bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ifosfamide Extravasation
Authors: Mateu Javier , Alzamora Mónica , Franco Mercedes , Buisán María-José 
Published: January 2017

OBJECTIVE: To report a case in which a local reaction is attributed to an ifosfamide extravasation. Previously, extravasated ifosfamide has been considered a nonirritant. CASE SUMMARY: A 54-year-old woman with a non-Hodgkin's lymphoma in stage IV B developed a local reaction in her right arm after an ifosfamide extravasation. No pressure was prescribed, no bandaging was applied on the affected area, and the limb was elevated to the heart level. In addition, chondroitinsulfatase 150 turbidity-reducing units was administered subcutaneously around the area. This procedure was repeated 12 hours later, resulting in a satisfactory decrease in the inflammatory signs and pain. DISCUSSION: The local reaction in the patient's arm cannot be attributed to the hypertonicity of the infusing solution or to the vehicle of the infusate. The antidote used was chondroitinsulfatase, an enzyme similar to hyaluronidase. It enhances the systemic uptake of the drug from the tissue. CONCLUSIONS: Extravasated ifosfamide is a potential irritant. General measures applied after its extravasation can be potentiated strongly by local subcutaneous administration of chondroitinsulfatase or hyaluronidase, repeated if necessary.
Salivary Concentrations of Ketoconazole and Fluconazole: Implications for Drug Efficacy in Oropharyngeal and Esophageal Candidiasis
Authors: Force Rex W. , Nahata Milap C. 
Published: January 2017

Objective: To determine whether salivary concentrations of ketoconazole and fluconazole may explain the apparent disparity between in vitro activity and clinical efficacy observed with these drugs. Design: Healthy subjects received a single oral dose of ketoconazole 400 mg or fluconazole 100 mg in a randomized, crossover fashion. Saliva was collected at 0, 1, 2, 3, 6, 12, and 24 hours. Blood samples were obtained at 2 and 24 hours. Salivary concentrations and plasma concentrations for each drug were determined by HPLC. Minimum inhibitory concentration (MIC) testing was determined in triplicate on 6 clinical isolates of Candida albicans, and times over the median MIC values were calculated. Participants: Eight subjects completed the study. Results: The mean (± SD) peak salivary concentration for ketoconazole was 0.119 ± 0.050 pg/mL at 3 hours; no subject had a detectable ketoconazole salivary concentration at 24 hours. At 2 and 24 hours, mean ketoconazole plasma concentrations were 7.64 ± 3.87 and 0.11 ± 0.05 μg/mL, respectively. The saliva to plasma concentration ratio at 2 hours was 0.01. The mean peak salivary concentration of fluconazole was 2.56 ± 0.34 pg/mL at 3 hours. At 24 hours, the mean salivary concentration was 1.44 ± 0.33 μg/mL. At 2 and 24 hours, mean fluconazole plasma concentrations were 4.39 ± 3.33 and 3.72 ± 2.83 pg/mL, respectively. The saliva to plasma concentration ratio at 2 hours was 0.55. Median MIC values were 0.0625 μg/mL (range 0.0313-0.125) for ketoconazole and 0.25 μg/mL (range 0.125-0.5) for fluconazole. Calculated times over which ketoconazole and fluconazole exceeded the median MICs in saliva were approximately 13 and greater than 24 hours, respectively. Conclusions: After a single oral dose, fluconazole achieved higher salivary concentrations than did ketoconazole. This may explain the increased clinical efficacy of fluconazole in the treatment of oropharyngeal-esophageal candidiasis when compared with ketoconazole.
Monitoring of Intravenous Quinidine Infusion in the Treatment of Plasmodium Falciparum Malaria
Authors: Bhavnani Sujata M. , Preston Sandra L. 
Published: January 2017

