InpharmD™





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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...

Summarize the evidence regarding the use of acetylcysteine in shock liver as well as current recommendations. What ar...
Is there any literature to support dexamethasone use in COPD exacerbation? What dose is recommended if so?
Is there data suggesting the risankizumab is more effective than other advanced agents for more severe ulcerative col...
What is the risk of cross-reactivity with acetazolamide in a patient with severe sulfa allergy?
What dose, frequency, and timing should oral tranexamic acid be given perioperatively in orthopedic surgery patients?...

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

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

INTRODUCTION BY INPHARMD™ RESEARCHER

Data to support the use of N-acetylcysteine (NAC) in the management of shock liver is currently limited to anecdotal reporting and observational data. While one case report observed successful treatment with NAC in combination with supportive management for a patient with shock liver, a separate observational study reported conflicting data, finding no clinical benefit associated with the use of NAC in shock liver patients. Due to the lack of data, there are currently no standard recommendati...

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 11 studies investigating the researchable question:

What is the evidence regarding the use of N-acetylcysteine in shock liver as well as current recommendations? What are the benefits and potential adverse effects from this therapy in non-acetaminophen toxicity patients?

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

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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: Naveed Aijaz, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines suggest systemic glucocorticoids in COPD exacerbation may improve outcomes, including recovery time, lung function, and oxygenation. A limited number of studies have investigated the use of IV dexamethasone for COPD exacerbations. Results from these studies vary. Some data demonstrated comparable efficacy between dexamethasone and methylprednisolone, while others showed significantly greater improvement with methylpr...

Per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD), updated in 2023, oral glucocorticoids are considered equally effective as intravenous (IV) administration. Studies, mostly set in hospitals, suggest systemic glucocorticoids in COPD exacerbations can shorten recovery time, improve lung function and oxygenation, reduce the risk of early relapse and treatment failure, and decrease hospital length of stay (LOS). The recommended systemic corticosteroid dose is 40 mg of prednisone-equivalent daily for 5 days. Longer courses of oral corticosteroids were associated with an increased risk of pneumonia and mortality in one observational study. Even short courses of corticosteroids were associated with an increased risk of pneumonia, sepsis, and death. If a steroid-sparing regimen is needed, one study found that nebulized budesonide alone provides similar benefits to IV methylprednisolone. The only time systemic dexam...

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

Is there any literature to support dexamethasone use in COPD exacerbation? What dose is recommended if so?

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

READ MORE→

[1] Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of COPD 2023 Report. https://goldcopd.org/2023-gold-report-2/
[2] Cosmi D, Mariottoni B, Angori P, et al. C82 Dexamethasone in acute cardiopulmonary syndrome with hyperinflammatory state. European Heart Journal Supplements. 2021;23(Supplement_C):C1-C48. doi:10.1093/eurheartj/suab063
[3] Hosseini A, Doustimotlagh AH, Afrasiabifar A, Sedaghattalab S. Comparison of dexamethasone and hydrocortisone in management of exacerbated chronic obstructive pulmonary disease patient...

InpharmD's Answer GPT's Answer

Author: Sunita Pirmal, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

While there is currently a lack of direct comparative data between risankizumab and other agents for the management of severe ulcerative colitis (UC), pooled data based on indirect evidence suggest risankizumab may have the highest likelihood of achieving clinical remission as induction therapy in biologic-naive patients with moderate-to-severe UC compared to other agents, such as adalimumab. However, its effectiveness in biologic-exposed patients appears to be lessened, with agents including...

A recent evidence synthesis by the American Gastroenterological Association (AGA) describes the comparative efficacy of advanced therapies for the management of moderate-to-severe ulcerative colitis (UC). It is stated that treatments with the greatest effect size for induction of clinical remission include upadacitinib, risankizumab, and ozanimod. After excluding Janus kinase (JAK) inhibitors as potential first-line treatment, there was determined to be low-certainty evidence that risankizumab was possibly associated with a higher likelihood of achieving remission compared with adalimumab with induction therapy in biologic-naive patients. Additionally, risankizumab was determined to possibly be associated with a higher likelihood of achieving remission compared with mirikizumab with induction therapy. After excluding JAK inhibitors, among biologic-naïve patients with moderately to severely active UC, risankizumab (P score= 0.86) and ozanimod (P score= 0.83) were ranked highest for i...

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

Is there data suggesting the risankizumab is more effective than other advanced agents for more severe ulcerative colitis?

Level of evidence
A - Multiple high-quality studies with consistent results  

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[1] Ananthakrishnan AN, Murad MH, Scott FI, et al. Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Ulcerative Colitis: 2024 American Gastroenterological Association Evidence Synthesis. Gastroenterology. 2024;167(7):1460-1482. doi:10.1053/j.gastro.2024.07.046
[2] Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis. Gastroenterology. 2020;158(5):1450-1461. doi:10.1053/j.gastro.2020.01.006
[3] Shehab M, Alrashed F, Alsayegh A, et al. Comparative Efficacy of Biologics and Smal...

