bluuebunny/crossref_metadata_2025 huggingface dataset:
Disability Pensions Due to Musculo-Skeletal Disorders among Men in Heavy Occupations A Case-Control Study
Authors: Eva Vingård , Lars Alfredsson , Evy Fellenius , Christer Hogstedt
Published: July 2017

The relative risk of disability pension due to musculoskeletal disorders has been studied with regard to occupation and work load. The study population comprised men born 1915 to 1934, living in Stockholm county. 1307 men who received a disability pension during 1979, 1980, 1981 and 1984 due to disorders from the low back, neck/shoulder, hip, and knee were compared with 298 randomly selected men concerning occupation and occupational work load. Disability pensions were more common both in men with medium and high physical work load compared to men with low physical work load. Construction workers and metal workers had a high relative risks of receiving disability pensions because of disorders in all four body regions, and men in many other occupations had disorders in two or three regions. In office workers the risk of disability pension because of musculo-skeletal disorders was low.
Mexiletine for Diabetic Peripheral Neuropathy
Authors: Nabulsi Lama H , McLendon Beth M , Vondracek Thomas G
Published: July 2017

Objective:

To evaluate the efficacy and safety of mexiletine for the treatment of painful diabetic peripheral neuropathy (DPN).

Data Sources:

English-language clinical studies and review articles involving human subjects were identified using MEDLINE (January 1966-January 1999).

Data Synthesis:

Peripheral neuropathy is a common complication of diabetes. Tricyclic antidepressants are the agents of choice for treatment of symptomatic peripheral neuropathy. However, other therapies are necessary in patients who do not respond to tricyclic antidepressants, do not tolerate their adverse effects, or have a contraindication to their use. The use of mexiletine for DPN has been evaluated in four studies. Two studies concluded that mexiletine was significantly better than placebo as treatment for DPN; another showed no difference. In the fourth study, improvement with use of mexiletine was not demonstrated, but posthoc analysis showed benefits in certain subgroups of patients, including patients with stabbing or burning pain, heat sensation, or formication. All studies excluded patients with cardiac, renal, or hepatic disease; in addition, only one study assessed quality of life, which raises questions about the safety and clinical significance of the reported benefits of mexiletine therapy.

Conclusions:

Four studies have evaluated the role of mexiletine in treating DPN. Although the results are not uniform, they suggest that mexiletine may be considered a potential alternative for patients unable to take tricyclic antidepressants. The long-term safety of mexiletine and its use in patients with renal, hepatic, or cardiac disease has not been established.
The Incidence and Nature of Adverse Reactions during Intravenous Acetylcysteine Therapy for Acetaminophen Overdose
Authors: Lifshitz Matitiahu , Kornmehl Perez , Reuveni Haim
Published: July 2017

Objective:

To determine the incidence of adverse drug reactions in patients with acetaminophen overdose following administration of intravenous acetylcysteine, and to evaluate the cost-benefit ratio of intravenous compared with oral acetylcysteine therapy.

Methods:

The incidence of adverse drug reactions to intravenous acetylcysteine therapy was studied retrospectively in all patients with acetaminophen overdose who were admitted to Soroka University Medical Center, Beer-Sheva, Israel, from 1994 to 1998. Data were obtained from hospital records. All patients were treated with a 20-hour intravenous regimen according to the Prescott protocol. Special attention was paid to the clinical manifestations of adverse reactions, time of onset, and history of patient allergy and asthma. Cost of therapy (drug prices, hospital per diems) for intravenous versus oral acetylcysteine administration was evaluated in accordance with average rates prevailing in Israel in December 1998.

Results:

Ninety-two patients, 32 adolescents aged 12–18 years (mean ± SD 14.2 ± 1.9) and 60 adults aged 18–52 years (28.2 ± 3.2), were treated with intravenous acetylcysteine for acetaminophen overdose during the study period. Three patients (3.2%) developed adverse reactions: one adult presented with a maculopapular rash and pruritus, and two adolescents developed mild urticaria; no other adverse reactions were reported. All adverse reactions occurred during administration of the loading dose, 15–20 minutes after initiation of therapy. The reactions subsided a few hours after the acetylcysteine infusion was stopped and did not require antiallergy therapy. None of the three patients had a history of allergy. The 20-hour intravenous acetylcysteine protocol is approximately three times less expensive than the recommended oral regimen in terms of drug cost and length of hospitalization.

Conclusions:

Intravenous acetylcysteine is a relatively safe antidote for acetaminophen poisoning. The incidence rate of adverse reactions is low, and they are mild and easily controlled by termination of the infusion. We recommend intravenous acetylcysteine therapy, particularly for patients with vomiting caused by the acetaminophen overdose or by oral acetylcysteine therapy. The 20-hour intravenous acetylcysteine therapy has a cost-benefit advantage over oral therapy; however, the oral formulation is not approved by the FDA.
The Use of Finasteride in Treating Androgenetic Alopecia in Adult Men
Authors: Hobdy-Henderson Karen C , LeClair Chad , Huynh Tam , Huynh Kiet
Published: July 2017

Objective:

To review the medical literature discussing the use of finasteride in the treatment of androgenetic alopecia in adult men.

Data Sources:

English-language journal articles, the Internet, and the manufacturer's package insert.

