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Showing 1 - 200 of 1079 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 5)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 21)
Academic Pathology     Open Access   (Followers: 5)
Accounting History     Hybrid Journal   (Followers: 17, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 2, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 3)
Acta Sociologica     Hybrid Journal   (Followers: 37, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 48, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 333, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 10, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 14, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 22, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 7, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 201, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 39)
Advances in Dental Research     Hybrid Journal   (Followers: 7, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 29, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 131, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 9)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 46, SJR: 0.599, CiteScore: 1)
Advances in Tumor Virology     Open Access   (Followers: 3, SJR: 0.108, CiteScore: 0)
AERA Open     Open Access   (Followers: 9)
Affilia     Hybrid Journal   (Followers: 4, SJR: 0.496, CiteScore: 1)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 2)
Air, Soil & Water Research     Open Access   (Followers: 14, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 63)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 11, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 9, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 22, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 5)
American Educational Research J.     Hybrid Journal   (Followers: 199, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 18, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 6)
American J. of Evaluation     Hybrid Journal   (Followers: 16, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 31, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 41, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 11, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 5, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 10, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 8, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 9, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 185, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 33, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 18, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 295, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 2)
Analytical Chemistry Insights     Open Access   (Followers: 25, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 3, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 13, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 9, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 15, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 51, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 46, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 9, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 41, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Full-text available via subscription   (Followers: 10)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal  
Applied Biosafety     Hybrid Journal   (SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 23, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 26, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 16, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 39, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 9, SJR: 0.558, CiteScore: 1)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 99, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 4)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 16, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15, SJR: 0.578, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 9, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 18, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 519, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 4)
Australian J. of Education     Hybrid Journal   (Followers: 41, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 12, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 306, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 10)
Behavior Modification     Hybrid Journal   (Followers: 11, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 25)
Bible Translator     Hybrid Journal   (Followers: 12)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 18, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 47)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 9)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 3, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 25, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 8, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 175, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 25, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 31, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 13, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 17)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 7)
Business & Society     Hybrid Journal   (Followers: 12)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 7, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 15, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 2)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Full-text available via subscription  
California Management Review     Hybrid Journal   (Followers: 30, SJR: 2.209, CiteScore: 4)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 6, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 13)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 123, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 26, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 11, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 7, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiovascular and Thoracic Open     Open Access  
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 8, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 5, SJR: 0.889, CiteScore: 3)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Transplantation     Open Access   (Followers: 4, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 7, SJR: 1.581, CiteScore: 3)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 31, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 9, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 18, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
China Information     Hybrid Journal   (Followers: 7, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 10, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 4)
Christianity & Literature     Full-text available via subscription   (Followers: 7)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 6, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 7, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 16, SJR: 0.49, CiteScore: 1)
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 44, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 6, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 10, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 1)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 32, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 9)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 2)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 29, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 3)
Clinical Pediatrics     Hybrid Journal   (Followers: 22, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 11, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 69, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 21, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 23, SJR: 0.36, CiteScore: 1)
Common Law World Review     Full-text available via subscription   (Followers: 18)
Communication & Sport     Hybrid Journal   (Followers: 7, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 1)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 19, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 8, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 217, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 11, SJR: 0.843, CiteScore: 2)
Competition and Regulation in Network Industries     Full-text available via subscription   (Followers: 8, SJR: 0.143, CiteScore: 0)
Concurrent Engineering     Hybrid Journal   (Followers: 3, SJR: 0.642, CiteScore: 2)
Conflict Management and Peace Science     Hybrid Journal   (Followers: 35, SJR: 2.441, CiteScore: 1)
Contemporary Drug Problems     Full-text available via subscription   (Followers: 2, SJR: 0.609, CiteScore: 2)
Contemporary Education Dialogue     Hybrid Journal   (Followers: 5, SJR: 0.102, CiteScore: 0)
Contemporary Issues in Early Childhood     Full-text available via subscription   (Followers: 6, SJR: 0.766, CiteScore: 1)
Contemporary Review of the Middle East     Full-text available via subscription   (Followers: 12)
Contemporary Sociology : A J. of Reviews     Full-text available via subscription   (Followers: 34, SJR: 0.195, CiteScore: 0)
Contemporary Voice of Dalit     Full-text available via subscription  
Contexts     Hybrid Journal   (Followers: 6)
Contributions to Indian Sociology     Hybrid Journal   (Followers: 4, SJR: 0.376, CiteScore: 0)
Convergence The Intl. J. of Research into New Media Technologies     Hybrid Journal   (Followers: 50, SJR: 0.521, CiteScore: 1)
Cooperation and Conflict     Hybrid Journal   (Followers: 21, SJR: 0.945, CiteScore: 2)
Cornell Hospitality Quarterly     Hybrid Journal   (Followers: 8, SJR: 1.198, CiteScore: 2)
Counseling Outcome Research and Evaluation     Hybrid Journal   (Followers: 12, SJR: 0.279, CiteScore: 1)

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Similar Journals
Journal Cover
Annals of Pharmacotherapy
Journal Prestige (SJR): 1.096
Citation Impact (citeScore): 2
Number of Followers: 51  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1060-0280 - ISSN (Online) 1542-6270
Published by Sage Publications Homepage  [1079 journals]
  • Evaluation of Mobile Applications Intended to Aid in Conception Using a
           Systematic Review Framework
    • Authors: Timothy C. Hutcherson, Nicole E. Cieri-Hutcherson, Peter J. Donnelly, Michael L. Feneziani, Kristina M. R. Grisanti
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: This review identified and evaluated apps intended to aid women in conception that were available across major mobile platforms; secondary objectives were to highlight additional criteria and considerations when evaluating conception-related apps. Data Sources: Apple iTunes and Google Play stores were searched using the keywords conception, fertility, and pregnant. Data Selection: Included apps were as follows: contained in the first 50 search results; presented in English; intended for layperson use; updated July 1, 2018, or after; marketed as a conception aid; and used a defined fertility tracking method. Excluded apps were intended for men only, marketed for contraception only, promoted a single fertility service or branded product, or not found in both app stores. Data Extraction: Apps were evaluated using the adapted APPLICATIONS Scoring System. Two additional criteria were assessed: inclusion of a privacy policy and inclusion of a search function, medical terminology glossary, or Frequently Asked Questions section. Data Synthesis: A total of 300 apps were screened; 7 app pairs were analyzed. Scores ranged from 9 to 13 of a possible 15 points (mean = 11; median = 11). No app reported advisement from a health professional during development. Relevance to Patient Care in Clinical Practice: Widely available apps that score highly per the adapted APPLICATIONS Scoring System may be considered for use by and recommended to women seeking apps useful for conception. Conclusion: Evaluation tools should evolve as app features change. Criteria related to privacy and search functions that promote health literacy should be considered for future app evaluation tools.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-09-12T05:54:25Z
      DOI: 10.1177/1060028019876890
  • Bivalirudin Use With Percutaneous Ventricular Assist Device in Suspected
           Heparin-Induced Thrombocytopenia
    • Authors: Zachary S. Robinson, Jared Vega, Neal S. Fox
      Abstract: Annals of Pharmacotherapy, Ahead of Print.

