Using team-based learning in an endocrine module taught across two campuses.

Objectives: To implement a team-based learning (TBL) format in an endocrine module to promote students' active learning in a course delivered to 2 campuses.

Methods: Course lectures were transformed into 13 TBL sessions consisting of content pre-assignments (self-directed learning), in-class readiness assurance tests (accountability), and team problem solving of patient cases and faculty-led class discussion (knowledge application). Student performance was evaluated through multiple assessments during the TBL sessions and on unit examinations.

Effect of oral corticosteroids on chronic warfarin therapy.

Background: A potential drug interaction exists between oral corticosteroids and warfarin, but there is limited documentation.

Objective: To evaluate the potential drug interaction between oral corticosteroids and long-term warfarin therapy.

Methods: A retrospective review was conducted of 387 medical records for active patients within an anticoagulation clinic.

Hemostatic mouthwashes in anticoagulated patients undergoing dental extraction.

Objective: To evaluate the efficacy and safety of local acting hemostatic agents in patients who are undergoing dental extraction(s) and are taking oral anticoagulants.

Data Sources: A search of MEDLINE (1966-July 2006), International Pharmaceutical Abstracts (1970-July 2006), and EMBASE (1966-July 2006) was conducted using the key terms anticoagulation, warfarin, hemostatic mouthwashes, epsilon aminocaproic acid, tranexamic acid, dental extraction, and oral surgery. Bibliographies of relevant papers were reviewed for additional references.

Cangrelor for treatment of coronary thrombosis.

Objective: To review and assess available literature on the chemistry, pharmacology, pharmacodynamics, pharmacokinetics, clinical studies, adverse events, drug interactions, special populations, and dosing and administration for cangrelor, a product in late stage Phase II clinical trials.

Data Sources: A literature search of MEDLINE (1966-March 2006), International Pharmaceutical Abstracts (1970-February 2006), and Cochrane database (first quarter 2006) was conducted using key terms of cangrelor, AR-C69931MX, and P2Y12 receptor antagonist. Bibliographies of relevant articles were reviewed for additional references.

Increasing warfarin dosage reductions associated with concurrent warfarin and repeated cycles of 5-Fluorouracil therapy.

Concurrent use of warfarin and 5-fluorouracil has resulted in elevated international normalized ratios (INRs). Although this drug interaction is well established in the literature, we found no documented cases that address its effects on anticoagulation parameters in patients requiring repeated cycles of 5-fluorouracil and continuous warfarin therapy. We describe the effect of multiple cycles of 5-fluorouracil administration in a patient receiving warfarin therapy.

Thiazolidinediones for treatment of polycystic ovary syndrome.

Objective: To review the pathophysiology and treatment of polycystic ovary syndrome (PCOS) and the evidence for use of thiazolidinediones in the treatment of this syndrome.

Data Sources: We conducted a MEDLINE database search for English-language literature published from January 1966-July 2004. Key terms used were thiazolidinediones, troglitazone, rosiglitazone, pioglitazone, polycystic ovary syndrome, and PCOS.

Optimal antithrombotic management of anticoagulated patients with a history of myocardial infarction.

A common clinical dilemma exists for optimal antithrombotic management of a patient requiring oral anticoagulation (such as venous thromboembolism) and continued secondary myocardial infarction prophylaxis. Often aspirin will be continued concomitantly with the indicated oral anticoagulation therapy; however, additional benefits and increased risks of this practice have not been established. A systematic literature review was conducted to determine the benefits and risks of antithrombotic treatment strategies.

Impaired warfarin response secondary to high-dose vitamin K1 for rapid anticoagulation reversal: case series and literature review.

The literature suggests that unresponsiveness to warfarin can continue for 1 week or longer after administration of high-dose vitamin K1 10 mg or greater; however, there is a lack of supporting data to define the duration and clinical consequences of impaired warfarin response with high doses of vitamin K1. This case series describes four patients receiving indefinite warfarin therapy who received high and, in most cases, repeated doses of vitamin K1 for urgent reversal of therapeutic anticoagulation for an invasive procedure or surgery. The patients displayed impaired warfarin response for 11 days-3.

Resistance to oral vitamin K for reversal of overanticoagulation during Crohn's disease relapse.

Objective: The purpose of this case report is to describe oral vitamin K resistance in a patient with concomitant Crohn's disease (CD) relapse and supratherapeutic anticoagulation. Additionally, a literature review was conducted to explore the mechanism and supporting evidence for poor response to oral vitamin K during CD relapse.

Case Report: A 36 year-old female presented with an elevated International Normalized Ratio (INR) of 7.

Nonestrogen treatment modalities for vasomotor symptoms associated with menopause.

Objective: To systematically review the literature regarding the efficacy and safety of nonestrogen treatments for menopause-associated vasomotor symptoms not due to cancer or chemotherapy.

Data Sources: Pertinent literature and clinical studies were identified by searching MEDLINE (1966-February 2004) and EMBASE (1959-February 2004) using the key search terms vasomotor symptoms, hot flashes, and menopause. Bibliographies of relevant articles were reviewed for additional references.

Levofloxacin and warfarin interaction.

Objective: To report 4 cases of hypoprothrombotic response resulting from addition of levofloxacin therapy to chronic warfarin therapy and to review related literature to support or refute a warfarin-levofloxacin interaction.

Case Summary: Four patients, 34-81 years old, were prescribed levofloxacin concomitantly with stable warfarin therapy. Three patients had a target international normalized ratio (INR) range of 2.