bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiotic Penetration in Abdominal Infection: A Case of Tobramycin Failure Responsive to Moxalactam
Authors: Carson Herbert B. , Heller Andrew S. , Koch Todd B. , Walczak Paul , Schentag Jerome J.
Published: May 2016

A 50-year-old male developed an Enterobacter cloacae abdominal infection as the result of gangrene of a gastric remnant after gastrectomy. Aggressive antibiotic treatment with tobramycin and clindamycin was instituted, but despite documented in vitro bacterial sensitivity and high serum tobramycin levels, the patient's clinical condition worsened. Enterobacter cloacae continued to grow in the abdominal drainage cultures. As a last resort, moxalactam therapy was started. Within 36 hours, dramatic clinical improvement was seen and Enterobacter disappeared from the abdominal fluid cultures. Antibiotic assays showed that abdominal fluid contained approximately 50 percent of the simultaneous serum moxalactam concentration, while tobramycin was present in abdominal fluid at < 15 percent of the serum concentration. In spite of bacterial sensitivity to both drugs, it is likely that moxalactam produced better results than did tobramycin, because of better tissue penetration characteristics.
A Mild Case of Toxic Shock Syndrome
Authors: Ponte Charles D. , Traugh Cathy
Published: May 2016

The toxic shock syndrome (TSS) most often is seen in young, healthy women who become symptomatic during menstruation. The association between TSS and the use of tampons is strong. The symptoms usually begin suddenly and are often nonspecific. Prostration and hypotensive shock can occur within 24 hours. Milder forms of the disease also may be seen. The overall mortality rate is approximately 8 percent.

This report describes a mild case of TSS in a young, healthy, 16-year-old female who developed symptoms during menstruation. She had been using regular-size tampons, which were changed frequently, but she did not change tampons during the night. A positive cervical culture for Staphylococcus aureus confirmed the diagnosis. The patient responded to supportive care and intravenous oxacillin. Her generalized maculopapular rash disappeared within 24 hours of admission, and her hands began to desquamate by the time of discharge. The patient was urged to avoid the use of tampons for four months subsequent to discharge.
The Effect of Ibuprofen on Serum Digoxin Concentrations
Authors: Quattrocchi Frank P. , Robinson J. Daniel , Curry R. Whit , Grieco Mario L. , Schulman Stephen G.
Published: May 2016

This study was undertaken to determine the effects of ibuprofen (Motrin), in daily doses of at least 1600 mg, on steady-state digoxin concentrations. A total of 12 ambulatory patients (10, female; 2, male), with a mean age of 66 years (38–81 yr), completed the study. An initial baseline serum digoxin level was obtained, with follow-up levels at 7 days and, whenever possible, 28 days after ibuprofen initiation. Serum creatinine concentrations were not significantly different from baseline to 7 or 28 days of ibuprofen therapy. Results show a statistically significant (p < 0.05) increase in digoxin levels after seven days of ibuprofen. The mean increase was 59 percent (range, 10.7–325.4 percent), with 10 of the 12 patients displaying increased seven-day levels. Digoxin levels drawn 28 days after ibuprofen initiation were not statistically different from baseline or seven-day digoxin levels.
Predicting Success of Pharmacy Students in Basic Science and Clinical Clerkship Courses
Authors: Kimberlin Carole L. , Hadsall Ronald S. , Gourley Dick R. , Benedict L. Kirk
Published: May 2016

A number of studies on the ability of admissions variables to predict success in pharmacy schools have examined only success in the first professional year, which typically consists primarily of basic science courses. This study examined not only grades in basic science courses but also performance on clinical clerkships, for two classes of students. It also examined the ability of various personality variables to predict performance in clinical and basic science coursework. Previous grade point average (GPA) was the best single predictor of performance. In one class, the personality variable of Responsibility best predicted clinical clerkship performance. However, it only accounted for 13 percent of the variance in clerkship grades. Pharmacy College Admission Test (PCAT) Biology and PCAT Verbal Ability scores added to the predictive ability of previous GPA in one class, but none of the PCAT scales entered a prediction equation for the other class. The limitations on our ability to predict, with any consistency, academic performance in pharmacy school is discussed.
Hetastarch: An Overview of the Colloid and its Metabolism
Authors: Hulse James D. , Yacobi Avraham
Published: May 2016

Hetastarch, ethoxylated amylopectin, has found clinical utility as a plasma volume expansion agent, a sedimenting agent during pheresis, and a pump priming fluid. Hetastarch is a complex mixture of derivatized amylopectin molecules of various molecular sizes. The derivatization causes resistance to enzymatic hydrolysis, therefore, allowing hetastarch sufficient vascular residence time to be an effective vascular osmotic agent. This has led to its use as a volume expander and to its consequent use as a pump priming fluid. The metabolism of hetastarch proceeds through α-amylase hydrolysis of glycosidic bonds, yielding molecules small enough for renal clearance, but does not result in complete hydrolysis. Hence, glucose is not a significant product of hetastarch metabolism. Metabolism proceeds at such a rate that volume expansion is seen for 24–36 hours with a maximum effect (100–172 percent of the infused volume) occurring shortly after infusion. Ninety percent of the dose is eliminated with a half-life of about 17 days.
Treatment of Chlorpropamide Overdose with Diazoxide
Authors: Jeffery William H. , Graham E. Michael
Published: May 2016

A patient who took a chlorpropamide overdose was treated for several hours with concentrated glucose solutions, with little success in maintaining adequate serum glucose concentrations. Intravenous diazoxide administration was begun with the hope of decreasing pancreatic insulin release. After diazoxide was begun, glucose requirements decreased dramatically, and serum glucose was supranormal for most of the period of diazoxide administration. The case was complicated by the fact that the patient had taken three agents that can cause hypoglycemia—chlorpropamide, alcohol, and aspirin. Drug interactions potentiating the hypoglycemic effect of the chlorpropamide were also possible.

