Opioids vs. Non-Opioids in the Emergency Department for Acute Extremity Pain

Kayla Peltier, Mercer University College of Pharmacy

It is reported that almost two thirds of patients visiting emergency departments do so for treatment of pain. [1] The National Institute on Drug Abuse reports that each day more than 90 Americans die from an opioid overdose (including prescription pain relievers, heroin, and synthetic opioids). Furthermore, it is reported that 21%-29% of patients who are prescribed opioids for chronic pain misuse them, and 8%-12% of chronic pain patients develop an opioid use disorder. [2]

Therefore, this study aimed to compare the efficacy of various oral analgesics in addition to acetaminophen in an effort to determine if a combination of non-opioid analgesics could be a potential treatment option in the setting of acute extremity pain in the emergency department (ED). [3]

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Surgical Site Infection Prophylaxis in Obese Women Undergoing Cesarean Delivery

Kayla Peltier, Mercer University College of Pharmacy

The Centers for Disease Control and Prevention (CDC) has reported that in 2015 cesarean deliveries accounted for 32.0% of all reported births. [1] One of the complications of cesarean deliveries is post-cesarean surgical site infection (SSI), and the reported incidence has ranged from 3.7% to 9.8% worldwide. [2] There several risk factors for developing post-cesarean SSI, and obesity is one of the reported factors. [2] This may raise a concern in the United States as the CDC also has reported 38.3% of women who are 20 years of age and older are obese. [3]

While obesity has been identified as an independent risk factor for the development of post-cesarean delivery SSI, limited data is available to attempt to determine the optimal antimicrobial regimen for prophylaxis in obese patients. [4] One gram of cefazolin has been identified as sufficient antimicrobial prophylaxis for post-cesarean SSIs in the general population; however, there are concerns of its efficacy in obese women. [2] Therefore, this study aimed to determine the efficacy of oral cephalexin and oral metronidazole as antimicrobial prophylaxis for post-cesarean SSI in obese women. [4]

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Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation

Kevin Lao, Mercer University College of Pharmacy

The 2016 European Society of Cardiology guidelines recommend a short period of triple therapy (oral anticoagulant [OAC], aspirin, clopidogrel) for patients with atrial fibrillation (AFib) undergoing percutaneous coronary intervention (PCI) with a stent placement. [1]

Contrary to the European guidelines, the American Heart Association guidelines state that it may be reasonable to use clopidogrel with OAC without aspirin in AFib patients with CHA2DS2-VASc score ≥ 2 following PCI based on evidence that showed higher rates of bleeding with triple therapy. [2] Additionally, one previous trial has shown that dual therapy (warfarin + clopidogrel [P2Y12 inhibitor]) was associated with lower incidence of bleeding without increased rates of stent thrombosis in PCI patients compared to triple therapy. [3]

With the availability of the new oral anticoagulant (NOAC), some evidence suggests that NOAC, instead of warfarin, with a P2Y12 inhibitor (i.e. clopidogrel) may be an effective thromboprophylaxis in PCI patients. Therefore, the RE-DUAL PCI trial aimed to compare the efficacy and safety of dual therapy composed of dabigatran and P2Y12 inhibitor among patients with AFib undergoing PCI. [4]

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Efficacy and Safety of Alirocumab in Insulin-treated Diabetics with High Cardiovascular Risk

Kayla Peltier, Mercer University College of Pharmacy

In 2015, the Centers for Disease Control and Prevention (CDC) estimates that 23.0 million Americans were living with diabetes and 7.2 million of Americans had undiagnosed diabetes. [1]

Diabetes is a risk factor for atherosclerotic cardiovascular disease (ASCVD), and the National Lipid Association (NLA) guidelines classify patients with diabetes as high-to-very-high-risk for developing ASCVD. [2] Due to the concern, the most current lipid guidelines from the American College of Cardiology (AHA)/American Heart Association (AHA) and the American Diabetes Association (ADA) standards of care recommend that patients aged 40 to 75 years with diabetes be started on moderate-intensity statin therapy for primary prevention of ASCVD. [3,4] The NLA guidelines recommend that diabetic patients receive either moderate- or high-intensity statin therapy, regardless of patient age. [2]

Alirocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin kexin type 9 (PCSK9) and is indicated for the treatment of heterozygous familial hypercholesterolemia or clinical ASCVD in addition to lifestyle modifications and maximally tolerated statin therapy in adults who require additional LDL-C lowering. [5] Concerns have been raised about the safety and efficacy of PCSK9 inhibitors in addition to the use of insulin therapy in diabetic patients. Therefore, this study aimed to investigate the efficacy and safety of alirocumab in patients with diabetes mellitus. [6] Continue reading

The Effect of Adding Lorazepam to Haloperidol on Agitated Delirium in Patients with Advanced Cancer

Kayla Peltier, Mercer University College of Pharmacy

Delirium has been identified as the most common serious neuropsychiatric complication in cancer patients. First-line treatment for delirium is often non-pharmacological and includes re-orienting the patient frequently, encouraging cognitively stimulating activities, avoiding immobility if possible, and promoting good sleep patterns and sleep hygiene. If non-pharmacological therapies are not effective or the patient is displaying severe agitation and poses a risk to self-harm or harm others, then treatment with pharmacological agents (including antipsychotic and sedating medications) may be considered. [1]

The authors of the study state that while antipsychotics and benzodiazepines are often used to treat delirium, the use of benzodiazepines is controversial due to a lack of adequate, well-controlled randomized trials. Therefore, this study aims to compare the effect of lorazepam to placebo as an adjuvant to haloperidol therapy in patients with agitated delirium in the setting of advanced cancer. [2]

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Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis

Long Buu Huynh, Mercer University College of Pharmacy

Osteoporosis, or “porous bone”, is a bone disease characterized by a loss of bone mass and change in bone structure. There are no symptoms since osteoporosis is a silent condition. Risk factors that can cause osteoporosis are lifestyle choices, certain diseases, medications, and age. [1] Romosozumab is a medication used to help increase bone formation and decrease bone resorption. Alendronate is classified as an antiresorptive agent and used as first-line therapy for osteoporosis. The aim of this study is to investigate the effectiveness of romosozumab followed by alendronate compared with alendronate alone in postmenopausal women with osteoporosis and a previous fracture. [2]

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Where are We with the New Zika Vaccine?

Tanya Huang, Mercer University College of Pharmacy

The Zika virus (ZIKV) was first discovered in 1947 in Uganda, and infection cases were observed sporadically in Africa and Southeast Asia. The virus is primarily transmitted to humans through Aedes mosquitoes, which are also present in the United States (Aedes albopictus). Transmission through mosquito bites are implicated for pathogenic outbreaks. Other modes of transmission include sexual transmission and transfusion-related transmission. Although the virus is detectable in breast milk, transmission via breastfeeding has not yet been reported.    Zika virus infection are often asymptomatic (~80%) or exhibit mild symptoms that resolve in a few days. Common symptoms of the infection are fever, itchy maculopapular rash, nonpurulent conjunctivitis, arthralgia of small joints of the hands and feet, myalgia, and headache involving retro-orbital pain. Serious complications such as death, hemorrhagic complications, and/or hospitalizations due to infection are rare compared to other types of infections (e.g. yellow fever and dengue infections). [1]

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