Potential Medication Interactions Research Articles

Assessment of the potential interactions between favipiravir and radiocontrast agents

BACKGROUND In cases of coronavirus disease 2019 (COVID-19), favipiravir is commonly included to the therapy regimen. Drug interactions between favipiravir and other COVID-19 therapy drugs are frequently researched. However, no research on possible drug interactions between Favipiravir and radiocontrast agents, which have become almost crucial in diagnostic processes while not being part of the treatment, has been found. AIM To determine potential medication interactions between Favipiravir and radiocontrast agents. METHODS The study comprised patients who were taking Favipiravir for COVID-19 therapy and underwent a contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) test while taking the medicine. The computerized patient files of the cases included in the study, as well as the pharmacovigilance forms in the designated hospital, were evaluated for this purpose. RESULTS The study included the evaluation of data from 1046 patients. The study sample's mean age was 47.23 ± 9.48 years. The mean age of cases with drug interactions was statistically significant greater than that of cases with no drug interactions (P = 0.003). When evaluated with logistic regression analysis, a 1-year raises in age increases the risk of developing drug interactions by 1.63 times (P = 0.023). There was no statistically significant difference in the occurrence of medication interactions between the sexes (P = 0.090). Possible medication interactions were discovered in 42 cases (4%). CONCLUSION The findings of this study revealed that the most notable findings as a result of the combined use of contrast agents and favipiravir were increased creatinine and transaminase values, as well as an increase in the frequency of nausea and vomiting. The majority of drug interactions discovered were modest enough that they were not reflected in the clinic. Drug interactions become more common as people get older.

Preoperative management of medications for psychiatric disorders.

Perioperative medication management is a complex topic. Physicians working in the perioperative space are frequently called upon to make decisions regarding continuing or stopping certain medications. For patients with psychiatric disorders, the overwhelming recommendation is to continue therapy with heightened awareness of anesthesiologists regarding potential side effects or medication interactions.

Analysing patient factors and treatment impact on diabetic foot ulcers in South Africa

In the South African public healthcare sector, 28% of diabetic patients present to primary healthcare clinics with diabetic foot ulcers (DFUs), often presenting in advanced stages of ulcer severity. In this study, we aimed to categorise factors predisposing individuals to developing a DFU and to identify the potential shortcomings in existing treatment plans in the South African healthcare system. In addition, the use of preventative measures in the management of DFUs was examined as well as the influence of past treatment practices. A total minimum sample size of 50 DFUs was required for this study. Participants who were selected for this study had their past records reviewed in order to determine the likelihood of previous DFU infections, as well as to determine the occurrence of co-morbidities. The treatment protocol implemented was recorded. Twelve-month patient records were used to identify the infection frequency and past treatment protocols. A total of 48.9% of patients reported that they did not make use of any preventative measures. The most frequent concurrent medical conditions were hypertension, dyslipidaemia, and peripheral neuropathy. Polypharmacy was prevalent, with 55% of the population prescribed five or more medications. Potential medication interactions were examined and a total of 210 interactions were documented. An analysis of past and current treatment practices revealed that 52.1% of the treatment protocols did not comply with local treatment guidelines. This study highlights the urgent need for updated DFU treatment protocols in relation to the overall management of DFUs, taking into account existing international guidelines.

The role of medicinal plants in rheumatoid arthritis-an updated review

Rheumatoid arthritis (RA) is a debilitating, persistent autoimmune condition that affects by a variety of endogenous and external causes. It is distinguished by cartilage and bone deterioration. The present traditional allopathic treatment is costly and has negative side effects. Recently, some ethnopharmacological research on RA was published, including anti-RA properties and therapeutic targets of various dosage forms of Traditional Herbal Treatments (THMs). Given the increased herbalists' interest medicines among people suffers from rheumatoid arthritis, further research into their safety and efficacy is needed. The goal of this research was to carry out a comprehensive assessment of the evidence based on the use of herbal medications in the treatment of RA Randomised Clinical Trials (RCTs).Different chemical ingredients discovered in various herbal treatments have modest support for lowering pain, sensitive joint count, and stiffness. Herbal remedies were generally considered safe to use. More study is required to evaluate the effectiveness, safety, and potential medication interactions of the numerous herbal remedies advocated for RA.

A Clinical Review on Paroxetine and Emerging Therapies for the Treatment of Vasomotor Symptoms.

