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1.
Hosp Pract (1995) ; : 1-5, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-32295428

RESUMEN

Objectives: Despite the availability of FDA-labeled anticoagulant reversal agents, there is considerable variability in clinical practice as to the regimen and agent used for reversal. The objective of this study was to characterize the current practices of pharmacists surrounding the reversal of anticoagulant-associated life-threatening hemorrhage. Methods: A cross-sectional analysis of critical care and emergency medicine pharmacists. Current practice was compared for the type of hospital, country region, and type of ordering physician. In addition, pharmacists were asked to rank their involvement with activities involved with the reversal of anticoagulants. Respondents ranked their involvement with these activities as either never involved, rarely involved, occasionally involved, frequently involved, or always involved. Results:281 respondents were included. The majority used 4-factor PCC for warfarin reversal (92.9%) and factor Xa inhibitor reversal (79.7%). However, only 58.7% used the labeled dose of 4-PCC for warfarin reversal. Of the 30.6% that utilized a fixed-dose regimen, the most common regimen was 1500 units once. A higher proportion of respondents practicing in a teaching hospital reported that they used activated prothrombin complex concentrates for reversal of factor Xa inhibitor (22 [12.2%] vs. 5 [5%]; p < 0.05) or coagulation factor Xa (recombinant)-inactivated-zhzo (31 [17.2%] vs. 5 [5%]; p < 0.05). In addition, the majority of respondents utilized idarucizumab for dabigatran reversal. The only involvement activity in which <50% of respondents said they were frequently involved or always involved was 'administration of reversal agent.' Conclusions: There is considerable variability in which agents were utilized for anticoagulant-associated bleeding reversal.

2.
Surgeon ; 2020 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-32213291

RESUMEN

BACKGROUND: Delirium is common in patients admitted to the surgical trauma intensive care unit (ICU), and the risk factors for these patients differ from medical patients. Given the morbidity and mortality associated with delirium, efforts to prevent it may improve patient outcomes, but previous efforts pharmacologically have been limited by side effects and insignificant results. We hypothesized that scheduled quetiapine could reduce the incidence of delirium in this population. METHODS: The study included 71 adult patients who were at high-risk for the development of delirium (PRE-DELIRIC Score ≥50%, history of dementia, alcohol misuse, or drug abuse). Patients were randomized to receive quetiapine 12.5 mg every 12 h for delirium or no pharmacologic prophylaxis within 48 h of admission to the ICU. The primary end point was the incidence of delirium during admission to the ICU. Secondary end points included time to onset of delirium, ICU and hospital length of stay (LOS), ICU and hospital mortality, duration of mechanical ventilation, and adverse events. RESULTS: The incidence of delirium during admission to the ICU was 45.5% (10/22) in the quetiapine group and 77.6% (38/49) in the group that did not receive pharmacological prophylaxis. The mean time to onset of delirium was 1.4 days for those who did not receive prophylaxis versus 2.5 days for those who did (p = 0.06). The quetiapine group significantly reduced ventilator duration from 8.2 days to 1.5 days (p = 0.002). CONCLUSIONS: The findings suggested that scheduled, low-dose quetiapine is effective in preventing delirium in high-risk, surgical trauma ICU patients.

3.
Nutr Clin Pract ; 35(3): 433-441, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32189422

RESUMEN

The gastrointestinal (GI) tract consists of trillions of organisms that support multiple functions in the body, from immunity, digestion, and absorption to drug metabolism. These microbes form an overall collection of microorganisms that form the body's microbiome. In critical illness, many of these functions are aberrant, and the microbiome is altered, leading to untoward effects. Some of the most common medications received by patients include antibiotics and proton pump inhibitors, which affect particular changes in the microbiome. In addition, patients receiving prolonged enteral and parenteral nutrition experience changes in the microbiological composition and diversity of their GI tracts. Research is ongoing to characterize the crosstalk between the microbiome and immune function as targets for drug and nutrition therapy.

5.
Crit Care Nurs Q ; 43(2): 232-250, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32084065

RESUMEN

Sleep plays an important role in the recovery of critically ill patients. However, patients in the intensive care unit (ICU) often suffer sleep disturbances and abnormal circadian rhythms, which may increase delirium and lengthen ICU stay. Nonpharmacologic strategies for preventing and treating sleep disturbances and delirium, such as overnight eye masks and ear plugs, are usually employed first, given the lack of adverse effects. However, a multimodal approach to care including pharmacotherapy may be necessary. Despite the limited available data supporting their use, medications such as melatonin, ramelteon, suvorexant, and dexmedetomidine may promote sleep and improve a variety of patient-centric outcomes such as delirium. This narrative review focuses on these nonbenzodiazepine agents used for sleep in the ICU. Practical application of each of these agents is described for when providers choose to utilize one of these pharmacotherapies to promote sleep or prevent delirium.

