scholarly journals Identify and Assess Drug Interactions with Atorvastatin in Inpatient Care

2021 ◽  
pp. 297-306
Author(s):  
Ibrahim Dighriri ◽  
Abdulrahman Hommadi ◽  
Hatim Zaeri ◽  
Rahaf Aldajany ◽  
Rahaf Alotaibi ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Health Care Professionals ◽  
Clinical Care ◽  
Density Lipoprotein ◽  
The Body ◽  
Heart Attacks ◽  
Treatment Regimens ◽  
Long Acting ◽  
Coa Reductase ◽  
Clinical Interactions

Background: Atorvastatin is a recent HMG-COA reductase inhibitor used to treat primary hypercholesterolemia, homozygous familial hypercholesterolemia, and mixed dyslipidemias. It is also taken to prevent heart disease, including strokes and heart attacks. In addition, Atorvastatin is used to lower bad cholesterol low-density lipoproteins (LDL) levels, increase good cholesterol high-density lipoprotein (HDL) levels, and lower triglycerides. It works by reducing the amount of cholesterol produced in the body, hence reducing the amount of cholesterol that may build up on the walls of arteries. Atorvastatin is long-acting, has few adverse effects, and is low in price. Nevertheless, it interacts with a wide variety of medications. These interactions may be lead to adverse drug reactions. Objective: The study aims to identify and asset atorvastatin interactions with other medicines at King Abdulaziz Hospital. Also, to prevent atorvastatin interactions in the future. Methods: The retrospective study investigated 280 electronic prescriptions inside the inpatient clinic at King Abdulaziz Hospital in Saudi Arabia between January and April 2021 to identify and asset interactions among atorvastatin and different medications. Results: Most atorvastatin interactions are category C (44.64%) and category B (41.43%). Atorvastatin had the most common interactions with esomeprazole (16.07%), clopidogrel (14.64%), and sitagliptin (12.14%). Atorvastatin had clinical interactions with medications metabolized by the cytochrome P450 3A4 )CYP3A4(. Use of atorvastatin with cyclosporine or clarithromycin increased the risk for atorvastatin toxicities such as myopathy and rhabdomyolysis. In addition, Atorvastatin decreases clopidogrel's antiplatelet effect and increases the risk of skeletal muscle toxicity of daptomycin. Conclusion: The majority of atorvastatin interactions may be avoided by adhering to best practices in clinical care and clinical pharmacology, such as avoiding complicated treatment regimens, utilizing a single pharmacy for all prescriptions, and recognizing patient risk factors. Health care professionals should use drug-drug interaction checkers such as Medscape and Micromedex, as well as a book such as the Handbook of Drug Interactions.

scholarly journals Detect Drug Interactions with Metronidazole

2021 ◽  
pp. 597-604
Author(s):  
Ibrahim Dighriri ◽  
Ahmed Mobarki ◽  
Naif Althomali ◽  
Khalid Alqurashi ◽  
Othman Daghriri ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Qt Interval ◽  
Clinical Care ◽  
Cost Effective ◽  
Interval Prolongation ◽  
Treatment Regimens ◽  
Risk Of Bleeding ◽  
Qt Interval Prolongation ◽  
Concurrent Use ◽  
Effective Medication

Introduction: Metronidazole has been prescribed to treat infections for over a century and continues to be helpful in the therapy of amoebiasis, trichomoniasis, and giardiasis. Metronidazole is a cost-effective medication because of its low price, few adverse effects, and favorable pharmacokinetic and pharmacodynamic properties; nevertheless, it interacts with a wide variety of other medications. Some interactions with other medicines diminish its effectiveness, while others increase it. Aims: The study aims to detect and evaluate metronidazole interactions with other medicines at King Abdulaziz Specialist Hospital. Methodology: This retrospective study encompasses the review of 360 computerized prescriptions inside the outpatient clinic at King Abdulaziz Specialist Hospital in Saudi Arabia between March and September 2020 to detect and evaluate interactions among metronidazole and different medications. Results: Metronidazole interactions are mostly major or moderate. Metronidazole had the most common interactions with domperidone (15.83 %), famotidine (13.89 %), and ciprofloxacin (11.67 %). Metronidazole contains a nitroimidazole ring, which suppresses the metabolism in the liver of numerous medications, including those that may be metabolized by the CYP3A4 and/or CYP450 2C9 isoenzymes. The combination of metronidazole with phenytoin or phenobarbital can cause metronidazole elimination to be accelerated and phenytoin clearance to be reduced. Metronidazole may improve warfarin's anticoagulant effects, leading to a longer prothrombin time and a higher risk of bleeding. Concurrent use of metronidazole with alfuzosin, escitalopram, and ondansetron may raise the risks of QT-interval prolongation and arrhythmias. Conclusion: Most metronidazole drug interactions can be avoided by following excellent clinical care and clinical pharmacology concepts, such as avoiding complex treatment regimens, educating patients. and identifying patient risk factors. Furthermore, before prescribing and dispensing medicines, physicians and pharmacists should utilize drug-drug interactions checkers such as Micromedex and Lexicomp or a book such as Stockley's Drug Interactions.

