bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clonidine Patch Ingestion in an Adult
Authors: Raber Jack H. , Shinar Chris , Finkelstein Stuart 
Published: January 2017

OBJECTIVE: To report a case of deliberate ingestion of a clonidine hydrochloride patch in an adult. CASE SUMMARY: A patient at a psychiatric hospital with a diagnosis of major depression and polysubstance abuse was administered a clonidine patch for opiate detoxification. The patient subsequently chewed and swallowed the patch (total clonidine content: 5 mg); he was subsequently transferred to a nearby general medical hospital for management of obtundation and profound sinus bradycardia. DISCUSSION: The use of clonidine in withdrawal states is discussed. The primary adverse effects attributable to clonidine overdose, hypotension, and profound sinus bradycardia, may be managed symptomatically. Accidental ingestion of clonidine patches by infants and children has previously been reported in the literature. This is the first reported case of deliberate ingestion of a clonidine patch in an adult. CONCLUSIONS: Before initiating topical clonidine therapy for chemical withdrawal states, patients should be evaluated carefully for suicide potential and a history of previous suicide attempts. If a patient expresses suicidal ideation or has attempted suicide in the past, he is probably not a candidate for topical clonidine therapy in either the inpatient or outpatient setting.
Nicotine Transdermal Systems
Authors: Gora Mary Lea 
Published: January 2017

OBJECTIVE: To review the role of transdermal nicotine as an aid to smoking cessation. DATA SOURCES: A MEDLINE search was performed that included clinical studies published in English involving transdermal nicotine; references used in those articles were screened for additional published information. STUDY SELECTION: Published clinical trials were reviewed with particular emphasis on controlled trials that evaluated safety and efficacy. DATA SYNTHESIS: Transdermal nicotine therapy has been shown to be a safe and effective pharmacologic aid in a smoking cessation program when used in conjunction with a psychologic or behavior support system. Habitrol, Nicoderm, Nicotrol, and PROSTEP differ in some characteristics (i.e., delivery systems, total nicotine content and amount absorbed, rate of delivery, recommended duration of application); however, the clinical implication of these differences has not been determined. CONCLUSIONS: Transdermal nicotine is effective for patients who are motivated to quit smoking and receive concomitant behavior support.
Intrathecal Baclofen for Severe Spasticity Secondary to Spinal Cord Injury
Authors: Lewis Kelly S. , Mueller Wade M. 
Published: January 2017

OBJECTIVE: To evaluate the use of intrathecal baclofen for the treatment of muscle spasticity in patients with spinal cord injury. DATA SOURCES: A MEDLINE search was used to identify relevant and pertinent literature. Information was obtained from open-label clinical trials, abstracts, conference proceedings, and review articles. Index terms in the search included baclofen, spasticity, intrathecal drug infusion, spinal cord disease, and neurosurgery. DATA EXTRACTION: Studies were selected for review if they evaluated intrathecal baclofen in patients with spinal cord injury. Emphasis was placed on human studies published in the English language. Trials were reviewed by dosage regimen, therapeutic response, adverse effects, and complications. DATA SYNTHESIS: Thus far, intrathecal baclofen administration shows promise in the treatment of spasticity resulting from spinal cord trauma. Few complications and adverse effects have been reported. CONCLUSIONS: Muscle spasms and spasticity constitute a significant problem in spinal cord injuries, interfering with rehabilitation and leading to inconveniences and complications in these patients. Oral baclofen is the drug of choice for spasticity due to spinal cord trauma. It often is ineffective, however, because of the large dosages required to cross the blood-brain barrier and the subsequent appearance of central nervous system adverse effects. These adverse effects are not tolerated by many patients. Intrathecally administered baclofen has been approved by the Food and Drug Administration (FDA) for the treatment of spasticity in patients with spinal cord injury who are refractory to or cannot tolerate oral baclofen. It is intended for use only in implantable pumps approved by the FDA for the administration of baclofen into the intrathecal space. Intrathecal administration achieves high concentrations in the spinal cord with small dosages, thus reducing the incidence of central nervous system adverse effects. To date, approximately 350 patients with spinal cord injury have been treated with intrathecal baclofen. Reductions in spasticity have been demonstrated in both open-label and placebo-controlled trials. Patients also often make substantial gains in activities of daily living. Few adverse effects and complications have been reported. However, tolerance to the clinical effects of intrathecal baclofen has been reported. Further studies are needed to determine specific patient populations that may benefit most from intrathecal baclofen administration. Individual dosage ranges and follow-up care also need to be defined more completely. In addition, the question of whether tolerance detracts from long-term clinical benefits with intrathecal baclofen needs to be addressed.
A Practical Alternative to Conventional Aminoglycoside Dosing Methods
Authors: Goldman Morton P. , Fuller Matthew A. 
Published: January 2017

