SIRIRAJ SURVIVAL GUIDE BOOK 2553

 Good to see a good attempt working on survival guide for Thai doctors.
Follow the link for more details and you can also download in form of pdf files as well.


http://free-medicalbook-thailand.blogspot.com/2015/01/survival-guide-siriraj.html

Variables Affecting Patient Adherence to T2DM Treatment: How Can Pharmacists Improve Outcomes?

Need some CEs? This is a pretty good one.

Ref: 

Jerry Meece, RPh, CDE, FACA, FAADE, Activity Chairman; Susan Cornell, PharmD, CDE, FAPhA, FAADE; David Pope, PharmD, CDM, CDE

Faculty and Disclosures

CE Released: 06/22/2015 ; Valid for credit through 06/22/2016

http://www.medscape.org/viewarticle/844933?src=wnl_cme_revw

It's been a long time.

I've been away from this blog for so long but I'm not totally gone from the cyber world.
Find me at https://www.facebook.com/EngforPharm?ref=hl
Anyway, I'm back to update more about pharmacy!

Warfarin Associated Coagulopathy: Reversal Options and Practical Considerations for the Pharmacist

Edith A. Nutescu, PharmD, MS, FCCP
Clinical Professor, Department of Pharmacy Practice
University of Illinois, College of Pharmacy
Co-Director, Center for Pharmacoepidemiology & Pharmacoeconomic Research
Co-Director, Personalized Medicine Service
University of Illinois Hospital & Health Sciences System
Chicago, Illinois

Clinical Considerations for Reversing Warfarin-Induced Coagulopathy

The management of patients receiving oral anticoagulants, who are bleeding or need an urgent invasive procedure, requires weighing the risks for thrombosis and bleeding with the consideration of short- and long-term treatment goals. Individualization of therapy is necessary, taking into consideration these goals, along with the patient's age, renal function, clinical status, and laboratory test results. Guidelines developed by the American College of Chest Physicians (ACCP) recommend withholding warfarin and, because of the lag time needed for depletion of vitamin K-dependent clotting factors, the administration of vitamin K and clotting factor concentrates when urgent warfarin reversal is needed.

In warfarin-treated patients with bleeding, vitamin K 5 to 10 mg by slow intravascular injection in addition to PCC-4 is recommended for urgent warfarin reversal.When the INR is > 10, pharmacologic intervention to reverse anticoagulation from warfarin is indicated.
Reversal is not warranted when the INR is ≤ 10 unless the patient is bleeding or requires urgent surgery. Reversal is indicated for patients treated with warfarin who are bleeding or require urgent surgery regardless of the INR. For patients treated with warfarin, who require surgery within 24 hours, a 2-drug combination of vitamin K 5 to 10 mg slow intravascular injection plus (1) PCC-4, (2) rFVIIa, or (3) aPCC will likely be effective for lowering the INR based on the published literature.

If surgery is needed, but can be delayed for more than 24 hours, intravascular vitamin K alone may suffice for warfarin reversal based on the pharmacodynamics of vitamin K. When urgent reversal is necessary, the ACCP guidelines recommend PCC-4 before FFP. These recommendations were based on several key differences between PCC-4 and FFP, including a more rapid INR reversaln (i.e., using FFP may delay treatment up to 1 hour because it requires the patient's blood to be typed and screened), it must be thawed before use, and it is infused at a slower rate. In addition, there is a higher potential for adverse sequelae related to fluid overload with FFP. The maximum volume of PCC-4 administered is approximately 250 mL, while more than a liter of FFP may be necessary for the same INR reversal. FFP also has an increased risk for transfusion-related adverse events, including acute lung injury, disease transmission, and hypersensitivity reactions. 

For the whole article go to:
 http://www.powerpak.com/course/content/110635

Ego is something very hard to fix especially it's not your ego :)

English For Pharmacists is something ALL pharmacists should know!

JNC 8 Guidelines Update

http://www.medscape.com/viewarticle/817991

Nine Recommendations
Those questions then form the basis for nine recommendations, discussed in depth and assigned a score for both the strength of the recommendation and the evidence supporting it. Among the recommendations:

• In patients 60 years or over, start treatment in blood pressures >150 mm Hg systolic or >90 mm Hg diastolic and treat to under those thresholds.
• In patients <60 140="" and="" be="" goals="" hg="" in="" initiation="" mm="" patients="" same="" should="" the="" threshold="" treatment="" u="" used="" years="">>

18 years with either chronic kidney disease (CKD) or diabetes.

