The Annals of pharmacotherapy
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Low hemoglobin (Hb) concentrations before lower limb joint replacement are associated with the need for blood transfusions and increased mortality. To optimize preoperative Hb, blood conservation protocols often recommend oral iron supplements, even in nonanemic patients. ⋯ Oral ferrous sulfate supplementation is not an effective method to increase preoperative Hb in patients scheduled for hip or knee arthroplasty, and its use is associated with adverse effects.
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Health literacy has gained prominence since the Institute of Medicine Report publicized the widespread prevalence of low health literacy. Pharmacists play an important role in enhancing health literacy as a result of their proximity to patients. Literature about pharmacists' perceptions and barriers in incorporating health literacy interventions is lacking. ⋯ Identification of components of pharmacists' attitudes and barriers toward health literacy will be useful to managers interested in incorporating health literacy interventions in their practice.
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To report a case of akathisia in a patient with type 2 diabetes after abrupt discontinuation of gabapentin. ⋯ If gabapentin discontinuation is desired, it is prudent to gradually taper the dose to avoid withdrawal symptoms, which may occur after as little as 1 month of treatment. Should the patient experience withdrawal symptoms, the optimal treatment is to restart gabapentin.
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To report a case of acute elevation of hepatic enzyme levels as a probable adverse reaction associated with pregabalin. ⋯ Prescribers should be alert to the possibility of idiosyncratic hepatotoxicity associated with pregabalin use.
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Dexmedetomidine is an α(2)-receptor agonist used for sedation in the intensive care unit (ICU). Although dexmedetomidine is labeled for sedation in critically ill patients at doses up to 0.7 μg/kg/h, recent studies have used more liberal dosing regimens. However, to our knowledge, no study has assessed the clinical impact of doses greater than 0.7 μg/kg/h when compared to doses within the Food and Drug Administration--approved labeling. ⋯ Patients treated with HD dexmedetomidine had fewer RASS scores at goal. Our data suggest that increasing the dose of dexmedetomidine may not enhance sedation efficacy or lead to an increased incidence of adverse effects. Patients who have not achieved goal sedation at doses of 0.7 μg/kg/h or less may not respond further to increased doses.