Oncology
Immunotherapy: A Promising Cancer Therapy
Overview ㅡ Our immune system keeps us protected from many threats such as infectious bacteria, viruses, and cancer too. However, cancer cells have their own ways and tricks to skip our defense system. Immunotherapy helps the immune cells to overcome these tricks and destroy cancer cells, which makes it a promising approach to treating canc…
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Oncology
Chemotherapy-induced Nausea & Vomiting: How to Defeat it?
OVERVIEW ― No one can deny that Chemotherapy-induced Nausea & Vomiting (CINV) is the most common undesired effect of chemotherapy and the most common cause of anxiety and distress in patients with cancer. Untreated CINV could affect 60% to 80% of cancer patients and impact their Quality of Life (QOL) as well as their families, which often leads them to discontinu…
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Nephrology and Urology
Can we use fondaparinux in RENAL patients?
As a clinical pharmacy specialist, it is important to address the safety of using fondaparinux ( Arixtra ) in renal patients with a creatinine clearance (CrCl) less than 30 mL/min. Fondaparinux is primarily used subcutaneously (SQ) for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE). According to the 2018 American Society of …
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Hematology and Oncology
Venous thromboembolism PROPHYLAXIS options
As a critical care pharmacist, it is crucial to identify patients who require venous thromboembolism (VTE) prophylaxis and those who should avoid it. According to the CHEST Guidelines, prophylaxis is recommended for acutely ill hospitalized medical patients at increased risk of thrombosis (hip replacement, obesity, cancer, advanced age, etc) , unless contraindicate…
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Side Effects
How to REVERSE bleeding due to Pradaxa or Xarelto
As a hospital pharmacist, the new oral anticoagulants are bringing up questions about how to reverse bleeding due to Pradaxa or Xarelto . Antidotes for Pradaxa (dabigatran) or Xarelto (rivaroxaban) are NOT available in many hospitals, like vitamin K for warfarin . But there are things you can do. Stopping the anticoagulant and w…
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Ticagrelor
The risk of stopping ANTIplatelet drugs too soon
As a cardiovascular pharmacist, you may be asked about the risk of stopping aspirin, clopidogrel, or other antiplatelet drugs too soon. This applies to the many patients with cardiovascular disease taking aspirin to prevent a recurrent event, or aspirin plus clopidogrel for acute coronary syndrome or after a stent. Stopping these t…
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Warfarin
When to Rely on WARFARIN Instead of a DOAC
As a clinical pharmacist, you will need to know when and why warfarin is sometimes preferred over a direct oral anticoagulant (DOAC). We’ve seen DOACs ( Eliquis , etc) take the lead for most uses, such as for atrial fibrillation or venous thromboembolism (VTE). But sometimes warfarin is still the go-to. Continue to rely on warfarin for patien…
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Surgery
How to manage ANTIplatelets around surgery
As a clinical pharmacist, you will be asked how to manage dual antiplatelet therapy (DAPT) around surgery in patients with a recent coronary stent. It’s a balancing act between risk of thrombosis and bleeding. American College of Cardiology guidelines still prefer at least 6 to 12 months of DAPT after most stent placements, but suggest shorter durations as an opti…
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Oncology
Act FAST when treating febrile neutropenia
As a clinical pharmacist, you should act fast when treating febrile neutropenia. Febrile neutropenia in patients with cancer is a medical emergency, since delays in care are linked to increased mortality. These patients have an isolated temp of 101°F or higher OR a temp of 100.4°F or higher for at least an hour. PLUS, an absolute neutrophil count (ANC) currently bel…
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Warfarin
DIET may interfere with warfarin therapy
As a nutrition support pharmacist, you should discuss with your patients who take warfarin ( Marevan ) about the interaction with food. Many patients are caught by surprise when fad diets or special foods interfere with their warfarin therapy . Most patients know that green leafy vegetables and other foods with high vitamin K can decrease warfarin's efficacy, (s…
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HIT
DOACs are options for treating HIT
As a hospital pharmacist, you will get questions about using direct oral anticoagulants (DOACs) for heparin-induced thrombocytopenia (HIT) . We usually treat HIT with IV argatroban or sometimes IV bivalirudin or subcutaneous fondaparinux ( Arixtra ). Then we transition to warfarin ( Marevan ) once the platelet count recovers, usually 150,000/mm3 or higher. Now there&…
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Pediatric
Ensure babies and kids get enough iron
As a nutrition support pharmacist, you are on the front lines to help prevent iron deficiency in kids under 2 years. Iron deficiency in young kids can impair motor and neurological development and may lead to anemia. It's common in low-income areas due to poor nutritional intake. But consider other risk factors for iron deficiency , such as preterm birth, born …
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Oncology
Manage febrile neutropenia
What about the best way to treat febrile neutropenia in cancer patients. These patients have an isolated temp of 38.5 (101.3 ℉) or higher OR a temp of 38 (100.4 ℉) or higher for at least an hour. PLUS an absolute neutrophil count (ANC) below 500 cells/mm 3 . Treat febrile neutropenia based on patient complication risks.... LOW-risk patien…
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Oncology
Ensure that oral antiemetics work well in CHEMO patients
As an oncology pharmacist, you will hear about the new ORAL antiemetic combo, Akynzeo. It will increase options to prevent chemo-induced nausea and vomiting (CINV). Akynzeo is the 5-HT3 antagonist palonosetron ( Aloxi ) plus a new long-acting neurokinin-1 antagonist, netupitant. Think of netupitant as an alternative to aprepitant ( Emend ). These help boost the…
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