Jill Michaud, Pharm.D., BCPS. I have no actual or potential conflicts of interest related to this presentation

Transcription

1 Jill Michaud, Pharm.D., BCPS I have no actual or potential conflicts of interest related to this presentation

2 Focus New drugs you might use in the Emergency department New drugs patients might be on Indications Side effects

3 Not covering New oncology medications If the generic name ends in nib or mab good chance it is a cancer drug New Hepatitis C and HIV medications If the generic name ends in vir, likely for hepatitis C or HIV

4 Reference Favorite quick reference Centerwatch.com Least favorite Direct to consumer advertising Professional pharmaceutical reps

5 FDA approvals 45 new drugs in 2015 & 41 in therapeutic classes Plus new drug dosage forms or indications

6 Drug or Pokѐmon I ll display a name If you think it is a new drug hold up your pink card If you think it is a Pokemon hold up your green card

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8 Novel Anticoagulants (NOCA) Factor Xa inhibitors rivaroxaban apixaban edoxaban approved Jan 2015 betrixaban expected to be approved late 2016 Direct Thrombin Inhibitors dabigatran

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10 Novel Anticoagulants Side effects Bleeding! Increases the risks Age greater than 80 Weight less than 60 kg Renal dysfunction dabigatran, rivaroxaban, edoxaban Hepatic dysfunction - apixaban How long to hold before surgery Ideally 2-5 days But do patients need to bridge with a heparin product

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12 Prothrombin Complex Concentrate Prothrombin Complex Concentrate (PCC) Approved for urgent reversal of acquired coagulation factor deficiency induced by vitamin K antagonist In other words reverses warfarin Indicated if reversal of anticoagulation is needed within an hour Always administer vitamin K iv with PCC Expensive!

13 idarucizumab First true reversal agent for novel anticoagulants (dabigatran only) Monoclonal antibody fragment targeted specifically for dabigatran Fun fact binds 350 times stronger than Thrombin IV 5 grams provided as 2 separate vials of 50 ml each

14 Andexanet alfa Inactivated factor Xa Binds and reverses anti-xa inhibitors Rivaroxaban, apixaban, edoxaban, betrixaban Not approved by the FDA yet

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16 ivabradine Indicated to reduce the risk of hospitalization due to worsening heart failure In stable patients taking beta-blockers at highest dose or do not tolerate beta blockers Ejection Fraction less than 35% Side effects: Bradycardia Teratogenic a. fib

17 Sacubitril + Valsartan Sacubitril neprilysin inhibitor Valsartan antigiotensin receptor blocker Indicated to reduce risk of death and hospitalization from heart failure Side effects dizziness, hypotension, hyperkalemia, cough, renal failure

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19 Alirucumab Evolcumab Proprotein Convertase Subtilisin Kexin Type 9 inhibitor antibody PCSK9 Indicated for lowering LDL cholesterol who have maxed out on statins Subcutanous injection every 2 weeks Side effects allergic reactions or injection site reactions

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21 patiromer Potassium binder for treatment of hyperkalemia NOT for emergency use as has a delayed onset of action Binds potassium in the gut Side effects: constipation

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23 dapagliflozin empagliflozin canagliflozin SGLT-2 inhibitor (sodium glucose cotransporter type 2) Inhibits reabsorption of glucose in the kidney, increasing excretion of glucose in the kidney Used alone or in combination with metformin 2015 FDA warning of ketoacidosis

24 albiglutide dulaglutide lirglutide GLP-1 agonist Glucogon-like peptide receptor agonist Slows gastric emptying Increases glucose dependent insulin release Once weekly subcutaneous injection

25 Insulin glargine 300units/ml Regular insulin 500units/ml pen Concentrated insulin products Watch doses!!!

26 insulin deguldec insulin degludec/insulin aspart Long acting once daily insulin and combination long/short acting Available in pens 100 unit/ml 200 unit/ml Watch doses! Hypoglycemia will be long lasting

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28 ceftazidime/avibactam ceftolozane/tazobactam Combination of a cephalosporin and beta-lactamase inhibitor Beta lactamase inhibitor is to overcome resistance For complicated intra abdominal infections or complicated urinary tract infections Side effects: nausea/diarrhea

29 oritavancin delbavancin Lipoglycopeptide antibacterial For gram-positive infections oritavancin single dose given over 3 hr infusion equivalent to 7 10 day course of vancomycin delbavancin weekly infusion Reserved for resistant gram positive organisms and long courses

30 fidaxomicin Treatment of Chlostridium difficile associate diarrhea Not inferior to vancomycin Use if patient fails on vancomycin Side effects: nausea, vomiting, abdominal pain Expensive! $4,000 for a 10 day course

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32 flibanserin Female Viagra Indicated for hypoactive sexual desire disorder Daily at bedtime Contraindicated with alcohol increases risk of hypotension and syncope Side effects: hypotension, syncope, accidental injury, CNS depression

33 deoxycholic acid When injected into subcutaneous fat, cause the destruction of fat cells Used to aid breakdown and adsorption of submental fat Subcutaneous injection Side effects: pain, numbness, injection site edema, induration

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35 isavuconazole isavuconazole Treatment of invasive aspergillosis and mucormycosis Triazole antifungal

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37 naloxegol Treats constipation resulting from opioid use in adults with chronic non-cancer pain Take on an empty stomach an hour before or 2 hours after a meal Side effects: abdominal pain, diarrhea, nausea, flactulance

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39 Meningococcal Group B Vaccine Prevent invasive meningococcal disease This is in addition to the current meningococcal vaccines Group B has been the strain of the meningitis outbreak on college campus over the past 2 years

40 Questions?