bluuebunny/crossref_metadata_2025 huggingface dataset:
Clonidine and Glucose Intolerance
Authors: Webster Willie B. , McConnaughey Mona M.
Published: May 2016

Changes in carbohydrate metabolism were observed in a diabetic, hypertensive patient managed with Clonidine. After a slight increase in the Clonidine dose, his blood sugar control deteriorated. However, when the Clonidine was withdrawn, the glucose intolerance subsided. Because Clonidine preferentially binds α2-subtype receptors, we investigated animal pancreatic tissue by radioligand binding technique and found it to contain α-adrenergic receptors predominantly of the α2-subtype. In consideration of the response from withdrawal of Clonidine and the results of our radioligand studies, we concluded the glucose intolerance seen in this patient was most likely due to the specific action of Clonidine on α2-pancreatic receptors.
Combined Phenytoin and Phenobarbital Overdose
Authors: Vlasses Peter H. , Rocci Mario L. , Koffer Harris , Ferguson Roger K.
Published: May 2016

A 32-year-old female attempted suicide by consuming large quantities of both phenytoin (P) and phenobarbital (Pb). On hospital admission, serum drug concentrations (SDC), measured by immunoassay, were 46 μg/ml for P and 86 μg/ml for Pb. The patient remained unconscious, requiring mechanical ventilation, for the next two weeks. Serial SDC demonstrated: (1) continued P absorption over the next five days; (2) different elimination patterns for the two drugs (Pb exhibited first-order elimination while P elimination represented Michaelis-Menten kinetics); and (3) the limited effectiveness of forced alkaline diuresis in lowering Pb serum concentration, though resulting in an episode of pulmonary edema. The patient's clinical status subsequently improved and correlated well with SDC decline into the usual therapeutic range.
Serum Digoxin Concentrations in Atrial Fibrillation: A Review
Authors: Masuhara Joy E. , Lalonde Richard L.
Published: May 2016

Studies evaluating the relationship of serum digoxin concentrations (SDCs) with pharmacodynamic effects in atrial fibrillation have important limitations. In general, a poor correlation is found between SDC and ventricular rate, but this is understandable, considering the many other factors that affect conduction through the atrioventricular node.

The ventricular rate, although a clinically important and easily monitored parameter, may not always be a good measure of digoxin effect. In certain patients, signs and symptoms of toxicity may develop before the desired decrease in heart rate. The SDC may provide, in many cases, information that cannot be obtained solely from the clinical response, but is of great relevance to therapeutic decision making.
Psychotropic Drug Usage in Quebec Urban Women: Pharmacological Aspects
Authors: Marinier R. , Pihl R.O. , Wilford C. , Lapp J.
Published: May 2016

Data on patterns of psychotropic drug use from a two-part study of Québec urban women are reported. Part I involved telephone interviews with 1187 women on their use of pain, sleep, and psychotropic medications. In Part II, 179 women participated in a further person-to-person interview. Areas covered included frequency and duration of use, efficacy of the product, dosage, presence of undesirable side effects, source of drug information, and the concomitant use of other medications. Diazepam and flurazepam (Valium and Dalmane) were the most frequently consumed psychotropes, with diazepam second only to aspirin as the most commonly used of all the medications. The majority of psychotropic users obtained the drug initially through a general practitioner for nonspecific health reasons, were satisfied with the efficacy of the drug, took the medication as directed, felt informed of the effects, and found no undesirable side effects. Multiple psychotrope use was not prevalent, and users of mood-modifiers were generally alcohol abstainers. The differences between the high and moderate users, including satisfaction with the psychotropes as well as initial dosages, are discussed along with comparative data from other similar drug studies. Findings lend credence to the hypothesis that the vague and ill-defined health problems precipitating a psychotropic prescription may in fact be economic, social, or psychological in origin.
The Impact of the Docent Clinical Pharmacist on Treatment of Streptococcal Pneumonia
Authors: Covinsky Joel O. , Hamburger Stephen C. , Kelly Kim L. , Pastewski Bonnie , Robertson Nancy , Eskridge Roger , Park Glen , Twin Edward J.
Published: May 2016

This two-phase retrospective study was designed to evaluate the impact of the clinical pharmacist on prescribing practice of physicians in an internal medicine service. Streptococcal (pneumococcal) pneumonia was chosen as the model disease state. The drug of choice was used more frequently and there was a statistically significant difference in raw cost of antibiotic, total cost for antibiotic administration, daily raw cost for antibiotics; total raw cost for antibiotic administration, and patient charges when physicians were exposed to the clinical pharmacists' influence.
An Evaluation of a Medication History Method
Authors: Truitt Cynthia A. , Longe R. Leon , Taylor A. Thomas
Published: May 2016

The purpose of this study was to evaluate a drug history method. The method consisted of a review of systems (ROS) history format, which utilized common symptoms/diseases per organ system matched with corresponding drug treatments. Findings of this method were compared with drug histories documented in the medical record. The study was conducted over an eight-week period on general medicine inpatients and ICU patients. All data retrieved were categorized into total number of drugs found and then analyzed as to legend, non-legend, and unidentifiable content. Findings were statistically analyzed using chi–square. During the study, 207 patients were admitted. Of these patients, 186 drug histories were obtained; 21 patients could not be interviewed. The ROS method documented 406 drugs as compared with 60 drugs by the medical record ( p < 0.001). Performance time was comparable to similar studies (14 ± 5.85 min). Using a concise, logically organized technique, more drugs were identified than reported by the medical record. We conclude that the experimental method is a productive method for obtaining a drug history.
Temazepam (Restoril, Sandoz Pharmaceuticals)
Authors: Jackson Eric A. , Cardoni Alex A. , McElnay James C. , Jones Mark E. , Alexander Bruce
Published: May 2016

