bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Inhaled Corticosteroid Use among Patients with Chronic Obstructive Pulmonary Disease: A Survey
Authors: Jackevicius Cynthia A , Chapman Kenneth R 
Published: May 2017

ObjectiveTo determine the extent of inhaled corticosteroid use among patients with chronic obstructive pulmonary disease (COPD).DesignReview of medical records.SettingTertiary-care university teaching hospital.PatientsSeventy-two consecutive patients prescribed an inhaled corticosteroid during hospitalization.InterventionNone.MeasurementsPatient demographics, inhaled corticosteroid regimen, respiratory diagnosis, and inhaled corticosteroid use before and during hospitalization.ResultsThe majority of patients (85%) were receiving their prescribed corticosteroid inhaler prior to admission. Beclomethasone dipropionate 250 μg/puff was the most commonly prescribed inhaled corticosteroid formulation accounting for 43% of the total corticosteroid inhaler orders. COPD was the most common respiratory diagnosis (43%) associated with inhaled corticosteroid use, followed by asthma (37%), COPD/asthma (13%), and no diagnosis (7%). During the study period, the proportion of all hospitalized patients with COPD who also received inhaled corticosteroid prescriptions (35%) was not significantly different from all hospitalized patients with asthma who received inhaled corticosteroid prescriptions (33%).ConclusionsThe rate of inhaled corticosteroid use far exceeds the rate expected among the general population of patients with COPD. Educational intervention is needed to encourage compliance with published guidelines for the management of COPD.
Algorithms Used in Adverse Drug Event Reports: A Comparative Study
Authors: Frick Pamela A , Cohen Louise G , Rovers John P 
Published: May 2017

Objective To determine if and how the Kramer and Karch algorithms differ in assigning a probability that a published case was actually an adverse drug event (ADE), and to determine if these algorithms could be used to assess published ADEs. Design Open, single-rater comparison of Karch and Kramer algorithms in 200 published ADE reports. Main Results The algorithms were not significantly different regarding the proportion of cases deemed definite (p = 0.5204) or probable (p = 0.2972) ADEs. The Kramer instrument was more likely to assign a possible risk of ADE (p = 0.0001), while the Karch instrument was more likely to assign a risk of unlikely (p = 0.0001). The algorithms agreed in 41% of the cases and could be used to assess published ADEs. Conclusions The Karch and Kramer algorithms may disagree in how they assign a probability of risk to a potential ADE. This may be due to how algorithms are applied, as well as to structural differences.
Therapeutic Monitoring: Revised Winter–Tozer Equation for Normalized Phenytoin Concentrations in Trauma and Elderly Patents with Hypoalbuminemia
Authors: Anderson Gail D , Pak Christopher , Doane Kenneth W , Griffy Kay G , Temkin Nancy R , Wilensky Alan J , Winn H Richard 
Published: May 2017

Objective To develop a revised equation reflecting the current practice of measuring unbound phenytoin at room temperature, and to evaluate the revised Winter–Tozer method of predicting normalized total phenytoin concentrations in two groups of patients with hypoalbuminemia — elderly nursing home patients and critically ill head trauma patients. Design Albumin, unbound phenytoin, and total phenytoin concentrations were obtained from two sources: prospectively from a group of elderly nursing home patients and by a retrospective chart review of trauma patients enrolled in a previous double-blind, placebo-controlled study. Setting Community nursing homes; a university-affiliated urban teaching hospital. Participants Elderly nursing home patients (n = 46) taking chronic phenytoin therapy and patients enrolled in a double-blind, placebo-controlled study (n = 58) evaluating the use of phenytoin to prevent posttraumatic seizures. Main Outcome Measures Prediction error analysis was performed by using the methods proposed by Sheiner and Beal. Bias and precision were evaluated by calculating the mean prediction error (MPE) and root mean squared error (RMSE), respectively. Results The Winter–Tozer equation consistently overpredicted the normalized phenytoin concentration in the elderly nursing home population (MPE = 3.2, RMSE = 5.9) and the trauma patients (MPE = 3.3, RMSE = 4.8). The equation was revised to reflect the increased protein binding of phenytoin with decreased temperature and resulted in significantly decreased bias in both groups of patients. Conclusions The revised equation is useful in predicting normalized phenytoin concentrations in both elderly nursing home patients and critically ill trauma patients.
Critical Care: Incidence and Risk Factors of Thrombocytopenia in Critically Ill Trauma Patients
Authors: Hanes Scott D , Quarles Deborah A , Boucher Bradley A 
Published: May 2017

