bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacy Practice Acts: A Five-Year Follow-up
Authors: Munger Mark A. , Stilling William J. , Gardner Stephanie F. 
Published: January 2017

OBJECTIVE: To rereview the status of state pharmacy practice acts since 1987. Additionally, this report discusses adoption of the 1992 National Association of Boards of Pharmacy Model State Pharmacy Practice Act as the standard state pharmacy practice statute. DATA SOURCES: State codes for 50 states and the District of Columbia, with attention focused on the pharmacy practice acts; Puerto Rico and the Virgin Islands were excluded. CASE LAW SELECTION: Case law utilizing state pharmacy statutes was selected to demonstrate pharmacists' liability. DATA EXTRACTION: The focus on each statute was the statutory definition of the “practice of pharmacy.” DATA SYNTHESIS: Twelve pharmacy laws (24 percent) contain no definition of the practice of pharmacy. Compounding (92 percent), dispensing (100 percent), interpretation and evaluation of prescriptions (72 percent), consultation (85 percent), drug utilization review (69 percent), drug product selection (54 percent), drug administration (21 percent), pharmacokinetic consultation and patient assessment (13 percent) were noted in the laws for the remaining 38 states and the District of Columbia. Significant pharmacy activities codified since 1987 include consultation, drug administration, pharmacokinetic consultation, and patient assessment. Statutes defining pharmacy practice impact the profession by affecting liability and by mirroring society's view of the role of the profession. CONCLUSIONS: States have enacted new statutes principally in the areas of progressive pharmacy practice functions since 1987. Enactment of the definition of professional practice contained in the National Association of Boards of Pharmacy Model State Pharmacy Practice Act would serve the pharmacy profession by: (1) creating a uniform professional purpose; (2) creating legal responsibility that reflects contemporary practice; (3) allowing pharmacists to enlarge the scope of their practice as the profession's societal role evolves; and (4) conserving revenues normally consumed by lobbying for constant legislative revisions.
Benzodiazepine Withdrawal Reaction in Two Children following Discontinuation of Sedation with Midazolam
Authors: van Engelen Baziel G.M. , Gimbrere Jules S. , Booy Leo H. 
Published: January 2017

OBJECTIVE: To report the occurrence of recurrent benzodiazepine withdrawal reactions in two very young children following discontinuation of sedation with midazolam. CASE SUMMARY: A 15-month-old boy with apneic episodes was sedated with midazolam for 12 days with constant infusion. Half a day after discontinuation of the midazolam the boy became restless, tachycardic, and hyperpyrexia. When midazolam was readministered, all symptoms disappeared. Four days later midazolam was again discontinued and within 12 hours the same signs and symptoms reappeared. Midazolam infusion was restarted, and the signs and symptoms disappeared for the second time. After thoracotomy, a 14-day-old boy received intravenous midazolam for sedation for 29 days. Within 12 hours after discontinuation of midazolam he became restless, developed a bulging stomach secondary to aerophagia, and was vomiting. Midazolam therapy was reinstituted and continued for another 2 months by constant infusion. Thereafter, the boy was successfully weaned from artificial ventilation in 5 days under sedation with midazolam. About 12 hours after discontinuation of midazolam the boy became restless, tachycardic, again developed a bulging stomach because of aerophagia, and vomited. When the child was sedated with clorazepate by continuous infusion, the signs and symptoms disappeared. DISCUSSION: Case reports describing benzodiazepine withdrawal reaction upon discontinuation of midazolam were reviewed and compared. The symptoms observed in the children we present resemble those mentioned in the three children and two adults reported previously. Unique in the very young children in this article is the occurrence of gastrointestinal symptoms, which most likely are the result of air being swallowed secondary to severe agitation. CONCLUSIONS: Midazolam withdrawal reactions in adults and children, particularly in an intensive care unit, can be significant. Considerable caution must be taken with relatively long-term administration and abrupt discontinuation of midazolam.
Nedocromil Sodium
Authors: Parish Roy C. , Miller Lisa J. 
Published: January 2017

