bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stability of Ondansetron Stored in Polypropylene Syringes
Authors: Casto Daniel T. 
Published: January 2017

OBJECTIVE: To evaluate the stability of ondansetron hydrochloride undiluted and mixed in dextrose 5% injection or NaCl 0.9% injection during storage in polypropylene syringes when frozen, refrigerated, or at room temperature. DESIGN: Batch quantities of ondansetron 0.25, 0.5, 1.0, and 2.0 mg/mL were prepared and individual doses of 10.5 mg were drawn into polypropylene syringes that were stored at −20 °C for up to 3 months, at 4 °C for up to two weeks, or at 22–25 °C for two days, and various combinations of these conditions. At defined sampling times aliquots were withdrawn from syringes, the solution visually inspected, pH measured, and ondansetron concentration determined by HPLC. Drug loss of ≥10 percent of the original content of the solution was considered clinically significant. RESULTS: The ondansetron concentration in each solution, regardless of storage conditions, remained above 90 percent of the original concentration at each observation time (range 92–107 percent). No changes in color or clarity of any of the solutions were observed, and only slight fluctuations in pH (≤0.05) were noted. CONCLUSIONS: Ondansetron 2 mg/mL undiluted, or at concentrations of 0.25, 0.5, or 1 mg/mL, mixed in dextrose 5% injection or NaCl 0.9% injection was determined to be stable when stored in polypropylene syringes for each storage condition at all time points studied, including the maximum for each: three months at −20 °C, followed by 14 days at 4 °C, and by 48 hours at 22–25 °C.
Erythema Multiforme and Hypersensivity Myocarditis Caused by Ampicillin
Authors: Garty Ben Zion , Offer Itamar , Livni Ella , Danon Yehuda L. 
Published: January 2017

OBJECTIVE: To report a case of erythema multiforme and hypersensitivity myocarditis caused by ampicillin. CASE SUMMARY: A 13-year-old boy was treated with ampicillin and gentamicin because of suspected septicemia. Medications were discontinued when erythema multiforme and congestive heart failure caused by myocarditis occurred. The patient was treated with methylprednisolone and gradually improved. Macrophage-migration inhibition (MIF) test with ampicillin was positive. DISCUSSION: After most infections causing erythema multiforme and myocarditis were ruled out, a drug-induced allergic reaction was suspected. Positive MIF test for ampicillin showed sensitization of the patient's lymphocytes to ampicillin. CONCLUSIONS: Hypersensitivity myocarditis is a rare and dangerous manifestation of allergy to penicillins.
Tacrine: First Drug Approved for Alzheimer's Disease
Authors: Crismon M. Lynn 
Published: January 2017

OBJECTIVE: To review the pharmacology, biopharmaceutics/pharmacokinetics, clinical efficacy, adverse effects, and therapeutic considerations regarding the use of tacrine in patients with Alzheimer's disease. DATA SOURCES: Data from the scientific and professional literature were analyzed, interpreted, and summarized. Citations were obtained by performing a MEDLINE search using the following indexing terms: tacrine, tetrahydroaminoacridine, and Alzheimer's drug therapy. Data also were obtained from a summary of the New Drug Application (Summary Basis of Approval of Cognex) and from the approved product labeling. STUDY SELECTION: Studies in Alzheimer's disease have been plagued by methodologic inconsistencies and deficiencies. Only efficacy studies subsequent to the Food and Drug Administration's (FDA) issuance of recommendations for studies in Alzheimer's disease (1991) were used. Therefore, only double-blind, placebo-controlled, parallel design studies of at least three-month's duration using the Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Clinical Interview-Based Impression of Change as efficacy parameters were included. DATA EXTRACTION: Trials were assessed according to the criteria listed above. Results were evaluated on the basis of both completed patients and last observation carried forward models. DATA SYNTHESIS: Tacrine is a cholinesterase inhibitor that increases the availability of acetylcholine in muscarinic neurons. It has a mean bioavailability after oral administration of about 17 percent and an elimination half-life of approximately three hours. Although drug interactions are poorly studied, tacrine is metabolized by isoenzyme P-450IA2 and may interact with other drugs metabolized by this isoenzyme. Tacrine has been shown to have efficacy in mildly to moderately impaired Alzheimer's patients on both psychometric testing and a clinician's structured interview. Although efficacious, its effects are not dramatic, and it does not affect the ultimate course of the disease. Adverse effects are frequent, and significantly elevated hepatic transaminase concentrations may occur in approximately 25 percent of patients. CONCLUSIONS: Tacrine is the first drug approved by the FDA for treatment of Alzheimer's disease. Although it may improve psychometric test scores in mild to moderately impaired patients, it is not a panacea and does not affect the course of the disease. Patients must be monitored closely for elevated transaminase, cholinergic adverse effects, and interactions with drugs metabolized through P-450IA2.
Beyond Thrombolysis: Other Effects of Thrombolytic Drugs
Authors: Stringer Kathleen A. 
Published: January 2017

