Ulcer
Do all ICU patients need Stress Ulcer Prophylaxis?
Introduction ㅡ Patients who are admitted to ICU may suffer from Stress Ulceration, which is the development of superficial ulcers in the upper gastrointestinal (GI) tract. This differs from the reactivation of chronic duodenal or gastric ulcers as it is caused by either hypersecretion of gastric acid or impaired mucosal protection. Thus, m…
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Nonalcoholic Steatohepatitis
Resmetirom for Nonalcoholic Steatohepatitis (NASH)
Resmetirom ( Rezdiffra ) is set to become the first medication approved for treating nonalcoholic steatohepatitis (NASH) with fibrosis in adults . About 5% of adults in the US have NASH. You will start to hear NASH called metabolic dysfunction-associated steatohepatitis (MASH) to reflect its link with cardiometabolic risk factors (diabetes, dyslipidemia, obesity, etc…
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Vonoprazan
Limit use of Voquezna for H. pylori
As a community pharmacist, you should be updated. Voquezna Dual Pak and Triple Pak will be new prescribed combos for treating H. pylori . These combos contain vonoprazan, the first potassium-competitive acid blocker (PCAB)... Think of vonoprazan as a "fancy PPI ", with some differences. For instance, PPIs block activ…
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PPIs
HYPOmagnesemia associated with PPI therapy
As a clinical pharmacist, you will hear about proton pump inhibitor-induced hypomagnesemia . PPI therapy has been associated with hypomagnesemia, possibly due to reduced magnesium absorption. Hypomagnesemia has been reported after three months of PPI therapy, but the risk increases after a year. Data is conflicting on whether PPI therapy causes hypomagnesemia. Two m…
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Probiotics
Give probiotic at least 2 hours after antibiotic
More controversy is stirring up about using probiotics in the hospital. Some clinicians advocate using probiotics to help prevent antibiotic-associated diarrhea . For example, giving 12 patients a probiotic seems to prevent one case of antibiotic-associated diarrhea, and giving a probiotic to 29 patients seems to PREVENT one case of C. difficile -associated diarrhea …
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Nutrition
Address medical concerns of dysphagia patients
As a nutrition pharmacy specialist, Patients with dysphagia will need your advice on how to take oral medictions safely. These patients have difficulty swallowing, often due to neuromuscular or structural changes in the mouth, pharynx, or esophagus. It's common in conditions such as stroke , Parkinson's disease, dementia and head and neck cancers. …
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Stress Ulcer
Minimize unsuitable use of PPIs for stress ulcers
As a critical care pharmacist, you will be asked to re-evaluate the use of proton pump inhibitors (PPIs) or H2-blockers for stress ulcer prophylaxis. We know that stress ulcer prophylaxis isn't indicated for floor patients. But many ICU patients don't need it either... Mounting evidence suggests it doesn't decrease mortality or clinically significan…
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Probiotics
Continue to expect a limited role for probiotics
There are more questions about using probiotics ( Lacteol Forte ) in the hospital for GI disorders due to new American Gastroenterology Association guidelines . Continue to expect limited use. Evidence of benefit is generally weak and study results often conflict. Plus data from one species or strain can't be applied to another. Some clinicians…
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PPIs
Proton pump inhibitors (PPIs)
PROTON PUMP INHIBITORS... EXAMPLES: Omeprazole, lansoprazole, esomeprazole, pantoprazole. MECHANISM OF ACTION: Inhibit H + /K + ATPase on luminal surface of gastric parietal cells and thereby reduce gastric acid secretion. INDICATIONS Gastric/duodenal ulceration. As part of triple therapy for eradication of Helicoba…
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Pregnancy and Breastfeeding
Gastrointestinal agents during pregnancy and breastfeeding
FDA pregnancy categories prior to 2014, figure (1) . Gastroesophageal reflux disease (GERD) occurs in up to 80%, of pregnancies and peaks in the third trimester. The exact mechanism and pathogenesis of this condition associated with pregnancy is likely multifactorial ( table 1 ) . Figure (1) FDA pregnan…
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Infectious Diseases
Pay attention when STARTING medications in patients taking hepatitis C antivirals
As a pharmacist, you'll face MANY potential drug interactions with hepatitis C antivirals ( Epclusa [ Qurevo ], Mavyret , etc) even if you didn't start these medications. Interactions can lead to toxicity or treatment failure. And this can be an expensive mistake. Plus, hepatitis C medications may fly under the radar if the physician didn't prescribe the…
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PPIs
When short- or long-term use of PPIs is appropriate
As a pharmacist, you should give more focus on reining in inappropriate use of proton pump inhibitors [PPIs] (omeprazole, etc) due to new expert guidance and payer restrictions. Washington State's Medicaid won't cover more than 2 months of a PPI per year without a prior auth. Other payers will likely consider similar limitations. This isn'…
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Pregnancy and Breastfeeding
OTC options for treating gastrointestinal issues in pregnancy
PREGNANT WOMEN WILL ASK THE PHARMACIST about OTCs for GI complaints. We know nausea and vomiting in pregnancy is common. But be ready to help manage other GI problems if nondrug measures aren't enough. HEARTBURN ― Suggest an antacid with calcium first or one with aluminum/magnesium ( Maalox , etc) . These are considered safe at labeled doses, work quickly an…
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