Most women experience vasomotor symptoms (VMS) during their menopausal transition. Menopausal hormone therapy (HT) is the most effective treatment for VMS, but some women choose not to use HT or have contraindications to using HT. Non-hormonal treatment options should be offered to these symptomatic menopausal women. Multiple large randomized controlled trials have demonstrated statistically significant reductions in hot flash severity and/or frequency with the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). To date, paroxetine mesylate remains the only non-hormonal treatment that has been approved by the United States Food and Drug Administration (FDA) for the management of moderate to severe postmenopausal vasomotor symptoms. Lower doses are needed to reduce VMS than those used to treat anxiety or depression, which is beneficial since side effects are typically dose dependent. The recommended dosage is 7.5 mg once daily at bedtime. Dose dependent side effects include nausea, fatigue, and dizziness. Knowing potential medication interactions is critical such as with medications that can lead to serotonin syndrome, concomitant use with monoamine oxidase inhibitors and being aware of p450 drug metabolism is essential for patients taking drugs that utilize the CYP2D6 enzyme for metabolism including tamoxifen. This review discusses in detail the available data supporting the use of paroxetine for the treatment of VMS, including side effects and considerations regarding prescribing. A discussion of other emerging treatments is included as well, including estetrol, oxybutynin and neurokinin 3 (NK3) receptor antagonists.

Postoperative Cognitive Dysfunction

The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and the development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves or whether other variables are causative of the observed changes in understanding. Furthermore, there are conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders or incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction.

Postoperative Cognitive Dysfunction

The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and the development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves or whether other variables are causative of the observed changes in understanding. Furthermore, there are conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders or incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction.

Randomized Trial to Improve Primary Care Patient Management and Patient Outcomes Using a Drug-Drug Interaction Test: Confirmation of the DECART Simulated Patient Clinical Utility Trial Results.

Drug–drug interactions (DDIs) are a serious problem in the healthcare system, leading to excess healthcare utilization and costs. We conducted a second prospective randomized, controlled trial to further establish the real-world clinical utility of a novel assay that objectively identifies potentially serious DDIs in real-world patients. Re-recruiting primary care physicians (PCPs) from our first randomized, controlled, simulated-patients study on DDIs, we experimentally introduced a definitive, urine-based mass spectrometry test intervention that the physicians could use when caring for their eligible patients. Patients were eligible if taking four or more prescription medications or suspected of taking other non-prescribed substances with potential medication interactions. The primary outcome was whether DDI testing changed clinical care. We explored a secondary outcome to see if the change in practice improved symptoms in patients with potential DDIs. A total of 169 control and 162 intervention patients were enrolled in the study, and their medical records were abstracted. In real-world patients, intervention physicians identified and/or treated a DDI at 3.0x the rate in their patient population compared to controls (21.6% vs. 7.1%, p < 0.001). Intervention physicians were more likely to discontinue or adjust the interacting agent compared to controls (62.9% vs. 8.3%, p = 0.001), and patient-reported symptoms also significantly declined (29.6% vs. 20.1%, p = 0.045). These results were nearly identical to concurrent measurements that used simulated patients, wherein intervention was more likely to both make a DDI diagnosis (56.3% vs. 21.6%, p < 0.001) and stop the interacting medications (58.3% versus 26.6%, p < 0.001). Bringing a new diagnostic test to market, particularly for an under-recognized clinical problem, requires robust data on both clinical validity and clinical utility. The results of this follow-up study showed that the use of DDI testing in real-world patients significantly improved (1) primary care patient management of drug interactions and (2) patient outcomes.

Cardiac Complications Attributed to Hydroxychloroquine: A Systematic Review of the Literature Pre-COVID-19.