      Citation: Annals of Pharmacotherapy
      PubDate: 2019-09-12T05:53:04Z
      DOI: 10.1177/1060028019875151
  • Comparison of the Effects of Intravenous and Oral Tranexamic Acid on
           Perioperative Hemoglobin Levels During Total Knee Arthroplasty
    • Authors: Sophia Pathan, Joseph E. Cruz, Patrick Curtin
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce perioperative blood loss in patients undergoing total knee arthroplasty (TKA), but there are limited data regarding the efficacy of intravenous (IV) in comparison to oral (PO) TXA. Objective: The purpose of this research was to compare the effects of IV and PO TXA on perioperative hemoglobin (Hgb) levels in patients who have undergone TKA. Methods: In this single-center, retrospective chart review, patients at least 18 years of age who received IV or PO TXA following medical center protocol from 1 of 3 orthopedic surgeons were included. The primary outcome was the change in Hgb within 24 hours following TKA. Secondary outcomes included comparisons of postsurgical complications and hospital length of stay. Results: The IV TXA group contained 62 participants, and the PO TXA group contained 61 participants. Patients receiving PO therapy had a larger decrease in Hgb compared with the IV TXA group (−2.382 vs −1.908, P = 0.02), but there were no statistically significant differences in mean length of stay (3.13 vs 2.95, P = 0.27), venous thromboembolism (VTE) occurrence (0 vs 0, P = 1), or requirement for transfusions (6 vs 5, P = 0.76). Conclusions and Relevance: IV and PO TXA may not be equivalent in outcomes for patients undergoing TKA. This study found a statistically significant decrease in the mean change of Hgb in patients receiving PO TXA compared with IV TXA. However, the rate of transfusions, mean length of stay, and rate of VTE were similar between groups.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-09-11T09:39:17Z
      DOI: 10.1177/1060028019876077
  • Splenic Infarction in a Narcoleptic Patient Treated With Methylphenidate,
           Venlafaxine, and Pitolisant
    • Authors: Charlotte Fouque, Romain Martin, Florent Seguro, Jean-Louis Montastruc, Claire de Canecaude
      Abstract: Annals of Pharmacotherapy, Ahead of Print.

      Citation: Annals of Pharmacotherapy
      PubDate: 2019-09-10T12:47:18Z
      DOI: 10.1177/1060028019872795
  • Brexanolone (Zulresso): Finally, an FDA-Approved Treatment for Postpartum
    • Authors: Jason G Powell, Scott Garland, Kayla Preston, Chris Piszczatoski
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: To review the safety and efficacy of brexanolone for the treatment of moderate to severe postpartum depression (PPD). Data Sources: A literature search through PubMed was conducted (January 2012 to July 2019) using the keyword brexanolone for clinical trials published in the English language. Study Selection and Data Extraction: Articles were selected if they were related to the Food and Drug Administration (FDA) approval of brexanolone or provided novel clinical information regarding this drug entity. Data Synthesis: The findings of the review show that brexanolone administered via IV infusion is both an effective and a fairly safe option for the treatment of PPD. Relevance to Patient Care and Clinical Practice: There are several antidepressants currently used to treat PPD; however, this is the first with FDA approval for this indication. The rapid onset of action of brexanolone may offer a quicker relief of these symptoms and may possibly lead to improved quality of life for both the mother and the child. Conclusion and Relevance: The recent FDA approval of brexanolone may offer an effective treatment of moderate to severe PPD and has been shown to rapidly decrease depression symptoms.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-09-03T08:44:19Z
      DOI: 10.1177/1060028019873320
  • Sarecycline Review
    • Authors: Wasim Haidari, Raquel Bruinsma, Jesus Alberto Cardenas-de la Garza, Steven R. Feldman
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: Sarecycline is a new oral tetracycline antibiotic recently approved by the US Food and Drug Administration. The aim of this article was to evaluate the data from published clinical trials of sarecycline in the treatment of acne, review the drug’s pharmacology, and understand how this new medication may apply to clinical practice. Data Sources: A systematic literature review was performed using the terms sarecycline (Seysara), P005672, and WC-3035 in the MEDLINE and EMBASE databases. was searched to identify ongoing or nonpublished studies. Study Selection and Data Extraction: Articles in English between January 2000 and April 2019 relating to clinical trials, pharmacology, safety, and microbiological profile were evaluated. Data Synthesis: In a phase 3 clinical trial (SC1401), absolute change from baseline in facial inflammatory lesion count at week 12 was −15.3 for the sarecycline arm and −10.1 for placebo (P < 0.01). In another phase 3 clinical trial (SC1402), the absolute change in this category was −15.7 for sarecycline and −10.7 for placebo (P < 0.01). Mean percentage change in facial inflammatory lesion count was higher in the sarecycline group than in the placebo group in both studies (P < 0.01). Relevance to Patient Care and Clinical Practice: The 1.5-mg/kg sarecycline dose has efficacy in reducing inflammatory lesions, is well tolerated, and has more targeted antimicrobial activity, which may help reduce the risk of developing antibiotic resistance. Conclusions: This novel, once-daily treatment may represent a useful treatment for patients with moderate to severe acne.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-29T06:10:45Z
      DOI: 10.1177/1060028019873111
  • Opioid and Benzodiazepine Requirements in Obese Adult Patients Receiving
           Extracorporeal Membrane Oxygenation
    • Authors: Brittany S. Verkerk, Amy L. Dzierba, Justin Muir, Caroline Der-Nigoghossian, Daniel Brodie, Matthew Bacchetta, Wim Rietdijk, Jan Bakker
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: The use of extracorporeal membrane oxygenation (ECMO) sometimes requires deep levels of sedation (Richmond Agitation Sedation Scale [RASS] −5) in patients with acute respiratory distress syndrome (ARDS). The role of obesity in opioid and sedative requirements remains unclear in patients receiving ECMO. Objective: This study sought to determine whether obesity increases midazolam and opioid requirements in patients receiving venovenous (vv)-ECMO up to the first 7 days after initiation. Methods: This was a retrospective cohort study of adult patients with ARDS managed with vv-ECMO. Results: The obese (n = 38) and nonobese (n = 43) groups had similar baseline characteristics. Fentanyl equivalents were significantly higher on day 3 in the obese group (P = 0.02) despite similar RASS scores with no differences in midazolam requirements. There were no differences in duration of ECMO, length of stay, or mortality. Conclusion and Relevance: Daily midazolam requirements were not significantly different, and opioid requirements were only significantly higher in the obese group on day 3 despite similar levels of sedation. The impact of obesity with the addition of ECMO and how to adapt doses of medications remains elusive.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-27T09:16:24Z
      DOI: 10.1177/1060028019872940
