bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liability Claims Based on Drug Use
Authors: Fink Joseph L. 
Published: May 2016

The incidence of drug-related liability claims is discussed, and data from a number of studies in this area are reviewed. Drug categories that appear to cause the greatest problems are hormones, anticoagulants, adrenal steroids, and antibiotics. Focusing attention on these categories may enable the pharmacist to function as a liability-reducing factor in the institutional setting.
Glucagon Therapy for β-Blocker Overdose
Authors: Peterson Charles D. , Leeder J. Steven , Sterner Steve 
Published: May 2016

Two cases of severe β-blocker overdose are presented that were treated successfully with glucagon therapy. The effects of glucagon in reversing the cardiovascular depression of profound β-blockade, including its mechanism of action, onset and duration of action, dosage and administration, cost and availability, and side effects are reviewed. Medical complications of β-blocker overdose include hypotension, bradycardia, heart failure, impaired atrioventricular conduction, bronchospasm and, occasionally, seizures. Atropine and isoproterenol have been inconsistent in reversing the bradycardia and hypotension of β-blocker overdose. Glucagon increases heart rate and myocardial contractility, and improves atrioventricular conduction. These effects are unchanged by the presence of β-receptor blocking drugs. This suggests that glucagon's mechanism of action may bypass the β-adrenergic receptor site. Because it may bypass the β-receptor site, glucagon can be considered as an alternative therapy for profound β-blocker intoxications. The doses of glucagon required to reverse severe β-blockade are 50 μg/kg iv loading dose, followed by a continuous infusion of 1–15 mg/h, titrated to patient response. Glucagon-treated patients should be monitored for side effects of nausea, vomiting, hypokalemia, and hyperglycemia. The high cost and limited availability of glucagon may be the only factors precluding its future clinical acceptance.
Heparin-Induced Thrombocytopenia-Association with a Platelet Aggregating Factor and Cross-Sensitivity to Bovine and Porcine Heparin
Authors: Guay David R.P. , Richard Anita 
Published: May 2016

Heparin-induced thrombocytopenia is an infrequently suspected adverse drug reaction since its sequelae often mimic the underlying condition for which the drug is being used. A concomitant decline in platelet count and increase in heparin requirements should alert the clinician to the possible presence of this disorder. A 36-year-old black male developed severe thrombocytopenia with thrombosis while being treated with porcine intestinal mucosal heparin. Platelet counts returned to near-normal levels upon discontinuation of heparin, but quickly dropped again upon resuming treatment with bovine lung heparin. The patient subsequently was treated with warfarin and dipyridamole, with no further complications. Treatment of delayed-onset severe heparin-induced thrombocytopenia consists of stopping the heparin and substituting antiplatelet agents and oral anticoagulants when continued inhibition of coagulation is required.
Baclofen Toxicity Associated with Declining Renal Clearance after Ibuprofen
Authors: Dahlin Patricia A. , George John 
Published: May 2016

A 64-year-old male with an incomplete spinal cord injury had been taking baclofen 20 mg tid for 2½ months without side effects. His blood urea nitrogen and serum creatinine rose from 13 and 0.9 mg%, respectively, to 59 and 2.8 mg% after ibuprofen 600 mg tid was begun. The patient displayed baclofen toxicity, developing confusion, disorientation, bradycardia, and hypothermia. His blood pressure dropped and he complained of blurred vision. Ibuprofen discontinuation and fluid repletion corrected the renal indices. Rapid tapering of baclofen was accompanied by reversal of baclofen toxicity. Patients taking baclofen must be monitored closely for toxicity when declining renal function is present. Clinicians should be alert to the possibility of renal insufficiency developing when ibuprofen is initiated. This case demonstrates the potential for ibuprofen-induced renal insufficiency to reduce baclofen clearance, thereby leading to baclofen toxicity. Published reports of ibuprofen-induced renal insufficiency are reviewed and pertinent pharmacokinetics of baclofen discussed.
Inservice Teaching and Adverse Drug Reactions in a Nursing Home
Authors: Lamy Peter P. , Jue Sandra G. , Clark Beverly G. , Araki Mark A. 
Published: May 2016

