bluuebunny/crossref_metadata_2025 huggingface dataset:
Leukotriene Modifiers to Prevent Aspirin-Provoked Respiratory Reactions in Asthmatics
Authors: Volkman Julie A , Pontikes Pamala J
Published: June 2003

OBJECTIVE:

To evaluate the use of leukotriene modifiers in preventing aspirin-provoked respiratory reactions in asthmatics.

DATA SOURCES:

Clinical literature accessed through MEDLINE (1965–February 2001). Key search terms included aspirin, asthma, leukotriene, and treatment.

DATA SYNTHESIS:

Aspirin-sensitive asthmatics experience a wide variety of symptoms, ranging from rhinitis to life-threatening bronchospasms, after the ingestion of aspirin or nonsteroidal antiinflammatory drugs (NSAIDs). The relationship between aspirin sensitivity, asthma, and nasal polyps was first reported in 1922. The exact mechanism of these reactions is not clearly understood. Four studies investigated the use of leukotriene modifiers to prevent aspirin-provoked respiratory reactions. The efficacy of these agents ranged from complete inhibition to no blockade.

CONCLUSIONS:

Patients who experience aspirin-sensitive asthma should be cautious when taking aspirin and NSAIDs, despite treatment with leukotriene inhibitors.
Serotonin Syndrome Caused by Selective Serotonin Reuptake-Inhibitors—Metoclopramide Interaction
Authors: Fisher Alexander A , Davis Michael W
Published: June 2003

OBJECTIVE:

To report 2 cases of serotonin syndrome with serious extrapyramidal movement disorders occurring when metoclopramide was coadministered with sertraline or venlafaxine.

CASE SUMMARY:

A 72-year-old white woman was treated with sertraline for depression for 18 months and was then admitted to the hospital with a fractured tibia. She was administered metoclopramide because of nausea and, within 2 hours, developed agitation, dysarthria, diaphoresis, and a movement disorder. These symptoms recurred following 2 subsequent administrations of metoclopramide. Treatment with diazepam led to resolution of symptoms within 6 hours, and there was no recurrence at 6 weeks' follow-up. A 32-year-old white woman with major depression was treated with venlafaxine for 3 years. She was admitted following a fall and, after being given metoclopramide, developed movement disorder and a period of unresponsiveness. After a second dose of metoclopramide, these symptoms recurred and were associated with confusion, agitation, fever, diaphoresis, tachypnea, tachycardia, and hypertension. She improved with administration of diazepam, but needed repetition of this treatment over the next 16 hours. Symptoms resolved within 2 days, and she continued venlafaxine with no further adverse effects.

DISCUSSION:

Both cases met Sternbach's criteria for serotonin syndrome and had serious extrapyramidal movement disorders. The possible pathophysiologic mechanisms for the adverse reactions include a single-drug effect, a pharmacodynamic interaction, and a pharmacokinetic interaction. We believe that a pharmacodynamic interaction is most likely.

CONCLUSIONS:

Clinicians should be aware of a risk of serotonin syndrome with serious extrapyramidal reactions in patients receiving sertraline or venlafaxine when metoclopramide is coadministered even in a single, conventional dose.
Role of Race in the Pharmacotherapy of Heart Failure
Authors: Kalus James S , Nappi Jean M
Published: June 2003

OBJECTIVE:

To review the literature assessing the differences in response to angiotensin-converting enzyme (ACE) inhibitors and β-blockers in black patients compared with the response in non-black patients in the management of systolic heart failure.

DATA SOURCES:

A MEDLINE search (January 1966–May 2001) was performed using heart failure, blacks, Negroid race, adrenergic β-antagonists, and angiotensin-converting enzyme inhibitors as key words. English-language articles were identified. Additional pertinent articles were identified from review of the references of these articles.

STUDY SELECTION AND DATA EXTRACTION:

All identified references were reviewed. All articles deemed relevant to the subject of this article were included.

DATA SYNTHESIS:

It has been suggested that the antihypertensive effect of ACE inhibitors and β-blockers may be less in black patients than in other racial groups. Retrospective reanalyses of major heart failure trials have suggested that black patients may not realize a significant benefit in morbidity or mortality when heart failure is managed with ACE inhibitors or β-blockers. It has also been suggested that black patients may respond more favorably than non-black patients to the combination of hydralazine and isosorbide dinitrate.

CONCLUSIONS:

Published reanalyses of ACE inhibitor and β-blocker trials in heart failure provide weak data to support a lack of benefit in black patients. The published literature on this topic is limited by its retrospective nature. Firm conclusions regarding the influence of race on effectiveness of ACE inhibitors and β-blockers cannot be made until prospective trials, with planned analysis of the effect of race, have been performed.
Discrepancies between Medical and Pharmacy Records for Patients on Anti-HIV Drugs
Authors: de Maat Monique MR , Frankfort Suzanne V , Mathôt Ron AA , Mulder Jan W , Meenhorst Pieter L , van Gorp Eric CM , Koks Cornelis HW , Hoetelmans Richard MW , de Boer Anthonius , Beijnen Jos H
Published: June 2003

OBJECTIVE:

To compare and evaluate drug notations in outpatient medical records and in pharmacy records in a cohort of HIV-1–infected patients treated with antiretroviral drugs.

