Drug Interaction Study Of Apixaban With Cyclosporine Or Tacrolimus: Results From A Phase 1, Randomized, Open-Label, Crossover Study In Healthy Volunteers

BACKGROUND Solid organ transplant recipients commonly require anticoagulation. Apixaban (APX) is principally metabolized by CYP3A4, undergoes direct intestinal excretion, and is a substrate to P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) transporters. We examined the potential drug interaction between cyclosporine (CsA) and tacrolimus (Tac) [combined inhibitors of CYP3A4, P-gp and, BCRP] with APX.https://jdc.jefferson.edu/petposters/1005/thumbnail.jp

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Population Pharmacokinetic and Pharmacodynamic Analysis of Buprenorphine for the Treatment of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a condition affecting newborns exposed to an opioid in utero. Symptoms of NAS include excessive crying, poor feeding, and disordered autonomic control. Up to 2/3 of infants will require pharmacologic therapies to reach symptom control. Opioids including morphine and methadone are the current first-line treatments. Buprenorphine is being investigated as a treatment of NAS. The purpose of this analysis was to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of BUP in infants with NAS. Poster presented at American Society for Clinical Pharmacology and Therapeutics (ASCPT) 2017 Annual Meeting, March 15-18, 2017 in Washington DC.https://jdc.jefferson.edu/petposters/1004/thumbnail.jp

Ethanol Pharmacokinetics in Neonates and Infants

Introduction: Ethanol has been used for years in neonatal and infant liquid medications, yet the pharmacokinetics, pharmacodynamics, and safety of ethanol in this vulnerable population have not been well characterized. The purpose of this review is to raise awareness of ethanol use as an excipient in neonatal and infant medications and to provide insight, based on the available evidence, into clearance rates of ethanol in babies. We also discuss ethanol pharmacokinetics in adults, theoretical pharmaco-kinetic changes in neonates and infants as it may apply to ethanol disposition, and case reports involving ethanol exposure in neonates and infants. Materials and methods: This study was a narrative review in which relevant papers were selected using databases and scientific search engines such as PubMed with the key words ethanol, infant, and newborn infant. Results: It remains unclear what ethanol exposure is safe for neonates and infants. The Food and Drug Administration and American Academy of Pediatrics have both taken action, by either setting limits of ethanol content in over-the-counter medications or by recommending restricted exposure to ethanol- containing pediatric formulations. Conclusions: Until the short- and long-term health effects of chronic ethanol administration can be further characterized, ethanol-containing medications should be used with caution

Towards More Practical Linear Programming-based Techniques for Algorithmic Mechanism Design

R. Lavy and C. Swamy (FOCS 2005, J. ACM 2011) introduced a general method for obtaining truthful-in-expectation mechanisms from linear programming based approximation algorithms. Due to the use of the Ellipsoid method, a direct implementation of the method is unlikely to be efficient in practice. We propose to use the much simpler and usually faster multiplicative weights update method instead. The simplification comes at the cost of slightly weaker approximation and truthfulness guarantees

Impact of Preadmission Beta-blocker Use on Cardiac Abnormalities and In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage

Introduction: Various cardiac abnormalities, including dysrhythmias, left ventricular (LV) dysfunction, and myocardial injury, are commonly seen after subarachnoid hemorrhage (SAH). In patients taking a beta-blocker (BB) chronically, the medication is generally discontinued after hospitalization due to the concern of compromising cerebral perfusion. We hypothesized that sudden BB discontinuation might inadvertently lead to an increased incidence of composite cardiac abnormalities and higher in-hospital mortality in patients presenting with nontraumatic SAH

A 73-Year-Old Female With Palpitations

Background Atrial fibrillation is a commonly encountered clinical problem. Although a large percentage of patients have no dearly identifiable precipitant, secondary atrial fibrillation is a well-documented clinical entity.\u27 Case presentation A 73-year-old female with a history of obstructive sleep apnea, hypertension, and chronic obstructive pulmonary disease presents with complaints of intermittent palpitations, substernal squeezing chest pressure, and shortness ofbreath for two weeks. Her most recent episode occurred on the bus, prompting her to come to the emergency room for evaluation. Further questioning revealed mild weight loss and diarrhea over the prior few weeks. Home medications included amlodipine, baby aspirin, albuterol as needed, and ciprofloxacin for a recently diagnosed URI

The Impact of Community Use of Novel Oral Anticoagulants on an Academic Medical Center

Warfarin has been a mainstay of therapy for treatment and prevention of venous thromboembolic disease (VTED) and prevention of stroke and systemic embolism for over 50 years. Recent FDA approval of several novel oral anticoagulants has offered more extensive treatment options for management of these disease states. The availability of the novel anticoagulants offers an attractive alternative to warfarin therapy for patients due to their convenience of use. In comparison to warfarin, dabigatran, rivaroxaban and apixaban offer: - a fixed dosage regimen - a relatively small potential drug interaction profile - minimal laboratory monitoring - little to no dietary restrictions. Although these agents offer a relatively fixed dose regimen, dosage adjustment is required in moderate renal dysfunction, and use is contraindicated in severe renal dysfunction. Currently there are no specific reversal agents in the event of a nov- el anticoagulant associated bleed. These concerns led to the development of an anticoagulation stewardship program at our institution to monitor and guide the usage of these agents

Mixing along the Red Giant Branch in Metal-poor Field Stars

We have determined Li, C, N, O, Na, and Fe abundances, and 12C/13C isotopic ratios for a sample of 62 field metal-poor stars (plus 43 taken from the literature). This large sample was used to show that small mass lower-RGB stars (i.e., fainter than the RGB bump) have abundances of light elements in agreement with theoretical predictions from classical evolutionary models. A second, distinct mixing episode occurs just after the RGB bump, reaching regions of incomplete CNO burning. No O-Na anticorrelation, as observed in globular cluster stars, is found in field stars. This means that the mixing episode is not deep enough to reach regions where ON-burning occurs.Comment: 6 pages, 3 encapsulated figures, LateX, uses crckapb.sty; invited talk, in "The Chemical Evolution of the Milky Way: Stars vs Clusters, Vulcano (Italy), 20-24 September 1999, F. Matteucci and F. Giovannelli eds, Kluwer, in pres