4- Thursday Pharmacotherapy News – 21th October

1 – Evaluation of Delirium in Critically Ill Patients Prescribed Melatonin or Ramelteon

• An impaired sleep-wake cycle may be one factor that affects the development of delirium in critically ill patients.
• Several small studies suggest that exogenous melatonin or ramelteon may decrease the incidence and/or duration of delirium.
• This study aims to compare the effect of prophylactic administration of melatonin, ramelteon, or no melatonin receptor agonist on the development of delirium in the intensive care unit (ICU).
• Therapy with melatonin, ramelteon, and no melatonin receptor agonist resulted in similar rates of delirium in a mixed ICU population.
• Despite significant differences in agitation, sedation, and medication utilization, there was no differences in the clinical outcomes evaluated.

Source: SAGE Journal

2 – Impact of Intravenous Methadone Administered Intraoperatively on Postoperative Opioid Utilization

• Studies have shown that intravenous methadone intraoperatively can reduce opioid usage postoperatively.
• This study’s purpose was to evaluate the effect of intravenous methadone on postoperative opioid use.
• Intravenous methadone intraoperatively did not show a significant reduction in postoperative opioid use and discharge prescription MMEs when comparing all patients; however, benefit was seen when examining opioid-naïve patients.

Source: SAGE Journals

3 – Use of Pediatric Injectable Medicines Guidelines and Associated Medication Administration Errors: A Human Reliability Analysis

• In a recent human reliability analysis (HRA) of simulated pediatric resuscitations, ineffective retrieval of preparation and administration instructions from online injectable medicines guidelines was a key factor contributing to medication administration errors (MAEs).
• The aim of the present study was to use a specific HRA to understand where intravenous medicines guidelines are vulnerable to misinterpretation, focusing on deviations from expected practice (discrepancies) that contributed to large-magnitude and/or clinically significant MAEs.
• Discrepancies during the use of an online injectable medicines guideline were often associated with subsequent MAEs, including those with potentially significant consequences.
• This highlights the need to test the usability of guidelines before clinical use.

Source: SAGE Journals

4- Evaluation of Dipeptidyl Peptidase-IV Inhibitor Use in Hospitalized Patients With Diabetes

• Glycemic control within goal blood glucose (BG) ranges is essential to minimize hospital complications for patients with type 2 diabetes mellitus (T2DM). Optimal treatment in the non–intensive care unit (ICU) setting includes a basal insulin containing regimen. Dipeptidyl peptidase-IV (DPP-IV) inhibitors have minimal hypoglycemia incidence and may be an appropriate bolus insulin replacement in the inpatient setting.
• This study aims to determine the effect of basal insulin plus DPP-IV inhibitor compared with basal plus bolus insulin in hospitalized patients with T2DM.
• A significant difference in mean daily BG and hospital LOS was found with a basal insulin plus DPP-IV inhibitor regimen.
• Use of a DPP-IV inhibitor to replace bolus insulin in hospitalized patients with T2DM should be considered.

Source: SAGE Journals

5 – Oseltamivir-Associated Bradycardia in Critically Ill Patients

• Oseltamivir is frequently administered to critically ill patients with presumed influenza. It may modulate Na+, K+, and Ca2+ channels to produce bradycardia.
• This study aims to evaluate the association between oseltamivir and bradycardia in critically ill patients and assess parameters associated with bradycardia.
• Oseltamivir was associated with clinically relevant bradycardia in critically ill patients.
• Clinicians should closely monitor HR in critically ill patients receiving oseltamivir.

Source: SAGE Journals

6 – The Impact of Body Weight and Renal Function on the Risk of Bleeding With Direct Oral Anticoagulants in Atrial Fibrillation

• Atrial fibrillation (AF) increases the risk of stroke and direct oral anticoagulants (DOACs) are first-line agents for prevention. Gaps in the literature cause reluctance in prescribing DOACs for patients with renal dysfunction and/or extremes in body weight.
• This study aims to evaluate the impact body weight and renal function have on major and clinically relevant nonmajor (CRNM) bleeding events and ischemic strokes in AF patients receiving a DOAC.
• This study demonstrates an association between higher baseline SCr, elevated HASBLED score, and lower weight, with an increased risk of bleeding in patients with NVAF or AFL receiving a DOAC.
• These findings add to prescribing considerations when initiating DOACs. Closer monitoring is advised for patients with significant renal dysfunction and/or low body weight, even with renal dose adjustments.

Source: SAGE Journals

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