Temazepam is a benzodiazepine derivative indicated for the treatment of insomnia. Pharmacokinetic studies of the hard capsule formulation indicate that the mean time to peak is 2.99 hours and the mean elimination half-life is 14.7 hours. Sleep laboratory studies have demonstrated improvements in all sleep parameters except sleep onset latency. Clinically, patients report improvements in all sleep parameters including sleep onset latency. The efficacy of temazepam compares favorably with barbiturates, glutethimide, nitrazepam, lorazepam, oxazepam, and flurazepam. It has not been compared with diazepam in the clinical setting. Side effects include drowsiness, dizziness, and lethargy. The incidence of hangover effects from 15- and 30-mg doses is relatively low. Temazepam has no proven advantages over other benzodiazepine hypnotics. The major issues that need further clarification include temazepam's sleep induction properties and the relative incidence of hangover and rebound insomnia when compared with longer-acting benzodiazepines.
Serum Quinidine Determination: Comparison of Mass-Spectrometric and Extraction-Fluorescence Methods
Authors: Smith Gary H. , Levy René H.
Published: May 2016

A comparison of two analytical methods of quinidine plasma determination—the modified extraction fluorometric method and the mass spectrometric method—was made. Plasma supplies collected at steady state from normal human volunteers participating in a bioavailability study were analyzed, using both methods. A total of 359 samples were analyzed. Comparison of both sets of values, by linear regression, yielded an r2 value of 0.84. The results of this comparison were consistent with the results reported by others, confirming that the commonly used extraction fluorometric method of quinidine determination is sufficiently accurate for monitoring quinidine plasma concentrations in the patient care setting, as well as for bioavailability comparisons between products.
ASA- or β-Blocker-Induced Hearing Loss
Authors: Davis Larry Jay , Hart Linda L. , Shimomura Sam K. , Rotblatt Michael D. , Pirrotta Joseph A. , Fraser Donald G.
Published: May 2016

The DIAS Rounds is a discussion of requests for information received by various drug information centers and is edited by the Drug Information Analysis Service at the University of California, San Francisco. This issue features four requests: ASA- or β-Blocker-Induced Hearing Loss, Adverse Effects of Intralipid 10% vs. 20%, Antidepressants and Seizures, and Morphine vs. Meperidine in Myocardial Infarction.
An Education Program That Improves the Psychomotor Skills Needed for Metaproterenol Inhaler Use
Authors: O'Bey Kimberly A. , Jim Lucia K. , Gee Joseph P. , Cowen Mark E. , Quigley Anne E.
Published: May 2016

This is the first report assessing an education program's impact on teaching patients the psychomotor skills needed for proper use of the metaproterenol inhaler. Most patients do not use pressurized inhalers correctly. This inability could lead to suboptimal or ineffective therapy.

Pharmacists provided a standardized education program to asthma patients and to those with chronic obstructive pulmonary disease for three clinic visits. Proper use of the inhaler was assessed by evaluating the patient's psychomotor performance for each visit before and after instruction.

Of 19 patients, 18 demonstrated a mean improvement of 33.5 percent from preinstruction to postinstruction evaluation at the first visit (Student's t-test, p < 0.0005). Both preinstruction and postinstruction scores demonstrated an upward trend for all three visits, the postinstruction scores always being higher than the preinstruction scores.

These results indicate that our standardized education program helped improve psychomotor performance. Certain instructional aspects that need emphasis in future education programs have been identified.
Slow-Release Oxprenolol Compared with Oxprenolol in Hypertensive Patients: A Multicenter Clinical Trial
Authors: Materson Barry J. , Friedman Basil A. , Hla Khin Mae , Neidorf Barry S. , Gray James M. , Glazer Norman , Gross Steven
Published: May 2016

Oxprenolol (OX) is a nonselective, β-adrenergic blocking agent with intrinsic sympathomimetic activity. We studied 178 patients in five centers to determine whether a polymer-matrix-based, slow-release preparation of oxprenolol (SR-OX) given once daily was as effective as the standard preparation given twice daily for the treatment of patients with mild to moderate hypertension. After a placebo washout phase, patients were treated with OX until blood pressure was controlled. They were then randomized in a double-blind fashion to continue the same dose, given as either OX bid or SR-OX qd with a placebo as the second dose. All patients took hydrochlorothiazide 50–100 mg/d throughout the study. Blood pressure was reduced 23/15 mm Hg ( p < 0.001) and pulse 8 beats/min in the SR-OX group (n = 67) and 24/17 mm Hg ( p < 0.001) and 8 beats/min in the OX group (n = 72) by titrating standard OX. After randomization to SR-OX or OX, there were no further changes over six weeks. Home-determined blood pressures showed no loss of control in the evening. There were no unexpected adverse effects. We conclude that SR-OX given once daily is as effective as OX given twice daily for the treatment of hypertension.
Zomepirac-Related Acute Renal Failure
Authors: Boike Steven C. , Rybak Michael J. , Tintinalli Judith E. , Veneri Robert
Published: May 2016

