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What is InpharmD™?


Literature searching is tedious. InpharmD™ is here to help.

Clinical pharmacists can ask any question, anytime, from anywhere, and we’ll perform a custom literature search.

(And a 32% chance it’s already been asked.)


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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

Please provide primary literature for Keytruda Dose Rounding
what is the recommended dose and duration of high dose corticosteroid (ie methylprednisolone) for Pulmonary hemorrhag...
How do inhaled steroids compare to systemic steroids for prevention and management of BPD/CLD in preterm infants?
Is there data to support vaginal administration of commercial diazepam tablets for pelvic floor dysfunction?
Does ketorolac have a “ceiling effect” with no added benefit of higher doses for acute pain?

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

Author:Naveed Aijaz, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Primary literature describing dose rounding for Keytruda (pembrolizumab) primarily focuses on cost savings (see Tables 1,2), generally finding that practical dose down-rounding procedures can significantly reduce cost. Tangentially-related data from studies comparing weight-based vs. fixed dose administration has found that both strategies may offer overall comparable benefits, while weight-based dosing may be associated with some cost savings.

A 2022 review explored the dosing and schedule optimization of immune checkpoint-targeted antibodies, particularly anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) and anti-programmed cell death protein/ligand 1 (anti-PD-1/PD-L1) monoclonal antibodies, which have become pivotal in cancer immunotherapy. These therapeutic antibodies, including ipilimumab, nivolumab, pembrolizumab, atezolizumab, and others, were developed with dosing regimens largely guided by conventional models from chemotherapy, emphasizing fixed intervals or weight-based calculations. Development trials identified no dose-limiting toxicities for most PD-1/PD-L1 inhibitors, allowing fixed dosing options to evolve from weight-based regimens, despite notable economic and clinical implications. Fixed-dose regimens, such as pembrolizumab at 200 mg every three weeks or nivolumab at 480 mg every four weeks, were standardized based on average patient weights during trials, often leading to overexposure in low...

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A search of the published medical literature revealed 3 studies investigating the researchable question:

What literature is available for dose rounding of Keytruda (pembrolizumab)?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Maritaz C, Broutin S, Chaput N, Marabelle A, Paci A. Immune checkpoint-targeted antibodies: a room for dose and schedule optimization?. J Hematol Oncol. 2022;15(1):6. Published 2022 Jan 15. doi:10.1186/s13045-021-01182-3
[2] Patel A, Akhade A, Parikh P, et al. Pembrolizumab weight based dosing – A call for policy change. Indian J Med Paediatr Oncol. 2022;43(3):306–310. doi:10.1055/s-0042-1742651
[3] Patail NK, Sher AF, Wu S. Improving tolerability of pembrolizumab with weight based dosing: A meta-analysis. JCO. 2021;39(15_suppl):2639-2639. doi:10.1200/JCO.2021.39.15_suppl.2639
[4] Ch...

InpharmD's Answer GPT's Answer

Author:Neil Patel, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Based on the available evidence, there is no single standardized dose or duration for high-dose corticosteroids in pulmonary hemorrhage, which might explain the variations in practice. While conventional regimens have used intravenous methylprednisolone pulses (500 mg to 2 g/day) for 3-5 days, emerging evidence questions the necessity of such high doses. In fact, recent studies in critically ill patients have found that lower-dose regimens (e.g., <250 mg/day of methylprednisolone) may be asso...

From a 2021 review, the conventional use of high-dose corticosteroids for diffuse alveolar hemorrhage (DAH), often initiated with intravenous methylprednisolone pulses (500 mg to 2 g/day) for 3-5 days, was being re-evaluated. While this regimen aims to suppress the acute inflammatory lung injury, its benefit, particularly in critically ill patients, remains undefined, and associated mortality remains high. Emerging evidence questions the necessity of such high doses, as one study found that patients treated with lower-dose methylprednisolone (<250 mg/day) had significantly lower ICU mortality compared to those on medium or high doses, without a difference in overall mortality. Furthermore, research in related conditions like ANCA-associated vasculitis shows that reduced-dose glucocorticoids are equally effective for mortality and reduce serious infections, challenging the validity of high-dose corticosteroid protocols for DAH. [1, 2] In a paragraph within a 2021 review of acute a...

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A search of the published medical literature revealed 3 studies investigating the researchable question:

What is the recommended dose and duration of high-dose corticosteroid for pulmonary hemorrhage?