  • Hepatitis C Treatment Differences in Elderly Patients: Single-Center
           Retrospective Study
    • Authors: Kamran Qureshi, Tess Petersen, Jennifer Andres
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Clinical studies evaluating direct-acting antivirals (DAAs) for hepatitis C virus (HCV) treatment show sustained virological response at 12 weeks (SVR12) rates>90%. However, there are few elderly patients included in these studies; thus, generalizability of high success rates to patients>70 years old cannot be assumed. Objective: To identify treatment differences between elderly and nonelderly patients. Methods: This is a retrospective cohort study of all patients who were treated with DAAs between June 2014 and September 2016 at our institution. Patients were divided into 2 groups: elderly, age ≥70 years at the time of initiation of DAAs, and nonelderly, 70 years to be the strongest predictor of treatment failure (odds ratio = 3.4), along with diagnosis of cirrhosis (odds ratio = 2.4), when corrected for gender, race, prior treatment experience, genotype, and presence of hepatocellular carcinoma. Conclusion and Relevance: Lower SVR12 was seen in elderly cirrhotic patients (69.4%), who are at higher risk of complications related to advanced liver disease and untreated HCV infection, highlighting the need to treat patients before cirrhosis develops.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-27T09:16:05Z
      DOI: 10.1177/1060028019871352
  • Clinical Controversy in Transplantation: Tacrolimus Versus Cyclosporine in
           Statin Drug Interactions
    • Authors: Daniel R. Migliozzi, Nicole J. Asal
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: To review the available literature that provides evidence for the absence of statin interactions with tacrolimus compared with cyclosporine. Data Sources: A literature search of PubMed was performed (1990 to June 2019) using the following search terms: calcineurin inhibitors, tacrolimus, cyclosporine, statins, atorvastatin, simvastatin, and drug interactions. Clinical practice guidelines, article bibliographies, drug interaction database references, and product monographs were also reviewed. Study Selection and Data Extraction: Relevant English-language studies describing the mechanism of interaction, the magnitude of pharmacokinetic alterations, and safety were evaluated. In vitro data and studies conducted in adult humans were considered. Data Synthesis: Studies demonstrate pharmacokinetic differences between cyclosporine and tacrolimus, particularly with regard to inhibition of 2 hepatic transporters: P-glycoprotein and organic anion transporting polypeptide (OATP). Compared with cyclosporine, tacrolimus does not affect these transporters, does not enhance statin exposure, and does not increase statin-associated safety events. Relevance to Patient Care and Clinical Practice: Clinical practice guidelines allude to the need to reduce statin doses in the setting of tacrolimus. Some providers have adopted this practice, and doing so may prevent transplant recipients from attaining cardiovascular benefit, especially when increased or high-intensity doses are required. The pharmacokinetic differences between tacrolimus and cyclosporine highlight different interaction potential with statins. Conclusions: Clinicians need to be aware that tacrolimus and cyclosporine are not the same with regard to causing drug interactions with statins. Tacrolimus can be used with statins without the need for dose adjustments because of lack of an interaction.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-23T11:54:57Z
      DOI: 10.1177/1060028019871891
  • Assessing the Rate of Antipsychotic Use in Ambulatory Care Patients With a
           Venous Thromboembolism
    • Authors: Christine Rarrick, Nicole Saccone, Amy Hebbard, Brittany Jones
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Evidence regarding the use of antipsychotics and associated venous thromboembolism (VTE) risk is inconclusive. Studies finding a relationship lack in-depth analysis; thus, the VTE risk among those treated with antipsychotic remains largely unknown. Objectives: The primary objective of this investigation was to compare the incidence of antipsychotic use in patients who developed a VTE versus those who did not. Methods: Data were collected via retrospective chart review from an ambulatory care clinic between January 2012 and August 2017. All active clinic patients within the study period were included unless they met the following criteria: age
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-16T07:00:27Z
      DOI: 10.1177/1060028019870874
  • A Previously Unknown Drug-Drug Interaction Is Suspected in Delayed
           Elimination of Plasma Methotrexate in High-Dose Methotrexate Therapy
    • Authors: Junko Ishizaki, Chihiro Nakano, Kana Kitagawa, Yukio Suga, Yoshimichi Sai
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: High-dose methotrexate (HD-MTX) therapy is widely implemented for leukemia, osteosarcoma, and lymphoma. Although various measures have been taken to avoid toxicity from high serum MTX concentrations, there are many cases of delayed elimination of MTX. Objective: We suspected that delayed elimination of serum MTX was caused by unknown interactions between MTX and concomitant drugs. Methods: Concerning concomitant drugs in the case of delayed elimination of MTX, we performed screening tests in 35 patients who had undergone HD-MTX therapy. We then investigated the risk factors for delayed MTX elimination in 94 patients with leukemia, lymphoma, or osteosarcoma retrospectively. Results: The percentages of concomitant use of Stronger Neo-Minophagen C (SNMC), a glycyrrhizin preparation, and vincristine were higher in the delayed group. The percentage of delayed MTX elimination in patients receiving HD-MTX therapy was 41%. Multiple logistic regression analysis revealed that the concomitant use of SNMC solely was a significant risk factor for delayed MTX (odds ratio = 12.20; 95% CI = 1.06-139.84). Conclusion and Relevance: Concomitant use of SNMC was shown to be related to delayed elimination of serum MTX, and our results suggested a previously unknown drug-drug interaction between MTX and SNMC.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-16T06:56:47Z
      DOI: 10.1177/1060028019870445
  • Faster Transition From Intravenous to Oral Antihypertensives Associated
           With Improved Outcomes After Aortic Dissection
    • Authors: Christopher J. Michaud, Anne E. Packard, Tomasz Timek