A case of acute renal failure in a chronic acetaminophen abuser receiving concurrent zomepirac therapy is reported. Zomepirac may have enhanced the negative effects of acetaminophen on renal medullary blood flow, so that the two drugs together were more likely to cause renal failure than either drug alone.
Theophylline Toxicity—A Consequence of Congestive Heart Failure
Authors: LeGatt Donald F.
Published: May 2016

A case is reported of an elderly patient with congestive heart failure (CHF), who was treated with juvenile oral doses of theophylline (Theo-Dur). The patient experienced toxic symptoms, and plasma concentrations were determined. A value of 60.6 μg/ml was reported and the theophylline administration was subsequently discontinued.

Plasma concentrations and toxicity of theophylline are unpredictable in patients with CHF because of the great variability in clearance. This case demonstrates the necessity for careful monitoring of theophylline plasma levels in CHF patients.
Cimetidine Potentiation of Narcotic Action
Authors: Sorkin Eugene M. , Ogawa Gary S.
Published: May 2016

A report of a cimetidine-methadone interaction is presented, with a discussion of the possible mechanism of action involved. Exaggeration of narcotic effects by cimetidine—and the potential hazards thereof—are cited as matters of concern, in view of the widespread use of cimetidine and the increasing use of narcotic analgesics for chronic pain.
Observations on Written Communications between Physicians regarding Patients' Drug Treatment Compared with Patients' Recall
Authors: Rosenbloom David , Buchanan W. Watson
Published: May 2016

The authors reviewed the quality of information shared by referring doctors with hospital consultants, in regard to past drug treatment in the cases of 95 consecutive patients with rheumatoid arthritis. Information contained in referral letters was compared with information obtained from patient interviews. It was found that the referral letters often contained little information on drug use and included no information on adverse reactions to drug therapy.
Drug Prescribing and Use among Elderly People in Spain
Authors: Mas Xavier , Laporte Joan-Ramon , Frati María Elisa , Busquet Leandre , Arnau Josep Maria , Ibañez Luísa , Séculi Elisa , Capellà Dolors , Arbonés Glòria
Published: May 2016

As a result of the lack of an adequate regulation, the supply and the use of medicines is irrational in Spain. In order to know the characteristics of the prescription and use of drugs among the elderly, two drug utilization studies were carried out. The first study was an analysis of 981 prescriptions from an outpatient clinic of the Spanish Social Security. The results show that a high proportion of fixed-dose combinations were prescribed and that drugs without any demonstrated therapeutic value are often prescribed for the elderly. The second study was a survey of 389 individuals randomly chosen among people affiliated with a pensioners' club. The results show that drug use is highly prevalent among the elderly, that many medicines without any demonstrated benefit are being taken, and that potentially harmful drugs were being used by a high proportion of patients without medical follow-up. The prevalence of the use of some particular groups of drugs is also presented.
Effect on Physician Prescribing Practices of Changing from a Qualitative to a Quantitative Antimicrobial Susceptibility Test Reporting System
Authors: Ward Thomas T. , Regner Michael J. , Collell Karen L. , Brown Ronald R. , Sewell David L.
Published: May 2016

The use of disc diffusion susceptibility testing has been criticized because it often fails to take into consideration achievable levels of antimicrobial agents at the actual sites of infection. An increasing number of hospitals are converting from disc diffusion antimicrobial susceptibility testing to more quantitative susceptibility testing techniques. Advocates of these latter techniques have suggested that providing information beyond sensitive, intermediate, and resistant reporting will emphasize, more effectively, the importance of considering achievable antibiotic concentrations at the site of infection, when choosing an antimicrobial agent. This study examined whether providing more quantitative susceptibility test reports would affect physicians' antimicrobial prescribing practices.

Results obtained on the preeducation and posteducation questionnaires indicate success in improving the collective knowledge of physicians. In retrospective audits of the appropriateness of antimicrobial use, both before and after the educational program, physician usage of antimicrobial agents was categorized as inappropriate in more than ⅔ of the cases. The major reason for the negative outcome in this study is probably due to physicians' indifference to the results of urine culture and susceptibility test data. A change was made in antimicrobial therapy after return of the susceptibility report less than 20 percent of the time.

As more laboratories convert to quantitative antimicrobial susceptibility testing, there will be a need for a closer liaison among physicians, clinical pharmacists, microbiologists, and infectious disease specialists, to ensure optimum utilization of the additional susceptibility data provided.
Science: Part of the Problem, Most of the Answer
Authors: Goyan Jere E.
Published: May 2016

The history of the drug approval process in the United States includes three phases. First, the Food and Drug Act of 1906 essentially required that the labeling of drugs be truthful. The 1938 Food, Drug, and Cosmetic Act added a requirement that drugs be proven safe, and the 1962 act added the requirement that drugs be efficacious. Each of these steps required more and more sophisticated science. Subsequent to the Kefauver-Harris Amendments of 1962, the number of innovative molecular entities each year has declined, the reasons for which have been subject to great debate. This decline has paralleled decreases in innovation across almost all American industry, leading to questions about the future of our country as an industrialized society. Both the Carter and Reagan administrations attempted to address this problem in a number of ways, including cutting back on those regulations that are perceived as unnecessary. Other innovative approaches have been used, such as the establishment of an Office of Small Manufacturers Assistance in the FDA Bureau of Medical Devices, mandated by the 1976 Medical Device Amendments. The latter came about in recognition of the fact that small businesses tend to be more creative and efficient than larger industries and more adversely affected by regulation.

