The Annals of pharmacotherapy
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Constipation is prevalent in the cystic fibrosis (CF) population and yet there are few data demonstrating the effectiveness of currently used treatments. Lubiprostone is a laxative that works by activating the type 2 chloride channel in the gastrointestinal tract and thus has the potential to be especially effective for constipation associated with CF. ⋯ Lubiprostone may be an effective option for the treatment of constipation in adults with CF.
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To review the pharmacology, pharmacokinetics, safety, and efficacy of boceprevir, a novel oral hepatitis C virus (HCV) nonstructural 3 (NS3) protease inhibitor for the treatment of chronic HCV infection, specifically, genotype 1. ⋯ Boceprevir should be used in combination with Peg-IFN-α-2b and ribavirin in the treatment of chronic HCV genotype 1 infection. The improved response rates achieved with that combination will make boceprevir a viable option compared with other developing and approved NS3 protease inhibitors for treatment-naïve and treatment-experienced nonresponders/relapsers. Additional data are needed to clarify the potential for resistance and drug interactions.
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Comparative Study
P2Y₁₂ receptor inhibitors: integrating ticagrelor into the management of acute coronary syndrome.
Acute coronary syndrome (ACS) is a continuum of disease that includes non-ST-segment elevation ACS and ST-segment elevation myocardial infarction. The purpose of this article is to define the developing role of ticagrelor in ACS and compare it to currently available P2Y₁₂ receptor inhibitors. ⋯ Although ticagrelor offers important advances in the management of ACS (eg, reversibility), there are also notable clinical considerations (eg, unique adverse effects such as dyspnea). Based on the current evidence, we propose an algorithm to aid clinicians in the selection of a P2Y₁₂ receptor inhibitor for patients with ACS in various clinical situations.
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Innovation in health care is difficult yet necessary in this era of health care delivery and payment reform. The Center for Medicare and Medicaid Services (CMS) Innovation Center and the CMS Partnership for Patients have announced priority areas to achieve better health, better care, and reduced costs through continuous improvement. Pharmacists possess the therapeutic knowledge and medication process expertise to create collaborative and innovative solutions that address medication use and safety problems. ⋯ As pharmacy practitioners, educators, and researchers, we face an unprecedented opportunity to make a difference. So, either individually or collectively in our workplaces and pharmacist professional organizations, we must respond to this call to action. Some practical suggestions are offered to get us started on this journey.
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To summarize literature describing use of neuromuscular blocking agents (NMBAs) for common critical care indications and provide a review of NMBA pharmacology, pharmacokinetics, dosing, drug interactions, monitoring, complications, and reversal. ⋯ NMBAs are high-alert medications used to manage critically ill patients. New data are available regarding the use of these agents for treatment of ALI/ARDS and status asthmaticus, management of elevated ICP, and provision of therapeutic hypothermia after cardiac arrest. To improve outcomes and promote patient safety, intensive care unit team members should have a thorough knowledge of this class of medications.