The Second Wave of COVID-19: Clinical Pharmacy Services During a Field Hospital Operation.

The second wave of COVID-19 emerged in the late fall months in the state of Massachusetts and inadvertently caused a rise in the number of cases requiring hospitalization. With a field hospital previously opened in central Massachusetts during the Spring of 2020, the governor decided to reimplement the field hospital. Although operations were effectively accomplished during the first wave, the reimplementation of the field hospital came with its new set of challenges for operating a satellite pharmacy. Experiences gathered include new pharmacy operation workflows, the clinical role of pharmacy services, introduction of remdesivir treatment, and pharmacy involvement in newly diagnosed diabetes patients requiring insulin teaching. Pharmacy services were successful in adapting to the rapidly growing number in patients with a total of over 600 patients served in a course of 2 months.

Systematic review of oral pharmacotherapeutic options for the management of uterine fibroids.

BACKGROUND: Uterine fibroids constitute a significant health problem in the United States, affecting upward of 11 million people. OBJECTIVE: Characterize the literature regarding the incidence of amenorrhea and reductions in abnormal uterine bleeding and fibroid size and to report on clinically relevant safety outcomes of oral medications that may be used to manage symptomatic uterine fibroids to assist in choice of therapeutic options. METHODS: A literature search was conducted through December 31, 2021, using Embase, MEDLINE, and International Pharmaceutical Abstracts databases. Primary literature reporting on safety or efficacy data of any oral medication for the treatment of symptomatic uterine fibroids was included. Relevant study characteristics, outcomes, and safety data were extracted. Data extraction was performed in duplicate with any discordant data reconciled by the entire investigative team. RESULTS: A total of 41 studies met inclusion criteria-28 randomized control trials (RCTs), 11 prospective observational studies, 1 phase-1 pharmacokinetic study, and 1 pooled study. The majority of literature involved the study of mifepristone (n = 26, [63.4%]), followed by vilaprisan (n = 5, [12.2%]), elagolix (n = 5, [12.2%]), relugolix (n = 4, [9.8%]), and linzagolix (n = 1 [2.4%]). A total of 33 articles (80.5%) reported results pertaining to the efficacy objectives of this review with all medications statistically significantly improving at least one of these domains. Hot flashes, liver function test abnormalities, and endometrial hyperplasia were the most often reported adverse events. Of the RCTs, 7 of 28 (25%) had a moderate-high risk of bias (RoB), whereas 10 of 11 (90.9%) observational studies had a moderate-high RoB. The majority of moderate-high RoB studies involved the study of mifepristone (15 of 18, 83.3%). CONCLUSIONS: Given higher quality of evidence, confirmed therapeutic efficacy, and a milder adverse effect profile, the contemporary gonadotropin releasing hormone antagonists (elagolix, relugolix, linzagolix) and vilaprisan represent preferred oral treatment options for the management of uterine fibroids.

Inpatient Initiation of Sacubitril/Valsartan.

OBJECTIVE: Discuss the literature and describe strategies to overcome barriers of inpatient initiation of sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF). DATA SOURCES: A PubMed, EMBASE, and Google Scholar literature search (January 2014 to June 2020) limited to English language articles was conducted with the following terms: sacubitril/valsartan, initiation, inpatient, hospitalized, B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), diuretic, cost, and cost-effectiveness. STUDY SELECTION AND DATA EXTRACTION: Included articles described inpatient initiation of sacubitril/valsartan or described its impact on BNP, NT-proBNP, diuretic dosing, or cost of care. DATA SYNTHESIS: A total of 20 studies were identified based on included search terms. CONCLUSIONS: Sacubitril/valsartan should be considered for hemodynamically stable patients with HFrEF (New York Heart Association class II or III), potassium <5.2 mmol/L, without a history of angioedema, and after a 36-hour washout from angiotensin-converting enzyme (ACE) inhibitor or aliskiren, if applicable. An appropriate dose can be determined based on the patient's previous ACE inhibitor or angiotensin receptor blocker dose and/or blood pressure along with patient-specific factors. To overcome barriers of use, the following are recommended: NT-proBNP or BNP with establishment of a new baseline 1 month after initiation may be used for prognosis or diagnosis; careful monitoring of diuretic requirements; utilization of multiple strategies to overcome cost barriers; and use of interdisciplinary care.