Pharmacists as Frontline Responders During COVID-19: Roles and Responsibilities Need to be Revisited.

The ongoing pandemic has disrupted the health care system, creating challenges for health care workers and patients alike. As workflows and job responsibilities have been adapted to provide care to coronavirus-infected patients, many primary care services have been postponed. This change has led to significant financial impacts that will be difficult to overcome.

Clinical and Economic Implications of Restrictions on Calcitonin Utilization in a Health System.

Hypercalcemia is a relatively common problem that may require hospital admission based on severity. A treatment option for hypercalcemia is calcitonin given intramuscularly or subcutaneously. In 2015, calcitonin was on our health system formulary, but due to a sharp rise in cost, restrictions were placed to ensure appropriate utilization.

Antithrombotic Usage Patterns in the Era of New Oral Anticoagulant Options for Atrial Fibrillation.

Background: Appropriate treatment reduces the risk of stroke in patients with atrial fibrillation (AF). Despite the known benefits of warfarin, anticoagulation prescribing rates remain inadequate in high-risk patients. Over the last 6 years, 4 novel oral anticoagulants have been approved for use for stroke prophylaxis in non-valvular AF (NVAF), which may allow prescribers to tailor therapy for each NVAF patient.

Evaluation of the treatment of methicillin-resistant Staphylococcus aureus bacteremia.

Background: Bloodstream infections are a leading cause of death in the United States. Methicillin-resistant Staphylococcus aureus (MRSA) encompasses >50% of all S aureus strains in infected hospitalized patients and increases mortality, length of stay and healthcare costs. The objective of this study was to evaluate the treatment of MRSA bacteremia with daptomycin, linezolid and vancomycin.

Nitrofurantoin-induced hepatotoxicity: a rare yet serious complication.

Nitrofurantoin is a commonly prescribed antibiotic for the treatment of recurrent uncomplicated urinary tract infections. Its importance has been emphasized by the current international clinical practice guidelines for the management of uncomplicated cystitis. Since its introduction into clinical practice, nitrofurantoin has been associated with various adverse effects, including hepatotoxicity.

Acute ascending muscle weakness secondary to medication-induced hyperkalemia.

Secondary hyperkalemic paralysis is an uncommon but potentially life-threatening consequence of drug-induced disease. We report a case of a 53-year-old female with history of chronic kidney disease presenting to the emergency department with a one-day history of upper and lower extremity weakness and paresthesias. Serum potassium concentration on admission was greater than 8 mEq/L, and serum creatinine was elevated above baseline.

Vancomycin-resistant Enterococcus bacteremia: an evaluation of treatment with linezolid or daptomycin.

Background: Due to high rates of resistance and a limited number of efficacious antimicrobials for vancomycin-resistant Enterococcus (VRE), appropriate antibiotic selection is vital to treatment success. The purpose of this study was to assess clinical and microbiologic outcomes associated with the use of linezolid or daptomycin in the treatment of VRE bacteremia.

Methods: A retrospective analysis of adult patients with VRE bacteremia between January 2004 and July 2009 was conducted at a tertiary care hospital in the United States.

An evaluation of inhaled bronchodilator therapy in patients hospitalized for non-life-threatening COPD exacerbations.

Objective: Chronic obstructive pulmonary disease (COPD) increasingly is a cause of morbidity and mortality in and economic burden on the US healthcare system, and COPD exacerbations continue to be among the top 10 causes of hospitalization in adults. The objective of this study was to evaluate the incidence and potential implications of missed scheduled nebulized bronchodilator therapy in the setting of acute, non-life-threatening COPD exacerbations.

Materials And Methods: This study was a retrospective chart review of all of the patients with a primary diagnosis of severe, non-life-threatening COPD exacerbations admitted from January 2007 to June 2008 at a university-affiliated hospital.

Gabapentin withdrawal syndrome in a post-liver transplant patient.

A 41-year-old male with a previous orthotopic liver transplant began experiencing insomnia, anxiety, diaphoresis, headaches, and palpitations that progressed over a 2-day period. As part of his home medication regimen, the patient was taking gabapentin for peripheral neuropathy. His acute onset of increasing symptoms coincided with an inadvertent discontinuation of gabapentin.

Are we failing to document adequate smoking histories? A brief review 1999-2009.

Background: Documenting a detailed smoking history is of obvious importance. Failure to adequately document the smoking history may result in the misdiagnosis and management of asthma, and may be associated with a deficiency of care in patients with cardiovascular disease and several other common diseases.

Scope: The purpose of this article is to review the evidence over the past decade that demonstrates inadequate documentation of smoking history.

A prospective evaluation and literature review of levetiracetam use in patients with brain tumors and seizures.

To determine the safety and tolerability of IV and oral levetiracetam monotherapy for seizures in brain tumor patients following resection. Brain tumor patients undergoing neurosurgery with >or=1 seizure within the preceding month prior to surgery were enrolled to receive intravenous levetiracetam for a minimum of 48 h, transitioned to oral levetiracetam at the same dose, and followed for 1-month after discharge. Patients were assessed daily in the hospital, provided with a seizure diary, and supplied with 30 days of levetiracetam upon discharge.

Inadequate documentation of asthma management in hospitalized adult patients.

Undocumented patient information in the medical record (MR) is a barrier to providing high quality care. Inadequate documentation has recently been reported for two cardiovascular diseases. This study was designed to evaluate the documentation of asthma management in the MR to determine if it is consistent with the NIH asthma guidelines.

Potential role of leukotriene modifiers in the treatment of chronic obstructive pulmonary disease.

Abstract Chronic obstructive pulmonary disease (COPD) is characterized by progressive, irreversible airflow limitation coupled with an abnormal inflammatory process. It is associated with high morbidity and mortality. Leukotriene modifiers, approved by the United States Food and Drug Administration as treatment for asthma and allergic rhinitis, may also alleviate the abnormal inflammatory response seen in patients with COPD.

Heparin-induced thrombocytopenia complicated by warfarin-induced skin necrosis.

Purpose: A case of heparin-induced thrombocytopenia (HIT) complicated by warfarin-induced skin necrosis (WISN) is reported.

Summary: A patient with a history of hypertension, heart failure, and myocardial infarction was admitted to the hospital after complaining of a two-day history of shortness of breath, diaphoresis, and chest pain. The patient underwent a cardiac catheterization and received several medications, including heparin.

Asthma treatment protocols in the emergency department: are they effective?

Management of asthma in emergency departments (ED) has been well documented to be deficient over many years, despite national and international guidelines. This review summarizes the effect of ED protocols aimed at improving the assessment and treatment of asthma in the ED. We performed a PubMed search of the English literature for ED asthma protocols published from 1986 to 2006 and identified 11 studies.