Pharmacy/Pharmacology

A Dark Side of Dexmedetomidine? Another Look at SPICE-III

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An increasing propofol dose, combined with a fixed dexmedetomidine infusion, was associated with decreased 90-day mortality in patients ≤ 65 years. An increasing dexmedetomidine dose, combined with a relatively fixed propofol dose, was associated with increased mortality in patients ≤65. Both associations were absent in patients > 65 years old.

Source
Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose Associated 90-day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE-III). Am J Respir Crit Care Med. 2022 Oct 10. doi: 10.1164/rccm.202206-1208OC. Online ahead of print.

SGLT-2 Inhibitors – New Drugs for Heart Failure You Need to Know

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Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are known to have cardioprotective effects and are now recommended for all heart failure patients no matter their baseline ejection fraction (EF) or starting medication regimens.

Source
SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet. 2022 Sep 3;400(10354):757-767. doi: 10.1016/S0140-6736(22)01429-5. Epub 2022 Aug 27.

REFACED RCT – Is Fluid Restriction in Sepsis Feasible?

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IV crystalloid fluid restriction in the first 24-hours for ED sepsis patients without associated shock significantly reduced volumes when compared to standard of care. A larger trial investigating patient-centered outcomes is likely imminent.

Source
Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial. Acad Emerg Med. 2022 Oct;29(10):1172-1184. doi: 10.1111/acem.14546. Epub 2022 Aug 5.

Hypo-K+ Equals Hypo-Mg++…Right??

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This retrospective single-center study found that hypokalemic patients who received magnesium within 4 hours of their potassium supplementation had no significant difference in time to serum potassium normalization.

Source
The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department. J Emerg Med. 2022 Oct 11:S0736-4679(22)00347-X. doi: 10.1016/j.jemermed.2022.06.007. Epub ahead of print.

Should We Use Steroids for Pediatric Bell’s Palsy?

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There was no statistical difference in 1, 3, or 6 month facial recovery with prednisolone vs placebo for children with Bell’s palsy in this underpowered RCT. I plan to keep using steroids, though opinions on this will differ.

Source
Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology. 2022 Aug 25;10.1212/WNL.0000000000201164. doi: 10.1212/WNL.0000000000201164. Online ahead of print.

Fluoroquinolone Resistance in UTI – Is It Time to Change Drugs?

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Fluoroquinolone-resistant (FQR) E. coli was present in 22.1% of UTI pathogens studied at 15 geographically diverse EDs. IDSA guidelines recommend changing empiric treatment if local resistance is >10% and adding a dose of parenteral antibiotic, such as ceftriaxone, prior to discharge home.

Source
High prevalence of fluoroquinolone-resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018-2020. Acad Emerg Med. 2022 Sep;29(9):1096-1105. doi: 10.1111/acem.14545. Epub 2022 Aug 5.

Spoon Feed – IDSA Guidelines for Pharmacologic Treatment of COVID-19

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The most recent IDSA guidelines recommend steroids in most patients who need oxygen. Consider nirmatrelvir or remdesivir in high-risk outpatients, and reserve most other therapies for particular circumstances, if at all.

Source
Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2022 Sep 5;ciac724. doi: 10.1093/cid/ciac724. Online ahead of print.

Does Nirmatrelvir Work for Vaccinated Patients In the Omicron Era?

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Nirmatrelvir (Paxlovid) use in a population of largely immune outpatients ≥65 years old, during the omicron variant era, was significantly associated with reduction in hospitalization and death.

Source
Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge. N Engl J Med. 2022 Sep 1;387(9):790-798. doi: 10.1056/NEJMoa2204919. Epub 2022 Aug 24.

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