Objective To determine the incidence of thrombocytopenia (<100 platelets × 103/mm3) and potential risk factors, including medications, associated with the development of thrombocytopenia in critically ill trauma patients. Design Prospective, observational study. Setting A 20-bed trauma intensive care unit (ICU) at a university hospital. Patients Sixty-three critically ill trauma patients without baseline thrombocytopenia admitted to the trauma ICU for at least 48 hours. Interventions Patients were followed for up to 14 days. Platelet counts were determined daily. The following data were collected and analyzed as potential risk factors for the development of thrombocytopenia: medications, age, sex, race, trauma score, mode and type of injury, alcohol history, units of packed red blood cells (PRBC) and platelets transfused, surgical procedures, duration of ICU stay, and the development of systemic inflammatory response syndrome or disseminated intravascular coagulation. Results Thrombocytopenia occurred in 26 (41%) of the patients. Among risk factors studied, nonhead injury, age, trauma score, duration of ICU stay, and the number of PRBC transfusions were significanüy associated with the development of thrombocytopenia (P < 0.05). However, nonhead injury, age, and trauma score were useful variables in predicting the development of thrombocytopenia by using multivariate analysis. Medications were not associated with the development of thrombocytopenia. Conclusions The type of injury sustained, the quantity of platelet-deficient transfusions, and age are the greatest risk factors associated with the development of thrombocytopenia in critically ill trauma patients. Drug-induced thrombocytopenia appears to play a minor role in the development of thrombocytopenia; therefore, medications should not be automatically discontinued or substituted when thrombocytopenia occurs.
Drug Stability: Rapid Loss of Fentanyl Citrate Admixed with Fluorouracil in Polyvinyl Chloride Containers
Authors: Xu Quanyun A , Trissel Lawrence A , Martinez Juan F 
Published: May 2017

Objective To study the physical compatibility and chemical stability of fluorouracil 1 and 16 mg/mL with fentanyl citrate 12.5 μg/mL in dextrose 5% and in sodium chloride 0.9% injection. Design Test solutions of the drugs in dextrose 5% injection and in sodium chloride 0.9% injection were prepared in triplicate and stored at −20, 4, 23, and 32 °C. Samples were removed immediately and at various times over 7 days and stored at −70 °C until analyzed. Physical compatibility was assessed visually and by measuring turbidity with a color-correcting turbidimeter; particle content was measured with a light-obscuration particle sizer and counter. Chemical stability was determined by measuring the concentration of each drug in the test solutions in duplicate with stability-indicating HPLC. Results Fentanyl citrate was rapidly lost when admixed with fluorouracil in polyvinyl chloride (PVC) containers, losing about 25% in the first 15 minutes and about 50% in the first hour. The loss of fentanyl citrate was so rapid that accurate time zero determinations were not possible. The extent of fentanyl loss increased with time and occurred more rapidly at the higher temperatures (i.e., 23,32 °C). Losses of 70% or more occurred in all samples within 24 hours. Fentanyl underwent rapid sorption to the containers at the high pH (9.0–9.5) of the fluorouracil admixtures. Adjusting the pH of a fentanyl citrate solution (containing no fluorouracil) in PVC containers to pH 9 with sodium hydroxide also resulted in rapid sorption loss. Fentanyl citrate sorption did not occur when admixtures were prepared in polyethylene containers. Fluorouracil remained stable for at least 7 days at all temperatures. There were no visual or subvisual changes in turbidity or particle content in any of the test solutions at any time. Conclusions When admixed with fluorouracil 1 and 16 mg/mL in dextrose 5% injection and sodium chloride 0.9% injection, fentanyl citrate 12.5 μg/mL underwent rapid and extensive loss due to sorption to the PVC containers, making the combination unacceptable within minutes of mixing. The sorption results from the alkaline pH of the admixture and, presumably, could occur from the admixture of fentanyl citrate with any sufficiently alkaline drug.
HIV: Cost of Medication Therapy in Ambulatory HIV-Infected Patients
Authors: Nykamp Diane , Barnett Candace W , Lago Maria , Parham Deborah L , Fernandez Enrique S 
Published: May 2017

