The Annals of pharmacotherapy
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Review Comparative Study
Does simvastatin cause more myotoxicity compared with other statins?
To review the literature regarding statins and myotoxicity and evaluate these data to determine whether incidence rates are higher with simvastatin. ⋯ Overall, the rates of severe myotoxicity with all statins are low, especially with low-to-moderate doses. However, recent trials for those using simvastatin 80 mg daily suggest a higher incidence of myotoxicity compared with maximum approved doses of other statins. Practitioners should be aware of these possible risks and individualize therapy to limit myotoxicity.
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The main adverse effect of polymyxin B is nephrotoxicity. There are few data on polymyxin-associated renal injury. ⋯ Patients who developed AKI had a strikingly elevated mortality rate. Polymyxin B should be used with extreme caution in patients who have an abnormal baseline SCr; use vasoactive drugs; or have abdomen, blood, or catheter as the infection site.
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Review Comparative Study
An updated focused review of dexmedetomidine in adults.
To evaluate recent comparative studies regarding the safety and efficacy of dexmedetomidine in adults. ⋯ Dexmedetomidine is an alternative for procedural sedation and can be used long-term (>24 h) in critically ill patients, in dosages up to 1.5 microg/kg/hour. More studies are needed to better define the role of dexmedetomidine in preventing and treating delirium.
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Comparative Study
Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients.
Adolescents with acute suicidal ideation and attempts are frequently treated with psychotropic medications in psychiatric hospitals. However, little is known about whether pharmacologic interventions used to stabilize suicidal adolescents within inpatient settings are effective in reducing early readmission. ⋯ In this sample of suicidal adolescents, antidepressant treatment was associated with a lower risk of readmission and polypharmacy was associated with a higher risk of readmission. Study findings highlight the need for quality improvement efforts that optimize pharmacologic treatment and physician decision making.
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Lorazepam is recommended by the Society of Critical Care Medicine as the preferred agent for sedation of critically ill patients. Intravenous lorazepam contains propylene glycol, which has been associated with toxicity when high doses of lorazepam are administered. ⋯ The continuous infusion rate and cumulative 24-hour lorazepam dose are strongly associated with and independently predict propylene glycol concentrations. Despite the absence of confirmed propylene glycol-associated adverse effects, clinicians should be aware that propylene glycol accumulation may occur with continuous-infusion lorazepam.