6.
Ann Pharmacother ; 54(1): 14-21, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31347376

RESUMEN

Objective: The objective of this study is to identify risk factors for the development of refractory status epilepticus (RSE). Methods: This was an IRB-approved, retrospective case control study that included patients admitted with status epilepticus between August 1, 2014, and July 31, 2017. Cases were defined as those with RSE, and controls were those who did not develop RSE. A bivariate analysis was conducted comparing those with RSE and those without RSE. A stepwise logistic regression model was constructed predicting for progression to RSE. Risk factors for progression to RSE were extrapolated from this model. Results: A total of 184 patients met inclusion criteria for the study (99 controls and 49 cases). After adjusting for covariates in the logistic regression, patients with convulsive seizures had a lower odds of developing RSE (odds ratio [OR] = 0.375; 95% CI = 0.148 to 0.951; P = 0.0388). Treatment with benzodiazepines plus levetiracetam had a higher odds of developing RSE (OR = 3.804; 95% CI = 1.523 to 9.499; P = 0.0042). Conclusion and Relevance: This study found that patients with convulsive seizures had a lower odds of developing RSE. In addition, patients treated with benzodiazepines and levetiracetam had a higher odds of developing RSE. This information can be used to potentially identify patients at higher risk of developing RSE, so that treatment can be modified to reduce morbidity and mortality. These results may warrant further investigation into the effectiveness of levetiracetam as a first-line agent for the treatment of SE.

7.
Pharmacy (Basel) ; 7(3)2019 Aug 03.
Artículo en Inglés | MEDLINE | ID: mdl-31382572

RESUMEN

Despite the widespread use of tetracycline antibiotics since the late 1940s, tetracycline hypersensitivity reactions have rarely been described in the literature. A comprehensive PubMed search was performed, including allergic and serious adverse reactions attributed to the tetracyclines class of antibiotics. Of the evaluated tetracycline analogs, minocycline was attributed to the greatest overall number and severity of serious adverse events reported in the literature, with notable reactions primarily reported as respiratory and dermatologic in nature. Reactions to tetracycline have also been well described in the literature, and although dermatologic reactions are typically less severe in comparison with minocycline and doxycycline, various reports of anaphylactic reactions exist. Although doxycycline has been noted to have had the fewest reports of severe allergic reactions, rare descriptions of life-threatening reactions are still reported in the literature. Allergic reactions regarding tetracyclines are rare; however, adverse reaction type, severity, and frequency among different tetracycline analogs is somewhat variable. A consideration of hypersensitivity and adverse reaction incidence should be performed prior to the selection of individual tetracycline entities.

10.
J Stroke Cerebrovasc Dis ; 28(3): 649-654, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30527789

RESUMEN

GOAL: Computed tomography angiography (CTA) is a well-tolerated, noninvasive study of the intracranial vascular circulation; however, contrast-induced nephropathy (CIN) has been reported in 5%-7% of patients undergoing CTA. Limited studies have evaluated the risks of CIN in patients undergoing CTA. Our study was designed to evaluate the prevalence and risk factors for CIN in patients with ischemic stroke who receive a CTA. MATERIALS AND METHODS: Single-center, nested, case-control study of patients with ischemic stroke who received a CTA between June 18, 2012 and January 1, 2016. Patients were grouped based on development of CIN. FINDINGS: A total of 209 patients were included in the final analysis (178 controls, 31 cases). The prevalence of CIN during the time period studied was 14.8% (95% confidence interval [CI]: 10.2-20.2). A higher proportion of patients who developed CIN had a history of diabetes mellitus (37 [20.56%] versus 15 [48.39%]; P = .0009) and reported taking no medications prior to admission (35 [19.44%] versus 11 [35.48%]; P = .0458). However, a lower proportion of patients who developed CIN had a history of smoking (59 [32.78] versus 3 [9.68]; P = .0091). After statistical adjustment, only a history of diabetes (odds ratio [OR] 4.15 [95% CI: 1.765, 9.754), taking no medications prior to admission (OR 3.56 [95% CI: 1.417, 8.941]) and a self-reported history of smoking (OR 0.204 [95% CI: 0.057, 0.721]) remained associated with the development of CIN. CONCLUSIONS: Those patients with a history of diabetes mellitus or not taking medications prior to admission should be monitored closely for the development of contrast-induced nephropathy CIN.


