Notes from the Pharm #13

THAT CASE.  I don’t think I’ve ever learned so much in 2 hours, including crash coursing new therapeutics material on the spot, integrating bits and pieces from my (limited) pharmacy experiences, and of course the awesome teamwork—thank you for having the guts to walk into the lion’s den with me, for the sake of intellectual curiosity.

O.M.G. I am sho excited for rotations.

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Revelation #18

I was scared out of my socks a few days ago when I couldn’t stop thinking about scary news about hotels, while I was at a hotel -_-;; Of course I would do this to myself…

Then I remembered that previously when I had fears, whether feeling queasy in a boat in the middle of the ocean, getting really tired after running but realizing I had to make it back, or finding myself in situations with impossible amounts of work to get done, how I would get by is by focusing on happy memories—i.e. my Patronus!  Harry Potter moment :)  

The Patronus Charm (Expecto Patronum) is the most famous and one of the most powerful defensive charms known to wizardkind. It’s an immensely complicated, very difficult spell that evokes a partially-tangible positive energy force known as a Patronus or spirit guardian. It is the primary protection against Dementors and Lethifolds, to which there is no other protection.

Can’t believe that all that I time I spent plowing through fatter-than-dictionary books about wizards and other seemingly nonsensical fantasy amounted to an important life lesson.

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Summer Break Shenanigans #17

Expectation: I had planned to go on a diet upon coming back from Socal.

Reality: Today I had smoked salmon eggs Benedict for brunch, vanilla and jasmine tea ice cream for snack, cold brew iced coffee, and fruit for dinner.  Not sure if I should be proud or ashamed.


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100 Therapeutic Days #25

1/4 way through!  After this I will take a little break from the 100 Therapeutic Days per my Big’s advice on doing less work, though yes I am bringing a therapeutics book on vacation teehee

  • For patients randomized to enalapril, lercanidipine, or a combination, for all groups there was a decrease in blood pressure from baseline.  The combination was more effective in decreasing monotherapies.  
  • There was no variation in lipid profile or fasting plasma glucose.
  • Because all treatments increased sRAGE levels and decreased sCD40L and MPO, and that lercanidipine (but not enalapril, though there was more improvement in the combination) improved Lp(a) levels, these biomarkers may be useful in risk stratifying hypertensive patients.

Source: Effects of enalapril/lercanidipine combination on some emerging biomarkers in cardiovascular risk stratification in hypertensive patients

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  • P: Heard your Big wants you to work less
  • Me: lmao rly?!?!??!??!?!?!?
  • P: Yeah, you should listen
  • Me: lol I don't remember her telling me that. Unless I wasn't listening :P

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Do “all good things come to an end”?

No, it is only the beginning.

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100 Therapeutic Days #24

Some antidepressants have analgesic effects… interesting philosophically because it implies that emotional and physical pain are physiologically linked.

  • Tricyclic antidepressants have an analgesic effect in neuropathic pain, as shown with amitriptyline, desimipramine, clomipramine, and imipramine.  
  • Doxepin, capsaicin, and the combination provided analgesia of similar magnitude for chronic neuropathic pain
  • The combination provided a more rapid onset of analgesia
  • Capsaicin significantly decreased sensitivity and shooting pain
  • Doxepin and capsaicin individually increased burning pain more than the combination

Source: Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-bind, placebo-controlled study

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Notes from the Pharm #12

My eyes got dry today because work got so busy I forgot to blink -_-;;

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100 Therapeutic Days #23
  • Colistin is the preferred drug for multi-drug resistant gram-negative bacteria infections, and high doses are usually recommended
  • For patients on low-dose colistin, cure rate was not associated with dose (by body weight), duration, site of infection, age, or gender.  Because the average minimal inhibitory concentration in the cure group was significantly lower than that of the failure group, the MIC or antimicrobial sensitivity data can be used to determine the colistin dose that would maximize efficacy
  • Nephrotoxicity was low and not associated with colistin dose or cocomitant nephrotoxic medications

Source: Efficacy and safety of low-dose colistin in the treatment for infections caused by multidrug-resistant gram-negative bacteria

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100 Therapeutic Days #22
  • The standard of care for metastatic renal cell carcinoma treatment is sunitinib.  Dose reduction and comedication to treat side effects are usually necessary due to its toxicity.
  • As a CYP3A4 substrate, there is a potential for drug interactions for patients taking chronic medications for comorbidities.
  • In a retrospective analysis from hospital files, pharmacodynamic drug interactions were common, including major ones such as QT prolongation.  Pharmacokinetic interactions were less common, major or moderate, and due to coadministration of CYP inhibitors, CYP inducers, CYP substrates, and PgP substrates.
  • Patients taking a decreased startign dose of sunitinib had a decreased progression-free survival with metastatic renal cell carcinoma compared to the full dose.  In order to avoid adverse drug reactions, a multidisciplinary team should identify and avoid drug-drug interactions and monitor ECG for high risk of QT prolongation

Source: Sunitinib for metastatic renal cell cancer patients: observational study highlighting the risk of important drug-drug interactions

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  • L: Flex!
  • Me: I'm flexing!!
  • L: No you aren't!
  • Time to condition -__-;;

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  • Me, at 85c: Iced sea salt jasmine milk tea, less sweet and less sugar.
  • Servers stares at me.
  • Me: Oh... I meant less sweet and less ice... Haha

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100 Therapeutic Days #21
  • Venus thromboembolism includes deep vein thrombosis and pulmonary embolism, and treatment can be influenced by comorbidities
  • Those with prior MI were more likely to have cardiovascular and urological comorbidities
  • Those with upper GI conditions were more likely to have cardiovascular and pain comorbidities
  • VTE patients with the common comorbid burdens of prior MI and upper GI conditions also showed additional comorbidities and general poor health status.  These comorbidities must be considered in determining appropriate therapy

Source: Prior myocardial infarction and presence of upper gastrointestinal conditions among patients with venous thromboembolism: prevalence, associated comorbidities and burden

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100 Therapeutic Days #20

1/5 way through 100 therapeutic days!

Boring article… yeah we all know community pharmacists can help with smoking cessation; the people who need to read this are the health policymakers who can encourage it through direct incentives and burnt-out pharmacists who need to realize the impact of what they’re doing.  Optimistic student pharmacists have no doubt.  

  • Pharmacist-led interventions resulted in significantly higher abstinence rates for short-term and long-term abstinence, in both measures of clinically validated and self-reported abstinence

Source: Meta-analysis of the effectiveness of smoking cessation interventions in the community pharmacy

However, interpreting this article forced me to learn some useful statistics:

  • Relative risk: probability of event occurring when exposed / probability when non-exposed
  • RR is used when a binary outcome has a low probability, suh as assessing the disease progression or side effect of a new drug compared to the standard of care or placebo
  • RR is a measure of effectiveness for RCTs and cohort studies, while OR is a measure of odds for case-control studies

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100 Therapeutic Days #19

This should not even count in my 100 therapeutic days challenge, because our P&T team has beat the ranibizumab vs bevacizumab argument to death… interesting article nonetheless.  Told ya so :)

  • A meta-analysis investigated the regimen, dosage, and anti-VEGF as well as non-anti-VEGF alternatives of ranibizumab for wet AMD
  • Visual acuity improved better for patients on monthly ranibizumab compared to PRN 
  • There were no significant differences between ranibizumab 0.3 mg and 0.5 mg
  • Ranibizumab was more efficacious compared to other non-anti-VEGF but not to bevacizumab

Source: Ranibizumab for age-related macular degeneration: a meta-analysis of dose effects and comparison with no anti-VEGF treatment and bevacizumab

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