bluuebunny/crossref_metadata_2025 huggingface dataset:
Teilhard's Vision as Agenda for Rahner's Christology
Authors: Edwards Denis
Published: July 2017

To what extent does Teilhard's vision set an agenda for Rahner's Christology? In response to this question, this article sketches Teilhard's vision of the relationship between the Omega of evolution and the Christ of Christian faith based upon his late works. Then it explores some of Rahner's explicit comments on Teilhard's work, and proposes that Rahner set himself an agenda with regard to Teilhard's vision. After noting the different methodological approaches of Teilhard and Rahner, it takes up three aspects of Rahner's Christology that develop Teilhard's vision: Rahner's view of the unity of creation and redemption in a theology of divine self-bestowal; his evolutionary Christology with its theology of creation's self-transcendence; and his view of the resurrection as the beginning of the deifying transformation of the whole creation.
A Sinner and a Pharisee: Challenge at Simon's Table in Luke 7:36–50
Authors: Crabbe Kylie
Published: July 2017

This article argues that Lukan meal scenes are encounters which bring to life the invitation and challenge at the heart of Jesus' proclamation in this Gospel. After a brief introduction to Greco-Roman and Old Testament influences, and the shape of Lukan meals, it outlines the central themes of Jesus' proclamation as exemplified by both what Jesus says and the response he receives in the inauguration of his ministry at Nazareth (Luke 4:16–30). In light of the key themes of acceptance, release and participation for both “insiders” and “outsiders”, the study then considers the meal scene in Luke 7:36–50 and draws conclusions about the challenge to transformation which takes place at Simon's table. It concludes by briefly alluding to ways in which other Lukan meal scenes embody these themes in Jesus' proclamation.
Christian Ethics in a Secular Society: Karl Barth in Conversation
Authors: McIntosh Adam
Published: July 2017

The aim of this study is to clarify the nature of Christian ethics and its implications for secular society. This is achieved by way of engagement with the theology of Karl Barth. Barth is useful on this question for he presents a thoroughly counter-modern theological ethics, as he works from an uncompromising theological framework. The implications of applying Christian ethics to secular society are discussed by way of conversation with Barth, and a way forward suggested in the form of a missional focused Christian ethic.
On the Implications of the Idea of Infinity for Postmodern Fundamental Theology
Authors: Wood Daniel A.
Published: July 2017

This essay provides a dimensional analysis of the various manners in which mathematics, phenomenology, and theology claim to make present or mediate infinity. Edmund Husserl's 1935 lecture, Philosophy and the Crisis of European Humanity, because engaged with each discipline to various degrees, will function as our primary, preparatory text. Husserl's discussion of the ideal objects of mathematics and the Greek attitude will call for further analysis of the relation between mathematics and infinity. Similarly, intentional infinities, insofar as related to transcendental phenomenology, will be compared to Jean-Luc Marion's distinct phenomenology of the icon. Next, the ways in which the infinite God is conceptualised by Husserl and Marion will be juxtaposed in order to demonstrate their disparate, theological thinking. Finally, the notion of multiple infinities will be analogically extended from set theory to the discursive wholes of mathematics, phenomenology, and theology in order to suggest a novel understanding of the role of the infinite within postmodern fundamental theology.
Universale Salutis Sacramentum: Understanding the Church as the Universal Sacrament of Salvation in Relation to the Challenges of Interreligious Dialogue
Authors: Friday John
Published: July 2017

Based on the premise that the task of systematic theology is to promote an understanding of doctrines by relating different doctrines to one another, and in dialogue with the religious-cultural context, this article provides a systematic proposal for understanding the Roman Catholic doctrine that affirms the church as the universal sacrament of salvation. This doctrine will be clarified by relating it to the doctrine that interreligious dialogue is part of the Catholic Church's evangelising mission. The context for this understanding is one in which religious diversity is both a fact and often times, a problem. The reflections begin with a survey of several terms and relations that are central to the doctrines that are being discussed. Bernard Lonergan's notion of mutual self-mediation is then explained and presented as a tool for both Christian and ecclesial self-understanding. Mark Heim's so-called “theology of religious ends” is appealed to as a concrete way for mutual self-mediation to be practised, and Lonergan's ecclesiologial suggestions allow the notion to be applied on an ecclesial level.
The God of the Patriarchs
Authors: Scullion John J.
Published: July 2017

We cannot write a rounded account of the history or of the religion of the patriarchs. We can only point to certain elements which the biblical texts preserve. When we remove the proper name, YHWH, and all characteristics of Yahwism, we are left with a personal God who is the God of the father of the clan (the extended family) and of the clan itself; he has no name; he is just El, God, the high God, the eternal one, the God of this father of this group, the God who appeared at this place. The father worships this God; he prays and presides at the worship; there is no mediator at the place of worship. This God preserves the group through a son, and guides the group “on the way”. It is a simple, uncomplicated religion where God comes directly to the person, and the person goes directly to God.
God and the Nuclear Catastrophe
Authors: Moltmann Jürgen
Published: July 2017