IntroductionHydroxychloroquine has been used for rheumatological diseases for many decades and is considered a safe medication. With the COVID-19 outbreak, there has been an increase in reports associating cardiotoxicity with hydroxychloroquine. It is unclear if the cardiotoxic profile of hydroxychloroquine is previously underreported in the literature or is it a manifestation of COVID-19 and therapeutic interventions. This manuscript evaluates the incidence of cardiotoxicity associated with hydroxychloroquine prior to the onset of COVID-19.MethodsPubMED, EMBASE, and Cochrane databases were searched for keywords derived from MeSH terms prior to April 9, 2020. Inclusion eligibility was based on appropriate reporting of cardiac conditions and study design.Results A total of 69 articles were identified (58 case reports, 11 case series). The majority (84%) of patients were female, with a median age of 49.2 (range 16-92) years. 15 of 185 patients with cardiotoxic events were in the setting of acute intentional overdose. In acute overdose, the median ingestion was 17,857 ± 14,873 mg. 2 of 15 patients died after acute intoxication. In patients with long-term hydroxychloroquine use (10.5 ± 8.9 years), new onset systolic heart failure occurred in 54 of 155 patients (35%) with median cumulative ingestion of 1,493,800 ± 995,517 mg. The majority of patients improved with the withdrawal of hydroxychloroquine and standard therapy.ConclusionMillions of hydroxychloroquine doses are prescribed annually. Prior to the COVID-19 pandemic, cardiac complications attributed to hydroxychloroquine were uncommon. Further studies are needed to understand the impact of COVID-19 on the cardiovascular system to understand the presence or absence of potential medication interactions with hydroxychloroquine in this new pathophysiological state.

The Impact of Alcohol in Inflammatory Bowel Diseases.

Several environmental factors have been implicated in the pathogenesis of inflammatory bowel diseases (IBD); however, the evidence for alcohol is sparse, as is its implications on disease activity and overall management. Here, we examine the available evidence for the effect of alcohol on IBD, including its association with the development of IBD, role in exacerbations, and potential medication interactions. Several mechanisms have been demonstrated to mediate the effects of ethanol in the gastrointestinal tract. Alcohol has been shown to alter the gut microbiome, disrupt intestinal barrier, and increase intestinal permeability, directly and indirectly promoting immune activation. Conversely, specific alcoholic beverages, notably red wine, may have anti-inflammatory properties capable of assisting in disease control and affecting disease monitoring. Nonetheless, most alcohol-mediated effects seem to facilitate intestinal inflammation and consequently impact disease onset, recurrence, and symptom control. Furthermore, alcohol use interferes with the metabolism of several medications leading to increased side effect profiles or even loss of effect. Notably, mesalamine, azathioprine, methotrexate, and biologic medications can all be affected by concomitant alcohol intake via a variety of mechanisms.

Alcohol-Antiretroviral Therapy Interactive Toxicity Beliefs and Intentional Medication Nonadherence: Review of Research with Implications for Interventions.

The successful treatment of HIV infection relies on adherence to antiretroviral therapy (ART). Alcohol use remains a threat to ART adherence, including the beliefs held by people who drink alcohol that it is harmful to take ART when consuming alcohol (i.e., alcohol-ART interactive toxicity beliefs, AA-ITB). We reviewed the current research that has investigated AA-ITB and their relationship to intentional ART nonadherence. The review of 17 published studies found that AA-ITB are prevalent among people receiving ART and that AA-ITB are directly associated with ART nonadherence and incomplete HIV suppression. Family, friends and healthcare providers are common sources and reinforcers of AA-ITB. Studies suggest that AA-ITB may best be explained by the Medication Necessity and Concerns Beliefs Model, treating AA-ITB as a specific circumstance of medication concerns. Interventions are needed to communicate the realities of potential medication interactions and dispel myths that it is harmful to mix alcohol with ART, while not inadvertently suggesting that it is safe to drink with all medications, which could undermine adherence to ART by increasing alcohol use.

Prevalence of potential interactions of medications, including herbs and supplements, before, during, and after chemotherapy in patients with breast and prostate cancer.

