Brodeur, Michael Publications

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https://hdl.handle.net/20.500.14303/278

ACPHS student authors are denoted by an asterisk (*).

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Midodrine-Induced Nightmares in the Treatment of Orthostatic Hypotension: A Case Report.
(The Senior Care Pharmacist, 2023-12) Tran, Lara*; Brodeur, Michael
Midodrine was the first medication approved by the Food and Drug Administration (FDA) for the treatment of orthostatic hypotension. Pharmacologically, midodrine is a peripheral selective alpha-1-adrenergic agonist that can improve standing, sitting, and supine systolic blood pressure. Common side effects include bradycardia, supine hypertension, and paresthesia. A novel side effect of midodrine-induced nightmares has been reported in our patient. To our knowledge, this is the first reported case of midodrine-induced nightmares. To investigate and report a clinically significant and unique drug adverse event of midodrine in the treatment of orthostatic hypotension. This report describes a case of persistent nightmares associated with midodrine use in an 83-year-old male who experienced frequent syncope episodes treated with midodrine for orthostatic hypotension (OH). After the initiation of midodrine, the patient complained of increased nightmares, which quickly led to his refusal of the medication, despite the initial improvements in his blood pressure. The timing of administration included an evening dose at 21:00. This novel adverse event of midodrine-induced nightmares will be highlighted and explored in this case report. This case demonstrated a unique adverse event of nightmares caused by midodrine. It is hypothesized that autonomic dysfunction plays a role and further investigations should be conducted to confirm this theory. We hope that our case report highlights the importance of careful consideration when prescribing midodrine in older people with orthostatic hypotension.
Optimizing Pharmacotherapy for Direct Oral Anticoagulants in Older Adults: Strategies for Managing Drug Interactions.
(Journal of Gerontological Nursing, 2023-09) Tran, Lara*; Brodeur, Michael R
Direct oral anticoagulants (DOACs) have been increasingly used by older adults. Although these medications offer several therapeutic advantages over traditional anticoagulants, such as warfarin, they have limitations. One significant concern associated with DOACs is their potential for drug-drug interactions. These interactions may compromise the safe and effective use of DOACs and can potentially lead to serious adverse events and complications, particularly major bleeding. Polypharmacy is common among older adults with chronic diseases, which can increase the risk of drug-drug interactions with DOACs. The current article discusses the impact and risks of drug-drug interactions with DOACs in the context of older adults and explores ways to improve and manage these interactions through the collaboration of an interprofessional team. [(9), 7-13.].
ASCP's 2021 Choosing Wisely® Recommendations: A Proud Accomplishment.
(The Senior Care Pharmacist, 5/1/2022) Beier, Manju T; Brodeur, Michael R
Choosing Wisely® (CW) is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments, and procedures. The campaign began in the United States in 2012 and in Canada in 2014, and now many countries around the world are adapting the campaign and implementing it. Currently, approximately 80 societies in the United States have published CW recommendations. Each recommendation is supported by clinical guidelines (when necessary), evidence-based ratinale, including information about when these tests or procedures may be appropriate. A deprescribing task force led by Chair Beier was created by ASCP in November 2018 after several conversations between ASCP leadership (notably, President J. Hirshfield) and Beier. Task force members comprise pharmacists practicing in academia, community, and long-term care settings. The chair also invited pharmacists from international countries (Canada and Australia) where deprescribing initiatives have a strong focus and scientific literature base. One of the primary goals for Chair Beier was to add ASCP's voice to the ABIM CW Campaign. Because ASCP is a membership association that represents pharmacists, health care professionals, and students serving the unique medication needs of older patients, by adding its name to the list of supporting partners, the organization makes a compelling argument to address deprescribing initiatives, tools, scientific literature, and resources to assist in initiating deprescribing conversations and their subsequent implementation.
A Review of Topical Povidone-iodine to Decrease Viral Load of COViD-19.
(The Senior Care Pharmacist, 5/1/2021) Benson, Katherine M*; Mancini, Amalia A*; Brodeur, Michael R
Topical povidone-iodine (PVP-I) is currently being considered as a potential preventive measure against the spread of COVID-19. Diluted PVP-I solutions have been historically used in Asia to treat upper respiratory tract infections (URTIs) by decreasing the bacterial and viral load on oropharyngeal mucosa to decrease the transmission of diseases. Efficacy of gargling 0.23% PVP-I mouthwash in Japan demonstrated to be efficacious in lowering the prevalence of URTIs when compared with placebo. The 0.23% concentration was used in vitro on severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, which produced undetectable results after 30 seconds of exposure. Additionally, a recent study in 2020 proved the efficacy of PVP-I 0.45%-10% in reducing COVID-19 (SARS-CoV 2) viral load in vitro. Numerous clinical trials are being conducted to determine if there is a decrease in viral load, and thus transmission, when using oral or nasal topical PVP-I in COVID-19 patients. Because of the current lack of evidence for the use of PVP-I in vivo with COVID-19, it is recommended to await the clinical trial results before initiating this practice.
Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility.
(Journal of the American Geriatrics Society, 2020-01) Davenport, Claire ++; Brodeur, Michael R; Wolff, Michael; Meek, Patrick D; Crnich, Christopher J
Objectives: To derive weighted-incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use. Design: Retrospective analysis of microbial data from a regional laboratory. Setting: We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015. Participants: A total of 28 regional SNFs (rSNFs) and 7 in-network SNFs (iSNFs). Measurements: WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole. Results: Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11-113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76-11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I2 = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols. Conclusion: These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55-61, 2019.

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