OBJECTIVE: To summarize the available pharmacokinetic and pharmacologic data on nedocromil sodium and to present representative clinical trials of this new agent in both mild-to-moderate and severe chronic asthma and allergic rhinitis. Adverse effects are reviewed. DATA SOURCES: A MEDLINE search was used to identify pertinent literature, excluding reviews and foreign-language articles. All available English-language studies were reviewed. DATA EXTRACTION: Pivotal and representative studies are discussed relating to the following issues: Pharmacology and pharmacokinetics, management of patients with non-steroid-dependent and steroid-dependent asthma, comparison with sodium cromoglycate (cromolyn), comparison with inhaled beclomethasone dipropionate, management of exercise-induced asthma, use in children with asthma, and use in allergic rhinitis. DATA SYNTHESIS: Nedocromil sodium is chemically grossly unrelated to cromolyn but has similar pharmacology, pharmacokinetics, and therapeutic benefits. Although ineffective in relieving acute asthma attacks, nedocromil appears to be superior to placebo in lessening the severity of chronic asthma and protecting against allergen-induced asthma when taken as chronic prophylaxis. Single doses attenuate exercise-induced asthma. It is also effective in the management of allergic rhinitis. Results have varied when nedocromil has been compared with cromolyn or inhaled beclomethasone. Studies to date indicate that, overall, nedocromil is not significantly better than cromolyn and is no better than or is inferior to inhaled beclomethasone, although individual response appears to be variable, with no identifiable predictive factors. CONCLUSIONS: Individual patients may receive marked improvement from nedocromil therapy, but there are no factors that identify which patients will respond. Nedocromil may be particularly useful in adults who frequently fail to respond to cromolyn.
Drug-Induced Alterations in Serum Creatinine Concentrations
Authors: Hartshorn Edward A. , Ducharme Murray P. , Smythe Maureen , Strohs Greg 
Published: January 2017

OBJECTIVE: To provide a comprehensive review of drug-induced alterations in serum creatinine concentrations (SCrs). DATA SOURCES: Information was obtained from a MEDLINE search, reference lists from articles identified in the search, review articles, and abstracts. STUDY SELECTION: Emphasis was placed on clinical studies of direct relevance to clinical practitioners. DATA EXTRACTION: Literature was assessed for its methodology, results, discussion, and conclusion. DATA SYNTHESIS: Two analytical systems to assay SCr are commonly employed in clinical practice—the Jaffé-based and enzymatic methods. Several drugs have been reported to interfere with SCr results obtained with both analytical systems by producing assay interference. In addition, trimethoprim, cimetidine, and salicylates produce elevations in the SCr by altering the normal elimination pathways of creatinine. Phenacemide has been reported to increase creatinine elimination, but the mechanism of this effect is unknown. CONCLUSIONS: Pharmacists should recognize the clinical significance of drug-induced interference with SCr and propose alternative methods of determining concentrations in selected patients.
Crossover Comparison of Drug Information Online Database Vendors: Dialog and Medlars
Authors: Rovers John P. , Janosik John E. , Souney Paul F. 
Published: January 2017

OBJECTIVE: To compare Dialog EMBASE with the National Library of Medicine's (NLM's) MEDLARS MEDLINE, TOXLINE, and TOXLIT to evaluate differences among the databases and vendors in a method consistent with routine drug information practice. DESIGN: Crossover comparison. METHODS: NLM MEDLARS databases MEDLINE, TOXLINE, and TOXLIT were searched directly. EMBASE was searched via Dialog Information Services. MEDLINE was searched back to 1980; TOXLINE and TOXLIT were searched back to 1981, reflecting the different database structures. EMBASE was searched back to 1980. To control bias, searches were randomized; identical strategies were used during the same session and were performed by the same trained searcher. RESULTS: Twenty-six drug information requests were compared. The MEDLARS and Dialog databases were generally similar, with no significant differences in the number of potentially relevant references, English references, clinically relevant references, available abstracts, unique citations, time online, and number of questions answered. EMBASE searches were more costly (p=0.0005). TOXLIT was costlier than TOXLINE and MEDLINE (p=0.0018). CONCLUSIONS: NLM MEDLARS databases were comparable to Dialog EMBASE. Although MEDLARS provided more total and English-language citations, the differences were small and did not influence the proportion of questions answered. The greatest difference between the vendors was the significantly lower cost of searching on MEDLARS. Although this difference may be partially offset by the significantly shorter search times on EMBASE, the mean 1.9 minutes saved would not recoup the mean $7.89 difference in cost. MEDLARS databases are less expensive for routine drug information requests.
Physical and Chemical Compatibility of Intravenous Ciprofloxacin with other Drugs
Authors: Jim Lucia K. 
Published: January 2017

