bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quinine Overdose: Hypoglycemia Potentiated by Age and Alcohol
Authors: Cox Craig D , Anderson Allan C , Chittivelu Subramanyam 
Published: July 2017

Objective: To discuss a case of quinine toxicity and the impact that age and alcohol can have on its clinical presentation of life-threatening hypoglycemia. Case Summary: A 55-year-old white woman with a history of ethanol abuse developed quinine toxicity after accidentally consuming approximately 4 g of quinine. During her hospital stay, the patient developed life-threatening hypoglycemia, signs of cinchonism (tinnitus, lethargy), hypotension, and hypokalemia. She was treated successfully with intravenous fluids, dextrose, and potassium. Discussion: In reviewing the literature involving quinine toxicity, few cases have discussed the role quinine may play in the development of hypoglycemia. Quinine has been implicated as the cause of hypoglycemia in patients with malaria, but has less commonly been considered the cause in healthy patients. In this case report, the patient developed life-threatening hypoglycemia after the consumption of 4.6 g of quinine. Toxicity associated with quinine is usually detected at doses >4 g, but lethal doses have been reported to range between 2 and 8 g. The cause of this patient's sudden drop in glucose concentration was determined to be multifactorial and attributed to a combination of quinine, ethanol, and potential biologic aging of metabolic organs. Conclusions: Quinine can cause hypoglycemia; in this case it occurred at a toxic dose of 4.6 g. In older patients or patients with a significant history of alcohol abuse, this effect may be potentiated.
Issues in Contemporary Drug Delivery: Part V: Total Parenteral Nutrition
Authors: Mohler Pamela A. , Banakar Umesh V. 
Published: July 2017

Objective: To provide an overview of common compounding and administration guidelines for total parenteral nutrition (TPN). The compatibility of various drug products with TPN preparations is also discussed. Data Sources: References were selected from published bibliographies of specialized nutrition and drug-nutrient interaction articles, package inserts and manufacturer's information, and specific topic searches in MEDLINE computerized database (English language, through 1989). Study Selection: Studies that investigated stability were selected preferentially to those studying compatibility alone; when stability data were not available, compatibility studies were included. Studies using products marketed in the US were chosen preferentially to those using European products; studies and case reports using human subjects were selected in preference to animal studies. Sixty percent of the initially identified studies were selected for inclusion. Data Extraction: Studies were reviewed by the authors for internal consistency and statistical validity. Data Synthesis: Intravenous solutions can be manufactured to meet various nutritional specifications. As additional nutrients and drugs are incorporated, the risk of incompatibility and instability of the admixture increases. Stability data are relatively sparse, leading to a dependence on compatibility studies for decision making. Conclusions: A wide variety of TPN formulations can be compounded to meet the individual needs of patients of all ages and assorted disease states. Addition of specific drugs to the TPN preparation may improve the efficiency of drug delivery and improve overall therapeutic response. Care must be taken, however, to ensure that incompatible compounds are not combined in a single TPN preparation.
Drug Information Sources Used by Community Pharmacists in Louisiana: A Preliminary Study
Authors: Rae Charlesworth E. , Rappaport Harvey M. , Mahajan Puneet 
Published: July 2017

