Ticagrelor as an alternative in clopidogrel-associated neutropenia.

Aspirin in combination with platelet P2Y12 receptor blocker has become the mainstay antiplatelet treatment strategy for the prevention of stent thrombosis. Ticlopidine was the first widely used P2Y12 receptor blockers, but clopidogrel has mostly replaced the use of ticlopidine due to its more favorable adverse event profile on bone marrow. However, when clopidogrel induced bone marrow toxicity occurs, little is known about the efficacy and safety of alternative treatments, and thus, in these cases, medical decisions may be very difficult. We report a case of clopidogrel-induced severe neutropenia in a patient treated with coronary stent and safety of alternative treatment with ticagrelor.

Implementation of a pharmacist-led transitional care clinic.

PURPOSE: To describe a pharmacist-led transitional care clinic (TCC) for high-risk patients who were recently hospitalized or seen in the emergency department (ED). SUMMARY: The Memphis Veterans Affairs Medical Center (VAMC) established a pharmacist-led face-to-face and telephone follow-up TCC to improve posthospitalization follow-up care through medication optimization and disease state management, particularly for veterans with high-risk disease states such as chronic obstructive pulmonary disease (COPD) and heart failure (HF). The clinic's clinical pharmacy specialists (CPSs) ordered diagnostic and laboratory tests, performed physical assessments, and consulted other providers and specialty services in addition to performing medication reconciliation, compliance assessment, and evaluation of adverse drug events. TCC patients were typically seen within 2 weeks of discharge and subsequently referred back to their primary care provider or a specialty care provider for continued management. A retrospective review of 2016 TCC data found that 7.8% of patients seen in the TCC were readmitted within 30 days of discharge; readmission rates for COPD and HF were reduced to 13% and 10%, respectively, compared to hospital-wide readmission rates of 17% and 24%. A separate observational analysis found that 30-day readmissions for COPD and HF were reduced in TCC patients, with pharmacists documenting an average of 6.2 interventions and 3.3 medication-related problems per patient. To reduce clinic appointment no-shows, the CPSs worked with inpatient providers and schedulers to emphasize to patients the importance of clinic attendance; also, TCC services were expanded to include telehealth appointments to increase access for rural and/or homebound patients. CONCLUSION: A pharmacist-led TCC effectively reduced readmissions and prevented medication-related problems for high-risk patients who were hospitalized or seen in the ED.

Skeletal-Related Events in Patients With Multiple Myeloma and Prostate Cancer Who Receive Standard vs Extended-Interval Bisphosphonate Dosing.

In patients with multiple myeloma and prostate cancer, extending the bisphosphonate dosing interval may help decrease medication-related morbidity without compromising therapeutic benefit.

Inadequate antibiotic dosing in patients receiving sustained low efficiency dialysis.

Background Patients requiring SLED are often critically ill and/or hemodynamically unstable, and often need antibiotic therapy for life-threatening infections. Antibiotic dosing recommendations for intermittent hemodialysis and continuous renal replacement therapy are not appropriate for SLED and there is substantial concern for under dosing. Objective To characterize the adequacy of antibiotic dosing during SLED. Setting: Inpatient adult acute care hospital. Methods A retrospective chart review was performed for the period of October 2010 to August 2013 to identify patients who received SLED and at least one of the selected antibiotics: cefepime, daptomycin, piperacillin/tazobactam, meropenem, and vancomycin. Dosing regimens were evaluated each day the patient was receiving one of these antibiotics concurrently with SLED. The administered antibiotic dosing regimens were defined as "adequate" or "inadequate" based on recommendations available in the literature. Main outcome measure The percentage of adequate antibiotic days for each antibiotic. Results Antibiotic regimens were evaluated for a total of 51 patients: 35 (69%) with acute kidney injury, 16 (31%) with end-stage renal disease, mean SLED duration 9.3 ± 1.7 h. The total percent of adequate antibiotic days were: vancomycin 86%, cefepime 62%, daptomycin 58%, meropenem 35%, and piperacillin/tazobactam 20%. Under dosing accounted for 63% of the days antibiotic dosing was considered inadequate. Conclusion: Antibiotic dosing was frequently inadequate, especially for antibiotics requiring more frequent dosing, suggesting a high potential for subtherapeutic levels during the majority of time critically ill patients are requiring SLED.