A prospective study was carried out in two skilled nursing facilities (SNFs) to determine: (1) the feasibility of identifying potential adverse drug reactions (ADRs) by monitoring drug order changes; (2) the ADR rate in the elderly in SNFs; (3) the ease of using an algorithm to assess the probability that an adverse event is drug-related; and (4) whether a one-hour inservice lecture could alter the number of drug order changes or the number of ADRs detected. Over three months, 27 of 248 order changes (10.8 percent) were identified as possible ADRs. Fifteen of 248 (six percent) of the orders were probable or definite ADRs. The ADR rates were 9.5 percent and 14.8 percent, for the study and control SNFs, respectively (p > 0.05). This method of detecting ADRs depends on recognition of a clinically observable adverse event by the nurse, nurse practitioner, or physician. Therefore, the hypothesis that an inservice lecture on ADRs could increase the recognition of ADRs was tested. More drug order changes were initiated in the control facility that retained a full-time nurse practitioner, but no change in the number of drug order changes or ADR rates was seen after the inservice lecture in the study facility. This method is the first to identify, prospectively, clinically manifest ADRs and to test a method to influence their rate in nursing home elderly.
Nitrofurantoin
Authors: D'Arcy P.F. 
Published: May 2016

For more than 30 years nitrofurantoin has been a widely prescribed and effective agent in the treatment of urinary tract infections. During this time, it has withstood the rigors of constant clinical evaluation and has competed successfully with more recent antibacterial agents. As with many widely used drugs, some serious and potentially hazardous reactions to therapy have been documented. This article reviews and analyzes major reported reactions and interactions from both published and unpublished sources. Incidence rates have been calculated for pulmonary, hepatic, neurological, and hematological responses. Calculated rates of occurrence were very low, and ranged from 0.001 percent of courses of therapy (all types of pulmonary reactions combined) to 0.0007 percent (neurological reactions). Reports on interactions of nitrofurantoin with alcohol, antacids, and oral contraceptives are unfounded and anecdotal. Interactions with nalidixic and oxolinic acids are not clinically significant, and only one case of interaction has been reported with phenytoin. Bioavailability is enhanced by food or propantheline. False positives occur with Benedict's test for urine glucose estimations.
A Comparative Study of Laboratory Parameters in Head-Injured Patients Receiving Either Phenytoin or Placebo for 24 Months
Authors: Bertch Karen E. , Norton Jane A. , Young A. Byron , Rapp Robert P. , Tibbs Phillip A. 
Published: May 2016

The effects of chronic phenytoin therapy on serum calcium, phosphorus, folate, and various hematological indices were assessed. One hundred and fifty-one patients, ages 18 months to 81 years, received phenytoin in a previously-conducted, double-blind, placebo-controlled study. Of the patients receiving phenytoin, initially 127 were evaluable while for control patients receiving placebo, 116 were evaluable. All patients had various laboratory parameters monitored at one day post-loading dose, one week, 1,3,6,9,12,15,18,21, and 24 months. Laboratory values examined were serum calcium, phosphorus, folate, white blood cell count with differential, hemoglobin, hematocrit, and red blood cell and platelet counts. A statistical analysis using the t-test method was employed to evaluate data. Data are reported as mean values ± standard deviation. Patients suffering early hypersensitivity, manifested by a morbilliform skin rash, were removed from the drug by day 30 and were not included in the chronic therapy review. Results indicate that the various laboratory values examined were not significantly affected by phenytoin administration in the patient population. Therefore, chronic phenytoin therapy following the initial hypersensitivity period does not cause abnormal laboratory values as followed in this study.
Routine Pertussis Immunization
Authors: True Bev Lorraine , Burns Elizabeth A. 
Published: May 2016

The benefits and risks of both the vaccine for pertussis and the disease itself are reviewed in this article. Unlike with the smallpox vaccine, it seems unlikely that a vaccine will be developed to eradicate pertussis completely, since most confer only a short-term immunity. A longitudinal study was undertaken to compare the mortality and morbidity rates of pertussis with the adverse reaction rate of the vaccination program. Risks of the vaccination, such as erythema, drowsiness, and vomiting are well known. However, the issue of neurologic difficulties has surfaced and disagreement exists. Some association does seem to exist between the vaccine and neurologic problems; however, the morbidity and mortality of whooping cough is of a greater health consequence than these rare neurologic reactions.
Early Use of Oral Theophylline in Hospitalized Chronic Obstructive Pulmonary Disease Patients: Cost-Containment through Medical Education
Authors: Self Timothy H. , Ellis Robert F. , Davis Harry L. , Lee Marilyn D. 
Published: May 2016