Glucose infusion is the mainstay of therapy for a sulfonylurea overdose. However, glucose acts as a further stimulus of insulin release from a sulfonylurea-primed pancreas. Administration of concentrated glucose solutions is technically difficult because of damage to veins. Metabolic consequences of high rates of glucose infusion to hyperinsulinemic patients include hypokalemia and hypophosphatemia.

Diazoxide appeared to decrease the glucose requirement in this patient, as it did in three other reported cases. Diazoxide is approved for certain hypoglycemic, hyperinsulinemic conditions. Sulfonylurea overdose represents a hypoglycemic, hyperinsulinemic condition; diazoxide appears to be an effective treatment.
Third-Generation and Investigational Cephalosporins: I. Structure-Activity Relationships and Pharmacokinetic Review
Authors: Garzone Pamela , Lyon James , Yu Victor L.
Published: May 2016

The structure-relationships and pharmacokinetic properties of the new second- and third-generation cephalosporins are reviewed. The new second-generation cephalosporins include ceforanide, cefotiam, and cefuroxime. The third-generation cephalosporins include cefmenoxime, cefoperazone, cefotaxime, cefsulodin, ceftazidime, ceftizoxime, ceftriaxone, and moxalactam. These new cephalosporins are semisynthetic analogs with different chemical substitutions on a 7-aminocephalosporanic nucleus. As a result of these chemical modifications, improvements in the antibacterial spectrum as well as pharmacokinetic properties have occurred. In general, the new cephalosporins have longer half-lives, higher and prolonged serum concentrations, and increased cerebrospinal fluid penetration. Selected cephalosporins also have increased biliary tract concentrations. A classification scheme for these new agents, based on generation and susceptibility to Pseudomonas aeruginosa, is presented.
Drug use and Accidental Falls in an Intermediate Care Facility
Authors: Lamy Peter P. , Sobel Kerry G. , McCart Gary M.
Published: May 2016

The relationship between nonenvironment-caused falls and drug use was evaluated in an intermediate care facility over a 14-month period. The medical problems and selected drug use of 45 patients who had fallen were retrospectively compared with those of a matched control population of 30 patients who had not fallen during this same period. Antihypertensives, diuretics, tranquilizers, sedative/hypnotics, antidepressants, and antianginal agents were reviewed for all patients. The use of diuretics, specifically furosemide, and sedative/hypnotics was significantly greater in the population who had fallen. Observations of dizziness, confusion, insomnia, and ataxia were recorded more frequently in that group, as well. Closer monitoring of medications, especially in specific drug classes, may help prevent accidental falls in this type of institution.
Labetalol: An Alpha- and Beta-Blocker
Authors: Conner Christopher S.
Published: May 2016

Labetalol is an investigational α- and β- adrenoreceptor antagonist. The ratio of effective β:α-blockade is approximately 7:1. Labetalol, administered intravenously or orally, has been effective in treatment of hypertension, with minimal effects on cardiac output. Labetalol will offer advantages over propranolol due to its more potent antihypertensive effects and less potent effects on left ventricular function at both rest and exercise in patients with coronary artery disease. The drug will be utilized in patients unresponsive to other β-blocking agents and in patients with congestive heart failure and concomitant hypertension, angina, or arrhythmias when other β-blockers are contraindicated. The drug appears to be safe in obstructive airway diseases and offers advantages over other β-blockers in long-term treatment after myocardial infarction.
Effect of Brand on the Serum Level of Aspirin
Authors: Jochsberger T. , Kirschenbaum H. , Gaynor H. , D'Agostino J.
Published: May 2016

The authors present a case of a four-year-old female, treated with aspirin for juvenile rheumatoid arthritis. A generic preparation was given first, but plasma salicylate levels remained significantly below the required therapeutic range. Upon changing to a brand-name product, however, therapeutic levels were achieved after one day. The authors conclude that the source of aspirin used had a marked effect on the serum salicylate level.
Drug-Induced Infertility
Authors: Buchanan James F. , Davis Larry Jay
Published: May 2016

Primary infertility may result from the use of various drugs. This phenomenon may be the result of an effect on the hypothalamic-pituitary-gonadal axis or a direct toxic effect on the gonads. Some of the drugs considered in this article demonstrate sex-related differences in their ability to cause infertility; there also may be age-related differences.

The drugs described in this review, in regard to their association with the development of infertility, include various individual antineoplastic agents (cyclophosphamide, chlorambucil, busulphan, and methotrexate) and combinations of these chemotherapeutic drugs, glucocorticosteroids, hormonal steroids (diethylstilbestrol, medroxyprogesterone acetate, estrogen, and the constituents of oral contraceptives), antibiotics (sulfasalazine and co-trimoxazole), thyroid supplements, spironolactone, cimetidine, colchicine, marihuana, opiates, and neuroleptic agents.
Thrombocytopenia Associated with Moxalactam Administration
Authors: Au Janet P. , Geiger Gail S.
Published: May 2016

Thrombocytopenia associated with moxalactam disodium administration occurred in an elderly, debilitated, 84-year-old male. The patient presented with a decreased platelet count and prolongation of prothrombin time and partial thromboplastin time. Occult blood was found in the urine and stool, and generalized petechiae with ecchymoses were found over the entire body.