METHODS:

Data on 103 patients were obtained from January 1, 1998, through December 31, 1999, by medical chart review and collection of pharmacy records. Two analyses were performed. First, antiretroviral drugs and comedication in the pharmacy records were documented and compared with their appearance in the outpatient medical records. Second, a detailed comparison was performed at 5 time points during the study period for the antiretroviral drugs. Generic name, formulation, strength, and frequency of dosing as registered in the outpatient medical records were compared with those registered in the pharmacy records.

RESULTS:

Total drug dispensation was 1607 (366 and 1241 antiretroviral drugs and comedication, respectively). The first screening resulted in a total discrepancy of 55.1% (n = 885), of which 97.1% (n = 859) was attributed to the comedication and 2.9% (n = 26) to the antiretroviral drugs. The discrepancy for the antiretroviral drugs at the specific time points ranged from 5.1% to 12.6% when the generic name only was used, and from 7.1% to 17% when formulation, strength, and frequency of dosing were also taken into account.

CONCLUSIONS:

The observed discrepancy between outpatient medical records and pharmacy records mainly concerns the comedication. For the antiretroviral drugs fewer, but still substantial, discrepancies were observed. These results indicate that full exchange of information concerning drug use in this population between general practitioners and specialists (infectious disease) is lacking.
Serotonergic Agents in the Treatment of Fibromyalgia Syndrome
Authors: Miller Lisa J , Kubes Kristy L
Published: June 2003

OBJECTIVE:

T o evaluate literature that discusses the treatment of fibromyalgia syndrome (FMS) with agents that involve the neurotransmitter serotonin.

DATA SOURCES:

Biomedical literature accessed through MEDLINE (1966–August 2001) and International Pharmaceutical Abstracts.

DATA SYNTHESIS:

The cause and pathophysiology of FMS remain elusive, although abnormalities in the serotonin pathway have been implicated. Several serotonergic agents have been studied for use in FMS. Trials and case reports focusing on the use of newer agents: the selective serotonin reuptake inhibitors, venlafaxine and tramadol, were reviewed.

CONCLUSIONS:

Current research suggests that the serotonergic agents may reduce at least some of the symptoms of FMS. However, medications that act on multiple neurotransmitters may prove to be more effective in symptom management. Additional long-term studies are required in order to validate these results.
Severe Thrombocytopenia Possibly Associated with TMP/SMX Therapy
Authors: Yamreudeewong Weeranuj , Fosnocht Brian J , Weixelman Janice M
Published: June 2003

OBJECTIVE:

To report a case of possible severe, life-threatening thrombocytopenia associated with trimethoprim/sulfamethoxazole (TMP/SMX) therapy.

CASE SUMMARY:

A 54-year-old white woman received a 10-day course of TMP/SMX for treatment of chronic sinusitis. One day after finishing the course of TMP/SMX therapy, she presented to the emergency department because of the development of scattered petechiae on both hands and blood blisters in her mouth. On admission, her complete blood cell count results revealed a severely low platelet count of 2 × 103/mm3. Other laboratory test results were normal, except for elevated blood glucose (nonfasting blood glucose). TMP/SMX was believed to be the most likely cause of thrombocytopenia. She was treated successfully with a transfusion of 2 units of platelets and oral prednisone. Her platelet count increased to 110 × 103/mm3 4 days after discontinuation of TMP/SMX. She was discharged on hospital day 5. On follow-up (2 wk after hospital discharge), her platelet count was normal (351 × 103/mm3).

DISCUSSION:

TMP/SMX has been implicated as a cause of thrombocytopenia, which is defined as platelet count <150 × 103/mm3. Although it is uncommon, spontaneous severe bleeding may occur when platelet count decreases to ≤10 × 103/mm3. Thrombocytopenia associated with TMP/SMX appears to be an immune-mediated process resulting in platelet destruction by drug-dependent platelet antibodies. Treatment of thrombocytopenia associated with TMP/SMX therapy includes discontinuation of the offending drug and the use of corticosteroids. Platelet transfusion and intravenous immunoglobulin may be required in some patients.

CONCLUSIONS:

Thrombocytopenia associated with TMP/SMX therapy can be serious or life threatening because it may result in significant bleeding complications. This hematologic adverse effect of TMP/SMX may occur even with the usual recommended dosage and duration of therapy. Careful monitoring of complete blood cell count, including platelet count, before and during TMP/SMX therapy is suggested.
Antidepressant-Induced Sexual Dysfunction
Authors: Gregorian Razmic S , Golden Katharine A , Bahce Asena , Goodman Clifford , Kwong W Jacqueline , Khan Zeba M
Published: June 2003

OBJECTIVE:

To review the evidence regarding antidepressant-induced sexual dysfunction and address implications for treatment strategy and health plan coverage policies for antidepressant medications.

DATA SOURCES:

Primary articles were identified by a MEDLINE and HealthSTAR search to identify English-language studies published between January 1986 and July 2000. Search terms included sexual dysfunction or sexual function and antidepressants, fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, venlafaxine, nefazodone, bupropion, and mirtazapine. A cross-check of references cited in 10 published reviews yielded additional in-scope articles.

STUDY SELECTION AND DATA EXTRACTION:

Approximately 200 articles were identified, including 8 randomized controlled trials and numerous open-label studies, case series, and case reports. Of the randomized controlled trials, only 5 were designed to evaluate the incidence of sexual dysfunction associated with antidepressant treatment. Three additional randomized controlled trials included a structured assessment of sexual dysfunction within an efficacy trial. Data extraction excluded case reports, letters, and other limited study designs. A panel survey augmented published reports.

