Hypertensive Crisis in the Setting of Non-Compliance

Hypertensive crisis is defined as severe hypertension with a blood pressure of greater than 180/120 mmHg, and may be further classified as urgency or emergency. Hypertensive urgency occurs over days to weeks, whereas hypertensive emergency occurs in hours to days and the patient presents with evidence of end organ damage. Patients of any age may present with hypertensive crisis, common etiologies include undiagnosed hypertension, noncompliance with therapy or inadequate therapy. Timely assessment of the patient is important and should include appropriate measurement of blood pressure, a thorough history and physical, and laboratory testing to evaluate for end organ damage. Antihypertensive agents utilized in the setting of hypertensive emergency should be short acting and easy titratable, with examples including labetalol, esmolol, nitroprusside, nitroglycerin, fenoldopam, and nicardipine. The patient may be switched to oral therapy once there is stable blood pressure control and there are no longer signs or symptoms of end organ damage. Selection of oral therapy and goal blood pressure is dependent upon patient characteristics such as age, race and co-morbidities

Safety and Efficacy of Ceftaroline Fosamil in the Management of Community-Acquired Bacterial Pneumonia

Ceftaroline fosamil is a new fifth-generation cephalosporin indicated for the treatment of community-acquired bacterial pneumonia (CABP). It possesses antimicrobial effects against both Gram-positive and Gram-negative bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), but not against anaerobes. Organisms covered by this novel agent that are commonly associated with CABP are Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, and Klebsiella pneumoniae; however, ceftaroline fosamil lacks antimicrobial activity against Pseudomonas and Acinetobacter species. FOCUS 1 and FOCUS 2 clinical trials evaluated the use of ceftaroline fosamil in the treatment of CABP as compared to ceftriaxone. These non-inferiority trials provided evidence that ceftaroline fosamil is as effective and safe as ceftriaxone in the treatment of CABP. As its role in the treatment has not been well established, ceftaroline fosamil should be reserved for patients at high risk for multidrug-resistant organisms (MDROs). This review summarizes ceftaroline fosamil\u27s pharmacokinetic and pharmacodynamic profile, clinical efficacy and safety, and place in therapy for the treatment and management of CABP

Pramlintide in the Management of Obesity

Obesity is a common problem that can lead to numerous comorbid conditions, including Type 2 diabetes. Currently, there are few pharmacologic options available to help obese patients lose weight. Pramlintide is an injectable, amylin analogue that is indicated in patients with Type 1 and Type 2 diabetes for use in conjunction with insulin to improve glycemic control. In addition to helping patients decrease hemoglobin A1c levels, pramlintide has also been shown to minimize weight gain, especially in patients with Type 2 diabetes. Studies have been conducted in various patient types, including those patients without diabetes, and the drug tends to have a positive effect on weight loss. It appears that the drug is well tolerated in patients without diabetes; however, current studies have been conducted in small patient populations. Additional research needs to be carried out to determine if the drug is a viable option for obese patients who have failed to respond to other weight loss products

Review of telehealth interventions for childhood obesity in minority, low-income or underserved populations: Opportunity for pharmacists

There has been a steady increase in childhood obesity, comparable to that seen in adults, over the past decade with the incidence almost tripling. As seen in adults, there are trends in discrepancy among gender, ethnicity, race, and underserved populations in the incidence of childhood obesity. Effective interventions for childhood obesity need to be broad including both diet and exercise, but there is little evidence on the most effective approach. The use of telehealth interventions to treat childhood obesity in ethnic, low-income, and underserved populations could be an effective platform. The pharmacist is a health care professional that is easily accessible to these populations and can assist with lifestyle modification counseling for weight loss. The purpose of this review is to summarize and evaluate the effectiveness of telehealth modalities on weight loss in overweight/obese children identified as minority, low-income, or underserved populations. The review found there were many different forms of telehealth interventions utilized which may have influenced the success of evaluated outcomes. The majority of modalities did not improve BMI or BMI z-score when not accompanied by a form of real-time intervention. Studies, where telehealth was accompanied by motivational coaching, did show a significant decrease in BMI and/or BMI z-score