The use of herbs and supplements (HS) is common among patients with cancer, yet limited information exists about potential medication interactions (PMIs) with HS use around chemotherapy. Patients with breast or prostate cancer who had recently finished chemotherapy at 2 academic medical centers were surveyed by telephone. Interviewers inquired about all medications, including HS, before, during, and after chemotherapy. Micromedex, Lexicomp, and Natural Medicines Comprehensive Database interaction software programs were used to determine PMIs. A total of 67 subjects (age range, 39-77 years) were evaluated in this study. Participants were primarily White patients (73%) with breast cancer (87%). The median number of medications was 11 (range, 2-28) during the entire study and was highest during chemotherapy (7; range, 2-22). Approximately four-fifths (84%) used HS. A total of 1747 PMIs were identified, and they represented 635 unique PMIs across all 3 timeframes, with most occurring during chemotherapy. Prescription-related PMIs (70%) were the most common type, and they were followed by HS-related (56%) and anticancer treatment-related PMIs (22%). Approximately half of the PMIs (54%) were categorized as moderate interactions, and more than one-third (38%) were categorized as major interactions. Patient use of HS increased from 51% during chemotherapy to 66% after chemotherapy, and this correlated with an increased prevalence of HS PMIs (46% to 60%). HS users were more likely to be at risk for a major PMI than non-HS users (92% vs 70%; P = .038). The use of HS remains prevalent among patients with cancer and may place them at risk for PMIs both during chemotherapy and after the completion of treatment. This study evaluates the risk of potential medication interactions for patients with breast or prostate cancer undergoing chemotherapy. The results show that patients often use herbs and supplements during treatment. Prescription medications are most often associated with medication interactions, which are followed by herb and supplement-related interactions. More than one-third of potential medication interactions are considered major. Patients should be educated about the risk of herb and supplement-related medication interactions during treatment.

INTEGRATING TOBACCO HEALTH INTO MAINSTREAM PULMONARY CLINIC: A NOVEL APPROACH

SESSION TITLE: Tobacco Cessation and Prevention Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Tobacco related health conditions account for a large cohort of chronic health conditions. Tobacco/Nicotine users are currently stigmatized and hence find it difficult to seek treatment. Our institution has an electronic best practice advisory which automatically populates in all smokers identified in the electronic medical record and generates a referral to the QUIT line if patient is interested in quitting. However only 25% of these patients actually engage with the QUIT line. The Tobacco Health Assessment and Treatment (THAT) Clinic is a new initiative to integrate tobacco health into mainstream pulmonary health, 1:1 patient provider interaction, engaging patients who are interested in quitting and destigmatizing tobacco treatment. METHODS: There is 1: 1 pulmonologist, tobacco nurse and patient interaction. Patients evaluated for overall tobacco health: history and physical, the Fagerström Test for Nicotine Dependence(FTND), Framingham Risk Score, prior quit attempts, obstacles, environmental triggers and severity of tobacco dependence based on the ACCP Tobacco toolkit. PFT's ordered when appropriate.The toxic effects of tobacco, nature of the addiction, nicotine hijacking the survival instincts , countering ambivalence and helping patients bring the tobacco treatment and medication interactions with proposed tobacco treatment are discussed. Patients who are newly diagnosed with COPD , ILD, asthma, other pulmonary conditions are triaged appropriately to respective clinics. A comprehensive medication review, potential medication interactions with proposed tobacco treatment and potential side effects are discussed before offering therapy. The patients who qualify for lung cancer screening are referred to low-dose CT screening for lung cancer. RESULTS: 60 pts 70%-1 visit, 27% >2 visits. Mean age 58.5 yrs, 53% women & 82% African-American.(46%) high nicotine dependence using FTND, 80% multiple quit attempts . Common triggers :stress, depression, anxiety, proximity to smokers, boredom, staying home & coffee. Comorbidities - hypertension (63%), COPD (47%), and (18%) cancer. 20/60 patients -LDCT lung cancer screening. Median Maryland area deprivation index:9 (10- worst). 40/60 active follow up , 8 quit,12 trying to quit, 20 lost to follow up. All had follow-up outreach,-total of 640 encounters of which 81% tobacco health check-in .Common combinations-nicotine patch & lozenge/gum/inhaler; Chantix & lozenge/gum/inhaler; Chantix with nicotine patch & lozenge/gum/inhaler; or Wellbutrin with nicotine patch & lozenge/gum/inhaler.Compliance with controller& rescue medications, associated with higher quit / trying to quit rates. CONCLUSIONS: 30% patients have quit/cut down- higher success rate than many other initiatives. CLINICAL IMPLICATIONS: Integrating tobacco as mainstream pulmonary health condition & treating it as one. DISCLOSURES: No relevant relationships by Janaki Deepak, source=Web Response No relevant relationships by Julia Melamed, source=Web Response

Implementation of a pharmacist-led fluoroquinolone stewardship program: Improving use within the ambulatory care setting

