The Annals of pharmacotherapy
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Review
Tofacitinib: The First Janus Kinase (JAK) inhibitor for the treatment of rheumatoid arthritis.
To review the pharmacology, pharmacokinetics, efficacy and safety, dosage administration, and adverse effects of tofacitinib for rheumatoid arthritis (RA) treatment. ⋯ Tofacitinib is an oral treatment option for RA patients who have inadequate response or intolerance to methotrexate. Postmarket surveillance will provide further insight to tofacitinib's role in RA therapy, especially in patients who may require different types of combination therapy with DMARDS.
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To review pharmacokinetic and pharmacodynamic drug-drug interactions (DDIs) involving new oral anticoagulants for atrial fibrillation. ⋯ Awareness of drugs that alter the function of the P-gp efflux transporter protein and CYP3A4 enzymes and provide additive effects should enable prescribers to anticipate and avoid potential DDIs involving the new oral anticoagulants. To this end, briefing documents and prescribing information have applied cautionary measures for individuals treated with these newer anticoagulants.
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Pharmacy practice studies have been criticized for presenting poor intervention description, which has serious implications when attempting to replicate interventions elsewhere. Evidence of improved outcomes for patients with chronic kidney disease (CKD) following pharmacist intervention exist in the literature, but similar concerns with intervention description have been raised. ⋯ Information contained in most articles reporting pharmacist interventions in CKD is not sufficient to ensure the implementation of the service in clinical practice. Pharmacy practice research articles should be written with the aim of improving clinical practice and not just showing the results of pharmacists' interventions.
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Medication-related harm can be detected using the adverse drug event (ADE) trigger tool and the medication module of the Global Trigger Tool (GTT) developed by the Institute for Healthcare Improvement (IHI). In recent years, there has been some controversy on the performance of this method. In addition, there are limited data on the performance of the medication module of the GTT as compared with the ADE trigger tool. ⋯ Applying the trigger tool method proposed by the IHI to a Belgian hospital led to the identification of one ADE out of 4 admissions. To increase performance, refining the list of triggers in the ADE trigger tool and in the medication module of the GTT would be needed. Recording nontriggered events should be encouraged.
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Refractory status epilepticus (RSE) requires aggressive management with multiple antiepileptic drugs (AEDs) often requiring the initiation of continuous infusions of propofol, midazolam, or pentobarbital to achieve adequate control in addition to intermittent agents. Ketamine has been implicated in several case reports as a successful agent for treating RSE given that it blocks the N-methyl-D-aspartate receptor, which is overexpressed in prolonged status epilepticus. ⋯ This is the first case report to describe a successful transition to a ketamine infusion in a patient with AHS and transaminitis.