This study measured the impact of an education program conducted by a clinical pharmacist on early conversion from intravenous to oral theophylline in hospitalized chronic obstructive pulmonary disease patients. Two separate two-month audit periods were conducted on the pulmonary medicine service (PMS) of a teaching hospital. During the first audit period (pre-ed), no education was provided. Prior to each month of the second two-month audit period (post-ed), an education program and handout outlining the rationale for early conversion from intravenous to oral theophylline was presented to medicine residents rotating onto the PMS. The results of this preliminary study suggest that the education program was responsible for a statistically significant decrease in intravenous aminophylline therapy from three days (pre-ed) to one day (post-ed). As a result of the reduction in length of intravenous therapy, both drug costs and patient charges were reduced by a statistically significant amount.
Experience with Intrainstitutional Clinical Evaluations of Newly Marketed Preparations as a Basis for Drug-Product Selection to Hospital Formularies
Authors: Green Jeffrey A. , Clementi William A. , Bufton Marilyn G. , Farringer John A. , Moiser Ronald , Durst Nancy L. , Gonzalez Lydia , Lalumiere Ann 
Published: May 2016

The decision to admit a new drug-product formulation (NDPF) to a hospital pharmacy formulary is a difficult task, particularly when minimal pharmacokinetic or clinical efficacy data are available. To provide objective information to the Pharmacy and Therapeutics (P&T) Committee, we implemented a procedure to evaluate these NDPFs at our institution. This procedure, termed clinical evaluation, was initiated at our institution in 1981. The clinical evaluations of two NDPFs were performed. The two NDPFs studied were a transdermal nitroglycerin preparation and a sustained-release procainamide preparation. The clinical assessment of the therapeutic and the pharmacokinetic performance of each preparation was made by clinical pharmacists. Following completion of the clinical evaluation, the data were presented at a regular meeting of the P&T committee. The presentation of clinical data derived from our patient population facilitated objective assessment by the P&T committee regarding formulary status. We conclude that the clinical evaluation represents a novel approach to acquire data necessary for objective decisions on NDPFs by the P&T committee.
Evaluation of the Ames Seralyzer for Therapeutic Drug Monitoring of Theophylline
Authors: Vaughan Leigh M. , Weinberger Miles M. , Milavetz Gary 
Published: May 2016

Dry reagent technology and reflectance photometry are combined in the Ames Seralyzer to offer a solid-phase plastic strip assay methodology. Light reflected from serum placed on the antibody-impregnated strip is quantitated with a two-point standard curve to display a theophylline result in 90 seconds. The accuracy and precision of the Seralyzer for serum theophylline are compared to the enzyme-multiplied immunoassay technique (Emit) which is commonly used to determine drug concentrations. Liquid calibrators (5 and 25 μg/ml) and liquid-spiked sera (10, 15, and 20 μg/ml) were measured six times daily simultaneously by both methods for twenty days. Eighty patient samples (theophylline range: 0–33 μg/ml) were measured twice each during the twenty days. Acceptable assay limits were established and maintained by measuring 15 μg/ml spiked sera prior to and during the evaluation period. All within-run and between-run means for the Seralyzer and Emit were within ± 1 μg/ml of the spiked value. All ranges of within-run and between-run means were within ± 2 μg/ml of the spiked value. Mean between-run coefficients of variation for the Seralyzer at the 5, 10, 15, 20, and 25 μg/ml values were 11.5, 6.7, 4.9, 4.6, and 4.9 percent, respectively. Linear regression on the 80 patient samples gave a slope of 1.02, intercept of −0.28, and correlation of 0.984. The Seralyzer's accuracy and precision compare favorably with Emit for theophylline determinations greater than 7.5 μg/ml.
Alfentanil in Anesthesia and Analgesia
Authors: Reitz Jeffrey A. 
Published: May 2016