DATA SYNTHESIS:

Sexual dysfunction is a relatively common adverse effect of many of the antidepressants in common use today. Rates of sexual dysfunction observed in clinical practice may be higher than those reported in the product information for several agents. Selective serotonin-reuptake inhibitors (SSRIs) appear to be the class of antidepressants most likely to cause sexual dysfunction. Published studies suggest that between 30% and 60% of SSRI-treated patients may experience some form of treatment-induced sexual dysfunction. Bupropion and nefazodone appear to be much less likely to cause sexual dysfunction (≤10% of patients). Mirtazapine also appears to be associated with a low rate of sexual adverse effects. Panel results largely reflect the consensus of the literature.

CONCLUSIONS:

Sexual dysfunction is a common adverse effect of antidepressant treatment. Physicians should monitor their patients for antidepressant-induced sexual adverse effects, as these may affect compliance with therapy and ultimate treatment success. In addition to the consequences for patient health and well-being, managed-care organizations should be concerned with sexually related adverse effects of antidepressants, insofar as additional healthcare resources may be required to treat depressed patients in whom these adverse effects arise.
Herbal and Nonherbal Alternative Medicine Use in Northwest Ohio
Authors: Martin Karen J , Jordan Timothy R , Vassar Alisha D , White Donald B
Published: June 2003

OBJECTIVE:

To determine the prevalence and characteristics of herbal and nonherbal alternative medicine use among adults living in northwest Ohio.

DESIGN:

Cross-sectional survey.

SETTING:

Three grocery store intercepts in northwest Ohio.

SUBJECTS:

A consecutive sample of 326 English-speaking persons ≥18 years old.

METHODS:

A 26-item survey self-administered to participants over a 6-month period.

OUTCOME MEASURES:

Prevalence of herbal remedy use.

RESULTS:

Forty percent of respondents have used an herbal remedy during the last 12 months. The average number of herbs used was 2.3 per person. Herbal remedy use was not associated with specific sociodemographic variables. Desire to improve general health was the most common reason for use of an herbal remedy (16%). Herbal users cited “herbals are natural” as the most common benefit. Magazines (17%), health food stores (16%), and friends (14%) were the most common sources of herbal remedy information. Only 50% of the population informed their physician of such use. Forty-one percent used an herbal remedy sometimes to always to self-treat before seeking medical care from a physician. Fifteen percent of adults treated their children with herbs. Nearly all (86%) respondents believed the herb was helpful or very helpful.

CONCLUSIONS:

A significant number of the adults surveyed in the Toledo metropolitan area commonly used complementary and alternative medicine (CAM). There were no independent factors associated with herbal remedy use. It is important for healthcare providers to acknowledge this growing trend of CAM therapy use and begin to incorporate open discussion about CAM into the patient—provider relationship.
Reversible Thrombocytopenia Associated with Eptifibatide
Authors: Yoder Monty , Edwards Rebecca F
Published: June 2003

OBJECTIVE:

To report a patient who experienced severe, reversible thrombocytopenia after receiving eptifibatide for acute coronary syndrome.

CASE SUMMARY:

A 61-year-old white man with a past medical history of coronary artery disease, peripheral vascular disease, insulin-dependent diabetes, hypertension, and dyslipidemia was treated with eptifibatide as an adjunct to standard antiischemic therapy for acute coronary syndrome. On administration of eptifibatide, the patient experienced chills accompanied by sharp pains that radiated throughout his body. The infusion was immediately stopped and the symptoms resolved. A platelet count obtained 11 hours later showed a decrease from a baseline of 230 to 3 × 103/mm3 (normal 160–360). Multiple platelet analyses confirmed profound thrombocytopenia. Over the course of the hospitalization, the patient's platelet count returned to normal; he experienced no other adverse hematologic sequelae.

DISCUSSION:

All of the glycoprotein IIb/IIIa receptor antagonists are associated with thrombocytopenia. However, the risk of thrombocytopenia has been observed to be less with eptifibatide. Because of the temporal relationship between eptifibatide administration and the patient's symptoms and laboratory analysis, we believe that the thrombocytopenia was the result of an adverse reaction.

CONCLUSIONS:

The temporal relationship to administration and the resolution of the adverse reaction on discontinuation of the drug support the likelihood that the severe, reversible thrombocytopenia was associated with eptifibatide.
Risedronate for the Prevention of Fractures in Postmenopausal Osteoporosis
Authors: Sickels Jennifer M , Nip Chi-Sing
Published: June 2003

OBJECTIVE:

To evaluate current scientific literature regarding the efficacy of risedronate in the prevention of vertebral and nonvertebral fractures in women with postmenopausal osteoporosis.

DATA SOURCES:

Primary research articles were identified by MEDLINE search (1966–May 2001) and through secondary sources. Key search terms were risedronate, postmenopausal osteoporosis, and fractures.

DATA SYNTHESIS:

Osteoporosis results in a reduction of bone mineral density, increased bone fragility, and increased risk of fractures. The goal of osteoporosis therapy is not only to increase bone mass, but also to reduce the rate of fractures. Risedronate is the newest bisphosphonate to be approved for the prevention and treatment of osteoporosis. An evaluation of clinical trials using risedronate in the treatment of postmenopausal osteoporosis was performed to determine its efficacy at decreasing fracture rates.

