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Article ; Online: Principles of Kidney Pharmacotherapy for the Nephrologist: Core Curriculum 2021.

Vondracek, Sheryl F / Teitelbaum, Isaac / Kiser, Tyree H

American journal of kidney diseases : the official journal of the National Kidney Foundation

2021 Volume 78, Issue 3, Page(s) 442–458

Abstract: Medications are an important part of the management of patients with kidney disease. When used appropriately, pharmacotherapy can slow disease progression and reduce morbidity and mortality. Unfortunately, reduced kidney function can significantly alter ... ...

Abstract	Medications are an important part of the management of patients with kidney disease. When used appropriately, pharmacotherapy can slow disease progression and reduce morbidity and mortality. Unfortunately, reduced kidney function can significantly alter the pharmacokinetics and pharmacodynamics of many medications, putting patients at risk for drug toxicity if modifications to therapy are not appropriately managed. Adding complexity to the appropriateness of medication and dosage selection is the difficulty in estimating kidney function and the discordance between the Cockcroft-Gault-derived dosing cut points in most medication package inserts and the estimations of glomerular filtration rate by newer and generally more accurate guideline-recommended equations. This installment of the AJKD Core Curriculum in Nephrology provides recent updates and practical considerations for designing optimal medication regimens. Given the prevalence of abnormal kidney function and its importance in medication selection and dose adjustment, additional focus and specific recommendations are provided for anticoagulant, anti-infective, analgesic, antidiabetic, and antihypertensive agents.
MeSH term(s)	Curriculum ; Glomerular Filtration Rate/physiology ; Humans ; Kidney/physiopathology ; Kidney Diseases/drug therapy ; Kidney Diseases/physiopathology ; Nephrologists/standards
Language	English
Publishing date	2021-07-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2021.02.342
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Article: Evaluation of Systemic Corticosteroids in Patients With an Acute Exacerbation of COPD and a Diagnosis of Pneumonia.

Scholl, Tyler / Kiser, Tyree H / Vondracek, Sheryl F

Chronic obstructive pulmonary diseases (Miami, Fla.)

2018 Volume 5, Issue 1, Page(s) 57–65

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2018-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2771715-X
ISSN	2372-952X
ISSN	2372-952X
DOI	10.15326/jcopdf.5.1.2017.0157
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Article ; Online: Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients.

Gaynor, Michelle F / Wright, Garth C / Vondracek, Sheryl

Therapeutic advances in cardiovascular disease

2018 Volume 12, Issue 1, Page(s) 7–15

Abstract: Background: The aim of this study was to evaluate the use of as-needed (PRN) labetalol and hydralazine [intravenous (IV) or oral] in hospitalized medicine patients for the treatment of severe asymptomatic hypertension and to examine the potential ... ...

Abstract	Background: The aim of this study was to evaluate the use of as-needed (PRN) labetalol and hydralazine [intravenous (IV) or oral] in hospitalized medicine patients for the treatment of severe asymptomatic hypertension and to examine the potential negative outcomes associated with their use. Methods: The electronic health record of 250 medicine patients hospitalized at the University of Colorado Hospital between November 2014 and April 2016 who received at least one dose of PRN IV or oral hydralazine or labetalol were retrospectively reviewed. The primary outcome was to describe the use of PRN antihypertensive medications in this population. Results: A total of 573 PRN doses of antihypertensive medication were administered. Oral hydralazine was the most common (521 doses, 90.9%). A total of 36% of PRN administrations were given for a systolic blood pressure (SBP) <180 mmHg and diastolic blood pressure (DBP) <110 mmHg (cut-point for acute severe hypertension). No serious adverse events were related to PRN antihypertensive administration. Despite receiving at least one PRN antihypertensive medication during hospitalization, 40.8% of patients were not continued on their home antihypertensive medication(s) while hospitalized, and 62.4% of patients did not have their home regimens intensified at discharge. Conclusion: As-needed oral hydralazine is frequently prescribed for acute blood pressure lowering with administration thresholds often less than what are used to define acute severe hypertension. Many patients are prescribed PRN antihypertensive medication instead of being continued on their home regimens, and most patients do not have the intensity of their home regimens increased. Providers need to be educated about the use of PRN antihypertensive medication for the management of severe asymptomatic hypertension in the hospital setting.
MeSH term(s)	Acute Disease ; Administration, Intravenous ; Administration, Oral ; Adrenergic Antagonists/administration & dosage ; Adrenergic Antagonists/adverse effects ; Adult ; Aged ; Antihypertensive Agents/administration & dosage ; Antihypertensive Agents/adverse effects ; Blood Pressure/drug effects ; Colorado ; Drug Utilization Review ; Electronic Health Records ; Female ; Hospitalization ; Hospitals, University ; Humans ; Hydralazine/administration & dosage ; Hydralazine/adverse effects ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/physiopathology ; Labetalol/administration & dosage ; Labetalol/adverse effects ; Male ; Middle Aged ; Practice Patterns, Physicians' ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Vasodilator Agents/administration & dosage ; Vasodilator Agents/adverse effects
Chemical Substances	Adrenergic Antagonists ; Antihypertensive Agents ; Vasodilator Agents ; Hydralazine (26NAK24LS8) ; Labetalol (R5H8897N95)
Language	English
Publishing date	2018-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2485062-7
ISSN	1753-9455 ; 1753-9447
ISSN (online)	1753-9455
ISSN	1753-9447
DOI	10.1177/1753944717746613
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Article ; Online: Managing osteoporosis in postmenopausal women.

