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Introduction: Although terlipressin is known to cause bradycardia, this adverse effect is usually described in association with hypertension and is considered a benign compensatory response mediated by arterial baroreceptors. Cardiac monitoring for patients receiving terlipressin is not routinely recommended. Case Presentation: A 77-year-old female patient with no history of coronary artery disease and no other coexisting risk factors for cardiac arrhythmias or conduction disturbances was admitted to intensive care unit with severe cholangitis, complicated by variceal bleeding. She developed severe sinus bradycardia following the use of terlipressin, which was associated with significant hypotension that required the infusion of norepinephrine. The bradycardia occurred again when terlipressin therapy was reattempted. Conclusion: Vasopressin is known to sensitize baroreceptor reflexes by a central mechanism though its actions on V1a receptors in the area postrema, and we speculate that vasopressin analogues such as terlipressin may act in the same manner. That this effect is not widely described in terlipressin safety literature may be due to the overall younger age range of the trial population. This raises the possibility that cardiac monitoring may be warranted for elderly patients receiving terlipressin.
RESUMO
Background There is increasing recognition for the role of pharmacy technicians in obtaining medication histories and performing administrative tasks which may represent an opportunity cost when completed by pharmacists. Technician-enhanced teams can therefore improve hospital clinical pharmacy services. In Australian hospitals, medication reconciliation and reviews can be documented in Medication Management Plans (MMPs) upon admission. Thus, MMPs can be used as feasible measures of the efficiency of pharmacy teams. Objective To quantify the impact of a technician-enhanced clinical pharmacy model on medication reconciliation and timeliness of pharmacist tasks. Setting 480-bed tertiary teaching hospital in New South Wales. Method The effect of a technician working alongside the geriatric pharmacist in a single hospital was evaluated. Outcomes were measured throughout two 4-week periods pre- and post-implementation for patients under the supervision of a geriatrician who were discharged during usual business hours. Data were collected by the supervising pharmacist. Main outcome measure Primary outcomes were the number of MMPs completed daily on average and during admission, as well as the timeliness of updating discharge summaries, medication histories and MMPs. Results The mean number of daily MMPs significantly increased from 2.25 to 4.90 with the technician (p < 0.001, 95% CI 1.66 to 3.64). The median time to update discharge summary significantly decreased from 6:48 to 2:33 h (p = 0.01). Conclusion This study suggested that technician-enhanced teams could improve the efficiency of clinical pharmacy services in an Australian hospital.
