Drug information

Acute arterial thromboembolism in patients with COVID-19 in the New York City area
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In 12,630 hospitalized patients with COVID-19.

A total of 49 patients with arterial thromboembolism and confirmed COVID-19 were identified.

Median age was 67 years (58-75) and 37 (76%) were male.

The most common preexisting conditions were hypertension (53%) and diabetes (35%). Median D-dimer level was 2673 ng/mL (723-7139).

The distribution of thromboembolic events included:

⭕upper 7 (14%)
⭕lower 35 (71%) extremity ischemia,
⭕bowel ischemia 2 (4%),
⭕cerebral ischemia 5 (10%).

⭕Six patients (12%) had thrombus in multiple locations.

⭕Concomitant deep vein thrombosis was found in 8 patients (16%).

⭕Twenty-two (45%) patients presented with signs of acute arterial ischemia and were subsequently diagnosed with COVID-19.

⭕The remaining 27 (55%) developed ischemia during hospitalization.

Revascularization was performed in 13 (27%) patients, primary amputation in 5 (10%), administration of systemic tissue plasminogen activator in 3 (6%), and 28 (57%) were treated with systemic anticoagulation only.

The rate of limb loss was 18%. Twenty-one patients (46%) died in the hospital. Twenty-five (51%) were successfully discharged and 3 patients are still in the hospital.

Source: Ann Vasc Surg. 2020 Aug 28

Ticagrelor in Conventional Antiplatelet Dosages Affect Antibiotic-Resistant Gram-Positive Bacteria without selecting for resistant mutants
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Ticagrelor and and its metabolite AR-C124910 had bactericidal activity against all gram-positive strains tested, including drug-resistant strains glycopeptide intermediate S aureus (GISA), MRSE, MRSA, and VRE.

The minimal bactericidal concentration was 20 μg/mL against MSSA, GISA, MRSA, and VRE; 30 μg/mL against MRSE; and 40 μg/mL against E faecalis and S agalactiae.

Although a dosage of 5 μg/mL delayed growth of MRSA, ticagrelor was ineffective against gram-negative strains in concentrations up to 80 μg/mL.

At minimal bactericidal concentration, ticagrelor was superior to vancomycin, with rapid killing of late-exponential-phase cultures of MRSA (time to kill 99.9% of the initial inoculum, 2 hours).

Bactericidal activity was similar to the bactericidal cyclic lipopeptide daptomycin, recently introduced against resistant strains of S aureus.

A subminimal bactericidal concentration of ticagrelor (10 μg/mL) combined with vancomycin (4 μg/mL) killed approximately 50% of the initial MRSA inoculum, depicting synergistic activity.

Ticagrelor also increased the bactericidal activity of rifampicin, ciprofloxacin, and vancomycin in a disk diffusion assay.

It displayed bactericidal activity against MRSE and VRE, with superiority over vancomycin for killing MRSE.

At 24 hours, its ability to kill MRSE and VRE was similar to daptomycin.

Ticagrelor inhibited MRSA, MRSE, and VRE biofilm formation in a dose-dependent manner;

biofilm mass was reduced by more than 85% after exposure to 20 μg/mL ticagrelor.

Finally, in mice, conventional oral antiplatelet dosages of ticagrelor (3 mg/kg loading dose, then 1.5 mg/kg twice daily) inhibited biofilm growth on S aureus–preinfected implants and dissemination of bacteria to surrounding tissues.

Source: JAMA Cardiol, May 8, 2019

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department
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New review was conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED.

Source: Pharmacotherapy, March 2019.
Full Article: bit.ly/2CvoFGT

Only 12 chapters

Cardiology Pharmacy Preparatory Review Course 2018 Shared with Dropbox

Role of Salivary Concentrations of Antituberculosis Drugs in Therapeutic Drug Monitoring.
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For gatifloxacin and linezolid, salivary therapeutic drug monitoring is likely possible due to a narrow range of saliva–plasma and saliva–serum ratios.

For isoniazid, rifampicin, moxifloxacin, ofloxacin, and clarithromycin, salivary therapeutic drug monitoring might be possible;

however, a large variability in saliva–plasma and saliva–serum ratios was observed. Unfortunately, salivary therapeutic drug monitoring is probably not possible for doripenem and amoxicillin/clavulanate, as a result of very low salivary drug concentrations.

Source:Therapeutic Drug Monitoring, February 2018