OBJECTIVE: One-compartment pharmacokinetic equations are adequate to perform clinical dosing adjustments for aminoglycoside monitoring. This article describes the Fuller-Goldman (FG) method, an alternative method of aminoglycoside dosage adjustment after serum concentrations have been obtained. The FG method uses pharmacokinetic principles, but does not use standard pharmacokinetic equations (SPE) for aminoglycoside dosage adjustment. A comparison of the FG method to SPE is also presented. DATA SOURCES: Information was obtained from pharmacokinetic textbooks and references using basic pharmacokinetic concepts. Forty sets of peak and trough serum drug concentrations were randomly chosen, retrospectively, from routine pharmacokinetic service data. All of the patients were men with a variety of infectious diseases and cared for on general surgical and medical floors, intensive care units, and a spinal cord injury unit. STUDY SELECTION: No studies have previously been published using this dosing method. DATA EXTRACTION: Peak and trough data were extracted from routine pharmacokinetic monitoring forms kept by the coordinator of the Pharmacokinetic Monitoring Service at the Department of Veterans Affairs Medical Center. DATA SYNTHESIS: The FG method is characterized by assumptions and limitations similar to those of standard pharmacokinetic dosing methods. Forty sets of data were evaluated using both the FG method and SPE. These data were analyzed using mean percent differences of projected dosages and projected half-lives (t1/2s) as measures of the average magnitude of the discrepancy between the two methods. Ninety-five percent confidence intervals for mean percent differences also are provided. CONCLUSIONS: The FG method overestimated by 10.18 percent the dosage recommendations of the SPE method. This method also underestimated t1/2 by 2.96 percent, compared with SPE. The FG method is a viable alternative aminoglycoside dosing technique that requires one to use learned pharmacokinetic concepts.
Sotalol: A Breakthrough Antiarrhythmic?
Authors: Nappi Jean M. , McCollam Patrick L. 
Published: January 2017

OBJECTIVE: To review the pharmacology, pharmacokinetic, dosing, adverse effects, and therapeutic uses of sotalol. DATA IDENTIFICATION: Articles were identified with an English-language literature computer search via Knowledge Finder, using the term sotalol, and with an extensive search of bibliographies of identified articles. STUDY SELECTION: Relevant or representative animal studies, human trials, and case reports were selected for evaluation. DATA EXTRACTION: The literature was assessed for quality, methodology, and outcome information. DATA SYNTHESIS: Sotalol is a racemic compound with Class II (beta-blocking properties) and Class III (prolonged action potential) antiarrhythmic activity. It has been suggested that the plasma concentration associated with QTc prolongation (a measure of the Class III action) is much greater than that associated with beta-blockade. Therefore, sotalol is categorized as a Class III antiarrhythmic agent. The l-isomer is responsible for the beta-blocking activity, whereas both isomers have Class III properties. After oral dosing in fasting patients with normal renal function, sotalol is >90 percent absorbed, achieves peak serum concentrations in 2–4 h, is excreted unchanged 80–90 percent in the urine, has a volume of distribution of 1–2L/kg, and has an elimination half-life of about 12 h. Sotalol is effective in patients with life-threatening ventricular arrhythmias that have been refractory to other conventional antiarrhythmic drugs. In general, sotalol appears to be well tolerated, with many of its adverse effects caused by beta-blocking activity. As with other antiarrhythmic agents, the possibility of proarrhythmia (frequently torsade de pointes) exists. CONCLUSIONS: Racemic sotalol is an effective Class III antiarrhythmic agent approved by the Food and Drug Administration for the treatment of documented life-threatening ventricular arrhythmias. Investigations continue with racemic sotalol in the management of supraventricular arrhythmias. Trials with the d-isomer are also ongoing.
Bacillary Angiomatosis in a Patient with AIDS
Authors: Teague A. Christine , Parks Sharon K. 
Published: January 2017