Vondracek, Sheryl F

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2010 Volume 67, Issue 7 Suppl 3, Page(s) S9–19

Abstract: Purpose: To describe strategies used in managing postmenopausal osteoporosis, including a bone-healthy lifestyle, adequate calcium and vitamin D intake, and drug therapy options; considerations in selecting osteoporosis drug therapy; and the role of ... ...

Abstract	Purpose: To describe strategies used in managing postmenopausal osteoporosis, including a bone-healthy lifestyle, adequate calcium and vitamin D intake, and drug therapy options; considerations in selecting osteoporosis drug therapy; and the role of health-system pharmacists in managing osteoporosis in postmenopausal women. Summary: Postmenopausal women are at risk for osteoporosis and fractures. Weight-bearing and resistance exercise, limiting alcohol and caffeine intake, smoking cessation, and fall prevention strategies are part of a bone-healthy lifestyle used to manage postmenopausal osteoporosis. Supplements containing calcium and vitamin D are needed by many postmenopausal women because of an inadequate intake and other factors. The choice of osteoporosis drug therapy should take into consideration patient characteristics and preference and drug efficacy, safety, route of administration, dosing frequency, convenience, cost, and potential for nonadherence. Bisphosphonates generally are preferred for the prevention and treatment of osteoporosis in postmenopausal women, with raloxifene, teriparatide, and calcitonin salmon as alternatives. Denosumab, a fully human monoclonal immunoglobulin G(2) antibody, may become available soon for prevention and treatment of postmenopausal osteoporosis. Health-system pharmacists can improve the management of osteoporosis in postmenopausal women by counseling them on a bone-healthy lifestyle and making recommendations for calcium and vitamin D supplements and osteoporosis medications to prevent or treat the disease. Conclusion: A variety of approaches are available to promote bone health in postmenopausal women. Health-system pharmacists can promote interventions to optimize patient outcomes.
MeSH term(s)	Bone Density Conservation Agents/administration & dosage ; Bone Density Conservation Agents/adverse effects ; Bone Density Conservation Agents/therapeutic use ; Bone Remodeling ; Calcium/administration & dosage ; Contraindications ; Female ; Humans ; Osteoporosis, Postmenopausal/diet therapy ; Osteoporosis, Postmenopausal/drug therapy ; Pharmacists ; Professional Role ; Risk Reduction Behavior ; Vitamin D/administration & dosage
Chemical Substances	Bone Density Conservation Agents ; Vitamin D (1406-16-2) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2010-03-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.2146/ajhp100076
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Article ; Online: Combination vitamin D therapy in stage 5 chronic kidney disease.

Vondracek, Sheryl F / Hoody, Dorie W

The Annals of pharmacotherapy

2011 Volume 45, Issue 7-8, Page(s) 1011–1015

Abstract: Objective: To review the data supporting combination therapy with vitamin D and vitamin D receptor activators (VDRAs) in patients with stage 5 chronic kidney disease (CKD).: Data sources: Literature was searched using PubMed and EMBASE using the ... ...