CONCLUSIONS:

Risedronate is an effective and safe option for the treatment of postmenopausal osteoporosis. Risedronate significantly decreases the risk of vertebral and nonvertebral fractures in women who have had ≥1 fractures in the past. More studies are warranted to evaluate the efficacy of risedronate in women without preexisting vertebral fractures.
Clinical Pharmacy in a South Indian Teaching Hospital
Authors: Parthasarathi Gurumurthy , Ramesh Madhan , Nyfort-Hansen Karin , Nagavi Bahubali Gundappa
Published: June 2003

OBJECTIVE:

To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing medication use problems, which are commonly encountered in India.

Clinical pharmacy is practiced in many countries and makes a significant contribution to improved drug therapy and patient care. India is a country with significant problems with medication use, but until recently Indian pharmacists have not been educated for a patient-care role. Postgraduate pharmacy practice programs have been established at 2 pharmacy colleges in South India as a result of a joint Indo-Australian program of cooperation. At a teaching hospital associated with the colleges, clinical pharmacy services such as drug information, medication counseling, drug therapy review, adverse drug reaction reporting, and the preparation of antibiotic guidelines are assisting clinicians to improve drug therapy and patient care. Seven hundred twenty-seven requests for drug information were received from July 1997 to February 2001, and 543 suspected adverse drug reactions were evaluated from November 1997 to February 2001. The most common drug classes causing adverse drug reactions were antibiotics, nonsteroidal antiinflammatory drugs, and antitubercular agents. Physician opinion and service utilization have also been surveyed: 82% of respondents had sought drug information from the Clinical Pharmacy Department and 71% of respondents had sought advice on individual patient management. The success of this program is raising awareness of clinical pharmacy among pharmacy educators elsewhere in India and has led to the introduction of clinical pharmacy services at other Indian hospitals.
Geriatric Drug Therapy and Healthcare Utilization in the United Kingdom
Authors: Kennerfalk Anita , Ruigómez Ana , Wallander Mari-Ann , Wilhelmsen Lars , Johansson Saga
Published: June 2003

OBJECTIVE:

To describe the use of prescription drug therapy, especially polypharmacy, in an elderly general population; to relate that use to age, gender, and different types of healthcare utilization; and to investigate the influence of selection of different time windows on the result of the quantity as well as the categories of drugs used.

METHODS:

Data on a sample of 5000 patients aged 65–90 years in 1996 were derived from the General Practice Research Database (GPRD). The population covered by GPRD is broadly representative of the UK population treated in general practice. Drug use was assessed using 2 time windows — Current use of individual drugs on a random day (index date) and 1 month following the index date. Healthcare utilization was analyzed by use of information on visits to general practitioners (GPs), hospitalizations, and referrals to specialists.

RESULTS:

Women used more drugs than men; however, the prevalence of polypharmacy, defined as concomitant use of ≥5 drugs, was similar in both genders. The most frequently used therapeutic groups were cardiovascular, central nervous, and gastrointestinal system drugs. Almost 80% of both women and men visited a GP at least once a year. Overall, women used more ambulatory care services and men were hospitalized more often. Use of random date compared with 1-month period resulted in a significant underestimation of the amount of drugs used for acute conditions and, consequently, the risk of polypharmacy.

CONCLUSIONS:

The overall results confirm the findings in earlier studies suggesting that the GPRD might be a useful tool in further studies on prescription drug use among elderly persons. More information on the appropriateness of drug use is needed to prevent overuse as well as underuse of medications among the elderly.
Effects of Panax Ginseng on Quality of Life
Authors: Ellis Jennifer M , Reddy Prabashni
Published: June 2003

OBJECTIVE:

To assess the time-dependent effects of Panax ginseng on health-related quality of life (HRQOL) by use of a general health status questionnaire.

METHODS:

Subjects were randomized in a double-blind manner to P. ginseng 200 mg/d (n = 15) or placebo (n = 15) for 8 weeks. The Short Form-36 Health Survey version 2 (SF-36v2), a validated general health status questionnaire, was used to assess HRQOL at baseline and at 4 and 8 weeks. HRQOL between the groups was compared by use of repeated-measures analysis of covariance. A p value <0.05 was considered statistically significant.

RESULTS:

There were no significant differences in baseline demographics and SF-36v2 scores between the groups. After 4 weeks of therapy, higher scores in social functioning ( P. ginseng 54.9 ± 4.6 vs. placebo 49.2 ± 6.5; p = 0.014), mental health ( P. ginseng 52.2 ± 7.7 vs. placebo 47.2 ± 7.3; p = 0.075), and the mental component summary ( P. ginseng 51.3 ± 7.4 vs. placebo 44.3 ± 8.3; p = 0.019) scales were observed in patients randomized to P. ginseng; these differences did not persist to the 8-week time point. The incidence of adverse effects was 33% in the P. ginseng group compared with 17% in the placebo group (p = 0.40). Subjects given P. ginseng (58%) were more likely to state that they received active therapy than subjects given placebo (17%; p < 0.05).

CONCLUSIONS:

P. ginseng improves aspects of mental health and social functioning after 4 weeks of therapy, although these differences attenuate with continued use.
Collaborative Care Model to Improve Outcomes in Major Depression
Authors: Boudreau Denise M , Capoccia Kam L , Sullivan Sean D , Blough David K , Ellsworth Allan J , Clark Dave L , Katon Wayne J , Walker Edward A , Stevens Nancy G
Published: June 2003

OBJECTIVE:

To develop a pharmacist intervention to improve depression care and outcomes within a primary care setting.

METHODS:

Pragmatic, randomized trial of a clinical pharmacist collaborative care intervention versus usual care in a busy, academic family practice clinic.