Objective: To report a case of Plasmodium falciparum malaria in which intravenous quinidine was used, resulting in a prolonged QT interval. Case summary: P. falciparum malaria was diagnosed in a woman visiting from Nigeria. Treatment was instituted with intravenous quinidine given the high level of parasitemia. During the quinidine infusion, the patient experienced a prolonged QT interval and an episode of supraventricular tachycardia. The infusion rate was decreased and the QT duration returned to normal; there was no further episode of arrhythmia. Subsequently the patient was given oral quinine. Her condition improved and she was discharged on day 4 of therapy. Discussion: P. falciparum malaria, not commonly seen in the US, is associated with severe morbidity and mortality. This condition necessitates prompt treatment with intravenous quinidine, which can be associated with toxicity. The use of this agent to treat malaria is reviewed herein. Conclusions: In patients with P. falciparum malaria, a high-level parasitemia may require treatment with a potentially toxic agent, intravenous quinidine. Cardiac monitoring of these patients is essential during such therapy.
Efficacy and Pharmacokinetics of Simvastatin in Heart Transplant Recipients
Authors: Campana Carlo , Iacona Isabella , Regazzi Mario B. , Gavazzi Antonello , Perani Guido , Raddato Vincenzo , Montemartini Carlo , Viganò Mario 
Published: January 2017

Objective: To evaluate the efficacy and safety of simvastatin administered to a group of heart transplant patients receiving triple-drug immunosuppressive therapy. We also assessed the potential pharmacokinetic interaction between simvastatin and cyclosporine by comparing mean plasma concentrations of simvastatin beta-hydroxy acid, the major metabolite of the drug, in a group of heart transplant patients treated with cyclosporine and in a control group of patients who had not received heart transplants. Both groups received long-term (>6 wk) simvastatin therapy. Design: We monitored hyperlipidemia in 20 hypercholesterolemic heart transplant patients receiving simvastatin 10 mg/d and triple-drug immunosuppressive therapy. Changes in laboratory results before and after 4 months of simvastatin therapy were considered. The same laboratory data were monitored in a control group of 20 nonhypercholesterolemic heart transplant patients who were not treated with simvastatin but were receiving triple-drug immunosuppressive therapy. Plasma concentrations of simvastatin beta-hydroxy acid were measured in 14 hypercholesterolemic patients, 7 of whom had received heart transplants and 7 who had not. Setting: The Division of Cardiology and the First Medical Clinic for the clinical study, as well as the Department of Pharmacology for the pharmacokinetic analysis. Participants: Forty heart transplant patients and 7 hypercholesterolemic nontransplant patients. Main Outcome Measures: Effectiveness of simvastatin was determined by comparing cholesterol and lipoprotein plasma concentrations in 20 patients who underwent heart transplant and were treated with simvastatin for 4 months. The safety of the drug was determined by analyzing changes in laboratory results in the treated group and in the control group, both those who had received heart transplants and those who had received immunosuppressive therapy. Results: After 4 months of simvastatin therapy, total cholesterol decreased by 12.5% and low-density lipoprotein cholesterol decreased by 21.3%. The only statistically significant laboratory change was an increase of 28.7% in the alanine aminotransferase concentrations. Plasma concentrations of simvastatin beta-hydroxy acid were higher in heart transplant patients than in those who had not received heart transplants, the control group. Conclusions: Low-dosage simvastatin treatment seems to be safe and sufficiently effective to decrease cholesterol concentrations. Concomitant treatment with immunosuppressive therapy (primarily cyclosporine) in heart transplant patients appeared to cause a reduced metabolic clearance of simvastatin from the plasma. More extensive studies on the interaction between simvastatin and cyclosporine are needed to understand the marked variability found in the response to simvastatin.
Pruritus Associated with Intravenous Rifampin
Authors: Walker-Renard Pamela 
Published: January 2017