AM:STARs: Hot Topics in Adolescent Health, Vol. 25, No. 2

2014 ◽  
Keyword(s):  
Adolescent Health ◽  
Primary Care Physicians ◽  
State Of The Art ◽  
Clinical Care ◽  
Diagnostic Techniques ◽  
Adolescent Medicine ◽  
Gender Nonconforming ◽  
Treatment Regimens ◽  
Mindfulness Practices ◽  
Long Acting

This issue of AM:STARs, Hot Topics in Adolescent Health, presents a wide array of articles exploring some of the most exciting advances and controversies in adolescent health. These topics and other evolving areas are presented to guide the reader toward providing state of the art clinical care to adolescents, as well as reviewing new research that will shape the future of adolescent health. Topics include: Nutritional and metabolic controversies including the diagnosis of gluten intolerance, vitamin D deficiency and metabolic syndrome in adolescents, and the use of bariatric surgery to treat the comorbidities of adolescent obesity. New diagnostic considerations, including updated DSM-5 diagnostic criteria for mental health disorders such as mood dysregulation, eating disorders, and ADHD. Reproductive health advances including new diagnostic techniques and treatment regimens for HIV and other sexually transmitted infections, as well as the expanding use of long-acting reversible contraceptives. New frontiers in adolescent medicine including office-based management of opiate addiction, support of gender nonconforming youth, and the use of mindfulness practices in the care of a variety of conditions. AM:STARs: Adolescent Medicine: State of the Art Reviews is the official publication of the American Academy of Pediatrics Section on Adolescent Health. Published 3 times per year, the journal offers adolescent medicine specialists and other primary care physicians who treat adolescent patients with state of the art information on all matters relating to adolescent health and wellness.

COMPARATIVE DOCKING STUDY OF ‘DUKUNG ANAK’ PHYTONUTRIENT COMPOUNDS WITH ANTI-CHOLESTEROL PROPERTIES

2015 ◽  
Vol 77 (31) ◽  
Author(s):  
Lina Rozano ◽  
Muhammad Redha Abdullah Zawawi ◽  
Muhammad Aizuddin Ahmad ◽  
Indu Bala Jaganath
Keyword(s):  
Cardiovascular Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Docking Study ◽  
Docking Studies ◽  
Binding Energies ◽  
The Body ◽  
Molecular Docking Study ◽  
In Silico Docking ◽  
Coa Reductase

Inhibition of 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGR) has been a useful strategy in the treatment of cardiovascular disease. Molecular docking study was carried out to study the effects of geraniin and its metabolites on 3-hydroxy-3-methyl-glutaryl-CoA reductase. 3-hydroxy-3-methyl-glutaryl-CoA reductase acts on melavonate pathway for cholesterol production in the liver but high level of cholesterol in the body may lead to cardiovascular disease where low density lipoprotein accumulates and forms atherosclerotic plaque. In clinical treatment, drug statin is used to block 3-hydroxy-3-methyl-glutaryl-CoA reductase function to reduce the risk of cardiovascular disease but there are unwanted effects where drug statin may cause muscle pain and liver damage. Naturally obtained phytonutrient compounds, geraniin and urolithin groups from dukung anak or scientifically known as Phyllanthus sp. were evaluated for 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitory activity using in silico docking studies. Most of these compounds were found to be potent inhibitors of 3-hydroxy-3-methyl-glutaryl-CoA reductase in comparison with known drugs of cardiovascular disease. The binding energies of urolithin A, urolithin B-glucoronide and urolithin D-glucoronide were compared with that of geraniin and it was found that these phytonutrient compounds may have more potent inhibition of 3-hydroxy-3-methyl-glutaryl-CoA reductase comparable with the current drug for cardiovascular disease.

