Antithrombotic Usage Patterns in the Era of New Oral Anticoagulant Options for Atrial Fibrillation.

BACKGROUND: Appropriate treatment reduces the risk of stroke in patients with atrial fibrillation (AF). Despite the known benefits of warfarin, anticoagulation prescribing rates remain inadequate in high-risk patients. Over the last 6 years, 4 novel oral anticoagulants have been approved for use for stroke prophylaxis in non-valvular AF (NVAF), which may allow prescribers to tailor therapy for each NVAF patient. OBJECTIVE: The goal of this investigation was to determine the effect of dabigatran and rivaroxaban availability on the rate of anticoagulant prescribing at hospital discharge in patients with a principal diagnosis of NVAF. METHODS: A retrospective chart review of adult patients presenting with NVAF (CHADS2 score ≥2) was conducted using a historical control group of patients from 2009 compared to patients admitted in 2012 following formulary availability of dabigatran and rivaroxaban. In addition to antithrombotic therapy prescribed, subsequent hospitalizations during a 1-year period were reviewed for major bleeding and stroke events. RESULTS: Two hundred patients were enrolled in the study. The rate of anticoagulant prescribing in the 2009 and 2012 groups was 68.3% and 77.1%, respectively (p = .16). Of the patients in the 2012 group prescribed an anticoagulant, 58 (64%) received warfarin, 26 (28%) received dabigatran, and 7 (8%) received rivaroxaban. One patient (1.2%) in the 2009 group and 4 patients (4.4%) in the 2012 group had a major bleed (p = .4). CONCLUSION: There was no statistical difference in the rate of anticoagulant prescribing between the 2 groups. Despite the availability of additional anticoagulant options, the rate of prescribing remains suboptimal in this high-risk population.

Lurasidone (latuda®): an atypical antipsychotic.

Lurasidone is a new atypical antipsychotic that has demonstrated positive effects on psychosis, mood, and cognition. This improved efficacy and safety profile for the treatment of schizophrenia. Its overall tolerability profile seems to be comparable to the other atypical antipsychotics. Perhaps its more potent blockade on the 5HT7 receptor will give it more of an advantage in treating the negative symptoms as well as improve cognitive and depressive symptoms associated with schizophrenia. Additionally, it does not appear to have any significant adverse impact on the metabolic profile, such as weight, glucose, or lipid metabolism. Lurasidone is also associated with good cardiovascular tolerability without widening of the QT interval. The use of this medication may be of particular interest in patients presenting with endocrine or cardiovascular abnormalities. The average price for a 30-day supply of lurasidone is $475.98.

Use of famotidine in adult patients with end-stage renal disease: assessment of dosing and mental status changes.

BACKGROUND: Famotidine dosage adjustment is required in patients with chronic kidney disease. Since recommendations on the degree of famotidine dose reduction vary between references, a chart review was conducted to evaluate the tolerability of varying famotidine doses in adults with end-stage renal disease (ESRD). METHODS: An assessment was made of famotidine doses prescribed to patients with ESRD over a 7-year period in a university hospital. Patient medical records were reviewed for evidence of mental status changes associated with famotidine. RESULTS: In 38 patients who met study criteria, 35 had no evidence of mental status change while receiving famotidine therapy. Among these 35 patients, the mean dose of famotidine was 24 mg/daily for 5.5 days. Three patients had mental status changes possibly associated with famotidine therapy. CONCLUSIONS: In this study, most ESRD patients seemed to tolerate famotidine 20 mg daily well, but larger prospective studies need to be done before final recommendations can be made. A small percentage of patients may require further dose reduction to minimize risk of mental status change.

Gender differences in the use of peak flow meters and their effect on peak expiratory flow.

STUDY OBJECTIVE: To determine if gender differences in the skill of using peak flow meters affect peak expiratory flow (PEF). DESIGN: Prospective observational study. SETTING: University classroom. SUBJECTS: One hundred sixteen first-year pharmacy students (76 women, 40 men). INTERVENTION: Students were taught correct use of a peak flow meter by means of classroom discussion and demonstrations. MEASUREMENTS AND MAIN RESULTS: The students' technique in use of the peak flow meter was scored 3 times, and their PEF was recorded. Men scored higher than women (p=0.03) for the steps of "inhale fully" and "exhale as hard and as fast as you can" in the first attempt. Percentage increases in PEF did not significantly differ between the groups. Percentage change in PEF improved from the second attempt to the third attempt in women (p=0.036) but not men. On the third attempt, 13.2% of women versus 2.6% of men had an increase in PEF of more than 50% (p=0.1). CONCLUSION: This study found that men learned the correct technique for using a peak flow meter and attained their best PEF more quickly than women.

Premenstrual asthma: emphasis on drug therapy options.

Premenstrual asthma is quite common, affecting up to 40% of women. Some studies suggest exacerbations of asthma requiring emergency department visits or hospitalizations are more common in the perimenstrual phase. Several drug treatment modalities for premenstrual asthma have been evaluated. Drug therapies that may be beneficial include leukotriene receptor antagonists, long acting inhaled beta2 agonists, progesterone, estradiol, and gonadotropin-releasing hormone (GnRH) analogs. Further double-blind, randomized, placebo-controlled studies are required before the optimal drug therapy for premenstrual asthma is established.