The moxalactam was discontinued because of suspected drug-induced thrombocytopenia, and daily vitamin K therapy was instituted. By day 2 of vitamin K therapy, the platelet count had risen slightly, but the patient's condition did not improve. On day 3 of vitamin K therapy, the platelet count had decreased. There was a generalized worsening of the patient's medical condition, and he expired two days later.

The use of moxalactam has been associated with thrombocytopenia. The possibility of hemorrhage consequent to the use of this antibiotic is clinically important.
An in Vivo Single- and Multiple-Dose Study of Several Marketed Brands of Conventional and Controlled-Release Theophylline
Authors: Kotzan Jeffrey A. , Vallner Joseph V. , Stewart James T. , Honigberg Irwin L. , Brown W.J.
Published: May 2016

In a single-dose study, 18 healthy adult males consumed each of six dosage forms of theophylline. A conventional-release tablet, a syrup, and four competing brands of controlled-release theophylline were studied. Serial serum samples were obtained and analyzed via high pressure liquid chromatography (HPLC).

After achieving steady state, 15 healthy adult males consumed each of five dosage forms of theophylline in a multiple-dose study. Serial blood samples were obtained between 0 and 72 hours and subjected to analysis with HPLC.

The results indicated that the controlled-release products were not bioequivalent, although they achieved longer time-to-peak values than did the immediate-release syrup and the conventional-release tablet. A single sustained-release product was uniquely different on most pharmacokinetic parameters when compared with the remaining three controlled-release products. In general, the dosage form variation exceeded the individual subject variation on the single-dose study, but the opposite was true for the multiple-dose study.
Hypoglycemia Induced by the Interaction of Chlorpropamide and Co-Trimoxazole
Authors: Baciewicz Anne M. , Swafford William B.
Published: May 2016

Sulfonylureas hypoglycemic action may be potentiated by sulfonamides. This case report describes a 69-year-old female with a hypoglycemic episode suggestive of an interaction between chlorpropamide and sulfamethoxazole (co-trimoxazole). The patient had no renal or liver dysfunction. This interaction is rare but one should be aware of it, especially with combination products.
Prescribing of Oral Metoclopramide for Nonapproved Indications
Authors: Schwinghammer Terry L.
Published: May 2016

All physician orders for metoclopramide tablets at a 500-bed hospital were monitored for a one-year period to determine whether the drug was being used exclusively for the one indication approved by the Food and Drug Administration, diabetic gastroparesis. Eighteen patients received a total of 20 courses of therapy with dosage schedules ranging from 5 mg tid to 10 mg qid. The drug was prescribed for a wide variety of indications, but no patient received it for the symptomatic treatment of diabetic gastroparesis. Extensive literature documentation was lacking for some of the uses, and the doses employed may have been insufficient in some cases. Use of metoclopramide for both approved and nonapproved indications may increase as clinical studies further define its potential uses and physicians become more familiar with the drug.
Relationships between Computer Use and Pharmacists' Professional Behavior
Authors: Kirking Duane M. , Ascione Frank J. , Thomas J. William , Boyd Eddie L.
Published: May 2016

Relationships between use of pharmacy computers and performance of selected professional activities were investigated, via a survey of southern Michigan pharmacists. Respondents included users of two major computer systems as well as pharmacists who do not use computers. A net response rate of 65.7 percent (213 usable questionnaires) was achieved. In general, computer users reported encountering more drug-related problems than did nonusers and more frequent contacts with prescribers for drug-therapy problems. Little difference was found between the two groups in regard to patient counseling activities, except that computer users were more likely to use auxiliary labels. When responses from users of the two computer systems were examined separately, results suggested that one of the systems contributed positively to certain aspects of pharmacists' professional activities while the other system had little influence. These results indicate that it may not be possible to state general conclusions about the effect of computers on the professional practice of pharmacy.
Estramustine Phosphate Sodium
Authors: Hauser Allen R. , Merryman Ruth
Published: May 2016

Estramustine phosphate is approved by the Food and Drug Administration for oral use in the palliative treatment of patients with metastatic and/or progressive carcinoma of the prostate. Estramustine is a conjugate of 17β-estradiol and the carbamate of nitrogen mustard. Although its therapeutic efficacy has been demonstrated, it is not clear to what extent each constituent contributes to estramustine's effectiveness. Estramustine phosphate therapy achieves objective response rates of 60–90 percent in advanced stage D prostatic cancer patients with no prior hormonal therapy. These results are consistent with those obtained with conventional hormonal therapy in similar patient populations. Therapeutic efficacy does not appear to increase when estramustine is used concurrently with other cytotoxic chemotherapeutic agents. An objective response rate of 20–30 percent can be anticipated in patients refractory to conventional hormonal therapy. It is in this group, the estrogen-resistant patients, that estramustine shows the most promise. Adverse effects of estramustine are similar to those of diethylstilbestrol. Gastrointestinal and cardiovascular side effects appear to be the most important and may be severe enough to require discontinuation of therapy.
Clinical Evaluation of a Small-Volume Infusion System in Surgical Intensive Care Patients
Authors: Illsley Steven S. , Swenson Elise , Russo John
Published: May 2016