Objective To examine the use and cost associated with prescribed medications as well as the use of over-the-counter medications and nontraditional therapies among ambulatory HIV-infected patients at Ryan White Title IIIb grantee centers. Methods Study participants (n = 223) were enrolled from eight centers across the US and Puerto Rico. Data were collected by a nurse, pharmacist, or physician through review of medical records and medication profdes. Information on the use of over-the-counter drugs and alternative therapies was obtained from the patients. Results Two hundred eleven (94.6%) patients received a mean ± SD of 5.3 ± 3.8 prescription medications during a consecutive 90-day period. The cost of medication was $1237.62 ± $1751.49 per patient. Patients with a diagnosis of AIDS received a greater number of prescription drugs: an average of 6.6 compared with 3.4 among HIV-positive patients and 3.5 among asymptomatic patients. Anti-retroviral agents were used by 143 (68.7%) patients. Zidovudine and stavudine had the highest cost ($611.81 ± $254.10 and $596.96 ± $352.80, respectively). Eighty-one (40.9%) patients reported the use of at least one over-the-counter product (range 0–11) and 11.8% reported use of alternative therapies. Conclusions This study shows the cost of drug treatment for HIV-infected patients has remained stable since the early 1990s. However, it is anticipated this will change due to the introduction of new anti-HIV agents, greater use of combination therapies, greater use of prophylactic therapies, and increased survival times.
Ambulatory Care: Medication Use Characteristics in an Ambulatory Elderly Population in Taiwan
Authors: Hsu Rou-Yee Chen , Lin Min-Shung , Chou Mei-Huei , Lin Ming-Fang 
Published: May 2017

Objective To compare prescribing patterns between the elderly and nonelderly in 1994, to disclose prescribing trends in the elderly between 1992 and 1994, to explore whether drug utilization is in agreement with disease prevalence, and to identify suboptimal prescribing by drug category for ambulatory elderly patients. Design Cross-sectional survey at two separate time intervals. Setting All public group practice centers (GPCs) in Taiwan. Patients Ambulatory adults who visited GPCs during 1 random week. Those 65 years or over were classified as the elderly group, and those 20-64 years were the nonelderly group. Main Outcome Measures Mean diagnosis, drug use, and expenditure; frequency of diagnosis; and prescribing by therapeutic category. Results Data on 30 777 elderly and 38 184 nonelderly patients were collected in 1994. There was widespread use of antacids. Compared with nonelderly adults, the elderly were diagnosed with more diseases (1.3 vs. 1.2, respectively; p < 0.01), received more medications (4.7 vs. 4.1, respectively; p < 0.01), and had higher drug expenditures (5.4 vs. 4.6, respectively; p < 0.01). Chronic illness was more prevalent in the elderly, which accounted for the extensive use of cardiovascular drugs (32.1%), nonsteroidal antiinflammatory drugs (25.9%), and anxiolytics (15.9%). The upward trend in the elderly from 1992 to 1994 with hypertension (18.6% vs. 20.0%) or diabetes (9.2% vs. 10.9%) did not result in more cases of cerebrovascular disease (7.1% vs. 4.9%). There was a substantial increase in use of antispasmodic and gastroprokinetic agents (4.5% to 10.7%); the use of antacids decreased (73.6% to 63.4%) in the elderly. Conclusions Compared with the prevalence of disease, there was extensive nonspecific use of anxiolytics and antacids. However, lessened use of antidepressants and postmenopausal hormone replacement may have an impact on morbidity and mortality and deserves particular attention.
Fixed Drug Eruption of the Penis Due to Hydroxyzine Hydrochloride
Authors: Cohen Herman Avner , Barzilai Asher , Matalon Andre , Harel Liora , Gross Samuel 
Published: May 2017

Objective To report four cases of fixed drug eruption induced by hydroxyzine hydrochloride (Otarex, Teva, Israel). Case Summary Four children with restlessness who were treated with hydroxyzine hydrochloride developed fixed drug eruption of the penis. Drug discontinuation was followed by complete resolution of the skin eruption. Rechallenge resulted in the same drug rash. Macrophage migration inhibiting factor (MIF) assay with hydroxyzine hydrochloride was positive. Discussion The pathogenesis of fixed drug eruption and the role of macrophage MTF assay in diagnosis is discussed. Conclusions A fixed drug eruption induced by hydroxyzine hydrochloride is possible, but is a rare phenomenon.
Management: Self-Directed Work Teams: Application to a Drug Information Center
Authors: Stachnik Joan M , Nunn-Thompson Cheryl L , Simon Pamela A , Seeger John D , Markind Jan E , Ross Jinnie R , Clark Toby 
Published: May 2017

