Showing posts with label Clinical. Show all posts
Showing posts with label Clinical. Show all posts

Correlation of weight-based i.v. immune globulin doses with changes in serum immunoglobulin G levels Society Logo Skip to main page content

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Correlation of weight-based i.v. immune globulin doses with changes in serum immunoglobulin G levels Collin R. Anderson? and Jared A. Olson
Collin R. Anderson, Pharm.D., Ph.D., BCPS, is Clinical Pharmacist; and Jared A. Olson, Pharm. D., BCPS, is Infectious Disease Stewardship Pharmacist, Department of Pharmacy, Primary Children’s Hospital, Salt Lake City, UT. Address correspondence to Dr. Anderson (collin.anderson{at}imail.org). Abstract Purpose Correlations between the i.v. immune globulin (IVIG) dose and the change in serum immunoglobulin G (IgG) concentration with three methods of weight-based dosing were investigated.

Methods A retrospective medical records review was conducted to identify patients in a multicenter healthcare system who received IVIG over a 10-year period and had serum IgG measurements within two days before and two days after the date of IVIG administration. For each of the 11 adults and 7 adolescents identified, the relationship between the weight-based dose of IVIG (determined using actual body weight [BW], adjusted BW, or ideal BW [IBW]) and the resulting change in serum IgG was evaluated. Correlation coefficients and corresponding p values for the three dosing methods were calculated and compared.

Results Among adult patients, the correlation of IVIG dose and postdose change in serum IgG was strongest with dosing by IBW (correlation coefficient [r], 0.83 [p < 0.05] versus r values of 0.73 and 0.70 for dosing by adjusted BW or actual BW, respectively [p = 0.05 for both]); the corresponding r values in adolescent patients were 0.99, 0.99, and 0.95, respectively (p < 0.005 for all). There were no statistically significant differences between the r values calculated for the three weight-based dosing methods in either adults or adolescents.

Conclusion In adult patients, the correlation between the dose of IVIG and the change in IgG level was strongest when doses were calculated using IBW; comparable degrees of correlation were observed with the three evaluated methods of weight-based dosing in the adolescent population.

Copyright ? 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved. Add to CiteULikeCiteULike Add to DeliciousDelicious Add to DiggDigg Add to FacebookFacebook Add to Google+Google+ Add to RedditReddit Add to TwitterTwitter What's this?

? Previous | Next Article ? Table of Contents This Article doi: 10.2146/ajhp140171 American Journal of Health-System Pharmacy February 15, 2015 vol. 72 no. 4 285-289 ? Abstract Full Text Full Text (PDF) Classifications Print Content Clinical Report Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eLetters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager eLetters Submit an eLetter No eLetters published Citing Articles Load citing article information Google Scholar Articles by Anderson, C. R. Articles by Olson, J. A. PubMed PubMed citation Articles by Anderson, C. R. Articles by Olson, J. A. Related Content Load related web page information Social Bookmarking Add to CiteULikeCiteULike Add to DeliciousDelicious Add to DiggDigg Add to FacebookFacebook Add to Google+Google+ Add to RedditReddit Add to TwitterTwitter What's this?

Current Issue February 15, 2015, 72 (4) Current Issue Alert me to new issues of American Journal of Health-System Pharmacy From the Cover RhOD immune globulin products for prevention of alloimmunization during pregnancy Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients Economic burden of recurrent venous thromboembolism: Analysis from a U.S. hospital perspective Comparative analytics of infusion pump data across multiple hospital systems ABOUT AJHP SUBSCRIPTIONS FOR AUTHORS/REVIEWERS PERMISSION REQUESTS ADVERTISING EMAIL ALERTS (FREE) Email Alerts (Free) RSS FEEDS (FREE) RSS Feeds (Free) HELP CONTACT US/FEEDBACK American Society of Health System Pharmacists Learning Center (CE) Store Meetings & Conferences ASHP Foundation MOST READ ARTICLES (Last 30 Days) Clinical practice guidelines for antimicrobial prophylaxis in surgery Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists How to write a patient case report Treatment of poisoning caused by {beta}-adrenergic and calcium-channel blockers ? View all Most Read articles Advertisement ? 2015 by the American Society of Health-System Pharmacists. Terms of Use | Copyright Online ISSN: 1535-2900 Print ISSN: 1079-2082