This study evaluated flow-rate accuracy, safety, and dependability of an infusion system manufactured by the 3M Company. The Small Volume Infusion (SVI) system is portable and consists of a mechanically powered infuser, calibrated flow-regulating set, and syringe. Intravenous fluids and drugs were administered to six surgical intensive care patients. Forty-one trials were carried out at infusion rates of 1, 10, or 30 ml/h. Flow rate varied ≤ 10 percent from the intended infusion rate in the majority of trials. One patient experienced pain at the injection site and one malfunction occurred. The SVI system is a safe, dependable alternative method for the administration of intravenous fluids and drugs. The device may prove to be particularly useful for the administration of drugs not requiring changes in flow rate during infusion or in situations where fluid restriction is desirable.
Commitments for the Future of Pharmacy: A Review and Opinion of the Pharm.D. Curricular Debate
Authors: Manasse Henri R. , Giblin Pamela Ward
Published: May 2016

For over 30 years, the content and form of the pharmacy curriculum and the title of the degree to be awarded have been subjects of controversy among pharmacy educators and practitioners. Scores of articles have been written about a universal Pharm.D. degree, all of which present different angles and opinions. Those who favor a universal Pharm.D. desire an improved image for the profession, greater employment opportunities, preparation for future pharmacy roles, the elimination of the multi-tiered structure, and decreasing costs for services. Those who oppose the entry-level Pharm.D. degree stress a need for multiple levels of education to meet the varying demands of practice, emphasize the oversaturation of the job market and increased costs to schools to adopt the new curriculum, and protest bestowing a doctoral title for reasons of self-esteem. The authors of this article consider it timely to present and evaluate these arguments, to provide the reader with a comprehensive review of the debate, and to call for unity within the profession as it considers the future educational needs of pharmacy practitioners.
The Role of the Pharmacist in a Geriatric Nursing Home: A Literature Review
Authors: Dyer Christopher C. , Oles Karen S. , Davis Stephen W.
Published: May 2016

This review delineates the pharmacist's controversial clinical role in nursing homes as it has developed within the legal, social, and economic climate of the Medicaid and Medicare conditions of participation. Special problems of the geriatric institutionalized patient include polypharmacy, adverse reactions, the overuse of prn drugs, and inadequate physician contact. These problems are compounded by an impoverished scientific data-base for appropriate drug use in the aged. Studies that clarify the impact consultant pharmacists have on the number of drugs prescribed, adverse reactions, and cost containment are compiled and evaluated. It is shown that pharmacists can reduce the number and cost of drugs. Physician acceptance of pharmacists' recommendations was found to be at least 60 percent in these reports. Well-controlled studies are lacking in the literature.
Phenytoin-Isoniazid Interaction: A Kinetic Approach to Management
Authors: Witmer David R. , Ritschel Wolfgang A.
Published: May 2016

A case of phenytoin-isoniazid drug interaction is reported. Pharmacokinetic evaluation was performed on the basis of two different phenytoin serum concentrations obtained on two different dosage regimens. Whereas Vmax was found to be in the normal range, the patient's Km was increased five-fold. The literature regarding this interaction is reviewed. This case illustrates the usefulness of pharmacokinetic methods in the management of phenytoin-isoniazid interaction.
A Zomepirac Reaction Mimicking Ectopic Pregnancy
Authors: Creasy George W. , Kousen Morton , Walker William R.
Published: May 2016

A case is presented of a 29-year-old woman who developed sudden onset of abdominal pain, vomiting, near syncope, abdominal tenderness, profound hypotension, and a late menstrual period. The patient was in good health and her only medication was zomepirac for musculoskeletal discomfort. An exploratory mini-laparotomy was performed for the suspicion of a ruptured ectopic pregnancy, but no evidence of hemoperitoneum or of ectopic pregnancy was found. A subsequent pregnancy test was negative, and the episode was attributed to a zomepirac reaction. A review of zomepirac and zomepirac reactions is included.
Alzheimer's Disease: Clinical Features, Pathogenesis, and Treatment
Authors: Rathmann Kaye L. , Conner Christopher S.
Published: May 2016

Alzheimer's disease is an insidious degenerative disease of the brain and is the leading cause of dementia in the U.S. Numerous etiologies have been postulated, including a large body of evidence suggesting a slow viral infection, possibly in genetically predisposed individuals, but this remains to be proven. Differential diagnosis is based primarily on exclusion of other treatable forms of dementia. Neurochemical studies suggest a cholinergic deficit; thus primary emphasis in treatment has been directed at enhancing cholinergic activity. Choline and lecithin supplementation generally has been ineffective. Results with physostigmine are encouraging and further studies with this drug prototype are needed. Physostigmine's clinical usefulness is limited, however, due to peripheral side effects and its short duration of action. Other pharmacological approaches, such as naloxone, neural metabolic enhancers, stimulants, and vasopressin analogs, have been investigated. The clinical features and pathology of the disease are reviewed.
Fatal Maprotiline Intoxication
Authors: Curtis Robert A. , Giacona Nicola , Burrows Donald , Bauman Jerry L. , Schaffer Michael
Published: May 2016

