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P&T March 2019


Health Care & Law
In the complex setting of obstetrics and reproductive medicine, the medication-related injuries leading to the most litigation involve some of the most commonly used drugs, rather than the newer, more complicated therapies. The authors present a number of cases illustrating how sophisticated treatment of high-risk pregnancies can be jeopardized by a simple negligent act.
HHS Plans Not a Boon to Some Players
The Trump administration’s multipronged effort to use regulatory tools to lower drug prices includes old and new initiatives. But opposition from some players is evident in each instance. Some of that opposition may be based on sound reasoning, some of it may be based on self-interest. The author discusses advertising, protected-class drugs, what’s next for rebates, and more.
Droxidopa is indicated for neurogenic orthostatic hypotension caused by primary autonomic failure. Sometimes, it is trialed in other uses as a last-line agent. Two cases add to the existing literature demonstrating that droxidopa may have varying effects in treating orthostatic hypotension caused by diabetes-related autonomic dysfunction and non-neurogenic etiologies, such as rheumatoid arthritis.
The authors attempt to put into perspective the unique coagulopathic imbalances seen in patients with cirrhosis, as well as the relative utility of administering vitamin K to patients simply because they present with elevated INRs. Five case reports exemplify the variability in response to vitamin K in these situations.
Meeting Highlights

We report on two presentations on β-thalassemia and myelodysplastic syndromes, three presentations on chronic lymphocytic leukemia, and others on perioperative oral anticoagulation, sickle-cell anemia, diffuse large B-cell lymphoma, and multiple myeloma.


Medication Errors
Neuromuscular blockers have been inadvertently administered to patients who were not receiving proper ventilatory assistance, causing death or permanent injuries.
Prescription: Washington
What role, if any, do group purchasing organizations play in drug shortages?
Approvals, new indications and formulations, and safety issues
Inbrija (levodopa inhalation powder) for oral inhalation for the treatment of “off” episodes in Parkinson’s disease; Ultomiris (ravulizumab) injection for treating adults with paroxysmal nocturnal hemoglobinuria; and Yupelri (revefenacin) inhalation solution for the maintenance treatment of patients with COPD
Drug Forecast
Meropenem-Vaborbactam (Vabomere) for carbapenem-resistant Enterobacteriaceae