OBJECTIVE: To report the clinical presentation and response to antimicrobial therapy of presumed bacillary angiomatosis in an AIDS patient. DESIGN: Single case report. SETTING: A 1058-bed, university teaching hospital. PATIENT: 28-year-old HIV-positive man (T4 lymphocyte count <3/mm3), who was diagnosed with AIDS in 1984. RESULTS: The skin lesions responded promptly to treatment with doxycycline and erythromycin. CONCLUSIONS: Bacillary angiomatosis is an infection that occurs with endstage AIDS. Skin lesions have recognizable characteristics and respond promptly to appropriate antibiotic therapy.
Drug Disposition in Neonates with Patent Ductus Arteriosus
Authors: Gal Peter , Gilman Jamie T. 
Published: January 2017

OBJECTIVE: To review the literature on the physiologic changes created by neonatal patent ductus arteriosus (PDA) and the potential impact on drug disposition in these infants. DATA SOURCES: An Index Medicus and bibliographic search of the English-language literature pertaining to neonatal PDA and drug usage in newborns. DATA SYNTHESIS: PDA in premature infants is associated with a variety of physiologic changes that could alter drug disposition. Perfusion of drug-elimination organs (i.e., liver and kidney) may be diminished, resulting in decreased drug elimination. Further, the general fluid overload state associated with PDA may result in larger volumes of distribution (Vd), and dilutional effects for many drugs. Drug absorption, Vd, tissue penetration, and clearance may be affected by the physiologic changes incurred by a PDA. Although the pharmacokinetics of several categories of therapeutic agents may be affected by a PDA, disposition changes with the aminoglycosides and indomethacin have been the best documented. The most reliable pharmacokinetic change appears to be related to drug Vd. The interpretation of many of these studies is confounded by a potential drug interaction with the concurrent administration of indomethacin for PDA closure. CONCLUSIONS: Close therapeutic drug monitoring is indicated in newborns with PDAs as abrupt changes in drug disposition can occur with PDA closure. PDA-induced changes in specific pharmacokinetic parameters of agents such as the aminoglycosides, indomethacin, and perhaps vancomycin may prove to be a valuable diagnostic adjunct for the identification of babies with undiagnosed PDA. More research into this pharmacophysiologic aspect of pharmacokinetics is warranted.
Assessing Physician Choice of Nonsteroidal Antiinflammatory Drugs in a Health Maintenance Organization
Authors: Kaplan Barbara , Farris Karen B. , Kirking Duane M. 
Published: January 2017

OBJECTIVE: To develop a categorization scheme for grouping various nonsteroidal antiinflammatory drugs (NSAIDs) by relative safety; to develop a method to quantify the appropriateness of the initial and subsequent choices of NSAID therapy; to assess whether NSAID prescribing was consistent with the developed criteria; to examine the cost of inappropriate, acute NSAID use as defined by the established criteria. DESIGN: Retrospective drug utilization review focusing on NSAIDs. SETTING/PARTICIPANTS: Members aged age⩾18 years of a 40 000-person southeastern Michigan health maintenance organization MAIN OUTCOME MEASURES: (1) Appropriateness of therapy using a four-level safety classification system for the NSAIDs developed by a consensus process; criteria based on safety under the assumption that any particular NSAID is equally likely to be effective when dosed appropriately; (2) evaluation of progression of NSAID therapy using the NSAID Therapy Progression Formula. RESULTS: For acute patients, almost half of the prescriptions were for ibuprofen and 33 percent were for naproxen. Ibuprofen usage accounted for 16 percent of total NSAID cost and naproxen agents accounted for over 50 percent of that cost. Potential cost savings of approximately $82 000 probably would have occurred had a 50 percent interchange rate for ibuprofen been acceptable. For chronic patients, 85 percent were treated with one or two NSAIDs; treatments were of reasonable high quality when compared by safety profiles. There was low use of ibuprofen in patients who only received one NSAID. CONCLUSIONS: NSAID usage assessment in a large population was achieved by developing a classification and scoring system based on NSAID safety; in this population, prescribing patterns were generally consistent with established criteria; however, when considering cost, improvement in initial NSAID selection for acute patients was possible.
Rapid Determination of Maintenance Heparin Infusion Rates with the Use of Non-Steady-State Heparin Concentrations
Authors: Kandrotas Robert J. , Gal Peter , Douglas Jean B. , Groce James B. 
Published: January 2017

