The Annals of pharmacotherapy
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Review Case Reports
Thrombolytics for cardiac arrest: case report and systematic review of controlled trials.
To describe a successful case involving the use of tenecteplase during cardiac arrest for presumed pulmonary embolism (PE) and to systematically review the evidence from controlled trials supporting the efficacy and safety of thrombolysis during cardiac arrest. ⋯ Controlled trials demonstrate that there is a lack of benefit and potential harm in administering thrombolysis in an undifferentiated patient with cardiac arrest. However, the case we present provides evidence that fibrinolysis may benefit selected patients with cardiac arrest in whom PE is confirmed or in whom there is high index of suspicion of PE.
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Home Medicines Review (HMR), a community-based collaborative service provided by general practitioners (GPs) and accredited pharmacists in Australia, has demonstrated effectiveness in preventing, detecting, and resolving medication-related problems. The Medication Appropriateness Index (MAI) has been found to be a reliable, valid, standardized instrument for assessment of multiple elements of drug therapy prescribing. ⋯ The study demonstrates that the provision of medication reviews by accredited pharmacists can improve the appropriateness of prescribing as demonstrated by the change in MAI score and, hence, has the potential to improve patient outcomes. Pharmacists who perform medication reviews could also consider including the systematic approach of applying the MAI to assist in optimizing prescribing in older people.
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Review Case Reports
Prolonged propofol use in a critically ill pregnant patient.
To describe the prolonged use of propofol for sedation of a critically ill pregnant patient in her second trimester. ⋯ Despite propofol's pregnancy category B rating, data are lacking in humans regarding its safe use during pregnancy and long-term developmental outcomes in children after exposure to propofol in utero. The safety of propofol as a sedative agent for critically ill pregnant patients remains unknown.
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Case Reports
First report of lamotrigine-induced drug rash with eosinophilia and systemic symptoms syndrome with pancreatitis.
To report a case of lamotrigine-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome with pancreatitis as the initial visceral involvement. ⋯ This is the first reported case of lamotrigine-induced DRESS syndrome with pancreatitis as the initial visceral involvement. Clinicians should be aware of this mode of presentation of DRESS syndrome.
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To review the efficacy, safety, dosing, drug interactions, as well as economic and therapeutic considerations of belimumab, an investigational B-lymphocyte stimulator (BLyS) inhibitor. ⋯ Belimumab has shown significant benefits for patients with SLE in the few Phase 3 trials that have been published. However, questions remain regarding optimal patient population, duration of treatment, place in therapy, and long-term adverse effects.