We report a fatal case of drug toxicity associated with torsade de pointes following an overdose of the tetracyclic antidepressant, maprotiline (Ludiomil). Tissue and plasma levels were obtained at autopsy and are noted. In addition, the cardiovascular effects, pharmacokinetics, and toxicity of maprotiline are reviewed and compared with that of tricyclic antidepressants.
Severe Bleeding Diathesis Associated with Moxalactam Administration
Authors: Meisel Steven
Published: May 2016

A case is presented of a severe bleeding diathesis associated with moxalactam administration that was confirmed on rechallenge. Potential mechanisms of action and recommendations for patient monitoring are discussed.
Pharmaceutical Education and the Practice of Pharmacy
Authors: Levy Gerhard
Published: May 2016

Community pharmacy has undergone a process of relative deprofessionalization; most community pharmacists are now and will continue to function primarily as drug distributors. More sophisticated professional services can and will be offered mainly in hospitals and clinics. There is need for a rigorous and objective assessment of future needs and career opportunities in pharmacy. Many of the expanded roles for pharmacists have not yet been justified by proper functional and economic evaluation. The acceptance of those who fill these new and nontraditional roles cannot be ascertained adequately as long as they are supported extensively by schools of pharmacy rather than by professional fees or by salaries from the institutions in which they practice. There has been an unwillingness or inability on the part of academic pharmacy to make objective and rigorous assessments of the career potential of the various new roles envisaged for pharmacists. Other important issues that have not been explored objectively include drug information leaflets for patients and the single professional degree (Pharm.D.). A good case can be made for having physicians rather than community pharmacists provide drug information literature to patients. There must be pharmacists with one of three different levels of training: The B.S., the Pharm.D., and the Ph.D. Of these, the most critically needed at the present time are Ph.D. pharmacists qualified for positions in drug discovery, formulation, pharmacokinetics and pharmacodynamics, and in the development and evaluation of new drug delivery systems.
Imipramine-Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion
Authors: Parker William A.
Published: May 2016

A case report of impramine-induced syndrome of inappropriate antidiuretic hormone (SIADH) secretion in a 54-year-old woman is presented along with a review of the literature on antidepressant-induced SIADH. The clinical and laboratory presentation, diagnosis, treatment, and monitoring of antidepressant-induced SIADH also are discussed.
The Effectiveness of Four Education Strategies in the Elderly
Authors: Ascione Frank J. , Shimp Leslie A.
Published: May 2016

A study was designed for practitioners wishing to provide comprehensive educational services to the elderly. The effectiveness of four methods (i.e., oral instructions alone or in combination with written information, a medication reminder calendar, or a medication reminder package) of changing patient attitudes, drug knowledge, and compliance behavior was measured in 158 ambulatory cardiovascular patients using a randomized, controlled, single-blind design. The results indicate that drug knowledge will most likely be improved by a strategy that provides small amounts of specific information, thereby reducing the possibility of overwhelming the patient. Noncompliance behavior caused by forgetfulness can be best improved by combining a reminder aid with oral reinforcement. The high levels of motivation present in these patients indicate that improving patient attitudes toward medication taking may be unnecessary.
Bupropion Hydrochloride
Authors: Dufresne Robert L. , Weber Stanley S. , Becker Robert E.
Published: May 2016

Bupropion is a trimethylated monocyclic phenylaminoketone that is an effective antidepressant in humans. It neither is sedating, anticholinergic, nor cardiotoxic. Its mechanism of action may be related to dopamine, but remains uncertain at this time.

Clinical trials comparing bupropion 300–750 mg/d with placebo show it to be superior to placebo in efficacy and as well tolerated. Bupropion, in controlled clinical trials, is as effective as amitriptyline or imipramine, with fewer side effects. The only clinically significant adverse reaction to bupropion in more than 1000 patients studied has been seizure induction at a frequency comparable with that of imipramine. Bupropion appears to be safe and effective in both adult and geriatric depressed patients. Although it appears to be safer and equally efficacious when compared with currently used antidepressants, it has not been tested by routine clinical use.
Review of the Status of Intermittent Positive Pressure Breathing Therapy
Authors: Gonzalez Edgar R. , Burke Timothy G.
Published: May 2016

With the advent of diagnosis related groups reimbursement schedules, the cost-effectiveness of therapies needs to be assessed. The safety and efficacy of intermittent positive pressure breathing (IPPB) has been controversial. IPPB employs the dilating effects of positive-pressure ventilation to deliver aerosolized particles to small and medium-sized bronchi of patients with obstructive airways disease. IPPB is expensive to implement and maintain. The hazards of IPPB (infection, pneumothorax, decreased cardiac output), although rare, could prolong hospital stays. Except for severely ill patients with fatigued respiratory muscles, IPPB offers no advantages over the less costly and safer compressor-nebulizer or metered-dose delivery of a β-agonist.
Chlorpropamide-Induced Hemolytic Anemia
Authors: Or Reuven , Merin Edna , Stupp Yehudith , Matzner Yaacov
Published: May 2016

Acute intravascular hemolysis developed when a diabetic patient, previously treated with glyburide, was started on another oral sulfonylurea drug, chlorpropamide.