However, the problems raised in the regulation of technology transfer almost inevitably arise because of perceived scientific questions. Such questions, in turn, can only be answered by good science performed by the sponsor and understood by the regulator. Thus, it is essential that the FDA be staffed with knowledgeable scientists who can interact easily with their peers in academia and industry. Although science is often the cause of our troubles, it is also our only hope for minimizing the costs of new drugs and other technology. In turn, minimizing such costs will maximize the opportunities for innovation.
Dispensing in 1982
Authors: Heller William M.
Published: May 2016

The author discusses the role of the pharmacist as a patient counselor, using as a background the history of the USP as a mirror to the changing roles of pharmacy practitioners. The controversy over patient package inserts is presented as a conflict between pharmacy's traditional functions and the Food and Drug Administration's perception of a need for higher standards in patient information and as an example of how pharmacists, through their own neglect, stand in danger of abrogating their function as patient counselors. The author advocates that pharmacy expand its activities through increased attention to and more judicious use of the USP Dispensing Information and the other services that the USPC offers.
Necessary, Optional, and Undesirable Drug Products
Authors: Halperin Jerome A.
Published: May 2016

The distinction between necessary and optional drugs depends on national policies of drug regulation, economics of the health care system, and traditions of competition and freedom of choice for physicians and patients. The World Health Organization (WHO) calls drugs that are basic to the medical needs of a country “Essential Drugs,” but more developed countries go beyond this category and expand the therapeutic armamentarium to include at least some optional drugs. However, financial considerations, including government payment, may keep the spectrum of choice narrow. Generic copies, while not optional therapeutic copies, stimulate free market competition in other countries. Undesirable drugs are easier to categorize. They are unsafe, ineffective, improperly manufactured or packaged, impure, subpotent, or falsely or misleadingly labeled. Once a country determines its policies for necessary and optional drug products, it is essential that criteria to prevent the marketing of undesirable drugs be maintained.
Therapy of Syndrome Malin
Authors: Conner Christopher S.
Published: May 2016

Syndrome malin refers to neuroleptic malignant syndrome (NMS), a combination of extrapyramidal symptoms, hyperthermia, autonomic dysfunction, hypertension, and coma, which has been reported primarily with haloperidol administration, but also with fluphenazine, thiothixene, and thioridazine. NMS is much more severe than typical extrapyramidal reactions to neuroleptic agents and can result in fatality. The syndrome is not dose related and can begin within hours of initiation of therapy or after months of treatment. Treatment of NMS has been mainly supportive in the past. Recent reports have suggested benefits from the use of bromocriptine and amantadine (dopaminergic agonists), based on a possible etiology of neuroleptic-induced dopaminergic blockade. Dantrolene also has been utilized successfully in NMS on the hypothesis that the syndrome is similar to anesthetic-induced malignant hyperthermia. These agents provide a more specific treatment for this potentially lethal syndrome.
Liability Claims Based on Drug Use
Authors: Fink Joseph L.
Published: May 2016

The incidence of drug-related liability claims is discussed, and data from a number of studies in this area are reviewed.

Drug categories that appear to cause the greatest problems are hormones, anticoagulants, adrenal steroids, and antibiotics. Focusing attention on these categories may enable the pharmacist to function as a liability-reducing factor in the institutional setting.
Drug Management of Antidiuretic Hormone Imbalance following Pituitary Surgery
Authors: Benzie Jennifer L. , Pullan Peter T.
Published: May 2016

ADH imbalance may occur in patients after pituitary surgery. Two cases are presented that demonstrate the problems associated with the disturbance of water metabolism. The medical management of these patients is discussed, with emphasis on the importance of the correct choice of pharmacological agents to control the manifestations of ADH imbalance.
Pirprofen
Authors: Dionne Roger E. , Weber Stanley S.
Published: May 2016

Pirprofen, a nonsteroidal antiinflammatory drug (NSAID) undergoing Phase III investigation as Rengasil (Ciba-Geigy Corp.), is useful in the management of both rheumatoid arthritis and osteoarthritis and as an analgesic. In doses of 600–800 mg/d, pirprofen has been found to be as effective as, but not superior to, aspirin 3.6 g/d in relieving the more common symptoms of rheumatoid arthritis. Pirprofen is as effective as, but not superior to, other available NSAIDs in terms of efficacy, tolerability, and incidence of adverse effects. The recommended dosage in osteoarthritis is 450–600 mg/d. As with all NSAIDs, including aspirin, the side effects most commonly seen with pirprofen are gastrointestinal in nature. Peptic ulceration and occult gastrointestinal blood loss have been reported in a small percentage of patients receiving pirprofen. Central-nervous-system-related side effects that are frequently associated with high-dose aspirin therapy appear less frequently with pirprofen. Although it does not offer distinct advantages over other NSAIDs, pirprofen offers an effective therapeutic alternative for patients who are unable to tolerate aspirin or other existing compounds.
Poison Prevention in the Elderly
Authors: Oderda Gary M. , Klein-Schwartz Wendy
Published: May 2016

