Kristin Watson

Evaluation of dexmedetomidine: safety and clinical outcomes in critically ill trauma patients.

BACKGROUND To compare safety and clinical outcomes of prolonged infusions with standard-dose (≤0.7 μg/kg/h) dexmedetomidine (SDD) or high-dose (>0.7 μg/kg/h) dexmedetomidine (HDD) to propofol in critically ill trauma patients. METHODS This was a retrospective review of 127 adult mechanically ventilated trauma patients between 2008 and 2009, who received propofol, SDD, or HDD for >24 hours. Primary outcomes were significant changes in blood pressure or heart rate. Secondary outcomes included hospital and intensive care unit (ICU) length of stay (LOS), ventilator time, and any concomitant analgesic, sedative, and antipsychotic use. Pairwise comparisons were based on Wilcoxon rank-sum test for continuous data and Pearsons chi-square test for categorical data. Statistical significance was defined as p value <0.05. RESULTS Patients in HDD group had higher rate of hypotension (98% vs. 78%; p = 0.02) but no significant differences in heart rate compared with propofol group. These patients had median longer hospital LOS (25 days vs. 12 days; p < 0.001), ICU LOS (20 days vs. 12 days; p = 0.004), and longer ventilator time (14 days vs. 7 days; p = 0.008). They also had increased requirements for oxycodone (74% vs. 40%; p = 0.003), midazolam (36% vs. 8%; p = 0.004), and haloperidol (50% vs. 24%; p = 0.02). Patients in SDD group had longer hospital LOS compared with propofol group (21 days vs. 13 days; p < 0.001). CONCLUSION Higher doses of dexmedetomidine may result in higher incidence of hypotension, longer LOS, and increased concomitant analgesic, sedative, and antipsychotic use, requiring further evaluation in trauma patients.

Cefazolin-induced hypoprothrombinemia

PURPOSE A case of cefazolin-induced hypoprothrombinemia in a patient with renal failure is reported. SUMMARY A 50-year-old African-American woman was transferred from the orthopedics service to the internal medicine service for management of acute renal failure. Before her transfer, she had spinal surgery and subsequently developed a wound infection complicated by Escherichia coli bacteremia. After trials of multiple antibiotics, she developed acute interstitial nephritis and renal failure. On the day of her transfer to the internal medicine service, i.v. cefazolin sodium 1 g was administered every 24 hours to eradicate the E. coli detected in blood cultures. Her baseline International Normalized Ratio (INR) was 1.3. On day 7 of cefazolin therapy, her INR increased to 4.0. Because of her recent history of bleeding and hypotension, vitamin K 10 mg i.v. was administered, followed by 5 mg orally for the next two days. Her INR decreased and normalized at 1.1. The patient had no changes to other drug therapies and had no medical conditions known to independently affect prothrombin time during this episode. The score on the Naranjo et al. adverse-event probability scale revealed a probable relationship between cefazolin and hypoprothrombinemia in this patient. CONCLUSION A patient with a postsurgery wound infection and acute renal failure developed hypoprothrombinemia after receiving cefazolin for seven days.

Prevalence of and Factors That Influence Board Certification Among Pharmacy Practice Faculty at United States Colleges and Schools of Pharmacy

Board certification is a means of demonstrating expertise above the minimum licensing standards. For many health care professionals, this credential is a necessity. As pharmacists become involved in more advanced patient care services, board certification becomes an essential component to ensuring quality care. The prevalence of United States pharmacy practice faculty members who are board certified, however, is unknown. In addition, to our knowledge, factors that serve to motivate or discourage faculty from obtaining board certification have not been previously described; thus, 900 pharmacy practice faculty members listed in the American Association of Colleges of Pharmacy (AACP) online directory were invited to complete an online survey regarding motivators and barriers for board certification. In addition, a list of board‐certified pharmacists, obtained from the Board of Pharmacy Specialties, was used to check the board certification status of all pharmacy practice faculty members listed in the AACP directory. In 2011, the prevalence of board certification among the 2867 pharmacy practice faculty members was 37% (1063 pharmacists), with the highest prevalence found among assistant professors (39.4%). A total of 322 faculty members (36% response rate) completed the survey; of these, 308 self‐identified as pharmacy practice faculty, and their responses were included in the analysis. Current board certification in pharmacy specialties was reported by 163 respondents (52.9%); 14 (4.5%) were previously certified. Among the 308 respondents, the most common perceived reason why pharmacy practice faculty become board certified was the desire to be recognized as an expert in the field (71.5%). Those who were currently board certified indicated personal growth as the most important reason (60.1%). Those previously certified indicated no perceived benefit as the most common reason for not recertifying (71.4%). Among those never certified, no perceived need (52.0%) or benefit (44.8%) were the most common reasons for not becoming certified; however, a majority of those never certified (68%) stated that they would become board certified if there was no associated cost and they were confident they would pass. To increase the prevalence of board certification in pharmacy practice faculty at U.S. schools and colleges of pharmacy, the benefits of this credential must be addressed at each institution. Steps should be taken to assist and encourage board certification.

Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is an uncommon, idiopathic complication of pregnancy associated with significant (10–30%) mortality. The disease occurs late in pregnancy or in the months following delivery, resulting in reduced systolic function and heart failure (HF) symptoms. Limited direction is provided for the management of PPCM, and the safe and effective use of medications in pregnant and breastfeeding women with PPCM presents a unique challenge. Although several HF therapies in pregnant and lactating women are supported by robust evidence, evidence to support the use of other therapies is significantly lacking. Current guidelines recommend treatment as in other forms of HF with reduced left ventricular ejection fraction (LVEF) but with consideration for the important nuances in this population as well as the unique and potential teratogenic effects of these therapies. Since most patients with PPCM recover their LVEF, the duration of therapy is currently unknown and warrants further study. We review the available literature surrounding pharmacologic and device therapy for PPCM and provide insight into managing patients with the condition.

Feedback in clinical pharmacy education

Feedback has been identified as one of the crucial components of clinical training programs.[1][1],[2][2] Specifically within pharmacy education, feedback to improve clinical judgment is noted as one of the main purposes of residency training.[3][3] However, the bulk of feedback literature pertains

Antihyperglycemic Medications and Impact on Cardiovascular Outcomes: A Review of Current Evidence

Patients with type 2 diabetes mellitus (DM) are known to be at an increased risk for macrovascular complications, and cardiovascular disease (CVD) is one of the greatest drivers of morbidity and mortality in this patient population. Over the past decade, the number of treatment options for type 2 DM has increased. In 2008, the United States Food and Drug Administration mandated an evaluation of cardiovascular (CV) outcomes associated with antihyperglycemic agents. Since that time, the CV risk‐benefit profile of many antihyperglycemic treatment modalities have been evaluated; however, results have remained inconsistent. This article will review the literature on the use of pharmacologic therapies in patients with type 2 DM and associated CVD risk, as well as provide recommendations for appropriate treatment selection in this population. Current evidence has demonstrated CV benefits with metformin, select glucagon‐like peptide‐1 receptor agonists (liraglutide), and sodium‐glucose co‐transporter 2 inhibitors (canagliflozin and empagliflozin).

Biologics for the Treatment of Dyslipidemias A Look Beyond Conventional Therapy

Objective: To evaluate the monoclonal antibodies to proprotein convertase subtilisin/kexin type 9 (PCSK9) in the management of dyslipidemias. Data Sources: MEDLINE/PubMed, NHS Evidence, TRIP database and EMBASE searches were conducted using the terms proprotein convertase subtilisin/kexin type 9, PCSK9, and monoclonal antibody. No date limits were utilized; search results were current to September 2013. Study Selection and Data Extraction: Articles were limited to phase 2 or 3 clinical trials of monoclonal antibodies to PCSK9 assessing surrogate markers of clinical end points. Data Synthesis: AMG145 and REGN727/SAR236553 are human monoclonal antibodies to PCSK9, a serine protease responsible for low-density lipoprotein cholesterol (LDL-C) regulation. PCSK9 binds to LDL receptors targeting them for intracellular degradation. AMG145 and REGN727/SAR236553 blocks the interaction between PCSK9 and the LDL receptor, increasing LDL receptor availability and allowing the removal of LDL-C from the circulation. These therapies have been evaluated as monotherapy and in combination with statins and ezetimibe in phase 2 trials and have demonstrated significant and dose-related reductions in LDL-C. LDL-C reductions were as high as 72% with REGN727/SAR236553 and 66% with AMG145. These agents were generally well tolerated; nasopharyngitis and injection site reactions were the most common reactions with both agents. Gastrointestinal disturbances and infections were also common with REGN727/SAR236553. Conclusions: These agents may eventually play a role as add-on therapy in those with dyslipidemias because of their significant effect on LDL-C. Further explorations in large phase 3 clinical trials are warranted to evaluate the effect of these therapies on cardiovascular clinical outcomes and long-term safety.

Professional development series in postgraduate pharmacy residency training: Experiences and opportunities

INTRODUCTION The American Society of Health-System Pharmacists (ASHP) identifies competency areas that categorize clinical and non-clinical skills to develop during postgraduate residency training. To address the competency areas related to non-clinical skills, some residencies have developed programs to focus on interpersonal, leadership, and other professional skills. There is limited guidance in the literature regarding the development or impact of these programs. PERSPECTIVE Professional development series have been implemented at two academic institutions to support the development of non-clinical skills during postgraduate residency training. While these programs address many of the non-clinical skills described in the competency areas, barriers such as program support, logistics, and need for assessment may impede the creation, growth, and success of similar programs. IMPLICATIONS With the continued increase in the number of residency programs and trainees, scalability and sustainability are vital components for the success of professional development programs. Assessment of the impact of current programs and further guidance from pharmacy organizations regarding important aspects of professional development would help standardize this process.

DURATION OF ORAL LOOP DIURETICS AND 30-DAY READMISSION IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Background: Heart failure (HF) is associated with high 30-day readmission rates and represents a significant financial burden to the health care system. Guidelines recommend intravenous loop diuretics to manage volume overload in patients presenting with acute decompensated HF (ADHF), but minimal

Emerging roles for pharmacists in performance-based risk-sharing arrangements

The changing landscape of healthcare payment models is providing new opportunities for pharmacists. Traditional models were focused on paying for a product or a service. Evolving models are focused on paying for positive healthcare outcomes. One of the emerging payment models, the performance-based