ObjectiveTo describe the implementation of a pharmacist-led fluoroquinolone stewardship program within the ambulatory care setting. SettingButler Veterans Affairs Healthcare System. Practice descriptionA fluoroquinolone stewardship program, comprising academic detailing and a standardized fluoroquinolone note in the computerized record system (CPRS), was implemented to facilitate prescribing-behavior change. An academic detailer met with all primary care providers before the implementation of a fluroquinolone note that was required to be completed with each new prescription. Both components were designed to ensure that the provider considered guideline-directed treatment alternatives before prescribing a fluoroquinolone and that the provider had a discussion with the veteran regarding potential medication adverse effects and interactions. Practice innovationThe evaluation of an ambulatory care fluoroquinolone stewardship program using academic detailing, with or without a robust note in the CPRS, has not been previously described in the literature to the authors’ knowledge. EvaluationComparisons of the mean average incidence of fluroquinolone prescribing before and after the intervention were performed using a 1-way analysis-of-variance model. In addition, a single-group generalized least-squares interrupted time series analysis was performed to estimate the impact of the intervention on the level and slope changes before and after the implementation. ResultsThe mean incidence of fluoroquinolone prescribing was greater in the preimplementation period than in the postimplementation period (4.44 vs. 1.96 per 1000 population; P < 0.001). At the time of the implementation there was an immediate drop in the incidence of fluoroquinolone prescribing by 2 per 1000 population (P < 0.001). Compared with the slope before the implementation that was not statistically different from zero, the downward slope after the implementation was statistically significant with an average monthly reduction of 0.013 per 1000 population in the incidence of fluoroquinolone prescribing (P < 0.001). ConclusionThe implementation of a fluoroquinolone stewardship program sustainably decreased fluoroquinolone use and improved the quality of care received.

Chronic Medication Burden and Complexity for US Patients with Type2 Diabetes Treated with Glucose-Lowering Agents.

IntroductionMost adults with type 2 diabetes (T2D) have several chronic conditions treated with complex regimens and multiple medications. The burden and complexity of multiple medication use are associated with worse patient outcomes, including reduced adherence and increased costs, hospitalizations, mortality rates, and HbA1c. This study quantifies the chronic medication burden, regimen complexity, and potential medication interactions in patients with T2D using a nationwide claims database in the USA.MethodsAdults with T2D treated for greater than half of the year with at least one glucose-lowering agent (GLA) in 2017 were included in this descriptive study. Chronic medications were defined as all GLAs and non-GLA medications prescribed for at least 90 days in 2017 to at least 2% of the cohort. Medication burden, defined as the number of medications prescribed, was examined. Medication complexity, proxied by the Medication Regimen Complexity Index (MRCI), and potential use of interacting medications were also examined. Results were investigated for all chronic medications and were reported on the basis of the disease treated (diabetes or other condition) and the route of administration (oral or other).ResultsOn average, in 2017, the 814,156 patients included in the study filled prescriptions for 4.1 chronic medications (standard deviation [SD] = 2.0), 3.7 oral chronic medications (SD = 1.9), 1.5 GLAs (SD = 0.8), and 1.1 oral GLAs (SD = 0.7). The average MRCI was 14.7 for all chronic medications (SD = 7.4), with a mean of 12.4 for all oral chronic medications (SD = 6.3), 6.6 for all GLAs (SD = 3.8), and 4.9 for oral GLAs (SD = 2.6).ConclusionOn average, patients with T2D used multiple medications, had a complex medication regimen, and were at potential risk of medication interactions. These findings suggest that patients, practitioners, pharmacists, and payers may benefit from interventions which decrease medication burden, complexity, and/or adverse events related to the treatment of T2D.Electronic supplementary materialThe online version of this article (10.1007/s13300-020-00838-6) contains supplementary material, which is available to authorized users.

