Pharmacotherapy
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Controlled Clinical Trial
Effects of an inhaled β2-agonist on cardiovascular function and sympathetic activity in healthy subjects.
To determine the effect of a short-acting, inhaled β(2)-adrenergic receptor agonist, albuterol sulfate, administered by nebulization, on cardiovascular function and sympathetic activity in healthy individuals. ⋯ In these healthy subjects, administration of a nebulized β(2)-agonist resulted in enhanced ventricular function and a decrease in SVR, suggesting peripheral vasodilation. In addition, the increase in norepinephrine level with albuterol, but not placebo, may have important implications in patients with known cardiovascular disease.
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To determine dosing options for decreasing the time to achieve a therapeutic international normalized ratio (INR) threshold of 2.0 when restarting warfarin in an ambulatory population whose previous warfarin maintenance doses are known, and to identify thromboembolic and major bleeding events up to 90 days after disruption of warfarin therapy. ⋯ In select patients, the option of administering a warfarin loading dose of approximately 40% greater than the previous daily maintenance dose for 2 or 3 days shortens the time to achieving therapeutic anticoagulation.
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To determine the impact of having an antimicrobial allergy label in the medical record on clinical outcomes in hospitalized patients. ⋯ Presence of an allergy label in the medical record was associated with increased length of hospital stay and worse clinical outcomes compared with no allergy label in hospitalized patients treated with antimicrobials.
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To assess the effect of substituting dexmedetomidine for propofol during a nationwide propofol shortage on postoperative time to extubation and opioid requirements in patients who underwent coronary artery bypass graft (CABG) surgery. ⋯ No statistically significant differences were noted between the propofol and dexmedetomidine groups when assessing the outcomes of opioid requirements and the time to extubation. A multicenter, prospective, randomized, blinded study is needed to determine the optimal sedative after CABG surgery.
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The United States Food and Drug Administration (FDA) Amendments Act of 2007 mandated that Risk Evaluation and Mitigation Strategies (REMS) be required of manufacturers. These REMS are strategies implemented to manage known or potential risks associated with drugs and to ensure ongoing pharmacovigilance throughout the life of a pharmaceutical product, including once the product becomes available as generic. The elements of an individual REMS program consist of three levels: medication guide or patient package insert, communication plan, and elements to assure safe use (ETASU). ⋯ The REMS are a permanent fixture in the development and marketing of pharmaceutical agents, and their further implementation in solid organ transplantation is inevitable. Transplantation providers should take a proactive role in patient education and implementation of REMS within the therapeutic area. It is imperative for health care providers to realize that the ultimate goals of REMS are to reduce the potential for serious risks and to make outcomes from the treatment of disease more predictable.