OBJECTIVE: To review the effects of plasminogen activators (tissue plasminogen activator, streptokinase, and anistreplase) on fibrinogen and thrombin, platelets, complement, blood rheology, and neutrophils. DATA SOURCES: A MEDLINE search, as well as a review of recent scientific abstracts, was conducted to identify pertinent literature. STUDY SELECTION: Focus was placed on studies conducted in humans. However, many in vitro studies have been performed to fully elucidate the effect of plasminogen activators on different aspects of hemostasis and on the fibrinolytic and immune systems. DATA EXTRACTION: Data from in vitro, human, and animal studies were evaluated. DATA SYNTHESIS: There is a discrepancy between 9O-minute patency and mortality in acute myocardial infarction patients treated with thrombolytic drugs. This could be caused, in part, by other hematologic and immunologic effects of thrombolytic drugs. Though the emphasis of clinical trials has been infarct-related artery patency, left ventricular function, and mortality, some studies have evaluated the effect of thrombolytic agents on fibrinogen and thrombin, platelets, blood rheology, complement, and neutrophils. This review discusses the alteration of systemic hematologic and immunologic parameters by thrombolytic drugs and the possible clinical implications of these effects. CONCLUSIONS: Although the interactions between thrombolytic drugs, hemostasis, and the fibrinolytic and immune systems are complex and still not fully understood, it appears that these drugs differ in their effects on these systems. A greater understanding of these properties and their clinical implications may ultimately enhance the care and outcome of acute myocardial infarction patients treated with thrombolytic therapy.
Immunization Requirements for Pharmacy Students
Authors: Mallet Louise , Bucci Kathryn K. 
Published: January 2017

OBJECTIVE: To identify current immunization requirements for pharmacy students throughout the US. DESIGN: Self-administered questionnaire. SETTING: Seventy-five colleges and schools of pharmacy in the US. MAIN OUTCOME MEASURES: Immunization policies, immunologic requirements, timing of vaccination in relation to the beginning of clerkship experience, payment, mechanism to revise policies. DATA ANALYSIS: Descriptive statistics. RESULTS: Overall, 57 programs (81 percent) have an immunization program in place, but 13 programs (19 percent) have no immunization program. More than 50 percent of the colleges or schools reported requiring that pharmacy students have measles, mumps, rubella, tetanus, and purified protein derivative of tuberculin (PPD) vaccinations upon entry of clerkship. Only 25 colleges or schools of pharmacy (44 percent) required students to have the hepatitis B vaccine and 8 (14 percent) to have a PPD evaluation upon completion of clerkship experience. Responsibility for the immunization program was shared evenly between the clerkship coordinator and the student health clinic. Approximately 65 percent of programs maintain an immunization record on file for each student. Completion of immunizations was required in 36 schools (64 percent) before entering clerkship activities, 15 (26 percent) before entrance to the professional program, and 3 (5 percent) in the first year of the program. Six schools (11 percent) had a program in place for less than one year, 27 (47 percent) between one and five years, and 24 (42 percent) for more than five years. At the majority of schools, students are responsible for the cost of immunization. CONCLUSIONS: Most schools of pharmacy do not adhere to the specific immunization recommendations described by the Centers for Disease Control and Prevention for healthcare workers. Pharmacy schools need to reexamine their immunization policies and update them to reflect the most current standards. We suggest a policy for immunization of pharmacy students.
Lisinopril Overdose and Management with Intravenous Angiotensin II
Authors: Trilli Lauren E. , Johnson Kjel A. 
Published: January 2017