Objective To describe the transition of a drug information center from a traditionally managed center to a self-directed work team responsible for service, education, research, and drug use policy development. Summary To adapt to economic, educational, and technologic changes, traditional management structures in healthcare organizations are being reassessed. In some instances, a team approach (using self-directed work teams [SDWTs]) is being implemented. SDWTs have the potential to provide a number of benefits to an organization, including reduced costs and greater employee motivation. The University of Illinois at Chicago Drug Information Center had functioned under a traditional management structure. For economic and professional reasons, the management structure of the center was changed to an SDWT, prompting a reevaluation of the mission and activities of the center. Discussion Although still in transition, the center's change to a team structure has proven to be positive. The nature of the SDWT requires greater involvement by team members in all aspects of the center's operation, adding to the experience of team members. The team structure also allows for greater freedom to pursue projects of personal interest to individual team members. A number of issues still need to be resolved, such as performance-based compensation and peer- and self-evaluations. Conclusions SDWTS can provide many benefits. The successful implementation of an SDWT, however, has a number of requirements, the most important of which are a commitment from management and effective communication among team members and with management.
Absolute Bioavailability of Bromfenac in Humans
Authors: Gumbhir-Shah Kavita , Cevallos William H , Decleene Sheryl A , Halstenson Charles E , Korth-Bradley Joan M 
Published: May 2017

ObjectiveTo estimate absolute bioavailability of bromfenac and to compare its pharmacokinetics after intravenous and oral administration.DesignThis was a randomized, open-label, single-dose, crossover study conducted under fasting conditions with a washout period of at least 48 hours between doses. Each subject received a 50-mg dose of bromfenac both intravenously and orally followed by collection of blood samples at specified time intervals. Bromfenac plasma concentrations were measured by using a validated HPLC method with ultraviolet detection.SettingThe study was conducted at the Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis, MN.SubjectsThe participants consisted of 12 healthy subjects between 18 and 45 years of age and within ± 15% of ideal body weight.ResultsThe mean ± SD absolute bioavailability of bromfenac was 67% ± 20%.ConclusionsThe pharmacokinetic parameters of bromfenac were similar after intravenous and oral administration, suggesting that the prototype oral dosage form is optimal and that the observed intersubject variability is due to bromfenac itself, not the type of dosage form.
Effects of Age and Gender on the Pharmacokinetics of Bromfenac in Healthy Volunteers
Authors: Boni Joseph P , Decleene Sheryl A , Cevallos William H , Hicks David R , Korth-Bradley Joan M 
Published: May 2017

Objective To compare the pharmacokinetic parameters of bromfenac, a nonsteroidal antiinflammatory drug under development, in healthy volunteers of various ages and either gender, after single and multiple doses. Design Open-label, single- and multiple-dose, nonrandomized, parallel study. Participants Twenty young (18–45 y), 12 young-elderly (65–74 y), and 12 elderly (75–85 y) subjects were studied. Half of the subjects in each group were women. Interventions Bromfenac was given as a single 50-mg dose and then as 50-mg doses every 12 hours for 3 additional days. Twelve blood samples were collected for 12 hours after the first and last doses. Main Outcome Measures Bromfenac concentrations were measured by using an HPLC procedure with ultraviolet detection. Unbound bromfenac concentrations were measured by equilibrium dialysis. Pharmacokinetic analysis was performed by noncompartmental techniques. Results No significant differences related to gender were detected. Significant differences were observed in half-life (t1/2), AUC, clearance, and apparent volume of distribution when the elderly group was compared with the young group and in t1/2 when the elderly group was compared with the young-elderly group, although substantial overlap among groups was observed. Conclusions Administration of bromfenac to young-elderly or elderly subjects of either gender does not require a dosage adjustment in acute settings. Consideration should be made to titrating dosages in patients over 75 years of age who require repeated doses.
Phenytoin-Induced Thrombocytopenia
Authors: Holtzer Christopher D , Reisner-Keller Lori A 
Published: May 2017