Objective: There is a paucity of information in the literature regarding the type of reference sources that are used by community pharmacists to answer drug information questions. This survey was conducted to determine the frequency of use of selected drug information references by independent and chain pharmacists in Louisiana. Design: A study population of 15 percent of registered pharmacists was obtained by random stratification of all pharmacists on the mailing list of the Louisiana Board of Pharmacy on the basis of zip code and gender. These pharmacists were mailed an uncoded, pretested questionnaire and were asked to complete and return it if they were employed by an independent or chain pharmacy; nonchain and independent pharmacists were asked to return their questionnaires uncompleted. No follow-up was performed. Participants: Ninety-one independent pharmacists (mean age = 45 y; mean years of experience = 21) and 71 chain pharmacists (mean age = 40 y; mean years of experience = 16). Outcome Measures: The frequency of use of selected drug information reference sources by independent and chain pharmacists and the type of drug information questions received by pharmacists were determined. A Statistical Analysis System software program was used to analyze the data. Spearman's rank test was used to determine statistical differences between independent and chain pharmacists. The a priori level of significance was p≤0.05. Results: A 54 percent response rate was obtained. The frequency of usage of textbook references (Spearman's correlation coefficient [rho]=0.837), journals and periodicals (rho=0.937), and general reference sources (rho=0.943) were similar for independent and chain pharmacists. Drug Facts and Comparisons was the most frequently used reference source. The types of drug information requests that were received by both groups of pharmacists were similar (rho=0.90). Conclusions: Independent and chain pharmacists not only receive the same types of drug information questions but they also rely on the same references to answer such questions. Drug Facts and Comparisons was the most used drug information reference, suggesting that this reference is valuable for pharmacists, particularly community pharmacists.
Analysis of Adverse Effects during Amantadine Prophylaxis in a Nursing Home Population
Authors: Denman Susan J. , Gloth F. Michael , Cloth Mark J. , Roca Robert P. , Thomas David R. , Finucane Thomas E. 
Published: July 2017

Objective: To evaluate adverse reactions during amantadine prophylaxis in a nursing home population, and to identify baseline characteristics that were associated with their development. Design: A retrospective chart review. Setting: A 233-bed teaching nursing home. Main Results: Amantadine prophylaxis was given to 199 of 210 residents (95 percent), 19 of whom died during the one-month period of amantadine prophylaxis. None of the deaths were attributed to amantadine. Of the surviving residents, 26 percent developed adverse effects after an average of two weeks of amantadine prophylaxis. The majority of adverse effects involved the central nervous system, including change in mental status in 40 percent, agitation or disruptive behavior in 34 percent, hallucinations in 19 percent, and mood changes in 19 percent. All adverse effects resolved. Baseline characteristics regarding age, gender, serum creatinine, number of medications, and dosage of amantadine of the residents who experienced adverse effects were similar to those of patients who did not. Adverse effects tended to occur less often in patients with an underlying cardiovascular illness than in those without (odds ratio = 0.52; confidence interval = 0.27–1.0). There was no obvious explanation for this association, which approached statistical significance. Patients with an underlying psychiatric disorder tended to develop adverse effects almost twice as often as those without, but this trend was also not statistically significant (odds ratio = 1.9; confidence interval = 0.93–3.8). Conclusions: Amantadine prophylaxis was associated with reversible adverse effects in 26 percent of these nursing home residents. Earlier identification of adverse effects (and subsequent dose reduction) with a prospective surveillance checklist might have lessened the severity and duration of adverse effects.
Treatment of Severe Hypercalcemia in Primary Hyperparathyroidism with Aminopropylidene Diphosphonate
Authors: de Valk Harold W. , Bartelink Anton K.M. , Cluysenaer Onno J.J. , Tjoeng Matthieu M. 
Published: July 2017

Objective: To test the clinical usefulness and potency for decreasing plasma calcium concentration of an intravenously administered diphosphonate (aminopropylide diphosphonate [APD]) in a patient with hypercalcemic crisis secondary to primary hyperparathyroidism, unresponsive to hydration and furosemide, and who was ineligible for surgery because of cardiac conduction defects. Design: Case report. Setting: Referred care setting. Intervention: The patient received APD 15 mg/d, dissolved in 100 mL of isotonic NaCl 0.9% and infused in one hour. Main Outcome Measure: Plasma calcium concentration. Results: The patient's plasma calcium concentration fell considerably in a few days. The concomitant decrease in urinary calcium excretion indicates that this fall is caused by a decreased entry of calcium to the extracellular fluid and not to increased renal calcium excretion. After nine days, a parathyroid adenoma was removed; plasma calcium concentration remained normal during the following three years. Conclusions: APD is a useful adjunct to medical therapy in patients with hypercalcemic crisis secondary to primary hyperparathyroidism.
Comparison of Predicted and Measured Energy Expenditure in Mechanically Ventilated Obese Patients
Authors: O'Connell Helen M. , Erstad Brian L. 
Published: July 2017

