An Underappreciated and Prolonged Drug Interaction Leads to Ineffective Anticoagulation.

A poorly understood significant drug-drug interaction compounded by ineffective communication among providers at times of care transition most likely contributed to multiple thromboembolic events in an 81-year-old patient. Increased awareness of drug interactions with direct oral anticoagulants (DOACs), as well as improved communication among inpatient and outpatient providers at the time of discharge is essential in maximizing efficacy and safety outcomes in patients requiring chronic anticoagulation. When rifampin is coadministered with apixaban, a reduction in apixaban exposure results in decreased efficacy and increased risk for thromboembolic events.

Assessing Guideline-Directed Medication Therapy for Heart Failure in End-Stage Renal Disease.

Background: Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine whether outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT.

Early Versus Delayed Initiation of Pharmacological Venous Thromboembolism Prophylaxis After an Intracranial Hemorrhage.

Background: Intracranial hemorrhage (ICH) accounts for up to 20% of all strokes with and carries an approximate 50% 30-day mortality. The risk of venous thromboembolism (VTE) is markedly higher in patients with ICH compared with ischemic strokes, but the optimal time to initiate pharmacological prophylaxis is ill-defined.

Design: Retrospective analysis.

Impact of Medicare Part D on Racial and Ethnic Minorities.

Objectives: Prior to the implementation of Medicare Part D in the United States, inequalities were found to exist in the use of medications between minority and white beneficiaries. Despite improvements in medication affordability after Medicare Part D implementation, it is still not clear whether the characteristics of the program have improved drug utilization patterns among minorities to the same degree as whites. This review aims to determine whether there were barriers for Medicare Part D to realize its potential to improve prescription drug utilization patterns among minorities.

Gefitinib and Sonidegib.

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A.

Trends in Medicare Part D Medication Therapy Management Eligibility Criteria.

Background: To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized.

Objectives: To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs.

Consequences of treating false positive heparin-induced thrombocytopenia.

Identification of patients with heparin-induced thrombocytopenia is encumbered by false positive enzyme-linked immuno assay (ELISA) antibody results, therefore a serotonin release assay (SRA) is used for confirmation. Recently, several studies have demonstrated that increasing the optical density (OD) threshold (currently at 0.4) of the antibody test enhances the positive predictive value.

Venous Thromboembolism Prophylaxis in Acutely Ill Veterans With Respiratory Disease.

This observational study assessed the rate and appropriateness of pharmacologic venous thromboembolism prophylaxis in veterans with pulmonary disease who were admitted to the hospital for a nonsurgical stay.

Key articles and guidelines in the management of patients undergoing cardiac surgery.

Significant numbers of patients undergo cardiac surgery worldwide each year. A large evidence base exists regarding the optimal pre-, intra-, and postoperative mediation management for patients undergoing coronary artery bypass grafting (CABG) surgery, valve replacements or repairs, and mechanical circulatory support (MCS). Prevention and treatment of perioperative arrhythmias, perioperative antimicrobial prophylaxis, prevention of thrombosis, and bleeding through proper management of perioperative antiplatelet and anticoagulant therapies, and the use of pharmacotherapy to optimize both short- and long-term patient outcomes after cardiac surgery are the focus of this first compilation of guidelines and key articles in this patient population to be published in the Journal of Pharmacy Practice.

Estimated glomerular filtration rate leads to higher drug dose recommendations in the elderly compared with creatinine clearance.

Purpose: The elderly are at risk for adverse drug events because of inappropriate dosing of renally eliminated medications. The purpose of this study was to evaluate differences in estimates of kidney function and recommended doses of select medications in the elderly using the Modification of Diet in Renal Disease (MDRD) or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations compared with the Cockcroft-Gault (CG) equation.

Methods: Patients 65 years of age and older were included in this retrospective, observational analysis.

Colchicine for the Treatment of Acute and Recurrent Pericarditis.

Objective: To evaluate the literature with colchicine for the acute treatment of pericarditis and prevention of recurrent pericarditis.

Data Sources: Searches of MEDLINE (1966-March 2014) and Cochrane Database (1993-March 2014) were conducted using the search terms pericarditis and colchicine. Limits were set for articles written in English with human subjects.

Key articles of dietary interventions that influence cardiovascular mortality.