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: After stabilization with intravenous (IV) antihypertensives, the impact of speed-of-transition from IV to enteral (PO) medications in the intensive care unit (ICU) is unknown. Objective: To assess ICU length of stay (LOS) based on transition time from IV to PO antihypertensive therapy. Methods: Retrospective study of aortic dissection patients admitted from June 2013 to July 2017 at a tertiary teaching hospital. Patients were grouped based on achieving full transition to PO medications in either ≤72 hours or>72 hours from the first PO dose. Secondary end points included hospital LOS, IV infusion volume, medication cost, and time spent with arterial/central lines. Results: A total of 56 patients transitioned completely from IV to PO therapy in ≤72 hours, and 72 patients required more than 72 hours. Demographics, IV and PO medication choices, and timing of first PO medication administration were similar between groups. ICU LOS was shorter in the group transitioned in ≤72 hours compared with those who took longer to transition (3.6 vs 10.5 days; P < 0.001). Hospital LOS, IV infusion volume, and cost were also significantly lower in the ≤72-hour group (P < 0.001). The rapid transition group also spent less time with arterial lines (44 vs 156 hours, P < 0.001) and central lines (45 vs 242 hours, P < 0.001). Conclusion and Relevance: In this cohort, transitioning to PO antihypertensives in ≤72 hours was associated with shorter ICU LOS and improvement in other measured outcomes. These observational data are the first to describe a potentially critical juncture in postdissection care; a prospective study is warranted.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-16T06:55:47Z
      DOI: 10.1177/1060028019870181
  • Doravirine: A Return of the NNRTI Class'
    • Authors: Sarah R. Blevins, E. Kelly Hester, Daniel B. Chastain, David B. Cluck
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: To compare and contrast doravirine (DOR) with other agents in the nonnucleoside reverse transcriptase inhibitor (NNRTI) class, review safety and efficacy data from both completed and ongoing clinical trials, and outline the potential place in therapy of DOR. Data Sources: A literature search using the PubMed database (inception to June 2019) was conducted using the search terms HIV, doravirine, non-nucleoside reverse transcriptase inhibitor, NNRTI, and MK-1439. Study Selection and Data Extraction: Clinical data were limited to those published in the English language from phase 2 or 3 clinical trials. Ongoing trials were identified through Data Synthesis: DOR was approved by the US Food and Drug Administration on the strength of 2 phase 3 randomized, double-blind, noninferiority clinical trials with additional studies currently underway examining its utility in other clinical scenarios. Relevance to Patient Care and Clinical Practice: The role of NNRTIs as part of antiretroviral (ARV) therapy has diminished in recent years given the introduction of more tolerable individual ARV agents and regimens. Despite this, new agents are still needed in the therapeutic arena because treatment failure as well as intolerance can still occur with many first-line therapies. The optimal place in therapy of DOR remains to be defined. Conclusions: DOR is a new NNRTI that represents a potential treatment option for treatment-naïve patients, without many of the previously described untoward effects of the NNRTI class.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-08-16T06:54:27Z
      DOI: 10.1177/1060028019869641
  • Sildenafil Use for Pulmonary Artery Hypertension With a Cobicistat-Boosted
           Antiretroviral Regimen
    • Authors: Patricia Pecora Fulco, Bianka Patel
      Abstract: Annals of Pharmacotherapy, Ahead of Print.

      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-31T10:20:59Z
      DOI: 10.1177/1060028019865542
  • Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic
           Review and Meta-analysis
    • Authors: Drayton A. Hammond, Simon W. Lam, Megan A. Rech, Melanie N. Smith, Jennifer Westrick, Abhaya P. Trivedi, Robert A. Balk
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: The optimal resuscitative fluid remains controversial. Objective: To assess the association between crystalloid fluid and outcomes in critically ill adults. Methods: Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, and Cochrane Central Register for Controlled Trials were searched from inception through July 2019. Cohort studies and randomized trials of critically ill adults provided predominantly nonperioperative fluid resuscitation with balanced crystalloids or 0.9% sodium chloride (saline) were included. Results: Thirteen studies (n = 30 950) were included. Balanced crystalloids demonstrated lower hospital or 28-/30-day mortality (risk ratio [RR] = 0.86; 95% CI = 0.75-0.99; I2 = 82%) overall, in observational studies (RR = 0.64; 95% CI = 0.41-0.99; I2 = 63%), and approached significance in randomized trials (RR = 0.94; 95% CI = 0.88-1.02; I2 = 0%). New acute kidney injury occurred less frequently with balanced crystalloids (RR = 0.91; 95% CI = 0.85-0.98; I2 = 0%), though progression to renal replacement therapy was similar (RR = 0.91; 95% CI = 0.79-1.04; I2 = 38%). In the sepsis cohort, odds of hospital or 28-/30-day mortality were similar, but the odds of major adverse kidney events occurring in the first 30 days were less with balanced crystalloids than saline (OR = 0.78; 95% CI = 0.66-0.91; I2 = 42%). Conclusion and Relevance: Resuscitation with balanced crystalloids demonstrated lower hospital or 28-/30-day mortality compared with saline in critically ill adults but not specifically those with sepsis. Balanced crystalloids should be provided preferentially to saline in most critically ill adult patients.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-31T10:20:19Z
      DOI: 10.1177/1060028019866420
  • The Incidence and Severity of Drug Interactions Before and After
           Antiretroviral Therapy Simplification in Treatment-Experienced Patients
           With HIV Infection
    • Authors: Nicholas V. Hastain, Aleena Santana, Jason J. Schafer
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Current guidelines advocate for antiretroviral therapy (ART) simplification in patients on complicated regimens. Simplifying ART improves patient adherence and quality of life, but changes in drug interactions (DIs) are uncertain. Objective: This study assessed changes in DIs following ART simplification in patients with HIV. Methods: This was an observational, retrospective cohort study of patients attending an urban HIV clinic. Patients were included if they had ART simplification (a decreased number of daily tablets) and ≥1 concomitant medication (CM). Total DI scores were generated for each patient pre–ART simplification and post–ART simplification using an online DI database. Each ART-CM pair labeled as “do not co-administer” was given a score of 2, “potential interaction” a score of 1, or “no interaction” a score of 0. Differences in total DI scores following simplification were analyzed with a Wilcoxon Signed-Rank test. Predictors of DI score reductions were examined with linear regression. Results: A total of 99 patients were included. Their median age was 54 years, and 79% were male. The median durations of HIV infection and ART were 16 and 10 years, respectively. Patients were receiving an average of 4.5 CMs. Median interaction scores presimplification and postsimplification were 3 (interquartile range [IQR], 1-6) and 1 (IQR, 0-2) respectively (P < 0.001). Predictors of score reductions were the patient’s number of CMs, discontinuing a protease inhibitor, and switching to a dolutegravir-based regimen. Conclusion and Relevance: ART simplification decreased the incidence of DIs in this analysis of patients with advanced age who had ART experience and polypharmacy.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-31T10:19:39Z
      DOI: 10.1177/1060028019867970
  • Successful Rifampin Administration After Rifabutin-Induced Leukopenia
    • Authors: Rachel S. Britt, Monica V. Mahoney, Christopher McCoy
      Abstract: Annals of Pharmacotherapy, Ahead of Print.

