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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Ursodeoxycholic acid
Gallstone Buster: Diet & Med Mix!
As a nutritional support pharmacist, you should know that gallstones are closely linked to diets rich in animal fat and protein, lacking in fiber. Traditional Asian and African diets, predominantly plant-based, show lower incidences of gallstones compared to Westernized diets. Key dietary factors associated with reduced gallstone risk include... Plant-based Die…
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Nutrition
Nutrition guide for CIRRHOSIS patients
As a nutrition support pharmacist, you will be asked more about the recent recommendations to ensure proper nutrition in patients with cirrhosis . Malnutrition is a significant concern for patients with cirrhosis, affecting up to 20% of those with compensated cirrhosis and 50% of those with decompensated cirrhosis . A state of malnutrition in cirrhosis has also been…
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GIT and Liver
Appropriate treatment for acute variceal bleeding
As a clinical pharmacist, you must be kept up to date. One-third of patients with varices will have variceal bleeding , the most life-threatening complication of cirrhosis . Expect patients to be resuscitated with fluids and blood if needed, then to have an endoscopy within 12 hours for esophageal banding. Start an octreotide bolus f…
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Procalcitonin
Reevaluate protocols for ACUTE pancreatitis
As a clinical pharmacist, you must be kept up to date. New evidence will lead to questions about treating acute pancreatitis .. Fluids. The standard has been to give aggressive fluids in the first 24 hours. But this is based on limited evidence linking early hydration to lower mortality. Now stronger data show that aggressive f…
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Nausea/Vomiting
Approach to managing Gastroparesis
New guidelines will put focus on how to manage gastroparesis. Patients with this delayed gastric emptying often struggle to relieve symptoms like bloating, early satiety, vomiting , etc. Causes include diabetes , abdominal surgery and medications that slow GI motility (anticholinergics, opioids, etc). Continue to follow a stepwise…
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Terlipressin
Assess TERLIpressin for Hepatorenal Syndrome
As a clinical pharmacist, you should evaluate the use of terlipressin for hepatorenal syndrome. Terlipressin ( Glypressin, Haemoxamine ) will be the first FDA-approved medication for hepatorenal syndrome with acute kidney injury (HRS-AKI). HRS-AKI typically occurs in patients with cirrhosis and ascites who develop splanchnic vasodilation. This causes decreased perf…
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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
Which patients on aspirin should get PPI
As a pharmacist, you will be asked, which patients on low-dose aspirin should also get a proton pump inhibitor . New recommendations will clarify which patients on low-dose aspirin should also get a proton pump inhibitor . Daily low-dose aspirin at least DOUBLES GI risk. There's one additional serious GI ulcer or bleed for every 200 patient…
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Vitamin-E
Guide to manage NONalcoholic fatty liver disease
As a clinical pharmacist, you will see more focus on managing nonalcoholic fatty liver disease (NAFLD) , partly due to new guidelines. It’s being called a “sleeper epidemic” About 1 in 4 patients have this steatosis, but most don’t have symptoms. NAFLD often goes hand in hand with cardiovascular (CV) risk factors, such as insulin resistance or diabetes , obesity an…
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Pediatric
Treating constipation in children
As a pharmacist, parents often ask you about treating constipation in children. Constipation is common in young children. It's a great source of worry for parents, but it's rarely serious. It's usually due to fear of a painful bowel movement , not enough exercise and inadequate hydration, etc. Before prescribing …
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GIT Infection
Medications for TRAVELER's diarrhea
As a pharmacy doctor, people often ask you, what to use for traveler's diarrhea. Travelers' diarrhea refers to diarrhea that develops in individuals from resource-rich settings during or within 10 days of returning from travel to resource-limited countries or regions. And these some medications used for managing traveler's diarrhea... …
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Infectious Diseases
Empiric antibiotics for intra-abdominal infections
Complicated intra-abdominal infections are problems in clinical practice and consume substantial hospital resources. New guidelines will clarify appropriate antibiotics for empiric treatment of complicated intra-abdominal infections ... Community-acquired infections For appendicitis and other mild to moderate community infections use a single age…
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