4- Thursday Pharmacotherapy News – 9th December

1 – Creatinine Assessment in Non–Steady-State Conditions: A Critical Review

• This study aims to discuss methods for the assessment of creatinine clearance (Clcr) when serum creatinine (SCr) is not at steady state in order to estimate kidney function and apply the estimate to kidney function staging for clinical assessment or drug dosing.
• The methods for kinetic clearance estimation and standards methods for clearance estimation, such as the Cockcroft-Gault equation, are mutually exclusive.
• There are no benefits of using the kinetic method in patients with stable SCr concentrations, and standard equations are not appropriate with unstable SCr concentrations.

Source: SAGE Journal

2 – Safety and Efficacy of Non–Vitamin K Oral Anticoagulant Use Early After Cardiac Surgery: A Systematic Review

• This study aims to determine the safety and efficacy of non–vitamin K oral anticoagulants (NOACs) initiated early after cardiac surgery.
• Overall, NOACs were used in 26% to 37.5% of patients early after cardiac surgery. Starting a NOAC on postoperative day 4 appeared to have similar bleeding rates compared with warfarin, but clinical application is limited by heterogeneity of outcome definitions, confounding, and bias.
• There is limited evidence to guide NOAC use early after cardiac surgery.
• Three ongoing randomized trials will add to the literature and provide guidance for clinicians on whether, in whom, when, and how to use NOACs safely early after cardiac surgery.

Source: SAGE Journal

3 – Pharmacogenomics in Pain Management: A Review of Relevant Gene-Drug Associations and Clinical Considerations

• This study aims to provide an overview of clinical recommendations regarding genomic medicine relating to pain management and opioid use disorder.
• A literature review was conducted using the search terms pain management, pharmacogenomics, pharmacogenetics, pharmacokinetics, pharmacodynamics, and opioids on PubMed.
• A one-size-fits-all approach to pain management is inadequate and outdated.
• With increasing genomic data and pharmacogenomic understanding, patient-specific genomic testing offers a comprehensive and personalized treatment alternative worthy of additional research and consideration.

Source: SAGE Journal

4- Conversion From Continuous Infusion Fentanyl to Continuous Infusion Hydromorphone in the Pediatric Intensive Care Unit

• Opioid rotations from fentanyl to hydromorphone may reduce opioid/sedative exposure in critically ill children.
• The primary objective was to determine the conversion percentage from fentanyl to hydromorphone infusions using equianalgesic conversions.
• Secondary objectives included identification of the median time and hydromorphone rate at stabilization.
• Additional outcomes included a comparison of opioid/sedative requirements on the day of conversion versus the three 24-hour periods prior to conversion.
• A median 14% fentanyl dose reduction was noted when transitioning to hydromorphone. Further exploration is needed to determine if opioid rotations with hydromorphone can reduce opioid/sedative exposure.

Source: SAGE Journal

5 – Reports of myocarditis and pericarditis following mRNA COVID-19 vaccines: A systematic review of spontaneously reported data from the UK, Europe, and the US and of the literature

• This study aims to bring together spontaneously reported data from around the world to estimate the reporting rate in different countries and better understand the risk factors for myocarditis and pericarditis following exposure to COVID-19 mRNA vaccines.
• This study provides evidence that younger vaccinees more frequently report myocarditis and pericarditis following mRNA COVID-19 vaccines compared with older vaccinees.
• These events had mild clinical course followed by full recovery in most cases. Results from published literature supported the results of our analyses.

Source: MedRxiv

6 – Probing Gut-Brain Links in Alzheimer’s disease with Rifaximin

• Gut-microbiome-inflammation interactions have been linked to neurodegeneration in Alzheimer’s disease (, theyAD) and other disorders.
• In this study hypothesized that treatment with rifaximin, a minimally absorbed gut-specific antibiotic, may modify the neurodegenerative process by changing gut flora and reducing neurotoxic microbial drivers of inflammation.
• This pilot study revealed that rifaximin, a minimally absorbed, gut-specific antibiotic, reduced surrogate markers of neurodegeneration while increasing, potentially beneficial, microbiota in phylum Firmicutes.
• These data provide initial support to the hypothesis that microbiome related products may play a role in neurodegenerative disorders.

Source: MedRxiv

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