Medicine and Health Sciences Commons^™

Optimization Of Albumin 5% Use In A Community Hospital, Robyn Feldman, Stephanie Palma, Erika Dittmar, Heidi Clarke

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Background: The debate surrounding the use of crystalloids versus colloids remains a source of controversy due to limited and conflicting evidence. Emerging data favors the use of crystalloids over colloids in addition to cost benefits. Baptist Hospital of Miami (BHM) has evidence-based guidance for albumin 5%, but it is unclear the degree of appropriate usage. The purpose of this study is to assess the prescribing practices of albumin 5% at BHM and optimize appropriate use through pharmacy driven interventions.

Methodology: A single-center, IRB-reviewed, bi-phasic study was conducted within a community hospital. In phase I, a retrospective chart review of patients …

Pharmacists’ Role In The Management Of Patients Receiving Dual Or Triple Antithrombotic Therapy, Laura Neubauer, Radhan Gopalani, Kristen De Almeida

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Purpose: Patients on dual and triple antithrombotic therapy present the therapeutic dilemma of mitigating bleed risk while sustaining antithrombotic efficacy. Lack of literature and variability in existing published guidance potentiates inconsistent management of these patients. Furthermore, suboptimal dosing of direct oral anticoagulants is relatively common. One study reported as high as 43% of patients receive higher and 13% receive lower than clinically indicated doses. These findings were associated with a significantly increased risk of major bleeding and incidence of stroke, thus highlighting the importance of selecting an ideal regimen. The purpose of this project is to highlight pharmacists’ role in …

Optimizing Empiric Vancomycin Use In Febrile Neutropenia Patients, Nicole Tadros, Erika Dittmar, Radhan Gopalani

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Introduction: Febrile neutropenia (FN) is a complication of chemotherapy resulting in a temperature 100.4⁰F or greater plus an absolute neutrophil count (ANC) below 500 cells/mm³ or an ANC below 1000 cells/mm³ and expected to decrease below 500 cells/mm³ within 48 hours. Timely administration of broad-spectrum antimicrobial therapy is a cornerstone for the initial management of FN. However, prolonged empiric antimicrobial treatment can lead to resistance and toxicity. National guidelines and published literature do not support vancomycin as a routine part of empiric antimicrobial regimens in FN; it is only recommended in patients with specific clinical indications. This …

Evaluation Of Antiplatelet-Related Bleeding Events In A Community Hospital, Frank C. Moreno Exposito, Heidi Clarke, Erika Dittmar

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Background:Bleeding rate among patients who take high-dose aspirin is approximately 1.92% with an expected 2-3 fold increase after a second antiplatelet is added. Similarly, the addition of an anticoagulant to single or dual antiplatelet therapy results in increased bleeding rates of approximately 13.9% and 15.7% respectively. The concomitant use of antiplatelets and anticoagulants has become a common practice due to the high incidence of clinical conditions for which these agents are used. Hence, reversal of antithrombotic agents is often needed during major bleeding events or invasive procedures. However, the use of antiplatelet reversal is still under-utilized, and its efficacy …

Impact Of Ketorolac On Opioid Consumption After Open Heart Surgery, Laura Neubauer, Radhan Gopalani, Kristen De Almeida, Andrea Marr-Peralto

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No abstract provided.

Retrospective Review Of Anticoagulation Regimens Used For The Prevention Of Venous Thromboembolisms In Critically Ill Patients Infected With Sars-Cov-2, Tony Nguyen, Heidi Clarke

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No abstract provided.

Evaluation Of Albumin 5% Prescribing Patterns In Adult Hospitalized Patients, Robyn Feldman, Nicole Tadros, Heidi Clarke, Erika Dittmar

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No abstract provided.

Evaluating The Association Between Vasopressin Use And In-Hospital Mortality In Patients With Septic Shock, Michael Pasqualicchio, Heidi Clarke, Jonathan Kline, Payal Patel

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No abstract provided.

Impact Of A Pharmacist-Driven Methicillin-Resistant Staphylococcus Aureus Nasal Swab Protocol On The De-Escalation Of Empiric Vancomycin In The Setting Of Community Acquired Pneumonia, Grether Hernandez Gama, Winifred Pardo, Wilbert Fuerte, James Adefisoye

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No abstract provided.