Alfentanil is a tetrazole derivative of fentanyl. Many of the pharmacologic effects of alfentanil are similar to those of fentanyl and sufentanil, but of quicker onset than those of fentanyl and of shorter duration than those of fentanyl and sufentanil. Alfentanil may cause less intense respiratory depression than equianalgesic doses of fentanyl. Alfentanil has a lower total body clearance, smaller volume of distribution, and shorter half-life than fentanyl and sufentanil. Clinical trials indicate alfentanil can be used effectively as an analgesic, an analgesic supplement to anesthesia, an anesthetic induction agent, and as the major component of a general anesthetic. Its short duration of effect makes it attractive as an analgesic supplement for short ambulatory surgical procedures. Alfentanil is recommended for addition to drug formularies, but its use should be restricted to anesthesia personnel.
How Pharmacists are Rated as a Source of Drug Information by Physician Assistants
Authors: Fincham Jack E. 
Published: May 2016

A study to examine physician assistants' (PAs) views of drug information sources was undertaken in a sample of practicing PAs in Georgia. Analysis of Kendall's coefficient of concordance statistic indicated Pharm.D.s were ranked highest as being good sources of drug information of the six categories listed. Next in descending order of classification as good sources of drug information were the categories of journal articles, physicians, non-Pharm.D. pharmacists, detail persons, and physician assistants. A significant correlation was found between PA contact with pharmacists and the classification of pharmacists as good sources of drug information. The difference in rating between Pharm.D.s and journal articles and physicians was not significantly different, but the rating differences between these categories and each of the other sources were statistically significant. Pharm.D. pharmacists were rated higher as a source of drug information than were non-Pharm.D. pharmacists. Results indicate pharmacists are viewed positively as sources of drug information for PAs, and that view increases with contact with pharmacists.
Drug Utilization Research in Clinical Practice
Authors: Hekster Yechiel A. , Vree Thomas B. 
Published: May 2016

This report describes the use of drug utilization studies in clinical practice, with special emphasis on future developments. It has been shown that pharmacy services affect prescribing patterns, have great potential for reducing health care costs, and are in a position to produce financial savings in drug therapy and drug use. However, it is essential to balance the drug utilization figures against the resulting outcome, and attention should be focused on the assessment of therapeutic results. To make therapeutic result assessment possible, end points need to be defined. Several examples of such end points are given and include incidence of nosocomial infections and postoperative wound infections. New parameters have been established to assess the severity of the illness and to follow the effect of drugs on the disease process in the form of an Index of Disease Activity (IDA). IDAs have been prepared for Crohn's disease, rheumatoid arthritis, and ankylosing spondylitis. It then becomes possible to link drug utilization data with a drug's influence on a disease, making drug utilization research a recognized discipline within the medical field.
Compatibility of Cefazolin and Gentamicin in Peritoneal Dialysis Solutions
Authors: Walker Paul C. , Kaufmann Ralph E. , Massoud Neil 
Published: May 2016

The compatibility of cefazolin and gentamicin in fluid commonly used for continuous ambulatory peritoneal dialysis (CAPD) was studied. Five admixtures containing cefazolin (75 mg/L and 150 mg/L) and gentamicin (8 mg/L), alone and in combination, were prepared in 1.5% dextrose peritoneal dialysis solution. Solutions were stored for 48 hours at 4°C, 26°C, and 37°C; aliquots for drug assay were obained at 0, 4, 8, 24, and 48 hours. HPLC and immunofluorescent assays were used to determine cefazolin and gentamicin concentrations, respectively. The cefazolin and gentamicin concentration changes over the study period did not reach statistical significance. Maximal cefazolin and gentamicin losses (12 and 7 percent of the initial concentrations, respectively) were observed at 48 hours in solutions stored at 37°C. No significant differences in concentration changes were observed between combination solutions and solutions containing either cefazolin or gentamicin alone. Cefazolin and gentamicin, alone or in combination, are compatible for at least 48 hours in CAPD solutions.
Is There Cost Reduction Potential for Extended Half-Life Cephalosporins?
Authors: Scalley Robert D. , Stuart Clifford C. 
Published: May 2016