Objective: To test the appropriateness of using actual body weight (ABW), ideal body weight (IBW), or an adjusted weight for predicting caloric requirements in moderately obese, mechanically ventilated patients receiving parenteral or enteral nutrition. Design: Prospective, nonrandomized pilot study involving seven patients. Setting: University medical center. Main Outcome Measures: Predicted caloric requirements based on ABW, IBW, or an adjusted weight were compared with measured requirements by indirect calorimetry after parenteral nutrition or tube feedings were at goal rate for 24–72 hours. Results: Mean differences between predicted and measured energy requirements for ABW, IBW, and adjusted weight were 821 ± 556 (p < 0.05), −256 ± 493, and 182 ± 501 kcal/d, respectively. Conclusions: Until additional studies are available, IBW or adjusted weight should be used for calculating caloric requirements in the moderately obese patient being mechanically ventilated when actual measurements are not available.
Use of Lithium, Carbamazepine, and Valproic Acid in a State-Operated Psychiatric Hospital
Authors: Citrome Leslie 
Published: July 2017

Objective: To examine the prescribing of mood stabilizers (lithium, carbamazepine, and valproic acid) in a 500-bed state-operated psychiatric hospital in New York. Method: All 129 inpatients receiving mood stabilizers were identified and their medical records reviewed using a standardized drug use evaluation form. Diagnosis, other indications, and prior experience with mood stabilizers were examined, as well as outcome and adverse effects. Results: Approximately one-quarter of the inpatient population received a mood stabilizer. The frequency of carbamazepine use exceeded the use of lithium, with 72 patients receiving carbamazepine and only 62 receiving lithium. Twenty-eight patients received valproic acid. Indications found most frequently for carbamazepine use included assaultive or aggressive behavior (70% for those receiving carbamazepine as the only mood stabilizer). Of those patients with bipolar or schizoaffective disorder and receiving either lithium, carbamazepine, or valproic acid, 36% were prescribed carbamazepine (10% as a first-line agent) and 50% lithium (26% as a first-line agent). None of these indications for carbamazepine has been approved by the Food and Drug Administration. In general, positive outcomes were documented but without supporting objective measures. Significant adverse effects were documented in the medical record in one-quarter of the patients. Conclusions: There was widespread use of the three mood stabilizers examined, singly and in combination, for a variety of indications. Lithium and valproic acid remain more frequently prescribed for the treatment of bipolar and schizoaffective disorders. Monotherapy with carbamazepine or valproic acid results in statistically significantly fewer adverse effects than lithium or combination therapy (p values between p = 0.00038 and p = 0.006). Current clinical practice has endorsed the use of carbamazepine for aggressive or assaultive behavior, although there does not appear to be sufficient proof of effectiveness in the literature. Formal studies of carbamazepine's antiagressive effects should be conducted.
Citrate: Valence and Milliequivalent Considerations
Authors: Hermann Joachim J. 
Published: July 2017

Objective: To demonstrate that an understanding of the valence of citrate in solution, as well as the valence of citric acid and citrate salts in the solid state, is essential to correctly quantify these compounds by milliequivalent (mEq) unit. Data Sources: Problems are presented and based on information provided in package inserts for citric acid/citrate salt-containing products. Data Synthesis: The rationale of the valence of citrate in solution is presented and the dependence of this variable on pH is illustrated graphically. The valence of citric acid and citrate salts in the solid state is reviewed. Conclusions: The intricate nature of the valence of citrate in solution makes the quantification of citrate using the mEq unit impractical. Whenever citrate is quantified by the mEq unit, the specific citrate ion that is referred to in a composition table should be clearly stated.
Efficacy and Toxicity of Amphotericin B Liposomal and Lipid Formulations
Authors: Rho Jay P , Cupo Jennifer H 
Published: July 2017

