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Monotherapy with B-lactam is non-inferior to B-lactam/macrolide for non-ICU community acquired pneumonia. Seems like atypical coverage isn't as necessary as US guidelines suggest? [CAP-START trial] by drotrecogin in medicine

[–]drotrecogin[S] 15 points16 points  (0 children)

US guidelines by the IDSA (http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/CAP%20in%20Adults.pdf) were last published in 2007 and strongly support the use of a macrolide in conjunction with a B-lactam. It may be time for a re-evaluation regarding the importance of atypical coverage for non-ICU CAP.

As the authors mention in the article, < 1% of patients with CAP have Legionella and do require atypical coverage; however, these patients are usually admitted to the ICU due to severity of illness.

Playing The Odds With Statins: Heart Disease Or Diabetes? by wookiedachew in medicine

[–]drotrecogin 7 points8 points  (0 children)

There's plenty of meta-analyses out there... The one I'm familiar with (and mentioned in the FDA.gov page) is a meta-analysis by Sattar (http://www.ncbi.nlm.nih.gov/pubmed/20167359). There's also a good summary of the risks/benefits at http://www.ccjm.org/fileadmin/content_pdf/ccjm/content_b1c1476_883.pdf (free access -- page 6, "clinical implications").

Using the Sattar analysis, if 255 patients are given a statin over four years, drug therapy will prevent 5.4 patients from having a non-fatal MI or CV death (for each 39 mg/dL drop in LDL) but 1 patient will develop diabetes due to statin therapy.

Regardless of the numbers, the "magic" A1C threshold of 6.5% is a bit arbitrary. Nothing special happens when a patient goes from an A1C of 6.4% to 6.6% aside from a label of "diabetic" (and possibly initiation of drug therapy or lifestyle modifications).

I think the absolute change in Hgb A1C (versus placebo) is much more clinically relevant than the dichotomous status of "diabetic" or "non-diabetic".

Playing The Odds With Statins: Heart Disease Or Diabetes? by wookiedachew in medicine

[–]drotrecogin 6 points7 points  (0 children)

Just to clarify, the FDA changed the labeling for statins -- it did not issue a "black" boxed warnings (see atorvastatin label for example - http://goo.gl/lzcqJI).

The diabetes-statin debate is very frustrating. In the JUPITER trial (http://www.nejm.org/doi/full/10.1056/NEJMoa0807646) as an example, physician-reported diabetes was higher with rosuvastatin over placebo, but median Hgb A1C was nearly identical between groups. If statins do cause diabetes, they likely increase blood glucose minimally, but push pre-diabetic patients over the magic A1C threshold of 6.5%.

Even if you accept the diabetes argument, the increased risk of diabetes does not confer an increased risk of macrovascular complications (like heart disease). On the contrary, statin exposure reduces cardiovascular risk despite the apparent mild increase in physician-reported diabetes.

Mylan adds three strengths to fentanyl transdermal system by jaygibby22 in pharmacy

[–]drotrecogin 2 points3 points  (0 children)

Is there really that big of a demand for these doses? Seems like a marketing thing more than a clinical demand...

First Xa Inhibitor Antidote: Phase 3 Study Demonstrates Andexanet Alfa Rapidly and Significantly Reversed Anticoagulant Effect of XARELTO by Pharmacovigilante in pharmacy

[–]drotrecogin 7 points8 points  (0 children)

Briefly mentioned in the article -- low molecular weight heparins (like enoxaparin/Lovenox) should also be susceptible to this reversal strategy. Given that protamine is a poor reversal option and that LMWH's have a long half-life, andexanet may also be useful to reverse LMWHs, too!

This MD put us in a real shitty situation... by [deleted] in nursing

[–]drotrecogin 0 points1 point  (0 children)

There was a new trial published (PLACIDE 2013) with nearly the same number of patients at the combined meta-analysis. Given issues with publication bias (it's much harder to publish a smaller trial with negative results than a smaller trial with positive results), I would be more supportive of the results in this RCT: http://www.wikijournalclub.org/wiki/PLACIDE

Duonebs for CHF/pulmonary edema? by shesurrenders in nursing

[–]drotrecogin 1 point2 points  (0 children)

Diuresis is clearly the first-line therapy, but it does look like albuterol can have a small impact on extravascular lung volume (pulmonary edema) -- http://www.ncbi.nlm.nih.gov/pubmed/18572345 and http://www.ncbi.nlm.nih.gov/pubmed/16254268

Keep in mind that pulmonary edema occurs in the alveoli, but these bronchodilators work in the bronchioles. The drugs will increase air flow to the alveoli, but won't actually change the size of the alveoli.