Immunoglobulins were not found in the patient's serum and the red cells were coated with C3 only, suggesting an “innocent bystander” reaction. This case demonstrates that there is no cross reactivity between glyburide and chlorpropamide in producing hemolytic anemia.
Clinical Pharmaceutical Services in Retail Practice II. Factors Influencing the Provision of Services
Authors: Nelson Arthur R. , Zelnio Robert N. , Beno Carolyn E.
Published: May 2016

The second phase of a two-part investigation of factors influencing the development of clinical pharmaceutical services in retail practice is presented. This report focuses on why pharmacists who reported a willingness and competency to perform services in Phase I had not developed such a practice.

Transcripts from 11 focus group interviews conducted with pharmacists throughout South Carolina were analyzed by two panels. The first panel summarized subjects' comments regarding the major dimensions: (1) awareness, (2) demand, (3) motivation, (4) requisites, and (5) barriers for delivery of services. The second panel judged the validity of the first panel's analysis.

Pharmacists were aware of common clinical services, but had given little thought to unique services oriented to patients' needs. Monetary factors were deemed to be more important than was concluded from the first phase. Pharmacists saw a minimal demand for services, but a great need. Pharmacists also felt the need for more clinical skills, but better systems of delivery also were emphasized. The report concludes with a strategy for promoting clinical services in retail practice.
Indomethacin Sustained-Release?
Authors: Green Jeffrey A.
Published: May 2016

Recently, many new formulations of older drugs have been marketed as sustained-release preparations. Only some of these compounds have scientific rationale supporting their development. At least two inherent properties of a drug are desirable in considering its reformulation into a sustained-release entity. One of these properties is the demonstration of a concentration/response relationship together with a short plasma elimination half-life and inactive or uncharacterized activity of any generated metabolites. The second property is the production of transient side effects associated with dissolution and/or peak concentrations. When neither of these conditions is satisfied, then a sustained-release preparation may offer no advantages over the conventional formulation. The literature on indomethacin was examined with respect to the above conditions and it was concluded that its marketing as a sustained-release preparation is not justified and that investigations have failed to demonstrate clinical advantages of this new formulation.
Accidental Massive IV Administration of Cyclosporine in Man
Authors: Wallemacq Pierre E. , Lesne Michel L.
Published: May 2016

A 23-year-old female patient being treated for Hodgkin's disease (pulmonary) received by mistake cyclosporine iv instead of tranexamic acid. We followed the evolution of the clinical signs, which were interpreted as possible signs of acute toxicity, and monitored the plasma concentrations over an 84-hour period.
Positions Held by Graduates of Postgraduate Pharmacy Fellowship Programs
Authors: Powell Stephen H. , Fanikos John R. , Kaul Alan F.
Published: May 2016

The Brigham and Women's Hospital Pharmacy Department conducted a survey to determine how recently trained (since 1981) postgraduate pharmacy fellows have been employed. We received responses to mailed survey questionnaires from 40 of 42 institutions or colleges offering a pharmacy fellowship. Survey results showed 117 pharmacists completed fellowships from 1981 through July 1984. Fifty percent (58/117) of all graduates are members of college of pharmacy faculty, 20 percent (24/117) are pharmacy staff specialists, and 12 percent (14/117) have pharmaceutical industry positions. The survey shows that the majority of fellowships completed are in pharmacokinetics, with clinical pharmacology and infectious disease a distant second and third, respectively. Postgraduate pharmacy fellowships are important to prepare pharmacists for faculty positions in clinical or pharmacy practice departments of colleges of pharmacy.
Pimozide: Use in Tourette's Syndrome
Authors: McLeod Donald C. , Colvin Carol L. , Tankanow Roberta M.
Published: May 2016

The orphan drug pimozide was recently approved for marketing in the U.S. for the treatment of Tourette's syndrome (TS). TS is characterized by recurrent, involuntary motor movements and vocal tics, and is believed to be due to neurochemical dysfunction. Pimozide's receptor selectivity differs from that of haloperidol, the standard agent used for TS. Clinical trials with pimozide demonstrate a positive response for many patients, although superiority over haloperidol has not been demonstrated in general. Pimozide causes annoying side effects in a large percentage of patients and may cause severe side effects (e.g., tardive dyskinesia, cardiovascular toxicity) with prolonged use and/or at higher doses. The long half-life of pimozide allows for once-daily dosing. Pimozide should be reserved for teatment of patients with TS who have not responded to haloperidol or who cannot tolerate haloperidol's adverse effects.
Anaphylactoid Reactions Associated with Parenteral Cyclosporine Use: Possible Role of Cremophor EL
Authors: Howrie Denise L. , Ptachcinski Richard J. , Griffith Bartley P. , Hardesty Robert J. , Rosenthal J. Thomas , Burckart Gilbert J. , Venkataramanan Raman
Published: May 2016

Acute anaphylactoid reactions occurred immediately after initiation of intravenous infusions of cyclosporine in three patients post-organ transplantation. Shortness of breath, flushing, tachypnea, chest pain, pruritus, or urticaria were noted; rapid recovery followed cessation of drug infusion. Subsequently, oral cyclosporine has been used in each patient without recurrence of the observed reaction. The presence of Cremophor EL as an emulsifying agent in the parenteral dosage formulation of cyclosporine is a likely etiology for this acute adverse reaction, Slowed rates of drug infusion and antihistamine premedication may permit continued intravenous cyclosporine use in affected patients.
Prolonged Elimination of Piperacillin in a Patient with Renal and Liver Failure
Authors: Green Laurence , Dick James D. , Goldberger Suanne P. , Angelopulos Chris M.
Published: May 2016

