bluuebunny/crossref_metadata_2025 huggingface dataset:
Foreign Investment and Development: The Positive Effects of Embedded Foreign Investment in China
Authors: Christerson Brad
Published: January 2017

This paper integrates the concept of “embeddedness” from economic sociology into the global political economy perspective in order to understand the effects of foreign investment on development. 604 foreign invested enterprises in China are used to test whether or not foreign investment that is embedded in ethnic ties leads to more positive development outcomes than those produced by investment not embedded in these institutions. The analysis concludes that foreign investment that is embedded in ethnic ties leads to greater linkages to local firms and more high-value activities being transferred to the investee nation. The article concludes by arguing for a greater integration of the economic sociology and global political economy literatures.
Competence-Based Strategies and Global Production Networks a Discussion of Current Changes and Their Implications for Employment
Authors: Palpacuer Florence
Published: January 2017

This paper adopts a multidisciplinary approach to analyse current changes in firms' organisational strategies and assess their implications from the perspective of industrial organisation and employment. The analysis first draws on recent developments in the strategic management literature that conceptualise the firm as knowledge-based or competence-based. This approach is built upon to develop a competence-based organisational model integrating both firms' internal management practices and external linkages into a unified analytical framework, and showing how firms respond to new competitive pressures by managing competencies on an intrafirm and interfirm basis. Part two considers how such a model can help to explain the emergence of global production networks, which are analysed by focusing on the key dimensions of power, activity and geography, along the lines of the global commodity chain framework. The employment outcomes of competence-based organisational strategies and network forms of organisation are then discussed from the perspective of labour market segmentation theory, with emphasis on the emergence of new forms of employment segmentation within and between firms.
Patterns of Prescribing Isotretinoin: Focus on Women of Childbearing Potential
Authors: Doering Paul L. , Araujo Oscar E. , Frohnapple David J. , LaMarre Alison S. , Flowers Franklin P.
Published: January 2017

OBJECTIVE:

The primary objectives of this study were to determine how dermatologists currently prescribe isotretinoin and to determine if the potential for adverse effects, especially those affecting the fetus, has influenced dermatologists' prescribing patterns.

DESIGN:

A survey was mailed to 1618 dermatologists practicing in the US. The survey comprised 22 multiple-choice and fill-in-the-blank questions about the use of isotretinoin. Eight weeks were allowed for completion and return of the survey.

SETTING:

The setting of the study included dermatologists in private practice, those with academic appointments, those in administration, and a few dermatologists in other pursuits.

PARTICIPANTS:

The membership roster of the American Academy of Dermatology served as the sampling frame from which survey recipients were drawn. After arranging the list by zip code, a sample of dermatologists was taken by systematically choosing every fifth name on the list, giving the researchers the total sample of 1618 physicians.

MAIN OUTCOME MEASURES:

Questions were organized into the following sections: (1) practice status of respondent, (2) prescriber demographics, (3) influence of adverse effects on prescribing, (4) prescribing practices, (5) discontinuation of therapy, and (6) restriction of isotretinoin to dermatologists. The survey concluded by providing participants the opportunity to make further observations or comments.

RESULTS:

Of the 1618 surveys mailed, 670 usable responses were received (41.4 percent). Most respondents were in private practice. Data show that dermatologists were prescribing isotretinoin for indications other than those contained in the official labeling. Most physicians reported that they do perform a pregnancy test before prescribing the drug, and many require written informed consent before prescribing. Physicians report that, in general, their patients tolerate isotretinoin well. When therapy is discontinued, it is most often secondary to hypertriglyceridemia. Dermatologists believe that they should have sole authority for prescribing isotretinoin.

CONCLUSIONS:

Our results show that there is still a need for emphasizing the limited indications for isotretinoin and a need for effective patient education for women of childbearing potential who may be prescribed this drug.
Bioavailability and Patient Acceptance of Cyclosporine Soft Gelatin Capsules in Renal Allograft Recipients
Authors: Min David I. , Hwang George C. , Bergstrom Susan , Madras Peter N. , Shaffer David , Sahyoun Anthony I. , Monaco Anthony P.
Published: January 2017

OBJECTIVE:

To evaluate the relative bioavailability and patient acceptance of cyclosporine (CSA) soft gelatin capsule versus oral solution in renal allograft recipients.

DESIGN, SETTING, AND PATIENTS:

The bioavailability of CSA capsules was compared with that of CSA solution with crossover study design in the outpatient clinic setting. Nine renal allograft recipients with stable renal function participated in this study.

METHODS:

CSA dose was switched from solution to capsule in each patient for seven days. At steady-state, nine blood samples were obtained over a 12-hour period from each patient on day 7 for CSA solution and on day 14 for CSA capsules. CSA blood samples were analyzed by HPLC and fluorescence polarization immunoassay (FPIA) methods. Time to peak concentration (Tmax), peak concentration (Tmax), and area under the curve (AUC) were calculated on days 7 and 14, and compared using the matched Student's t-test. Patient acceptance was evaluated by patient preference on the questionnaire.

RESULTS:

For CSA blood concentrations measured by HPLC assay, the Tmax, Cmax, and AUC were 3.4 ± 1.3 h, 569 ± 240 nmol/L, and 4659 ± 2144 h • nmol/L (mean ± SD), respectively, with solution and 4.2 ± 2.1 h, 560 ± 257 nmol/L, and 4765 ± 1799 h • nmol/L (mean ± SD), respectively, with capsules. These differences were not significant (p>0.1). The bioavailability was not significantly different between capsules and solutions when it was measured by PFIA assay (p>0.1). The mean (± SD) relative bioavailability of capsules compared with solution was 109 ± 29 percent AUC (0–12 h) measured by HPLC and 111 ± 27 percent AUC (0–12 h) measured by FPIA. All patients expressed preference for capsules over the solution.