OBJECTIVE: This report describes a case of lisinopril overdose managed in part with an infusion of angiotensin II in a patient with dilated cardiomyopathy and reviews other literature reporting angiotensin-converting enzyme (ACE) inhibitor overdose. DATA SOURCES: Information concerning this patient was obtained through review of the medical chart, conversation with the attending physician, and personal involvement late in the course of the patient's therapy. We conducted MEDLINE and PAPERCHASE searches of the English language literature (restricted to human studies) from 1976 to the present, manually searched Current Contents and references from each publication reviewed, and contacted the manufacturer of lisinopril for any further references they could provide. STUDY SELECTION: All case reports that described an ACE inhibitor overdose. DATA EXTRACTION: Case reports were evaluated for the ACE inhibitor involved, amount ingested, and therapeutic management. DATA SYNTHESIS: Ten patients with ACE inhibitor overdose have been reported, most of whom required only intravenous fluids for blood pressure support. The case presented here is the second report in which the patient's blood pressure was not adequately controlled with fluid and traditional vasopressors and required an infusion of angiotensin II. CONCLUSIONS: Although only a few cases of ACE inhibitor overdose have been reported, it is possible that with widespread use of these agents, overdose may become a more common problem. Management of ACE inhibitor overdose should include general supportive care, gut decontamination when possible, intravenous fluids, and vasopressors if necessary. Intravenous angiotensin II may be effective in situations in which traditional vasopressors fail, and is a physiologically rational treatment.
Worsening of Liver Function with Fluconazole and Review of Azole Antifungal Hepatotoxicity
Authors: Gearhart Maureen O. 
Published: January 2017

OBJECTIVE: To report a case of fluconazole worsening of liver dysfunction. CASE SUMMARY: A patient with hepatitis experienced worsening of her liver function when treated with fluconazole for a Candida infection in her urine. Elevations in aspartate aminotransferase, alanine aminotransferase, and total bilirubin concentrations along with increased prothrombin time and activated partial thromboplastin time were noted as early as the second day of therapy. After discontinuation of the fluconazole, the liver parameters returned to their normal baseline level. DISCUSSION: Hepatotoxicity associated with azole antifungal therapy is reviewed. This patient experienced elevations in liver function enzymes; the literature relating to this topic is evaluated. CONCLUSIONS: It is probable that fluconazole therapy was involved in the worsening of this patient's liver function. Liver function should be monitored during the course of fluconazole therapy in patients with underlying liver dysfunction. It appears from the published reports that HIV-positive patients may be at risk for hepatotoxicity with fluconazole.
Repeated Assessment of Methylprednisolone Pharmacokinetics During Chronic Immunosuppression in Renal Transplant Recipients
Authors: Tornatore Kathleen M. , Reed Kristine A. , Venuto Rocco C. 
Published: January 2017