Asunto(s)
Angiografía Cerebral/efectos adversos , Angiografía por Tomografía Computarizada/efectos adversos , Medios de Contraste/efectos adversos , Enfermedades Renales/inducido químicamente , Accidente Cerebrovascular/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Angiografía Cerebral/métodos , Medios de Contraste/administración & dosificación , Diabetes Mellitus/epidemiología , Femenino , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/epidemiología , Enfermedades Renales/terapia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Prevalencia , Terapia de Reemplazo Renal , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Tennessee/epidemiología , Factores de Tiempo
14.
Nutr Clin Pract ; 33(4): 510-514, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29730896

RESUMEN

BACKGROUND: We report a case of a patient who was 3 months post-sleeve gastrectomy and presented with acute stroke symptoms ultimately due to Wernicke's encephalopathy (WE) after bariatric surgery. A 20-year-old white female presented to an outside hospital 3 months after sleeve gastrectomy complaining of nausea and vomiting. She initially underwent a cholecystectomy and later became less responsive and required intubation. Magnetic resonance imaging changes, presumed to be an acute stroke, prompted her transfer to our facility. Intravenous (IV) thiamin was administered, and the patient's symptoms improved over the course of her hospital stay. RESULTS: Thiamin levels were markedly low, and the patient rapidly improved with the administration of IV thiamin. The patient was discharged to inpatient rehabilitation. CONCLUSION: Bariatric surgery is a less common cause of WE but can lead to acute WE due to malabsorption of thiamin. In patients undergoing bariatric surgery, clinicians should be vigilant about the potential for WE to occur. In addition, based on history, WE should be considered in the differential diagnosis for symptoms of acute ischemic stroke.


Asunto(s)
Cirugía Bariátrica/efectos adversos , Gastrectomía/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Accidente Cerebrovascular/diagnóstico , Deficiencia de Tiamina/tratamiento farmacológico , Tiamina/uso terapéutico , Encefalopatía de Wernicke/diagnóstico , Adulto , Cirugía Bariátrica/métodos , Femenino , Humanos , Síndromes de Malabsorción/etiología , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/tratamiento farmacológico , Accidente Cerebrovascular/etiología , Deficiencia de Tiamina/etiología , Encefalopatía de Wernicke/tratamiento farmacológico , Encefalopatía de Wernicke/etiología , Adulto Joven
17.
AACN Adv Crit Care ; 27(4): 430-440, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27959299

RESUMEN

Drug-induced liver injury (DILI) can result from both idiosyncratic and intrinsic mechanisms. This article discusses the clinical impact of DILI from a broad range of medications as well as herbal and dietary supplements. Risk factors for idiosyncratic DILI (IDILI) are the result of multiple host, environmental, and compound factors. Some triggers of IDILI often seen in critical care include antibiotics, antiepileptic medications, statins, novel anticoagulants, proton pump inhibitors, inhaled anesthetics, nonsteroidal anti-inflammatory agents, methotrexate, sulfasalazine, and azathioprine. The mechanism of IDILI due to these medications varies, and the resulting damage can be cholestatic, hepatocellular, or mixed. The primary treatment of IDILI is to discontinue the causative agent. DILI due to acetaminophen is intrinsic because the liver damage is predictably aligned with the dose ingested. Acute acetaminophen ingestion can be treated with activated charcoal or N-acetylcysteine. Future areas of research include identification of mitochondrial stress biomarkers and of the patients at highest risk for DILI.


Asunto(s)
Antibacterianos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/tratamiento farmacológico , Cuidados Críticos/normas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/tratamiento farmacológico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/enfermería , Suplementos Dietéticos/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/enfermería , Educación Médica Continua , Humanos , Extractos Vegetales/efectos adversos , Guías de Práctica Clínica como Asunto , Factores de Riesgo
18.
Pharmacotherapy ; 36(11): 1132-1137, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27726162