Study Selection:

Clinical trials evaluating the efficacy and safety of finasteride in the treatment of men with mild to moderate androgenetic alopecia were selected. Of these trials, those evaluating the efficacy of finasteride were blinded, randomized, placebo-controlled studies of 12-months' duration conducted in men between 18 and 41 years of age; those evaluating the safety of finasteride were conducted in rats, mice, and rabbits.

Data Extraction:

Data were extracted and analyzed if the information was relevant and consistent. Study selection was based on study design and clinical end points.

Data Synthesis:

Male pattern hair loss is a common condition in which men experience thinning of the hair on the scalp. This often results in a receding hairline or balding on the top of the head. This type of hair loss is known as androgenetic alopecia. In men with androgenetic alopecia, the balding scalp contains miniaturized hair follicles and increased amounts of dihydrotestosterone (DHT) compared with a hairy scalp. Administration of finasteride decreases scalp and serum DHT concentrations in these men, causing an increase in the number of scalp hairs for most men and helping to fill in thin or balding areas of the scalp.

Conclusions:

Finasteride is the first oral drug in its class to be used in treating alopecia in men only. It maintains and regrows hair on top of the head and anterior midscalp area. Finasteride begins to block the formation of DHT almost immediately; however, because hair grows slowly, visible results from the daily use of finasteride are not seen for at least three months. This drug is not recommended for use in women and children. Finasteride demonstrates an excellent profile in treating men with hair loss.
Retrospective Evaluation of the Lipid-Lowering Effects of Atorvastatin
Authors: Buys Lucinda M , Rosenkrans Kurt A
Published: July 2017

Objective:

To evaluate the lipid-lowering effects, particularly changes in high-density lipoprotein (HDL) cholesterol, associated with atorvastatin use in a typical outpatient family medicine practice.

Design:

Retrospective case series.

Setting:

A community-based family medicine residency program.

Patients:

One hundred twenty-three patients with hyperlipidemia.

Interventions:

Treatment with atorvastatin to meet National Cholesterol Education Program (Adult Treatment Program) II goals.

Main Outcome Measures:

Fasting lipid profiles, including total cholesterol, low-density lipoprotein (LDL) cholesterol, HDL cholesterol, and triglycerides.

Results:

Atorvastatin lowered total cholesterol, LDL cholesterol, and triglycerides. HDL cholesterol was essentially unchanged from baseline to follow-up. In a subset of patients (∼50%), HDL cholesterol decreased by 13.1%. In the remainder of patients, HDL cholesterol increased by 10.7%. The decrease of HDL cholesterol was as much as 24 mg/dL.

Conclusions:

Atorvastatin is an effective agent for lowering total cholesterol, LDL cholesterol, and triglycerides. In a subset of patients, atorvastatin appeared to lower HDL cholesterol. Close monitoring of HDL cholesterol concentrations while patients are receiving atorvastatin is important.
Infectious Vulvovaginitis: Current Trends and Management
Authors: Ponte Charles D
Published: July 2017

Objective:

To review the clinical presentation, diagnosis, and contemporary management of infectious vulvovaginitis.

Data Sources:

A MEDLINE search on English-language literature was performed, with emphasis on 1999 publications. Search terms included trichomoniasis, candida vaginitis, and bacterial vaginosis (BV). Personal files containing relevant published reviews and original research were also reviewed.

Results:

Vulvovaginitis is a common gynecologic disorder. The three most prevalent types of infectious vulvovaginitis are BV, candidiasis, and trichomoniasis. Patients typically report discharge, odor, itching, dysuria, or dyspareunia. The healthy vagina is resistant to pathogenic organisms due to an acidic pH and the production of hydrogen peroxide. Any disruption of the healthy vaginal ecosystem can result in infection. Candidiasis is an opportunistic infection that can be sexually transmitted and is diagnosed by presence of fungal hyphae or pseudohyphae in vaginal secretions. Treatment is usually initiated with topical imidazoles or triazoles, which are highly effective against Candida albicans; however, drug-resistant nonalbicans species (e.g., Candida glabrata) are becoming more prevalent and pose treatment challenges. Trichomoniasis is a sexually transmitted disease caused by Trichomonas vaginalis, a protozoan that invades the paraurethral structures of both sexes and is diagnosed by presence of motile trichomonads in vaginal secretions. Oral metronidazole is the only drug recommended for treatment; however, the incidence of metronidazoleresistant trichomoniasis is increasing and poses therapeutic challenges for the clinician. BV is characterized by an overgrowth of aerobic and anaerobic organisms that replace normal lactobacilli. Amsel's criteria are useful in making the diagnosis of BV. Effective treatment is necessary since BV is associated with various gynecologic and obstetric complications. Recommended therapies include oral or topical metronidazole or clindamycin.

Conclusions:

Patient history and physical examination findings are paramount in diagnosing infectious vulvovaginitis. Despite effective oral and topical treatments, resistant organisms are becoming more prevalent, necessitating a search for more effective management of this disorder.
Efficacy of d-Penicillamine in Reducing Lead Concentrations in Children: A Prospective, Uncontrolled Study
Authors: Lifshitz Matitiahu , Levy Jacov
Published: July 2017

Objective:

To evaluate the efficacy of oral d-penicillamine therapy in children with high blood lead concentrations.

Design:

A prospective, uncontrolled study.

