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Cardiopulmonary Resuscitation
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Then discharge home on prednisolone 50 mg once daily, cetirizine 10 mg or fexofenadine 180 mg once daily plus ranitidine 150 mg b.d., all orally for 3 days. Inform the GP by fax or letter.Refer all significant or recurrent attacks to the allergy clinic, especially if the cause is unavoidable or unknown.Prescribe an EpiPen or Anapen 300 µg in adults as part of an Anaphylaxis Management Plan.
Recognition, treatment, and prevention of systemic allergic reactions and anaphylaxis *
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Emma Westermann-Clark, Stephen F. Kemp, Richard D. deShazo
Demonstration of proper self-administration technique using a placebo trainer is recommended [123]. An EpiPen (Mylan, Canonsburg, Pennsylvania) auto-injector for adults is available with a single 0.3 mg epinephrine (USP, 1:1000, 0.3 mL) dose. Similarly, an EpiPen Jr., with a 0.15 mg epinephrine (USP, 1:2000, 0.3 mL) dose, is available for children weighing less than 30 kg. Auvi-Q (Kaléo, US, Richmond, Virginia) is an auto-injector device that is available in 0.1, 0.15, or 0.3 mg single dose. About the size of a credit card, it is equipped with blinking lights at the needle end and a voice recording that guides the user throughout administration. Other generic products enter and exit the market periodically.
The Problem of Rising Healthcare Costs and Spending
Published in Kant Patel, Mark Rushefsky, Healthcare Politics and Policy in America, 2019
Comparative pricing is one element. Another is the increase in prices within the United States. Consider EpiPen. It is the brand name for the drug epinephrine. EpiPen is given via injection to reverse allergic reactions. In 2007, Mylan Pharmaceutical acquired the delivery system from Merck KGaA, which owned the company that developed it, Dey LP. The cost to make the drug and delivery system is about $1, and each unit was sold for $57 in 2007 (Willingham 2016). By 2017, the price for the drug and the delivery system had soared to $600 (Silver and Hyman 2018). Turing Pharmaceutical sold Daraprim, used to treat people with AIDS. The price increased from $13.50 to $750 a pill (Silver and Hyman 2018). Ambien, a sleep aid, increased by 843 percent in 2018 (Rockoff 2018).
Ketamine Stability over Six Months of Exposure to Moderate and High Temperature Environments
Published in Prehospital Emergency Care, 2022
Madeline J. Foertsch, Jason T. McMullan, Nicole J. Harger, Dario Rodriquez, Ann Salvator, Eric W. Mueller PharmD, Christopher A. Droege
Other medications have been evaluated and analyzed when stored at extreme temperatures. Epinephrine auto-injectors used for anaphylaxis (EpiPens®) showed significant degradation when stored at a constant temperature of 158 °F (70 °C) or when cycled from 68 °F to 158 °F (20 °C to 70 °C) (21). A systemic review evaluating epinephrine degradation, which demonstrated exposure to extreme heat resulted in significant degradation while extreme cold did not appear to have significant degradation effects (22). In addition, several medications (including lidocaine, diltiazem, dopamine, nitroglycerin, ipratropium, succinylcholine, haloperidol, naloxone, diazepam, and lorazepam) have shown significant degradation when stored per normal routine on EMS vehicles (3–5,12). Finally several medications stored by the national park service were analyzed when exposed to temperatures outside the recommended storage temperatures; atropine and naloxone were shown to have extensive heat dependent degradation (23).
The current paradigm for biologic initiation: a mixed-methods exploration of practices, unmet needs, and innovation opportunities in self-injection training
Published in Expert Opinion on Drug Delivery, 2021
Amy Rinaldi, Dimos Katsaros, James Hawthorne, Matthew D’Auria, Katherine Brigham, Erika Bajars, Chris Franzese, Marty Coyne
Finally, HCPs themselves may lack the capacity to adequately train patients despite their best intentions. In the current healthcare environment, physicians must contend with shortened time blocks for each patient and decreasing proportions of face-to-face time [19,20]. Time constraint has been cited as a significant barrier to performing in-office inhaler training, with physicians forced to deprioritize training to make room for other tasks[21]. Similarly, in an ethnographic study of biologic initiations, discussion of biologic therapy was often limited in a single visit[22]. HCP experience with injection devices and knowledge of technical nuances may also vary amongst practice specialties according to the prevalence of biologic treatments in clinical guidelines. In a survey of pediatricians on the use of several variants of EpiPen, only 18% of physicians were found to be familiar with and demonstrate correctly at least 1 device[23].
Barriers to self-management behaviors in college students with food allergies
Published in Journal of American College Health, 2018
Sarah E. Duncan, Rachel A. Annunziato
Finally, an important area of future research is the impact of recent dramatic increases in auto-injector costs on college students' adherence behaviors. In 2016, the list price for a 2-pack of EpiPens (Mylan, Canonsburg, PA), a major epinephrine auto-injector brand, climbed to over $600—a 400% increase from 2007.31 Research suggests that, even with insurance coverage, consumers bear the burden of at least a portion of this price increase: a study of commercially insured patients' out-of-pocket spending for EpiPens found that patients in 2014 paid more than double the cost they paid in 2007.32 Notably, research using Mylan data suggests that EpiPen prescription abandonment rates increase as the patients' costs increase.33 While generic versions of the epinephrine auto-injector exist,31 the impact of the price of EpiPens on college students specifically and how to address these effects warrant investigation.