Poison exposures in the elderly are largely unintentional and, therefore, amenable to prevention techniques. Based on an analysis of the major causes of unintentional exposures in persons age 60 years and older, injury control strategies are applied to poisoning. These strategies address pre-event, event, and post-event phases. Ideas for specific changes to protect the elderly, especially in the areas of labeling and packaging, are presented.
Parenteral-Verapamil-Induced Sustained Hypotension
Authors: Tucker Robert A. , Serote William F.
Published: May 2016

The incidence of oral-verapamil-induced hypotension in the presence of concomitant β-adrenergic blockade by the oral route is quite rare. The major contraindication to the use of intravenous verapamil is recent administration of intravenous β-blocking agents (i.e., within the past two hours). We report a case of sustained hypotension after administration of parenteral verapamil. Vasopressors were required to support blood pressure for approximately five hours. The patient had been on oral propranolol for the past five years and had taken his last dose of propranolol approximately ten hours before the administration of parenteral verapamil for treatment of a supraventricular tachycardia documented by an electrocardiogram.
Therapy of Chronic Obstructive Airways Disease
Authors: Alexander Michael R. , Taylor Jerry W. , Dull William L. , Kasik John , Mustion Alan L.
Published: May 2016

The most frequently employed measure in attempts to alleviate symptoms and improve the quality of life of patients with chronic obstructive airways disease (COAD) is to prescribe medications. However, COAD is largely an irreversible condition and no therapeutic intervention has been shown to be universally useful. Theophylline or corticosteroid are occasionally helpful but most patients will not benefit. Of the remaining options, only oxygen has been shown to be effective in selected patients and should be administered on a continuous basis. It is becoming increasingly evident that clinicians should be more discriminating when making therapeutic decisions for persons with COAD. Maintenance therapy with pharmacological agents should be entertained only after individually conducted therapeutic trials. Moreover, enormous costs can result from treating even a small fraction of the population estimated to have COAD.
Alprazolam Reversal of Reserpine-Induced Depression in Patients with Compensated Tardive Dyskinesia
Authors: Holt Robert J.
Published: May 2016

Two patients are described who developed neuroleptic drug-induced tardive dyskinesia (TD) secondary to the treatment of schizophrenia. In both patients, neuroleptic drug discontinuation brought about a decrease in the severity of the TD and an increase in schizophrenic symptomatology. Reserpine was added for both antipsychotic coverage and reported beneficial effects in the treatment of TD. The patients' schizophrenia was controlled using reserpine 1 mg/d; the TD dissipated in one patient and decreased in the other. After about seven weeks of reserpine therapy, both patients developed depressive symptoms that required the addition of alprazolam. Within a month of the initiation of alprazolam, the depressions had cleared. Alprazolam may block reserpine-induced increases in β-adrenergic receptors in the brain and may account for the antidepressive effects in these two patients.
Hypoprothrombinemia Associated with Cefoperazone Treatment
Authors: Cristiano Pasquale
Published: May 2016

A patient with acute renal failure and gram-negative septicemia developed hypoprothrombinemia during treatment with cefoperazone. The coagulation defect was corrected by vitamin K administration. A multifactorial pathogenetic mechanism of vitamin K deficiency that developed during treatment with parenteral antibiotics is presented.
Treatment of Subacute Sclerosing Panencephalitis: An Overview
Authors: Taylor William J. , DuRant Robert H. , Dyken Paul R.
Published: May 2016

Subacute sclerosing panencephalitis (SSPE) is a rare central nervous system degenerative disease that occurs primarily in children and adolescents. It is believed to be caused by a measles-like virus. Initial symptoms usually present as a variety of personality changes followed by myoclonus with progression of mental and motor deterioration, which leads to death within a few months to years. New experimental treatment with inosiplex has been shown to be helpful for patients stricken with this progressive neurological disease. A response to inosiplex therapy is best in patients with a slowly progressing form of the disease. Inosiplex treatment is safe with few adverse effects. The duration of treatment appears to be lifelong since many patients relapse when inosiplex therapy is discontinued. This article reviews the etiology, pathogenesis, and experimental treatment of SSPE.
Cimetidine in Anesthesia: Does it Minimize the Complications of Acid Aspiration?
Authors: Kowalsky Steven F.
Published: May 2016

The use of cimetidine, an H2-receptor antagonist, to minimize the complications of acid aspiration pneumonia is reviewed. Since Mendelson's early description of acid aspiration in 66 obstetrical patients, attempts have been made to decrease gastric acidity by administering perioperative antacids and/or antihistamine drugs such as atropine and glycopyrrolate. In this review of the literature, strict attention is given to study design and subject selection, methods of collecting gastric samples and reporting both pH and volume measurements, and medications taken on admission, given preoperatively, and as anesthetics. Clinical trials evaluating cimetidine alone and compared with other prophylactic regimens were reviewed, detailing the timing, route, and frequency of drug administration. Cimetidine appears to be effective in minimizing complications of acid aspiration since gastric acidity (pH < 2.5) is a contributing factor in both the morbidity and mortality of this disease state. In general terms, cimetidine 300 mg po 1.5–2.0 h prior to intubation or 45–60 minutes iv before surgery will decrease gastric acidity below the critical level. This effect may be maintained for up to three hours. Perioperative cimetidine administration, to minimize the complications of acid aspiration, appears to be safe in terms of drug-drug interactions and effects on labor, the fetus, and the newborn child.
Glucagon Therapy for β-Blocker Overdose
Authors: Peterson Charles D. , Leeder J. Steven , Sterner Steve
Published: May 2016

Two cases of severe β-blocker overdose are presented that were treated successfully with glucagon therapy. The effects of glucagon in reversing the cardiovascular depression of profound β-blockade, including its mechanism of action, onset and duration of action, dosage and administration, cost and availability, and side effects are reviewed.