RESUMEN

STUDY OBJECTIVE: To evaluate the efficacy and safety of an activated four-factor prothrombin complex concentrate (aPCC) versus plasma for the reversal of warfarin-associated hemorrhage. DESIGN: Single-center, retrospective cohort analysis of adult patients with warfarin-associated hemorrhage treated with either aPCC or plasma. PATIENTS: Patients received either aPCC or plasma as treatment for warfarin-associated hemorrhage between January 1, 2011, and July 1, 2013. Patients with missing data points were excluded from the final analysis. Of the 276 patients included in the final analysis, 128 received aPCC and 148 received plasma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Those patients who received aPCC achieved a lower posttreatment INR (1.1 [0.1] vs 1.6 [0.5]; p<0.05). In addition, patients who received aPCC had a 4.3 times higher odds of achieving an INR of less than 1.4 (97 [75.8%] vs 65 [43.9%]; p<0.05; odds ratio [OR] = 4.3 [95% confidence interval (CI) 2.6-7.3]). When controlling for vitamin K administration, history of diabetes mellitus, receipt of the recommended reversal agent dose, and pretreatment INR, aPCC administration remained an independent predictor for achieving an international normalized ratio (INR) of less than 1.4 in the first 24 hours after treatment (OR = 3.75 [95% CI 2.11-6.65]; p<0.001). In addition, there was no statistical difference between the groups with regard to occurrences of infusion reaction, pulmonary embolism, deep vein thrombosis, stroke, or myocardial infarction. CONCLUSIONS: Compared with patients who received plasma, patients who received aPCC achieved a lower posttreatment INR, had a larger INR change, and were more likely to achieve an INR less than the prespecified goal. Those patients who received aPCC did not have a higher incidence of thromboembolic events.


Asunto(s)
Anticoagulantes/efectos adversos , Factores de Coagulación Sanguínea/administración & dosificación , Hemorragia/terapia , Plasma , Warfarina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Estudios de Cohortes , Femenino , Hemorragia/inducido químicamente , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tromboembolia/epidemiología , Resultado del Tratamiento , Warfarina/administración & dosificación
19.
Am J Pharm Educ ; 80(6): 97, 2016 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-27667834

RESUMEN

Objective. To assess student preferences regarding online learning and technology and to evaluate student pharmacists' social media use for educational purposes. Methods. An anonymous 36-question online survey was administered to third-year student pharmacists enrolled in the Drug Information and Clinical Literature Evaluation course. Results. Four hundred thirty-one students completed the survey, yielding a 96% response rate. The majority of students used technology for academic activities, with 90% using smart phones and 91% using laptop computers. Fifty-eight percent of students also used social networking websites to communicate with classmates. Conclusion. Pharmacy students frequently use social media and some online learning methods, which could be a valuable avenue for delivering or supplementing pharmacy curricula. The potential role of social media and online learning in pharmacy education needs to be further explored.


Asunto(s)
Instrucción por Computador/tendencias , Educación en Farmacia/tendencias , Medios de Comunicación Sociales/tendencias , Red Social , Estudiantes de Farmacia , Instrucción por Computador/métodos , Instrucción por Computador/estadística & datos numéricos , Educación en Farmacia/métodos , Humanos , Internet/estadística & datos numéricos , Internet/tendencias , Medios de Comunicación Sociales/estadística & datos numéricos , Encuestas y Cuestionarios
20.
J Crit Care ; 30(6): 1283-6, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26383104

RESUMEN

PURPOSE: Increased awareness of delirium in the intensive care unit (ICU) has led to higher use of antipsychotic medications for treatment of delirium. These medications are often not discontinued at ICU or hospital discharge, which may increase the risk of inappropriate polypharmacy. Our study sought to identify risk factors for being discharged on a new antipsychotic medication after admission to a trauma-surgical ICU or neurocritical care unit. METHODS: This was a retrospective cohort study at an academic medical center and included patients who were admitted to the trauma-surgical ICU or neurocritical care unit and received an antipsychotic medication. Those younger than 18 years, died before hospital discharge, or did not have complete documentation were excluded. RESULTS: A total of 341 records were included in the final analysis. Of those, 82 (24%) were discharged on a new antipsychotic and 67% of those patients had no documented indication. Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.030 [95% confidence interval, 1.030-1.110]) and days treated with benzodiazepines (odds ratio, 1.101 [95% confidence interval, 1.060-1.143]) were independently associated with being discharged on a new antipsychotic medication. CONCLUSIONS: Those patients with higher Acute Physiology and Chronic Health Evaluation II scores and more benzodiazepine days are at increased odds of being discharged on a new antipsychotic.


Asunto(s)
Antipsicóticos/uso terapéutico , Delirio/tratamiento farmacológico , Errores de Medicación/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , APACHE , Centros Médicos Académicos/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Benzodiazepinas/uso terapéutico , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo
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