Two new second-generation cephalosporin derivatives with extended half-lives, ceforanide and cefonicid, have recently entered the U.S. marketplace. Because longer dosing intervals require fewer daily doses, potential exists for overall cost reduction if pharmacy and nursing time can be effectively saved. Reduction in personnel costs, however, must be sufficient for these more expensive products to be truly cost effective. We studied the impact of substituting these newer agents for older, less expensive products with formulary status at our 200-bed community hospital. Results show that no nursing expenses could be recovered, and there is little chance of consistently reducing pharmacy compounding expenses. Within the constraints of these studies, particularly physician prescribing habits, the GRASP (Grace Reynolds Application and Study of PETO) system of determining nurse staffing, and our drug acquisition costs, we find that the newer extended half-life products have very limited usefulness and may only increase the cost of antibiotic utilization.
A Clinical Pharmacy-Oriented Drug Surveillance Network: I. Program Description
Authors: Grasela Thaddeus H. , Schentag Jerome J. 
Published: May 2016

The limitations of the new drug development process, particularly in regard to the evaluation of drug safety, have resulted in a need for monitoring drug experience in the postmarketing period. Although a number of systems have evolved to perform postmarketing surveillance, each has important limitations, suggesting the need for an alternative, innovative approach that would permit rapid identification of potential problems and support studies of multiple drugs and/or disease states in patient populations large enough to permit identification of uncommon, but significant adverse drug reactions. This has led to the organization of a nationwide network of clinical pharmacists with an active role in patient-care monitoring to collect information regarding the safety and effectiveness of drugs. At the present time there are 383 clinical pharmacists from all 50 states participating in the network. These individuals collectively monitor more than 150000 inpatient hospital beds, more than 40000 nursing home beds, and more than 800000 ambulatory care visits per year. Participating clinical pharmacists, using standardized data collection forms, perform concurrent monitoring of drug-therapy outcome in targeted patient populations. Careful analysis and interpretation of this information will yield clinically relevant information regarding the outcome of drug therapy under actual clinical conditions.
Concentration Guidelines for Parenteral Antibiotics in Fluid-Restricted Patients
Authors: Robinson Daniel C. , Cookson Thomas L. , Grisafe Joseph A. 
Published: May 2016

A guideline for the preparation of peripherally administered antibiotics in fluid-restricted patients was developed. A maximum osmolality of 560 mOsmol/kg was selected since this corresponds to the theoretical osmolality of dextrose 5% in NaCl 0.9%, a solution commonly administered peripherally without significant incidence of phlebitis. Percentage concentrations corresponding to 560 mOsmol/kg of 26 intravenous antibiotics were calculated using sodium chloride equivalents. The antibiotics were reconstituted using sterile water, dextrose 5%, and NaCl 0.9% to provide an osmolality of 560 mOsmol/kg. The resulting solutions were measured for osmolality using a freezing-point depression osmometer. A total of 78 solutions were prepared and measured in triplicate. Of the 78 measured osmolalities, 67 (86 percent) were within 20 percent of the desired 560 mOsmol/kg. Only two osmolalities were more than 10 percent above the projected value. The percentage concentrations of 26 antibiotics in three solutions corresponding to 560 mOsmol/kg are presented. A method is also provided for tailoring concentrations to achieve desired osmolalities other than 560 mOsmol/kg.
Drug Information Services in Quebec: Determination of Community and Hospital Pharmacists' Needs
Authors: Mailhot Claude , Giacona-Dahl Nicola S. 
Published: May 2016

A survey of Quebec pharmacists was conducted to determine drug information resources currently available, obtain information on pharmacists' involvement as drug information providers, and determine their perceived drug information needs. Responses were obtained from 665 of 3283 registered pharmacists for a response rate of 20.3 percent. Hospital and community pharmacists represented more than 90 percent of the respondents. The two reference texts most frequently found in community pharmacists' libraries were Compendium of Pharmaceutical Specialties and Goodman and Gilman's The Pharmacological Basis of Therapeutics, the latter being available to only 49 percent of the pharmacists. More than 60 percent of the hospital pharmacists had at least 10 of the reference texts listed on our survey instrument. The majority of pharmacists were actively involved in a variety of clinical pharmacy services. Providing drug information to consumers or health professionals was one of the most common activities. Several pharmacists expressed their needs for drug information center (DIC) support in different drug information categories. Information on drug interactions and adverse drug reactions was rated as an important need by 68 and 59.9 percent of the community pharmacists, respectively. The institution of a regional DIC may provide the support system needed by the pharmacists of Quebec.