Methods and Patients:

Seven children (2–16 y old; mean 8.7) with elevated blood lead concentrations but no symptoms of lead poisoning were treated with oral d-penicillamine. Lead-contaminated homemade flour as found to be the source of poisoning. Mean ± SD blood lead concentrations prior to therapy were 60.3 ± 12.9 μg/dL (range 47.8–83). Mean blood zinc protoporphyrin (ZPP) was 337.86 ± 58.55 μmol/mol hemoglobin (Hb) (range 247–394).

Results:

Ninety days of treatment with d-penicillamine lowered the mean blood lead concentration by 31.7% to a mean of 40.7 ± 8.6 μg/dL (range 30–53) and lowered mean ZPP blood concentrations by 40% to a mean of 201.14 ± 14 μmol/mol Hb (range 150–278). Three patients with blood lead concentrations >45 μg/mL at the end of this therapy were subsequently treated with succimer, an alternative oral chelator; the blood lead concentrations were further reduced to <45 μg/mL.

Conclusions:

d-Penicillamine therapy significantly reduced blood lead concentrations but did not achieve acceptable lead and ZPP concentrations for young children. Therefore, we conclude that 90 days of d-penicillamine treatment is of limited effectiveness in young children who have high blood lead concentrations and also show symptoms of lead poisoning.
Pharmacologic Regulation of the Renin—Angiotensin System: Physiologic and Pathologic Effects
Authors: Jutte Sara B , Sprague Jon E
Published: July 2017

Objective:

To review the physiologic and pathologic roles of the renin-angiotensin system in maintaining blood pressure, glomerular filtration rate, and myocardial tissue growth. The pharmacologic regulations of the pathologic effects of the renin-angiotensin system are emphasized, with a comparison between angiotensin-converting enzyme (ACE) inhibitors and angiotensin1 receptor (AT1) antagonists.

Data Sources:

English-language basic science, clinical studies, and review articles were identified using MEDLINE, IOWA, and a manual search from January 1966 through September 1999. References were also obtained from the reference section of relevant published articles.

Study Selection and Data Extraction:

All articles identified were evaluated for possible inclusion in this review. Evaluative and comparative data from basic science and controlled clinical studies were reviewed.

Data Synthesis:

The renin-angiotensin system has a plethora of physiologic and pathologic roles in the regulation of blood pressure, renal function, and cell growth. The cellular mechanisms involved in eliciting the responses to the renin-angiotensin system are discussed in detail, with an emphasis on the pharmacologic regulation of the cellular responses. The role of angiotensin II in maintaining blood pressure, glomerular filtration rate, and in regulating myocardial cell growth secondary to myocardial infarction or as a complication of congestive heart failure are all reviewed. The ACE inhibitors and AT1 antagonists have comparable pharmacologic effects that can influence their therapeutic application. The ACE inhibitors and AT, antagonists are compared regarding clinically and experimentally observed differences that may affect their therapeutic application.

Conclusions:

The physiologic and pathologic roles of the renin-angiotensin system make the ACE inhibitors and AT1 antagonists ideal candidates in treating many conditions. Presently, few studies have been conducted that directly compare ACE inhibitors and AT, antagonists. An understanding of the basic underlying pharmacologic principles is essential when attempting to apply the scientific and clinical information of the ACE inhibitors and AT1 antagonists with the intention of extrapolating to therapeutic utility.
Serum and Cerebrospinal Fluid Vancomycin and Gentamicin Concentrations during Ventriculoperitoneal Shunt Surgery: An Observational Study
Authors: Faillace Walter J , Tan Paul
Published: July 2017

Background:

Ventriculoperitoneal shunts become infected predominantly during surgery. Optimal antibiotic prophylaxis during cerebrospinal fluid (CSF) shunt surgery has not been fully determined.

Objective:

To quantitate the concentrations of vancomycin and gentamicin in the serum and CSF during 100 ventriculoperitoneal shunt surgeries at the time of shunt manipulation.

Design:

Descriptive, prospective, observational study with a 27- to 76-month postoperative follow-up period range.

Setting:

University hospital.

Patients:

Eighty-three hydrocephalic patients ranging from premature to adult ages.

Interventions:

Intraoperatively, children received intravenous vancomycin 15 mg/kg/dose and gentamicin 2.5 mg/kg/dose; adults received vancomycin 1 g/dose and gentamicin 1.5 mg/kg/dose. Antibiotics were continued for 24 hours postoperatively, with dosage and schedule adjusted for age. Antibiotic serum and CSF concentrations were sampled one hour after infusion, and measured via fluorescence polarization immunoassay. Meticulous surgical infection control measures were followed.

Main Outcome Measures:

Correlation of intraoperative serum and CSF antibiotic concentrations with postoperative infection rate.

Results:

Intraoperative vancomycin serum concentrations ranged from 10.8 to 53.8 μg/mL (28.0 ± 9.5 μg/mL, mean ± SD). Intraoperative gentamicin serum concentrations ranged from 3.9 to 9.4 μg/mL (4.8 ± 2.0 μg/mL). In all surgeries, intraoperative CSF vancomycin and gentamicin concentrations were low (vancomycin <5 μg/mL, gentamicin <2 μg/mL). The infection rate among surgeries was 2.0%, and the infection rate among patients was 2.4%. Two shunt infections occurred, one with Candida albicans and one with Citrobacter freundii.