Effect Of Epoetin Alfa-Epbx Versus Epoetin Alfa On Hemoglobin Levels In Myelodysplastic Syndromes, Chemotherapy Induced Anemia, And Chronic Kidney Disease, Gabrielle Dubruille, Sigal Nadulek, Anderson Mabour

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No abstract provided.

Risk Of Acute Kidney Injury In Patients Receiving Vancomycin And Piperacillin-Tazobactam Compared To Vancomycin And Cefepime, Viktoria Andonova

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No abstract provided.

Etomidate Use In Septic Patients Requiring Rapid Sequence Intubation, Elizabeth Osmon, Nishika Patel

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No abstract provided.

Review Of Adjunctive Midodrine To Facilitate Weaning Intravenous Vasopressors In Critically Ill Patients, Claudia Martin Diaz, Heidi Clarke, Payal Patel, Radhan Gopalani, Stephanie Palma

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Background/Purpose: Intravenous (IV) vasopressor agents are mainstay therapy for the management of refractory hypotension in critically ill patients in the intensive care unit (ICU). Patients remain in the ICU for vasopressor administration and monitoring which results in increased length of stay (LOS). Midodrine is an oral alpha-1 adrenergic agonist that causes vasoconstriction and increased blood pressure. It is commonly utilized off-label as an adjunctive therapy to help wean off vasopressors and decrease ICU LOS. Although midodrine offers many benefits, a study by Rizvi, et al stated that inappropriate continuation at hospital discharge resulted in a 1.6-fold higher risk of 1-year …

Calcitonin Prescribing Criteria For The Management Of Hypercalcemia In A Community Hospital, Jessica Hernandez, Radhan Gopalani, Heidi Clarke, Joyce Lee, Alyssa Donadio

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Purpose/Background: Hypercalcemia is a clinical condition in which serum calcium levels exceed the upper limit of normal (>10.5 mg/dL). The most common causes of hypercalcemia are primary hyperparathyroidism and malignancy, however, it can also be caused by vitamin D intoxication, endocrine disorders, and immobilization due to an increase in bone resorption. First-line treatment of hypercalcemia includes hydration with intravenous (IV) normal saline and IV bisphosphonates. Calcitonin (Miacalcin®) is a synthetic hormone with a rapid onset of action and used intramuscularly (IM) or subcutaneously (SQ) as a second-line treatment in the management of hypercalcemia, specifically in severe and in symptomatic …

Pharmacological Prevention Of Atrial Fibrillation After Cardiac Surgery With And Without The Use Of Nonsteroidal Anti-Inflammatory Drugs, Laura Neubauer, Radhan Gopalani, Faaria Quadri, Mario Pascual, Heidi Clarke, Andrea Marr-Peralto

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Purpose: Atrial fibrillation after cardiac surgery (AFACS) is the most common complication following open heart procedures, with significantly increased morbidity and mortality associated with its occurrence¹. A previous study done at Baptist Hospital of Miami (BHM) showed a decrease in the incidence of AFACS from 36% to 22% after implementation of a prevention protocol that includes guideline-directed therapy with a beta-blocker and amiodarone. The protocol also includes nonsteroidal anti-inflammatory drugs (NSAIDs) modeled after a study published in 2004 that showed that NSAIDs lowered the incidence of postoperative atrial fibrillation by 65% when they were used in the postoperative …

Evaluation Of Clinical Outcomes Of 4-Factor Prothrombin Complex Concentrate Versus Andexanet Alfa In The Treatment Of Intracerebral Hemorrhage, Eduardo Guizan Corrales, Radhan Gopalani, Heidi Clarke, Jonatha Kline, Felipe De Los Rios La Rosa, Thomas Wolfel