Objective: To report a probable case of moderate pruritus associated with intravenous rifampin. Case Summary: A 57-year-old woman was started on vancomycin 1 g iv q72h following a positive blood culture for methicillin-resistant Staphylococcus epidermidis. The patient's past medical history was significant for uterine carcinoma, radiation-induced enteritis, congestive heart failure, and renal insufficiency. Other therapy consisted of total parenteral nutrition, digoxin 0.125 mg/d iv, and furosemide 60 mg iv prn for edema. Seven days later, the patient's white blood cell count increased and rifampin 600 mg/d iv was added to the drug regimen for potential synergy. On day 3 of rifampin therapy, the patient experienced pruritus beginning 30 minutes after the rifampin infusion ended and lasting for 6–8 hours. After 7 days of rifampin therapy, the medication was discontinued and the pruritus resolved. Conclusions: This case evaluation demonstrated probable pruritus induced by intravenous rifampin. Clinicians should be alerted that intravenous rifampin, as well as orally administered rifampin, has the potential to cause moderate pruritus.
Surveillance of Colony-Stimulating Factor use in us Academic Health Centers
Authors: Yim Josephine M , Matuszewski Karl A , Vermeulen Lee C , Ratko Thomas A , Burnett David A , Vlasses Peter H 
Published: January 2017

Objective: To characterize and evaluate hematopoietic colony-stimulating factor (CSF) use, including cost implications, in US academic health centers. Design: An observational study of patients who received granulocyte colony-stimulating factor (G-CSF) or granulocytemacrophage colony-stimulating factor (GM-CSF) from September 1 to October 15, 1993. Setting: Thirty academic health centers in the US. Participants: Five hundred sixty-five patients were evaluated. Main Outcome Measures: The appropriateness of CSF use was assessed, based on consensus-derived indication guidelines and the Food and Drug Administration-approved product labeling. Indication, type of CSF, and dosage were considered in determining the appropriateness of CSF therapy. Results: Based on indication evaluation criteria, 71% of CSF use was appropriate, 7% was inappropriate, and 22% was unproven, although the majority of unproven use was deemed promising by the expert panel. Based on dosage evaluation criteria, 51% of CSF use was appropriate, 27% was inappropriate, and 22% was for promising and other unproven indications. More than 90% of the patients studied received G-CSF. Approximately 3.4% of patients who received G-CSF had an adverse event, compared with 22% of those who received GM-CSF. Approximately $791 000 was spent on CSF therapy in the 565 patients: $401 000 (51%) on appropriate indications and doses, $160 000 (20%) on inappropriate doses for appropriate indications, $124 000 (16%) on promising indications, and $106 000 (13%) on unproven or inappropriate indications. Conclusions: Substantial costs are incurred currently for CSF therapy without adequate literature support. Further studies are warranted to justify promising but unproven uses of CSFs, as well as to clarify proper dosing, monitoring, and relative safety of CSFs.
Two Cases of Therapeutic Failure Associated with Levothyroxine Brand Interchange
Authors: Copeland Paul M 
Published: January 2017

Objective: To report the loss of therapeutic control in 2 hypothyroid patients and remind clinical pharmacists and other healthcare professionals to remain cognizant of possible product quality differences within or bioequivalency differences between levothyroxine products. Case Summaries: Two patients with stable hypothyroidism experienced symptoms of hypothyroidism with increased serum thyroid-stimulating hormone (TSH) concentrations after switching from 1 levothyroxine product to another. One tablet from 1 of the patient's levothyroxine prescriptions was assayed, and its levothyroxine content was 74.5% of the label claim, a value outside of the United States Pharmacopeia requirements of 90–110%. Discussion: Two patients with hypothyroidism had remained euthyroid and stable while receiving 1 levothyroxine product, but became symptomatic with dramatically increased serum TSH concentrations while receiving what were thought to be comparable dosages of another levothyroxine product. Therapeutic control was reestablished in both patients after therapy with the original levothyroxine product was reinstated. Conclusions: Clinical pharmacists and other healthcare professionals should remain cognizant of possible product quality differences within or bioequivalency differences between levothyroxine products. These differences necessitate close monitoring of hypothyroid patients, counseling these patients about the clinical signs of sub- and supratherapeutic levothyroxine dosages, and prudence when switching patients with stable hypothyroidism to alternative levothyroxine products. If there are inconsistencies between levothyroxine products, resultant deleterious effects on the therapeutic stability of patients with hypothyroidism may undermine cost savings that might be incurred by such a change. If these patients are switched to alternative levothyroxine products, it is recommended that thyroid function tests be repeated after equilibration to the new product.
Low-Dose Dopamine in Severe Right Heart Failure and Chronic Obstructive Pulmonary Disease
Authors: Chan Thomas YK 
Published: January 2017

