Pharmacology

They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

September 23, 2011
They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

By Santosh Vardhana, MD

A 36-year-old obese male with hypertension and hyperlipidemia presents to the ER with new knee pain, swelling, and erythema.  Joint aspiration reveals negatively birefringent crystals.  He is started on oral prednisone.

A 26-year-old woman with lupus presents to ER with edema, hematuria, and fevers.  On exam she hypertensive, febrile to 100.4C, and has periorbital and lower extremity edema.  Urine dipstick reveals 2+blood and protein.  She is started on IV methylprednisolone.

A 60-year-old man with HIV on HAART presents to the ER…

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Avastin and the Meaning of Evidence

September 9, 2011
Avastin and the Meaning of Evidence

By Antonella Surbone MD PhD and Jerome Lowenstein MD

The recent hearings at the Food and Drug Administration regarding the revocation of approval for the use of Avastin in the treatment of breast cancer bring into sharp focus several very important issues in medicine today.

The pharmaceutical industry, armed with powerful new tools for deciphering the signaling mechanisms and mutations responsible for the development and progression of malignancies, has developed new therapies for treating cancer and other malignancies. The cost of development of each new…

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More Pills, More Problems: The Polypill Revisited

August 3, 2011
More Pills, More Problems: The Polypill Revisited

By Jonathan Leventhal

Faculty Peer Reviewed

Polypharmacy has become an integral part of daily life for millions of chronically ill patients worldwide, and rightfully so. Evidence-based studies have repeatedly demonstrated that multiple drugs are required for optimal therapeutic management in chronic diseases including diabetes, hypertension, and heart disease. A typical patient with cardiovascular disease will likely be on aspirin, a statin, an ACE inhibitor, a diuretic, a calcium channel- or beta-blocker, and possibly antidiabetic medications. Cardiovascular disease is only one area in which effective…

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Low Dose Vitamin K Supplementation and Anticoagulation Control

July 21, 2011
Low Dose Vitamin K Supplementation and Anticoagulation Control

By Joanna Becker

Faculty Peer Reviewed

Patients who are placed on long-term warfarin (Coumadin) therapy are sent home with a lengthy list of restrictions to minimize variations in warfarin efficacy. The agents that can alter warfarin levels can be divided into 2 categories: (1) those that interact with cytochrome P450, which metabolizes warfarin and (2) those that alter phytonadione (vitamin K) levels.  The majority of inter- and intra-individual warfarin dose variability is attributable to the agents in category 1 above, which include everything from…

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Breaking News: FDA issues new dosing limitations for Simvastatin

June 10, 2011
Breaking News: FDA issues new dosing limitations for Simvastatin

By Saleem Ali, MD

The FDA has issued new warnings regarding the use of high dose Simvastatin. The FDA is now recommending that the 80mg dose only be used in patients who have been taking that dosage for at least 12 months with no signs of toxicity.  Patients who are currently on simvastatin and require more than 40 mg. should be considered for alternative lipid lowering therapy. The FDA is issuing this warning because recent data has shown that the 80 mg. dose has a…

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Resveratrol: The Modern Fountain of Youth?

February 9, 2011
Resveratrol: The Modern Fountain of Youth?

By Lee Rasamny

Faculty Peer Reviewed

For thousands of years, humans have been fascinated with the idea of slowing and perhaps even reversing the process of aging. From Ponce de León to modern research into substances like telomerase and resveratrol, philosophers, explorers, and scientists have dedicated countless hours to this pursuit.

Resveratrol, a substance found in the skin of red grapes and other plants such as eucalyptus, spruce, and lily, has developed a buzz for its hypothesized potential to slow the…

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The Polymyxins: Why am I using them all the time, and what are they?

December 8, 2010
The Polymyxins: Why am I using them all the time, and what are they?

By Jon-Emile S Kenny

Faculty Peer Reviewed

A 65-year-old female with locally advanced rectal cancer is admitted to the ICU, hypotensive and febrile.  Her PICC line is removed and blood cultures drawn.  Fourty-eight hours later all cultures return ESBL Klebsiella with susceptibility only to polymyxin.

I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘polymyxin’ like an endless antimicrobial mantra.  What strange dosing it has, and an even more…

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Kayexalate: What is it and does it work?

December 1, 2010
Kayexalate: What is it and does it work?

By Todd Cutler, MD

Faculty Peer Reviewed

A 62-year-old male is hospitalized with an acute congestive heart failure exacerbation. On hospital day three, the patient’s symptoms have significantly improved with twice daily furosemide 80mg IV. He is continued on IV diuretics and aggressive electrolyte repletion. On day five of his admission, his basic metabolic panel is significant for a creatinine of 2.3 mg/dL (increased from 1.3 on admission) and a potassium concentration of 5.9 mEq/L. His EKG is

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Proton Pump Inhibitors 2.0

November 26, 2010
Proton Pump Inhibitors 2.0

By Mary C. Whitman, MD

Faculty Peer Reviewed

Proton pump inhibitors (PPIs) are generally considered “safe” medications and are prescribed to over 100 million patients per year for a variety of indications, often for long durations. Recently, new data has emerged that suggests that we should be more judicious in prescribing PPIs.

In a recent development, the FDA announced that it will require new labeling of PPIs indicating that their use at high dosage and for prolonged…

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Clopidogrel (Plavix®) and Proton Pump Inhibitors: An Update on the Potential Drug Interaction

July 28, 2010
Clopidogrel (Plavix®) and Proton Pump Inhibitors: An Update on the Potential Drug Interaction

By Antony Q. Pham, Pharm.D. and Reena M. Tejura, Pharm.D.

Faculty Peer Reviewed

Recent publications have described a potential drug interaction between clopidogrel (Plavix®) and proton pump inhibitors (PPIs). Several retrospective studies have concluded that the use of PPIs can lower the effectiveness of clopidogrel and as a result, increase the possibility of cardiovascular events. Limited data from prospective trials have yet to show a clinical significance from this potential interaction. The Food and Drug Administration (FDA) released an…

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Antimicrobial Therapy Geared at Pseudomonas aeruginosa for Bronchiectasis

April 7, 2010
Antimicrobial Therapy Geared at Pseudomonas aeruginosa for Bronchiectasis

Diana Hubulashvili, Pharm.D.

Edited by Tania Ahuja, Pharm.D., BCPS

Faculty peer reviewed

Bronchiectasis is an uncommon condition that is characterized by irreversible dilation of the bronchi. Chronic pulmonary infections and airway inflammation cause bronchial damage through destruction of the muscular and elastic layer of the bronchial…

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When Clopidogrel Fails…

March 10, 2010
When Clopidogrel Fails…

Marisa Mizus

Faculty peer reviewed

Clopidogrel (Plavix) has been the standard of care for patients with coronary artery disease following percutaneous coronary intervention (PCI) for the past decade.  Although it is a successful antiplatelet treatment in many patients, like any hero, it has a weakness: formation of its active metabolite depends on two hepatic cytochrome P450 (CYP450)-dependent steps.  Clopidogrel resistance, or non-response, is correlated with an increased risk of major adverse cardiovascular events, including reinfarction and stent thrombosis.(1)  It…

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