scholarly journals Rejecting Humanae Vitae: The Social Costs of Denying the Obvious

2018 ◽  
Vol 85 (4) ◽  
pp. 322-326 ◽  
Author(s):  
Hanna Klaus
Keyword(s):  
Family Planning ◽  
Side Effects ◽  
Health Care Professionals ◽  
The Body ◽  
Natural Family Planning ◽  
Fertility Awareness ◽  
Natural Family ◽  
Humanae Vitae ◽  
The Social ◽  
Long Acting

Since contraceptives have been used to remove fertility from the conjugal act, the social consequences predicted in the encyclical Humanae vitae, such as the rise in cohabitation, decline of marriage, rise of divorce, and single parenthood, have exceeded expectations. The degradation of the sexual act from total mutual self-giving to momentary union has led to doubting the significance of the biological truth of the body and opened the door to gender fluidity. Promiscuity became normative, and the need for consent became eroded until women revolted with the #MeToo movement. Promiscuity, cohabitation, and divorce have resulted in 40 percent of children born to unmarried parents whose tenuous unions often leave the children in melded and dysfunctional families. Relation-free “hookups” have become the norm among young adults, leaving a flood of emotionally damaged women, an epidemic of sexually transmitted infections, and unplanned pregnancies, to which the healthcare industry has responded by doubling down on the means which caused the problem in the first place with near-coercive promotion of long-acting, reversible contraceptives (LARCs). LARCs must be inserted and removed professionally and make reproductive choice moot. Respecting the truth of the body is the precise counter measure. A woman’s cyclic fertility is easily observed with reliable biomarkers—natural family planning—which requires the whole person. Fertility awareness–based methods of family planning have no side effects, are easy to learn, and can be used to achieve as well as delay conception. The self-discovery inherent in learning fertility literacy has empowered adolescent girls and boys to understand and value their sexuality and fertility and avoid choosing harmful behaviors. Why does society continue to treat fertility as if it were a disease? Summary: Removing the idea of pregnancy from the sexual act as the result of readily available contraception has effectively limited choices about sexual behavior to the satisfaction of momentary desires. As Humanae vitae predicted, fewer marriages were contracted, divorce increased and now 40% of children are born out of wedlock despite extensive public education campaigns to promote contraception. Side effects of the hormonal pill have reduced their use so health care professionals have doubled down, providing long acting contraceptives which do not require the user to exercise choice before each act of intercourse, or of taking a pill. There is a much better way to regulate births–to learn to read the book of nature. Fertility is not a disease to be removed from the body. All that is needed is to understand the natural signs of fertility–natural family planning, now called FABM–Fertility Awareness-Based Methods. These have no side effects, enhance couple communication and offer effective choice for child spacing and demonstrably support premarital chastity for teens.

scholarly journals Erythropoietin, Forkhead Proteins, and Oxidative Injury: Biomarkers and Biology

2009 ◽  
Vol 9 ◽  
pp. 1072-1104 ◽  
Author(s):  
Kenneth Maiese ◽  
Jinling Hou ◽  
Zhao Zhong Chong ◽  
Yan Chen Shang
Keyword(s):  
Oxidative Stress ◽  
Cell Biology ◽  
Cellular Proliferation ◽  
Clinical Care ◽  
Disease Onset ◽  
Cell Development ◽  
The Body ◽  
Treatment Regimens ◽  
Cellular Pathways ◽  
Novel Therapeutic Strategies