Lifestyle modifications, particularly diet, are a key component to the reduction of cardiovascular events. Diets high in carbohydrates and saturated fat have been shown to negatively affect blood cholesterol, thereby increasing the risk for cardiovascular disease (CVD). Dietary interventions that emphasize the consumption of whole grains, fruits, and vegetables have been shown to be successful in reducing cardiovascular risk.

Comparison of hemoglobin A1c goal achievement with the addition of pioglitazone to maximal/highest tolerated doses of sulfonylurea and metformin combination therapy.

Objectives: It has been proposed that the combination of thiazolidinedione (TZD) therapy to metformin and sulfonylurea is beneficial due to each medication having a unique mechanism of action. Within the Veterans Affairs Hospital, specific criteria of use define when TZD therapy can be initiated. Most patients who receive TZD therapy have failed other medications prior to use.

Assessment of sotalol prescribing in a community hospital: opportunities for clinical pharmacist involvement.

Objective: Due to risk of serious adverse drug events (ADEs) sotalol use is limited in renal insufficiency and heart failure. To reduce potential life-threatening ADEs, medication safety initiatives that ensure appropriate dosing of sotalol are necessary. Pharmacist-managed renal dosing assessment programmes ensure appropriate dosing of renally eliminated medications.

Use of estimated glomerular filtration rate for drug dosing in the chronic kidney disease patient.

Purpose Of Review: Assessment of kidney function is necessary to stage chronic kidney disease (CKD) and appropriately dose medications. The Cockcroft-Gault equation provides an estimate of creatinine clearance (eClCr) and is the method commonly referenced in pharmacokinetic studies. The Modification of Diet in Renal Disease (MDRD) and CKD-Epidemiology Collaboration (EPI) equations provide an estimate of glomerular filtration rate (eGFR), with the MDRD eGFR now automatically reported by most clinical laboratories.

Clinical outcomes and pharmacists' acceptance of a community hospital's anticoagulation management service utilizing decentralized clinical staff pharmacists.

Background: In 2008, the Joint Commission released an updated National Patient Safety Goals document that requires institutions to implement practices that reduce the likelihood of patient harm associated with use of anticoagulation therapy. One of the expectations associated with this goal was that each organization would establish an anticoagulant management program. To our knowledge, few data exist to describe the implementation and assessment of anticoagulation programs in smaller, nonteaching community hospitals using decentralized pharmacists in an integrated practice model.

Dynamic changes in size distribution of emulsion droplets during ethyl acetate-based microencapsulation process.

This study investigated the dynamic effect of the emulsification process on emulsion droplet size in manufacturing microspheres using ethyl acetate as an organic solvent. A dispersed phase consisting of poly(lactide-co-glycolide) and ethyl acetate was emulsified in a poly(vinyl alcohol) aqueous solution for a predetermined time ranging from 2 to 9, 16, 23, 30, 40, 50, or 60 minutes. Ethyl acetate was then quickly extracted to transform emulsion droplets into solidified microspheres, and their size distribution was determined.

Tetracyclines for treating multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia.

Objective: To report the use of tetracyclines for the treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP).

Design: Observational case series.

Setting: .

Comparison of ampicillin-sulbactam and imipenem-cilastatin for the treatment of acinetobacter ventilator-associated pneumonia.

Acinetobacter organisms, which are a common cause of ventilator-associated pneumonia (VAP) in some health care centers, are becoming more resistant to such first-line agents as imipenem-cilastatin (Imi-Cil). Sulbactam has good in vitro activity against Acinetobacter organisms; thus, ampicillin-sulbactam (Amp-Sulb) may be a viable treatment alternative. The outcomes for critically ill trauma patients with Acinetobacter VAP treated with either Amp-Sulb or Imi-Cil were compared retrospectively.

Ethyl formate - alternative dispersed solvent useful in preparing PLGA microspheres.

In an effort to substitute methylene chloride with a less toxic solvent, this study was aimed at developing new ethyl formate-based emulsion processes to fabricate poly-D,L-lactide-co-glycolide (PLGA) microspheres. To do so, a polymeric dispersed phase was emulsified in a 1% polyvinyl alcohol aqueous solution at an ethyl formate to aqueous volume ratio of 8:20. Microsphere hardening was then achieved by solvent evaporation and quenching techniques.