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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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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Canagliflozin Effect on Cardiovascular and Renal Events in Type 2 Diabetes

Kishan Patel, Mercer University College of Pharmacy

Canagliflozin is a sodium-glucose cotransporter 2 (SGLT-2) inhibitor that allows for lower blood glucose in patients with type 2 diabetes (T2D) by increasing the urinary excretion of glucose. [1] There is a large amount of data that suggests T2D is an independent risk factor for cardiovascular disease.  Furthermore, cardiovascular disease is also the cause of death for the majority of patients with T2D. [2] Current evidence suggests that canagliflozin may be more effective than comparative options such as dipeptidyl peptidase-4 (DPP-4) inhibitors in lowering glycated hemoglobin (HbA1C), body weight, and blood pressure when used as an add-on therapy with metformin. Canagliflozin also appears to be superior when used in combination with metformin than sulfonylureas (SU) in regard to lowering body weight, blood pressure, and risk of hypoglycemia. However, direct evidence from comparative studies is only limited to sitagliptan (DPP-4 inhibitor) and glimepiride (SU) for their respective drug classes.  Therefore, conclusions for canagliflozin’s comparative effectiveness against other agents in the same class as DPP-4 inhibitors and sulfonylureas have been deduced from indirect evidence in network meta-analyses. [3] Continue reading

Effect of marijuana use on cardiovascular and cerebrovascular mortality

Eku Oben, Mercer University College of Pharmacy

 

Marijuana was shown to increase heart rate and blood pressure by 20 to 100%. [1] However, it can cause hypotension in high doses or when taken orally. [2] Users 14-18 years old with heavy marijuana use (~56 g/month) performed worse on flexible thinking tests compared to controls with limited marijuana use (<7 g/month). When comparing marijuana users to non-marijuana users, the adjusted hazards ratio (HR) for hypertension mortality was 3.42 (95% CI: 1.2- 9.79) and for each year of marijuana use, was 1.04 (95% CI: 1- 1.07). The adjusted HR for heart disease mortality between the two groups was 1.09 (95% CI: 0.63 -1.88); and 1 (95% CI: 0.98-1.02) for each year of marijuana use. [3]

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Praxbind® : Clinical Efficacy

Akpan Anani, Mercer University College of Pharmacy

While oral anticoagulants are used for the prevention or treatment of thrombotic events, certain life-threatening scenarios may warrant interventions in which anticoagulant reversal is needed to achieve hemostasis. Consequently, the availability and efficacy of reversal agents can have a large impact on the decision making of healthcare providers in regards to the anticoagulant therapy regimen being utilized by patients. Pradaxa® (dabigatran) is an oral anticoagulant approved in the U.S. in 2010 for the treatment and prevention of different thrombotic events. [1] Conversely, Praxbind® (idarucizumab) is an aptly named humanized monoclonal antibody fragment that binds to dabigatran and reverses its anticoagulant activity. [2] Idarucizumab has been licensed in numerous countries (first approved in the U.S. in 2015) [3] based on preliminary results from the first 90 patients enrolled in the Reversal Effects of Idarucizumab on Active Dabigatran (RE-VERSE AD) trial. [4]

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