This article discusses the use of paracetamol in frail older people. It explores the pharmacokinetics of paracetamol and how it differs between the elderly and young people. Finally, the article provides practical considerations about dosing paracetamol in frail older people.

https://dtb.bmj.com/content/56/6/69 

Overexpression of the cyclooxygenase 2 (COX-2) gene, also known as prostaglandin-endoperoxide synthase 2 (PTGS2), occurs in breast cancer. This study analysed a cohort of 156 patients and investigated the relationships between PTGS2 expression and celecoxib use during neoadjuvant chemotherapy (NAC). Patients were treated by sequential NAC with or without celecoxib.  

 

This article looks at the oral tablet Juluca containing dolutegravir and rilpivirine in combination. This tablet is newly listed on the PBS as Authority required (streamlined) and is a section 100 drug. The article gives a brief explanation of the patient criteria to meet PBS requirements, explains what the drug is, mechanism of action, place in therapy, safety issues, drug interactions, side effects, and practice points. 

 

https://www.nps.org.au/radar/articles/dolutegravir-rilpivirine-fixed-dose-combination-juluca-new-antiretroviral-available-on-pbs#article

(Kellie Hill - RBWH)

This paper discussed the survival and acute health care use after a gastrostomy or gastrojejunostomy in children with neurological impairment. It concluded that mortality is high among this population, however the stability of health care use before and after a procedure suggests that the mortality rate may reflect the underlying fragility of these patients. 

http://pediatrics.aappublications.org/content/143/2/e20182863.supplemental 

This article discusses the missed opportunity of administering influenza vaccinations to inpatients. The article acknowledges the concerns associated with vaccinating inpatients including blunted responses due to age, their admitting condition and other pre-existing comorbidities. However a study has evaluated several outcomes including fever, clinical laboratory results pertaining to infection, outpatient and emergency department presentations and readmissions with those who were vaccinated during hospital admission with those who did not receive the vaccination during their hospital stay. The study concluded that there was no overall increase in fever, clinical signs of infection, outpatient visits or risk of readmission within 7 days of discharge compared to those who were not vaccinated as inpatients. It is well known that the influenza vaccination can prevent significant mortality and morbidity and is therefore, strongly recommended to be administered during hospitalisation. 

https://www-clinicalkey-com-au.ezproxy.library.uq.edu.au/#!/content/journal/1-s2.0-S0025619619300692

Grace O'Halloran (RBWH)

 

This article explains the role of medications in the deregulation of the hypothalamic–pituitary–adrenal axis which can result in a rise in core temperature. It explores the common drug classes responsible for drug-induced hyperthermia and identifies non-drug causes that require consideration and exclusion. The article explains the importance of the drug history in differentiating the underlying causes of drug-induced hyperthermia.

 

 

https://www.nps.org.au/australian-prescriber/articles/the-hot-patient-acute-drug-induced-hyperthermia

DOI: 10.1056/NEJMoa1812851

 

This paper discusses whether the initiation of sacubitril-valsartan therapy is safe and effective among patients who are hospitalised for acute decompensated heart failure.

It discusses the PIONEER-HF trial which compared sacubitril-valsartan versus enalapril on the effect they had on NT-proBNP in patients stabilized from an acute heart failure episode. The results of the PIONEER-HF trial to extend the evidence base regarding the use of sacubitril-valsartan to populations for which there had been limited or no data. 

 

https://www-nejm-org.ezproxy.library.uq.edu.au/doi/full/10.1056/NEJMoa1812851

This external validity study compared the short-term efficacy of esmolol and amiodarone in treating severe Recent-Onset Atrial Fibrillation (RAF) in an emergency setting. The methodology was a retrospective survey analysing patient records between 2002 and 2013.  

https://www.jem-journal.com/article/S0736-4679(18)31199-5/fulltext

R Horner (Rockhampton)

This randomised placebo-controlled multicentre noninferiority trial explored the effect of linagliptin, a selective DDP-4 inhibitor, on both cardiovascular and kidney outcomes in patients with type 2 diabetes who are at a higher risk of cardiovascular and kidney events. The primary outcome measure was the time to the first occurrence of either cardiovascular death, nonfatal myocardial infarction or nonfatal stroke.

Evidence suggest older adults are at more of a risk of injurious falls when initiating antihypertensive medications compared to once stabilised on long term antihypertensive therapy. However, those on long term antihypertensive medications who stop and re-start these medications are theoretically likely to have the same risk of falls as those who are initiating antihypertensive. This study explored this theory across a cohort of 938 individuals on antihypertensive medications, aged greater than 65 years. It found that at 12 months, 8.1% of the cohort reported an injurious fall, with each 5-day gap in antihypertensive therapy increasing the risk of a fall by 18%. Thus suggesting gaps in antihypertensive therapy may be a marker for increased risk of injurious falls. 

