Pharmacotherapy
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Multicenter Study Comparative Study
Outcomes associated with vasoactive therapy in patients with acute decompensated heart failure.
To describe the clinical management of acute decompensated heart failure (ADHF) in patients receiving intravenous treatment with dobutamine, milrinone, or nesiritide, and to evaluate differences, based on treatment received, in the in-hospital mortality rate, length of stay (LOS), total health care costs, and 30-day hospital readmission rate. ⋯ Nesiritide therapy was associated with a lower in-hospital mortality rate and shorter LOS compared with dobutamine and milrinone. In addition, total health care costs with nesiritide were decreased compared with milrinone. These observations need to be validated by a randomized controlled trial.
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Review Case Reports
Cefepime neurotoxicity: case report, pharmacokinetic considerations, and literature review.
A 67-year-old woman with diabetes mellitus, chronic renal insufficiency, and recurrent urinary tract infections experienced encephalopathy and myoclonus while receiving cefepime. The adverse drug event was accompanied by elevated cefepime levels and abnormal electroencephalograms. This syndrome resolved after discontinuation of cefepime. ⋯ Most cases reverse on drug cessation. In patients with renal disease, the maintenance dosage should be reduced and the patient monitored for neurotoxicity. Cefepime toxicity should be suspected whenever a patient receiving the drug experiences a change in mental status or myoclonus.
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Hypertensive crises are commonly seen in the emergency department, and acute stroke is often the inciting etiology of a hypertensive crisis. Cerebral autoregulation is disrupted in acute stroke, and efforts to lower blood pressure may reduce cerebral perfusion and worsen outcomes. Although most patients with stroke have elevated blood pressure, evidence from clinical trials to guide therapy are scarce. ⋯ Similar recommendations have been made for intracerebral hemorrhage. Subarachnoid hemorrhage is managed with nimodipine and other calcium channel blockers to prevent vasospasm and improve clinical outcomes. Data from ongoing clinical trials may improve guidance about the management of elevated blood pressure after acute stroke.
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Comparative Study
Pharmacologic management of constipation in the critically ill patient.
To compare the effectiveness of common laxatives in producing a bowel movement in patients admitted to a medical intensive care unit (MICU). ⋯ Critically ill patients have a high frequency of constipation, and opioid therapy is a significant risk factor. Routine administration of stimulant or osmotic laxatives should be considered for this patient population.
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Case Reports
Amphotericin B-associated hyperbilirubinemia: case report and review of the literature.
A 53-year-old woman with an intraabdominal infection secondary to Candida albicans experienced hyperbilirubinemia after receiving amphotericin B in two different formulations--amphotericin B deoxycholate and amphotericin B lipid complex. Only a few case reports of amphotericin B-induced hyperbilirubinemia have been documented in the literature, each with different patterns of corresponding abnormalities in liver function tests. The unpredictable nature of this adverse effect warrants monitoring of bilirubin levels and liver function at baseline and potentially during therapy with amphotericin B, regardless of formulation, dosage, or duration of therapy.