Conclusions:

Serum concentrations of vancomycin and gentamicin were above the minimum inhibitory concentrations for likely pathogens in 84% and 74% of surgeries, respectively. Intraoperative bacteriostatic and bactericidal CSF antibiotic concentrations may not be necessary to achieve a low postoperative shunt infection rate. Larger confirmatory studies are needed.
Impact of Monitoring Vancomycin Peak and Trough Concentrations versus Trough Concentrations Alone on Dose Adjustments: An Outcomes Analysis
Authors: Benkert Steven C , Sinnett Mark J , Amodio-Groton Maria
Published: July 2017

Objective:

To determine whether monitoring both steady-state peak and trough serum vancomycin concentrations or steady-state trough serum vancomycin concentrations alone resulted in differences between two groups of patients in terms of dose adjustment, clinical outcome, and toxicity.

Design:

The study was a retrospective chart review of patients treated with vancomycin during two time periods. Group 1 represented patients hospitalized between July 1, 1996, and January 31, 1997. These patients routinely had vancomycin peak and trough concentrations measured. Group 2 represented patients hospitalized from July 1, 1997, to January 31, 1998, who were monitored with trough vancomycin concentrations only.

Setting:

A university teaching hospital.

Patients:

Adults at least 18 years of age who received a constant dose of intravenous vancomycin for at least three consecutive days were eligible for inclusion in the study. Patients were selected from lists generated by the Microbiology Department. The lists contained vancomycin serum concentrations measured during those time frames.

Main Outcome Measures:

The main outcome measure was to assess whether dose adjustments by prescribers were influenced by both vancomycin peak and trough concentrations or by the trough concentration alone.

Results:

Forty-nine and 37 patients met the criteria for inclusion into group 1 and group 2, respectively. The mean duration of therapy in group 1 (15 ± 10 d) was not statistically different from that of group 2 (14 ± 12 d). Patients in both groups received a mean daily vancomycin dose of approximately 1,500 mg. In analyzing treatment decisions, trough concentration was the only significant factor influencing a change in total daily dose of vancomycin (p = 0.038). Furthermore, although the method of vancomycin serum concentration monitoring varied between the two groups, the mean clinical outcome parameters were comparable.

Conclusions:

Prescribers tended to adjust vancomycin regimens based only on trough serum concentrations; monitoring peak serum vancomycin concentrations did not enhance patient care. Mean outcome parameters in the two groups were comparable.
Visual Hallucination in Craniometaphyseal Dysplasia Successfully Treated with Olanzapine
Authors: Alao Adekola O , Armenta Wendy A , Yolles Jennifer C , Naprawa Steven A
Published: July 2017

Objective:

To report the successful treatment of visual hallucinations in a patient with craniometaphyseal dysplasia (CMD) with olanzapine.

Case Summary:

A 15-year-old girl with CMD presenting with transient episodes of total blindness and complex visual hallucinations was successfully treated with olanzapine.

Discussion:

The co-occurrence of visual hallucination and blindness in this patient suggests a variety of the Charles Bonnet syndrome, a diagnosis made almost exclusively in the older population. Compared with traditional antipsychotics, the reduced propensity of olanzapine to produce extrapyramidal side effects may make it more favorable in specific situations.

Conclusions:

More experience with olanzapine in treating visual hallucinations is needed to determine whether it is more effective than typical antipsychotics in treating visual hallucinations associated with CMD or Charles Bonnet syndrome.
Quinine Overdose: Hypoglycemia Potentiated by Age and Alcohol
Authors: Cox Craig D , Anderson Allan C , Chittivelu Subramanyam
Published: July 2017

Objective:

To discuss a case of quinine toxicity and the impact that age and alcohol can have on its clinical presentation of life-threatening hypoglycemia.

Case Summary:

A 55-year-old white woman with a history of ethanol abuse developed quinine toxicity after accidentally consuming approximately 4 g of quinine. During her hospital stay, the patient developed life-threatening hypoglycemia, signs of cinchonism (tinnitus, lethargy), hypotension, and hypokalemia. She was treated successfully with intravenous fluids, dextrose, and potassium.

Discussion:

In reviewing the literature involving quinine toxicity, few cases have discussed the role quinine may play in the development of hypoglycemia. Quinine has been implicated as the cause of hypoglycemia in patients with malaria, but has less commonly been considered the cause in healthy patients. In this case report, the patient developed life-threatening hypoglycemia after the consumption of 4.6 g of quinine. Toxicity associated with quinine is usually detected at doses >4 g, but lethal doses have been reported to range between 2 and 8 g. The cause of this patient's sudden drop in glucose concentration was determined to be multifactorial and attributed to a combination of quinine, ethanol, and potential biologic aging of metabolic organs.

Conclusions:

Quinine can cause hypoglycemia; in this case it occurred at a toxic dose of 4.6 g. In older patients or patients with a significant history of alcohol abuse, this effect may be potentiated.
Issues in Contemporary Drug Delivery: Part V: Total Parenteral Nutrition
Authors: Mohler Pamela A. , Banakar Umesh V.
Published: July 2017

Objective:

To provide an overview of common compounding and administration guidelines for total parenteral nutrition (TPN). The compatibility of various drug products with TPN preparations is also discussed.

Data Sources:

References were selected from published bibliographies of specialized nutrition and drug-nutrient interaction articles, package inserts and manufacturer's information, and specific topic searches in MEDLINE computerized database (English language, through 1989).