In nonblack patients with hypertension, initial treatment can be a thiazide-type diuretic, CCB, ACE inhibitor, or ARB, while in the general black population, initial therapy should be a thiazide-type diuretic or CCB.

In patients >18 years with CKD, initial or add-on therapy should be an ACE inhibitor or ARB, regardless of race or diabetes status.

Embedding pharmacists throughout a health system

Phillip Olley, PharmD, talks with Michelle Ma, RN, flow coordinator 

 (left) and Zin Mie Oo, MD, infectious disease fellow (right)

From APhA

It's almost end of 2013. This is what pharmacist can do and we definitely can make a difference. Keep up the good work everyone!

Many Faces of MTM

Froedtert Hospital joins with two community hospitals and 30 clinics to make up Froedtert & the Medical College of Wisconsin, which has 772 beds, nearly 40,000 annual admissions, and more than 900,000 annual outpatient visits.

Pharmacists are everywhere at Froedtert & the Medical College of Wisconsin Froedtert Hospital. From the moment patients enter the hospital to the moment they leave, pharmacists play an active role in managing and monitoring medications. 

“We have pharmacists on the [hospital] floors, in ambulatory clinics, and in medical homes, so our pharmacists really take ownership of the patient no matter where he or she is in the transition of care,” said Erika Smith, PharmD, Clinical Pharmacy Manager at Froedtert Hospital in Milwaukee.

With more than 200 pharmacists, pharmacy technicians, and pharmacy administration and informatics team members, Froedtert Hospital has a longstanding history of embedding pharmacists at transition points in the hospital.

Four clinical pharmacy managers are aligned with each medical service line and manage the corresponding inpatient pharmacy services all the way through ambulatory pharmacy services. This model helps the organization and its pharmacists gain a better understanding of how pharmacy services can best meet the needs of patients.

Read More [Click Here]

Need CEs? Here is a good one from ASHP

http://elearning.ashp.org/

:)

FDA Approvals: Plasma-Derived Agent for Anticoagulation Reversal

Patients with atrial fibrillation or an artificial heart valve often need long-term anticoagulation to reduce their high risk for thrombotic events. Warfarin and other vitamin K antagonist (VKA) anticoagulants can prevent thrombosis, but there is an increased risk of major bleeding.
Human prothrombin complex concentrate can be used more quickly than plasma for reversal of VKA anticoagulation, as it can be used without blood group typing or thawing. This therapy offers clinicians a new option for patients requiring urgent reversal of VKA anticoagulation.
cont. reading 

New Drugs Approved for Treating Hypercholesterolemia

Unique mechanisms of action

Lomitapide is a microsomal triglyceride transfer protein (MTP) inhibitor. MTP resides in the lumen of the endoplasmic reticulum, thereby preventing the assembly of apo B–containing lipoproteins in enterocytes and hepatocytes. This inhibition leads to a reduction in the synthesis of chylomicrons and very low–density lipoprotein, resulting in a reduction in plasma LDL levels. This is the first MTP inhibitor approved by FDA for any indication.
Mipomersen is an oligonucleotide inhibitor of apo B-100 synthesis that reduces LDL cholesterol by preventing the formation of atherogenic lipids. It decreases the production of apo B, which provides the structural core for all atherogenic lipids, including LDL cholesterol, which carry cholesterol through the bloodstream.

VERY COOL! :)

Ref: Pharmacy Today 2013 (APhP)

Strategy for managing acid suppression in the ICU

http://www.pharmacypracticenews.com//ViewArticle.aspx?ses=ogst&d=Operations+%26+Management&d_id=53&i=ISSUE%3a+April+2013&i_id=950&a_id=22973

Every evening during a two-month verification phase, tele-ICU nurses assessed the risk for GI bleeding for each patient in the 38-bed ICU at one of the system’s hospitals. The three-week intervention phase that followed involved all adult ICU beds. On-site nurses and pharmacists recommended 102 conversions from IV to oral PPIs; 86 (84.3%) were accepted. Discontinuation of SUP was recommended 173 times; prescribers accepted 91 (52.6%) of the recommendations. The cost of SUP treatment decreased from $1.06 per adjusted patient-day to 77 cents and the projected annual cost savings from decreased SUP amounted to $78,052.