CONCLUSIONS:

CSA oral soft gelatin capsule is bioequivalent to CSA oral solution and most patients preferred the capsule to the oral solution.
Pleurocerebral Nocardia in a Patient with Human Immunodeficiency Virus
Authors: Idemyor Vincent , Cherubin Charles E.
Published: January 2017

OBJECTIVE:

To report a case of Nocardia asteroides pneumonia and subsequent brain abscess in an immunocompromised host.

SETTING:

Private, community, teaching hospital.

PATIENT:

A man readmitted to the hospital for a third time with a fatal brain abscess, after responding to (misdirected) therapy in previous admissions.

INTERVENTIONS:

Treatment with cefuroxime, erythromycin, trimethoprim/ sulfamethoxazole at different times.

RESULTS:

Patient's condition deteriorated and he died after one month of intravenous trimethoprim/sulfamethoxazole therapy.

CONCLUSIONS:

Because it is an infection of the immunocompromised host, it may be considered an AIDS-defining illness. Several other similar cases have been reported in the literature.
Cefotetan Disodium-Induced Hemolytic Anemia
Authors: Wagner Bertil K.J. , Heaton Alan H. , Flink James R.
Published: January 2017

OBJECTIVE:

To report a case of cefotetan disodium-induced hemolytic anemia.

DATA SOURCES:

Original research articles and case reports.

DATA SYNTHESIS:

A 46-year-old woman developed fulminant hemolytic anemia following a second exposure to intravenous cefotetan disodium for postoperative prophylaxis. She developed respiratory failure requiring intubation and acute renal failure requiring hemodialysis. The hemolysis was successfully treated with plasmapheresis, but the patient died on the 25th postoperative day. Positive Coomb's tests have been reported in less than three percent of patients receiving cefotetan. To our knowledge, this is the first case of fulminant hemolytic anemia associated with intravenous cefotetan disodium therapy.

CONCLUSIONS:

Cefotetan should be added to the list of drugs known to cause hemolytic anemia. Monitoring for hemolysis should be considered for patients who receive multiple courses of therapy.
Aerosolized Vancomycin Therapy Facilitating Nursing Home Placement
Authors: Gradon Jeremy D. , Wu Edward H. , Lutwick Larry I.
Published: January 2017

OBJECTIVE:

To demonstrate a novel method of eliminating nasopharyngeal colonization by methicillin-resistant Staphylococcus aureus (MRSA) in a debilitated, hospitalized patient.

DESIGN:

Single-patient, nonblind, nonplacebo, case study.

SETTING:

Community hospital, Brooklyn, NY.

PATIENT:

Hospitalized patient with recalcitrant nasopharyngeal MRSA colonization that could not be eliminated by conventional therapeutic interventions.

INTERVENTIONS:

Aerosolized vancomycin hydrochloride 120 mg q6h administered in room air via face mask together with vancomycin nasal drops, 2 drops to each nostril q6h.

MAIN OUTCOME MEASURE:

Elimination of MRSA from the nasopharynx of the patient.

RESULTS:

Successful elimination of MRSA colonization after four days of therapy.

CONCLUSIONS:

Aerosolized vancomycin in combination with vancomycin nasal drops is beneficial in eliminating nasopharyngeal colonization by MRSA. Clinical trials are warranted to confirm this clinical observation.
Fluoxetine-Induced Psoriasis
Authors: Hemlock Camille , Rosenthal Jesse S. , Winston Arnold
Published: January 2017

BACKGROUND:

A number of medications have been reported to induce psoriasis. We report two cases of fluoxetine-related psoriasis and discuss similarities between lithium-, trazodone hydrochloride-, and fluoxetine-induced psoriasis.

OBSERVATIONS:

Two women being treated for depression with fluoxetine developed psoriasis after 6 and 12 months' exposure. This time frame is clinically similar to that observed with lithium-induced psoriasis.

CONCLUSIONS:

The occurrence of lithium- and fluoxetine-induced psoriasis may not be random. Both drugs modulate serotonergic function, a factor that may contribute to the pathophysiology of psoriasis. If a patient on acute or long-term fluoxetine therapy develops psoriasis, the drug should be considered as a possible etiologic agent.
Parkinsonism Treatment: Part III—Update
Authors: Collier Dean S. , Berg Mary J. , Fincham Richard W.
Published: January 2017

OBJECTIVE:

The purpose of this review is to update clinicians with recent advances in the management of parkinsonism, including drug therapy, transplantation, and diet.

DATA SOURCES:

Pertinent articles were obtained from an English-language literature search using MEDLINE (1970–1991), Index Medicus (1987–1991), Current Contents (1990), and bibliographic reviews of review articles. Index terms included parkinsonism, selegiline, pergolide, vitamin E, and transplantation. Fifty-five articles (representing 85 percent of the complete literature search) were selected by multiple reviewers for their contribution to the stated purpose. Emphasis was placed on double-blind, placebo-controlled, and randomized studies. Data from cited articles were examined by multiple reviewers for support of their stated hypothesis and were included as background for justification of major points in this article; critical studies were abstracted in more detail.