There is no apocalyptical meaning of the nuclear world annihilation, but only the protest of apocalyptic hope in God against all powers which make that world annihilation possible. God's stories in the Bible speak and awaken hope where otherwise there is nothing else to hope. The memories of being rescued from disaster do not deny the disaster. They speak of the God who made the hopeless disaster of his people his own and who led his people out of it. The Christian memory represents the suffering and dying of Christ in the abandonment of God and, through the anticipation of his resurrection from the dead, awakens hope for the victory of life over death.
The Necessary Angel: Imagination and the Bible
Authors: Coleridge Mark
Published: July 2017

The point of this article is to explore the role of imagination in both the production and interpretation of the biblical texts. To speak of the metaphoric character of the Bible is to reject all authoritarian notions of interpretation which would claim that there is only one correct interpretation of a text. The biblical texts demand constantly fresh interpretations, the discovery of new possibilities. All our reading of the Scripture runs down to the sea of adoration, into that dark moment when we surrender to the infinite possibility which imagination has perceived at the heart of things. A failure to actualise Scripture in the life of the Church is a failure primarily of imagination.
Genesis 2: 1–3 - Creation and Sabbath
Authors: Wallace Howard N.
Published: July 2017

In Gen 2:1-3 the Priestly writer has emphasised the sabbath of God at the end of the creation account. In exile, when Israel had been severed from land and temple, pastoral consideration was needed in the reshaping of the traditions. The temple no longer stood as a symbol of the sovereignty of Israel's God. In the creation account, the construction of the heavenly sanctuary, which usually concludes ancient Near Eastern creation myths, has been replaced by the motif of the divine rest. The Priestly writer connects God's sabbath rest at creation with the institutions of tabernacle and human sabbath observance and gives the people a means whereby the sovereignty of their God can be proclaimed
Not Meddling with Divinity: Theological Worldviews and Contemporary Physics
Authors: Honner John
Published: July 2017

The history of the relationship between theology and physics shows moods varying between détente and dalliance. Important theological issues cannot be articulated without implicit reference to a physical worldview. Modern physics challenges us to revise the classical Newtonian way of looking at the world as a stable, causal mechanism of isolated objects. And physics today is possibly offering a worldview in which a synthesis of physics and metaphysics is again feasible.
A Call to Contemplation: Peace Politics and the Church
Authors: Kane John F.
Published: July 2017

Church action for nuclear disarmament must be seen in the context of thought about the deeper currents formative of modern life, thought about the situation of Christianity in a world at once increasingly given over to technical rationality and increasingly shaken by confusions and crises. In the end it is suggested that there are two levels to the Church's involvement in peace politics: first, the more immediate level of action on such issues as nuclear disarmament and, secondly, a more radical level of response to fundamental issues raised by modernity. This radical response includes the call to form a contemplative community of worship.
The Status of Biblical Narrative
Authors: Prickett Stephen
Published: July 2017

Biblical scholarship has yet fully to come to terms with the problematic status of the narratives which constitute so large a part of its subject. Neither proposals that they be treated as “history” nor as “fiction” address the fact that our modern concepts of both history and (to a lesser degree) of fiction are themselves derived to a surprising degree from those narratives themselves. Rather than encapsulating them in anachronistic straightjackets, we should therefore rather try to ask what we have lost by being no longer able to read them in their own terms. Such an approach would not involve putting the clock back, nor breaking with the great hermeneutical tradition, but would rather be an extension of it to meet the challenges created by the continuing evolution of our modern scholarly skills.
Israel among the Nations
Authors: Cazelles Henri
Published: July 2017

The Old Testament reflects the historical, cultural and social experiences of the thousand year period during which it took shape. Ancient Israel borrowed much from the surrounding world and its cultures. These borrowings, however, are consistently subjected to the radical critique enabled by the Bible's peculiar faith in the one God. The Bible is not tied to any particular culture, but it uses cultures both to give expression to the unique religious experience perfected in Jesus Christ and to unite people of all cultures into the one body.
The Integrity of Creation: Science, History, and Theology
Authors: McPherson Jim
Published: July 2017

Both Jürgen Moltmann and Arthur Peacocke have sought to address environmental concerns in their theologies. Moltmann espouses the traditional Western theology of history articulated by Augustine, which hinders him in using scientific information with credibility and respect. Peacocke, as a scientist, writes from a theology of history more akin to that of the ancient Greek and Roman history writers, and this makes it difficult for him to accommodate the unique and revelatory content of the Christian faith. This impasse may be resolved by loosening the theology-history nexus, and by allowing the cosmos a limited autonomy in its relationship to God.
Christ and Ministry
Authors: Murphy-O'Connor Jerome
Published: July 2017

Circumstances at Corinth forced Paul to develop a profoundly christological vision of ministry on both communal and individual levels. The need to differentiate the church from the world, and to overcome divisions within the community led to the insight that believers formed an organic unity, a body, which he then saw as the active presence of Christ in the world. This understanding deepened when accusations of “weakness” brought him to the realisation that the comportment of an authentic minister manifests “the life of Jesus”.
Disillusionment: Reflections on the Experience of Theological Education
Authors: Dutney Andrew
Published: July 2017

