Real Time Pharmacology

The global monkeypox outbreak has been declared a public health emergency of international concern by the WHO. Monkeypox is a smallpox-like illness that can be accompanied by a range of significant medical complications.  Monkeypox is less dangerous and contagious than smallpox.  To date there are no standard or optimized guidelines for the clinical management of monkeypox Photo credit: UK health security agency Symptoms of monkeypox can include: Fatigue Fever Headache Muscle aches and backache Swollen lymph nodes Chills A rash that can look like pimples or blisters that appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus.  The virus can spread from person-to-person through: direct contact with the infectious rash, scabs, or body fluids respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex touching items (such as clothing) that ...

 T reatment of  Methicillin Resistant Staphylococcus aureus ( MRSA) infections is difficult due to limited antibiotic options.   The choice of treatment depends on the antibiotic susceptibility of the pathogen.  MRSA accounts for more than 60 per cent of  S. aureus  infections (1).  Daptomycin is a good alternative to vancomycin in the treatment of MRSA infections where nephrotoxicity is a concern. Real Time Patient: Hypertension, MRSA bacteremia, Opioid dependence, Discitis, vertebral osteomyelitis, paraspinal  abscess. Heparin 5000 Unit/mL Vial (heparin SODIUM)  Inject 5000 unit (1 mL) subcutaneously Twice Daily Look-Alike/Sound-Alike *High Alert* DAPTOmycin 500 mg Vial (Cubicin)  840mg/1.68vial(s) in Sodium Chloride 0.9% 100mL, Infuse 840 mg over 30 Minutes intravenously Every 24 Hours, Rate: 200 mL/Hour *DOCUMENT FLUSH BEFORE AND AFTER ACCESS* Indication: MRSA Vertebral Osteomyelitis DiphenhydrAMINE/Zinc 2% Cream (Benadryl Cream) ...

The U.S. Food and Drug Administration has issued an EUA for the emergency use of the unapproved PAXLOVID which is combination of nirmatrelvir, a SARS-CoV-2 main protease (Mpro: also referred to as 3CLpro or nsp5 protease) inhibitor, and ritonavir, an HIV-1 protease inhibitor and CYP3A inhibitor, for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive test of direct severe acute respiratory syndrome coronavirus 2 Administer orally with or without food within 5 days of COVID infection. Dosage: 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet), with all three tablets taken together twice daily for 5 days Dose reduction for moderate renal impairment (eGFR ≥30 to <60 mL/min): 150 mg nirmatrelvir (one 150 mg tablet) with 100 mg ritonavir (one 100 mg tablet), with both tablets taken together twice daily for 5 days PAXLOVID is not recommended...

Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Usually, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia.   Optimal medication therapy for MSSA infections is unclear. Current standard of care consists of nafcillin, oxacillin and cefazolin. Ceftriaxone has advantage as a once-daily outpatient regimen. (1) Current evidence suggests there is no difference in efficacy between ceftriaxone and ASPs for MSSA infection, with a lower risk of toxicity with ceftriaxone. Ceftriaxone is a good option for definitive therapy of MSSA infection. (1) Real time patient medications: Diagnosis:  Back pain, sepsis due to MSSA bacteremia and Lumbar spine abscess. Nafcillin 10 G Vial (Nafcil)  12gram/1.2vial(s) in Sodium Chloride 0.9% 500 mL, Infuse 12 gm over 24 Hours intravenously Every 24 Hours, Rate: 20.8 mL/Hour GIVE CEFTRIAXONE IV FIRST THEN START NAFCILLIN ...