Journal of pharmacy practice
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Tramadol is an opioid analgesic that binds to mu-opioid receptors and inhibits the uptake of norepinephrine and serotonin. Through its activation of these receptors, it has potential to increase the utilization of glucose and/or decrease hepatic gluconeogenesis. ⋯ This case illustrates that hypoglycemia can be a presenting symptom in patients with an acute overdose of tramadol with no previous history of glycemic dysregulation. Upon presentation it is important to closely monitor serum glucose concentrations to identify hypoglycemia early in order to initiate necessary hypoglycemia protocols.
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To review available evidence on corticosteroids in acute respiratory distress syndrome (ARDS), Coronavirus Disease 2019 (COVID-19), and other viral pneumonias. ⋯ Based on data from available randomized trials, patients that require respiratory support or mechanical ventilation benefit from corticosteroid therapy. Corticosteroids are an inexpensive and readily available therapy that should be standard of care in hospitalized COVID-19 patients requiring respiratory support.
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The direct comparison of twice daily (BID) and thrice daily (TID) dosing of subcutaneous low dose unfractionated heparin (LDUH) for venous thromboembolism (VTE) prophylaxis in a mixed inpatient population is not well-studied. ⋯ This study did not demonstrate a difference in effectiveness or safety between BID and TID dosing of LDUH for VTE prevention.
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Although the interaction between methylene blue and serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors is well documented, there remains a paucity of literature on identifying patient groups who may be at risk for experiencing this interaction. Here, we report a case of methylene blue and venlafaxine-induced serotonin syndrome in a patient with cancer.
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Sepsis and septic shock are significant health issues in the United States. Novel treatment options focusing on mitigating the dysregulated host response while reducing the need for vasopressor support are needed. This review discusses ascorbic acid, thiamine, and steroids as monotherapy and in combination for the treatment of sepsis and septic shock. ⋯ Initial studies in patients with sepsis and septic shock demonstrated beneficial effects of ascorbic acid, thiamine, and steroids as monotherapy or in combination without safety concerns. However, the efficacy and safety of these therapies warrant further validation in larger clinical studies.