Oxidative stress significantly impacts multiple cellular pathways that can lead to the initiation and progression of varied disorders throughout the body. It therefore becomes imperative to elucidate the components and function of novel therapeutic strategies against oxidative stress to further clinical diagnosis and care. In particular, both the growth factor and cytokine erythropoietin (EPO), and members of the mammalian forkhead transcription factors of the O class (FoxOs), may offer the greatest promise for new treatment regimens, since these agents and the cellular pathways they oversee cover a range of critical functions that directly influence progenitor cell development, cell survival and degeneration, metabolism, immune function, and cancer cell invasion. Furthermore, both EPO and FoxOs function not only as therapeutic targets, but also as biomarkers of disease onset and progression, since their cellular pathways are closely linked and overlap with several unique signal transduction pathways. Yet, EPO and FoxOs may sometimes have unexpected and undesirable effects that can raise caution for these agents and warrant further investigations. Here we present the exciting as well as the complex role that EPO and FoxOs possess to uncover the benefits as well as the risks of these agents for cell biology and clinical care in processes that range from stem cell development to uncontrolled cellular proliferation.

scholarly journals Priorities for Rural Lymphoma Survivors: An Exploratory Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4789-4789
Author(s):  
Jackelyn B. Payne ◽  
Lillian Chen ◽  
Cathy D. Ho ◽  
Kaylin V. Dance ◽  
Andrew Ritter ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Rural Areas ◽  
Research Funding ◽  
Treatment Plan ◽  
Clinical Care ◽  
Eastern Cooperative Oncology Group ◽  
The State ◽  
The Body ◽  
Cancer Centers ◽  
Lymphoma Survivors

Abstract Background: Rural cancer patients, including those with lymphoma, have unique needs and barriers to care, including access to preventive and specialized care, economic resources, and proximity to supportive services. Research is needed to thoroughly understand these needs and propose solutions to health outcome disparities in these populations. Objective: We conducted a qualitative study with lymphoma survivors living in rural areas to: 1) determine perceived unmet needs regarding lymphoma care in rural areas and 2) examine views, understanding, and priorities for rural patients' participation in and education about therapeutic and non-therapeutic clinical research studies. Methods: We conducted 11 individual semi-structured phone interviews in the spring of 2018 with lymphoma survivors living in rural counties in the state of Georgia. Patients were identified by a home address in counties classified as rural based on Rural/Urban Commuting Areas (RUCAs), a categorization system used in the research community to classify rural and urban areas based on census track level data. Individual interview participants were recruited from regional patient education conferences and among current research participants at a university research hospital in the state of Georgia. Interviews were recorded and transcribed verbatim. Thematic analysis was used to identify themes emerging from these data. MAXQDA 18.0.8 qualitative data analysis software was utilized to facilitate a constant-comparative coding process to identify the resulting themes. Results: The greatest barrier to care expressed by the participants was distance. Interviewees had to frequently take time off of work and travel any time they needed to see a specialist or visit a cancer center in a larger city, often requiring several hours of travel by car. Many participants felt they were burdening their family and friends by relying on them for transportation. Rural lymphoma patients and caregivers described difficulty navigating between their local clinics and the larger cancer centers. Distance also was a barrier to attending educational events or support groups. Many participants were frustrated with their diagnosis experience at small clinics and regretted that they didn't seek the opinion of a specialist sooner. Some also felt that the team at their local clinic was not as knowledgeable about their treatment plan or its long-term effects. Although smaller, local clinics facilitated building relationships with the team and provider, there were drawbacks to relying on a local clinic, including lack of specialized providers and opportunities to participate in research. Communication between local and specialized clinics complicated the process, and participants had more difficulty contacting or seeking advice from the team at larger cancer centers. However, electing to receive treatment from specialized clinics farther away also had consequences. One solution agreed upon by nearly all of the participants was the use of technology to communicate. Participants were extremely supportive of online patient portals available at larger cancer centers which allowed them to more easily communicate with their clinical care team and helped them feel involved with their care, while educational or informative smartphone applications allowed them to access and streamline information that otherwise was not available in a rural area. Conclusion: These findings suggest that targeted research and interventions are necessary to address the specific needs of rural lymphoma survivors. To address the disparity in health outcomes that exists in this population, health care professionals and investigators can utilize these data to engage rural survivors in their treatment decision-making. In particular, the preference in this study population for using technological innovation to communicate contributes to the body of research regarding the significance technology has and can continue to have in lymphoma care. Disclosures Flowers: TG Therapeutics: Research Funding; Pharmacyclics: Research Funding; Denovo Biopharma: Consultancy; Gilead: Research Funding; Abbvie: Research Funding; Spectrum: Consultancy; Janssen Pharmaceutical: Research Funding; Burroughs Wellcome Fund: Research Funding; Karyopharm: Consultancy; Genentech/Roche: Consultancy; Bayer: Consultancy; Genentech/Roche: Research Funding; Millennium/Takeda: Research Funding; OptumRx: Consultancy; Celgene: Research Funding; Eastern Cooperative Oncology Group: Research Funding; Abbvie: Consultancy, Research Funding; BeiGene: Research Funding; Acerta: Research Funding; Pharmacyclics/ Janssen: Consultancy; Gilead: Consultancy; National Cancer Institute: Research Funding; V Foundation: Research Funding.

