Comparison of three generic vancomycin products using liquid chromatography-mass spectrometry and an online tool.

Purpose: Three different generic vancomycin products were compared using liquid chromatography-mass spectrometry (LC-MS) and open-access metabolomic tools.

Methods: Single-lot samples of vancomycin hydrochloride from three different manufacturers (Hospira, APP Pharmaceuticals, and Pfizer) were reconstituted and injected into a high-resolution LC-MS system. The mass spectral fingerprints were compared for similarity of nonvancomycin B components using the XCMS Online system through Scripps University.

Prophylaxis against venous thromboembolism in hospitalized medically ill patients: Update and practical approach.

Purpose: Major updates in the medical literature for the prevention of venous thromboembolism (VTE) in medically ill patients are reviewed. A suggested approach for risk assessment is provided along with a brief review of chemical prophylaxis use in special populations of the hospitalized medically ill.

Summary: Despite new and updated guidelines, the assessment of risk for both thrombosis and bleeding in medical patients continues to lack valid standardization.

Use of argatroban and catheter-directed thrombolysis with alteplase in an oncology patient with heparin-induced thrombocytopenia with thrombosis.

Purpose: The case of an oncology patient who developed heparin-induced thrombocytopenia with thrombosis (HITT) and was treated with argatroban plus catheter-directed thrombolysis (CDT) with alteplase is presented.

Summary: A 63-year-old Caucasian man with renal amyloidosis undergoing peripheral blood stem cell collection for an autologous stem cell transplant developed extensive bilateral upper-extremity deep venous thrombosis (DVT) and pulmonary embolism secondary to heparin-induced thrombocytopenia. A continuous i.

Variations in pharmacy-based transition-of-care activities in the United States: a national survey.

Purpose: A national survey was conducted to assess pharmacist roles in transition-of-care (TOC) activities in the United States.

Methods: An online survey was sent to 1246 pharmacy directors who were members of the American Society of Health-System Pharmacists to assess their involvement in TOC activities including medication reconciliation, admission histories, medication counseling, and postdischarge follow-up; pharmacy student and pharmacy technician involvement in TOC activities; the use of technology to facilitate TOC activities; and barriers to performing such activities.

Results: A total of 393 respondents completed the survey (31.

Prolonged coagulopathy after brodifacoum exposure.

Purpose: A case of brodifacoum exposure leading to coagulopathy lasting for approximately one year despite treatment with large doses of phytonadione is reported.

Summary: A 36-year-old man was diagnosed with severe coagulopathy. He was treated and discharged on 40 mg of oral phytonadione daily.

High-dose transdermal nicotine replacement for tobacco cessation.

Purpose: The safety and efficacy of high-dose transdermal nicotine-replacement therapy (NRT) for the treatment of tobacco-use cessation were reviewed.

Summary: Transdermal nicotine doses of 7, 14, and 21 mg daily are approved by the Food and Drug Administration for use in tobacco cessation. However, studies have suggested that these doses are more adequate for people who smoke fewer than 20 cigarettes per day.

Designing a resident research program.

Purpose: The development of a resident research program and the role of the residency research advisory board (RRAB) in the program are described.

Summary: Over the past decade, there have been numerous barriers to successfully implementing a residency research program. An RRAB was subsequently developed to assist with research mentoring to help prepare residents to incorporate research into future positions.

Residency scramble: program directors' experiences with the Pharmacy Online Residency Centralized Application Service.

Purpose: Residency program directors' perceptions of the scramble process in 2013 using the Pharmacy Online Residency Centralized Application Service (PhORCAS) were evaluated.

Methods: After the ASHP Resident Matching Program ("Match") results were released in 2013, programs were asked to not extend offers to applicants until the following Monday, allowing a week for programs and applicants to evaluate their options and make the best decisions. A survey consisting of open-ended and structured response questions was sent electronically to 1905 program directors.

Medication absorption considerations in patients with postpyloric enteral feeding tubes.

Purpose: The gastrointestinal absorption sites of medications administered via postpyloric enteral feeding tubes were examined.

Summary: Many issues must be considered when administering medications via the postpyloric route, including interactions with enteral feeds, additional toxicities, and the concern of whether the medication will be absorbed. Despite the potential clinical significance of this information, data regarding the gastrointestinal site of absorption for most medications are lacking.