Addressing the unique health requirements of the older adult Population

The number of people at least 65 years of age in the U.S. is at a record high.1 As outlined in this month's lead feature article, the number of Americans in this age group is projected to reach 95 million by 2060, almost double the number in 2018.1 This population increase can be attributed to an increased life expectancy resulting from a shift in the leading cause of death: from infection to chronic conditions.2 The older adult population has specific health requirements that health care teams will need to understand to provide optimal care.3 It is important to recognize that each older patient has a distinct health history and that the conventional features of age do not apply to the entire older adult population. A patient could be 80 years of age, but have a biological age of 65 years from living a healthy lifestyle and having a high level of physical activity. A comprehensive evaluation can help the health care team identify each patient's biological age, physiological response to aging, and functional status.4 It is expected that by 2030, 60 percent of the baby-boom generation will have at least two chronic health conditions that will increase the complexity of their care.2 Health care teams will need to anticipate the presence of such comorbidities and implement appropriate management strategies. This will require an interdisciplinary approach; a focus on preventive rather than reactive care; and knowledge of potential behavior changes, medication interactions and adverse effects, and options for addressing pain and other symptoms.2, 3 In addition, these patients may benefit from receiving a more comprehensive care plan before discharge, additional monitoring after discharge, and notification when follow-up care is required.2 Adding to the complexity of caring for older adults are possible end-of-life issues. For patients whose general health and function are deteriorating, quality of life should become the focus of care; each patient's circumstances, culture, values, beliefs, and preferences should be taken into consideration. Helping these patients work through care decisions to determine the most effective and appropriate interventions will require sensitivity and understanding from each member of the health care team.4, 5 With the older adult population expected to continue to increase in numbers, health care teams need to be prepared to address the unique concerns associated with these patients. This can include managing frailty, as outlined in this month's lead feature article; assessing for biological age; managing comorbidities; and considering end-of-life concerns and quality of life when making treatment decisions.

Substance Use Among Older Adults: Ethical Issues.

Substance Use Among Older Adults: Ethical Issues.

Potential Dietary Supplement and Medication Interactions in a Subset of the Older Adult Population Attending Congregate Sites

This study assessed possible dietary supplement–medication interactions of 62 older adults recruited from 8 senior congregate sites in Bexar County, Texas. Dietary supplement and medication use were collected by paper questionnaire and potential supplement–medication interactions were assessed using online databases. The majority of participants reported dietary supplements (77%), non-prescription medication (50%), and prescription medication (73%) use. Fifty percent of participants who reported dietary supplement and medication use were at-risk for a potential supplement–medication interaction, ranging from one to eight potential interactions. Calcium and multivitamin-mineral supplements were the most common dietary supplements with potential medication interactions. Surveyed older adults reported dietary supplements should be reported to a physician (97%), but over 20% believe herbal products are pure (38%) and dietary supplements are risk free (34%) and will not cause harm (22%). In conclusion, regular education and screening of dietary supplement and medication use among older adults is recommended.

Pharmacology and Perioperative Considerations for Psychiatric Medications.

Psychotropic medications are being used increasingly as analgesics and for other off-label indications for patients with and without psychiatric conditions. While the pharmacology of most of these drugs is now known, their interaction with anesthetic drugs and implications of regular use are still relatively unclear. We discuss the pharmacology, side effects, and potential medication interactions with anesthetic agents of various commonly prescribed psychotropic medications and the current recommendations regarding the continuation of these medications during the patients' perioperative care. A review of the current literature present on PubMed and Medline was conducted between the years 2000-2016. The reference lists of each selected article were also reviewed for additional sources of information. Psychotropic medications can be broadly divided into classes, which include antidepressants, antipsychotics, anxiolytics, mood stabilizers, and stimulants. Although most evidence suggests the continuation of these medications in the perioperative period, it is still important to determine how psychotropic medications interact with routinely used anesthetic agents and which medications should be continued and which should not be continued on an individualized basis for each patient.

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

Introduction: Cardiac arrhythmias, including supraventricular and ventricular tachycardias, portend a higher risk of morbidity and mortality. These arrhythmias also are associated with increased healthcare resource utilization, decreased quality of life, and increased activity impairment. Pharmacologic conversion is a treatment option for conversion to sinus rhythm that has the advantage of avoiding sedation from DC cardioversion. Objective: To review the efficacy, side effects, clearance, and prescribing considerations for antiarrhythmic medications for pharmacologic cardioversion. Methodology: We included studies evaluating the efficacy of antiarrhythmic drugs. We included prescribing indications including half-life, clearance, and side effects. We arranged the manuscript by Vaughan Williams classification. Results: Class IA, class IC, and class III antiarrhythmic medications are effective at conversion of supraventricular arrhythmias with rates frequently greater than 50%. Amiodarone and Lidocaine may be used for conversion of ventricular tachycardias. The specific agent utilized depends upon the potential other medication interactions, clearance and toxicity. Conclusion: Pharmacologic cardioversion provides a reasonable alternative to electrical cardioversion in many cases.