RESULTS:

New therapeutic measures have been added to the treatment of parkinsonism. Selegiline, a monoamine oxidase inhibitor type B, has shown beneficial results, especially in early stages. Pergolide, a dopamine agonist, may be an efficacious alternative to bromocriptine resistance or intolerable adverse effects. Vitamin E may have protective antioxidant properties, but very few clinical data are available. Fetal tissue transplantation needs continued research and remains very controversial. Diet modification may maximize the results of therapy with exogenous dopamine therapy.

CONCLUSIONS:

Clinicians should familiarize themselves with new alternatives for the management of parkinsonism in order to be reliable consultants for both professional and lay persons.
Methotrexate and Nonsteroidal Antiinflammatory Drug Interactions
Authors: Frenia Maureen L. , Long Kimberly S. , Hartshorn Edward A.
Published: January 2017

OBJECTIVE:

To determine if the coadministration of methotrexate (MTX) and nonsteroidal antiinflammatory drugs (NSAIDs) results in a clinically significant drug interaction.

DATA SOURCES:

A case report of hematologic toxicity following the administration of MTX and flurbiprofen at our institution is presented. Six previously published case reports and five pharmacokinetic studies regarding MTX and NSAID interactions are available to assist in the evaluation of this potential interaction.

DATA SYNTHESIS:

Cases of various clinical manifestations during concomitant MTX and NSAID administration, including acute renal failure and pancytopenia, have been reported. The exact mechanism of the interaction has not been fully elucidated. Suggested theories to explain the mechanism of MTX toxicity include reduction in MTX clearance secondary to renal capillary constriction induced by NSAIDs, displacement of MTX or its metabolite from plasma proteins, competition between MTX and NSAIDs for renal tubular excretion, or impairment of hepatic metabolism of MTX by NSAIDs. Studies comparing MTX pharmacokinetics with or without concurrent NSAID therapy have not shown statistical differences in the parameters evaluated. However, one study did demonstrate differences in the pharmacokinetics of 7-hydroxymethotrexate, the active metabolite of MTX, when MTX was administered with aspirin.

CONCLUSIONS:

Although a clinically significant interaction does not occur in all patients, numerous case reports are available that demonstrate possible problems following the coadministration of MTX and NSAIDs. To date, the specific circumstances during which the reaction may occur have not been well defined.
Didanosine
Authors: Shelton Mark J. , O'Donnell Alice M. , Morse Gene D.
Published: January 2017

OBJECTIVE:

To review the chemistry, intracellular metabolism, pharmacokinetics, and clinical experience with didanosine (2',3'-dideoxyinosine [ddI]).

DATA SOURCES:

English-language articles and conference proceedings (indexing terms were didanosine, 2′,3′-dideoxyinosine, and ddI).

STUDY SELECTION:

Available Phase I studies and abstracts determined to have clinical significance were included.

DATA EXTRACTION:

Clinical experience with ddI is limited to uncontrolled Phase I studies and a large “expanded-access” program. The primary outcome parameters used to evaluate ddI were the HIV surrogate markers: CD4+ lymphocytes and p24 antigen. Thus, the clinical data reviewed here must be evaluated critically and be considered preliminary until the results of studies comparing ddI with zidovudine (ZDV) and combination studies are available.

DATA SYNTHESIS:

Didanosine has been approved for the treatment of HIV infection in patients who are unable to tolerate ZDV because of adverse effects (e.g., anemia and neutropenia) or who experience clinical or immunologic deterioration while receiving ZDV. Compared with ZDV, ddI has a long intracellular half-life and negligible bone-marrow toxicity. It also has in vitro activity against ZDV-resistant strains of HIV. Phase I studies indicate that ddI has a beneficial effect on the CD4+ cell counts and HIV p24 antigen concentrations. As a result of the acid-labile nature of ddI, oral formulations are buffered or must be mixed with antacid to neutralize gastric pH. Bioavailability then averages 20–40 percent, depending on the dose and formulation given. The plasma half-life, total body clearance, and volume of distribution of ddI are one to two hours, 0.7–1 L/kg/h, and 0.8–1 L/kg, respectively. Painful peripheral neuropathy and pancreatitis (dose-limiting toxicities of ddI) occurred in 34 and 9 percent of patients in Phase I studies, respectively.

CONCLUSIONS:

Didanosine has demonstrated preliminary efficacy in the treatment of late-stage HIV infection; however, its effect on patient survival, its efficacy relative to ZDV, and its utility in combination with other agents are still under evaluation.
Automated Therapeutic Drug Monitoring in an Ambulatory Care Endocrine Clinic
Authors: Foy John L. , Eastman Richard C. , Nealon Reggie C. , Bowen Patty M. , Pengelly Mary L. , Drass Jan A. , Dorworth Thomas E. , Pucino Frank
Published: January 2017

OBJECTIVE:

To develop and implement an automated therapeutic drug monitoring system for accessing data from endocrine clinic patients who had been prescribed insulin, oral hypoglycemic agents (OHA), or levothyroxine.

DATA SOURCES:

We designed a computer system to retrieve clinical data from the Medical Information System (MIS), a centralized hospital computer system, and import this information directly into a Macintosh personal computer. Physician entry of prescriptions for insulin, OHA, or levothyroxine into MIS formed the basis for a computer program to retrieve daily diagnostic and prescription information, demographics, and laboratory analyses, including blood glucose and glycosylated hemoglobin for insulin and OHA orders and free and total thyroxine, total triiodothyronine, and thyroid stimulating hormone for levothyroxine orders. The information was imported into a database program (4th Dimension).