InpharmD's Answer GPT's Answer

Author: Sunita Pirmal, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

The risk of cross-reactivity with acetazolamide in patients with sulfa allergy is deemed to be low. Of note, chemical differences between sulfonamide antibiotics and nonantibiotics (i.e., acetazolamide) make a reaction unlikely, as only the antibiotic subgroup contains the arylamine moiety associated with hypersensitivity. Experts suggest a clinic test dose (observation for one to two hours) may be feasible to ensure the patient can tolerate acetazolamide if there is concern.

A 2012 report described three case reports evaluating the safety and efficacy of acetazolamide in individuals with sulfonamide antibiotic allergies and neurologic channelopathies. The described cases included a 61-year-old man with late-onset episodic ataxia, an 83-year-old woman with genetically confirmed Andersen-Tawil syndrome type 1, and a 21-year-old woman with episodic ataxia type 2 associated with a CACNA1A genetic mutation. All three patients presented with a history of severe hypersensitivity reactions to sulfonamide antibiotics, manifesting as skin rashes, facial swelling, and generalized hives. Due to these documented allergies, they were initially denied treatment with acetazolamide, a carbonic anhydrase inhibitor frequently used in managing episodic ataxia and periodic paralysis. Following a comprehensive review of the pharmacologic literature, which indicated that cross-reactivity between sulfonamide antibiotics and nonantibiotic sulfonamides was negligible, acetazolam...

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

What is the risk of cross-reactivity with acetazolamide in a patient with severe sulfa allergy?

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

READ MORE→

[1] Platt D, Griggs RC. Use of acetazolamide in sulfonamide-allergic patients with neurologic channelopathies. Arch Neurol. 2012;69(4):527-529. doi:10.1001/archneurol.2011.2723
[2] Kelly TE, Hackett PH. Acetazolamide and sulfonamide allergy: a not so simple story. High Alt Med Biol. 2010;11(4):319-323. doi:10.1089/ham.2010.1051
[3] Lee AG, Anderson R, Kardon RH, Wall M. Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?. Am J Ophthalmol. 2004;138(1):114-118. doi:10.1016/j.ajo.2004.02.019
[4] Ame...

InpharmD's Answer GPT's Answer

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

INTRODUCTION BY INPHARMD™ RESEARCHER

A meta-analysis suggests that multiple-dose oral TXA (e.g., 2 g preoperatively followed by 1 g doses postoperatively) is a safe and effective strategy for managing perioperative blood loss in total joint replacement patients. However, there was a wide range of doses studied, and the optimal dosing regimen is not yet fully established. In particular, the timing of TXA is seldom discussed.

As a synthetic derivative of amino acid lysine, tranexamic acid (TXA) competitively inhibits the plasminogen activator, leading to ​​the antifibrinolytic effect. At low oral doses, 50% of TXA is absorbed through the gastrointestinal tract. TXA decreases intraoperative blood loss in multiple studies and diminishes blood loss after surgical removal of third molars in healthy patients. Concerns over thromboembolism after systemic intravenous (IV) administration makes the oral formulation an attractive option due to less systemic absorption leading to a lower incidence of thromboembolic complications. Overall, the oral formulation is well-tolerated and easy to administer. However, given the variability in oral dosing regimens across clinical studies, more evidence is required to establish an optimized dosing strategy. [1-2] A 2018 randomized controlled trial (N= 100) assessed the blood loss and cost-effectiveness of the oral and IV administration of TXA for the treatment of primary ...

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A search of the published medical literature revealed 6 studies investigating the researchable question:

What literature is there to support oral tranexamic acid versus IV for orthopedic procedures (hip, knee, shoulder) as well as scoliosis surgeries?

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

READ MORE→

[1] Eftekharian HR, Rajabzadeh Z. The Efficacy of Preoperative Oral Tranexamic Acid on Intraoperative Bleeding During Rhinoplasty. J Craniofac Surg. 2016;27(1):97-100. doi:10.1097/SCS.0000000000002273
[2] Wang D, Wang HY, Luo ZY, Pei FX, Zhou ZK, Zeng WN. Finding the Optimal Regimen for Oral Tranexamic Acid Administration in Primary Total Hip Arthroplasty: A Randomized Controlled Trial. J Bone Joint Surg Am. 2019;101(5):438-445. doi:10.2106/JBJS.18.00128
[3] Wu Y, Zeng Y, Hu Q, et al. Blood loss and cost-effectiveness of oral vs intravenous tranexamic acid in primary total hip arthroplast...

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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