In this paper “disillusionment” is applied as an heuristic motif to interpret the experience of theological education. It is found to describe not only a necessary characteristic of the educational experience, but also a central aspect of the theological task in itself. The methodological convergence of doing theology and teaching theology is identified. In the light of this, the reformed model of “teaching elder” is reconsidered in relation to the understanding of ministry of the Word in the Uniting Church in Australia.
The Begetting of Wisdom: The Teacher and the Disciples in Matthew's Community
Authors: Trainor Michael
Published: July 2017

As we seek to develop an authentic approach to leadership within our society, Matthew offers us profound insights about the nature of leadership within the Christian community. In this gospel, Jesus is presented as the teacher, like Moses and one of the ancient scribes of Wisdom. The disciple, who is an intimate and permanent student of Jesus, becomes the apprentice of wisdom. Consequently, the disciple and Christian leader who is called into a life-long relationship with Jesus, like Jesus, becomes a social critic and bearer of wisdom.
Old Testament Narrative as Theology
Authors: Campbell Antony F.
Published: July 2017

This article considers two areas of narrative text. Firstly, it goes into some detail about a splendid example of Old Testament theological storytelling called the Ark Narrative. Secondly, it points to four critical moments in Israel's understanding of its world, indicating that each of these is portrayed in the Old Testament text in irreconcilably contrasting ways. The four moments are: creation, flood, exodus, and settlement. The thesis sustained is this: if sharply contrasting views of the past are preserved and juxtaposed, the concern is not with the manner of what happened but with its meaning in faith. To simplify: the narrative is not history but theology.
The Historical Jesus and Human Subjectivity: A Response to John Meier
Authors: Kelly Tony
Published: July 2017

Problems associated with the distinction between the historical Jesus and the historic Jesus can be satisfactorily clarified only by paying much greater critical attention to the subject, the person making and using such distinctions, and by a methodological reintegration of the wholeness of consciousness. Faith can thus employ historical scholarship, not cowed or threatened, but astutely aware of the possibilities, limitations and necessity of searching into its past, and of incarnating itself in this stream of time, space, human experience and development.
Of Food, Bodies, and the Boundless Reign of God in the Synoptic Gospels
Authors: Franzmann Majella
Published: July 2017

This article takes its point of departure from the comparison of Jesus and John the Baptist in Matt 11:18-19/Luke 7:33-34. After considering the broader Synoptic context of the passages, the study focusses on the behaviour of Jesus to do with food and bodies. Drawing on the theories of social anthropology with regard to the correlation between body and food symbolism and social setting, it is argued that Jesus' everyday behaviour with food and with bodies is directly related to his proclamation, in word and deed, of the coming reign of God. Implications are drawn for contemporary celebrations of Eucharist.
The Relation between Text and Experience in Narrative Theology of Revelation
Authors: Gascoigne Robert
Published: July 2017

This article presents a critique of the narrative theology of revelation developed in Ronald Thiemann's Revelation and Theology and George Lindbeck's The Nature of Doctrine: Religion and Theology in a Post-Liberal Age. Both these writers are critical of any theological method that employs a correlation between scripture and human experience, because such a correlation assumes either a foundation of knowledge in experience or the possiblitiy of meaningful experience independent of concrete narrative. It is argued here that only a dialectical conception of the relationship between experience, text, and tradition can do justice to the character of biblical revelation.
The Social Imagination of Radical Christianity
Authors: Hogan Trevor
Published: July 2017

This article reviews Gary Dorrien's Reconstructing the Common Good and Christopher Rowland's Radical Christianity. Dorrien aims to retrieve Christian socialism as a central and vital tradition of Christian social theology and practice. Rowland endeavours to show that despite, or because of, its historically marginalised position vis à vis the institutional churches, radical apocalypticism is anything but heretical. Christian hope represents a life-affirming disposition for a humanity confronting the possibility of its own collective death. If hope is to be prophetic, however, its witnesses must stipulate in what they hope and for whom. The constructive imagining of social order implies the need of a theological anthropology and social theory and ethics as well.
God's Justice and Mercy: What Can We Hope for?
Authors: O'Donnell John
Published: July 2017

Is the theology of universal salvation reconcilable with the New Testament warnings about the possibility of damnation and with the long-standing teaching of the Church on hell? Does it take into account the doctrine of the last judgement where the just God gives to each man and woman according to his or her deeds? How can God be both just and merciful? Did God punish Jesus for our sins? If the greatness of God's transcendence consists in the infinite quality of God's mercy and God's saving justice, may we not hope that God's love made visible in the cross of Christ will wear down the heart of even the most hardened sinner.
Presence or Absence? The Question of Women Disciples at the Last Supper
Authors: Lee Dorothy A.
Published: July 2017

This article examines the literary role of women in the passion and resurrection narratives and the practice of the historical Jesus which lies behind the Gospels. Jesus probably included a wider group of disciples than the twelve at the Last Supper, among whom were a number of women. This is reflected in the uneven dynamic between female presence and absence in the Synoptics. Only in John is there the real possibility of women's presence at the Last Supper, although Mark uses the motif of presence/absence to contrast female fidelity with male infidelity.
Metaphorical Theology
Authors: Begley John
Published: July 2017

