Pharmacologic Therapy for Spinal Cord Injury.

Neuroprotective strategies aimed at preventing secondary neurologic injury following acute spinal cord injury remain an important area of clinical, translational, and basic science research. Despite recent advancement in the understanding of basic mechanisms of primary and secondary neurologic injury, few pharmacologic agents have shown consistent promise in improving neurologic outcomes following SCI in large randomized clinical trials. The authors review the existing literature and clinical guidelines for pharmacologic therapy investigated for managing acute SCI, including corticosteroids, GM-1 ganglioside (Sygen), Riluzole, opioid antagonists, Cethrin, minocycline, and vasopressors for mean arterial pressure augmentation. Therapies for managing secondary effects of SCI, such as bradycardia, are discussed. Current clinical trials for pharmacotherapy and cellular transplantation following acute SCI are also reviewed. Despite the paucity of current evidence for clinically beneficial post-SCI pharmacotherapy, future research efforts will hopefully elucidate promising therapeutic agents to improve neurologic function.

Emergent Reversal of Direct Oral Anticoagulants Permitting Neurosurgical Intervention for Nonhemorrhagic Pathology.

BACKGROUND: Direct oral anticoagulants (DOACs) are becoming the medication of choice for the management of venous thromboembolism and stroke prevention in atrial fibrillation because of simplified dosing, a more predictive pharmacokinetic profile, and better clinical outcomes when compared with traditional vitamin K antagonists. Recently, reversal agents for DOACs have been approved by the U.S. Food and Drug Administration for use in managing life-threatening or uncontrolled bleeding; however, for acute nonhemorrhagic conditions requiring surgical intervention, such as acute hydrocephalus requiring ventriculostomy, there is little evidence to help guide appropriate management for patients on DOACs. CASE DESCRIPTION: We report the use of andexanet alfa to counteract rivaroxaban treatment in a 28-year-old woman who developed herniation syndrome and acute hydrocephalus from a cerebellar tumor. CONCLUSIONS: We describe how appropriate timing of administration of the DOAC reversal agent may permit urgent neurosurgical intervention.

Visual compatibility of caspofungin acetate with commonly used drugs during simulated Y-site delivery.

PURPOSE: The physical compatibility of i.v. caspofungin with other commonly used i.v. medications was tested. METHODS: Two methods were used to combine caspofungin and the secondary drugs. For drugs administered by i.v. push, caspofungin was delivered through a poly-vinyl chloride (PVC) i.v. solution set with secondary drugs injected into the Y-site of the i.v. extension set. For drugs given by i.v. infusion (over 10 minutes), secondary drugs were infused into the Y-site of the i.v. solution set through microbore PVC tubing. The two drugs shared 39 in of tubing. Attached to each end of the i.v. extension set were 0.8-mum filter disks. All drug combinations were tested three times; after each infusion, the filters were bubble-point tested. Drug combinations were considered physically compatible if no visible precipitate was seen and no color change was noted by the unaided eye during the infusion, or if the number of particles found on the filter under a microscope did not exceed the number stated in United States Pharmacopeia guidelines for particulate levels of large-volume parenteral fluids. RESULTS: A total of 8 of the 31 drugs tested (acyclovir, ceftriaxone, cefazolin, clindamycin, furosemide, heparin, pantoprazole, and piperacillin-tazobactam) were found to be physically incompatible with caspofungin. CONCLUSION: Caspofungin acetate was physically compatible during Y-site injection with 23 of 31 medications tested.