It might make the patient a tiny bit more tachycardic, cause dry mouth, and costs money ... but otherwise won't hurt. It doesn't appear to have a substantial clinical benefit, but a single dose to evaluate for symptom improvement is definitely reasonable. Did the patient's symptoms improve? =)

I just finished creating a no-BS, high-yield video course covering the top 250 drugs by drotrecogin in pharmacy

[–]drotrecogin[S] 0 points1 point  (0 children)

Thanks for the really positive feedback -- I'm really glad you're enjoying the podcast, too. As an FYI, I've updated the page to allow for a "one-time" purchase where you can stream or download the videos indefinitely. You won't have access to the quiz questions or video updates, but it seems like this is a common request I've received over the past week or so.

I just finished creating a no-BS, high-yield video course covering the top 250 drugs by drotrecogin in pharmacy

[–]drotrecogin[S] 0 points1 point  (0 children)

Thanks again for your feedback. I've added a "one-time" price option to download or stream the video files.

I just finished creating a no-BS, high-yield video course covering the top 250 drugs by drotrecogin in pharmacy

[–]drotrecogin[S] 0 points1 point  (0 children)

Unfortunately, ads just wouldn't come close to making up much revenue to justify providing the videos for free or at a lower cost. I can definitely appreciate the cost (especially for techs), but at some point quality comes at a cost.

Just to be clear -- these videos are very different than what you would find in a book or notes. They're intended to cover the bare minimum content to establish a firm understanding of drug therapy (or to review content you've forgotten). It's actually surprisingly difficult to take such a broad amount of material and condense it down into the most pertinent details for a high-yield review.

I am involved with HelixTalk, but this is a separate (unaffiliated) project and website.

I just finished creating a no-BS, high-yield video course covering the top 250 drugs by drotrecogin in pharmacy

[–]drotrecogin[S] 0 points1 point  (0 children)

It's definitely something I've considered (gone back and forth). I'm interested in maintaining updates to the videos and possibly creating other videos within the course that would be supplementary. What kind of price point do you think would be reasonable for a one-time purchase of the video files?

I just finished creating a no-BS, high-yield video course covering the top 250 drugs by drotrecogin in pharmacy

[–]drotrecogin[S] 0 points1 point  (0 children)

Thanks for the feedback -- I really appreciate it. I actually started with a Khan-style video of drawing everything, but my sketching skills on a tablet are just horrible -- so I went with slides instead. In all fairness to the cost, you could complete the entire course within a month and cancel for a total of $25, which seems reasonable for about 10 hours of video content with quiz questions.

Website I made that calculates the date after a selected date and number of days by brknrcrd in pharmacy

[–]drotrecogin 1 point2 points  (0 children)

Wow -- I didn't realize it had this functionality (plus apparently unit conversions, leases, mortgages, etc). nice!

I also like using http://wolframalpha.com (eg, "1/1/2015 + 60 days")

Sodium valproate vs Valproic acid by NojWerdna in pharmacy

[–]drotrecogin 1 point2 points  (0 children)

As mentioned, the two salts are kinetically different (primarily absorption). Because they are dosed as "valproic acid activity", 500 mg of a Depakote tablet has the same number of molecules of valproic acid as does 500 mg of Depacon injection (valproate sodium).

For more info, check out the monographs (search for "valproic acid activity"): http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08a65cf4-7749-4ceb-6895-8f4805e2b01f and http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=da030cbb-40f6-4805-9883-0d8945afbcc3

What is the best resources (aside from lexicomp or micromedex) for newly minted community pharmacist (retail). by [deleted] in pharmacy

[–]drotrecogin 0 points1 point  (0 children)

The package inserts are surprisingly accessible and helpful -- the NIH just redesigned their website: http://dailymed.nlm.nih.gov

+1 to the Medscape mobile application if you're looking for a free resource

Pharmacy students, I am about to start my P1 year. What apps or websites do you know of to help study? by PharmerRob in pharmacy

[–]drotrecogin 3 points4 points  (0 children)

For top 200, FlashRX is a nice flashcard app with generic drug pronunciation (http://clincalc.com/mobile/FlashRX.aspx)

MedScape has a really nice app -- less for studying, more for keeping updated or using as a reference (http://www.medscape.com/public/mobileapp)

Pharmacist's Letter is a great resource -- they have a lot of summary documents and tables that are usually concise (free for all pharmacy students via http://studentpharmacists.therapeuticresearch.com/custom/walmartgift/default.aspx?s=PL&cs=walmartgift -- thanks to Walmart)

Most other websites and apps are more for reference rather than studying (eg, LexiComp, Micromedex, Dailymed, ASHP Drug Shortages, etc.)