Metaphorical theology rightly insists that metaphorical language about God can be both cognitively meaningful and spiritually nourishing. Metaphors, models and stories all have use and value. On the other hand, despite some claims, they also have their limitations. As Aquinas pointed out, systematic theology depends on the analogical, literal use of language.
Human Rights as Land Rights in the Pacific
Authors: May John D'Arcy
Published: July 2017

Do human rights in their conventional, Western understanding really meet the needs of Pacific peoples? This article argues that land rights are a better clue to those needs. In Aboriginal Australia, Fiji, West Papua and Papua New Guinea, case studies show that people's relationship to land is religious and implicitly theological. The article therefore suggests that rights to land need to be supplemented by rights of the land extending to the earth as the home of the one human community and nature as the matrix of all life.
A New Ontology?: A Response to a Recent Suggestion
Authors: Kelly Tony
Published: July 2017

In offering a constructive response to Honner's “New Ontology”, this article suggests: (1) some continuities with a number of traditional theological techniques; (2) the desirability of greater emphasis on the doctrines of creation and the Trinity; (3) the need for a more careful retrieval of some former distinctions dealing with the incarnation, the eucharist and eschatology; and (4) the foundational relevance of a more thorough-going “turn to the subject”.
Edmond Jabès: Rabbi-Poet of the Book
Authors: Veling Terry
Published: July 2017

This article serves as an introduction to the writings of Jewish poet Edmond Jabès. Whereas the Christian metaphor of “fulfilment” has influenced Western interpretive practice, the Jewish metaphor of “exile” runs as a counter-history to the dominant Christian tradition. Jabès points to a wandering, nomadic truth that knows absence and the desert, sustained by an open, indeterminate Book rather than a closed, completed Book. This “exilic hermeneuric” is central to Jabès' writings.
“To Expound Discipline or Judgement”: The Portrait of the Scribe in Ben Sira
Authors: Foulkes Pamela A.
Published: July 2017

This article explores the portrait of the scribe presented in the Book of Ben Sira in an attempt to draw some conclusions about the dimensions of the scribal role in second century BCE Israel. The scribe's education fits him for a range of positions of power and authority in the public life of his community, particularly in the judiciary.
The World as Sacrament: Insights into an Orthodox Worldview
Authors: Chryssavgis John
Published: July 2017

If there exists today a vision able to transcend or transform national conflicts and confessional tensions, it may well be the appreciation of the world seen as sacrament. The earth that we all share reveals to us glimpses of wholeness and holiness. This paper examines, from the perspective of Orthodox theology and spirituality, the notions of sacrament and symbol, the concept of creation “out of nothing”, the doctrine of the Incarnation, and the relationship of the transcendent God to the world around us.
Aboriginal Disadvantage and Collective Moral Responsibility
Authors: Prowse Christopher C.
Published: July 2017

Australia's relationship with its Aboriginal and Torres Strait Islander peoples has changed in recent years. A most positive movement towards reconciliation is growing but not without being continually challenged by entrenched racist attitudes and sinful social structures within the community. This article attempts to offer some ethicaltheological parameters around which this fragile desire for reconciliation might mature. It discusses the results of recent data in the light of the concept of collective responsibility with its corresponding ethical implications. An application of these concepts to the Australian Christian churches is initiated and an overall challenge to all Australians will be suggested.
Gandhi and “Lead, Kindly Light”
Authors: Emilsen William
Published: July 2017

John Henry Newman and Mohandas Gandhi represent an odd coupling. Newman's popular hymn, “Lead, kindly Light”, exerted a powerful influence upon Mahatma Gandhi's spirituality and India's struggle for independence. The hymn was transmitted to Gandhi in Noncomformist circles in England and South Africa. “Lead, kindly Light” came to represent the spirit of his satyagraha campaigns against the British and Indian Governments. It also assumed an important place in Gandhi's developing understanding of religious pluralism.

In my daily prayers I earnestly pray to God to lead me from untruth to truth. Isn't the same idea conveyed in “Lead kindly Light”?

Gandhi to Vinoba Bhave, 10 March 1947
Beyond 2000: The Global World and Theological Education
Authors: Berling Judith A.
Published: July 2017

This article offers an outline of the major challenges to theological education at the end of the millennium. The challenge of religious pluralism and the problem of denominational identity are given particular attention. Future theological education is anticipated also to demand greater attention to a new sense of tradition and identity formation. Finally, local experience and changes in culture and society have been too long ignored in theological education and need to be made part of the foundations of future teaching.
Living the Task: Advanced Ministry Studies
Authors: Gordon J. Dorcas
Published: July 2017

This study offers an account of the origins and evolution of the D.Min. programme, with particular reference to the Toronto School of Theology and the influence of contemporary biblical hermeneutics. Inductive and deductive methods of learning are considered, leading to a discussion of a community model of learning. Theological education is also seen to require an integration of theory and practice. Attention is drawn to the nature of the student in advanced ministry studies today, and differences from the past. Finally, the requirements of teaching in such programmes are considered, with particular emphasis on the need for imagination, vulnerability and courage.
To Teach the Text: The New Testament in a New Age
Authors: Moloney Francis J.
Published: July 2017