      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-31T10:18:39Z
      DOI: 10.1177/1060028019867971
  • The Intersection of Implementation Science and Pharmacy Practice
    • Authors: Marie A. Smith, Carrie Martin Blanchard, Erika Vuernick
      Abstract: Annals of Pharmacotherapy, Ahead of Print.

      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-27T09:14:29Z
      DOI: 10.1177/1060028019867253
  • Identification of Risk Factors for Refractory Status Epilepticus
    • Authors: Hayley A. Tatro, Leslie A. Hamilton, Cassey Peters, A. Shaun Rowe
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: The objective of this study is to identify risk factors for the development of refractory status epilepticus (RSE). Methods: This was an IRB-approved, retrospective case control study that included patients admitted with status epilepticus between August 1, 2014, and July 31, 2017. Cases were defined as those with RSE, and controls were those who did not develop RSE. A bivariate analysis was conducted comparing those with RSE and those without RSE. A stepwise logistic regression model was constructed predicting for progression to RSE. Risk factors for progression to RSE were extrapolated from this model. Results: A total of 184 patients met inclusion criteria for the study (99 controls and 49 cases). After adjusting for covariates in the logistic regression, patients with convulsive seizures had a lower odds of developing RSE (odds ratio [OR] = 0.375; 95% CI = 0.148 to 0.951; P = 0.0388). Treatment with benzodiazepines plus levetiracetam had a higher odds of developing RSE (OR = 3.804; 95% CI = 1.523 to 9.499; P = 0.0042). Conclusion and Relevance: This study found that patients with convulsive seizures had a lower odds of developing RSE. In addition, patients treated with benzodiazepines and levetiracetam had a higher odds of developing RSE. This information can be used to potentially identify patients at higher risk of developing RSE, so that treatment can be modified to reduce morbidity and mortality. These results may warrant further investigation into the effectiveness of levetiracetam as a first-line agent for the treatment of SE.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-26T09:27:34Z
      DOI: 10.1177/1060028019867155
  • Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent
           Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and
           Continuous Renal Replacement Therapy: An Update
    • Authors: Brian M. Hoff, Jenana H. Maker, William E. Dager, Brett H. Heintz
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: To summarize current antibiotic dosing recommendations in critically ill patients receiving intermittent hemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT), and continuous renal replacement therapy (CRRT), including considerations for individualizing therapy. Data Sources: A literature search of PubMed from January 2008 to May 2019 was performed to identify English-language literature in which dosing recommendations were proposed for antibiotics commonly used in critically ill patients receiving IHD, PIRRT, or CRRT. Study Selection and Data Extraction: All pertinent reviews, selected studies, and references were evaluated to ensure appropriateness for inclusion. Data Synthesis: Updated empirical dosing considerations are proposed for antibiotics in critically ill patients receiving IHD, PIRRT, and CRRT with recommendations for individualizing therapy. Relevance to Patient Care and Clinical Practice: This review defines principles for assessing renal function, identifies RRT system properties affecting drug clearance and drug properties affecting clearance during RRT, outlines pharmacokinetic and pharmacodynamic dosing considerations, reviews pertinent updates in the literature, develops updated empirical dosing recommendations, and highlights important factors for individualizing therapy in critically ill patients. Conclusions: Appropriate antimicrobial selection and dosing are vital to improve clinical outcomes. Dosing recommendations should be applied cautiously with efforts to consider local epidemiology and resistance patterns, antibiotic dosing and infusion strategies, renal replacement modalities, patient-specific considerations, severity of illness, residual renal function, comorbidities, and patient response to therapy. Recommendations provided herein are intended to serve as a guide in developing and revising therapy plans individualized to meet a patient’s needs.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-25T09:14:14Z
      DOI: 10.1177/1060028019865873
  • Amifampridine for the Management of Lambert-Eaton Myasthenic Syndrome: A
           New Take on an Old Drug
    • Authors: Connie H. Yoon, Jocelyn Owusu-Guha, Adam Smith, Pamela Buschur
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: The purpose of this article is to review the literature for both 3,4-diaminopyridine (3,4-DAP) and amifampridine for the treatment of Lambert-Eaton myasthenic syndrome (LEMS). Amifampridine (Firdapse) is the salt form of 3,4-DAP and was approved by the Food and Drug Administration for the treatment of LEMS. Data Sources: PubMed, TRIP database, and EMBASE searches were conducted without a back date (current to June 2019) utilizing the following search terms: amifampridine, 3,4-diaminopyridine, and Lambert-Eaton myasthenic syndrome. Completed trials were also reviewed at Study Selection and Data Extraction: Criteria for article inclusion consisted of human subjects, age ≥18 years, phase II or III clinical trials, and English language for both drugs. Observational and pharmacokinetic studies for amifampridine were also included. Data Synthesis: Prior to the approval of amifampridine, 3,4-DAP was first-line for the management of LEMS symptoms. Two phase III trials have evaluated amifampridine to confirm efficacy, both showing superiority over placebo in the management of LEMS symptoms, with minimal adverse effects. A significant improvement in both quantitative myasthenia gravis scores and Subjective Global Impression scores was established at days 4 and 14. Relevance to Patient Care and Clinical Practice: With an improved stability profile and decreased dose variability, amifampridine will likely assume the role of first-line management of LEMS. Conclusions: Amifampridine has been shown to improve symptoms of LEMS and is generally well tolerated.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-19T06:00:21Z
      DOI: 10.1177/1060028019864574
  • Emergency Department Visits for Psychotropic-Related Adverse Drug Events
           in Older Adults With Alzheimer Disease, 2013-2014
    • Authors: Aryana Sepassi, Jonathan H. Watanabe
      First page: 1173