RESULTS:

Seventy-four patients diagnosed with a new episode of major depression and started on antidepressant medications were randomized to enhanced care (EC) or usual care (UC) groups. EC consists of a clinical pharmacist collaborating with primary care providers (PCPs) to facilitate education, initiation, and titration of acute-phase antidepressant treatment to monitor treatment adherence and to prevent relapse. Control patients receive UC by their PCP. The main end point is reduction of depression symptoms over time as measured by the Hopkins Symptom Checklist (SCL-20). Other outcomes include the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) criteria for major depression, health-related quality of life measured by the Medical Outcomes Study Short Form 12 (SF-12), medication adherence, patient satisfaction, and healthcare utilization. The main end point and the cost of treating major depression will be used to estimate the cost-effectiveness of the collaborative care model.

CONCLUSIONS:

The study is a unique, ongoing trial that may have important implications for the treatment of depression in primary care settings as well as new roles for clinical pharmacists.
Cross-Sensitivity between Paroxetine and Sertraline
Authors: Warnock Caroline A , Azadian Abbas G
Published: June 2003

OBJECTIVE:

To report a case of possible cross-sensitivity between selective serotonin-reuptake inhibitors (SSRIs).

CASE SUMMARY:

A 20-year-old Southeast Asian man developed a maculopapular rash soon after starting paroxetine. Following resolution of this rash, another skin reaction with the same distribution and appearance occurred after sertraline therapy was started.

DISCUSSION:

Cross-reactivity between drugs with similar structures has been reported; however, cross-reactivity among SSRI antidepressants is unexpected given their differences in chemical structure.

CONCLUSIONS:

The possibility of cross-reactivity between SSRI antidepressants should be considered by clinicians who wish to switch from one SSRI to another due to a dermatologic reaction.
Fluoxetine in the Treatment of Premenstrual Dysphoric Disorder
Authors: Carr Roxane R , Ensom Mary HH
Published: June 2003

OBJECTIVE:

To examine the role of fluoxetine in the treatment of premenstrual dysphoric disorder (PMDD).

DATA SOURCES:

Search strategy included MEDLINE (1966–February 2002), Embase (1988–February 2002), HealthStar (1975–December 2000), Current Contents (1996–November 2001), and Copernic (November 2001). Search terms included fluoxetine, premenstrual dysphoric disorder, PMDD, late luteal-phase dysphoric disorder, and severe premenstrual syndrome.

STUDY SELECTION:

English-language human studies were selected and evaluated based on quality of evidence.

DATA SYNTHESIS:

Eight prospective trials (3 double-blind, placebo-controlled, crossover; 3 double-blind, randomized, controlled; 2 open-label), 1 case series, and 1 meta-analysis were identified. Although 6 of the studies involved small sample sizes (n < 50), all found fluoxetine to be effective in the treatment of PMDD.

CONCLUSIONS:

Despite limited data, fluoxetine 20 mg/d appears to be effective in the treatment of PMDD. However, adverse effects, particularly headaches and sexual dysfunction, are possible. Given the long half-life of fluoxetine and the short duration of PMDD symptoms per cycle, larger, well-designed clinical trials evaluating intermittent dosing for only 1 week or a few doses need to be performed.
Effect of Coffee Consumption on Intraocular Pressure
Authors: Avisar Rahamim , Avisar Erez , Weinberger Dov
Published: June 2003

BACKGROUND:

Many ophthalmologists instruct patients with glaucoma to avoid coffee, although data supporting this practice are insufficient.

OBJECTIVE:

To estimate the effect of drinking coffee on intraocular pressure (IOP).

METHODS:

In this crossover study, the effect of the consumption of regular (180 mg caffeine in 200 mL beverage) and decaffeinated coffee (3.6 mg caffeine in 200 mL beverage) was compared in patients with normotensive glaucoma (n = 6) or ocular hypertension (n = 22). IOP was monitored in both groups at 30, 60, and 90 minutes after coffee ingestion.

RESULTS:

In patients with normotensive glaucoma who drank regular coffee, the mean ± SD changes in IOP at 30, 60, and 90 minutes were 0.9 ± 0.5, 3.6 ± 1.1, and 2.3 ± 0.66 mm Hg, respectively; in those who drank decaffeinated coffee, they were 0.75 ± 0.36, 0.70 ± 0.4, and 0.4 ± 0.6 mm Hg, respectively. The corresponding values in patients with ocular hypertension were as follows: after regular coffee, 1.1 ± 0.7, 3.4 ± 1.0, and 3.0 ± 2.7 mm Hg; and after decaffeinated coffee, 0.6 ± 0.4, 0.9 ± 0.2, and 0.5 ± 0.5 mm Hg. The difference in the change in IOP from baseline after ingestion of regular versus decaffeinated coffee was statistically significant in each group at 60 and 90 minutes. Subjects who drank regular coffee demonstrated a greater elevation in IOP; this elevation may be clinically significant.

CONCLUSIONS:

Intake of caffeinated beverage (≥180 mg caffeine) may not be recommended for patients with normotensive glaucoma or ocular hypertension.
Efavirenz-Induced Skin Eruption and Successful Desensitization
Authors: Phillips Elizabeth J , Kuriakose Beena , Knowles Sandra R
Published: June 2003

OBJECTIVE:

To report a patient with efavirenz-induced hypersensitivity syndrome reaction who was successfully desensitized to efavirenz.