Objective To describe a patient with severe thrombocytopenia induced by the administration of phenytoin for prevention of seizures. A review of the literature supplements this case description to alert clinicians to this potentially serious hematologic reaction. Case Summary A woman who had experienced two seizures was prescribed phenytoin to prevent seizure recurrence. Further evaluation revealed a tumor, which was resected, and phenytoin was continued. Thrombocytopenia was noted 15 days after initiation of phenytoin, which was replaced with phenobarbital. Platelet transfusion and administration of intravenous immune globulin were used to treat her thrombocytopenia. Platelets were within the normal range by day 8 after the operation. Discussion Phenytoin has been reported to induce various hematologic reactions, including thrombocytopenia. An intermediate epoxide metabolite of phenytoin is suspected as the cause of platelet destruction, which may occur via a complement-antibody reaction. Our patient experienced some confusion as a possible consequence of her thrombocytopenia, but no long-term sequelae followed. Conclusions Due to widespread use of phenytoin, clinicians must recognize the potential for the rare but serious adverse effect of thrombocytopenia, particularly in the neurosurgical population. Confusion, as observed in our patient, makes postoperative evaluation of central nervous system and cognitive function difficult, and can obscure the clinical presentation. At its worst extreme, disruption of platelet function may produce cerebral hemorrhage, which results in long-term functional deficits.
Digoxin–Itraconazole Interaction: Possible Mechanisms
Authors: Alderman Christopher P , Allcroft Peter D 
Published: May 2017

Objective To document a case in which the administration of itraconazole was associated with an apparent decrease in digoxin clearance, resulting in an increase in the serum digoxin concentration. Case Summary A man receiving digoxin for atrial fibrillation was concurrently treated with itraconazole 200 mg/d for esophageal candidiasis. The estimated urinary digoxin clearance was decreased during this combination therapy. Discussion Digoxin is primarily cleared by the kidneys, and the mechanism of renal clearance involves both glomerular filtration and tubular secretion. We postulate that itraconazole or a metabolite of this compound may have resulted in decreased tubular secretion of digoxin, accounting for decreased urinary digoxin clearance. Conclusions Monitoring of serum digoxin concentrations should be performed if patients taking digoxin are treated with itraconazole. Further investigation is necessary to elucidate the nature of the interaction between digoxin and itraconazole.
Pralidoxime Continuous Infusion in the Treatment of Organophosphate Poisoning
Authors: Tush Gretchen M , Anstead Michael I 
Published: May 2017

Objective To report a case of organophosphate poisoning treated with a continuous infusion of pralidoxime chloride. Case Summary A 27-year-old white man presented with extreme agitation, muscle weakness and fasciculations, and respiratory failure after ingesting an organophosphate pesticide (Dursban, active ingredients chlorpyrifos and xylene) as a suicide attempt. Atropine sulfate and pralidoxime chloride were administered intermittently, ut the patient continued to be extremely agitated and have muscle fasciculations. Subsequently, a continuous intravenous infusion of pralidoxime (8 mg/mL concentration) at 500 mg/h was initiated to help control breakthrough nicotinic symptoms. Therapy with atropine and pralidoxime was continued for approximately 72 hours. Therapy was discontinued due to the predominance of anticholinergic symptoms and the patient's increased awareness. Discussion Severe organophosphate poisoning with nicotinic and/or central manifestations should be treated with pralidoxime in addition to atropine. The rationale supporting the use of pralidoxime as a continuous infusion in this case includes: (1) slow absorption of organophosphate compounds following exposure to large quantities, (2) unknown quantity ingested, (3) delayed nicotinic effects from distribution of lipid-soluble organophosphate and metabolic activation of phosphorothioates such as chlorpyrifos, and (4) intensive care monitoring. There is limited documentation in the literature of continuous infusions of pralidoxime used to treat organophosphate poisoning and the stability of the admixture is unknown. Conclusions A continuous pralidoxime infusion successfully managed the prolonged nicotinic symptoms seen after ingestion of an organophosphate. A continuous infusion of pralidoxime may be particularly useful in cases of organophosphate poisoning when the extent of chemical exposure or quantity of chemical ingested is unknown but potentially toxic and the therapy must be symptomatically managed.