Objective: To compare the pharmacokinetics of methylprednisolone in renal transplant recipients on 2 occasions separated by at least 1 month during chronic immunosuppression. Design: A prospective unblinded trial. Patients: Ten renal transplant recipients (aged 25–62 years) evaluated in a public university-affiliated hospital clinic. Interventions: All patients received their chronic oral dose of methylprednisolone as a 10–20-minute intravenous infusion during the 2 study periods. Main Outcome Measures: Serum methylprednisolone concentrations were determined by HPLC and were used to generate the pharmacokinetic parameters of the drug. Results: During study 1, which ranged from 1.2 to 24 months posttransplant, the mean ± SD methylprednisolone dose was 13.2 ± 6.4 mg. In study 2 (2.5–38,5 mo posttransplant), the mean dose was 10.6 ± 3 mg. During both study periods, methylprednisolone concentrations exhibited a monoexponential decline. Considerable variability in methylprednisolone clearance was observed between periods in certain patients. Four of the 10 patients demonstrated a reduction in clearance from study 1 to study 2, which ranged from a 28% to a 53% decrease. Two patients exhibited an increase in clearance of 40% and 49%. The mean ± SD total body clearance in study I was 363 ± 330 mL/min/kg, whereas the mean volume of distribution was 1.18 ± 0.53 L/kg. The mean elimination rate constant was 0.29 ± 0.14 h−1, with a mean serum half-life of 2.87 ± 1.15 h during the first phase. In study 2, the mean methylprednisolone clearance was 261 ± 150 mL/min/kg (p > 0.05) and the mean volume of distribution was 0.89 ± 0.31 L/kg (p > 0.05). The mean serum half-life of methylprednisolone was 2.91 ± 0.60 h (p > 0.05), with the mean elimination rate constant of 0.25 ± 0.06 h−1(p > 0.05). Conclusions: These data demonstrate that intrapatient variability in methylprednisolone clearance exists among certain renal allograft recipients. As a result of the observed variability, patients who are continued on the same dose of methylprednisolone during the posttransplant period of chronic immunosuppression will be subjected to a changing pattern of exogenous glucocorticoid exposure. The impact of these changing patterns requires further prospective evaluation.
Sulpiride: an Antipsychotic with Selective Dopaminergic Antagonist Properties
Authors: Caley Charles F. , Weber Stanley S. 
Published: January 2017

Objective: To review the pharmacology, pharmacokinetics, clinical investigations, and adverse effects of sulpiride as a treatment for schizophrenia. Data Sources: Information was selected from a MEDLINE search of English-language medical literature using “sulpiride” as the search term. Manual searches of pertinent journal article bibliographies also were performed. Study Selection: Clinical investigations with a blind, controlled, randomized design and treatment durations of at least 6 weeks were preferred. Formal assessment of a patient's schizophrenia was required. One clinical investigation using a 4-week treatment duration and 1 open investigation were included for purposes of adverse reaction assessment. Data Extraction: Clinical investigations were evaluated for design, sample size, diagnosis, duration, and outcome. Data from all investigations were selected by 1 author and reviewed by both authors. Data Synthesis: Sulpiride is a substituted benzamide with selective dopaminergic blocking activity. Early pharmacology reports hypothesized that sulpiride was selective for dopamine (D)2 receptors only, but sulpiride also blocks D3 and D4 receptors. Sulpiride does not block D1, adrenergic, cholinergic, gamma-aminobutyric acid–ergic, histaminergic, or serotonergic receptors to an appreciable extent. The oral bioavailability of sulpiride is poor, with estimates approximating 35%. Sulpiride does not appear to have an extensive first-pass metabolism, nor is it extensively protein-bound. There have been no identified active metabolites, and elimination appears to depend primarily on the kidneys. Clinical studies support sulpiride as being equally effective as active controls in the acute treatment of patients with schizophrenia. Daily doses permitted in these clinical investigations ranged from 100 to 3200 mg. Further investigation is required to determine the usefulness of sulpiride as a chronic treatment of schizophrenia and its effectiveness in treating the negative symptoms of schizophrenia. Sulpiride may cause extrapyramidal effects, autonomic effects, tardive dyskinesia, and the neuroleptic malignant syndrome. The incidence of these adverse reactions has not been established. Conclusions: Sulpiride is a safe and effective pharmacotherapeutic treatment for the acute management of schizophrenia. A unique pharmacology does not appear to provide sulpiride with a greater effectiveness than the standard antipsychotics, but may provide it with minor safety advantages.
Use of Erythropoietin in Premature Neonates: Controversies and the Future
Authors: Wandstrat Todd L. , Kaplan Barbara 
Published: January 2017