CASE SUMMARY:

A 37-year-old HIV-positive white man was placed on efavirenz, amprenavir, stavudine, lamivudine, and didanosine due to virologic failure with a previous regimen. Eight days into treatment, the patient developed a generalized rash and all medication was discontinued. Two weeks later, he was started on efavirenz, stavudine, didanosine, lamivudine, and lopinavir. The next morning, he awoke with red, itchy skin. All of the medications were discontinued. At the HIV Drug Safety Clinic, the patient was successfully restarted on amprenavir, stavudine, didanosine, lamivudine, and lopinavir. A 14-day desensitization to efavirenz was also undertaken; on day 12 of the desensitization, he once again developed a rash. He was treated symptomatically, and the desensitization protocol was extended. Sixteen months following the successful desensitization, he is tolerating full-dose efavirenz in combination with the other antiretroviral agents.

DISCUSSION:

The incidence of efavirenz-induced hypersensitivity ranges between 10% and 34%. Generally, an erythematous, maculopapular rash with or without fever develops 1–3 weeks after the initiation of therapy. In many patients without systemic manifestations, an attempt should be made to continue therapy and treat the rash symptomatically. If this fails, desensitization with the implicated drug can be tried.

CONCLUSIONS:

A history of antiretroviral-induced hypersensitivity reactions often limits the choices of medications that can be used in subsequent treatment regimens. Desensitization may allow for the continued use of previously restricted medications.
Colchicine-Induced Rhabdomyolysis
Authors: Boomershine Kellie H
Published: June 2003

OBJECTIVE:

To report a case of rhabdomyolysis occurring during treatment with colchicine.

CASE SUMMARY:

A 44-year-old African American man was admitted to the hospital due to persistent diarrhea, vomiting, and diffuse weakness. Past medical history was significant for renal failure requiring peritoneal dialysis, gout, and a new skin lesion. Approximately 2 months prior to admission, he had been started on colchicine and allopurinol. Creatine kinase concentration on admission was >14 000 U/L. Liver function tests were elevated 5 × the upper limit of normal. Colchicine was discontinued on admission. Creatine kinase concentrations decreased significantly, and strength and ambulation improved throughout hospitalization.

DISCUSSION:

Colchicine was thought to be the causative factor for rhabdomyolysis in conjunction with chronic renal failure and elevated liver function tests. After discontinuation of colchicine, creatinine kinase concentrations declined and the patient's ability to walk improved. Limited case reports of colchicine-induced rhabdomyolysis have been published.

CONCLUSIONS:

Chronic renal failure in conjunction with elevated liver function tests appear to increase the possibility of colchicine-induced toxicity, specifically, rhabdomyolysis.
Accuracy and Precision of the CoaguChek S versus Laboratory INRs in a Clinic
Authors: Havrda Dawn E , Hawk Toni L , Marvin Carrie M
Published: June 2003

BACKGROUND:

The CoaguChek S is the next-generation coagulation monitor for measuring the international normalized ratio (INR) that replaces the CoaguChek device. Studies are lacking comparing the CoaguChek S with local laboratory INR assessment to ensure its accuracy and precision for monitoring patients on anticoagulation.

OBJECTIVE:

To evaluate accuracy, precision, and technical ease-of-use of the CoaguChek S compared with laboratory measurements.

METHODS:

Accuracy was evaluated in 101 patients by parallel assessment of INRs (CoaguChek S and laboratory); precision was evaluated in 31 patients using duplicate INRs from CoaguChek S and laboratory and from liquid quality controls. Accuracy was determined using orthogonal regression, Bland—Altman plot, and clinical applicability (INRs discrepant in categorization of INR goal and resulting in different therapeutic decisions). Precision was examined by comparing mean difference ± SD between repeated INRs from CoaguChek S and laboratory, coefficient of variation (CV), and coefficient of repeatability (CR). The influence of low and elevated INRs on accuracy and precision was also examined. To assess ease-of-use of the monitor, the number of technical errors was recorded.

RESULTS:

The CoaguChek S significantly correlated to laboratory measurement (r = 0.93); 16.7% of INRs resulted in discrepant categorization and 24.5% would have required a different therapeutic plan. The CV and CR compared well between CoaguChek S and laboratory (6% vs. 4.9%; 0.455 vs. 0.346, respectively). When subgroups of INR values <4.0 and <3.0 were evaluated, the precision improved with both methods. Precision, based on liquid quality controls, was good (CV 4.6% = low-level; 3.3% = high-level). The CoaguChek S was found to have an error rate of 1.8%.

CONCLUSIONS:

The CoaguChek S is an accurate and precise alternative to laboratory assessment of the INR at values <4.0; it is an efficient device with a low likelihood of errors during testing.
Fluticasone versus Salmeterol/Low-Dose Fluticasone for Long-Term Asthma Control
Authors: Heyneman Catherine A , Crafts Rachel , Holland Jerry , Arnold Aaron D
Published: June 2003

OBJECTIVE:

To evaluate the relative clinical superiority of increasing the dose of fluticasone propionate versus the addition of salmeterol to low-dose fluticasone propionate for long-term asthma control.

DATA SOURCES:

Literature was identified by a MEDLINE search (1966–October 2002). Key search terms included asthma, inhalation, corticosteroid, β-adrenergic agonist, and combination drug therapy.