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RhOD immune globulin products for prevention of alloimmunization during pregnancy Society Logo Skip to main page content

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RhOD immune globulin products for prevention of alloimmunization during pregnancy Samuel L. Aitken and Eric M. Tichy?
Samuel L. Aitken, Pharm.D., BCPS, is Clinical Pharmacy Specialist in Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Senior Clinical Pharmacy Specialist, Solid Organ Transplantation, and Director, Postgraduate Year 2 Residency, Department of Pharmacy Services, Yale–New Haven Hospital, New Haven, CT. Address correspondence to Dr. Tichy (eric.tichy{at}ynhh.org). Abstract Purpose The pharmacologic properties of Rhesus (Rh) immune globulin (RhIG) and clinical data on its effectiveness in preventing Rh-antigen alloimmunization in pregnant women are reviewed.

Summary RhIG is a human plasma derivative that targets red blood cells (RBCs) positive for RhO antigen (also called D antigen). In the United States and other countries, the widespread use of RhIG has markedly reduced the occurrence of hemolytic disease of the fetus and newborn (HDFN), a devastating condition caused by D-antigen sensitization of a pregnant woman via exposure to fetal RBCs (usually during detachment of the placenta in labor) that results in a maternal immune response leading to severe hemolysis in the fetus. Routine administration of RhIG at 26–30 weeks’ gestation and again within 72 hours of delivery has been shown to be highly effective in preventing maternal Rh alloimmunization, with very low rates of D-antigen sensitization (in the range of 0–2.2%) reported in multiple studies of at-risk women. The four RhIG products currently available in the United States have common clinical indications but differ in certain attributes. Pharmacists can play an important role in guiding other clinicians on the rationale for the use of RhIG, important differences between products, and appropriate timing of RhIG therapy.

Conclusion Routine administration of RhIG to women at risk for Rh alloimmunization is clinically effective and has made HDFN a rare clinical event. The available RhIG products are not the same and should be carefully reviewed to ensure that they are administered safely.

Copyright ? 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved. Add to CiteULikeCiteULike Add to DeliciousDelicious Add to DiggDigg Add to FacebookFacebook Add to Google+Google+ Add to RedditReddit Add to TwitterTwitter What's this?

? Previous | Next Article ? Table of Contents This Article doi: 10.2146/ajhp140288 American Journal of Health-System Pharmacy February 15, 2015 vol. 72 no. 4 267-276 ? Abstract Full Text Full Text (PDF) Classifications Print Content Clinical Review Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eLetters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager eLetters Submit an eLetter No eLetters published Citing Articles Load citing article information Google Scholar Articles by Aitken, S. L. Articles by Tichy, E. M. PubMed PubMed citation Articles by Aitken, S. L. Articles by Tichy, E. M. Related Content Load related web page information Social Bookmarking Add to CiteULikeCiteULike Add to DeliciousDelicious Add to DiggDigg Add to FacebookFacebook Add to Google+Google+ Add to RedditReddit Add to TwitterTwitter What's this?

Current Issue February 15, 2015, 72 (4) Current Issue Alert me to new issues of American Journal of Health-System Pharmacy From the Cover RhOD immune globulin products for prevention of alloimmunization during pregnancy Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients Economic burden of recurrent venous thromboembolism: Analysis from a U.S. hospital perspective Comparative analytics of infusion pump data across multiple hospital systems ABOUT AJHP SUBSCRIPTIONS FOR AUTHORS/REVIEWERS PERMISSION REQUESTS ADVERTISING EMAIL ALERTS (FREE) Email Alerts (Free) RSS FEEDS (FREE) RSS Feeds (Free) HELP CONTACT US/FEEDBACK American Society of Health System Pharmacists Learning Center (CE) Store Meetings & Conferences ASHP Foundation MOST READ ARTICLES (Last 30 Days) Clinical practice guidelines for antimicrobial prophylaxis in surgery Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists How to write a patient case report Treatment of poisoning caused by {beta}-adrenergic and calcium-channel blockers ? View all Most Read articles Advertisement ? 2015 by the American Society of Health-System Pharmacists. Terms of Use | Copyright Online ISSN: 1535-2900 Print ISSN: 1079-2082

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Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients Society Logo Skip to main page content