Study Selection:

Studies that investigated stability were selected preferentially to those studying compatibility alone; when stability data were not available, compatibility studies were included. Studies using products marketed in the US were chosen preferentially to those using European products; studies and case reports using human subjects were selected in preference to animal studies. Sixty percent of the initially identified studies were selected for inclusion.

Data Extraction:

Studies were reviewed by the authors for internal consistency and statistical validity.

Data Synthesis:

Intravenous solutions can be manufactured to meet various nutritional specifications. As additional nutrients and drugs are incorporated, the risk of incompatibility and instability of the admixture increases. Stability data are relatively sparse, leading to a dependence on compatibility studies for decision making.

Conclusions:

A wide variety of TPN formulations can be compounded to meet the individual needs of patients of all ages and assorted disease states. Addition of specific drugs to the TPN preparation may improve the efficiency of drug delivery and improve overall therapeutic response. Care must be taken, however, to ensure that incompatible compounds are not combined in a single TPN preparation.
Drug Information Sources Used by Community Pharmacists in Louisiana: A Preliminary Study
Authors: Rae Charlesworth E. , Rappaport Harvey M. , Mahajan Puneet
Published: July 2017

Objective:

There is a paucity of information in the literature regarding the type of reference sources that are used by community pharmacists to answer drug information questions. This survey was conducted to determine the frequency of use of selected drug information references by independent and chain pharmacists in Louisiana.

Design:

A study population of 15 percent of registered pharmacists was obtained by random stratification of all pharmacists on the mailing list of the Louisiana Board of Pharmacy on the basis of zip code and gender. These pharmacists were mailed an uncoded, pretested questionnaire and were asked to complete and return it if they were employed by an independent or chain pharmacy; nonchain and independent pharmacists were asked to return their questionnaires uncompleted. No follow-up was performed.

Participants:

Ninety-one independent pharmacists (mean age = 45 y; mean years of experience = 21) and 71 chain pharmacists (mean age = 40 y; mean years of experience = 16).

Outcome Measures:

The frequency of use of selected drug information reference sources by independent and chain pharmacists and the type of drug information questions received by pharmacists were determined. A Statistical Analysis System software program was used to analyze the data. Spearman's rank test was used to determine statistical differences between independent and chain pharmacists. The a priori level of significance was p≤0.05.

Results:

A 54 percent response rate was obtained. The frequency of usage of textbook references (Spearman's correlation coefficient [rho]=0.837), journals and periodicals (rho=0.937), and general reference sources (rho=0.943) were similar for independent and chain pharmacists. Drug Facts and Comparisons was the most frequently used reference source. The types of drug information requests that were received by both groups of pharmacists were similar (rho=0.90).

Conclusions:

Independent and chain pharmacists not only receive the same types of drug information questions but they also rely on the same references to answer such questions. Drug Facts and Comparisons was the most used drug information reference, suggesting that this reference is valuable for pharmacists, particularly community pharmacists.
Analysis of Adverse Effects during Amantadine Prophylaxis in a Nursing Home Population
Authors: Denman Susan J. , Gloth F. Michael , Cloth Mark J. , Roca Robert P. , Thomas David R. , Finucane Thomas E.
Published: July 2017

Objective:

To evaluate adverse reactions during amantadine prophylaxis in a nursing home population, and to identify baseline characteristics that were associated with their development.

Design:

A retrospective chart review.

Setting:

A 233-bed teaching nursing home.

Main Results:

Amantadine prophylaxis was given to 199 of 210 residents (95 percent), 19 of whom died during the one-month period of amantadine prophylaxis. None of the deaths were attributed to amantadine. Of the surviving residents, 26 percent developed adverse effects after an average of two weeks of amantadine prophylaxis. The majority of adverse effects involved the central nervous system, including change in mental status in 40 percent, agitation or disruptive behavior in 34 percent, hallucinations in 19 percent, and mood changes in 19 percent. All adverse effects resolved. Baseline characteristics regarding age, gender, serum creatinine, number of medications, and dosage of amantadine of the residents who experienced adverse effects were similar to those of patients who did not. Adverse effects tended to occur less often in patients with an underlying cardiovascular illness than in those without (odds ratio = 0.52; confidence interval = 0.27–1.0). There was no obvious explanation for this association, which approached statistical significance. Patients with an underlying psychiatric disorder tended to develop adverse effects almost twice as often as those without, but this trend was also not statistically significant (odds ratio = 1.9; confidence interval = 0.93–3.8).

Conclusions:

Amantadine prophylaxis was associated with reversible adverse effects in 26 percent of these nursing home residents. Earlier identification of adverse effects (and subsequent dose reduction) with a prospective surveillance checklist might have lessened the severity and duration of adverse effects.
Treatment of Severe Hypercalcemia in Primary Hyperparathyroidism with Aminopropylidene Diphosphonate
Authors: de Valk Harold W. , Bartelink Anton K.M. , Cluysenaer Onno J.J. , Tjoeng Matthieu M.
Published: July 2017

Objective:

To test the clinical usefulness and potency for decreasing plasma calcium concentration of an intravenously administered diphosphonate (aminopropylide diphosphonate [APD]) in a patient with hypercalcemic crisis secondary to primary hyperparathyroidism, unresponsive to hydration and furosemide, and who was ineligible for surgery because of cardiac conduction defects.

Design:

Case report.

Setting:

Referred care setting.