Objective: To review the efficacy and toxicity of amphotericin B liposomal and various lipid formulations with conventional amphotericin B desoxycholate. Data Sources: Pertinent literature was identified via a MEDLINE search. Study Selection: English-language clinical trials. Conclusions: The incorporation of amphotericin B into liposomes or lipid formulations appears to be a novel method of administering amphotericin B for the treatment of serious systemic fungal infections for patients who have either failed therapy with, or are intolerant to, conventional amphotericin B desoxycholate.
Ranitidine and Thrombocytopenia
Authors: Yim Josephine M , Frazier Jerry L 
Published: July 2017

Objective: To provide an overview of thrombocytopenia, focusing on ranitidine-induced thrombocytopenia. Data Sources: References were selected from published bibliographies of books, case reports, and topical searches in the MEDLINE database (English language, through 1994) on thrombocytopenia, ranitidine-induced thrombocytopenia, and cimetidine-induced thrombocytopenia. Study Selection: All reports of ranitidine-induced thrombocytopenia have been published as case reports. All reports were given equal weight because none involved a rechallenge. Only human data were included. There was only one case of a patient receiving ranitidine after experiencing cimetidine-induced thrombocytopenia. Data Synthesis: Literature systematically examining the incidence and cause of ranitidine-induced thrombocytopenia is lacking. No cases of rechallenge have been reported, thus raising the concern of effect versus association. Conclusions: Ranitidine has been reported to induce thrombocytopenia by several different mechanisms. Although the incidence of ranitidine-induced thrombocytopenia is relatively rare, healthcare providers need to be aware of this possible adverse drug reaction.
Ofloxacin: Why the Increased Popularity?
Authors: Krop Lynne C 
Published: July 2017

Objective: To provide a rationale for the increasing use of ofloxacin as a substitute for ciprofloxacin, and to review the appropriate use of these agents. Data Source: A MEDLINE search was conducted to identify relevant literature. References in those articles were reviewed for additional published information. Study Selection: Published review articles and clinical trials on ofloxacin were reviewed, with particular emphasis on pharmacoeconomics, pharmacodynamics, and studies evaluating the safety and efficacy of ofloxacin. Data Synthesis: Ofloxacin is a broad-spectrum antimicrobial agent that has in vitro activity similar to that of ciprofloxacin. Ciprofloxacin exhibits lower minimum inhibitory concentrations for Pseudomonas aeruginosa, and ofloxacin is more active against Chlamydia trachomatis and gram-positive aerobic organisms. Both agents have limited anaerobic activity. Unlike ciprofloxacin, ofloxacin is 100% bioavailable, exhibits a greater area under the concentration curve, contributing to its bactericidal activity, and is eliminated primarily by the kidney. Both ciprofloxacin and ofloxacin have long half-lives, allowing twice-daily dosing. However, because a decrease in renal function often accompanies increasing age, ofloxacin can be administered once daily in the elderly. Both agents have a large volume of distribution and exhibit excellent tissue and cell penetration. Several clinical studies have demonstrated ofloxacin's effectiveness in treating a variety of systemic infections caused by susceptible organisms, including P. aeruginosa. Adverse effects are infrequent with both fluoroquinolones, and if they occur such effects are usually gastrointestinal in nature. Ofloxacin has a much lower incidence of drug interactions, in particular with theophylline and caffeine. Ofloxacin is less expensive than ciprofloxacin. Conclusions: Overall, the activity of ofloxacin is similar to that of ciprofloxacin and the two agents are therapeutically equivalent. The data presented warrant routine therapeutic substitution of ofloxacin for ciprofloxacin. Ciprofloxacin should be reserved for instances in which specific prescribing criteria are met.
Anticoagulant Clinic Warfarin Adherence Rates and Assessment
Authors: Mason Barb J 
Published: July 2017

