bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding Technician Roles and Educating Students to Assist in Role Definition
Authors: Janke Kristin Kari , MacDonald Margaret L 
Published: July 2017

Objective: To develop a process for defining an ideal technician role in pharmaceutical care and to communicate this process to technician educators and the pharmacy community. Background: A process for defining the technician role was developed as part of Dalhousie's Pharmaceutical Care Project in Halifax, Nova Scotia, Canada. In May 1995, technician-related work began with the staff from a community demonstration site. Through interviews, observation, surveys, and review of the literature, an optimal technician role was defined. Results: The technician role definition is composed of four components: Technician tasks, work-flow priorities, levels of pharmacist supervision, and performance standards. Technician tasks must be identified by each dispensary to address site-specific concerns. Once a technician task list has been developed, consideration can be given to priorities, levels of pharmacist supervision, and performance standards. After the technician role has been defined, an implementation plan and training can be devised. This process for defining technician roles can be used in other dispensaries. Conclusions: Students in pharmacy-related educational programs may graduate to work in a dispensary without a defined technician role or with a technician role that requires further development. Therefore, a concerted effort should be made to equip pharmacy and technician students with the skills and resources needed to help create the necessary roles. In addition, consideration should also be given to discussion of technician role components during in-house training.
Dexrazoxane: A New Cardioprotective Agent
Authors: Abbott Beverly D , Ippoliti Cindy M 
Published: July 2017

Objective: To review the literature discussing the use of dexrazoxane (e.g., Zinecard, ICRF-187) to prevent doxorubicin-induced cardiotoxicity. Data Sources: Pertinent English-language reports of studies in humans were retrieved from a MEDLINE search (January 1980-January 1997); search terms included chelating agents, razoxane, dexrazoxane, Zinecard, ICRF-187, ADR-529, and ICRF-159. Study Selection: Representative articles discussing the chemistry, pharmacology, pharmacokinetics, dosing, and administration of dexrazoxane and those discussing clinical trials were selected. Data Extraction: Data were extracted and analyzed if the information was relevant and consistent. Studies were selected for review in the text on the basis of study design and clinical end points. Data Synthesis: Dexrazoxane is a chemoprotective agent developed to prevent cardiac tissue toxicity. Dexrazoxane exerts a cardioprotective effect with some clinically significant toxicities; it may also interfere with the antitumor activity of doxorubicin. Until there are sufficient data to support its use in first-line supportive care therapy, dexrazoxane should be reserved for use in patients responding to doxorubicin-based chemotherapy but who have risk factors for cardiac toxicity or have received a cumulative doxorubicin bolus dose of 300 mg/m2. Conclusions: The management of doxorubicin-induced cardiotoxicity has led to the development of supportive care drugs that specifically counteract the dose-limiting toxicities. Dexrazoxane may not completely eliminate the concern about doxorubicin-induced cardiotoxicity, but it may open new avenues for continuing doxorubicin-based chemotherapy.
A Comparison of Retrospective and Concurrent Drug Utilization Review of Omeprazole
Authors: Chabot Isabelle , Morin Johanne , Bourbeau Kateri , Moisan Jocelyne 
Published: July 2017

Objective: To compare the appropriateness of omeprazole prescriptions in a concurrent drug utilization review (DUR) with the assessed appropriateness of a retrospective DUR. Methods: A retrospective DUR of omeprazole was conducted on prescriptions written from August 23, 1993, to October 8, 1993, in a 340-bed university hospital. This DUR served as a baseline for a concurrent DUR that began on January 27, 1995, and ended on March 16, 1995. The concurrent DUR integrated three steps aimed at improving the quality of omeprazole use: Approval of the criteria by the pharmacology and therapeutics committee of the hospital, distribution of a drug bulletin to all physicians, and a pharmacist's verbal recommendations to physicians whose prescriptions did not meet explicit criteria. Results: Twenty-nine and 64 prescriptions were reviewed in the retrospective and concurrent DURs, respectively. During the concurrent DUR, the pharmacist made 34 verbal recommendations. Of these, 25 (74%) were agreed to by the prescribers. In comparison with the retrospective DUR, the percentage of prescriptions meeting the criteria of indication, combination therapy, and dosage went from 38% to 75% (p < 0.05), from 76% to 95% (p < 0.05), and from 83% to 100% (p > 0.05), respectively, during the concurrent DUR. Conclusions: The concurrent DUR appeared to successfully improve the quality of omeprazole utilization in the hospital.
Current Concepts in the Management of Heart Failure
Authors: Alex Sumana , Mehrotra Prafulla P 
Published: July 2017

