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Tenecteplase for Acute Ischemic Stroke: Insights from a Large Community Teaching Hospital
Ithar Alsarraf, Jennifer Pilotto, Rebecca E. Baker, and Emily Reich
Publication Date: 12-2024
Acute Ischemic Stroke (AIS) is a leading cause of disability and death in the United States, requiring urgent treatment1,2; earlier treatment improves patient outcomes.
Fibrinolytic agents including alteplase and tenecteplase (TNK) reduce long-term disability in AIS but are associated with hemorrhagic risks3,4.
As of January 2024, Corewell Health East hospitals updated their guidelines that TNK would be the first line agent in the treatment of AIS.
Alteplase is the only approved agent for AIS, but TNK shows similar effectiveness along with shorter preparation and administration time which may ultimately improve door-to-needle time2 .
Careful consideration of patient characteristics is important to minimize hemorrhagic risk: blood pressure (BP), surgical history, head imaging, medications prior to symptom onset, and National Institutes of Health Stroke Scale (NIHSS).
The American Heart Association (AHA) and American Stroke Association (ASA) recommend a door-to needle time of 60 minutes or less, and a medication order entry to thrombolytic treatment of 45 minutes or less1,2.
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Multidisciplinary Approach to Pulmonary Arterial Hypertension Therapy Transition: A Patient Case Report
Jacqueline Brewer, Tania Saeed, and Bhavinkumar Dalal
Publication Date: 10-2024
Pulmonary arterial hypertension (PAH) is a rare, incurable disease that causes vasoconstriction of the pulmonary vasculature
Therapy goals include improving hemodynamics as well as alleviating symptoms
Therapies range from injectable to inhaled to oral to parenteral
PAH treatment teams often transition between the various forms of therapies to reach therapy goals but also to improve patient’s quality of life
The use of a supportive, multidisciplinary team approach, including physicians, nurse practitioners (NP), pharmacists, and nurses during these therapy transition phases is beneficial to achieve success and improve patient care
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Evaluation of peri-operative antibiotic prophylaxis in patients undergoing total joint hip or knee arthroplasty
Heidi Klotz, Lauren Kassab, Muddasser Saiyed-Javed, Sandra Hartnagle, and Sapna Shah
Publication Date: 12-6-2023
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Evaluation of asymptomatic bacteriuria treatment
Klea Noskey, Brian Bui, Selena Hailo, Katherine Bassil, Jennifer Pilotto, and Sandra Hartnagle
Publication Date: 12-6-2023
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Transition of continuous intravenous epoprostenol to oral treprostinil in a patient with pulmonary arterial hypertension: A patient case report
Tania Saeed, Heidi Klotz, Klea Noskey, Jacqueline Brewer, Samuel Allen, and Rebecca Baker
Publication Date: 9-28-2023
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Impact of Continuous Infusion Ketamine as Sedation on Concomitant Opioid and Sedative Requirements in Mechanically Ventilated COVID-19 Patients
Gabrielle R. Bradley, Megan Cadiz, and Allycia Natavio
Publication Date: 12-7-2022
Characterize the impact of continuous infusion ketamine (CIK) on concomitant opioid and sedative requirements in mechanically ventilated COVID-19 patients
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Levetiracetam for Seizure Prophylaxis in Spontaneous Intracerebral Hemorrhage
Alanah Bratley, Krystal Commons, and Allycia Natavio
Publication Date: 12-7-2022
Characterize the use of levetiracetam for early seizure prophylaxis in patients with sICH
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Pharmacist-Provided Educational Intervention and its Impact on Medical Resident Knowledge and Comfort Level with Continuous Glucose Monitors (CGMs)
Chelsea Dezfuli, Sarah Muench, and Colleen Lauster
Publication Date: 12-7-2022
Continuous glucose monitors (CGMs) have become an integral component of diabetes care
American Diabetes Association now recommends that CGMs be offered to all patients on insulin who can use the device safely
Integrating CGMs into clinical practice can be challenging for several reasons: – Data overload – Cost – Need for education on data interpretation
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Evaluation of Antimicrobial Prophylaxis in Spine Surgery within an Enhanced Recovery Program at a Large Community Teaching Hospital
Sabrina DiPietro, Klea Noskey, Richard Zoltowski, Tania Saeed, and Sapna Shah
Publication Date: 12-7-2022
The risk of surgical site infections post spine surgery is 0% to 18%.1
• American Society of Health System Pharmacists (ASHP) and Enhanced Recovery After Surgery (ERAS) Society guidelines recommend using an agent with activity against the most common surgical site pathogens including Staphylococcus aureus. 2,3
• The preferred agent is cefazolin 2 grams intravenous (IV) (3 grams if patient weighs ≥120 kilograms [kg]) administered 30 minutes prior to skin incision and re-dosed every four hours intraoperatively.2,3
• In the case of a cephalosporin allergy, clindamycin 900 milligrams (mg) IV or vancomycin 15 mg/kg IV are recommended alternatives.2,3
• Due to lack of appropriate documentation of allergies in the electronic medical record (EMR), alternative antimicrobials are often prescribed.
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Impact of Soy-Based Versus Composite Lipid Emulsion (Soybean, Medium Chain Triglycerides, Olive and Fish Oil) in Critically Ill Patients
Sandra Kless, Lisa Hall Zimmerman, and Olaf Kroneman
Publication Date: 3-2022
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Evaluation of Antibiotic Selection and Duration in Patients with Non-Severe Community Acquired Pneumonia
Emily Reich, Sandra Hartnagle, Jennifer Pilotto, Heidi Klotz, and Ryan Herc
Publication Date: 12-7-2022
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Evaluation of Safety Outcomes of Two Hydrocortisone Dosing Regimens in Patients in Septic Shock
Alexandra Rola, Joshua Wirtz, Daniel Kalaj, Vasil Rrushi, and Megan Cadiz
Publication Date: 12-7-2022
• Steroids are used in shock to minimize the impact of shock-induced dysregulation of inflammatory response – Hydrocortisone is preferred for its activity as a glucocorticoid and a mineralocorticoid • Available data on the use of hydrocortisone shows mixed benefit – Data to guide dosing is limited, use of 100 mg IV every 8 hours may have benefit over 50 mg IV every 6 hours • Use of steroids has been associated with potential risks, including gastrointestinal bleeding, hyperglycemia, hypernatremia, superinfection, etc.
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Ertapenem Versus Meropenem for the Treatment of ESBL-Producing Enterobacterales Bacteremia in Critically Ill Patients
Sydney VanDorf, Prakash Shah, Chad Richardson, and Christine Yost
Publication Date: 12-7-2022
The purpose of this study is to evaluate clinical outcomes for critically ill patients receiving ertapenem or meropenem for ESBL-producing Enterobacterales bacteremia.
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Safety Evaluation of Intravenous Heparin Protocol Following Alteplase Treatment in Patients with Suspected or Confirmed Pulmonary Embolism
Erika Waldsmith, Lisa Hall Zimmerman, and Claudia Hanni
Publication Date: 12-7-2022
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