OBJECTIVE: To determine the physical and chemical compatibilities of ciprofloxacin lactate infusion with other commonly used intravenously administered drugs. DESIGN: Ciprofloxacin lactate injection in a commercially available concentration of 2 mg/mL was mixed with 15 intravenous drugs during simulated Y-site injection. Ciprofloxacin was mixed with usually employed concentrations of other drugs in a 1:1 ratio and examined physically by visual inspection and chemically by HPLC analysis. Adsorption of ciprofloxacin to intravenous administration sets with or without inline filters was also studied. SETTING: The study was carried out at ambient temperature (25 °C) under fluorescent lighting except for vitamin B complex, which was protected from light. All samples were prepared in a laminar airflow hood. MAIN OUTCOME MEASURES: Physical incompatibility was determined by visual inspection against a black-and-white background, and chemical incompatibility was measured by a stability-indicating HPLC assay for ciprofloxacin. Concentrations determined at time zero (before mixing) were defined as 100 percent. Values estimated for each sample at subsequent time points were calculated as percentages of the initial concentration. Recovery below 90 percent of the initial concentration is defined as significant loss. RESULTS: Of the 15 drugs studied, only heparin, furosemide, and teicoplanin were found to be incompatible with ciprofloxacin. Adsorption of ciprofloxacin to administration sets with and without inline filters was minimal. Metronidazole was also found to decrease to 90 percent of its initial concentration immediately upon mixing. CONCLUSIONS: Ciprofloxacin ready-to-infuse solution is compatible with most of the drugs studied except heparin, furosemide, teicoplanin, and, perhaps, metronidazole. Because only the stability and potency of ciprofloxacin were studied, further testing is needed to confirm if any chemical deterioration of the other drugs occurred when combined with ciprofloxacin.
Intravenous Streptomycin Use in a Patient Infected with High-Level, Gentamicin-Resistant Streptococcus Faecalis
Authors: Kim-Sing Angela , Kays Michael B. , James Vivien E. , Weart C. Wayne 
Published: January 2017

OBJECTIVE: To report a case of intravenous streptomycin sulfate use in a patient infected with high-level, gentamicin-resistant Streptococcus faecalis. CASE SUMMARY: A 37-year-old woman with a history of schizoaffective disorder, diabetes insipidus possibly induced by lithium, chronic renal insufficiency, and anemia presented with a two-day history of decreased responsiveness, decreased verbalization, and tremulousness. Her hospital course was complicated by polymicrobial sepsis ( S. faecalis, coagulase-negative staphylococci, Citrobacter diversus, Enterobacter aerogenes, and unidentified gram-negative bacilli #2) requiring vancomycin and gentamicin therapy. Gentamicin was discontinued after two doses because she developed acute-on-chronic renal insufficiency. Subsequent susceptibility data showed the enterococcus to be highly resistant to gentamicin. The patient deteriorated clinically when treated only with vancomycin. She remained septic with a blood pressure of 80/40 mm Hg; streptomycin was added to her regimen. We were concerned that streptomycin concentrations obtained following intramuscular administration would not be adequate because of possible hypoperfusion. Based on limited published literature, streptomycin was administered intravenously via a central intravenous catheter. DISCUSSION: A review of high-level aminoglycoside-resistant S. faecalis and treatment with intravenous streptomycin therapy are discussed. The availability and monitoring of streptomycin therapy are also described. CONCLUSIONS: Streptomycin is an antimicrobial agent that must be used with vancomycin in serious infections to eradicate high-level, gentamicin-resistant S. faecalis. Its unique administration and monitoring concerns require individual patient assessment.
Syndrome of Inappropriate Secretion of Antidiuretic Hormone Secondary to Fluoxetine
Authors: Blacksten Joleen V. , Birt Julie A. 
Published: January 2017

OBJECTIVE: To report a case of possible fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE SUMMARY: A 92-year-old patient was prescribed oral fluoxetine 20 mg daily for depression. After 13 days of therapy, she developed severe weakness and was found to have hyponatremia. Fluoxetine was discontinued. Treatment included fluid restriction and sodium chloride and potassium supplementation. Eight days after admission, the hyponatremia resolved and the patient was discharged without any pharmacologic treatment for depression. DISCUSSION: Case reports on fluoxetine-induced SIADH were reviewed. Fluoxetine-associated SIADH appears to occur most commonly after short-term therapy in elderly patients. Resolution of hyponatremia occurs six days to two weeks after discontinuation of fluoxetine. CONCLUSIONS: Geriatric patients receiving fluoxetine should be monitored regularly to detect abnormal electrolyte values.
Vasopressor-Resistant Hypotension following a Massive Ingestion of Theophylline
Authors: Dasta Joseph F. , Dettloff Richard W. , Touchette Mark A. , Zarowitz Barbara J. 
Published: January 2017

