American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Nov 2014
Perioperative nonopioid agents for pain control in spinal surgery.
Commonly used nonopioid analgesic agents that are incorporated into multimodal perioperative pain management protocols in spinal surgery are reviewed. ⋯ Preemptive analgesic therapy combining nonopioid agents with opioids may reduce narcotic consumption and improve patient satisfaction after spinal surgery. Such therapy should be considered for patients undergoing various spinal procedures in which postoperative pain control has been historically difficult to achieve.
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Am J Health Syst Pharm · Nov 2014
ReviewRiociguat for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.
The pharmacology, pharmacokinetics, clinical efficacy, safety, and role in therapy for riociguat are reviewed. ⋯ Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of CTEPH and PAH. It can be considered first-line therapy for the treatment of CTEPH and should be considered as an alternative to phosphodiesterase type-5 inhibitors in patients with PAH.
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Am J Health Syst Pharm · Nov 2014
Observational StudyImpact of a phenytoin loading dose program in the emergency department.
The use of a combined physician-and pharmacist-directed phenytoin loading dose program in an emergency department (ED) was evaluated. ⋯ No change in the percentage of optimal phenytoin loading doses in the ED was observed after implementation of a combined pharmacist- and physician- dosing program. When stratified into pharmacist or prescriber dosing, the pharmacist-led dosing program significantly improved the proportion of patients who received optimal phenytoin loading doses.
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Published evidence regarding the influence of cirrhosis on the clinical pharmacokinetics of antibacterial agents is reviewed; dosing recommendations and a decision algorithm are provided. ⋯ Cirrhosis has multiple effects on the disposition of a wide range of antibacterial agents. Appropriate antibiotic therapy selection and individualized dosing can contribute to optimal clinical outcomes while decreasing the risk of hepatotoxicity.