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Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients Catherine A. Pennington and Jeong M. Park?
Catherine A. Pennington, M.S., Pharm.D., BCPS, is Clinical Hospital Pharmacist, Jackson Memorial Hospital, Miami, FL. Jeong M. Park, M.S., Pharm.D., BCPS, is Clinical Pharmacist Specialist, University of Michigan Hospitals and Health Centers, Ann Arbor, and Clinical Associate Professor, College of Pharmacy, University of Michigan, Ann Arbor. Address correspondence to Dr. Park (jeongp{at}med.umich.edu). Abstract Purpose Available data regarding sublingual tacrolimus were analyzed to provide recommendations for solid organ transplant recipients.

Summary Tacrolimus is an immunosuppressive agent with a narrow therapeutic range that is commonly used in solid organ transplantation. Achieving and maintaining appropriate tacrolimus exposure are critical for preventing rejection and minimizing toxicity. A variety of clinical situations requiring nonoral medication delivery arise, presenting the need for reliable alternative routes of tacrolimus administration. A review of the currently available literature revealed nine reports of sublingual tacrolimus use in human subjects. Seven reported that sublingual administration could achieve comparable tacrolimus trough concentrations to oral administration, but none investigated the correlation between tacrolimus trough concentration and exposure. One study of lung transplant recipients found that approximately 50% of the oral dose was needed to obtain therapeutic trough concentrations when converted to sublingual administration. Another study of patients with end-stage renal disease identified a similar sublingual:oral dosing ratio of 1:2. When converted from oral tacrolimus in combination with clotrimazole to sublingual administration, the sublingual:oral dosing ratio was 1:1.

Conclusion In addition to enteral tube and i.v. tacrolimus dosing, sublingual administration may be considered for short-term use in patients who are unable to receive medications orally. Based on the available data, it is reasonable to initiate sublingual tacrolimus at 50% of the current or anticipated oral dose in the absence of interacting medications. Dosing must be individualized, taking into consideration concomitant interacting medications, and adjusted to target levels based on therapeutic drug monitoring.

Copyright ? 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved. Add to CiteULikeCiteULike Add to DeliciousDelicious Add to DiggDigg Add to FacebookFacebook Add to Google+Google+ Add to RedditReddit Add to TwitterTwitter What's this?

? Previous | Next Article ? Table of Contents This Article doi: 10.2146/ajhp140322 American Journal of Health-System Pharmacy February 15, 2015 vol. 72 no. 4 277-284 ? Abstract Full Text Full Text (PDF) Classifications Print Content Clinical Consultation Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Alert me when eLetters are published Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager eLetters Submit an eLetter No eLetters published Citing Articles Load citing article information Google Scholar Articles by Pennington, C. A. Articles by Park, J. M. PubMed PubMed citation Articles by Pennington, C. A. Articles by Park, J. M. Related Content Load related web page information Social Bookmarking Add to CiteULikeCiteULike Add to DeliciousDelicious Add to DiggDigg Add to FacebookFacebook Add to Google+Google+ Add to RedditReddit Add to TwitterTwitter What's this?

Current Issue February 15, 2015, 72 (4) Current Issue Alert me to new issues of American Journal of Health-System Pharmacy From the Cover RhOD immune globulin products for prevention of alloimmunization during pregnancy Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients Economic burden of recurrent venous thromboembolism: Analysis from a U.S. hospital perspective Comparative analytics of infusion pump data across multiple hospital systems ABOUT AJHP SUBSCRIPTIONS FOR AUTHORS/REVIEWERS PERMISSION REQUESTS ADVERTISING EMAIL ALERTS (FREE) Email Alerts (Free) RSS FEEDS (FREE) RSS Feeds (Free) HELP CONTACT US/FEEDBACK American Society of Health System Pharmacists Learning Center (CE) Store Meetings & Conferences ASHP Foundation MOST READ ARTICLES (Last 30 Days) Clinical practice guidelines for antimicrobial prophylaxis in surgery Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists How to write a patient case report Treatment of poisoning caused by {beta}-adrenergic and calcium-channel blockers ? View all Most Read articles Advertisement ? 2015 by the American Society of Health-System Pharmacists. Terms of Use | Copyright Online ISSN: 1535-2900 Print ISSN: 1079-2082

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