RESULTS:

The system identifies laboratory values outside of predetermined therapeutic ranges, maintains an up-to-date patient profile, and edits and generates reports. Preliminary experience suggests that automation eliminates 75–90 percent of the time required to manually collect the same information, and improves the accuracy, comprehensiveness, and utility of reports.

CONCLUSIONS:

Automated therapeutic drug monitoring minimizes the time required to collect clinical data, alerts clinicians to potential problems, and provides a means to assess overall therapeutic management. Our methodology can be used to evaluate other medications in a variety of general or specialty clinics.
Pharmacy Computer Prescription Databases: Methodologic Issues of Access and Confidentiality
Authors: Beto Judith A. , Geraci Mark C. , Marshall Patricia A. , Bansal Vinod K.
Published: January 2017

OBJECTIVE:

To examine methodologic issues of access and confidentiality regarding the use of pharmacy computer prescription databases (PCPDs) for participant selection to receive mailed, self-administered, hypertensive quality-of-life survey outside a primary-care setting.

DESIGN:

Two separate PCPD searches by pharmacist owners for patients prescribed at least one of 130 potential antihypertensive medications. The first PCPD used a nonrandom sample of all patients (n=635); the second PCPD used a random sample (n=100) of three specific antihypertensive drug groups. Research protocol was approved by the investigators' institutional review board.

SETTING:

Two independent, privately owned PCPDs.

PATIENTS OR OTHER PARTICIPANTS:

Individuals prescribed at least 1 of 130 PCPD medications potentially used in antihypertensive treatment.

INTERVENTIONS:

Individually addressed cover letter on pharmacy letterhead signed by a pharmacist requesting voluntary completion of the enclosed, self-administered, opinion survey on quality of life.

MAIN OUTCOME MEASURE:

Anonymous survey return to off-site post office box in envelope provided.

RESULTS:

Favorable or no opposition to PCPD methodology from pharmacist or participants. Ethical opposition was encountered when incorporating PCPD sampling technique into grant proposal.

CONCLUSIONS:

The American Pharmaceutical Association Code of Ethics is used as a basis to provide recommendations to examine and justify PCPD investigative use. Increasing availability of PCPD technology encourages more efficient and easier methods of research strategy. PCPD use, however, demands identical stringent guidelines used in traditional research and raises potential issues regarding pharmacist-patient confidentiality as well as the right of PCPD use by others.
Possible Association of Benzalkonium Chloride in Nebulizer Solutions with Respiratory Arrest
Authors: Boucher Michel , Roy Myrella T. , Henderson John
Published: January 2017

OBJECTIVE:

To report a case of possible association of benzalkonium chloride in nebulizer solutions with respiratory arrest and to review the involvement of various preservative agents in paradoxical bronchoconstrictive reactions.

DATA SOURCES:

Reference articles, case reports, and editorials are identified in the text.

DATA SYNTHESIS:

Many pharmacologic agents are available for nebulization. In addition to the active drug, these nebulizer solutions may contain preservatives. We describe a case of respiratory arrest in a 64-year-old man following nebulization therapy with albuterol and ipratropium solutions. These solutions contain benzalkonium chloride as a preservative. We are aware of only one report describing two deaths associated with such a severe reaction attributable to nebulization therapy. However, many reports of milder paradoxical bronchoconstriction are available in the medical literature.

CONCLUSIONS:

Clinicians should be aware of the possibility of paradoxical bronchoconstrictive reactions when patients are treated with nebulized bronchodilators.
Hyperkalemia Associated with Ketorolac
Authors: Rotenberg Fred A. , Giannini Victor S.
Published: January 2017

OBJECTIVE:

To report and describe the apparent first case of hyperkalemia following intramuscular administration of ketorolac and to discuss the proposed mechanism of action.

PATIENT:

The patient was a 59-year-old man who developed hyperkalemia following a right upper lobectomy; he had received an intramuscular injection of ketorolac 30 mg for incisional pain.

RESULTS:

All possible causes of the hyperkalemia, including other drugs and intraoperative and postoperative events, were thoroughly evaluated and ruled out. Hyperkalemia has been reported in patients who have received other nonsteroidal antiinflammatory drugs (NSAIDs). The proposed mechanism of action for the occurrence of this hyperkalemia appears to be related to the suppression of prostaglandin synthesis.

CONCLUSIONS:

Considering the temporal sequence of events and drugs administered prior to the hyperkalemia in this patient and the hyperkalemic potential associated with other NSAIDs, ketorolac appears to be the precipitating agent. The possibility of hyperkalemia associated with the parenteral use of ketorolac may warrant practitioners to closely monitor the blood chemistry of patients receiving this agent.
Compatibility of Ceftazidime and Aminophylline Admixtures for Different Methods of Intravenous Infusion
Authors: Pleasants Roy A. , Vaughan Leigh M. , Williams Dennis M. , Fox Janet L.
Published: January 2017

OBJECTIVE:

Aminophylline and ceftazidime are sometimes used concurrently in patients with respiratory disorders. Parenteral aminophylline usually is administered as a constant infusion, and ceftazidime is given intermittently or less commonly as a constant infusion. We evaluated the stability and compatibility of the two drugs when aminophylline is given as a constant intravenous infusion and ceftazidime is administered simultaneously either through a y-site (piggyback method) or as a continuous infusion (constant infusion method).