A 22-year-old female with acute leukemia was admitted to the oncology center for evaluation and treatment. Piperacillin was used during her admission for treatment of Pseudomonal sepsis. The patient's renal and liver function deteriorated during the hospital course, requiring large dose adjustments of piperacillin. The elimination half-life of piperacillin was estimated to be 32 hours. Patients with both liver and renal disease require only small doses of piperacillin to achieve therapeutic plasma concentration.
Hepatitis Associated with Allopurinol
Authors: Ohsawa Tomoji , Ohtsubo Masatoshi
Published: May 2016

When adverse reactions occur, it is important to identify the etiologic drug. We describe a case of hepatitis associated with allopurinol.

A 66-year-old female was admitted for rehabilitation of a cerebral hemorrhage on September 11, 1981. Allopurinol, clofibrate, and baclofen were administered. Severe hepatitis developed on November 13. The clinical laboratory data returned to normal on November 30. Challenge tests were conducted on clofibrate, allopurinol, and baclofen. The challenge test was positive after the administration of allopurinol.

Allopurinol hepatitis is most likely a hypersensitivity reaction, as is suggested by the symptoms of eosinophilia and rash. Renal dysfunction may predispose one to develop hepatitis associated with allopurinol.
β-Lactamase Inhibitors
Authors: Conner Christopher S.
Published: May 2016

Numerous β-lactamase inhibitors have been developed to overcome the problems of bacterial resistance to β-lactam antibiotics. One such agent, clavulanic acid, has been combined with amoxicillin, and the combination is effective against many amoxicillin-resistant organisms. Clinical studies have demonstrated the efficacy of amoxicillin/clavulanate in a variety of infections, however, comparative studies are few and have not demonstrated sufficiently the superiority of the combination over conventional antibiotic therapy. In addition, side effects appear to be more frequent than with amoxicillin alone. The place in therapy of amoxicillin/clavulanate is discussed.
Tocainide: A New Oral Antiarrhythmic
Authors: Hasegawa Guy R. , McLeod Donald C.
Published: May 2016

Tocainide is an orally active lidocaine analog indicated for the suppression of ventricular arrhythmias. It is electrophysiologically similar to lidocaine and produces minimal hemodynamic and electrocardiographic changes. Oral bioavailability is virtually complete, elimination half-life is 11–15 hours, and 40 percent of a dose is excreted unchanged in urine.

Tocainide therapy is commonly associated with gastrointestinal and neurologic side effects that generally are well tolerated. Rash, aggravation of arrhythmias, and worsening of heart failure may also occur.

While tocainide does not consistently suppress arrhythmias following myocardial infarction, it does control chronic ventricular arrhythmias, being particularly effective in patients responsive to lidocaine. Tocainide has not been shown to be more effective than quinidine or procainamide.

Tocainide should be a useful agent in patients who are unable to tolerate other antiarrhythmics, who are responsive to lidocaine, or who have been troubled with Q-T prolongation with or without torsade de pointes.
Iohexol and Iopamidol: Second-Generation Nonionic Radiographic Contrast Media
Authors: Kawada Tom K. , McLeod Donald C.
Published: May 2016

Iohexol and iopamidol are new second-generation nonionic contrast media. We review their physical/chemical properties and describe the improvements made over the first-generation nonionic prototype, metrizamide, and conventional ionic contrast media. The significance of low osmolar solutions is discussed and the relationship between osmolality and adverse reactions is emphasized. The convenience of a ready-to-use stable solution that offers an advantage over the lyophilized metrizamide in practical application is suggested. Clinical studies using randomized, double-blind comparison techniques are cited. An attempt is made to define the exact role for iohexol and iopamidol.
Amoxapine-Induced Tardive Dyskinesia
Authors: Tao Glen K. , Harada Don T. , Kootsikas Maria E. , Gordon Martin N. , Brinkman Joseph H.
Published: May 2016

A case report of amoxapine-induced tardive dyskinesia following discontinuation of amoxapine therapy is reported. During 68 weeks of therapy, the patient received a maximum of amoxapine 400 mg/d. Six months after amoxapine discontinuation, the patient continued to have symptoms of tardive dyskinesia. These symptoms correlate with the dopamine receptor-blocking property of amoxapine and its metabolites. We propose that amoxapine therapy be monitored for the long-term as well as the short-term adverse effects of dopamine receptor-blockade.
Potential Uses for Metoclopramide
Authors: Shaughnessy Allen F.
Published: May 2016

Metoclopramide, a dopamine antagonist, is approved in the U.S. for the treatment of various gastrointestinal disorders. Its use has been investigated in a wide variety of diseases, including those not involving the intestinal tract. Although more study is required before routine clinical use of metoclopramide can be advocated, it may be effective in the treatment of tardive dyskinesia, in decreasing the risk factors associated with anesthetic-related aspiration, and as an adjunct in the treatment of gastric bezoars. It also may be used safely in patients with Parkinson's disease. The use of metoclopramide in the treatment of neurogenic bladder, orthostatic hypotension, tumor-associated gastroparesis, nonprolactinemic amenorrhea, failure to thrive, Tourette's syndrome, anorexia nervosa, and hiccups, as well as an adjunct to migraine therapy, has been investigated, but sufficient evidence has not been accumulated to advocate the use of metoclopramide in these disorders.
Molindone and Hepatotoxicity
Authors: Bhatia Subhash C. , Banta Lawrence E. , Ehrlich Donald W.
Published: May 2016

An adolescent male with chronic schizophrenic disorder, paranoid type, was treated with molindone. He developed hepatotoxicity in the early treatment phase as evidenced by flu-like symptoms and laboratory abnormalities of liver functions. These symptoms and his hepatic functions improved on discontinuing molindone. Similar liver function trends were seen on reintroduction and subsequent withdrawal of the drug.

