197 Perioperative Diabetic Medication Prescribing- Adherence to Local Guidelines

Aim

Optimization of diabetic medications around the time of operation is critical to avoid complications, hence we aimed to conduct an audit to review perioperative diabetic medication prescribing.

Method

Drug charts for peri-operative cardiac and thoracic patients were reviewed retrospectively on Medchart, a local electronic system used for prescribing medications. The omission or adjustment of oral anti-diabetic medications and insulin prescriptions were recorded.

Results

Over a one-month period, the prescriptions of 104 patients were recorded with an average age of 65.8 and out of which 21 patients were diabetic.

Conclusions

Our Audit demonstrated errors in perioperative diabetic medication prescribing. We focused our intervention by circulating a poster depicting the guidelines around the doctors and ANP offices. We did a re-audit in two months’ time to check the adherence.

These are the findings we found in the re-audit for 101 patients: -

Discovery of PH-797804, a highly selective and potent inhibitor of p38 MAP kinase

The synthesis and SAR studies of a novel N-aryl pyridinone class of p38 kinase inhibitors are described. Systematic structural modifications to the HTS lead, 5, led to the identification of (-)-4a as a clinical candidate for the treatment of inflammatory diseases. Additionally, the chiral synthesis and properties of (-)-4a are described.

Synthesis of highly substituted 5-(trifluoromethyl)ketoimidazoles using a mixed-solid/solution phase motif

Using a combination of solid phase synthesis for the preparation of N-substituted-N-acylglycines 7 followed by solution-phase ring transformation of trifluoromethylacyl munchnone intermediate 8, a library of 200 trisubstituted-5-trifluoromethylketo (TFMK) imidazoles 9 was prepared. In a sublibrary, bromoacetate resin 4 was treated with 5 amines in parallel to give N-substituted glycines 5 followed by acylation with 12 acid chlorides to provide, upon cleavage from the resin, 60 individual N-substituted-N-acylglycines 7. The glycines 7 were converted to munchnones 8 by treatment with trifluoroacetic anhydride followed by reaction with benzamidine to give trisubstituted-5-TFMK-imidazoles 9. The structural content of the library was analyzed using PlateView of the LCMS results, and individual members were isolated by automated preparative LCMS.