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: More than 1.3 million emergency department visits have been associated with adverse drug events (ADEs) in older adults. Increasing Alzheimer’s disease (AD) prevalence in the geriatric population poses an additive risk of ADEs because of the array of psychotropic medications prescribed for AD patients. Scant research has been conducted at a nationwide level on psychotropic-related ADEs in this population. Objective: This study aimed to determine the incidence and economic burden of psychotropic ADEs in the geriatric AD population compared with the non-AD geriatric population. Methods: A retrospective analysis was conducted of geriatric AD patients who visited the ED in 2013 with a psychotropic-related ADE to determine the incidence and resource utilization of these events. The relationship between presence of AD and an ADE was analyzed using multiple logistic regression. Results: There were 427 969 Alzheimer’s ED visits compared with 20 492 554 ED visits without. Of the AD cases, 1.04% were associated with at least 1 adverse event. AD cases more frequently were admitted as inpatients (64.90% vs 34.92%, P < 0.01). Common drug classes associated with AD-related ADEs were benzodiazepines, antipsychotics, and autonomic nervous system–affecting agents (adrenergic agonists, antimuscarinic agents, anticholinergic agents). There was a significantly higher likelihood for Alzheimer’s cases to experience any psychotropic-related adverse event (OR = 1.66; 95% CI = 1.20, 1.82). Conclusion and Relevance: Alzheimer’s patients more frequently experienced psychotropic-related adverse events and related adverse outcomes than older adults without Alzheimer’s. Application of these findings should be implemented in protocol development to reduce future psychotropic-related adverse outcomes for this population.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-25T09:14:26Z
      DOI: 10.1177/1060028019866927
  • Warfarin-Induced Rapid Rise in INR Post–Cardiac Surgery Is Not
           Associated With Increased Bleeding Risk
    • Authors: Logan M. Olson, Andrea M. Nei, Ross A. Dierkhising, David L. Joyce, Scott D. Nei
      First page: 1184
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Post–cardiac surgery bleeding can have devastating consequences, and it is unknown if warfarin-induced rapid international normalized ratio (INR) rise during the immediate postoperative period increases bleed risk. Objective: To determine the impact of warfarin-induced rapid-rise INR on post–cardiac surgery bleeding. Methods: This was a single-center, retrospective chart review of post–cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester. Patients were grouped based on occurrence or absence of rapid-rise INR (increase ≥1.0 within 24 hours). The primary outcome compared bleed events between groups. Secondary outcomes assessed hospital length of stay (LOS) and identified risk factors associated with bleed events and rapid rise in INR. Results: During the study period, 2342 patients were included, and 56 bleed events were evaluated. Bleed events were similar between rapid-rise (n = 752) and non–rapid-rise (n = 1590) groups in both univariate (hazard ratio [HR] = 1.22; P = 0.594) and multivariable models (HR = 1.24; P = 0.561). Those with rapid-rise INR had longer LOS after warfarin administration (discharge HR = 0.84; P = 0.0002). The most common warfarin dose immediately prior to rapid rise was 5 mg. Risk factors for rapid-rise INR were low body mass index, female gender, and cross-clamp time. Conclusion and Relevance: This represents the first report to assess warfarin-related rapid-rise INR in post–cardiac surgery patients and found correlation to hospital LOS but not bleed events. Conservative warfarin dosing may be warranted until further research can be conducted.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-15T05:14:45Z
      DOI: 10.1177/1060028019858677
  • Evaluation of FDA Boxed Warning on Prescribing Patterns of
           Fluoroquinolones for Uncomplicated Urinary Tract Infections
    • Authors: Kevin Cowart, Marylee Worley, Nihal El Rouby, Karen Sando
      First page: 1192
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Little is known regarding the impact of the Food and Drug Administration (FDA) boxed warning on prescribing rates of fluoroquinolone (FQ) antibiotics in the outpatient setting. Objective: The primary objective of this study was to evaluate the 2016 FDA boxed warning update on FQ prescribing rates for uncomplicated urinary tract infection (uUTI). Methods: This was a single-center retrospective cohort study conducted at 6 family medicine practices, including women aged 18 to 65 years with an outpatient visit for uUTI from January 1, 2016, to December 31, 2016. Results: A total of 436 patients met inclusion. FQs were prescribed in 38% of patients before the FDA boxed warning and in 30% of patients after (8% reduction). Non-FQ prescribing had a corresponding 8% increase, comprising 62% of uUTI prescribing before the FDA boxed warning and 70% after (P = 0.08). The likelihood of being prescribed a FQ was not significantly different following release of the FDA boxed warning (adjusted odds ratio = 0.67 [95% CI = 0.41-1.10]). Variables significantly associated with an increase in FQ prescribing based on logistic regression were age ≥58 years and chronic kidney disease. Concordance of antibiotic prescribing with the Infectious Diseases Society of America clinical practice guidelines for uUTI was low, and the incidence of treatment failure was low. Conclusion and Relevance: The 2016 FDA boxed warning was not significantly associated with decreased FQ prescribing for uUTI across a large academic family medicine practice. Methods to improve education and disseminate FDA warnings in practice are needed.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-19T06:00:41Z
      DOI: 10.1177/1060028019865224
  • Evaluation of Acute Kidney Injury Associated With Anticancer Drugs Used in
           Gastric Cancer in the Japanese Adverse Drug Event Report Database
    • Authors: Mayako Uchida, Yuki Kondo, Shinya Suzuki, Keiko Hosohata
      First page: 1200
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Development of acute kidney injury (AKI) depends on the severity of renal dysfunction, clinical setting, comorbid factors, and geographical location. Gastric cancer is one of the deadliest malignancies worldwide, and its incidence is significantly high in Japan. Objective: We analyzed the rank-order of the association of anticancer agents for gastric cancer with AKI using a spontaneous reporting system database, the Japanese Adverse Drug Event Report database. Methods: We performed a retrospective pharmacovigilance disproportionality analysis using the adverse event reports submitted to the Pharmaceuticals and Medical Devices Agency between April 2004 and March 2017. Results: Anticancer drug-related AKI was common in patients in their 60s and 70s (39.2% and 43.2%, respectively). AKI occurred most frequently within 1 month after anticancer drug administration. The signals of AKI were reported after treatment with S-1 (tegafur/gimeracil/oteracil), cisplatin (CDDP), and capecitabine, with significant adjusted reporting odds ratios (95% CI) of 1.50 (1.09-2.07), 3.43 (2.48-4.74), and 1.82 (1.15-2.90), respectively. CDDP-induced AKI was more likely to occur in patients who were male, hypertension, or diabetes mellitus. Conclusion and Relevance: This study showed that most AKI cases were related to S-1 and/or CDDP adjuvant chemotherapy for gastric cancer treatment. The data also clarified that AKIs occurred within 1 month and that their clinical outcomes were more severe than previous reports of drug-induced AKI in general medicine. Our study provides useful information to minimize the risks of administration to patients at high risk for S-1 and/or CDDP containing chemotherapy–induced AKI.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-26T09:23:34Z
