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(American Journal of Health System Pharmacy[TA])
9,333 results
  • Defective DNA repair in hereditary ovarian cancers: Implications for therapy. [Review]
  • AJAm J Health Syst Pharm 2018 Sep 18
  • Burgess BT, Kolesar JM
  • CONCLUSIONS: OC is the most lethal of all gynecologic malignancies and encompasses a highly diverse collection of cancers. Hereditary OCs are a unique subtype of OC encompassing up to 24% of all OCs, including cancers driven by germline mutations of the BRCA1 or BRCA2 genes, mutations associated with Fanconi anemia (FA), BRCAness germline mutations, and Lynch syndrome. With an increasing wealth of genomic data available in cancer research, a common thread of defective DNA repair pathways as a primary driver of hereditary OCs has emerged. OCs driven by BRCA1/2, FA-associated, and BRCAness germline mutations have a demonstrated sensitivity to PARP inhibitors due to underlying deficiencies in DNA homologous recombination; however, clinical responses are often partial and highly dependent on platinum sensitivity. Additionally, the immune checkpoint inhibitor pembrolizumab is indicated for certain metastatic solid tumors characterized by microsatellite instability, a distinguishing feature highly associated with DNA mismatch repair deficiency in Lynch syndrome-associated cancers, including some OCs.In hereditary OC syndromes, mutations in DNA repair pathways form the clinical basis for the use of PARP inhibitors and an immune checkpoint inhibitor as novel targeted therapies.
  • Predictors of oversedation in hospitalized patients. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Sep 15; 75(18):1378-1385
  • Brant JM, Stringer L, … Karera D
  • CONCLUSIONS: The identified risk factors for oversedation and potential OIRD in hospitalized patients can form the basis of quality-improvement initiatives to prevent oversedation through improved prescribing and patient monitoring.
  • Nimodipine for the treatment of otolaryngic indications. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Sep 15; 75(18):1369-1377
  • Sin JH, Shafeeq H, Levy ZD
  • CONCLUSIONS: Nimodipine is currently indicated for the improvement of neurologic outcomes in adult patients with aneurysmal subarachnoid hemorrhage (aSAH). However, other oral and i.v. calcium channel blockers have not exhibited the same beneficial effects in patients with aSAH, leading clinicians to believe that nimodipine possesses unique neuroprotective effects in addition to its calcium channel-blocking and vasodilatory properties. Consequently, clinical investigations of nimodipine have been conducted for cochlear and facial nerve preservation after vestibular schwannoma (VS) surgery, symptomatic management of Ménière's disease and peripheral vertigo, and recovery of vocal cord paralysis after laryngeal nerve injury. Three prospective randomized studies have investigated nimodipine for hearing and/or nerve preservation in patients undergoing VS resection, the results of which have suggested a potential benefit of initiating nimodipine during the perioperative period. Several studies of Ménière's disease and/or peripheral vertigo have reported improved symptom control with nimodipine. For vocal fold paralysis associated with recurrent laryngeal nerve (RLN) injury, nimodipine may increase the recovery rate based on the results of 1 nonrandomized prospective study that used nimodipine in a protocolized manner. One small pilot study found that nimodipine improved facial nerve function after maxillofacial surgery.Due to its proposed vasoactive and neuroprotective effects, nimodipine may play a role in the treatment of a number of otolaryngic pathologies including VS, Ménière's disease, peripheral vertigo, RLN injury, and facial weakness after maxillofacial surgery. Small studies have shown improved symptom control and recovery after surgery. Since all of the aforementioned indications are still considered off label, clinicians and patients should collaboratively assess the risks and benefits before initiating treatment.
  • Noninsulin medication therapy for hospitalized patients with diabetes mellitus. [Journal Article]
  • AJAm J Health Syst Pharm 2018 Sep 15; 75(18):1361-1368
  • Petite SE
  • CONCLUSIONS: The American Diabetes Association recommends against the routine use of noninsulin antidiabetic therapies during hospitalization and supports insulin use instead. There are significant risks associated with insulin therapy, including hypoglycemia, and use of alternative therapies may be considered in hospitalized patients. A MEDLINE literature search was conducted to find articles on studies evaluating the use of noninsulin antidiabetic therapies in the inpatient setting; all full-text English-language publications presenting observational and randomized clinical trial data on the topic of interest were considered for inclusion in the review, with 9 publications selected for review. The majority of the reviewed research focused on incretin-based therapies, and favorable safety and efficacy outcomes were reported with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors. The available evidence indicates that the use of other noninsulin medications, including glucagon-like peptide-1 receptor agonists and sulfonylureas, to achieve and maintain glycemic control in the inpatient setting may be limited by adverse effects.Optimal glycemic control in hospitalized patients with diabetes is necessary to avoid adverse effects. Insulin therapy is currently the primary medication recommended for this patient population. DPP-4 inhibitors have been demonstrated to be safe and effective for use in the inpatient setting in patients with well-controlled diabetes. Further research is needed to help define the role of noninsulin medications in the inpatient setting.
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