Abstract	Objective: To review the data supporting combination therapy with vitamin D and vitamin D receptor activators (VDRAs) in patients with stage 5 chronic kidney disease (CKD). Data sources: Literature was searched using PubMed and EMBASE using the terms kidney disease, kidney failure-chronic, and vitamin D. Limits applied included humans, adults (19 years or older), and clinical trials (and related), with publication dates between January 1, 1980, and May 16, 2011. Study selection and data extraction: All English-language publications were analyzed for relevance. Studies appropriate to the objective were evaluated, including 3 prospective observational studies, 1 prospective cohort study, and 1 retrospective study. Data synthesis: To our knowledge, there have been no randomized controlled trials evaluating the safety and efficacy of vitamin D supplementation in combination with VDRA therapy in patients with stage 5 CKD. Relatively small observational studies have demonstrated improvements in 25-hydroxyvitamin D (25-OHD) concentrations and markers of mineral and bone metabolism as well as reduced VDRA use in patients with stage 5 CKD. Not all patients in these studies were receiving VDRA therapy. Therapy was safe, with no patients exceeding the recommended upper limit for 25-OHD concentrations and only a small percentage experiencing transient/correctable hypercalcemia. Conclusions: Vitamin D supplementation to maintain 25-OHD concentrations at 20-30 ng/mL or higher with or without VDRA therapy is inexpensive, appears safe, and may have additional health benefits in patients with stage 5 CKD. Well-designed, randomized controlled trials are needed to determine the efficacy and safety of combination vitamin D therapy in patients with stage 5 CKD.
MeSH term(s)	Adult ; Bone Resorption/prevention & control ; Cholecalciferol/administration & dosage ; Cholecalciferol/adverse effects ; Cholecalciferol/therapeutic use ; Drug Therapy, Combination ; Ergocalciferols/administration & dosage ; Ergocalciferols/adverse effects ; Ergocalciferols/therapeutic use ; Humans ; Kidney Failure, Chronic/drug therapy ; Kidney Failure, Chronic/physiopathology ; Receptors, Calcitriol/agonists ; Severity of Illness Index ; Vitamin D/administration & dosage ; Vitamin D/adverse effects ; Vitamin D/therapeutic use
Chemical Substances	Ergocalciferols ; Receptors, Calcitriol ; Vitamin D (1406-16-2) ; Cholecalciferol (1C6V77QF41)
Language	English
Publishing date	2011-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1101370-9
ISSN	1542-6270 ; 1060-0280
ISSN (online)	1542-6270
ISSN	1060-0280
DOI	10.1345/aph.1P782
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Article ; Online: Diagnosis and management of osteoporosis in the older senior.

Vondracek, Sheryl F / Linnebur, Sunny A

Clinical interventions in aging

2009 Volume 4, Page(s) 121–136

Abstract: The older senior is at high risk for osteoporosis. It is important for healthcare providers to be fully aware of the potential risks and benefits of diagnosing and treating osteoporosis in the older senior population. Data indicate that bone mineral ... ...

Abstract	The older senior is at high risk for osteoporosis. It is important for healthcare providers to be fully aware of the potential risks and benefits of diagnosing and treating osteoporosis in the older senior population. Data indicate that bone mineral density testing is under-utilized and drug therapy is often not initiated when indicated in this population. Bone mineral density testing with central dual energy x-ray absorptiometry is essential and cost-effective in this population. All older seniors should be educated on a bone-healthy lifestyle including age-appropriate weight-bearing exercise and smoking cessation if necessary. It is important to remember that falls play a very important role in the risk for osteoporotic fractures, especially in the older senior. All older seniors should be evaluated annually for falls and strategies should be implemented to reduce fall risk in this population. The risk for vitamin D insufficiency and deficiency is high in the older senior and can contribute to falls and fractures. Adequate intakes of calcium and vitamin D are important and deficiencies need to be treated. Data on osteoporosis drug therapy in the older senior are lacking. Based on data from subgroup analyses of large osteoporosis trials in postmenopausal women, current osteoporosis therapies appear safe and efficacious in the older senior and most will live long enough to derive a benefit from these therapies. Further studies are needed in older seniors, especially men, to better understand the risks and benefits of pharmacologic therapy for the management of osteoporosis.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Fractures, Bone/physiopathology ; Geriatric Nursing/methods ; Humans ; Male ; Mass Screening/methods ; Osteoporosis/diagnosis ; Osteoporosis/drug therapy ; Vitamin D Deficiency
Language	English
Publishing date	2009-05-14
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2364924-0
ISSN	1178-1998 ; 1176-9092
ISSN (online)	1178-1998
ISSN	1176-9092
DOI	10.2147/cia.s4965
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Article: Retrospective evaluation of systemic corticosteroids for the management of acute exacerbations of chronic obstructive pulmonary disease.

Vondracek, Sheryl F / Hemstreet, Brian A

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2006 Volume 63, Issue 7, Page(s) 645–652

Abstract: Purpose: The use of systemic corticosteroids for the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was studied.: Methods: Medical charts of patients admitted to the hospital between July 2002 and November 2003 ... ...