DESIGN:

The chemical stability of intravenous aminophylline and ceftazidime in dextrose 5% and NaCl 0.9% for both methods was studied. Three different formulations of ceftazidime from the same manufacturer were studied (minibag using reconstituted ceftazidime, premixed minibag, and ceftazidime arginine). For the piggyback and constant infusion methods, samples were collected at 0,1, and 2 hours; and 0,6, and 24 hours, respectively. All experiments were conducted in triplicate. Samples were analyzed in duplicate by a stability-indicating HPLC assay method.

OUTCOME MEASURE:

Ceftazidime and aminophylline were considered stable if concentrations remained above 90 percent of the original concentrations over the time periods studied.

RESULTS:

Ceftazidime was determined to be compatible with aminophylline in the piggyback method. In contrast, when aminophylline and ceftazidime were admixed in the same intravenous container (constant infusion method), the two drugs were not stable.

CONCLUSIONS:

These data indicate that aminophylline and ceftazidime admixtures are incompatible when prepared in the same intravenous container, which may occur if both are given as a constant infusion. The two drugs are compatible when the ceftazidime is piggybacked into a primary intravenous set in which aminophylline is administered as a constant infusion.
Two Cases of Suspected Immunologic-Based Hypersensitivity Reactions to Etoposide Therapy
Authors: Kasperek Cynthia , Black Curtis D.
Published: January 2017

OBJECTIVE:

To report two cases of suspected immunologic-based hypersensitivity reactions to etoposide therapy.

DATA SYNTHESIS:

Two cases are presented that differ from the majority of reported hypersensitivity reactions to etoposide. One patient, who tolerated etoposide during his first three-day chemotherapeutic dosage regimen, developed a hypersensitivity reaction to etoposide upon re-exposure to the drug during the first day of a subsequent three-day cycle. Another patient experienced a hypotensive episode on the first day of an initial three-day regimen, which did not recur on the two subsequent days of the cycle. However, when the patient was re-exposed to etoposide four weeks later, he experienced a severe reaction within minutes of drug infusion. Both patients were premedicated with corticosteroids and neither reported prior drug allergies.

CONCLUSIONS:

Based upon these cases and other literature reports, we believe these reactions primarily represent a type II or immunologic-based hypersensitivity reaction to etoposide.
Cephalexin-Induced Stevens-Johnson Syndrome
Authors: Murray Kim M. , Camp Michael S.
Published: January 2017

OBJECTIVE:

To report a case of cephalexin-induced Stevens-Johnson syndrome (SJS), a devastating adverse drug reaction that involves the entire skin surface and mucosal areas of the body.

DATA SOURCES:

MEDLINE search (key terms cephalosporins, Stevens-Johnson syndrome, erythema multiforme, and systemic lupus erythematosus) and references identified from bibliographies of pertinent articles.

DATA SYNTHESIS:

Clinical presentation and manifestations of SJS include the skin, eyes, gastrointestinal tract, and pulmonary system. Infectious complications are the leading cause of mortality. Early intervention is important to prevent progression of SJS. The case described is consistent with the features of this syndrome. The patient presented with fever, arthralgias, and malaise. Skin lesions included a diffuse violet macular rash with erythema and multiple bullous lesions on her neck and abdomen. The skin biopsy was consistent with SJS. Multiple mucocutaneous ulcers were found in her mouth, but no evidence of lower gastrointestinal tract involvement was documented. She remained relatively free of pulmonary complaints except for the presenting bronchitis.

CONCLUSIONS:

Cephalexin should be added to the list of agents to consider as iatrogenic causes of SJS.
Anaphylactoid Reaction following Ketorolac Tromethamine Administration
Authors: Goetz Carla M. , Sterchele James A. , Harchelroad Fred P.
Published: January 2017

OBJECTIVE:

To report a case of an anaphylactoid reaction to injectable ketorolac tromethamine in a patient with no prior history of allergies or risk factors associated with nonsteroidal antiinflammatory drug-induced hypersensitivity reactions.

CASE SUMMARY:

A 37-year-old man without a significant medical history presented to an emergency department with vague, dull, left-sided chest pain. Myocardial infarction was ruled out based on an unremarkable electrocardiogram, chest X-ray, and laboratory data that were within normal limits. Sublingual nitroglycerin 0.4 mg, magnesium/aluminum hydroxide gel 30 mL, and intravenous ranitidine 50 mg were administered without resolution of symptoms. Ketorolac tromethamine 60 mg was administered intramuscularly with resolution of symptoms. The patient was discharged; however, within 30 minutes, he returned to the emergency department with facial swelling, shortness of breath, and chest tightness. Multiple doses of aerosolized albuterol and intravenous methylprednisolone and diphenhydramine were administered, resulting in a slight improvement of symptoms. The patient was admitted for a complete cardiac evaluation that proved negative. The allergic symptoms resolved and the patient was discharged without medication after a three-day hospitalization.

DISCUSSION:

Ketorolac tromethamine is the first injectable nonsteroidal antiinflammatory drug approved for short-term pain management. A review of the literature revealed no similar cases of anaphylactoid reaction.

CONCLUSIONS:

Healthcare professionals must be aware of the potential risks of anaphylactoid reactions, especially in light of the increased use of injectable ketorolac in the ambulatory setting and availability of the oral formulation.
Chlorpropamide-Induced Hyponatremia in the Veteran Population
Authors: Hirokawa Catherine A. , Gray David R.
Published: January 2017

OBJECTIVE:

To determine the incidence and possible risk factors associated with chlorpropamide (CPA)-induced hyponatremia in the veteran population.