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Purpose: Oral anticoagulants account for up to 20% of intracerebral hemorrhages (ICH) with one-year mortality estimated as high as 54%. Several studies have examined the use of 4-Factor prothrombin complex concentrate (4F-PCC) and andexanet alfa in the treatment of factor Xa associated ICH. High cost burden, lack of clinical outcomes, and risk of thromboembolic events continues to be a major dilemma behind product selection at many healthcare systems. The purpose of this project is to compare clinical outcomes between 4F-PCC and andexanet alfa in the management of patients with ICH secondary to apixaban and rivaroxaban at Baptist Hospital of Miami …

Evaluating The Association Between Vasopressin Use And In-Hospital Mortality In Patients With Septic Shock, Michael Pasqualicchio, Heidi Clarke, Jonathan Kline, Payal Patel

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Purpose/Background: The Surviving Sepsis Campaign recommends norepinephrine as the first-line vasopressor in patients with septic shock to maintain a mean arterial pressure (MAP) of at least 65 mmHg. The guideline also makes a weak recommendation (2B) to use vasopressin as an adjuvant therapy to raise MAP to goal or to reduce the norepinephrine rate required to maintain the goal MAP. The recommendation is based on conflicting results of the VASST trial that showed no significant difference in 28-day all-cause mortality between patients managed with norepinephrine alone compared to norepinephrine and vasopressin. However, in subgroup analysis, the VASST trial showed mortality …

Transition From Fixed-Dosing To Symptom-Triggered Management Of Alcohol Withdrawal Syndrome In The Intensive Care Unit Of A Community Hospital, Marianela Robainas, Heidi Clarke, Claudia Chang, Frances Ordieres Gonzalez, Lorenzo Porras Jr.

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Background/Purpose: In the United States, 2 to 7% of heavy alcohol users admitted to the hospital for general medical care will develop severe alcohol withdrawal (AW) requiring treatment. The most dangerous complications of AW are delirium tremens and seizures. Benzodiazepines (BZD) are considered first-line therapy, with varying modality options available to providers. Fixed-dosing has historically been used to manage AW. However, studies suggest that symptom-triggered therapy (STT) can decrease length of stay and BZD duration of therapy. The purpose of this study was to evaluate the current fixed-dose protocol and outline the transition to STT in the intensive care unit …

Medical Marijuana High On Drug Interaction, Shahrzad Ghanavi

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No abstract provided.

What A Blood Bath! Andexxa® Makes A Splash! Current Trends In Anticoagulation Reversal, Marianela Robainas

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No abstract provided.

Update On Oral Oncolytics, Elizabeth Osmon

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No abstract provided.

Controlled Substance Validation, Claudia Martin Diaz, Jessica Hernandez, Laura Neubauer, Eduardo Guizan Corrales

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No abstract provided.

Update On Oral Oncolytics: A Focus On Hematology Drugs, Monica Tadros

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No abstract provided.

Oral Oncolytics, Gaines Kyna Gania

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No abstract provided.

What A Blood Bath! Andexxa® Makes A Splash! Current Trends In Anticoagulation Reversal, Michael Pasqualicchio

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No abstract provided.

Precautions & Handling Of Hazardous Chemotherapeutic Agents, Paula Sayegh

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No abstract provided.

Evaluating Antipsychotic Prescribing In The Intensive Care Unit And Across The Continuum Of Care, Michael Pasqualicchio, Heidi Clarke

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Purpose/Background: The 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS) recommend against both typical and atypical antipsychotic use for delirium in critically ill patients. This recommendation is based on evidence showing that these medications are not associated with shorter durations of delirium, mechanical ventilation, intensive care unit (ICU) length of stay, or reduced mortality. There are many long term complications associated with the use of antipsychotics including QTc prolongation, extrapyramidal symptoms, metabolic abnormalities, and anticholinergic effects. Regardless, antipsychotics remain the most common medication used …

Association Of Lowering Low-Density Lipoprotein Cholesterol With Contemporary Lipid-Lowering Therapies And Risk Of Diabetes Mellitus: A Systematic Review And Meta-Analysis, Victor Okunrintemi

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No abstract provided.

Update On Anticoagulation Agents And Reversals, Carolyn Ruiz

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No abstract provided.

Abuse And Misuse Of Stimulants For Adhd, Rita Chamoun

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No abstract provided.