Medical complications of β-blocker overdose include hypotension, bradycardia, heart failure, impaired atrioventricular conduction, bronchospasm and, occasionally, seizures. Atropine and isoproterenol have been inconsistent in reversing the bradycardia and hypotension of β-blocker overdose.

Glucagon increases heart rate and myocardial contractility, and improves atrioventricular conduction. These effects are unchanged by the presence of β-receptor blocking drugs. This suggests that glucagon's mechanism of action may bypass the β-adrenergic receptor site. Because it may bypass the β-receptor site, glucagon can be considered as an alternative therapy for profound β-blocker intoxications. The doses of glucagon required to reverse severe β-blockade are 50 μg/kg iv loading dose, followed by a continuous infusion of 1–15 mg/h, titrated to patient response. Glucagon-treated patients should be monitored for side effects of nausea, vomiting, hypokalemia, and hyperglycemia. The high cost and limited availability of glucagon may be the only factors precluding its future clinical acceptance.
Heparin-Induced Thrombocytopenia-Association with a Platelet Aggregating Factor and Cross-Sensitivity to Bovine and Porcine Heparin
Authors: Guay David R.P. , Richard Anita
Published: May 2016

Heparin-induced thrombocytopenia is an infrequently suspected adverse drug reaction since its sequelae often mimic the underlying condition for which the drug is being used. A concomitant decline in platelet count and increase in heparin requirements should alert the clinician to the possible presence of this disorder.

A 36-year-old black male developed severe thrombocytopenia with thrombosis while being treated with porcine intestinal mucosal heparin. Platelet counts returned to near-normal levels upon discontinuation of heparin, but quickly dropped again upon resuming treatment with bovine lung heparin. The patient subsequently was treated with warfarin and dipyridamole, with no further complications.

Treatment of delayed-onset severe heparin-induced thrombocytopenia consists of stopping the heparin and substituting antiplatelet agents and oral anticoagulants when continued inhibition of coagulation is required.
Injectable Ketoprofen VS. Acetylsalicylic Acid for the Relief of Severe Cancer Pain: A Double-Blind, Crossover Trial
Authors: Sacchetti Gabriele , Camera Paolo , Rossi Andrea Paolo , Martoni Andrea , Bruni Giancarlo , Pannuti Franco
Published: May 2016

Thirty-six patients suffering from severe pain due to bone involvement from cancer participated in an analgesic study that compared single doses of ketoprofen 100 or 400 mg iv or injectable acetylsalicylic acid 1 g. A double-blind, balanced incomplete block design was adopted, in which each patient received two of the three test treatments, with an interval of 24 hours. Ketoprofen 400 mg proved significantly superior to 100 mg of the same drug, and was superior to 1 g of the acetylsalicylic acid derivative in the patients' assessment of the overall response. This was expressed by a visual analog scale and preferences. No adverse reaction was observed with any treatment.
A Study of Pharmacists' Involvement in Drug Use by the Elderly
Authors: Lamy Peter P. , Smith Mickey C. , Sharpe Thomas R.
Published: May 2016

Three hundred elderly persons in a single Mississippi county were interviewed to determine drug use patterns and relationships with pharmacists. Although three-fourths had used the same pharmacy for longer than five years, only one in six used that pharmacy as their usual source for over-the-counter (OTC) drugs. More than eight percent incorrectly identified the use of their prescription drugs and 140 instances of potential drug interaction were identified. Communications with pharmacists were limited, as only one-fifth had talked with the pharmacist at the time their last prescription was filled and only one in six mentioned the pharmacist as someone they would ask about prescription drugs.
Treatment of Gestational Trophoblastic Tumors
Authors: Hansen Lea Ann , Clayton Bruce D.
Published: May 2016