DESIGN:

Retrospective cohort study.

SETTING:

Federal tertiary care medical center.

PATIENTS:

Veterans receiving CPA from our facility with at least one serum sodium concentration below 135 mmol/L within the past year were eligible. A randomly selected control group consisting of patients taking CPA with normal sodium concentrations was also chosen. One hundred forty-five of 799 patients who had received CPA were included in the study.

RESULTS:

The average daily dose of CPA was 425 ± 207 mg (± SD). The incidence of hyponatremia associated with CPA was 7.1 percent (57/799 patients). The majority of patients were mildly hyponatremic (48/57 patients, 84 percent) with serum sodium concentrations between 130 and 134 mmol/L. The incidence of CPA-induced syndrome of inappropriate antidiuretic hormone was 2.1 percent. Concurrent angiotensin-converting enzyme (ACE) inhibitor use was identified as a risk factor; thiazide diuretic use was not.

CONCLUSIONS:

The incidence of hyponatremia related to CPA use in elderly veterans is consistent with other reports in the literature. ACE inhibitors may be a predisposing factor for CPA-induced hyponatremia.
Fatal Angioedema Associated with Lisinopril
Authors: Ulmer Jack L. , Garvey Michael J.
Published: January 2017

OBJECTIVE:

To report a case of fatal angioedema associated with the use of lisinopril, a long-acting angiotensin-converting enzyme (ACE) inhibitor.

DATA SOURCES:

Case reports, review articles, short reports, and pertinent information from the patient's medical record.

DATA EXTRACTION:

Data was collected from contemporary medical journals and reviewed by both authors.

DATA SYNTHESIS:

Angioedema associated with ACE inhibitors (captopril and enalapril) is well documented in the literature. With increased prescribing of newer, longer-acting agents, this potentially lethal adverse reaction is of even greater concern. Because angioedema associated with ACE inhibitors is a class-related event, the number of reported cases would be expected to increase with increasing numbers of prescriptions written for these drugs. This report, describing a patient who developed angioedema following therapy with lisinopril, illustrates the severity of this adverse reaction.

PATIENT:

A 66-year-old man presented to the emergency room complaining of increased swelling of the back of his throat and difficulty breathing. Despite treatment with epinephrine, antihistamines, and corticosteroids, the patient's condition progressed from that of severe laryngeal edema to total laryngospasm and complete airway obstruction. Emergency measures to intubate the patient were complicated by severe swelling of his neck and oropharynx, forcing the physician to perform a grossly traumatic tracheotomy. The difficulty encountered during intubation deprived the patient of oxygen for a significant amount of time, precipitating cardiopulmonary arrest. The anoxic episode resulted in hypoxic, ischemic encephalopathy and, ultimately, death.

CONCLUSIONS:

Angioedema is a serious, potentially life-threatening adverse effect associated with the use of ACE inhibitors. Clinicians need to be aware of this effect when prescribing ACE inhibitors to treat hypertension and congestive heart failure, and when assessing patients presenting to the emergency room with complaints of tongue or pharyngeal swelling. Patients should be instructed to report immediately to an emergency room for medical attention if they experience any unexplained shortness of breath or swelling of the throat or tongue.
Adjuvant Intravesical Therapy for Superficial Bladder Cancer
Authors: Batts Cynthia N.
Published: January 2017

OBJECTIVE:

To review the results of clinical trials and adverse drug effects of thiotepa, BCG vaccine, mitomycin, and doxorubicin, which are used as adjuvant intravesical therapy for superficial bladder cancer.

DATA SOURCE:

Information was retrieved from a MEDLINE search, of the English-language literature. Indexing terms included adjuvant pharmaceutics, bladder neoplasms, thiotepa, mitomycin, BCG vaccine, and doxorubicin.

DATA EXTRACTION:

Data from several human and in vitro studies were assessed and evaluated, according to the strength of comparative data and therapeutic response.

STUDY SELECTION:

Emphasis was placed on clinical trials that assessed and evaluated dosage, therapeutic regimens, and therapeutic response of adjuvant intravesical therapy for superficial bladder cancer.

DATA SYNTHESIS:

Adjuvant intravesical therapy and long-term prophylaxis are effective for superficial bladder cancer. Studies have shown that doxorubicin, thiotepa, BCG, and mitomycin, when used as adjuvant therapy, provide better protection than transurethral resection alone against tumor recurrence and prolong the time to when cystectomy is required.

CONCLUSIONS:

Several randomized clinical trials suggest that BCG is superior to thiotepa, doxorubicin, and mitomycin in preventing bladder tumor recurrence and tumor progression. Local cystitis is an adverse effect produced by all four agents; however, BCG vaccine has been reported to cause a higher incidence of adverse reactions (e.g., dysuria, hematuria). BCG may also cause an influenza-like syndrome, arthralgias, and fever, but most of these reactions have resulted in few severe adverse effects when the drug is given in the relatively modest recommended doses.
Impact of Therapeutic Drug Monitoring of Intravenous Theophylline Regimens on Serum Theophylline Concentrations in the Medical Intensive Care Unit
Authors: Dager William E. , Albertson Timothy E.
Published: January 2017

OBJECTIVE:

The primary objective of this study was to determine if a clinical pharmacist ensuring appropriate use and performing careful pharmacokinetic analysis of serum theophylline concentrations (STCs) can result in optimal theophylline regimens for patients in a medical intensive care unit (ICU).

