arterial Pressure and Furosemide Stress Test Success Rates: A Retrospective Cohort Study.

BACKGROUND: The furosemide stress test (FST) is a safe and easy assessment of renal tubular function. Other factors, such as mean arterial pressure (MAP), which may influence the success rates of the FST, have not been well defined. OBJECTIVE: To evaluate the relationship between MAP and success rates of the FST in critically ill patients. METHODS: Retrospective, single-center, institutional review board (IRB)-approved cohort study. Critically ill adult patients given at least one dose of intravenous (IV) furosemide (≥1-1.5 mg/kg) were included. Primary outcome was whether a MAP ≥ 75 mm Hg would equate to a higher FST success rate. Secondary outcome was the success rates of patient on one or more vasopressors. RESULTS: Of 225 patients, 88 (39.1%) had a successful FST. In patients with a MAP ≥ 75 mm Hg, 60 out of 104 (57.7%) had a successful FST compared to 28 out of 121 (23.1%) of patients who had a MAP < 75 mm Hg (odds ratio [OR], 4.53, 95% CI, 2.55-8.74, P < 0.001). Patients on vasopressors at the time of the furosemide dose had lower rates of success compared to those not on vasoactive agents (30.4% versus 68.2%, p = 0.026). Limitations of this study include its retrospective design and reliance on documented urine output. CONCLUSION AND RELEVANCE: Patients with a MAP ≥ 75 mm Hg were significantly more likely to have a successful FST compared to those with a MAP < 75 mm Hg. This represents the first report of factors that may influence FST success rates.

Student training for community screening events: Asynchronous and live training comparison.

INTRODUCTION: One way pharmacy students contribute to their community while simultaneously practicing critical skills is by providing community blood pressure (BP) and blood glucose (BG) screenings. Instruction on correct techniques ensures student participants obtain accurate results and develop confidence. Previously, community event training had been held live and in person, but due to a curriculum change, an asynchronous online training program was piloted. The purpose of this study was to determine if the online training provides similar confidence, convenience, and knowledge when compared to live training. METHODS: Three online training modules (BP, BG, and event procedures) were built into a web-based course management system. Each online module consisted of an educational slideshow, an instructional video, and a short quiz. A 10-question anonymous survey was given both before and after the live training in 2017, as well as before and after the asynchronous, online training in 2018. Data were compared using descriptive statistics to see if the increase in knowledge and confidence was similar. RESULTS: The live training event had 69 participants; the online training had 77 participants. Both the live and online training had 99 to 100% successful completion, based upon skill demonstration (live), or quiz (online). Both the live and online training had increases in reported student confidence. Both formats were rated as convenient by participants (9.7/10 for live, 9.6/10 for online). CONCLUSIONS: The use of an online, asynchronous training program is an effective alternative for student training to prepare for participation in community screening events.

Combination Anti-IgE and Anti-IL5 Therapy in a Pediatric Patient With Severe Persistent Asthma.

Biologic agents, including anti-immunoglobulin E (omalizumab) and anti-interleukin 5 (mepolizumab), target different mediators involved in the inflammatory process and may work synergistically to decrease symptoms in patients with severe asthma. Here we describe a 12-year-old female on 2 biologic agents, omalizumab and mepolizumab, to control severe persistent asthma. Omalizumab was started years earlier with an initial response; however, her asthma again became uncontrolled and mepolizumab was added. Both biologics were administered concomitantly for over 6 months with marked improvement of asthma symptoms without significant side effects. A combination of biologic agents may be a potential therapy for pediatric patients with severe persistent asthma that remains uncontrolled on a single agent.