Level of evidence
C - Multiple studies with limitations or conflicting results  

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[1] Park JA. Treatment of Diffuse Alveolar Hemorrhage: Controlling Inflammation and Obtaining Rapid and Effective Hemostasis. Int J Mol Sci. 2021;22(2):793. Publis[2] Raptis A, Mavroudis D, Suffredini A, et al. High-dose corticosteroid therapy for diffuse alveolar hemorrhage in allogeneic bone marrow stem cell transplant recipients. Bone Marrow Transplant. 1999;24(8):879-883. doi:10.1038/sj.bmt.1701995
hed 2021 Jan 14. doi:10.3390/ijms22020793[3] Saha BK. Idiopathic pulmonary hemosiderosis: A state of the art review. Respir Med. 2021;176:106234. doi:10.1016/j.rmed.2020.106234
[3] Saha BK....

InpharmD's Answer GPT's Answer

Author:Neil Patel, PharmD, BCPS + InpharmD™ AI LEARN MORE 

The use of inhaled corticosteroids in the preterm infants has been explored primarily in preventing and treating bronchopulmonary dysplasia (BPD). While some studies suggest that inhaled corticosteroids (ICS) may offer a targeted approach with potentially fewer systemic side effects compared to their systemic counterparts, meta-analyses did not find a significant advantage for ICS compared to systemic corticosteroids, with ICS being associated with a potentially increased risk of mortality. D...

A 2017 Cochrane review update analyzed whether inhaled corticosteroids, which theoretically offer localized lung benefits with fewer systemic side effects, are superior to systemic corticosteroids for preventing death or bronchopulmonary dysplasia (BPD) in ventilated, very low birth weight preterm infants. Based on two randomized controlled trials involving 294 infants, the analysis found no statistically significant difference between inhaled and systemic steroids for the primary outcomes of death or BPD at 36 weeks' postmenstrual age. However, key secondary outcomes revealed significant trade-offs: infants receiving inhaled steroids had a significantly longer duration of both mechanical ventilation and supplemental oxygen. On the other hand, they experienced a substantially lower incidence of hyperglycaemia but a higher rate of patent ductus arteriosus. A small long-term follow-up suggested a potential benefit of inhaled steroids in reducing later asthma diagnosis. The authors con...

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A search of the published medical literature revealed 2 studies investigating the researchable question:

How do inhaled steroids compare to systemic steroids for prevention and management of BPD/ CLD in preterm infants?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Shah SS, Ohlsson A, Halliday HL, Shah VS. Inhaled versus systemic corticosteroids for preventing bronchopulmonary dysplasia in ventilated very low birth weight preterm neonates. Cochrane Database Syst Rev. 2017;10(10):CD002058. Published 2017 Oct 17. doi:10.1002/14651858.CD002058.pub3
[2] Shah SS, Ohlsson A, Halliday HL, Shah VS. Inhaled versus systemic corticosteroids for the treatment of bronchopulmonary dysplasia in ventilated very low birth weight preterm infants. Cochrane Database Syst Rev. 2017;10(10):CD002057. Published 2017 Oct 16. doi:10.1002/14651858.CD002057.pub4
[3] Rocha ...

InpharmD's Answer GPT's Answer

Author:Frances Beckett-Ansa, PharmD, BCPS + InpharmD™ AI LEARN MORE 

There appears to be a paucity of data to support vaginal administration of commercial diazepam tablets for pelvic floor dysfunction. Our comprehensive literature search identified one retrospective review of 21 women with pelvic floor dysfunction who elected to use oral diazepam tablets intravaginally rather than compounded formulations (Table 1). After one month, 62% reported moderate or marked improvement with reduced pain scores, and serum diazepam concentrations remained within the therap...

A 2020 systematic review evaluated intravaginal diazepam for chronic pelvic pain and sexual dysfunction associated with high-tone pelvic floor dysfunction. A total of five investigations met inclusion criteria (two observational studies and three small randomized controlled trials [RCTs]). The observational studies reported subjective improvements in sexual function in most patients, but no significant changes in Female Sexual Function Index (FSFI) or Visual Analog Scale (VAS) scores. The RCTs were largely negative, with one showing benefit only when diazepam was combined with transcutaneous electrical nerve stimulation. Additionally, limited pharmacokinetic data suggested systemic absorption within therapeutic ranges. Of note, this review did not specifically discuss the use of commercial oral diazepam tablets for intravaginal administration in pelvic floor dysfunction. However, the authors referenced one study where patients were offered either compounded diazepam cream or supposi...

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A search of the published medical literature revealed 1 study investigating the researchable question:

Is there data to support vaginal administration of commercial diazepam tablets for pelvic floor dysfunction?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Stone RH, Abousaud M, Abousaud A, Kobak W. A Systematic Review of Intravaginal Diazepam for the Treatment of Pelvic Floor Hypertonic Disorder. J Clin Pharmacol. 2020;60 Suppl 2:S110-S120. doi:10.1002/jcph.1775
[2] Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction: serum diazepam levels and efficacy data. Urol Nurs. 2011;31(5):279-299.