Modern critical biblical scholarship has long laboured under the belief that the object of teaching the biblical text was to communicate the original meaning of a traditional and canonical text. Contemporary criticism points more and more to the intertextuality of both text and reader in the interpretative process. The interpreter is inevitably inscribed in the act of interpretation. A reading of the Nicodemus material in the Fourth Gospel attempts to show that “autobiographical” readings need not abandon the achievements of more traditional forms of scholarship. Text, tradition, rhetoric and reader can combine to provide a reading of the text which continues and enriches Christian beliefs and practice.
A Spiritual Director from Antioch
Authors: Hill Charles
Published: July 2017

Along with the Gospels, the Psalter was a staple of spiritual formation for Christians in the early centuries of the Church. Hence, many psalm Commentaries were composed, often taking pride of place in an author's literary output. Theodoret of Cyr likewise, though a busy pastor in a time of theological turmoil, composed such a work to help people understand this favourite book as they sang it. Drawing on his predecessors from Antioch and Alexandria, and betraying current trends in Christology, scriptural interpretation and ascetical practice, he offered with typical conciseness “some benefit in concentrated form” that today we might find at variance with our expectations of a spiritual director.
Competing Theoretical Explanations of Cocaine Use: Differential Association Versus Control Theory
Authors: Macdonald Patrick T.
Published: July 2017

Questionnaires from 1,517 respondents were obtained by means of both a convenience and a snowball sample. 1,091 (72%) respondents had used cocaine at least once, while 426 (28%) had never used it. The data from this information about criminal cocaine use have been used to test the efficacy of two competing theoretical models of delinquent or criminal behavior, differential association and control theory. Both tabular and multiple regression techniques were used to analyze the cause of the respon dents' cocaine use. Differential association theory variables were found to be far more effective than control theory variables in explaining the use of cocaine.
Criminality and Driving While Intoxicated: A Comparison of DWI's and A Random Sample of Licensed Drivers
Authors: Gould Larry A.
Published: July 2017

Prior research suggests a link between alcohol consumption and certain types of criminal activity. This research explores the relationship between arrest for driving while intoxicated (DWI), an alcohol related offense, and prior criminal activity. Additionally, the difference between single and multiple DWI offenders is examined. The hypothesis is that DWI is not an isolated incident of abhorrent behavior on the part of an individual, but rather a part of a continuing criminal activity. It follows that the more DWI's the individual has, the greater the likelihood of other forms of criminal activity. The research involves the archival review of prior criminal histories for people arrested for DWI in Louisiana. The type and number of prior criminal arrests are reported as well as certain demographic attributes. The analysis reveals that there is a significant difference in the number of arrests for the group of individuals with a DWI arrest as compared to those individuals included in a random sample of all male licensed drivers in Louisiana.
Salicylate Intoxication
Authors: Bender Kenneth J.
Published: July 2017

A review of pathology, corrective measures, and incidence of salicylate poisoning is presented.

A composite patient case (developed to illustrate symptomatology of salicylism) demonstrates a wide range of signs and symptoms. Subsequent discussion of supportive and corrective measures emphasizes correction of the acid-base, and fluid and electrolyte imbalance associated with salicylate poisoning. Treatment is considered within the context of both moderate and severe poisoning; recently developed and traditional procedures are reviewed.
Overdoses with Tricyclic Antidepressants
Authors: Bryan Candace K. , Ludy Judith A. , Hak Sandra H. , Roberts Rosemary , Marshall William R.
Published: July 2017

The authors present a 46-year-old female and a 14-month-old female following ingestion of an overdose of tricyclic antidepressants, amitriptyline and imipramine, respectively. The discussion, following the cases, reviews the toxic manifestations of the antidepressive agents, i.e., CNS depression, agitation, delirium, coma, cardiac manifestations and anticholinergic effects. Review of appropriate treatment, particularly the use of physostigmine, is also presented.
Uncontrollable Seizures in an Epileptic
Authors: Zarek John E.
Published: July 2017

A case of possible phenytoin-induced systemic lupus erythematosus is presented in a patient with a twenty-year history of epilepsy. The failure of seizure control in the presence of adequate anticonvulsant blood levels pointed to an underlying disease state. Drug-induced and idiopathic systemic lupus erythematosus are quite similar in clinical and laboratory manifestations. However, antibodies to native (double-stranded)-DNA seem to be consistent with the idiopathic form. A review of drug-induced systemic lupus erythematosus is presented.
The Pharmacology of Antiulcer Drugs
Authors: Hurwitz Aryeh , Carter Charles A.
Published: July 2017

The use of medications for the treatment of gastrointestinal ulcers has evolved to a great extent since the early days of therapy with diet and antacids. Today a number of different agents are available to treat the causative factors of ulcer formation. Currently, antacids, histamine2-receptor antagonists, and sucralfate are considered frontline therapies suitable for most patients. The future also looks promising for newer agents, such as omeprazole and prostaglandin analogs. The purpose of this article is to provide practitioners with an understanding of the pharmacology of these agents so that their rational use can be achieved more efficiently and effectively.
Comparison of the Parenteral Histamine2-Receptor Antagonists
Authors: Skoutakis Vasilios A.
Published: July 2017