OBJECTIVE: To report the unusual and poorly understood occurrence of vasopressor-resistant hypotension following a suicidal ingestion of theophylline. DESIGN: Single case report. SETTING: Eight-bed, respiratory intensive care unit in a 937-bed teaching hospital. PATIENT: A 52-year-old man with a past medical history significant only for hypertension. RESULTS: The additive influence of markedly elevated theophylline serum concentrations, status epilepticus, and vasopressor-resistant hypotension was associated with the patient's death. Intravenous dosages of epinephrine, norepinephrine, and phenylephrine (ranges 160–210, 32–105, and 200–250 μg/min, respectively) were ineffective in controlling the patient's dramatic hypotension. CONCLUSIONS: In addition to the usual metabolic abnormalities and central nervous system effects seen in theophylline poisoning, severe hypotension can occur and prove resistant to commonly used vasopressors. Early identification and treatment of theophylline poisoning is warranted to prevent the development of severe sequelae.
Comparative Clinical, Microbiologic, and Economic Audit of the Use of Oral Ciprofloxacin and Parenteral Antimicrobials
Authors: McGhan William F. , Bootman J. Lyle , Townsend Raymond J. , Cooke Jonathan , Cairns Christopher J. , Tillotson Glenn S. , Conner Susan , Lewin Sharron K.M. , Nicholls Jane , Tredree Roger L. , Willis Jackie V. , Hitchings Colin R. 
Published: January 2017

OBJECTIVE: To examine the use of oral ciprofloxacin and parenteral antimicrobials in the treatment of acute infection (respiratory tract, urinary tract, blood) in hospitalized patients, with particular reference to severity of infection, outcome, and associated economic implications of each treatment. DESIGN: A prospective, multicenter comparative audit was conducted in the UK over an 18-month period. The audit was undertaken by clinical pharmacists who reviewed the antimicrobial treatment of patients with infective episodes, who were receiving or could have received oral therapy. PARTICIPANTS: Clinical pharmacists who collated the data all are employed in teaching hospitals. MAIN OUTCOME MEASURES: Patients were identified for analysis by their type of infection, severity of illness, antimicrobial prescribed, route of administration, and response to therapy. Additionally, data on costs of the antimicrobials prescribed and the supplementary costs of drug administration were calculated. RESULTS: Four hundred eighty-five patients were enrolled for analysis; 208 of the patients had respiratory tract infection, 112 had urinary tract infection, 138 had septicemia, and 27 had mixed infections. Sepsis scores were applied to 152 patients receiving oral ciprofloxacin and 333 patients receiving parenteral antimicrobials and yielded mean scores of 5.9 (SD 3.1, range 1–13) and 8.7 (SD 4.2, range 1–22), respectively. of 485 patients, 188 were paired according to sepsis score results and route of administration. Resolution occurred in 133 patients (79 receiving oral and 54 receiving parenteral therapy), further therapy was required in 49 (11 oral and 38 parenteral), and treatment was withdrawn in 6 (4 oral and 2 parenteral). Microbiologic assessment yielded positive results in 227 patients (47 percent). Drug acquisition costs (based on 1 UK £ = 1.80 US $) per course of treatment were $47.23 (SD $38.32, range 5.40–218.70) for the oral group and $173.70 (SD $209.77, range 2.11–1021.40) for the parenteral group. Overall costs for treatment courses were $74.00 (SD $52.81, range 8.10–309.17) and $305.59 (SD $304.70, range 14.69–1345.00) for the two groups, respectively (p<0.001). CONCLUSIONS: This study suggests that, in patients with moderate infective episodes, oral ciprofloxacin may reduce overall treatment costs compared with the use of parenteral antimicrobial agents.
Rhodococcus Equi Pneumonia: Case Report and Literature Review
Authors: Frame Bill C. , Petkus Alan F. 
Published: January 2017

