Selexipag is an oral prostacyclin IP receptor agonist approved for use as monotherapy or in combination with other therapies to slow PAH progression and reduce the risk of hospitalization in patients with FC II or III symptoms. Its stability and relatively long half-life offer conveniences over conventional prostanoid therapies.
New literature and recommendations for managing hypertensive emergencies in the setting of pregnancy, stroke, and heart failure have been published. Oral nifedipine is now considered an alternative first-line therapy, along with intravenous hydralazine and labetalol for women presenting with pre-eclampsia. Clevidipine is now endorsed by guidelines as a first-line treatment option for blood pressure reduction in acute ischemic stroke and may be considered for use in intracranial hemorrhage. Treatment of hypertensive heart failure remains challenging; clevidipine and enalaprilat can be considered for use in this population although data supporting their use remains limited.
As compared to the standard doses of oseltamivir, higher-dose (ie, double dose) oseltamivir was not associated with improvement in any clinical outcomes. Using higher doses empirically on all patients during influenza season may exacerbate local drug shortages.
Background: Direct oral anticoagulants (DOACs) are considered high-risk medications and pose a serious threat to patients if mismanaged. Furthermore, medication error rates involving DOACs in the acute care setting range from 25% to 40%. To reduce medication error rates at our institution, we implemented a pharmacist-driven DOAC protocol that permitted pharmacists to independently order and monitor DOACs pursuant to a consult order.Objective: To determine the impact of a pharmacist-to-dose DOAC protocol on medication errors at an academic medical center.Methods: This was a retrospective, single-center cohort study using a pre-post design to evaluate the impact of a pharmacist-to-dose DOAC protocol on rates of medication errors. Patient data were evaluated during a 6-month period before and after the implementation of the protocol. Patients were excluded if they were receiving a DOAC for an indication other than venous thromboembolism and/or atrial fibrillation.Results: A total of 502 patients (pre-phase = 256; post-phase = 246) admitted to the hospital and receiving a DOAC were included in the study. A total of 41 patients in the pre-phase received a medication error involving a DOAC compared with 22 patients in the post-phase (16% vs 8.9%; relative risk reduction 44%; P = .017).Rates of near misses were numerically higher in the post-phase group (7.4% vs 11.8%; P = .1), and rates of discharge DOAC errors were numerically lower (8.5% vs 4.9%; P = .1). The most common error was underdosing (N = 31).
Conclusion:In this study, the implementation of a pharmacist-to-dose DOAC protocol was associated with a 44% reduction in DOAC-related medication errors. These findings underscore the impact of a protocolized approach to DOAC management, as well as the role of pharmacists in overseeing inpatient DOAC use and reducing medication errors.
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