DATA SYNTHESIS:

Current guidelines for long-term control of asthma include treatment with either inhaled corticosteroids (medium dose) or inhaled corticosteroids (low to medium dose) in combination with a long-acting bronchodilator. Previous studies evaluating salmeterol or formoterol combination therapy with beclomethasone or budesonide have generally produced superior results compared with increasing the dose of the inhaled corticosteroid. Four recent controlled clinical trials have compared the clinical utility of fluticasone propionate monotherapy versus salmeterol/low-dose fluticasone propionate for long-term asthma control in patients with moderate to severe persistent asthma. Based on spirometry data, rescue albuterol use, and symptom scores, the addition of salmeterol to low-dose fluticasone propionate was superior to increasing the dose of fluticasone propionate.

CONCLUSIONS:

Based on improvements in forced expiratory volume in 1 second, peak expiratory flow, and symptom control, the addition of salmeterol to low-dose fluticasone propionate provides better control of asthma than increasing the dose of fluticasone propionate.
Neonatal Cholestatic Hepatitis from Carbamazepine Exposure during Pregnancy and Breast Feeding
Authors: Frey Bernhard , Braegger Christian P , Ghelfi Daniela
Published: June 2003

OBJECTIVE:

To report a case of transient cholestatic hepatitis occurring in an infant between the third and seventh weeks of life, most likely due to carbamazepine exposure during pregnancy and breast feeding.

CASE SUMMARY:

A boy, born to an epileptic mother who had been treated with carbamazepine monotherapy throughout pregnancy and breast feeding, experienced asphyxia at birth with transient hepatic dysfunction in the first week of life. After full recovery from asphyxia, he experienced a second period of liver dysfunction, presenting as cholestatic hepatitis that lasted approximately 5 weeks. Infectious and metabolic etiologies as well as extrahepatic biliary atresia were excluded.

DISCUSSION:

Carbamazepine is known to induce hepatic damage in children and adults. As the drug crosses the placenta and is excreted into breast milk, infants of mothers taking carbamazepine might also develop liver dysfunction. In addition to the present case, there are 2 well-documented case reports of cholestasis in association with transplacental and transmammary carbamazepine exposure.

CONCLUSIONS:

Carbamazepine-induced hepatitis may occur in association with prenatal exposure and breast feeding. This may expose infants to unnecessary diagnostic procedures, and should therefore be mentioned in the company's product information.
Substitution of Generic Warfarin for Coumadin in an HMO Setting
Authors: Milligan Paul E , Banet Gerald A , Waterman Amy D , Gatchel Susan K , Gage Brian F
Published: June 2003

BACKGROUND:

Substitution of generic warfarin for Coumadin presents safety concerns due to warfarin's narrow therapeutic index and because a prior generic formulation was removed from the US market after it was associated with adverse events.

OBJECTIVE:

To determine whether a health maintenance organization (HMO) can add generic warfarin to its formulary without adversely affecting warfarin management or increasing adverse events.

DESIGN:

In a prospective, observational study, an HMO that formerly dispensed only Coumadin added a generic warfarin preparation (Barr Laboratories, Pomona, NY) to its formulary.

SETTING:

An anticoagulation service (ACS) affiliated with an HMO that was based in St. Louis, MO.

PARTICIPANTS:

The cohort consisted of 182 enrollees in the ACS as of May 1, 1999. At the start of the study, these participants were taking Coumadin; by October 31, 2000, all had switched to Barr warfarin.

MEASUREMENTS AND MAIN RESULTS:

We collected data 8 months prior to and 10 months after the introduction of generic warfarin for the following endpoints: international normalized ratio (INR) control, frequency of INR monitoring, number of dose changes, and rate of thrombotic and hemorrhagic events. Statistical process control charts were used to differentiate between random variation in the endpoints and changes due to different warfarin formulations, and we used the Wilcoxon signed-rank test to look for a change in any endpoint after patients changed to generic warfarin. No significant differences were found in any endpoint.

CONCLUSIONS:

Substitution of Barr warfarin for Coumadin did not significantly affect INR control, warfarin management, or adverse events. Our findings suggest that HMOs can safely substitute at least 1 generic formulation of warfarin without extra monitoring.
Exploring Prescription Drug Coverage and Drug Use for Older Americans
Authors: Mott David A , Schommer Jon C
Published: June 2003

OBJECTIVE:

To describe existing prescription drug insurance coverage for older Americans, to describe out-of-pocket payment levels per prescription associated with service benefit prescription drug plans used by older persons, and to examine the association of prescription drug coverage types with the reported use of prescription drugs by older persons.

PATIENTS AND METHODS:

Data were obtained from a national survey of 1570 community-dwelling older persons (≥65 y) conducted in June 1998. A 2-part utilization model was estimated using logistic regression and ordinary least-squares regression.

RESULTS:

Data from 310 respondents were used for analysis. Overall, 66.1% of respondents reported having prescription drug insurance coverage. A majority (76.6%) of respondents having private drug coverage reported having a service benefit plan (requiring copayment or coinsurance amount to be paid for each prescription). The median copayment per brand name and generic prescription for persons reporting having coverage by service benefit plans was $10 and $5, respectively.

CONCLUSIONS:

Overall, a majority of older persons reported paying relatively small amounts out-of-pocket per prescription during 1998. Among persons who reported having drug insurance coverage, there were no statistically significant differences in the reported number of drugs used daily, regardless of out-of-pocket payment amount per prescription. Patient need and level of past drug use were significantly associated with both the likelihood of using any prescription drugs and the level of use among users. More research is needed to examine differences in drug expenditures and characteristics of drugs used across prescription drug insurance types for older persons.
Development and Evaluation of an Electronic Drug and Therapeutics Bulletin
Authors: Alderman Christopher P
Published: June 2003

OBJECTIVE:

To describe the development, implementation, and initial evaluation of a paperless drug and therapeutics bulletin that is distributed by electronic mail from the pharmacy department of an Australian teaching hospital.