The chemical structure, pharmacokinetic properties, and drug–drug interaction profiles of the parenterally available histamine2 (H2)-receptor antagonists were compared. Famotidine is a guanidinothiazole derivative, ranitidine contains an aminomethylfuran ring, and cimetidine has an imidazole ring. Data from the literature indicate that because of its chemical structure famotidine has a much greater potency and affinity for the H2-receptor and a notable lack of drug–drug interactions when compared with ranitidine and cimetidine. As a result, famotidine should be considered the H2-receptor antagonist of choice for critically ill patients who require gastric-acid suppression and at the same time are being treated with other drugs that depend on the cytochrome P-450 mixed-function oxidase system for their metabolism and/or on renal tubular mechanisms for their excretion.
Cost Considerations of Intravenously Administered Histamine2-Receptor Antagonists
Authors: Nolly Robert J. , Skoutakis Vasilios A.
Published: July 2017

The cost of intravenously administered histamine2 (H2)-receptor antagonists to hospitalized patients is high. Costs can be expressed as either direct or indirect. Direct costs include drug cost, labor costs (pharmacy/nursing time), and the materials required for iv administration of these agents. Indirect costs include adverse effects, drug interactions, and allergic reactions. Due to the high percentage of total cost for labor and materials associated with the iv H2-receptor antagonists, a reduction in drug cost, although certainly desired, is unlikely to substantially reduce the amount charged the patient per intravenous dose administered or the daily cost of therapy. However, if less frequent dosing were required to achieve similar therapeutic effects, the daily therapy cost for iv H2-receptor antagonists could be substantially reduced. Assuming that cimetidine, ranitidine, and famotidine are equally effective and safe, our cost analyses at the University of Tennessee Medical Center/William F. Bowld Hospital indicate that famotidine administered q12h, regardless of the iv administration technique used, is the most cost-effective H2-receptor antagonist and is the drug of choice.
Safety and Acid-Suppressant Properties of Histamine2-Receptor Antagonists for the Prevention of Stress-Related Mucosal Damage in Critical Care Patients
Authors: Schentag Jerome J. , Carter Charles A. , Welage Lynda S.
Published: July 2017

Therapeutic intervention for the prevention of stress-related mucosal damage (SRMD) is currently directed at decreasing mucosal exposure to endogenous hydrochloric acid. We conducted a double-blind, parallel-group study in critically ill patients to investigate the comparative safety and acid-suppressant properties of the intravenously administered H2-receptor antagonists cimetidine and famotidine. This is a preliminary analysis. Study patients received either famotidine 20 mg q12h or cimetidine 300 mg q6h or q12h. Cimetidine dosing intervals were based upon the degree of renal and hepatic dysfunction due to pharmacokinetic considerations. In critically ill patients with severe renal impairment, a pH of ≥4.0 was maintained more consistently with famotidine 20 mg q12h compared with treatment with cimetidine. In terms of safety, a greater number of patients receiving cimetidine reported adverse clinical experiences than those receiving famotidine and a greater number of cimetidine patients had to be withdrawn from the study when compared with famotidine patients. In conclusion, preliminary results of this study suggest that famotidine has superior acid-suppressant properties and a better safety profile when used intravenously for the prevention of SRMD in critically ill patients.
Use of Continuous Infusion of Histamine2-Receptor Antagonists in Critically Ill Patients
Authors: Siepler John K. , Trudeau Walter , Petty Daniel E.
Published: July 2017

Certain clinical situations require the use of a histamine2 (H2)-receptor antagonist to reduce gastric-acid volume and concentration or an antacid to act as a buffering agent. Presently, there are three H2-receptor antagonists available for iv use: Cimetidine, ranitidine, and famotidine. Conventional therapy dictates that the H2-receptor antagonist be given by intermittent intravenous infusion, resulting in peaks and valleys of acid secretory control. Antacids, although capable of providing adequate gastric acidity control, must be administered frequently, often hourly, and thus require excessive nursing time. Presented here is a review of the rationale for the use of an H2-receptor antagonist by continuous infusion.
Stability of Famotidine in Minibags Refrigerated and/or Frozen in Total Parenteral Nutrition Solutions
Authors: Bullock Linda S.
Published: July 2017