Pharmacotherapy Options in the Treatment of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that is characterized by frequent episodes of snoring and a cessation in breathing for greater than 10 seconds, resulting in disrupted sleep.1 It has an estimated prevalence of 3% to 7% in males, 2% to 5% in females, and up to 78% in morbidly obese patients. OSA results from decreased motor tone of either the tongue or airway dilator muscles, causing complete or partial obstruction of the upper airway during sleep. Patients with OSA frequently suffer from daytime sleepiness and reduced quality of life, as well as cardiac, metabolic, and psychiatric disorders. OSA affects people of all ages and is most prominent in middle-aged obese males, with a higher incidence as age increases. Obesity is the primary risk factor and contributes to the other disorders commonly diagnosed in this population

Diabetes-Related Medication-Induced Hypoglycemia

Hypoglycemia is a common adverse event in patients with both type 1 and type 2 diabetes and may be a barrier to patients achieving tight glycemic control. It is diagnosed either biochemically, as a blood glucose value, or clinically based on symptoms caused by an autonomic response to changes in blood glucose. Patients that experience repeated episodes of hypoglycemia lose the counterregulatory response that produces symptoms and results in hypoglycemia unawareness. Medications account for the most frequent cause of hypoglycemia in both the inpatient and outpatient setting. Treatment of hypoglycemia may be accomplished via the oral or parenteral route with 15 to 20 g of carbohydrate. Following treatment of the episode, it is important to evaluate for the cause and, if medication related, adjust the patient’s treatment regimen

Diabetes-Related Medication-Induced Hypoglycemia

Hypoglycemia is a common adverse event in patients with both type 1 and type 2 diabetes and may be a barrier to patients achieving tight glycemic control. It is diagnosed either biochemically, as a blood glucose value, or clinically based on symptoms caused by an autonomic response to changes in blood glucose. Patients that experience repeated episodes of hypoglycemia lose the counterregulatory response that produces symptoms and results in hypoglycemia unawareness. Medications account for the most frequent cause of hypoglycemia in both the inpatient and outpatient setting. Treatment of hypoglycemia may be accomplished via the oral or parenteral route with 15 to 20 g of carbohydrate. Following treatment of the episode, it is important to evaluate for the cause and, if medication related, adjust the patient’s treatment regimen

Evidence-Based Acute Bronchitis Therapy

Acute bronchitis is a disease characterized by inflammation of the large airways within the lung accompanied by a cough lasting from 1 to 3 weeks. The inflammation occurs as a result of an airway infection or environmental trigger, with viral infections accounting for an estimated 89% to 95% of cases. Symptomatic treatment of cough is primarily required for patients, though in most cases the condition is self-limiting. Therapy consists of both nonpharmacological and pharmacological options to include antibiotics and antivirals, antitussive agents, protussive agents, and beta-2-agonists. This article reviews the treatment options for acute bronchitis and recommends criteria for use

Combination Pharmacotherapy in the Treatment of Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a disorder of the small pulmonary arteries characterized by progressive fibrotic and proliferative changes that result in an increased pulmonary vascular resistance. It is a progressive and debilitating disease that leads to right ventricular dysfunction, impairment in activity tolerance and eventually right-sided heart failure, and premature death. The treatment goals for PAH include improvement in symptoms, improvement in functional class and exercise class, decreased morbidity, and preventing mortality. Combination therapy in the treatment of PAH is an emerging therapeutic option. Combining therapies with differing mechanisms of action will maximize therapeutic benefits such as symptom control and increased rate of survival. The updated 2007 American College of Chest Physicians evidence-based clinical practice guidelines recommend combination therapy in functional classes III and IV if there is no improvement with current therapy or if there is deterioration in class. PAH monotherapy has been shown to improve symptoms, but the patients’ hemodynamic parameters may not be normalized, leading to further pulmonary vascular remodeling. Combination therapy offers an additional option for those patients who are unable to stabilize on monotherapy

Complementary and Alternative Medicines for the Treatment of Diabetes

There is a growing interest among diabetic patients in the role of complementary and alternative medicine (CAM) in controlling blood sugar and prevention of complications. It is being used among diabetic patients in addition to usual medical treatment and lifestyle modifications. Complementary and alternative medicine products are marketed for the treatment of diabetic complications and lowering of blood glucose, but the actual therapeutic role remains controversial due to lacking information regarding safety and efficacy. The majority of evidence for the use of CAM is as an adjunctive therapy to the patient’s current diabetic regimen. Trials have shown CAM to be effective for diabetes treatment, but further rigorous study is needed to establish safety, efficacy, and the exact mechanism of action. As the use of CAM increases among the diabetic population, there is a need for patients to communicate with health care professionals to educate them about the safety and efficacy of alternative therapy