Objective: To describe the beneficial effects of low-dose dopamine infusion (2-5 μg/kg/min) in a patient with severe cor pulmonale complicating chronic obstructive pulmonary disease (COPD). Case Summary: A 53-year-old woman with severe cor pulmonale and generalized edema complicating COPD received low-dose dopamine to stabilize blood pressure and, perhaps, improve cardiac output. Low-dose dopamine also improved her renal function and enhanced the diuretic response to furosemide therapy. Discussion: Previous studies of dopamine in such patients were reviewed. Both dopamine infusion (4 μg/kg/min) and oral administration of its precursor, l-dopa, can increase the cardiac output, decrease pulmonary vascular resistance, and enhance oxygen delivery in patients who are stable with cor pulmonale secondary to COPD. In patients with COPD during acute respiratory failure, high-dose dopamine (10 μg/kg/min) has been shown to increase the diaphragmatic blood flow and contraction. Low-dose dopamine also has been reported to be useful in patients with congestive heart failure or cirrhosis of the liver. Conclusions: Low-dose dopamine is useful in the acute management of patients with severe cor pulmonale complicating COPD because of the drug's beneficial effects on blood pressure, cardiac output, renal perfusion, natriuresis, and diuresis. Low-dose dopamine also may enhance the natriuretic and diuretic response to loop diuretics, decrease pulmonary vascular resistance, and enhance oxygen delivery.
Estimating Phenytoin Concentrations by the Sheiner-Tozer Method in Adults with Pronounced Hypoalbuminemia
Authors: Dager William E , Inciardi John F , Howe Ted L 
Published: January 2017

Objective: To assess the performance of the Sheiner-Tozer equation when used to evaluate total phenytoin concentrations in patients with pronounced hypoalbuminemia. Design: Patients with phenytoin concentrations drawn at least 5 days after initiation of therapy and with serum albumin concentrations of less than 25 g/L were identified during routine daily monitoring. Phenytoin samples were frozen at −30 °C, batched, and later thawed for total and free phenytoin assay. Separation of free phenytoin concentration was performed at 37 °C using a Centrifree micropartition filter. Setting: A 400-bed university teaching hospital. Patients: Twenty-nine adults with hypoalbuminemia receiving phenytoin therapy. Patients receiving drugs known to displace phenytoin, or those with renal failure, abnormal liver enzymes, or increased bilirubin concentrations were excluded. Main Outcome Measure: Precision and bias of the normalized result using the Sheiner-Tozer equation were assessed with respect to observed phenytoin concentrations. Results: The Sheiner-Tozer equation underpredicts the measured free concentration by approximately 12.4%. The equation provides a small but statistically significant bias (−2.7 mg/L) and a root mean squared error significantly different from 0. For most of our patients these departures appear small enough to warrant an initial empiric appraisal of hypoalbuminemia using the Sheiner-Tozer method. Conclusions: The Sheiner-Tozer equation can normalize total phenytoin concentrations reliably in patients with low albumin concentrations at our institution.
Disease-Based Assessment of Peripheral Vascular Disease in Nursing Facility Patients
Authors: Gonzalez Edgar R , Liberto Rhonda B , Davidson H Edward , Chamberlain Thomas M , Mendelson Marilyn A 
Published: January 2017