Objective: To identify warfarin medication-taking patterns and the relationship between adherence and international normalized ratio (INR). Design: Two-month, single-blind, observational cohort. Setting: Veterans Affairs Medical Center ambulatory care clinics. Patients: Twenty-three veteran outpatients followed in a nurse-managed anticoagulation clinic were enrolled by consecutive sample. Patients were excluded if they used a medication reminder device, were scheduled to have warfarin discontinued within the next 2 months, or had been receiving warfarin less than 1 month. Twenty patients were evaluable. Intervention: All study patients received warfarin in a vial with an electronic medication-event monitoring system (MEMS) device. Patients were not told that adherence was being monitored. Main Outcome Measure: Mean and preclinic warfarin adherence, dosage changes, and INR values were tabulated. Results: Thirty-five percent of the patients were nonadherent with warfarin therapy. Mean and preclinic warfarin adherence rates were 86% and 90%, respectively. Medication-taking behavior was underestimated in 75% of patients. Dosage changes were more common in nonadherent patients. There was not a significant correlation between INR and adherence. Conclusions: MEMS adherence data could have changed pharmacologic management in select patients.
Clomiphene for Male Infertility
Authors: Elanjian Sona I 
Published: July 2017

Objective: To review the use of clomiphene for the treatment of male infertility. Data Sources: A MEDLINE search covering the years 1966 through 1994 was used to identify pertinent literature. Study Selection: Only placebo-controlled studies using dosages of clomiphene 25–50 mg/d for at least 3 months were reviewed. Data Extraction: Because there are numerous uncontrolled reports claiming success with clomiphene for the treatment of male infertility, only controlled studies with clomiphene 25–50 mg/d are discussed. This dosage range was selected because higher dosages of clomiphene may suppress spermatogenesis. Data Synthesis: Although the study conducted by the World Health Organization demonstrated an increase in both sperm count and motility after clomiphene treatment, no difference in pregnancy rates between the clomiphene-treated and placebo groups was observed. No significant difference in pregnancy rates was seen in a randomized trial comparing clomiphene with vitamin C. Of the four studies discussed, only one concluded that clomiphene was effective in increasing sperm concentration and pregnancy rates. However, the results do not establish a causal role for clomiphene. Conclusions: To assess the efficacy of clomiphene for the treatment of male infertility, better-designed studies need to be done. Information regarding comparability of female cohorts should be included, and results should be stratified according to the severity of oligospermia.
Meta-Analytic Review of the Effect of Subcutaneous Sumatriptan in Migraine Headache
Authors: Harrison Donald L , Slack Marion K 
Published: July 2017

Objective: To provide a rationale for the increasing use of ofloxacin as a substitute for ciprofloxacin, and to review the appropriate use of these agents. Data Source: A MEDLINE search was conducted to identify relevant literature. References in those articles were reviewed for additional published information. Study Selection: Published review articles and clinical trials on ofloxacin were reviewed, with particular emphasis on pharmacoeconomics, pharmacodynamics, and studies evaluating the safety and efficacy of ofloxacin. Data Synthesis: Ofloxacin is a broad-spectrum antimicrobial agent that has in vitro activity similar to that of ciprofloxacin. Ciprofloxacin exhibits lower minimum inhibitory concentrations for Pseudomonas aeruginoea, and ofloxacin is more active against Chlamydia trachomatis and gram-positive aerobic organisms. Both agents have limited anaerobic activity. Unlike ciprofloxacin, ofloxacin is 100% bioavailable, exhibits a greater area under the concentration curve, contributing to its bactericidal activity, and is eliminated primarily by the kidney. Both ciprofloxacin and ofloxacin have long half-lives, allowing twice-daily dosing. However, because a decrease in renal function often accompanies increasing age, ofloxacin can be administered once daily in the elderly. Both agents have a large volume of distribution and exhibit excellent tissue and cell penetration. Several clinical studies have demonstrated ofloxacin's effectiveness in treating a variety of systemic infections caused by susceptible organisms, including P. aeruginosa. Adverse effects are infrequent with both fluoroquinolones, and if they occur such effects are usually gastrointestinal in nature. Ofloxacin has a much lower incidence of drug interactions, in particular with theophylline and caffeine. Ofloxacin is less expensive than ciprofloxacin. Conclusions: Overall, the activity of ofloxacin is similar to that of ciprofloxacin and the two agents are therapeutically equivalent. The data presented warrant routine therapeutic substitution of ofloxacin for ciprofloxacin. Ciprofloxacin should be reserved for instances in which specific prescribing criteria are met.