Type 2 Diabetes and Blood Glucose: Is There a Benefit to Testing?

Kyle Savio, Mercer University College of Pharmacy

Self-monitoring of blood glucose (SMBG) has been considered a key component of managing diabetes, allowing patients a level of autonomy and safety through detection of inappropriate blood glucose trends that may spur insulin or diet adjustments. In insulin-dependent patients, SMBG has been associated with preventing hypoglycemia. [1] Type 2 diabetes is believed to account for 90–95% of all diabetes and its treatment may not typically utilize insulin until disease progression. Diabetes guidelines have not required the use of SMBG in type 2 diabetes patients unless they are insulin-dependent. [2]

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A New Standard in Non-Small Cell Lung Cancer? Alectinib vs. Crizotinib

Bhargav Patel, Mercer University College of Pharmacy

Non-small cell lung cancer (NSCLC) is characterized by symptoms such as hoarseness, weight loss, loss of appetite, shortness of breath, and a prolonged cough. It may account for up to 85% of all lung cancer cases and is thought to be insensitive to treatment with chemotherapy. [1] Several treatment options, such as surgery, radiation therapy, and chemotherapy, are available. Crizotinib acts to inhibit anaplastic lymphoma kinase (ALK) and is the standard of therapy to manage ALK-positive disease. Alectinib attempts to block ALK tyrosine kinase and could be a new treatment option due to its possible activity against the ALK mutations that confer resistance against crizotinib. [2]

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Development of another PCSK9 inhibitor for hyperlipidemia

Renzo Gonzalez, Mercer University College of Pharmacy

It has been shown that lowering low density lipoprotein cholesterol (LDL-C) will reduce cardiovascular (CV) risk. [1] Statins effectively reduce LDL-C levels, but individual responses may vary. [2-3] Bococizumab is a monoclonal antibody that targets proprotein convertase subtilisin-kexin type 9 (PCSK9).  Unlike the two existing PCSK9 inhibitors Praluent® (alirocumab) and Repatha® (evolocumab), bococizumab is a humanized monoclonal antibody, rather than a fully human one.  Fully human monoclonal antibodies (mAbs) have binding sites composed of fully human sequences, whereas humanized mAbs still contain trace amount of mouse sequences.  Given that bococizumab is a humanized mAb, the likelihood of forming antidrug antibodies is higher compared to the existing PCSK9 inhibitors. [4] These agents are very potent in lowering LDL-C, [5,6] but there is uncertainty in the variability and durability of its LDL-C lowering effect.

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How Much does Timing Matter when Treating Sepsis?

Reem Gebrekidan, Mercer University College of Pharmacy

Sepsis is characterized as a systemic detrimental response to infection which could lead to tissue damage, organ failure, and death. Management of sepsis may include source control, fluid resuscitation, antibiotics, and vasopressors depending on hemodynamic stability after fluid resuscitation. [1] The Surviving Sepsis Campaign (SSC) recommends initiating antibiotics within the first hour of sepsis recognition and a treatment bundle which requires administration of 30 mL/kg crystalloid for hypotension or lactate level of less than 4 mmol/L within 3 hours from admission. [2] It was stated that administration within 3 hours of emergency department triage and/or within 1 hour of shock recognition was not associated with significant improvement in mortality and might not be feasible. [3]

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Pushing for New Treatment Regimens in Uncomplicated Cellulitis

Sahil Desai, Mercer University College of Pharmacy

Over half of the 14 million annual visits for skin and soft tissue infections (SSTIs) in the U.S. are caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA). These infections can be classified by severity and evidence of purulence. [1] Uncomplicated SSTIs are defined as localized infections without evidence of systemic response and do not meet the Systemic Inflammatory Response Syndrome (SIRS) criteria. These criterium include: white blood cell counts <4,000 μL or >12,000 μL; temperature <36°C or >38°C; respiratory rate >20 beats per minute (bpm); and heart rate >90 bpm. Guidelines recommend antibiotics effective against streptococci for uncomplicated cellulitis [2] but new treatment regimens are being explored to combat MRSA. [3]

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Could Cannabidiol be Effective for Seizures?

Reem Gebrekidan, Mercer University College of Pharmacy

Dravet Syndrome is a genetic epileptic encephalopathy beginning in infancy that is characterized by febrile, prolonged, and lateralized seizures.[1] Epilepsy guidelines consider sodium valproate or topiramate as first-line treatment in children with Dravet syndrome while clobazam or stiripentol are supported as adjunctive therapy. Medications such as carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin were advised to be avoided. [2]
The U.S. Food and Drug Administration (FDA) has approved two synthetic cannabinoids based on a substance present in marijuana and a substance acting similarly to another compound in marijuana. Attempting to use components of marijuana is considered to be in the public’s best interest; however, safe and effective use has not been determined. [3] Continue reading

RAAS to the Rescue: Angiotensin II for the Treatment of Vasodilatory Shock

Kyle Savio, Mercer University College of Pharmacy

Vasodilatory shock is characterized as hypotension resulting from peripheral vasodilatation and poor response to vasopressor therapy. Sepsis is considered the main cause for vasodilatory shock by reducing the body’s ability to constrict blood vessels and maintain hemodynamics. Therapy is claimed to be reliant on adrenergic vasopressors such as norepinephrine, but these may fail in refractory vasodilatory shock. The renin-angiotensin-aldosterone system (RAAS) is noted to play an important role in preserving the vasculature to prevent vasodilatory shock. [1]

In vasodilatory shock, RAAS failure may present without a known mechanism. It is believed that the endothelial cells are blocked or hyperpolarized, preventing a response to angiotensin II. The lungs have shown production and storage of angiotensin converting enzyme I and II which can limit effectiveness of RAAS in septic patients. Supplementing the body with angiotensin II may serve as therapy to reverse these vasodilatory effects. [2] Continue reading