Objective: To determine the frequency of diagnosis of peripheral vascular disease (PVD) and selected related conditions in patients in a nursing facility, to determine the frequency of patients with risk factor(s) for or clinical evidence of PVD but without a diagnosis of PVD or a related condition, and to determine the frequency with which patients with and without a diagnosis of PVD or a related condition were treated with drug and nondrug therapies. Design: A multicenter, disease-based, retrospective evaluation. Settings: 41 nursing facilities in 6 regions of the US. Patients: 4038 patients in a nursing facility: 827 patients with a PVD or related diagnosis; 2719 patients without a PVD or related diagnosis but with risk factor(s) for or clinical evidence of PVD; and 492 patients without a PVD or related diagnosis, risk factor(s), and clinical evidence. Main Outcome Measures: Evidence of disease and drug therapy for PVD. Results: PVD was documented in 21% of patients; another 67% had risk factor(s) for or clinical evidence of PVD but no diagnosis of PVD or a related condition. Pentoxifylline was prescribed for 3% of the total sample and 12% of patients with PVD or a related condition. Conclusions: PVD appears to be inadequately evaluated in patients in a nursing facility. Disease treatment strategies should be developed and implemented to educate healthcare professionals and the general public about the need to acknowledge, assess, and treat PVD and related conditions.
Hydrochlorothiazide-Induced Acute Pulmonary Edema
Authors: Fine Stanley R , Lodha Ajay , Zoneraich Samuel , Mollura Joseph L 
Published: January 2017

Objective: To describe a patient with noncardiogenic acute pulmonary edema induced by hydrochlorothiazide. Case Summary: A 70-year-old woman in generally good health, except for mild pedal edema, developed acute pulmonary edema after ingesting hydrochlorothiazide 12.5 mg for the first time. Discussion: This is the fifteenth reported case of noncardiogenic pulmonary edema induced by hydrochlorothiazide. The investigations by previous authors seemed to rule out an immunologic mechanism; thus, the pathogenesis of the reaction is unknown. Most of the reactions have occurred in women. Conclusions: Noncardiogenic pulmonary edema appears to be an idiosyncratic reaction that occurs with some specificity with the thiazide diuretics. Clinicians should be aware of this potential, serious adverse reaction that occurs without warning.
Continuous Subcutaneous Heparin Infusion for Treatment of Trousseau's Syndrome
Authors: Alderman Christopher P , McClure Anna F , Jersmann Hubertus PA , Scott Shane D 
Published: January 2017

Objective: To describe the use of continuous subcutaneous heparin infusion in the treatment of 2 cases of Trousseau's syndrome. Case Summaries: Two patients with metastatic carcinoma presented to the hospital with acute coagulopathies consistent with a diagnosis of Trousseau's syndrome. In both cases conventional anticoagulant therapies proved to be impractical and ineffective. Discussion: Considerable literature suggests that oral anticoagulants such as warfarin are ineffective in the treatment of Trousseau's syndrome. Heparin is more effective for this purpose, although continuous intravenous infusion may prove difficult in the ambulatory setting. Intermittent subcutaneous injections of heparin or low-molecular-weight heparin may not provide reliable anticoagulation for the entire dosage interval. Although the use of continuous subcutaneous infusion of heparin has been used for anticoagulation during pregnancy, this is the first report of the use of sodium heparin administered by continuous subcutaneous infusion in the treatment of Trousseau's syndrome. Conclusions: Continuous subcutaneous heparin infusion may be an effective option for the treatment of Trousseau's syndrome in the ambulatory setting.
Diclofenac-Associated Thrombocytopenia and Neutropenia
Authors: Kim Harold L , Kovacs Michael J 
Published: January 2017

Objective: To report a case of thrombocytopenia and a case of neutropenia, both associated with the use of diclofenac. Case Summaries: A 63-year-old woman was receiving diclofenac for osteoarthritis. During a hospital admission for pneumonia, she was found to have severe thrombocytopenia. Diclofenac therapy was stopped and the thrombocytopenia resolved. Several months later she was inadvertently treated with diclofenac by another physician and again experienced thrombocytopenia, which again resolved on discontinuation of the drug and has not recurred since. A 72-year-old man was receiving diclofenac for 9 months for osteoarthritis. He was then found to have asymptomatic neutropenia. Diclofenac therapy was stopped and the neutropenia resolved with no other intervention. He was not rechallenged. Discussion: Severe thrombocytopenia and neutropenia are extremely rare adverse reactions to diclofenac. To date, there is only 1 case of each that is well documented and supported in the literature. Conclusions: Severe thrombocytopenia and neutropenia are potential serious adverse effects of the use of diclofenac. Patients who are receiving diclofenac and develop symptoms of either thrombocytopenia or neutropenia should have a complete blood count, and if this diagnosis is confirmed, the drug therapy should be stopped.