Intervention:

The patient received APD 15 mg/d, dissolved in 100 mL of isotonic NaCl 0.9% and infused in one hour.

Main Outcome Measure:

Plasma calcium concentration.

Results:

The patient's plasma calcium concentration fell considerably in a few days. The concomitant decrease in urinary calcium excretion indicates that this fall is caused by a decreased entry of calcium to the extracellular fluid and not to increased renal calcium excretion. After nine days, a parathyroid adenoma was removed; plasma calcium concentration remained normal during the following three years.

Conclusions:

APD is a useful adjunct to medical therapy in patients with hypercalcemic crisis secondary to primary hyperparathyroidism.
Comparison of Predicted and Measured Energy Expenditure in Mechanically Ventilated Obese Patients
Authors: O'Connell Helen M. , Erstad Brian L.
Published: July 2017

Objective:

To test the appropriateness of using actual body weight (ABW), ideal body weight (IBW), or an adjusted weight for predicting caloric requirements in moderately obese, mechanically ventilated patients receiving parenteral or enteral nutrition.

Design:

Prospective, nonrandomized pilot study involving seven patients.

Setting:

University medical center.

Main Outcome Measures:

Predicted caloric requirements based on ABW, IBW, or an adjusted weight were compared with measured requirements by indirect calorimetry after parenteral nutrition or tube feedings were at goal rate for 24–72 hours.

Results:

Mean differences between predicted and measured energy requirements for ABW, IBW, and adjusted weight were 821 ± 556 (p < 0.05), −256 ± 493, and 182 ± 501 kcal/d, respectively.

Conclusions:

Until additional studies are available, IBW or adjusted weight should be used for calculating caloric requirements in the moderately obese patient being mechanically ventilated when actual measurements are not available.
Use of Lithium, Carbamazepine, and Valproic Acid in a State-Operated Psychiatric Hospital
Authors: Citrome Leslie
Published: July 2017

Objective:

To examine the prescribing of mood stabilizers (lithium, carbamazepine, and valproic acid) in a 500-bed state-operated psychiatric hospital in New York.

Method:

All 129 inpatients receiving mood stabilizers were identified and their medical records reviewed using a standardized drug use evaluation form. Diagnosis, other indications, and prior experience with mood stabilizers were examined, as well as outcome and adverse effects.

Results:

Approximately one-quarter of the inpatient population received a mood stabilizer. The frequency of carbamazepine use exceeded the use of lithium, with 72 patients receiving carbamazepine and only 62 receiving lithium. Twenty-eight patients received valproic acid. Indications found most frequently for carbamazepine use included assaultive or aggressive behavior (70% for those receiving carbamazepine as the only mood stabilizer). Of those patients with bipolar or schizoaffective disorder and receiving either lithium, carbamazepine, or valproic acid, 36% were prescribed carbamazepine (10% as a first-line agent) and 50% lithium (26% as a first-line agent). None of these indications for carbamazepine has been approved by the Food and Drug Administration. In general, positive outcomes were documented but without supporting objective measures. Significant adverse effects were documented in the medical record in one-quarter of the patients.

Conclusions:

There was widespread use of the three mood stabilizers examined, singly and in combination, for a variety of indications. Lithium and valproic acid remain more frequently prescribed for the treatment of bipolar and schizoaffective disorders. Monotherapy with carbamazepine or valproic acid results in statistically significantly fewer adverse effects than lithium or combination therapy (p values between p = 0.00038 and p = 0.006). Current clinical practice has endorsed the use of carbamazepine for aggressive or assaultive behavior, although there does not appear to be sufficient proof of effectiveness in the literature. Formal studies of carbamazepine's antiagressive effects should be conducted.
Citrate: Valence and Milliequivalent Considerations
Authors: Hermann Joachim J.
Published: July 2017

Objective:

To demonstrate that an understanding of the valence of citrate in solution, as well as the valence of citric acid and citrate salts in the solid state, is essential to correctly quantify these compounds by milliequivalent (mEq) unit.

Data Sources:

Problems are presented and based on information provided in package inserts for citric acid/citrate salt-containing products.

Data Synthesis:

The rationale of the valence of citrate in solution is presented and the dependence of this variable on pH is illustrated graphically. The valence of citric acid and citrate salts in the solid state is reviewed.

Conclusions:

The intricate nature of the valence of citrate in solution makes the quantification of citrate using the mEq unit impractical. Whenever citrate is quantified by the mEq unit, the specific citrate ion that is referred to in a composition table should be clearly stated.
Efficacy and Toxicity of Amphotericin B Liposomal and Lipid Formulations
Authors: Rho Jay P , Cupo Jennifer H
Published: July 2017

Objective:

To review the efficacy and toxicity of amphotericin B liposomal and various lipid formulations with conventional amphotericin B desoxycholate.

Data Sources:

Pertinent literature was identified via a MEDLINE search.

Study Selection:

English-language clinical trials.

Conclusions:

The incorporation of amphotericin B into liposomes or lipid formulations appears to be a novel method of administering amphotericin B for the treatment of serious systemic fungal infections for patients who have either failed therapy with, or are intolerant to, conventional amphotericin B desoxycholate.
Ranitidine and Thrombocytopenia
Authors: Yim Josephine M , Frazier Jerry L
Published: July 2017

Objective:

To provide an overview of thrombocytopenia, focusing on ranitidine-induced thrombocytopenia.