C. Profitt (GCUH)

Miranda Niethe (Redland)

Verma S, Jüni P, Mazer CD. (2019). Pump, pipes, and filter: do SGLT2 inhibitors cover it all? Lancet, 393(10166), pp. 3–5.

 

This randomised trial investigates the efficacy of calcium and vitamin D supplementation for atrial fibrillation (AF) prevention on the background that vitamin D deficiency is associated with AF risk factors.

Jaz Walker (RBWH)

Orkambi (Lumacaftor/Ivacaftor) is a new drug for cystic fibrosis, approved in 2016 by Health Canada. The basis for regulatory approval was based off the findings of two 24 week trials, conducted in patients over the age of 12, with the most common genetic mutation; homozygous F508 depletion of the cystic fibrosis transmembrane regulator gene. This is a gene that affects 50% of the Canadian cystic fibrosis population. The findings of these trials showed a 3% improvement in lung function tests when using the drug combination. However further research needs to be done as there is currently insufficient evidence as to whether Orkambi improves quality of life, mortality or morbidity, in patients living with cystic fibrosis.  

Julie (CBH)

https://www.medscape.com/viewarticle/909156_print 

1.         Pereira MJ, Eriksson JW. Emerging Role of SGLT-2 Inhibitors for the Treatment of Obesity. DRUGS, 2019(1179-1950 (Electronic)).

 

Through meta-analysis this article explores the role of Sodium-glucose co-transporter 2 (SGLT2) inhibitors as a treatment for obese non-diabetic patients. It discusses the rationale behind SGLT2 monotherapy showing modest results of 1.5-2kg of weight loss compared to studies using combination therapy of an SGLT2 inhibitor and GLP-RA reduced adipose body weight by 4.5kg at 24 weeks and continued to maintain this weight loss in the following year. This paper also explores the benefits of SGLT2 inhibitors in obese patients suffering from CVD, heart failure and renal disease. 

 

 

Available from: https://link.springer.com/article/10.1007%2Fs40265-019-1057-0

US FDA Press Announcement. March 2019. This paper discusses the rationale, indications and implementation of Esketamine use in the United States. It also discusses the similarities between Ketamine and Esketamine. - Aqsa Farooq
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632761.htm

 

This guideline summary addresses the lack of evidence-based deprescribing guidelines available to clinicians to optimise medication use in older adults currently utilising cholinesterase inhibitors and memantine. It is approximated that one-third of cholinesterase inhibitors and memantine use is potentially inappropriate, whereby the likely harm, outweighs the likely benefit to the individual. The recommendations included identifying those patients that may be suitable for trial deprescribing such as those patients that do not have an appropriate indication (i.e indications other than Alzheimer disease, dementia of Parkinson disease, Lewy body dementia or vascular dementia), those who have never experienced a benefit, those that appear to be no longer benefitting, and those who have severe or end-stage dementia. It is recommended that deprescribing should be a trial discontinuation, involving close periodic monitoring (every four weeks with each dose reduction and after discontinuation) and tapering by halving the dose or decreasing the dose according to the tolerability of the individual patient (every four weeks or otherwise appropriate for the individual). It is important to know that re-initiation of medications should occur if the individual demonstrates clear worsening of condition after withdrawal.

Mackenzie (RDCH)

https://www.mja.com.au/journal/2019/210/4/deprescribing-cholinesterase-inhibitors-and-memantine-dementia-guideline-summary

 

Afluria Quad’s indications were extended from 18 years and older to 5 years and above.

 

 

Usefulness of therapeutic drug monitoring of piperacillin and meropenem in routine clinical practice: a prospective cohort study in critically ill patients

Eur J Hosp Pharm Published Online First: 27 February 2019. doi: 10.1136/ejhpharm-2018-001713

This prospective non-controlled intervention study evaluated the usefulness of therapeutic drug monitoring (TDM) in patients receiving Piperacillin and Meropenem in a Spanish University Hospital ICU. Piperacillin is a time-dependant antibiotic and concentration above minimum inhibitory concentration (MIC) is critical when considering clinical effectiveness. If the time above MIC is not sustained at 30-70% of the dosing interval alongside concentration 4-5 times above the MIC, consequences can include reduced efficacy and increased antimicrobial resistance. The pharmacy service mentioned in the study provided a TDM service that reported whether these target concentrations were met and astonishingly, despite the assistance, the plasma levels of piperacillin only reached a target level of 58.6% of the time!
https://ejhp.bmj.com/content/early/2019/02/27/ejhpharm-2018-001713