Bivalirudin vs. Heparin for Improving Clinical Outcomes in PCI patients

Akpan Anani, Mercer College of Pharmacy

For patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS), anticoagulant therapy is necessitated by risk of thrombotic events. [1] Angiomax® (bivalirudin) is a direct thrombin inhibitor indicated for patients undergoing PCI and concurrently using a glycoprotein IIb/IIIa inhibitor (GPI). [2] Bivalirudin has been shown in some studies to cause less major bleeding than Hep-Lock® (heparin) in myocardial infarction (MI) patients needing anticoagulation [1,3]; however, limited research exists comparing bivalirudin to heparin for assessment of repeat MI or all-cause mortality risk.

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Long-Term Effects of Repeated Injections of Local Anesthetic with or Without Corticosteroid for Lumbar Spinal Stenosis

Eku Oben, Mercer University College of Pharmacy

 

Lumbar spinal stenosis is the narrowing of the space around the spinal cord, most commonly caused by arthritis. [1] Guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, corticosteroid injections, anesthetic injections, physical therapy, or a lumbar brace for treatment of lumbar spinal stenosis. [2] Comparing lumbar spinal stenosis patient pain scores shows no difference between groups that received steroid injections after anesthesia and placebo groups at the first month (p= 0.793). [3]

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Does Oxygen Therapy Reduce Mortality in Myocardial Infarction?

Kenneth L. Smith, Mercer College of Pharmacy

 Myocardial Infarction (MI), commonly known as a heart attack, is caused by a lack of oxygen to the myocardium, which leads to ischemia followed by cell death.[1] For more than a century, supplemental oxygen has been considered an integral part of treatment for suspected MI and is currently recommended in clinical guidelines.[2,3] The role of supplemental oxygen is to increase oxygen delivery to the myocardium tissue and prevent cell death. Above normal levels of oxygen can cause complications such as coronary vasoconstriction[4] and formation of reactive oxygen species[5]. Efficacy of routine oxygen therapy in patients with MI is considered uncertain.[6] In this randomized clinical trial, one year all-cause mortality benefits of routine oxygen therapy in patients with MI was explored.

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Rivaroxaban plus Aspirin for Stable Cardiovascular Disease?

Akpan Anani, Mercer University College of Pharmacy

Xarelto® (rivaroxaban) is an oral anticoagulant with indications for the treatment and prevention of thromboses, but not for the secondary prevention of cardiovascular events. [1] Conversely, aspirin has been shown to lower the risk of major adverse cardiovascular events and even cardiovascular death compared to placebo. [2] As a result, low dose aspirin (≤100 mg) is recommended for all tolerant patients in need of secondary prevention. [3] Due to bleeding risks, anticoagulants have not been recommended for these same patients. [4]

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Subcutaneous Injection of Triamcinolone and Lidocaine to Prevent Postherpetic Neuralgia

Eku Oben, Mercer University College of Pharmacy

Postherpetic neuralgia (PHN) is a complication of herpes zoster, with a 4.2% increase in risk with an increase in age[1] Guidelines for the treatment of herpes zoster (HZ) recommend antivirals as first line therapy. However, this treatment has not been shown to prevent PHN. Zostavax® (zoster vaccine live), is 51.3% effective in preventing herpes zoster and 66.5% effective in preventing PHN. It is also recommended for patients 60 years and older in preventing the onset of herpes zoster and PHN. [2] Topical Lidoderm® (lidocaine) 5% patch is recommended as first-line treatment for PHN. [3] This study shows the effect of using a combination of drugs to prevent PHN, and the use of a subcutaneous injectable lidocaine formulation, as opposed to the well-studied patch in preventing PHN. [4]

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Use of Aspirin in the Reduction of Preeclampsia in High Risk Pregnancies

Kenneth L. Smith, Mercer College of Pharmacy

 Preeclampsia is a disorder that can lead to hypertension in pregnancy and is often accompanied with a significant amount of protein excreted in the urine. [1] It has been considered to be an important cause of both maternal and prenatal death [2] and affects approximately 5–8% of all pregnancies worldwide [3]. Placental anti-angiogenic factors may play a central role in the vascular dysfunction that leads to this disorder. [4 The American College of Obstetricians and Gynecologist recommends the use of aspirin in women with a history of preeclampsia in either more than one pregnancy or those that resulted in a delivery prior to 34 weeks gestation. This study explored the reduction in incidence of preeclampsia, in high risk pregnancies, starting from 11 to 14 weeks and continuing through the 36th week of gestation. [5]

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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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