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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10 Life Lessons I Learned from Surviving My 20s

Yay, another good read about twentysomething.

My favorite:

I remember reading an interview of Dustin Moskovitz, the co-founder of Facebook and Mark Zuckerberg’s college roommate. The interviewer asked Dustin what it felt like to be part of Facebook’s “overnight success.” His answer was something like this, “If by ‘overnight success’ you mean staying up and coding all night, every night for six years straight, then it felt really tiring and stressful.”

We have a propensity to assume things just happen as they are. As outside observers, we tend to only see the result of things and not the arduous process (and all of the failures) that went into producing the result. I think when we’re young, we have this idea that we have to do just this one big thing that is going to completely change the world, top to bottom. We dream so big because we don’t yet realize — we’re too young to realize — that those “one big things” are actually comprised of hundreds and thousands of daily small things that must be silently and unceremoniously maintained over long periods of time with little fanfare. Welcome to life.

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100 Therapeutic Days #18

Amyloid diseases are kind of scary, but very interesting

  • In autosomal dominant familial amyloidosis, transthyretin dissociates from tetramers and monomers rapidly misfold and misassemble.  Senile systemic amyloidosis has a similar pathogenesis at the molecular level.
  • The first-line treatment of familial transthyretin amyloidosis is liver transplantation because transplantation replaces the variant transthyretin gene with a wild-type in the liver, rapidly decreasing serum concentrations of variant transthyretin.  
  • In addition to donor shortage, many patients are not suitable candidates due to the need for surgery and immunosuppresive therapy.  Even after transplantation, there is progression of eye, CNS, and cardiac amyloidosis.
  • Transthyretin tetramer stabilizers such as tadamidis and difluisal, as well as gene therapies with antisense oligonucleotides and small interfering RNAs, are new therapies for transthyretin amyloidosis.  Based on the mechanism of action, they are expected to be effective for familial and senile systemic amyloidosis.

Source: Recent progress in understanding and treatment of transthyretin amyloisosis

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  • J: I feel like I never see you anymore outside of Yelp and Tumblr...
  • Me: lol I exist in real life. Like now!
  • Catching up, one hangout at a time : )

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Revelation #17

How is it that it’s taken me the whole summer to realize the importance of weekends.

Previously: try to be productive on weekends, but half the time I end up writing Yelp reviews.

Now: I’m just going to chill and play, but set and accomplish small goals with a long-term game plan.

In the end, the outcome is the same of getting some amount of work done, but the quality of life for the latter is significantly better.


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100 Therapeutic Days #17
  • Mucopolysaccharidoses, metabolic diseases caused by genetic defects in lysosomal enzymes, manifest as progressive visceral, skeletal, and neurological deterioration. 
  • Enzyme replacement therapy (IV infused and internalized by M6P receptors) significantly improves somatic symptoms such as walking and respiratory function, but has little benefit for neurological symptoms because enzymes are blocked by the blood-brain barrier
  • Hematopoietic stem cell transplantation has a high risk profile and lack of evidence for efficacy except for preserving cognition and prolonging survival for young patients with a type of severe mucopolysaccharidosis
  • The major barriers of hematopoietic stem cell transplants are donor compatibility and the morbidity/mortality associated with the procedure.  However, the life-long source of enzymes improves disease complications including joint mobility, vision, hearing, and cardiopulmonary function, though the bone and cornea show more limited benefits.  If performed early enough, stem cell transplants are able to preserve cognition and increase survival.
  • Substrate reduction therapy and gene therapy are still under investigation, but these newer treatments may help to prevent neurodegeration

Source: Current and potential therapeutic strategies for mucopolysaccharidoses

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100 Therapeutic Days #16

I remember at one point when I thought pharmacogenetics was the future of medicine, before I realized the caveat of questionable clinical significance.

  • Carvedilol, the standard of care for heart failure patients, is metabolized the polymorphic enzyme CYP2D6
  • Patients were genotyped and classified as poor metabolizers, intermediate metabolizers, extensive metabolizers, and ultrarapid metabolizers
  • Among the genotype groups, there were no significant differences in adverse events or carvedilol dose, suggesting that genotype group and adverse drug reaction are not predictive of carvedilol dose for heart failure therapy

Source: Variation of CYP2D6 genotype is not associated with carvedilol dose changes in patients with heart failure

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100 Therapeutic Days #15

Do fixed-dose pill combinations actually have a value in decreasing pill burden to improve compliance, or is it just more expensive and less flexible for dosage adjustments?

  • Metformin and acarbose are recommended monotherapy for type 2 diabetes.  A fixed-dose combination of 500 mg metformin and 40 mg acarbose has been developed, and a study assessed the bioequivalence, safety and tolerability, and potential drug interactions.
  • The fixed-dose combination is bioequivalent to the loose combination: acarbose slightly decreased metformin bioavailability, but the efficacy for the combination suggests the PK interaction to be clinically equivalent.
  • The safety profile is consistent with current knowledge of the two drugs and the combination did not have higher rates of adverse effects than the monotherapy.  All adverse effects were mild and most were gastrointestinal which is expected.  

Source: Investigation of bioequivalence of a new fixed-dose combination of acarbose and metformin with the corresponding loose combination as well as the drug-drug interaction potential between both drugs in healthy adult male subjects

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Woah I love this immuno quiz!  And my result is probably the most insightful one yet—learning more about myself, one internet distraction at a time (<— lol I guess I am all about me -__-;;)

100 Therapeutic Days #14
  • A 3-compartment model using drug concentration data was generated to estimate the site-specific PD action of clarithromycin and telithromycin in the epithelial lining fluid of brunchopulmonary sites.
  • The site-specific PD evaluation provides information for determining dosages for respiratory tract infections.
  • Further studies in more patients can confirm findings and therapeutic implications.

Source: Pharmacokinetic modeling of serum and bronchial concentrations for clarithromycin and telithromycin, and site-specific pharmacodynamic simulation for their dosages

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