A brief discussion of the definition, etiology, epidemiology, classification, and prognosis of the gestational trophoblastic tumor (GTT) is presented. Current therapeutic options are summarized. GTTs arise from fetal tissues and can be divided into three histologic categories, hydatidiform mole, chorioadenoma destruens, and choriocarcinoma. Clinically, it is classified as nonmetastatic, metastatic—low risk, or metastatic—high risk. Diagnosis is based on clinical signs and symptoms, ultrasound and X-ray examinations, and the presence of elevated serum levels of the B-subunit of human chorionic gonadotropin (hCG). Primary therapy for hydatidiform mole is evacuation of the uterine contents. Prophylaxis for metastases with actinomycin D sometimes is performed, but generally is not recommended. For persistent disease that is classified as nonmetastatic or low-risk metastatic, a methotrexate-leucovorin rescue protocol is preferred, with actinomycin D used in patients who show resistance to the regimen. Standard therapy for high-risk metastatic disease involves triple agent therapy with methotrexate, actinomycin D, and chlorambucil, but toxicity is significant. Other alternatives include the modified Bagshawe protocol, a VBC (vinblastine, bleomycin, cisplatin) regimen, cisplatin in combination with vincristine and high-dose methotrexate, and VP16–213 (etoposide) in combination with other agents. Other treatment modalities include radiation and surgery. Use of the most appropriate therapies can maximize the survival of a patient with gestational trophoblastic disease.
Extraordinary Analgesic Requirement in a Patient Previously Unexposed to Narcotics
Authors: Graves David A. , Baumann Terry J. , Bennett Richard L. , Batenhorst Randal L. , Griffen Ward O. , Plumlee John E. , Foster Thomas S.
Published: May 2016

Patient-controlled analgesia (PCA) is a relatively new therapeutic modality that allows patients to administer doses of intravenous narcotics, using a syringe pump and sequencing device. We used PCA to deliver analgesic therapy to a 35-year-old man seriously injured in an aviation accident. Although the patient gave no previous history of narcotic use or abuse, he required morphine dosing rates as high as 56 mg/h to maintain adequate analgesia. The delivery of relatively high doses of narcotic was not accompanied by significant sedation, as might be expected. The patient underwent two surgical procedures while on PCA therapy. Following each procedure, dosing requirements increased, but within three days after each operation, dosing tapered. The patient was converted to oral hydromorphone therapy, which gradually was tapered and then discontinued. PCA should be considered a useful therapeutic adjunct in the management of patients refractive to empirical narcotic analgesic regimens.
Acute Pneumonitis Associated with MOPP Chemotherapy of Hodgkin's Disease
Authors: Cersosimo Robert J. , Licciardello Jere T.W. , Matthews S. James , Bromer Richard , Hong Waun Ki
Published: May 2016

A case of a 69-year-old man admitted with procarbazine pneumonitis and a review of the literature are presented. The patient completed a second course of MOPP chemotherapy for Hodgkin's disease three days before admission. He presented with a recent onset of fever, chills, anorexia, and malaise. Chest radiography indicated diffuse bilateral interstitial pneumonitis, and pulmonary function studies revealed restrictive lung disease. Attempts to identify an infectious etiology, including open lung biopsy, were negative, and empirical antibiotic therapy was ineffective. The diagnosis was drug-induced hypersensitivity reaction, most likely due to procarbazine. Corticosteroid therapy was instituted with gradual improvement. Six other cases of pneumonitis associated with procarbazine therapy are briefly reviewed, and the use of pulmonary function tests to identify the type and degree of injury and monitor therapy is discussed.
Notation of Allergies and Body Weight on Patient Profiles
Authors: Zenk Karin E. , Randall Rollin J. , Fukumitsu Clifford J.
Published: May 2016

The purpose of this study was to increase the documentation of allergy and body weight information on pharmacy medication profile cards for pediatric patients. The intent was to facilitate pharmacist evaluation of medication dosages ordered for these patients. A plastic allergy/weight imprinting card was supplied to each nursing unit and was used to imprint all admitting physician's order sheets. Allergy and weight information was to be filled in by the physician and/or nurse before routing a copy of these orders to the satellite pharmacy. Inservice education was presented and follow-up phone calls were made. During an 18-day control period, baseline data on documentation of allergies and weight were collected. During an 18-day study period, the allergy/weight card was used and follow-up phone calls were made. During an 18-day post-study period, the card and phone calls were removed. Percent of profiles having allergies and weight were, respectively: control period, 33 percent and 28 percent; study period, 80 percent and 76 percent; post-study period, 47 percent and 46 percent. Imprinting “allergy/weight” with space for filling in this information can result in an increased number of pharmacy patient profiles having these data so that medications can be checked prior to dispensing the first dosages of medication.
Pharmacotherapy of Memory Loss in the Geriatric Patient
Authors: Galizia Virginia J.
Published: May 2016

Memory loss is a common problem with advancing age and a prominent symptom in dementia. Categories of drugs used to reverse memory loss and enhance recall are reviewed. Positive results have been observed with cholinergic drugs, acetylcholine precursors, and the newer category of cerebral metabolic enhancers and nootropic agents. Combinations of these classes of drugs are being tried in current research.
Oral Gold in Arthritis
Authors: Conner Christopher S.
Published: May 2016

There are few drugs available with purported disease-modifying or healing effects in rheumatoid arthritis. The two agents that have gathered the most support in favor of these effects are parenteral gold and cyclophosphamide; however, both can produce intolerable toxicity. A new oral gold compound (auranofin; Ridaura) is being investigated in rheumatoid arthritis. Available studies suggest that auranofin may be slightly less effective than parenteral gold, but is significantly less toxic, the main side effect being diarrhea. There is evidence to suggest auranofin slows radiologic progression of the disease, but further studies are indicated. If further studies demonstrate a healing effect of the drug, comparable with data suggesting this effect for parenteral gold, auranofin may become a first-line agent in rheumatoid arthritis.
Baclofen Toxicity Associated with Declining Renal Clearance after Ibuprofen
Authors: Dahlin Patricia A. , George John
Published: May 2016

A 64-year-old male with an incomplete spinal cord injury had been taking baclofen 20 mg tid for 2½ months without side effects. His blood urea nitrogen and serum creatinine rose from 13 and 0.9 mg%, respectively, to 59 and 2.8 mg% after ibuprofen 600 mg tid was begun. The patient displayed baclofen toxicity, developing confusion, disorientation, bradycardia, and hypothermia. His blood pressure dropped and he complained of blurred vision. Ibuprofen discontinuation and fluid repletion corrected the renal indices. Rapid tapering of baclofen was accompanied by reversal of baclofen toxicity.

