Real Time Pharmacology

Mismatch repair–deficient, locally advanced rectal cancer was completely treated in 12 patients by  single-agent  treatment with dostarlimab (Jemperli, monoclonal antibody) programmed death receptor-1 ( PD-1) blockade.   These patients have undergone at least 6 months of follow-up. All 12 patients (100%; 95% confidence interval, 74 to 100) showed no evidence of tumor on magnetic resonance imaging,  18 F-fluorodeoxyglucose–positron-emission tomography, endoscopic evaluation, digital rectal examination, or biopsy. No patients had received chemoradiotherapy or surgery, and no cases of progression or recurrence had been reported during follow-up (range, 6 to 25 months). Amazingly no adverse events of grade 3 or higher. JEMPERLI is a programmed death receptor-1 (PD-1)–blocking antibody approved by FDA for the treatment of adult patients with mismatch repair deficient (dMMR) recurrent or advanced:  • endometrial cancer, as determined by an FDA-approved test, that has ...

 Fluticasone and runny noses: Available as OTC and prescription Use 1-2 sprays per nostril per day depending on the age. Use 1 spray for 6 years and young Cost:$9-$20 Carethera Pharmacy cost: $9 www.carethera.com Produces anti-inflammatory and vasoconstrictive effects Two main classes of corticosteroids: Glucocorticoids  and mineralocorticoids play an important role in stress response, inflammation, electrolyte balance and immune response. Fluticasone is a commonly prescribed glucocorticoid medication in United States (Top 20). With about 30 million prescriptions written during 2019. Rhinitis can be nonallergic or allergic, or occur without any IgE-mediated sensitization to aeroallergens.  https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020121s045lbl.pdf

LUVOX (Fluvoxamine):  Fluvoxamine  REDUCED HOSPITALIZATIONS BY 67% and decreased death by 91%, reported  in patients who took and tolerated the fluvoxamine 100 mg twice daily for 10 days, per October 27 Lancet Global Health . The trial was initiated on June 2, 2020, with the current protocol reporting randomization  to fluvoxamine from Jan 20 to Aug 5, 2021, when the trial arms were stopped for superiority. 741 patients were allocated to fluvoxamine and 756 to placebo.  Investigators monitored participants for 28 days after treatment. In the placebo group, 119 of 756 patients, or 15.7 percent, developed complications requiring hospitalization or more than six hours of emergency care. In comparison, 79 of 741, or 10.7 percent, of fluvoxamine-treated patients got that sick.  In this trial taking fluvoxamine cut emergency visits and hospitalization by 32 percent Fluvoxamine cut serious complications in  patients who took at least 80 percent of their doses...

Migraine is the most prevalent neurological disorder worldwide and it has immense impact on quality of life. Release of CGRP (   calcitonin gene-related peptide)  is released during migraine  induction of migraine attacks. It causes inflammation of coverings of brain leading to pain. Two different classes of drugs blocking CGRP receptors have been developed: small molecule CGRP receptor antagonists (gepants), and monoclonal antibodies, targeting either CGRP or the CGRP receptor. Erenumab  (brand name  Aimovig) , targets the calcitonin gene-related peptide receptor (CGPCR)  for the prevention of migraine. Dosing: Migraine; Prophylaxis Injection administered in the abdomen, thigh, or upper arm subcutaneously, 70 mg subQ once a month; may go up to 140 mg subQ once a month. WARNINGS AND PRECAUTIONS-- 1. Hypersensitivity Reactions: If a serious hypersensitivity reaction occurs, discontinue administration of AIMOVIG and initiate appropriate therapy. Hypersensiti...

 Diabetes management in patients with kidney disease: Discharged this patient after medication therapy management. Family was educated about diabetes management, few medications were discontinued and others were changed. Importance of monitoring blood sugar levels was emphasized. Glyburide was discontinued; Glipizide started. Augmentin and Gabapentin were renally dosed. Lisinopril and hydrochlorothiazide were discontinued. Normal blood pressure was recorded for few days, family consulted to monitor blood pressure and check with the primary care physician. Patient's family was excited about the improvement in quality of life. Reference: Betônico CC, Titan SM, Correa-Giannella ML, Nery M, Queiroz M. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control.   Clinics (Sao Paulo) . 2016;71(1):47-53. doi:10.6061/clinics/2016(01)08

 Stroke patient (69 year old) with low energy levels and tardive dyskinesia What is Co-Q 10? Ubiquinone or Co Q 10  is a vitamin like substance and is a cofactor of an enzyme. It is present in the mitocondrial membranes where it is involved in the energy production.  The most common Coenzyme Q in human mitochondria is Co Q 10 . 'Q'  represents quinone head and 10 refers to the number of isoprene repeats in the tail.  Dietary CoQ 10 -supplementation was associated with demonstrable benefits in CPZ-induced Parkinsonism-like changes in mice. Clinical effects have not been well studied in humans. Meat (10-120 mg/kg) and oils (10-280 mg/kg) are the richest sources of dietary Co Q 10 References: 1.  Onaolapo OJ, Odeniyi AO, Jonathan SO, Samuel MO, Amadiegwu D, Olawale A, Tiamiyu AO, Ojo FO, Yahaya HA, Ayeni OJ, Onaolapo AY. An Investigation of the Anti-Parkinsonism Potential of Co-enzyme Q 10  and Co-enzyme Q 10  /Levodopa-carbidopa Combination in ...

  West Nile virus (WNV) is most commonly spread to people by the bite of an infected mosquito. In humans, disease ranges from asymptomatic infection, seen frequently, to encephalitis/paralysis and death, seen rarely.  Symptoms No symptoms in most people.  Most infected individuals  (8 out of 10) do not experience any symptoms. Fever:  About 1 in 5 infected individuals have a fever with other mild symptoms such as rash, headache, body aches, joint pains, vomiting, and diarrhea Serious symptoms   About 1 in 150 infected individuals develop a severe illness affecting the central nervous system such as encephalitis (inflammation of the brain) or meningitis (inflammation of the membranes that surround the brain and spinal cord) About 1 out of 10  people who develop severe illness affecting the central nervous system die. Y ou can reduce your risk of WNV by wearing long-sleeved shirts, long pants, masks, gloves and goggles  to prevent mosquito b...