Pharmacotherapy
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To evaluate the performance of kidney function estimation equations and to determine the frequency of drug dose discordance in an older population. ⋯ The MDRD and CKD-EPI equations significantly overestimated creatinine clearance (mClcr and CG) in elderly individuals. This leads to dose calculation errors for many drugs, particularly in individuals with severe renal impairment. Thus equations estimating glomerular filtration rate should not be substituted in place of the CG equation in older adults for the purpose of renal dosage adjustments. In addition, the common practice of rounding or replacing low Scr values with an arbitrary value of 1.0 mg/dl for use in the CG equation should be avoided. Additional studies that evaluate alternative eGFR equations in the older populations that incorporate pharmacokinetic and pharmacodynamic outcomes measures are needed.
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Four breakpoint cluster region (BCR)-ABL1 tyrosine kinase inhibitors (TKIs) are currently available for the treatment of chronic myeloid leukemia (CML): imatinib, nilotinib, dasatinib, and bosutinib. Choosing the most appropriate TKI requires clinicians to consider a host of patient-, disease-, and treatment-related factors, not the least of which include the safety profiles of the agents. This review discusses the potential impact of treatment-, patient-, and disease-related characteristics on the emergence of adverse events during TKI therapy, with a focus on the underlying mechanisms believed to be responsible for a number of important adverse events associated with these agents and what implications they may have for treatment choice, particularly in the setting of first-line treatment. ⋯ Clinical studies suggest that imatinib, nilotinib, dasatinib, and bosutinib have differing safety profiles, which are in part attributable to the specificity and selectivity of each agent. Although much basic research must be conducted to further illuminate the mechanisms responsible for TKI-related adverse events, on- and off-target effects are believed to be at least partly responsible for cardiovascular toxicity, myelosuppression, fluid retention, gastrointestinal toxicity, and dermatologic toxicity. Increased understanding of the factors that affect TKI-associated adverse events and long-term safety data will enable a more informed approach to the selection of therapy best suited to the individual needs of patients with CML.
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Randomized Controlled Trial
Effects of caffeinated versus decaffeinated energy shots on blood pressure and heart rate in healthy young volunteers.
To evaluate the effects of a caffeinated 5-hour Energy shot compared with a decaffeinated 5-hour Energy shot as assessed by changes in blood pressure and heart rate in healthy, nonhypertensive volunteers. ⋯ Caffeinated energy shots significantly increased SBP and DBP over a 3-hour period compared with decaffeinated energy shots in healthy, nonhypertensive individuals.
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Comparative Study Observational Study
Risk factors for hospital admissions associated with adverse drug events.
To identify predictors of hospital admissions associated with adverse drug events (ADEs) and to determine the preventability of ADEs in patients admitted to two hospitals. ⋯ Adverse drug events are an important cause of hospital admission. Better systems for health care practitioners to identify patients at high risk of preventable hospital admissions associated with ADEs (e.g., age > 65 years old, receiving more than five drugs, and starting new high-risk drugs) should be implemented in order to minimize the risks to patients and the burden on the health care system.
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To evaluate the association between the administration of intravenous (IV) colistin and the emergence of renal dysfunction. ⋯ In this critically ill population, renal dysfunction occurred frequently and was associated with older age and receipt of nephrotoxins.