The use of histamine2-receptor antagonists could be beneficial in critically ill patients for protection against stress-induced gastrointestinal bleeding. Famotidine, similar to cimetidine and ranitidine, is stable when mixed in dextrose 5% injection and NaCl 0.9% injection at a concentration of 200 μg/mL and stored in polyvinyl chloride bags at 4 °C for 14 days or when frozen for 28 days and subsequently refrigerated for 14 days. Furthermore, famotidine, also like cimetidine and ranitidine, is stable when added to most common total parenteral nutrition (TPN) solutions. Famotidine in concentrations of 20 mg/L and 40 mg/L is stable in crystalline amino acid solutions (20 g/L and 42.5 g/L) when refrigerated for 24 hours, then held at room temperature for 24 hours, at room temperature for 48 hours, or refrigerated for seven days. The concentration of amino acids in the TPN solutions containing 42.5 g/L also is not affected by the addition of famotidine 40 mg/L when stored under conditions similar to those stated above for 48 hours. TPN solutions remain clear and free of turbidity.
Lack of Effect of Piroxicam on Theophylline Clearance in Healthy Volunteers
Authors: Maponga Charles , Barlow Jared C. , Schentag Jerome J.
Published: July 2017

This study was conducted to determine if piroxicam alters the clearance or metabolism of theophylline in healthy adults. Six male volunteers were given aminophylline 6 mg/kg iv before and after piroxicam treatment. Piroxicam 20 mg/d po was administered for seven days. Serum samples were collected before and for 24 hours after each aminophylline dose. Theophylline serum concentrations were determined using the Abbott TDx automated immunoassay system. Theophylline and its 1,3-dimethyluric acid metabolite were measured in 24-hour urine collections. Serum theophylline concentration versus time curves were plotted and pharmacokinetic parameters determined for each subject. None of the derived parameters differed as a result of piroxicam exposure. Theophylline metabolites, clearance, half-life, and volume of distribution were compared during the baseline and piroxicam phases and were found to be similar. It was concluded that piroxicam does not alter the clearance, distribution, volume, or metabolism of theophylline in healthy adult volunteers.
Prospective Evaluation of Liver Function Tests in Patients Treated with Aminoglycosides
Authors: Mor Felix , Leibovici Leonard , Cohen Ohad , Wysenbeek Arjeh J.
Published: July 2017

We investigated the relationship between therapy with aminoglycoside antibiotics and alterations in serum liver enzymes and bilirubin. One hundred fourteen patients treated with aminoglycosides and 96 treated with other antibiotics were assessed prospectively during eight days. No elevation in serum alanine aminotransferase, lactic dehydrogenase, or bilirubin was detected in the aminoglycoside and control groups. Alkaline phosphatase increased significantly in the aminoglycoside group (average elevation of 28 ± 16 units/L on day 6), but no patient had an elevation greater than twice the upper limit of the normal range. We conclude that the abnormality in liver enzymes during aminoglycoside therapy is a mild elevation in alkaline phosphatase, probably with no clinical significance.
Potential Neurologic Toxicity Related to Ciprofloxacin
Authors: Schwartz Marla T. , Calvert John F.
Published: July 2017

A 74-year-old woman with multiple medical problems including chronic renal failure was admitted for treatment of a diabetic foot infection. On day 12 of therapy with oral ciprofloxacin and metronidazole, the patient experienced generalized myoclonus and muscle twitching. At that time it was realized that although the ciprofloxacin regimen prescribed was a usual dose for a skin and soft-tissue infection, it was excessive for her degree of renal function This was thought to be the most likely cause of the patient's neurotoxicity. Seizure activity has been reported to occur with the quinolone antibiotics and, with the increasing use of these agents, dose reductions should be kept in mind to avoid potentially serious adverse reactions.
A Suspected Case of Trimethoprim/Sulfonamide-Induced Localized Exfoliation
Authors: Ponte Charles D. , Arbogast James G. , Dattola Richard K.
Published: July 2017

A variety of skin reactions have been associated with the use of sulfonamides. Most of the reactions are uneventful and abate with drug discontinuation. Rare but severe skin reactions can occur and include the Stevens-Johnson syndrome and exfoliative dermatitis. Dermal reactions appear to be the most commonly reported adverse effect in children. Drug continuance following the development of a mild skin rash may be associated with the development of a more severe dermal reaction. This report summarizes a case involving a six-year-old white girl who developed exfoliative dermatitis confined to the feet following a course of oral trimethoprim/sulfamethoxazole (TMP/SMX) for otitis media. Exfoliation is an uncommon cutaneous manifestation following sulfonamide use. Although usually a generalized process, it is unusual to find it confined to the feet. Unfortunately there is no useful diagnostic method that could specifically elucidate the cause of a dermatologie eruption. Available evidence suggests that TMP/SMX was the probable cause of our patient's rash. Drug discontinuation will usually lead to the resolution of the rash. Adjunctive antihistamines and corticosteroids are often useful when pruritus is present. Severe reactions require vigorous supportive treatment.
Norepinephrine in Septic Shock: Renewed Interest in an Old Drug
Authors: Dasta Joseph F.
Published: July 2017

Vasopressors are the mainstay after fluids in the hemodynamic support of patients with septic shock. Although dopamine is commonly used in this situation, it is sometimes ineffective. Because of its potential adverse vasoconstrictive effects, norepinephrine usually has been chosen only when all other drugs have failed in septic shock. However, several recent reports have suggested a beneficial effect of norepinephrine, often in doses higher than those commonly used. Specifically, these studies in 77 patients showed that norepinephrine effectively elevates blood pressure and increases systemic vascular resistance without decreasing cardiac output. Renal function in these patients appears to be maintained. Information on oxygen transport is variable; however, the mortality from sepsis remains high at between 17 and 50 percent. Until more information becomes available, norepinephrine appears to be a useful drug in maintaining blood pressure in patients with septic shock, but higher than usual doses may be needed.
Parenteral Iron Dextran Therapy
Authors: Kumpf Vanessa J. , Holland Eileen G.
Published: July 2017