scholarly journals Potential drug interactions with statins: Estonian register-based study

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Maia Gavronski ◽  
Daisy Volmer ◽  
Sirpa Hartikainen ◽  
Alexander Zharkovsky
Keyword(s):  
Drug Interactions ◽  
National Level ◽  
Current Data ◽  
Insurance Fund ◽  
Prescription Database ◽  
Potential Drug ◽  
Treatment Regimens ◽  
Interaction Database ◽  
Reductase Inhibitors ◽  
Coa Reductase

AbstractIn Estonia, HMG-CoA reductase inhibitors are widely used to modify lipid levels but there are no current data on additional medicines prescribed alongside the statins. The aim of this study was to identify the frequency of potential clinically relevant interactions at a national level among an outpatient population treated with statins between January and June 2008, based on the prescription database of the Estonian Health Insurance Fund. This retrospective prevalence study included 203,646 outpatients aged 50 years or older, of whom 29,367 received statin therapy. The study analysed individuals who had used at least one prescription medicine for a minimum of 7 days concomitantly with statins. Potential drug interactions were analysed using Epocrates online, Stockley’s Drug Interactions, and the drug interaction database developed in Estonia. Statins metabolised by the CYP3A4 isoenzyme were prescribed to 64% of all statin users. Medicines known to have potentially clinically significant interactions with statins were prescribed to 4.6% of patients. The drugs prescribed concomitantly most often with simvastatin were warfarin (5.7%) and amiodarone (3.9%), whereas digoxin (1.2%) and ethinylestradiol (2%) were prescribed with atorvastatin. Potential interactions were not detected in the treatment regimens of rosuvastatin, pravastatin, and fluvastatin users.

Potentially (near) fatal asthma

2019 ◽  
Vol 40 (6) ◽  
pp. 403-405 ◽  
Author(s):  
Paul A. Greenberger
Keyword(s):  
Severe Asthma ◽  
Health Care Professionals ◽  
Rescue Therapy ◽  
Respiratory Acidosis ◽  
Acute Severe Asthma ◽  
Increased Risk ◽  
High Risk Type ◽  
Fatal Asthma ◽  
Long Acting ◽  
Near Fatal Asthma

Potentially (near) fatal asthma (PFA) defines a subset of patients with asthma who are at increased risk for death from their disease. The diagnosis of PFA should motivate treating physicians, health professionals, and patients to be more aggressive in the monitoring, treatment, and control of this high-risk type of asthma. A diagnosis of PFA is made when any one of the following are present: (1) a history of endotracheal intubation from asthma, (2) acute respiratory acidosis (pH < 7.35) or respiratory failure from acute severe asthma, (3) two or more episodes of acute pneumothorax or pneumomediastinum from asthma, (4) two or more episodes of acute severe asthma, despite the use of long-term oral corticosteroids and other antiasthma medications. There are two predominant phenotypes of near-fatal exacerbations: “subacute” exacerbation and “hyperacute” exacerbation. The best way to “treat” acute severe asthma is 3‐7 days before it occurs (i.e., at the onset of symptoms or change in respiratory function) and to optimize control of asthma by decreasing the number of symptomatic days and the days and/or nights that require rescue therapy and increasing baseline respiratory status in “poor perceivers.” PFA is treated with a multifaceted approach; physicians and health-care professionals should appreciate limitations of pharmacotherapy, including combination inhaled corticosteroid‐long-acting β-agonist products as well as addressing nonadherence, psychiatric, and socioeconomic issues that complicate care.

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