OBJECTIVE: To compare heparin dosage adjustment using only activated partial thromboplastin time (APTT) with a method using non-steady-state heparin concentrations (HCs) to rapidly achieve and maintain an APTT ratio greater than or equal to 1.5 times baseline throughout the first 24 hours of therapy. DESIGN: Randomized, blind, parallel comparison of an empiric dosing method based only on APTT with a dosing method based on the calculation of heparin clearance using non-steady-state HCs. SETTING: A private community teaching hospital. The patient, physician, nurses, and investigators were blinded to the dosing method. Only the clinical staff pharmacist, who received the consult and made all dosage adjustments, was not blinded. PATIENTS: All patients requiring heparin for the treatment of thromboembolic disease were evaluated for potential inclusion in the study. Patients were enrolled in the study if they had a clinical diagnosis of deep venous thrombosis confirmed by objective means such as venography or ultrasonography. Patients were excluded if they had active bleeding, platelet dysfunction, thrombocytopenia, severe hepatic disease (total bilirubin >25.7 μmol/L), renal disease, or evidence of stroke. Patients were also excluded if they were receiving heparin prior to enrollment. MAIN OUTCOME MEASURE: Maintenance of an APTT ratio greater than or equal to 1.5 times baseline throughout the first 24 hours of heparin therapy. RESULTS: Thirty-four patients were enrolled in the study; 17 in each group. The groups were not significantly different with regard to gender, age, baseline APTT, or mean loading dose (p>0.5). Mean initial infusion rates for the control and HC groups were 1042 ± 194 and 1071 ± 143 units/h, respectively (p>0.5). After the first rate adjustment at 4 hours, the difference achieved significance at 1032 ± 232 and 1367 ± 317 units/h for the control and HC groups, respectively (p<0.01). At 12 hours, 18.8 percent of the patients in the control group were subtherapeutic; by 24 hours, 33.3 percent were subtherapeutic. No patients became subtherapeutic in the HCs group during the first 24 hours. CONCLUSIONS: This study demonstrates that, in contrast to standard heparin dosing methods, the use of non-steady-state HCs allows patients with deep venous thrombosis to rapidly achieve and maintain therapeutic APTT ratios throughout the critical first 24 hours of therapy.
Fluosol: Therapeutic Failure in severe Anemia
Authors: Kale Pramodini B. , Sklar Grant E. , Wesolowicz Laurie A. , DiLisio Ralph E. 
Published: January 2017

OBJECTIVE: To report the use of Fluosol in the management of a severe anemia and to review the literature regarding the use of Fluosol. CASE REPORT: A 40-year-old woman, at 40.5 weeks gestation, was admitted for induction of labor. Her hospital course was complicated by a postpartum hemorrhage and severe anemia. Because the patient was a Jehovah's Witness, she received non-blood products including hetastarch, iron dextran, and erythropoietin, and a total of 33 mL/kg of Fluosol, but she did not survive. DISCUSSION: Fluosol is an oxygen-carrying, perfluorochemical blood substitute. It was administered to our patient, who presented with the lowest hemoglobin (Hb) (11 g/L) and hematocrit (0.31 fraction of 1.00) of all reported cases. Almost all patients with an Hb <20 g/L do not survive. CONCLUSIONS: Although the use of Fluosol as a blood substitute appears theoretically promising, its use in the management of severe anemia cannot be recommended.
Fluvoxamine-Associated Manic Behavior: A Case Series
Authors: Dorevitch Abraham , Frankel Yehuda , Bar-Halperin Asher , Aronzon Rami , Zilberman Liana 
Published: January 2017

OBJECTIVE: To report cases of manic-like behavior induced by fluvoxamine, a selective serotonin-reuptake inhibitor; to review pertinent literature; and to encourage replication of our findings in larger patient samples. DESIGN: Description of a case series of fluvoxamine-induced, manic-like behavior. PATIENTS: Eight patients with depression or obsessive features who developed manic-like behavior after initiation of fluvoxamine therapy. RESULTS: Manic symptomatology resolved in all eight patients following dosage reduction or withdrawal of fluvoxamine. Four patients still are maintained on low-dose fluvoxamine without recurrent manic symptoms. CONCLUSIONS: Our case series suggests that fluvoxamine may have the ability to induce or unmask manic behavior in depressed patients. Clinicians are alerted to monitor for this “switching” effect, especially in patients previously or currently treated with neuroleptics or lithium, and in those patients exhibiting characteristics of obsessive-compulsive disorder.
Vesicular Eruptions following Acyclovir Administration
Authors: Buck Marcia L. , Vittone Sarah B. , Zaglul Horacio F. 
Published: January 2017

