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 ...

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...