      DOI: 10.1177/1060028019865870
  • Predictors of Treatment Failure Following De-escalation to a
           Fluoroquinolone in Culture-Negative Nosocomial Pneumonia
    • Authors: Amanda C. Bultas, Amit I. Bery, Eli N. Deal, Aaron P. Hartmann, Sara K. Richter, William B. Call
      First page: 1207
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Little evidence exists for de-escalation of nosocomial pneumonia therapy without positive cultures. Objective: The purpose of this study was to identify potential predictors of treatment failure following de-escalation to a fluoroquinolone in culture-negative nosocomial pneumonia. Methods: The study involved a single-center, retrospective cohort of patients admitted with diagnosis of nosocomial pneumonia and positive chest radiography who received at least 24 hours of fluoroquinolone monotherapy following at least 24 hours of appropriate empirical antibiotics. Treatment failure was defined using a composite of all-cause death within 30 days of discharge, treatment re-escalation, or readmission for pneumonia within 30 days of discharge. The Cox proportional hazards model was used to analyze predictors of treatment failure. Duration of empirical antibiotics and significant univariable exploratory predictors were included in multivariable analysis. Results: Of 164 patients, 23 (14%) failed de-escalation. Duration of empirical antibiotics (68.5 ± 32.1 vs 65.8 ± 35 hours) was not associated with treatment failure in univariable (Hazard Ratio [HR] = 1.002 [95% CI = 0.991-1.013]) or multivariable analyses (HR = 1.003 [95% CI = 0.991-1.015]). Significant exploratory predictors on univariable analysis included active cancer, intensive care unit (ICU) admission at empirical initiation, APACHE II score, and steroid use ≥20-mg prednisone equivalent. ICU admission at empirical initiation (HR = 2.439 [95% CI = 1.048-5.676]) and steroid use ≥20-mg prednisone equivalent (HR = 2.946 [95% CI = 1.281-6.772]) were associated with treatment failure on multivariable analysis. Conclusion and Relevance: Duration of empirical antibiotics does not appear to influence failure of de-escalation to fluoroquinolone monotherapy in culture-negative nosocomial pneumonia.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-26T09:26:15Z
      DOI: 10.1177/1060028019867114
  • The Role of the Clinical Pharmacist in a Preventive Cardiology Practice
    • Authors: Bruce A. Warden, Michael D. Shapiro, Sergio Fazio
      First page: 1214
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. In response, a multidisciplinary team approach, which includes clinical pharmacists, is recommended to improve patient outcomes. The purpose of the study was to describe interventions associated with integration of a clinical pharmacist, with an emphasis on pharmacist-generated patient cost avoidance. Methods: This is a prospective observational study detailing pharmacist-initiated interventions within an academic preventive cardiology service. Interventions targeting pharmacotherapy optimization, side effect management, patient education, medication adherence, and cost avoidance were implemented during shared office visits with providers and/or on provider consultation for remote follow-up. Tabulation of cost avoidance was arranged into 2 formats: clinical interventions implemented by the pharmacist and direct patient out-of-pocket expense reduction. Money saved per clinical intervention was extrapolated from data previously published. Patient out-of-pocket expense prior to and after pharmacist involvement was calculated to assess aggregate yearly patient cost savings. Results: Over 12 months the pharmacist intervened on 974 patients, totaling 3725 interventions. Cost avoidance strategies resulted in yearly savings of $830 748 in aggregate—$149 566 from clinical interventions and $681 182 from patient out-of-pocket expense reduction. Monthly patient out-of-pocket expense was reduced from a median (interquartile range) of $217 ($83.5-$347) before to $5 ($0-$18) after pharmacist intervention. Conclusions: Addition of a clinical pharmacist within an academic preventive cardiology clinic generated substantial pharmacotherapy interventions, resulting in significant cost avoidance for patients. The resulting cost avoidance may result in improved medication adherence and clinical outcomes.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-25T09:14:28Z
      DOI: 10.1177/1060028019864669
  • Sufentanil Sublingual Tablet: A New Option for Acute Pain Management
    • Authors: Caitlin E. Reardon, Sandra L. Kane-Gill, Pamela L. Smithburger, Joseph F. Dasta
      First page: 1220
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: The purpose of this article is to review the safety and efficacy of sufentanil sublingual tablet (SST) and suggest its place in therapy for managing acute pain in patients requiring intravenous (IV) opioids. Data Sources: A MEDLINE/PubMed search was performed (2010 to April 2019) using the following keywords: sufentanil sublingual tablet, sufentanil, opioid, moderate to severe acute pain. Study Selection and Data Extraction Quantification: We included English language articles evaluating SST pharmacology, pharmacokinetics, efficacy, and safety in humans for the treatment of acute pain. Data Synthesis: SST is Food and Drug Administration approved and considered safe and effective for the treatment of acute pain in Risk Evaluation and Mitigation Strategy–certified and medically supervised health care settings. Phase III clinical trials showed a statistically significant decrease in summed pain intensity score when SST was compared with placebo. Relevance to Patient Care and Clinical Practice: SST can be a useful option in patients requiring a parenteral opioid who do not have IV access, or it may be unnecessary or difficult to obtain. Because of its quick onset and sustained analgesia, SST may also be useful for procedural pain in the critically ill, to expedite discharges for outpatient procedures, in emergency departments (EDs), and in the battlefield. Conclusions: SST can satisfy an unmet need in patients with acute pain, who require parenteral opioids, and either have no IV access or require prolonged time to achieve IV access such as patients in outpatient surgical centers, EDs, and the battlefield. During periods of parenteral opioid shortage, SST may provide another option for adequate analgesia.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-08T04:52:23Z