OBJECTIVE: To report the occurrence of vesicular lesions on the skin of a child receiving intravenous acyclovir therapy. CASE SUMMARY: A 12-year-old boy with presumed herpes simplex encephalitis developed cutaneous vesicular lesions following intravenous acyclovir administration. The lesions were initially thought to be herpetic. Further evaluation of the vesicle fluid and the temporal relationship of the development of the lesions with acyclovir administration led to the conclusion that the reaction was drug induced. DISCUSSION: Although inflammation and phlebitis are fairly common after acyclovir infusion, the development of vesicular lesions appears to be rare. Only two cases, both in adults, have been published in the medical literature. Although several theories have been proposed, including hypersensitivity, local drug toxicity, and tissue damage associated with extravasation, the mechanism of this reaction remains unclear. CONCLUSIONS: Vesicular eruption is a rare adverse reaction in patients receiving acyclovir. Careful evaluation is necessary to differentiate this reaction from herpetic lesions.
Treatment of Cryptosporidial Diarrhea in an AIDS Patient with Paromomycin
Authors: Danziger Larry H. , Kanyok Thomas P. , Novak Richard M. 
Published: January 2017

OBJECTIVE: To report a case of diarrhea caused by Cryptosporidium in an AIDS patient which was successfully treated with paromomycin. CASE SUMMARY: An AIDS patient with a 12-month history of Cryptosporidial diarrhea unresponsive to other treatment measures was treated with paromomycin 500 mg q6h for 14 days. Before initiating therapy, the patient was experiencing, on average, 20 bowel movements per day and had lost more than 25 kg. After therapy was initiated, the number of bowel movements dropped to 1–2 per day and the patient began to gain weight. The diarrhea recurred when therapy was discontinued. After retreatment for 14 days with paromomycin 500 mg q6h, the diarrhea stopped. The patient has not had a recurrence of Cryptosporidium diarrhea, stool cultures remain negative for Cryptosporidium oocysts, and the patient has regained most of the weight. DISCUSSION: Literature concerning the use of paromomycin for the treatment of cryptosporidiosis is discussed. A treatment algorithm for the management of cryptosporidiosis in AIDS patients is presented. CONCLUSIONS: We believe that we have presented a clear example of a case in which paromomycin was effective in treating and eradicating intestinal cryptosporidiosis in an AIDS patient. Paromomycin is the most effective agent available to date for the treatment of this devastating complication of AIDS.
Amiodarone-Clonazepam Interaction
Authors: Witt Daniel M. , Ellsworth Allan J. , Leversee John H. 
Published: January 2017

OBJECTIVE: To describe a potential drug interaction between amiodarone and clonazepam. CASE SUMMARY: A 78-year-old man with a history of congestive heart failure and coronary artery disease began taking amiodarone to suppress sustained ventricular tachycardia. Following the development of restless leg syndrome, therapy with clonazepam 0.5 mg qhs was initiated. Subsequently, the patient demonstrated signs and symptoms of benzodiazepine toxicity, which cleared following the discontinuation of clonazepam. DISCUSSION: Amiodarone is a Class III antiarrhythmic with an adverse-effect profile involving many different organ systems. It also has been shown to inhibit the metabolism of drugs cleared by oxidative microsomal enzymes. Clonazepam undergoes extensive hepatic metabolism, primarily by reduction and acetylation, and is therefore susceptible to altered disposition during concomitant administration of agents that inhibit hepatic microsomal enzymes. Hypothyroidism, occurring in up to 11 percent of patients treated with amiodarone, can also alter drug metabolism and sensitize the central nervous system, thus increasing the potential for toxicity. It is likely that a combination of these factors was responsible for the symptoms described in this patient. CONCLUSIONS: The complex pharmacologic profile of amiodarone and its effects on multiple organ systems necessitates close patient monitoring during concurrent administration of medications such as clonazepam, which are cleared by oxidative metabolism.