Hepatic hypersensitivity has not been reported previously with the use of this drug. It is suggested that clinicians should be aware of this association and should assess hepatic functions in patients who develop a prodromal flu-like syndrome with this drug, especially in the early treatment phase.
Switching Monoamine Oxidase Inhibitors
Authors: True Bev Lorraine , Alexander Bruce , Carter Barry
Published: May 2016

Substituting one monoamine oxidase inhibitor for another is recommended only after a drug-free interval to avoid hypertensive emergencies. The evidence and mechanism firmly supporting this caution is lacking. We report a case where monoamine oxidase inhibitors were substituted without apparent adverse consequences.
Encainide: A New Antiarrhythmic Agent
Authors: Wehmeyer Ann E. , Thomas Robert L.
Published: May 2016

Encainide is classified as a type Ic antiarrhythmic agent. Absorption is essentially complete, but bioavailability is variable because of first-pass metabolism. Two metabolic phenotypes, extensive and poor metabolizers, have been identified. O-demethyl encainide and 3-methoxy-O-demethyl encainide are active metabolites of encainide and contribute significantly to its antiarrhythmic effect. In clinical trials, encainide has been shown to be highly effective in suppressing premature ventricular contractions and ventricular tachyarrhythmias. The drug is useful in treating ventricular arrhythmias refractory to other agents. Encainide is also moderately effective in supraventricular arrhythmias involving an accessory pathway. It is highly effective in cases of Wolff-Parkinson-White syndrome, where the accessory pathway has a short refractory period. Common adverse effects of encainide are dizziness, visual disturbances, nausea, and headache. Encainide appears to be a safe and effective antiarrhythmic agent with few adverse effects and negligible hemodynamic effects. Encainide may be a useful agent for ventricular and supraventricular arrhythmias, particularly those refractory to other agents.
Early Use of β -Adrenergic-Blocking Agents in Acute Myocardial Infarction
Authors: Mauro Vincent F. , Zeller Frederick P.
Published: May 2016

Of recent interest is the acute use of β-adrenergic-blocking agents in patients who have suffered an acute myocardial infarction (AMI). Acute use of β-blockers refers to initiation of therapy within hours following the onset of symptoms suggestive of AMI. The proposed goal of therapy is to alter the infarction process to improve mortality. Because of the hyperadrenergic activity present in patients during an infarction, β-blockers are theoretically an attractive therapeutic intervention because of their sympatholytic properties. Acute use of β-blockers has been shown to limit infarct size, as determined by cardiac enzyme activity, and reduce the incidence of major ventricular arrhythmias. β-blockers may also prevent infarction in patients with symptoms suggestive of infarction. However, the acute use of β-adrenergic-blocking agents has not been shown to reduce short-term (≤30 d) mortality. In view of this fact, the acute use of β-adrenergic-blocking agents cannot be recommended.
Postpericardiotomy Syndrome
Authors: McClendon Candace E. , Leff Richard D. , Clark Edward B.
Published: May 2016

Postpericardiotomy syndrome, a frequent complication of open-heart surgery, is characterized by fever, chest pain, and pericardial and pleural effusions. These signs may develop 1 to 12 weeks after intracardiac surgery in ∼30 percent of patients. Although the etiology of the syndrome is unknown, evidence points to a viral and/or autoimmune cause. Postpericardiotomy syndrome is diagnosed after excluding other conditions such as endocarditis and pneumonia. In many cases, the syndrome is self-limiting and occurs only once, but in other cases the symptoms have recurred as many as eight times. When the symptoms recur, management is more difficult because optimal pharmacologic treatment is not known.

Antiinflammatory agents, such as salicylates and steroids, represent the drugs most commonly used. Although analgesics with codeine or oxycodone are important for the patients' symptomatic relief, early recognition of the syndrome is the key to limiting the discomfort and possible complications associated with this condition.
Dilemmas in Primary Care: Antibiotic Treatment of Acute Otitis Media
Authors: True Bev Lorraine , Helling Dennis K.
Published: May 2016

Antibiotic treatment of acute otitis media (AOM) accounts for a significant number of all antibiotic prescriptions each year. In the primary care setting, initial antibiotic selection is rarely based on direct evidence, such as cultures of middle ear fluid. Initial antibiotic therapy by the primary care practitioner involves the evaluation and application of information related to prevalence of infecting organisms; in vitro antibiotic spectrum and penetration into middle ear fluid; initial cure rate, relapse and recurrence rates; and antibiotic cost, safety, and convenience.

The influence of these factors on the initial antibiotic choice for AOM is reviewed. Several therapeutic dilemmas confronting the prescriber are discussed and a rational approach to initial antibiotic therapy is presented.