Objective: To review and evaluate current research on the use of recombinant human erythropoietin (rhEPO) for the treatment of anemia of prematurity (AOP). Data Sources: A Medline search (1985–September 1994) was used to identify and retrieve pertinent data about erythropoietin's use in premature neonates. Bibliographies in the relevant literature and International Pharmacy Abstracts were reviewed as well. Study Selection: The authors extrapolated data from trials and other literature in which the entire paper or abstract was published. Because of the paucity of data on the use of rhEPO in neonates, all available literature was reviewed and cited, regardless of study methodology. Data Synthesis: Most data support that rhEPO is efficacious in treating AOP. Until recently, the published investigations have included only small numbers of patients. Larger, multicenter, placebo-controlled trials suggest that infants weighing less than 1500 g benefit from rhEPO therapy. Questions remain concerning the rhEPO dose and nutrient requirements for optimal efficacy. Conclusions: Published clinical trials that have examined the efficacy of rhEPO in the treatment of AOP vary considerably with regard to methodology, rhEPO dose, nutrient doses, and outcome measurement. At present, many questions remain to be answered including ascertaining rhEPO's long-term benefit versus cost/risk as well as its potential contribution to improving the care of the premature neonate.
Japanese Pharmacy: Innovation Mixed with Tradition
Authors: Armstrong Edward P. , Akaho Eiichi , Fujii Masami 
Published: January 2017

Objective: To report the current status of pharmacy practice in Japan. Data Sources: Published conference reports, journal articles, human resource consultation with medical and pharmacy practitioners, and site visitation by the authors. Data Extraction And Synthesis: Data on areas related to Japanese history, practice of pharmacy, and professional innovations were obtained through interviews and the literature. Information is provided to give an appreciation of current pharmacy practice in Japan. Conclusions: Japanese pharmacy practice is a strong combination of tradition and professional innovation. The potential for professional growth is immense; Japanese pharmacy has successfully established payment for nondistributive pharmacy services. Payment for cognitive services creates many positive incentives for the future practice of pharmacy in Japan.
Prescribing Patterns of Anttlipemic Drugs and Prevalence of Hypercholesterolemia in the Nova Scotia Population More than 65 Years Old
Authors: Sketris Ingrida S , Kephart George C , Hicks Vern A , Hubbard Eleanor J , Brown Murray G , Chandler R Frank , Maclean David R 
Published: January 2017

Objective: To examine the prevalence of antilipemic drug use, demographic characteristics of patients using these drugs, and the prevalence of hypercholesterolemia in the Nova Scotia population over 65 years of age. Design: Information was collected on the prescribing of antilipemic drugs using Nova Scotia Medical Services Insurance Pharmacare program data from October 1991 through March 1992. Pharmacare data were compared with prevalence data on increased low-density lipoprotein (LDL) cholesterol concentrations obtained from the Nova Scotia Heart Health Survey (NSHHS). Setting: Pharmacare is a centrally administered drug insurance system maintained in computerized claims files since 1974. It provides prescription drugs to all residents of Nova Scotia who are at least 65 years old and who are insured under the provincial Medicare program. Participants: In the 1991–1992 fiscal year, 47 000 men and 65 700 women were eligible for Pharmacare. The NSHHS was administered to a probability sample of 2108 individuals, representative of the 1986 population aged 18–74 years. Main Outcome Measures: Prescriptions for antilipemic agents. Results: The NSHHS data indicated that 3.7% of women and 2.3% of men at least 65 years old and 4.8% of women and 2.8% of men 65–74 years old received a prescription for antilipemics. Approximately 10% of men and approximately 16% of women aged 65–74 years had LDL cholesterol concentrations in excess of 4.9 mmol/L. Conclusions: Elderly women received antilipemic drugs more frequently than did elderly men. The proportion of Nova Scotia's senior population using antilipemic drugs was less than the proportion with increased serum total cholesterol and LDL cholesterol concentrations. More specific studies need to assess the use of antilipemic drugs in relation to patients' risk factors for cardiovascular disease, patient adherence with antilipemic drug therapy, and the effectiveness of antilipemic drugs.