Abstract	Purpose: The use of systemic corticosteroids for the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was studied. Methods: Medical charts of patients admitted to the hospital between July 2002 and November 2003 with a primary diagnosis of AECOPD were retrospectively reviewed. The primary objective was to characterize the drug, dosage, route, frequency, and duration of systemic corticosteroids prescribed for the management of AECOPD. The secondary objective was to compare the mean length of stay (LOS) and 30-day relapse rate between patients who received lower and higher dosages of corticosteroids. Results: One hundred forty-five admissions (123 patients) for AECOPD (mean +/- S.D. age, 65 +/- 11 years) were evaluated. Higher dosages of systemic corticosteroids (>80 mg of prednisone equivalent [PE] per day) were prescribed for 51% and i.v. therapy for 56% of admissions. The mean +/- S.D. total systemic corticosteroid exposure during hospitalization for all admissions was 759 +/- 971 mg of PE (mean +/- S.D. daily exposure = 134 +/- 111 mg of PE per day). The mean LOS was significantly longer for the higher-dosage group than for the lower-dosage group (6.1 versus 4.2 days, p = 0.0004). A tapered regimen was prescribed for 79% of discharges. Twenty-seven percent of the discharges with routine follow-up care had a relapse of disease within 30 days. Conclusion: This retrospective observational study confirmed a wide variability in the dosages of systemic corticosteroids for the inpatient management of AECOPD, including the use of higher dosages and tapered regimens. Prospective randomized studies are needed to determine the most effective regimen of systemic corticosteroids in patients with AECOPD.
MeSH term(s)	Acute Disease ; Aged ; Drug Administration Routes ; Drug Administration Schedule ; Drug Utilization ; Female ; Glucocorticoids/administration & dosage ; Glucocorticoids/therapeutic use ; Hospital Bed Capacity, 300 to 499 ; Hospitals, University ; Humans ; Male ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Recurrence ; Retrospective Studies
Chemical Substances	Glucocorticoids
Language	English
Publishing date	2006-03-13
Publishing country	England
Document type	Journal Article
ZDB-ID	1224627-x
ISSN	1079-2082
ISSN	1079-2082
DOI	10.2146/ajhp050316
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Article: Is there an optimal corticosteroid regimen for the management of an acute exacerbation of chronic obstructive pulmonary disease?

Vondracek, Sheryl F / Hemstreet, Brian A

Pharmacotherapy

2006 Volume 26, Issue 4, Page(s) 522–532

Abstract: Systemic corticosteroids are standard of care for the management of an acute exacerbation of chronic obstructive pulmonary disease (COPD). Several prospective, randomized trials demonstrated modest improvements in patient outcomes when short courses of ... ...

Abstract	Systemic corticosteroids are standard of care for the management of an acute exacerbation of chronic obstructive pulmonary disease (COPD). Several prospective, randomized trials demonstrated modest improvements in patient outcomes when short courses of systemic corticosteroids were used. However, the most appropriate dosage regimen remains controversial, as the corticosteroid regimens used in these trials differed greatly, and no studies have directly compared medium-, high-, and low-dose regimens. In addition, data are lacking on the safety, efficacy, and appropriate dosing of systemic corticosteroids in women and in patients with an acute exacerbation of COPD and concomitant pneumonia or severe respiratory failure. Systemic corticosteroid use is associated with several adverse effects that are dose and/or duration dependent. Evidence suggests that higher dose corticosteroid regimens may place patients at increased short-term and long-term risk, without additional clinical benefit. Tapering of systemic corticosteroid regimens, although a common practice, is unnecessary in most circumstances. The risk for hypothalamic-pituitary-adrenal-axis suppression is negligible when low-dose, short-course corticosteroid regimens are used, and no evidence exists to suggest that abruptly stopping a low-dose steroid regimen will increase the risk of disease relapse. Still, no studies have directly compared tapered and non-tapered regimens in patients with an acute exacerbation of COPD. Consistent with clinical guideline recommendations, safety and efficacy data support the use of low-dose corticosteroid regimens such as prednisone 40 mg orally once/day for 10-14 days in most patients with an acute exacerbation of COPD. Further studies are needed to clarify the optimal systemic corticosteroid regimen for an acute exacerbation of COPD.
MeSH term(s)	Acute Disease ; Clinical Trials as Topic ; Drug Administration Schedule ; Glucocorticoids/administration & dosage ; Glucocorticoids/adverse effects ; Glucocorticoids/therapeutic use ; Humans ; Prednisone/administration & dosage ; Prednisone/adverse effects ; Prednisone/therapeutic use ; Pulmonary Disease, Chronic Obstructive/drug therapy
Chemical Substances	Glucocorticoids ; Prednisone (VB0R961HZT)
Language	English
Publishing date	2006-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603158-4
ISSN	1875-9114 ; 0277-0008
ISSN (online)	1875-9114
ISSN	0277-0008
DOI	10.1592/phco.26.4.522
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Article ; Online: Diagnosis and management of osteoporosis in the older senior

Sheryl F Vondracek / Sunny A Linnebur

Clinical Interventions in Aging, Vol 2009, Iss default, Pp 121-

2009 Volume 136

Abstract: Sheryl F Vondracek, Sunny A LinneburDepartment of Clinical Pharmacy, School of Pharmacy C238-L15 ...