OBJECTIVE: To present a case of Rhodococcus equi (RE) pneumonia and discuss its pathophysiology and treatment. CASE SUMMARY: An HIV-positive patient presented with pneumonia. A lung biopsy was performed after sputum and thoracentesis cultures failed to identify a pathogen. The lung biopsy revealed an unidentifiable, diphtheroid-like, gram-positive rod. A bronchoscopy performed five days after the lung biopsy produced the same diphtheroid-like, gram-positive rod. The patient was treated with several injectable antibiotics, but emergence of resistance to two of the antibiotics was suspected. Two weeks after the bacterial isolate was sent to a reference laboratory, it was identified as RE. The patient was discharged on oral antibiotics and experienced no recurrence of RE pneumonia. CONCLUSIONS: RE can be difficult to identify in the microbiology laboratory, or it may be assumed to be a colonizing diphtheroid. The isolation of difficult-to-identify, gram-positive rods, or diphtheroids, from a pulmonary source in a patient with decreased cell-mediated immunity should cause one to suspect RE. RE has been noted to develop resistance to beta-lactam antibiotics during therapy. A prolonged course of combination antibiotic therapy directed at the intracellular component of infection is necessary.
Placebo-Controlled Trial of Intravaginal Clindamycin 2% Cream for the Treatment of Bacterial Vaginosis
Authors: Stein Gary E. , Christensen Sharon L. , Mummaw Nancy L. , Soper David E. 
Published: January 2017

OBJECTIVE: To compare the safety and efficacy of intravaginal clindamycin 2% cream with placebo in nonpregnant women with bacterial vaginosis. DESIGN: A randomized, double-blind, placebo-controlled clinical trial. SETTING: Ambulatory patients in the general community. PATIENTS: Two hundred fifteen nonpregnant outpatients with a diagnosis of bacterial vaginosis were entered into this study. Of the 134 evaluable patients, 65 received clindamycin and 69 placebo. Demographic parameters were comparable between the two treatment groups. INTERVENTION: Study subjects were equally randomized to receive either 5 g of clindamycin 2% vaginal cream or placebo cream for seven nights. MAIN OUTCOME MEASURES: Clinical and microbiologic follow-up evaluations were scheduled for 5–10 days and 25–39 days posttreatment. Patients were interviewed about signs and symptoms, adverse events, and compliance. Diagnostic examinations were performed. RESULTS: Clinical success rates (cure and improvement) occurred in 50 of 65 patients who received clindamycin (77 percent) and 17 of 69 patients who received placebo (25 percent) by the first posttreatment visit (p<0.001). Microbiologic cures or improvement were observed in 59 of the 65 patients treated with clindamycin (91 percent) compared with 20 of 69 placebo-treated patients (29 percent) (p<0.001). At the end of the study, clinical and microbiologic cures or improvement were evident in 45 of 57 (79 percent) and 37 of 57 clindamycin-treated patients (65 percent), respectively, and 18 of 51 (35 percent) and 14 of 51 (28 percent) of the placebo-treated patients, respectively. The success rates with clindamycin 2% cream were statistically higher than those with placebo. The adverse-effect profiles in the two groups were similar and no serious adverse effects were reported. Patients who received clindamycin had a statistically higher incidence of nonbacterial vaginitis/cervicitis (18.5 vs. 7.5 percent, p=0.003). CONCLUSIONS: Intravaginal clindamycin 2% cream appears to be an effective and safe treatment of symptomatic bacterial vaginosis in nonpregnant women.
Influence of Beta Carotene, Vitamin E, and Vitamin C on Endogenous Antioxidant Defenses in Erythrocytes
Authors: Regnault Corinne , Postaire Eric R.R. , Rousset Gérard J.P. , Bejot Marie , Hazebroucq Georges F. 
Published: January 2017

OBJECTIVE: To evaluate the in vivo radical scavenger activity of vitamin E, vitamin C, and beta carotene on erythrocyte membranes. DESIGN: A prospective, open trial without placebo. SETTING: Department of Clinical Pharmacy. PATIENTS: Ten healthy volunteers being supplemented with beta carotene, vitamin E, and vitamin C. MEASUREMENTS: Erythrocytes were incubated in water bath with 2,2′ azobis (2 amidinopropane) hydrochloride (AAPH). AAPH decomposes spontaneously at 37 °C to generate free radicals inducing membrane cellular damage and hemolysis. The absorbance was measured at 405 nm at 0, 30, and 60 min, and then every 20 minutes for four hours. The time for 50 percent of maximal hemolysis (T50%), which expresses the radical scavenger activity of erythrocytes, was determined. RESULTS: The physiologic T50% value determined in 52 healthy volunteers is 117 ± 12 min. Patients receiving these supplements have a higher value of T50% (143.2 ± 11.6 min at 30 d and 145.7 ± 10.5 min at 60 d) than the physiologic value (p<0.001). CONCLUSIONS: These data suggest that vitamin C, vitamin E, and beta carotene stimulate the radical scavenger activity of erythrocyte membranes after 30 days.