OUTCOMES:

A standardized format for the bulletin was designed and approved in February 2001. The aim of the bulletin is to facilitate the timely dissemination of concise, factual information about issues of current interest in therapeutics, drug safety, and the cost-effective use of medicines. A simple and attractive graphic design was chosen, and the hospital's clinical pharmacists and drug information staff developed an initial bank of content during the period immediately preceding the launch. The bulletin is presented as a 1-page, read-only file in Word for Windows format and was initially distributed by electronic mail to all users of the hospital's computerized communication network. As the popularity of the bulletin increased, healthcare practitioners from outside of the hospital began to request permission for inclusion on the circulation list, and the content was frequently forwarded by E-mail to workers in other hospitals and community-based settings. The bulletin is now distributed to pharmacists around Australia via 2 separate moderated discussion lists, one of which provides an archive site for previous editions. Healthcare workers in Singapore, the US, Canada, and New Zealand also receive the bulletin, which is now also abstracted by a major Australian pharmacy journal. A readership survey (also electronically distributed) was used to seek feedback after the publication of the first 12 editions. Readers indicated a high level of satisfaction with the content, format, and frequency of distribution of the materials.

CONCLUSIONS:

Although the concept and execution of this project was relatively simple, an extensive literature review did not reveal any previously published reports describing this type of approach to the distribution of a pharmacy bulletin. The development and implementation of the electronic drug and therapeutics bulletin has provided an opportunity to use modern communication technology to promote safe and effective medication use and appears to have been well received.
Headache Education in Colleges of Pharmacy
Authors: Wenzel Richard G , Neidich Mindy R
Published: June 2003

OBJECTIVE:

To assess primary headache education in colleges of pharmacy during the 2000–2001 academic year.

DESIGN:

A survey seeking to quantify students' primary headache education was mailed to all 82 American Association of Colleges of Pharmacy member schools.

RESULTS:

A usable response was obtained from 65 of 74 answering schools. Per professional year, the average pharmacy student receives 1 headache core course contact hour and no headache elective course contact hours. Two schools offer clerkships devoted exclusively to headaches. Six schools offer clerkships in which a student could expect to focus on headache therapy at least 25% of the time. Seven schools plan to alter their current curriculum to include more headache education, all via additional lectures.

CONCLUSIONS:

Few opportunities exist for students to learn about primary headaches in colleges of pharmacy. Given the high prevalence and poor medical management of primary headache disorders along with the commonality of pharmacist—headache patient interactions occurring in practice, pharmacy schools should evaluate and alter their curriculum to include more primary headache education.
Acute Renal Failure in Hospitalized Patients: Part I
Authors: Pruchnicki Maria C , Dasta Joseph F
Published: June 2003

BACKGROUND:

Acute renal failure (ARF) is a common condition in hospitalized patients. Morbidity, mortality, and health resource use are considerable, but the true magnitude of the problem is not well described in the literature.

OBJECTIVE:

To provide a detailed discussion of the epidemiology, economic costs, and classification of ARF.

DATA SOURCES:

A MEDLINE search (1996–December 2001) was conducted using the search terms kidney and acute kidney failure: epidemiology, etiology, and drug therapy/drug effects. Bibliographies of selected articles were also examined to include all relevant investigations. Economic data were identified using the terms costs and cost analysis and cost of illness.

STUDY SELECTION AND DATA EXTRACTION:

Review articles, meta-analyses, and clinical trials describing epidemiology and classification of hospital-acquired ARF were identified. Results from prospective, controlled trials were given priority when available.

CONCLUSIONS:

ARF occurs in up to 25% of critically ill patients, resulting in significant morbidity and high mortality. Characterization of ARF is difficult due to multiple etiologic factors and variable definitions. Limited cost data describe the extensive economic burden associated with the disorder, although further pharmacoeconomic research is needed. Epidemiology and classification of ARF allow prospective management of at-risk patients.
Postfertilization Effect of Hormonal Emergency Contraception
Authors: Kahlenborn Chris , Stanford Joseph B , Larimore Walter L
Published: June 2003

OBJECTIVE:

To assess the possibility of a postfertilization effect in regard to the most common types of hormonal emergency contraception (EC) used in the US and to explore the ethical impact of this possibility.

DATA SOURCES AND STUDY SELECTION:

A MEDLINE search (1966–November 2001) was done to identify all pertinent English-language journal articles. A review of reference sections of the major review articles was performed to identify additional articles. Search terms included emergency contraception, postcoital contraception, postfertilization effect, Yuzpe regimen, levonorgestrel, mechanism of action, Plan B.

DATA SYNTHESIS:

The 2 most common types of hormonal EC used in the US are the Yuzpe regimen (high-dose ethinyl estradiol with high-dose levonorgestrel) and Plan B (high-dose levonorgestrel alone). Although both methods sometimes stop ovulation, they may also act by reducing the probability of implantation, due to their adverse effect on the endometrium (a postfertilization effect). The available evidence for a postfertilization effect is moderately strong, whether hormonal EC is used in the preovulatory, ovulatory, or postovulatory phase of the menstrual cycle.

CONCLUSIONS:

Based on the present theoretical and empirical evidence, both the Yuzpe regimen and Plan B likely act at × by causing a postfertilization effect, regardless of when in the menstrual cycle they are used. These findings have potential implications in such areas as informed consent, emergency department protocols, and conscience clauses.