Data Sources:

References were selected from published bibliographies of books, case reports, and topical searches in the MEDLINE database (English language, through 1994) on thrombocytopenia, ranitidine-induced thrombocytopenia, and cimetidine-induced thrombocytopenia.

Study Selection:

All reports of ranitidine-induced thrombocytopenia have been published as case reports. All reports were given equal weight because none involved a rechallenge. Only human data were included. There was only one case of a patient receiving ranitidine after experiencing cimetidine-induced thrombocytopenia.

Data Synthesis:

Literature systematically examining the incidence and cause of ranitidine-induced thrombocytopenia is lacking. No cases of rechallenge have been reported, thus raising the concern of effect versus association.

Conclusions:

Ranitidine has been reported to induce thrombocytopenia by several different mechanisms. Although the incidence of ranitidine-induced thrombocytopenia is relatively rare, healthcare providers need to be aware of this possible adverse drug reaction.
Ofloxacin: Why the Increased Popularity?
Authors: Krop Lynne C
Published: July 2017

Objective:

To provide a rationale for the increasing use of ofloxacin as a substitute for ciprofloxacin, and to review the appropriate use of these agents.

Data Source:

A MEDLINE search was conducted to identify relevant literature. References in those articles were reviewed for additional published information.

Study Selection:

Published review articles and clinical trials on ofloxacin were reviewed, with particular emphasis on pharmacoeconomics, pharmacodynamics, and studies evaluating the safety and efficacy of ofloxacin.

Data Synthesis:

Ofloxacin is a broad-spectrum antimicrobial agent that has in vitro activity similar to that of ciprofloxacin. Ciprofloxacin exhibits lower minimum inhibitory concentrations for Pseudomonas aeruginosa, and ofloxacin is more active against Chlamydia trachomatis and gram-positive aerobic organisms. Both agents have limited anaerobic activity. Unlike ciprofloxacin, ofloxacin is 100% bioavailable, exhibits a greater area under the concentration curve, contributing to its bactericidal activity, and is eliminated primarily by the kidney. Both ciprofloxacin and ofloxacin have long half-lives, allowing twice-daily dosing. However, because a decrease in renal function often accompanies increasing age, ofloxacin can be administered once daily in the elderly. Both agents have a large volume of distribution and exhibit excellent tissue and cell penetration. Several clinical studies have demonstrated ofloxacin's effectiveness in treating a variety of systemic infections caused by susceptible organisms, including P. aeruginosa. Adverse effects are infrequent with both fluoroquinolones, and if they occur such effects are usually gastrointestinal in nature. Ofloxacin has a much lower incidence of drug interactions, in particular with theophylline and caffeine. Ofloxacin is less expensive than ciprofloxacin.

Conclusions:

Overall, the activity of ofloxacin is similar to that of ciprofloxacin and the two agents are therapeutically equivalent. The data presented warrant routine therapeutic substitution of ofloxacin for ciprofloxacin. Ciprofloxacin should be reserved for instances in which specific prescribing criteria are met.
Anticoagulant Clinic Warfarin Adherence Rates and Assessment
Authors: Mason Barb J
Published: July 2017

Objective:

To identify warfarin medication-taking patterns and the relationship between adherence and international normalized ratio (INR).

Design:

Two-month, single-blind, observational cohort.

Setting:

Veterans Affairs Medical Center ambulatory care clinics.

Patients:

Twenty-three veteran outpatients followed in a nurse-managed anticoagulation clinic were enrolled by consecutive sample. Patients were excluded if they used a medication reminder device, were scheduled to have warfarin discontinued within the next 2 months, or had been receiving warfarin less than 1 month. Twenty patients were evaluable.

Intervention:

All study patients received warfarin in a vial with an electronic medication-event monitoring system (MEMS) device. Patients were not told that adherence was being monitored.

Main Outcome Measure:

Mean and preclinic warfarin adherence, dosage changes, and INR values were tabulated.

Results:

Thirty-five percent of the patients were nonadherent with warfarin therapy. Mean and preclinic warfarin adherence rates were 86% and 90%, respectively. Medication-taking behavior was underestimated in 75% of patients. Dosage changes were more common in nonadherent patients. There was not a significant correlation between INR and adherence.

Conclusions:

MEMS adherence data could have changed pharmacologic management in select patients.
Clomiphene for Male Infertility
Authors: Elanjian Sona I
Published: July 2017

Objective:

To review the use of clomiphene for the treatment of male infertility.

Data Sources:

A MEDLINE search covering the years 1966 through 1994 was used to identify pertinent literature.

Study Selection:

Only placebo-controlled studies using dosages of clomiphene 25–50 mg/d for at least 3 months were reviewed.

Data Extraction:

Because there are numerous uncontrolled reports claiming success with clomiphene for the treatment of male infertility, only controlled studies with clomiphene 25–50 mg/d are discussed. This dosage range was selected because higher dosages of clomiphene may suppress spermatogenesis.

Data Synthesis:

Although the study conducted by the World Health Organization demonstrated an increase in both sperm count and motility after clomiphene treatment, no difference in pregnancy rates between the clomiphene-treated and placebo groups was observed. No significant difference in pregnancy rates was seen in a randomized trial comparing clomiphene with vitamin C. Of the four studies discussed, only one concluded that clomiphene was effective in increasing sperm concentration and pregnancy rates. However, the results do not establish a causal role for clomiphene.