Patients taking baclofen must be monitored closely for toxicity when declining renal function is present. Clinicians should be alert to the possibility of renal insufficiency developing when ibuprofen is initiated. This case demonstrates the potential for ibuprofen-induced renal insufficiency to reduce baclofen clearance, thereby leading to baclofen toxicity. Published reports of ibuprofen-induced renal insufficiency are reviewed and pertinent pharmacokinetics of baclofen discussed.
Doxorubicin-Induced Hypersensitivity Reactions
Authors: Solimando Dominic A. , Wilson James P.
Published: May 2016

An uncommon side effect of the anthracycline antibiotics is allergic reactions. We report three patients treated with doxorubicin hydrochloride who developed systemic hypersensitivity reactions to the drug. In all three cases, the onset of the reaction coincided with the initiation of the doxorubicin, and was confirmed by rechallenge with the drug. An urticarial rash with pruritis was the primary clinical manifestation seen in all cases. All reactions responded to treatment with diphenhydramine, or diphenhydramine and hydrocortisone. None of the reactions were life-threatening or required hospitalization of the patient. In two patients, use of the drug was discontinued because of the reaction. Pretreatment with diphenhydramine, prednisone, and cimetidine may have reduced the severity of the reaction in one patient.
Generalized Motor Seizure following Metrizamide Cisternography
Authors: Saltiel Emmanuel , Adelman Daniel C. , Ellis Jon C. , Young William Isaac
Published: May 2016

Metrizamide is a water-soluble contrast medium used as a diagnostic tool in myelography and cisternography. Despite its accepted safety, its use has been associated with generalized motor seizures, and several cases of this toxicity have been reported. Risk factors include phenothiazine ingestion, seizure history, and large doses of the contrast material. Abnormal electroencephalographic wave patterns, as well as seizure activity, are less frequent after cisternography than myelography. A case of a metrizamide-induced generalized motor seizure following cisternography is reported in a patient with none of the above risk factors. The need for a thorough medication history and the use of prophylactic anticonvulsants in selected patients is discussed.
Spurious Increase in Serum Creatinine Associated with Intravenous Methyldopate Therapy
Authors: Nanji Amin A. , Whitlow Karen J.
Published: May 2016

A patient with subarachnoid hemorrhage treated with intravenous methyldopate experienced a sudden marked increase in serum creatinine. This increase was due to interference by methyldopate in the assay for serum creatinine. By performing in vitro interference studies, we confirmed that methyldopate interferes with the creatinine assay.
Sequential Ventricular Fluid Concentrations of Ceftazidime—Report of Three Cases
Authors: Polk Ronald E. , Mayhall C. Glen , Tartaglione Teresa , Baggett Jane , Patterson Pat
Published: May 2016

Three adult subjects, each with a ventriculostomy, received ceftazidime 2g iv q8h for three doses. Serial samples of serum and CSF ventricular fluid were obtained following the third dose; ceftazidime concentrations were measured by high pressure liquid chromatography. In one patient without inflammatory cells in the CSF, ceftazidime CSF concentrations were only ∼0.3 μg/ml. In two other patients who had inflammatory cells and blood in the CSF, concentrations of ceftazidime in ventricular fluid demonstrated a slow rise and decline over an eight-hour period. Although contamination of the CSF by blood in these two patients confounds the interpretation of the concentrations achieved, it is concluded that obtaining serial samples of CSF from a ventriculostomy offers a more realistic appraisal of the dynamics of antibiotic penetration compared with the single-point method.
Enhanced Theophylline Clearance Secondary to Phenytoin Therapy
Authors: Sklar Stephen J. , Wagner Jon C.
Published: May 2016

This report describes two cases in which theophylline clearance accelerated markedly with concomitant phenytoin administration. Maximum calculated theophylline clearance ranged from 2½ to 3½ times baseline. Onset of the interaction began within five days of beginning concurrent therapy. With combined use, clinicians should be aware, when phenytoin is added, of the potential for reexacerbation of pulmonary symptomatology due to lowered serum theophylline concentrations.
A Third Class of Drugs: An Overview
Authors: Brushwood David B. , Abood Richard R.
Published: May 2016

Drug distribution in the U.S. allows certain products to be used only under the supervision of a physician or dentist. The distribution of other products is underrestricted, such that they may be used by consumers without any supervision. This article discusses the possibility of establishing a third class of drugs that would be available without a prescription but could be purchased only from a pharmacist. The current prescription-to-OTC switch process may provide an excellent opportunity to establish a third class of drugs. However, significant obstacles exist to such a move. For there to be sufficient public policy justification for a third class of drugs, it must be shown that the public will benefit through increased quality of health care and that the economic consequences will not be prohibitive.