DESIGN:

In phase 1 of the study, housestaff physicians determined the theophylline dosing regimen. A clinical pharmacist prospectively followed these initial patients, but did not intervene. Patients in phase 2 received intravenous theophylline, with all dosing regimens being based on prospective therapeutic drug monitoring (TDM) by a clinical pharmacist.

PARTICIPANTS:

The first phase enrolled 11 consecutive patients admitted into the medical ICU and requiring intravenous theophylline. This was followed by a second phase of 14 medical ICU patients whose intravenous theophylline regimen was determined by a clinical pharmacist performing pharmacokinetic analysis.

MAIN OUTCOME MEASURES:

Questions were organized into the following sections: (1) number of STC blood samples drawn, (2) number of emergency STCs performed, (3) number of concentrations per infusion-rate changes, (4) number of STC results in the pharmacist-generated regimens that were within the physicians' predetermined acceptable range.

RESULTS:

In phase 1, 27 theophylline rate changes occurred, with a mean ± SD of 1.01 ± 0.3 STCs per day. In phase 2, 44 theophylline infusion rates were changed, with a mean ± SD of 0.62 ± 0.3 STCs per day. The TDM group had a significant reduction (p<0.001) in inappropriate concentrations (15 vs. 40 percent) as set by predetermined criteria, and fewer emergency theophylline concentration requests (2 vs. 14). Serum theophylline concentrations ordered by the physician were achieved in 85 percent of the pharmacist-generated regimens.

CONCLUSIONS:

Pharmacokinetic analysis when performing TDM in the determination of intravenous theophylline regimens can result in optimal therapy for patients, while significantly reducing the number of STCs required.
Pharmacokinetics of Pravastatin in Elderly versus Young Men and Women
Authors: Pan Henry Y. , Waclawski Anthony P. , Funke Phillip T. , Whigan Daisy
Published: January 2017

OBJECTIVE:

To assess the effect of age on the pharmacokinetics of pravastatin in men and women. A secondary objective was to evaluate the effect of oral contraceptive steroids on the pharmacokinetics of pravastatin in young women.

DESIGN:

Open, single-dose study.

SETTING:

Clinical Pharmacology Unit of Princeton Medical Center for study in men and Hill Top Pharmatest, Cincinnati, for study in women.

PARTICIPANTS:

Normal, healthy male (aged 19–75 y) and female (aged 18–78 y) volunteers.

INTERVENTIONS:

Subjects received a single 20-mg dose of pravastatin after an overnight fast

MAIN OUTCOME MEASURES:

The maximum plasma pravastatin concentration (Cmax), time required for that concentration to develop (Tmax). and the elimination half-life (βt1/2). Serum concentrations of pravastatin and its major metabolite, the 3-α isomer, SQ 31,906, were determined at 12 intervals from 0.33 to 48 hours after the dose. Urine was collected cumulatively during the same period to determine urinary excretion of pravastatin and SQ 31,906. Both measures were used to determine pharmacokinetic parameters.

RESULTS:

The pharmacokinetic profiles of pravastatin and SQ 31,906 in young and elderly subjects of men and women differed little. Although the mean area under the concentration time curve of pravastatin was higher in the elderly and significantly higher in the elderly women, Cmax and βt1/2 values were similar in the young and the elderly volunteers. Concomitant administration of oral contraceptives in young women did not affect the pharmacokinetics of pravastatin or SQ 31,906.

CONCLUSIONS:

The pharmacokinetics of pravastatin do not necessitate dosage adjustments in elderly men or women. No differences were detected between the disposition of the parent drug or its metabolite in men and women.
Acute Pulmonary Edema after Polyethylene Glycol Intestinal Lavage in a Child
Authors: Paap Christopher M. , Ehrlich Robert
Published: January 2017

OBJECTIVE:

To report the case of an eight-year-old girl, without preexisting cardiac or renal disease, who developed acute pulmonary edema and severe respiratory distress after balanced electrolyte with polyethylene glycol (BE-PEG) intestinal lavage.

CASE SUMMARY:

During the nasogastric infusion of a one-liter dose of BE-PEG (OCL, Abbott), the patient experienced abdominal discomfort, gagging, vomiting, and coughing. After the nasogastric infusion, the patient again had emesis, developed tachypnea, intercostal retractions, and acute respiratory distress. She received oxygen and subsequently required intubation and ventilatory support. Physical examination revealed pulmonary congestion bilaterally but no signs of cardiac failure or sepsis. Chest X-ray revealed bilateral pulmonary edema. Ventilatory support was continued for 36 hours and the patient was extubated after two days.

DISCUSSION:

Enteral BE-PEG may have caused acute pulmonary edema secondary to aspiration or systemic fluid overload. Although the exact cause remains unknown, the close temporal onset of pulmonary edema after BE-PEG administration in an otherwise healthy child suggests a causal relationship.

CONCLUSIONS:

This case should alert clinicians to the potential for significant morbidity with BE-PEG solutions, particularly if used in outpatient settings. Patients who receive BE-PEG should be closely observed and monitored for potential aspiration, excessive infusion rates, and gastrointestinal symptoms to optimize efficacy and reduce morbidity.
Neurologic Adverse Effects during Concomitant Treatment with Ciprofloxacin, Nsaids, and Chloroquine: Possible Drug Interaction
Authors: Rollof Jan , Vinge Ellen
Published: January 2017

OBJECTIVE:

To report a case of neurologic adverse effects that developed during concomitant treatment with ciprofloxacin, nonsteroidal antiinflammatory drugs (NSAIDs), and chloroquine. Possible mechanisms for a drug interaction are discussed.