InpharmD's Answer GPT's Answer

Author:Kevin Shin, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Studies suggest acute pain control with ketorolac in emergency settings is dose-capped at 10 mg, as increasing dosages do not provide additional pain relief but allow the possibility of adverse events.

A 2023 systematic review and meta-analysis published in Annals of Emergency Medicine synthesized data from five randomized controlled trials (RCTs) encompassing 627 adult patients presenting to emergency departments (EDs) with acute pain. The review evaluated the comparative effectiveness and safety of low-dose (10-20 mg) versus high-dose (≥30 mg) parenteral (both intravenous and intramuscular) ketorolac; pain etiologies ranged from renal colic and musculoskeletal pain to abdominal and headache-related discomfort. Results from pooled analyses showed that parenteral ketorolac at doses of 15-20 mg likely produces no clinically meaningful difference in analgesia compared to doses ≥30 mg (mean difference -0.05 mm on a 100 mm visual analog scale [VAS], 95% CI -4.91 to +5.01; moderate certainty). Similarly, 10 mg dosing showed no significant effect on pain scores versus higher doses (mean difference -1.58 mm, 95% CI -8.86 to +5.71; low certainty). Low-dose ketorolac may be associated with...

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A search of the published medical literature revealed 3 studies investigating the researchable question:

Does ketorolac have a “ceiling effect” with no added benefit of higher doses for acute pain?

Level of evidence
B - One high-quality study or multiple studies with limitations  

READ MORE→

[1] Forestell B, Sabbineni M, Sharif S, Chao J, Eltorki M. Comparative Effectiveness of Ketorolac Dosing Strategies for Emergency Department Patients With Acute Pain. Ann Emerg Med. 2023;82(5):615-623. doi:10.1016/j.annemergmed.2023.04.011
[2] Jaglal R, Nemec EC 2nd. What is the analgesic ceiling dose of ketorolac for treating acute pain in the ED?. JAAPA. 2023;36(5):43-44. doi:10.1097/01.JAA.0000923576.90074.2a
[3] Catapano MS. The analgesic efficacy of ketorolac for acute pain. J Emerg Med. 1996;14(1):67-75. doi:10.1016/0736-4679(95)02052-7
[4] Stinson J, Naser B. Pain management in ch...

Why choose us?

Find answers, not documents.

Before InpharmD™


BeforeTime
Your team spends hours per week cobbling together literature from different studies, many behind paywalls, leaving little time for action.
BeforeTime
TI opportunities are discovered (or presented by third parties) months after the fact, resulting in costly missed savings.
BeforeTime
Decisions may be made without a complete picture, or pushed out while gathering consensus.

After InpharmD™


BeforeTime
InpharmD™ delivers customized, actionable drug information in real time, so you can focus on execution.
BeforeTime
Your team stays informed immediately when new data emerges or prices change, and you’ll always be the first to know when any changes impact your formulary.
BeforeTime
With InpharmD™, your team can make faster, more informed decisions and move forward with confidence.

What Clinical Pharmacists Are Saying...


     

Assists in our research and is a great way or us to get an answer to a medical question without spending an average of 2 hours researching UptoDate or PubMed ourselves.


  Jordan C., PharmD, New Jersey

     

Huge time saver with thorough responses.


  Jane D., PharmD, Georgia

     

I’d never heard of a DI pharmacist before, now I have one. In. My. Pocket. Amazing!


     

Holy Shhh. Cow! Holy Cow! These summaries are beautiful.


  Jane D., PharmD, Georgia

     

I just want to say: This is such a brilliant idea! You people are genius.


     

OH MY GOD WHERE HAVE YOU BEEN ALL MY LIFE!


     

I can’t tell you how much time I spend literature searching. And how I CANNOT STAND PAYWALLS. THIS IS UNBELIEVABLE!! (covers face for sec) thank you, thank you, thank you!


     

So they’re basically connecting academic researchers with front line providers and then automating everything. It’s simply brilliant.


     

The clinical pharmacist was our secret weapon anyway. (Smiles wryly) This pharmacist AI seems superhuman. I’m just blown away, honestly. (Looks at camera somberly.)


     

It’s an ENTIRE DI DEPARTMENT, that lives in Epic. Give me a second. I’m just having a hard time wrapping my head around that.


     

Sorry just give me a second, my mind is blown.


     

Stop reading and just download the app already! I’ve tried all of them. This is by far the most advanced, best-in-class.


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