Conclusions:

To assess the efficacy of clomiphene for the treatment of male infertility, better-designed studies need to be done. Information regarding comparability of female cohorts should be included, and results should be stratified according to the severity of oligospermia.
Meta-Analytic Review of the Effect of Subcutaneous Sumatriptan in Migraine Headache
Authors: Harrison Donald L , Slack Marion K
Published: July 2017

Objective:

To provide a rationale for the increasing use of ofloxacin as a substitute for ciprofloxacin, and to review the appropriate use of these agents.

Data Source:

A MEDLINE search was conducted to identify relevant literature. References in those articles were reviewed for additional published information.

Study Selection:

Published review articles and clinical trials on ofloxacin were reviewed, with particular emphasis on pharmacoeconomics, pharmacodynamics, and studies evaluating the safety and efficacy of ofloxacin.

Data Synthesis:

Ofloxacin is a broad-spectrum antimicrobial agent that has in vitro activity similar to that of ciprofloxacin. Ciprofloxacin exhibits lower minimum inhibitory concentrations for Pseudomonas aeruginoea, and ofloxacin is more active against Chlamydia trachomatis and gram-positive aerobic organisms. Both agents have limited anaerobic activity. Unlike ciprofloxacin, ofloxacin is 100% bioavailable, exhibits a greater area under the concentration curve, contributing to its bactericidal activity, and is eliminated primarily by the kidney. Both ciprofloxacin and ofloxacin have long half-lives, allowing twice-daily dosing. However, because a decrease in renal function often accompanies increasing age, ofloxacin can be administered once daily in the elderly. Both agents have a large volume of distribution and exhibit excellent tissue and cell penetration. Several clinical studies have demonstrated ofloxacin's effectiveness in treating a variety of systemic infections caused by susceptible organisms, including P. aeruginosa. Adverse effects are infrequent with both fluoroquinolones, and if they occur such effects are usually gastrointestinal in nature. Ofloxacin has a much lower incidence of drug interactions, in particular with theophylline and caffeine. Ofloxacin is less expensive than ciprofloxacin.

Conclusions:

Overall, the activity of ofloxacin is similar to that of ciprofloxacin and the two agents are therapeutically equivalent. The data presented warrant routine therapeutic substitution of ofloxacin for ciprofloxacin. Ciprofloxacin should be reserved for instances in which specific prescribing criteria are met.
Use of Atypical Antipsychotics on an As-Needed Basis
Authors: Demczar Dorothy , Levin Gary M
Published: July 2017

Objective:

To review the literature and determine whether atypical antipsychotics should be used on an as-needed (prn) basis.

Data Sources:

Pertinent English-language literature dealing with atypical antipsychotics, typical antipsychotics, phamacokinetics, and prn dosing strategies was retrieved from a MEDLINE search (1960–1995).

Data Extraction:

Articles that discussed either pharmacokinetic parameters or the rationale for using antipsychotics on a prn basis.

Data Synthesis:

Administration of typical antipsychotics on a prn basis, either alone or in combination with scheduled antipsychotics, is a common practice. However, it has recently been recognized that the atypical agents, clozapine and risperidone, are also being prescribed for prn dosing. Clozapine has a sedative component that may provide a therapeutic benefit when prescribed prn, but it is also associated with dose-related seizures and orthostatic hypotension. Risperidone does not appear to exhibit sedation, except at very high doses.

Conclusions:

The risk-to-benefit ratio is not acceptable in using the atypical antipsychotic agents on a prn basis. There are documented safety and efficacy data that support the use of the typical antipsychotic agents such as chlorpromazine, or haloperidol in combination with lorazepam, on a prn basis. These latter choices are also more cost-effective.
Community Pharmacists' Knowledge of Antioxidant Vitamins
Authors: Offricht Debra M , Malone Margaret
Published: July 2017

Objective:

The current interest in antioxidant vitamins has led consumers to seek advice from community pharmacists. The primary objective of this study was to evaluate community pharmacists' knowledge of antioxidant vitamins.

Design:

An interviewer-based questionnaire was developed to represent the questions most frequently asked by consumers in community pharmacies about antioxidant vitamins.

Setting:

Pharmacies in the Tri-cities area (Albany, Schenectady, and Troy, NY) were identified from the Yellow Pages of the Albany, NY telephone directory, and each was visited by the interviewer (DMO).

Main Outcome Measures:

Questions were divided into the demographic data and practice setting of the participant; the antioxidant vitamins, knowledge of supplements and foods containing antioxidants, dosage recommendations, and toxicities; and therapeutic claims attributed to their use.

Results:

Of 75 pharmacists approached, 70 agreed to participate in the study. The number of questions per week received from customers regarding antioxidant vitamins was estimated to be between 0 and 25. All pharmacists had heard of the terms “free radical” and “antioxidant,” but few were able to provide an adequate definition of either term. The majority of pharmacists knew which vitamins are considered to be antioxidants, but were unfamiliar with appropriate dosage recommendations. In keeping with current literature recommendations, the use of antioxidant supplements was generally not advocated.

Conclusions:

In this study, pharmacists provided inadequate information regarding antioxidant vitamins. Because antioxidants are rarely indicated according to the current literature, pharmacists have a responsibility to base their recommendations to customers on substantiated data.