CASE SUMMARY:

A 68-year-old woman who was receiving chronic treatment with NSAIDs and chloroquine developed dizziness, anxiety, and tremors when ciprofloxacin 500 mg twice daily was begun for Salmonella osteitis. When she discontinued the antirheumatic treatment, there was a prompt relief of symptoms. After indomethacin was reintroduced, the patient developed signs and symptoms of peripheral neuropathy, which partially subsided when ciprofloxacin was discontinued.

DISCUSSION:

Enhanced neurologic adverse effects of ciprofloxacin when taken together with NSAIDs or chloroquine may result from reduced effects of gamma-aminobutyric acid. An alternative explanation could be that NSAIDs and chloroquine impair the elimination of ciprofloxacin, thereby contributing to toxic concentrations of the antibiotic.

CONCLUSIONS:

The possibility of interactions between ciprofloxacin and antirheumatic drugs should be considered.
Thrombotic Thrombocytopenic Purpura Associated with Ticlopidine
Authors: Kovacs Michael J. , Soong Patrick Y. , Chin-Yee Ian H.
Published: January 2017

OBJECTIVE:

To report a case of possible ticlopidine-induced thrombotic thrombocytopenic purpura (TTP).

CASE SUMMARY:

A 68-year-old man was started on ticlopidine therapy for transient ischemic attack because of aspirin intolerance. Three weeks after starting therapy, the patient developed TTP, manifest by severe thrombocytopenia, renal failure, microangiopathic hemolytic anemia, and neurologic symptoms. The condition reversed over three to five days coincident with the discontinuation of ticlopidine and therapy with daily plasma infusion and exchange. No evidence of relapse was found at one-year follow-up.

DISCUSSION:

TTP is a well-defined clinical entity with varied etiologies. Ticlopidine has been reported as causing neutropenia and isolated thrombocytopenia. Case reports have linked ticlopidine to the development of TTP.

CONCLUSIONS:

Including this case there are now seven patients who have been documented as developing TTP while receiving ticlopidine. In addition to monitoring for neutropenia and isolated thrombocytopenia, patients receiving ticlopidine also should be monitored for the development of TTP.
Tricyclic Antidepressant Withdrawal Syndrome
Authors: Garner E. Michelle , Kelly Michael W. , Thompson Dennis F.
Published: January 2017

OBJECTIVE:

To examine the evidence pointing to a withdrawal syndrome associated with the discontinuation of tricyclic antidepressants (TCAs).

DATA SOURCES:

MEDLINE searches were conducted. References used in relevant articles were screened for additional published information.

STUDY SELECTION:

Emphasis was placed on human trials and individual case reports.

DATA SYNTHESIS:

Symptoms of gastrointestinal and somatic distress, sleep disturbance, and movement disorders and mania have been temporally linked to withdrawal of TCAs. Cholinergic and adrenergic overdrive after TCA discontinuation have been suggested as the proposed mechanism for this syndrome. Reported symptoms may be psychosomatic or related to underlying mental illness.

CONCLUSIONS:

Clinicians should be aware that discontinuation of TCA therapy may produce a withdrawal syndrome in some patients.
Review of in Vitro Activity, Pharmacokinetic Characteristics, Safety, and Clinical Efficacy of Cefprozil, a New Oral Cephalosporin
Authors: Barriere Steven L.
Published: January 2017

OBJECTIVE:

To review the pharmacokinetics, microbiology, clinical efficacy, safety, and tolerance of cefprozil, a new, broad-spectrum oral cephalosporin.

DATA SOURCES:

Published clinical trials and microbiologic, pharmacokinetic, and safety data were identified by MEDLINE; additional references were derived from bibliographies of these articles; microbiologic data on file were provided by Bristol-Myers Squibb.

STUDY SELECTION:

Only published comparative clinical trial reports are included in the review of clinical efficacy. Noncomparative clinical data pertaining to uses of cefprozil not approved by the Food and Drug Administration are not included.

DATA SYNTHESIS:

Data are presented on the in vitro microbiologic activity of cefprozil against 10 152 bacterial isolates, including most of the clinically important streptococci (e.g., Streptococcus pyogenes, Streptococcus pneumoniae), beta-lactamase-positive and -negative Staphylococcus aureus and Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, Proteus mirabilis, Clostridium difficile, and numerous other gram-negative aerobes and anaerobes. In clinical trials, cefprozil appears to be at least as effective as commonly used comparison agents such as cefaclor, cefixime, and amoxicillin/clavulanic acid. Additionally, cefprozil is better tolerated than the latter two agents, especially with regard to gastrointestinal adverse effects.

CONCLUSIONS:

Cefprozil is a broad-spectrum cephalosporin that provides coverage against both gram-negative and -positive bacteria that may cause otitis media, pharyngitis/tonsillitis, skin and skin-structure infections, secondary bacterial infection of acute bronchitis, and acute bacterial exacerbations of chronic bronchitis. The beta-lactamase stability of cefprozil appears to exceed that of other oral cephalosporins for some important pathogens. Cefprozil is used primarily for second-line treatment as less-expensive, first-line generic alternatives generally are available. Cefprozil demonstrates clinical advantages over many other orally administered beta-lactam antibiotics in terms of antimicrobial spectrum, a once- or twice-daily dosing regimen, and/or reduced incidence of adverse effects.