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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.

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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

Is there any evidence for using N-acetylcysteine (acetadote) in acute liver failure due to shock (ie hypotension due ...
What weight (actual, adjusted, ideal) is generally recommended for chemotherapy dosing?
What data supports the use of valproic acid IV push vs. IVPB? Is there an increased incidence of reported adverse eff...
Please provide primary literature for Keytruda Dose Rounding
what is the recommended dose and duration of high dose corticosteroid (ie methylprednisolone) for Pulmonary hemorrhag...

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

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

Evidence supporting the use of N-acetylcysteine (NAC) in shock liver is limited, primarily consisting of case reports and observational studies, with mixed findings regarding clinical benefit. No standardized recommendations exist for NAC in this context. In non–acetaminophen-induced acute liver failure (NAI-ALF), individual studies report conflicting outcomes, but pooled data suggest NAC may improve overall survival. Common NAI-ALF etiologies include drug-induced liver injury, autoimmune hep...

Per 2017 American Gastroenterological Association Institute (AGA) guidelines for the diagnosis and management of acute liver failure, no dosing recommendations were given for patients presenting with non-acetaminophen-associated acute liver failure, as the panel recommends N-acetyl cysteine (NAC) be used only in the context of clinical trials. The recommendation was based on two randomized controlled trials (RCTs) which demonstrated no effect on overall mortality with NAC when compared to placebo in 228 patients with non-acetaminophen-associated acute liver failure; the direct references for those 2 RCTs were not provided within the guidelines. In cases of acute liver failure of indeterminate cause, NAC can be considered given that those indeterminate cases may be related to acetaminophen overdose. [1] As opposed to the 2017 AGA guidelines, the 2011 American Association for the Study of Liver Disease (AASLD) guidelines concluded that NAC may be beneficial for acute liver failure ...

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A search of the published medical literature revealed 12 studies investigating the researchable question:

Is there any evidence for using N-acetylcysteine (acetadote) in acute liver failure due to shock (ie hypotension due to septic on pressor - Shocked liver, or shock after cardiac arrest)?

Level of evidence
D - Case reports or unreliable data  

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[1] Flamm SL, Yang YX, Singh S, Falck-Ytter YT; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guidelines for the Diagnosis and Management of Acute Liver Failure. Gastroenterology. 2017;152(3):644-647. doi:10.1053/j.gastro.2016.12.026
[2] Lee WM, Larson AM, Stravitz RT, American Association for the Study of Liver Diseases. AASLD Position Paper: The Management of Acute Liver Failure: Update 2011. Updated September 2011. Accessed August 29, 2024. https://www.aasld.org/sites/default/files/2023-03/Acute%20Liver%20Failure%20Update2011.pdf
[3] Wa...

InpharmD's Answer GPT's Answer

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

The majority of data appears focused on obese patients. Dosing by actual body weight seems to be preferred, as using ideal body weight may lead to underdosing without a significant increase in toxicity. This approach is supported by guidelines from organizations like ASCO, which warn that dose-capping can result in insufficient therapy and worse survival outcomes. Exceptions exist for certain specific agents, such as carmustine or thiotepa, where ideal or adjusted body weight may be utilized.

The American Society of Clinical Oncology (ASCO) 2021 guideline update for systemic chemotherapy in obese adults do not recommend utilizing ideal body weight to adjust doses as it may lead to underdosing. The guidelines were focused on obese patients. While there may be potential increased risk of adverse events from excessive doses, using ideal body weight may lead to insufficient therapy and worse survival outcomes. Only one out of ten retrospective studies observed higher toxicity in obese patients given full, weight-based dosing compared to obese patients receiving ideal body weight-adjusted chemotherapy agents. Thus, using ideal body weight to calculate dose regimens based on weight may lead to insufficient dosage in obese patients. [1] The American Society for Blood and Marrow Transplantation Practice Guideline Committee performed an evidence review for dose adjusting chemotherapy regimens in obese patients. Though the list of chemotherapeutic agents is limited to the setti...

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

What weight (actual, adjusted, ideal) is generally recommended for chemotherapy dosing?

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

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[1] Griggs JJ, Bohlke K, Balaban EP, et al. Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update. J Clin Oncol. 2021;39(18):2037-2048. doi:10.1200/JCO.21.00471
[2] Bubalo J, Carpenter PA, Majhail N, et al. Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee. Biol Blood Marrow Transplant. 2014;20(5):600-616. doi:10.1016/j.bbmt.2014.01.019
[3] Kouno T, Katsumata N, Mukai H, Ando M, Watanabe T. Standardization of the bod...

InpharmD's Answer GPT's Answer

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

Limited observational data suggest that IV push valproic acid may be as effective and safe as IV piggyback valproic acid. Available findings suggest that IVP administration may be feasible, with low rates of adverse events; however, further research is needed to determine the optimal administration strategy for IV push valproic acid in treating status epilepticus specifically.

A recent review article on intravenous push (IVP) administration of antiseizure medications emphasizes the growing use of this approach in emergency departments. IVP offers a significant advantage by eliminating the need for pharmacy compounding and preparation, as well as the setup of infusion materials, tubing, and pumps, allowing for faster drug administration. Regarding the intravenous push of valproic acid (VPA), the authors highlight that this method could reduce delays associated with traditional infusion techniques, offering the potential for quicker intervention. Current dosing guidelines for VPA suggest a range of 15 to 45 mg/kg, with infusion times of 2.5 to 7.5 minutes. Limited research indicates that IVP administration at a rate of 6 mg/kg/min may be feasible, with low rates of adverse events, such as dizziness, thrombocytopenia, and mild hypotension, none of which were related to the infusion rate. Given the promising data from studies on undiluted rapid VPA administra...

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

What data supports the use of valproic acid IV push vs. IVPB? Is there an increased incidence of reported adverse effects with IV push administration?

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[1] Aljadeed R, Gilbert BW, Karaze T, Rech MA. Intravenous push administration of anti-seizure medications. Front Neurol. 2025;15:1503025. doi:10.3389/fneur.2024.1503025
[2] Wang FY, McLaughlin KC, Schontz MJ, DeGrado JR, Dannemiller RE. Safety of Intravenous Push Valproate Compared with Intravenous Piggyback at a Tertiary Academic Medical Center. Clin Drug Investig. 2024;44(3):175-181. doi:10.1007/s40261-024-01349-z
[3] Dutta S, Faught E, Limdi NA. Valproate protein binding following rapid intravenous administration of high doses of valproic acid in patients with epilepsy. J Clin Pharm T...

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  

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[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  

READ MORE→

[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....

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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.


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Huge time saver with thorough responses.


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


     

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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.)


     

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