Ruxolitinib for the treatment of primary myelofibrosis.

Purpose: The pharmacology, pharmacokinetics, pharmacogenomics, clinical efficacy, and safety profile of ruxolitinib for the treatment of primary myelofibrosis are reviewed.

Summary: Ruxolitinib, an oral tyrosine kinase inhibitor that targets the Janus-associated kinases (JAKs) 1 and 2, has been recently approved for the treatment of patients with intermediate- or high-risk myelofibrosis. Unlike previous treatment options for patients with myelofibrosis, ruxolitinib offers a targeted therapy option for these patients who often suffer with severe and debilitating symptoms associated with the disease process.

ASHP therapeutic position statement on strategies for identifying and preventing pneumococcal resistance.

The incidence of MDRSP continues to increase, causing significant morbidity and mortality. Health care providers should seize the opportunity to promote the judicious use of antimicrobials and vaccinate patients with the pneumococcal vaccines as a means to lessen this significant health problem. Pharmacists are poised to play a key role in patient care by assessing for the need and administering vaccines in compliance with the current guidelines.

Elevated International Normalized Ratio in a patient concurrently using warfarin and vismodegib.

Purpose: A case report of a sharp rise in International Normalized Ratio (INR) values during a patient's concomitant use of warfarin and the antineoplastic agent vismodegib is presented.

Summary: About three weeks after he was prescribed vismodegib for skin cancer, a 78-year-old Caucasian man whose INR had been stable during nine months of warfarin use was found to have a critical INR value (9.5) during a visit to a pharmacy anticoagulation clinic.

Major publications in the critical care pharmacotherapy literature: February 2012 through February 2013.

Purpose: Recent impactful additions to the professional literature on the role of pharmacotherapy in treating the critically ill are summarized.

Summary: An unusually large number of updated practice guidelines and other publications with broad critical care pharmacotherapy ramifications appeared in the primary biomedical literature during the designated review period (February 2012-February 2013). Hundreds of relevant articles were evaluated by the Critical Care Pharmacotherapy Literature Update group (CCPLU), a national group of pharmacists who routinely monitor 25 peer-reviewed journals for emerging evidence that pertains to rational medication use in the intensive care unit (ICU) setting.

Implementation of a pharmacy technician-centered medication reconciliation program at an urban teaching medical center.

Purpose: An inpatient medication reconciliation (MR) program emphasizing pharmacy technicians' role in the MR process is described.

Summary: As part of quality-improvement (QI) efforts focused on MR-related adverse drug events, an urban academic medical center in New Jersey implemented a pharmacy technician-centered MR (PTMR) program targeting patients on its internal medicine, oncology, and clinical decision units. The program is staffed by five full- or part-time technicians who are trained in MR methods and work under direct pharmacist supervision, interviewing newly admitted patients and using other information sources (e.

Medication-use evaluation with a Web application.

Purpose: A Web-based application for coordinating medication-use evaluation (MUE) initiatives within the Veterans Affairs (VA) health care system is described.

Summary: The MUE Tracker (MUET) software program was created to improve VA's ability to conduct national medication-related interventions throughout its network of 147 medical centers. MUET initiatives are centrally coordinated by the VA Center for Medication Safety (VAMedSAFE), which monitors the agency's integrated databases for indications of suboptimal prescribing or drug therapy monitoring and adverse treatment outcomes.

Management of digoxin therapy using pharmacokinetics in a patient undergoing continuous venovenous hemofiltration.

Purpose: The management of digoxin therapy using pharmacokinetics in a patient undergoing continuous venovenous hemofiltration (CVVH) is reported.

Summary: A 46-year-old African-American woman with New York Heart Association class IV, American College of Cardiology- American Heart Association stage D heart failure arrived from an outside facility with complaints of dyspnea after minimal exertion, orthopnea, and lower-extremity edema. A transthoracic echocardiogram revealed an estimated left ventricular ejection fraction of 15%.

Implementation of a nontraditional postgraduate year 1 pharmacy residency program.

Purpose: The development and implementation of a nontraditional pharmacy residency program at a Veterans Affairs medical center (VAMC) are described.

Summary: The nontraditional pharmacy residency program at Lebanon VAMC was designed in accordance with the ASHP accreditation standard. The residency program was structured to meet staff needs without compromising patient care or significantly affecting the pharmacy services provided.