from Pharmacy Practice News 2013

Pharmacologic and Complementary Therapy for Migraine Prophylaxis

Ref: US Pharmacist

 

The revised guidelines developed by the AAN and the AHS for the use of pharmacologic agents and complementary therapies for migraine prophylaxis provide recommendations that were based on evidence-based clinical trials conducted after the release of the 2000 guidelines. This in-depth analysis gives an oversight of the methods, designs, and results of the clinical trials examining the efficacy of these agents. The updated guidelines address new therapies for the short-term prevention of MAM, namely, frovatriptan, naratriptan, and zolmitriptan. Also, new evidence in correlation with already established trial-based evidence supports the ineffectiveness of lamotrigine for migraine prophylaxis. Finally, the use of complementary therapies, such as herbal formulations, for migraine prophylaxis has been advanced by evidence-based efficacy in clinical trials, providing a new arsenal of evidence-based treatment during a time when the use of herbal formulations has become increasingly popular.

 http://www.uspharmacist.com/content/d/feature/c/38550/

2012's Top 5 for Pharmacists

http://www.medscape.com/viewarticle/775232?src=mp 

After many busy months, I finally get a chance to update this blog.
I personally think number 1 read article is good for everyone.

click here to view the article

IV Acetaminophen Improves Pain Management and Reduces Opioid Requirements in Surgical Patients: A Review of the Clinical Data and Case-based Presentations.

I found this quite interesting since acetaminophen is such an old and common drug. We've been using it for ages. We can use IV acetaminophen as an "add-on" to opioid and/or NSAIDs especially in patients who cannot take pills such as post op patients.

http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Special%2bReports&d_id=62&i=April+2012&i_id=829&a_id=20499

Tuberculosis and PDR/MDR-TB

Key Point from Updated WHO Guideline

1. Rapid drug susceptibility testing for isoniazid and rifampicin or rifampicin alone allows earlier identification of patients with drug-resistant TB. It is considered the most cost effective approach.
   
2. Monitoring patients with sputum smear microscopy and culture, rather than sputum smear microscopy alone, for multidrug-resistant TB (MDR-TB) to detect failure as early as possible during treatment.
3. The use of fluoroquinolones and ethionamide, with later-generation fluoroquinolone, rather than earlier-generation forms of the drug recommended for patients with MDR-TB. For example avoiding the use of ofloxacin and use later generation instead.
4. For patients with MDR-TB, the minimum duration of treatment has been extended by 2 months from previous guidelines to reflect research showing improved treatment success with the longer duration. Intensive treatment should therefore last at least 8 months, and for those who have not been treated with second-line drugs for TB in the past, treatment should extend to 20 months. The duration may be adjusted for some patients according to their clinical and bacteriologic response.
5. Early use of antiretroviral agents for HIV-infected patients with TB who are receiving second-line drug regimens, irrespective of CD4 cell-count, as early as possible (within the first 8 weeks) after initiation of anti-TB treatment.

2011 Updated WHO Guidelines for Drug-Resistant Tuberculosis

New guidelines from the World Health Organization (WHO) on the management of drug-resistant tuberculosis (TB) offer the latest approaches for better control of the disease that claims millions of lives each year.

The guidelines, published online August 4 in the European Respiratory Journal, update recommendations from previous guidelines published in 2008 and are intended to help inform practitioners, particularly those in lower-income settings, of the very latest and most cost-effective standards of care for achieving optimal patient outcomes.

Click Here for full guideline

Clinical Practice Guideline

ICH Good Clinical Practice Guideline (Thai Version)
from Thailand FDA
contain ICH GCP (International Conference on Harmonization)

Guideline on how to conduct a research by ICH standard

Cardiac Emergencies (Thai Version)

PDF file in Thai language - Cardiac Emergencies By Chaisit Wongwipaporn, Srinakarin Hospital Khonkaen University
ภาวะฉุกเฉินระบบหัวใจและหลอดเลือด

Medscape - Patient Handout in English

Patient Handout