Abstract	Sheryl F Vondracek, Sunny A LinneburDepartment of Clinical Pharmacy, School of Pharmacy C238-L15, University of Colorado Denver, Aurora, CO, USAAbstract: The older senior is at high risk for osteoporosis. It is important for healthcare providers to be fully aware of the potential risks and benefits of diagnosing and treating osteoporosis in the older senior population. Data indicate that bone mineral density testing is under-utilized and drug therapy is often not initiated when indicated in this population. Bone mineral density testing with central dual energy x-ray absorptiometry is essential and cost-effective in this population. All older seniors should be educated on a bone-healthy lifestyle including age-appropriate weightbearing exercise and smoking cessation if necessary. It is important to remember that falls play a very important role in the risk for osteoporotic fractures, especially in the older senior. All older seniors should be evaluated annually for falls and strategies should be implemented to reduce fall risk in this population. The risk for vitamin D insufficiency and deficiency is high in the older senior and can contribute to falls and fractures. Adequate intakes of calcium and vitamin D are important and deficiencies need to be treated. Data on osteoporosis drug therapy in the older senior are lacking. Based on data from subgroup analyses of large osteoporosis trials in postmenopausal women, current osteoporosis therapies appear safe and efficacious in the older senior and most will live long enough to derive a benefit from these therapies. Further studies are needed in older seniors, especially men, to better understand the risks and benefits of pharmacologic therapy for the management of osteoporosis.Keywords: osteoporosis, aged, elderly, eighty and over, senior, diphosphonates
Keywords	Medicine (General) ; R5-920 ; Medicine ; R ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Geriatrics ; RC952-954.6
Subject code	300
Language	English
Publishing date	2009-03-01T00:00:00Z
Publisher	Dove Medical Press
Document type	Article ; Online
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Article: Clinical challenges in the management of osteoporosis.

Vondracek, Sheryl F / Minne, Paul / McDermott, Michael T

Clinical interventions in aging

2008 Volume 3, Issue 2, Page(s) 315–329

Abstract: While knowledge regarding the diagnosis and treatment of osteoporosis has expanded dramatically over the last few years, gaps in knowledge still exist with guidance lacking on the appropriate management of several common clinical scenarios. This article ... ...

Abstract	While knowledge regarding the diagnosis and treatment of osteoporosis has expanded dramatically over the last few years, gaps in knowledge still exist with guidance lacking on the appropriate management of several common clinical scenarios. This article uses fictional clinical scenarios to help answer three challenging questions commonly encountered in clinical practice. The first clinical challenge is when to initiate drug therapy in a patient with low bone density. It is estimated that 34 million America have low bone density and are at a higher risk for low trauma fractures. Limitations of using bone mineral density alone for drug therapy decisions, absolute risk assessment and evidence for the cost-effectiveness of therapy in this population are presented. The second clinical challenge is the prevention and treatment of vitamin D deficiency. Appropriate definitions for vitamin D insufficiency and deficiency, the populations at risk for low vitamin, potential consequences of low vitamin D, and how to manage a patient with low vitamin D are reviewed. The third clinical challenge is how to manage a patient receiving drug therapy for osteoporosis who has been deemed a potential treatment failure. How to define treatment failure, common causes of treatment failure, and the approach to the management of a patient who is not responding to appropriate osteoporosis therapy are discussed.
MeSH term(s)	Aged ; Aged, 80 and over ; Bone Density ; Bone Density Conservation Agents/therapeutic use ; Diphosphonates/therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Osteoporosis/diagnosis ; Osteoporosis/drug therapy ; Osteoporosis/physiopathology ; Raloxifene Hydrochloride/therapeutic use ; Vitamin D/therapeutic use ; Vitamin D Deficiency/drug therapy ; Vitamin D Deficiency/prevention & control
Chemical Substances	Bone Density Conservation Agents ; Diphosphonates ; Vitamin D (1406-16-2) ; Raloxifene Hydrochloride (4F86W47BR6)
Language	English
Publishing date	2008-08-04
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2364924-0
ISSN	1176-9092
ISSN	1176-9092
DOI	10.2147/cia.s2539
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