      DOI: 10.1177/1060028019863144
  • Sodium-Glucose Cotransporters as Potential Therapeutic Targets in Patients
           With Type 1 Diabetes Mellitus: An Update on Phase 3 Clinical Trial Data
    • Authors: Kajal Patel, Antonia Carbone
      First page: 1227
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: To review phase 3 trials of sodium-glucose cotransporter (SGLT) inhibitors in type 1 diabetes mellitus (T1DM) patients. Data Sources: A literature search of Ovid MEDLINE databases (1946 through May 17, 2019) limited to English-language human clinical trials was conducted using the following terms: sodium-glucose transporter 2 inhibitors, canagliflozin, dapagliflozin, empagliflozin, sotagliflozin, ertugliflozin, ipragliflozin, or remogliflozin combined with type 1 diabetes mellitus. Results were verified via Google Scholar and Study Selection and Data Extraction: Articles were included if they were phase 3 trials in adults with T1DM. Data Synthesis: Phase 3 trials are available for dapagliflozin, empagliflozin, and sotagliflozin. All 3 drugs demonstrated statistically significant reductions in hemoglobin A1C, weight, and total daily insulin dose without an increased risk of hypoglycemia in up to 52 weeks of therapy. The incidence of diabetic ketoacidosis (DKA) was higher in patients on a SGLT inhibitor at all doses, with the exception of empagliflozin 2.5 mg (0.8% vs 1.2% with placebo). Relevance to Patient Care and Clinical Practice: SGLT inhibitors are potential adjuncts to insulin in T1DM patients, providing clinically meaningful benefits. Regulatory bodies have either approved or are reviewing these agents for use in T1DM. Clinicians should be familiar with the DKA risk associated with SGLT inhibitors and utilize DKA risk-mitigation strategies. Empagliflozin 2.5 mg warrants additional investigation given its efficacy without an increased incidence of DKA. Conclusions: Phase 3 trial data of SGLT inhibitors provide evidence for sustained efficacy in T1DM patients. Appropriate patient selection for therapy and routine monitoring are essential to minimize associated risks.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-06-22T06:04:54Z
      DOI: 10.1177/1060028019859323
  • Management of Idiopathic Pulmonary Fibrosis
    • Authors: Roy Pleasants, Robert M. Tighe
      First page: 1238
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: Provide information for pharmacists on idiopathic pulmonary fibrosis (IPF) and its treatment. Study Selection and Data Extraction: All articles with data from randomized controlled trials of nintedanib or pirfenidone were reviewed. Data Synthesis: IPF is a progressive and ultimately fatal interstitial lung disease characterized by decline in lung function and worsening dyspnea. It is uncommon and mainly occurs in individuals aged>60 years, particularly men with a history of smoking. Nintedanib and pirfenidone were approved in the United States for the treatment of IPF in 2014 and received conditional recommendations in the 2015 American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association treatment guidelines. These drugs slow the progression of IPF by reducing the rate of decline in lung function. Their adverse event profile is characterized mainly by gastrointestinal events, which can be managed through dose adjustment and symptom management. Management of IPF should also include smoking cessation, vaccinations, and supportive care such as patient education, pulmonary rehabilitation, and the use of supplemental oxygen as well as optimizing the management of comorbidities. Relevance to Patient Care and Clinical Practice: This review provides clinical pharmacists with information on the course of IPF, what can be expected of current treatments, and how to help patients manage their drug therapy. Conclusions: IPF is a progressive disease, but treatments are available that can slow the progression of the disease. Clinical pharmacists can play an important role in the care of patients with IPF through patient education, monitoring medication compliance and safety, ensuring drugs for comorbidities are optimized, and preventive strategies such as immunizations.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-08T04:51:17Z
      DOI: 10.1177/1060028019862497
  • β-Blockers and the Rate of Chronic Obstructive Pulmonary Disease
    • Authors: Tracey L. Mersfelder, Dane L. Shiltz
      First page: 1249
      Abstract: Annals of Pharmacotherapy, Ahead of Print.
      Objective: To review the rate of exacerbations relative to β-blocker use in patients with chronic obstructive pulmonary disease (COPD). Data Sources: A MEDLINE search (1953 to May 2019) was performed using the search terms beta-blockers, chronic obstructive pulmonary disease, and exacerbations. An EMBASE search was also performed using the search terms chronic obstructive lung disease and beta adrenergic receptor blocking agents (1970 to May 2019). References from the review of literature citations were also identified. Study Selection and Data Extraction: English-language studies assessing COPD exacerbations in patients prescribed a β-blocker were included. Any article not addressing exacerbations was excluded. Data Synthesis: A total of 15 articles were included; 7 articles showed no change, 1 provided mixed results, and 7 indicated a significant decrease in COPD exacerbations in a variety of exacerbation severities. Two of the studies differentiated between cardioselective and noncardioselective β-blockers. Relevance to Patient Care and Clinical Practice: This work represents an initial assessment of the use of β-blockers to reduce COPD exacerbations. The findings raise the question if β-blockers should be used more frequently in patients with COPD. Conclusions: Based on the limited number of studies that address β-blocker use in COPD, it appears that exacerbations are not increased and may be decreased. A randomized, placebo-controlled trial is in progress to possibly provide more definitive answers to this question. Until the trial is complete, β-blockers should not be withheld in COPD patients who have concurrent cardiovascular conditions, especially where there is a mortality benefit.
      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-04T11:54:57Z
      DOI: 10.1177/1060028019862322
  • Rapid-Onset Vancomycin-Induced Thrombocytopenia With Reexposure
    • Authors: Ted M. Getz, Clifford D. Packer
      First page: 1259
      Abstract: Annals of Pharmacotherapy, Ahead of Print.

      Citation: Annals of Pharmacotherapy
      PubDate: 2019-07-27T09:13:59Z
      DOI: 10.1177/1060028019867433
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