Parenteral iron therapy is indicated in patients with iron-deficiency anemia associated with conditions that interfere with the ingestion or absorption of oral iron. Replacement doses of iron required to replenish iron stores are based on body weight and the observed hemoglobin value. Methods of administering iron dextran are reviewed, including intramuscular and intravenous injections of the undiluted drug, intravenous infusion of a diluted preparation, and as an addition to parenteral nutrition solutions. The overall incidence of adverse reactions associated with the parenteral administration of iron is low, but the potential for an anaphylactic reaction requires that an initial test dose be given followed by careful patient observation.
Drug Interactions Involving Immunologic Agents Part II. Immunodiagnostic and other Immunologic Drug Interactions
Authors: Hartshorn Edward A. , Grabenstein John D.
Published: July 2017

Part I of this series appeared in the January 1990 issue.

This two-part review addresses pharmacists' need for information about immunologic drug interactions. Reports of interactions involving vaccines, immune globulins, and immunodiagnostic reagents are widely dispersed and, therefore, difficult to access. In the conclusion of this two-part article, immunodiagnostic drug interactions as well as interactions involving interferons and other biologic-response modifiers are discussed, as are epinephrine interactions that affect treatment of immunologic-induced anaphylaxis. Host factors of groups and individuals relating to the clinical significance of proposed interactions are covered, such as those involving influenza vaccine with theophylline, warfarin, or phenytoin, and other combinations. Vigilance by all pharmacists is needed to detect previously unreported immunologic drug interactions and further assess known interactions.
A Team Approach to Reduce Antibiotic Costs
Authors: Karki Shyam D. , Holden J.M.C. , Mariano Erlinda
Published: July 2017

After partial success in reducing antibiotic drug costs by traditional methods (i.e., closed formulary, use of generic drugs, retrospective drug usage review, continuing education), a study of a new “team approach” was implemented. The study involved a clinical pharmacist and physicians working together to select the most appropriate antibiotic therapy. The clinical pharmacist reviewed the culture and sensitivity data and the pattern of infectious disease over the six-month period prior to the initiation of the study and prepared a list of the most appropriate antibiotics based on clinical efficacy and cost effectiveness. He then joined the physicians on morning rounds to monitor therapy and help in the selection of the most appropriate drug regimen. At the end of the study period, antibiotic cost savings of 58.6 percent were achieved.
Characterization of Dexamethasone Binding in Normal and Uremic Human Serum
Authors: Cummings Doyle M. , Larijani Ghassem E. , Conner Dale P. , Ferguson Roger K. , Rocci Mario L.
Published: July 2017

The purpose of this study was to examine the extent and linearity of dexamethasone binding over a wide concentration range in normal and uremic serum. Tritiated dexamethasone was added to both untreated and charcoal-treated pooled normal serum and to pooled uremic serum to produce concentrations similar to those attained therapeutically (10–1000 ng/mL). Protein binding was determined by equilibrium dialysis at 37°C. Dexamethasone serum binding was linear over the entire range of concentrations for each set of pooled serum. The mean (± SD) percent bound (mean ± SD) for dexamethasone was similar for untreated (75.1 ± 3.6 percent) and charcoal-treated (77.3 ± 3.5 percent) normal serum. Dexamethasone binding (69.2 ±1.8 percent, p<0.05) and serum albumin concentrations (39.9 vs. 55.1 mmol/L) were significantly less in uremic vs. normal serum, respectively. These results suggest that (1) the binding of dexamethasone is linear and occurs primarily to albumin, with little or no binding to corticosteroid-binding globulin; (2) endogenous cortisol does not compete with dexamethasone for protein binding sites; and (3) steroid pharmacokinetics may be altered in uremic patients due to the 24 percent higher free fraction of dexamethasone in this population.
Symptomatic Hypoglycemia Secondary to a Glipizide—Trimethoprim/Sulfamethoxazole Drug Interaction
Authors: Johnson June Felice , Dobmeier Michael E.
Published: July 2017

Sulfonamides have been reported to augment the hypoglycemic effects of chlorpropamide, glyburide, and tolbutamide. This case report is the first to describe a possible interaction with glipizide. An 83-year-old man receiving glipizide 10 mg bid developed symptomatic hypoglycemia within three days of adding trimethoprim/sulfamethoxazole (TMP/SMX) to his regimen. All other factors, including laboratory data, dietary intake, activity level, and concurrent use of other medications, were stable and noncontributory. This patient may have been at increased risk for this interaction secondary to his age and history of alcohol abuse. The mechanism of the interaction is probably inhibition of glipizide metabolism rather than protein-binding displacement. This case suggests that, when TMP/SMX is combined with glipizide, patients should be closely monitored, especially those at high risk for hypoglycemia.