Objective: To give an overview of the epidemiology, etiology, and symptoms and signs of heart failure (HF), and the role of various therapeutic modalities that influence functional status, morbidity, and mortality in HF. Data Sources: Computerized search of the MEDLINE database (1976–1998) and review chapters from medical textbooks. Data Extraction: Clinical trials evaluating the effect of drugs on morbidity and mortality of patients with HF. Data Synthesis: HF is a clinical syndrome with high prevalence and mortality. The treatment approach varies depending on the etiology and type of HF. Several large-scale clinical trials with angiotensin-converting enzyme (ACE) inhibitors demonstrate improved survival and reduced hospitalization in patients with all degrees of HF. Several other trials report similar benefits in postmyocardial infarction patients with HF. Angiotensin II type 1 receptor blocking agents have also been shown to reduce morbidity and mortality in elderly patients with HF and may be used in patients who cannot tolerate ACE inhibitors. Therapy with hydralazine and isosorbide dinitrate also improves exercise tolerance as well as survival in patients with HF. The combination of these agents with ACE inhibitors may be useful in patients who remain symptomatic while taking ACE inhibitors. Such second-generation dihydropyridine calcium-channel blockers as amlodipine have also been shown to improve symptoms, exercise tolerance, and survival in nonischemic patients. Diuretics are effective in reducing the symptoms of HF resulting from fluid overload. Inotropic drugs such as digoxin may improve symptoms and reduce hospitalization for patients with HF but do not reduce overall mortality. Long-term, continuous use of inotropic agents, such as amrinone, milrinone, dobutamine, and high-dose vesnarinone, may improve quality of life but increase mortality in HF. Beta-blockers, particularly Carvedilol, with vasodilating properties demonstrate positive survival results in patients with mild-to-moderate HF. Conclusions: ACE inhibitors are the initial drug of choice in the treatment of HF; however, angiotensin II receptor antagonists may be used in patients who are intolerant to ACE inhibitors. Diuretics are useful mainly to control the fluid overload in HF. Digoxin is helpful in patients with atrial fibrillation and rapid ventricular response and in patients who are resistant to ACE inhibitors and diuretics. Hydralazine and isosorbide dinitrate therapy is valuable in patients whose symptoms cannot be controlled with optimal doses of diuretics, digoxin, and ACE inhibitors. Careful use of newer beta-blockers, with optimal titration of diuretics, in mild-to-moderate HF may help prolong life. Newer dihydropyridine calcium-channel blockers may be beneficial in nonischemic patients with HF.
Thiamine-Responsive Lactic Acidosis, Encephalopathy, and Shock
Authors: Witkowski Alina A , Sarnaik Ashok P , Heidemann Sabrina M , Abella Esteban 
Published: July 2017

Objective: To report a case of severe lactic acidosis, encephalopathy, and hypotension in a patient receiving total parenteral nutrition without multivitamin supplementation and the dramatic response to intravenous administration of thiamine. Case Summary: A 15-year-old African-American girl undergoing treatment for chronic myelogenous leukemia with allogenic bone marrow transplantation and requiring total parenteral nutrition was admitted to our intensive care unit for management of life-threatening lactic acidosis, encephalopathy, and hemodynamic instability. Because of the manufacturing shortage of parenteral multivitamin preparations, oral multivitamins were prescribed; however, the patient was unable to swallow the oral multivitamins because of oral mucositis. Intravenous administration of thiamine promptly reversed the profound metabolic, neurologic, and hemodynamic abnormalities. Discussion: Carbohydrate loading associated with inadequate thiamine intake may result in potentially lethal metabolic, neurologic, and hemodynamic alterations. Prompt intravenous administration of thiamine can rapidly reverse metabolic acidosis, encephalopathy, and shock in such situations. Conclusions: Adequate administration of multivitamins must be ensured in all patients receiving total parenteral nutrition.
Undiagnosed Triazolam Withdrawal
Authors: Ibrahim Zafar Y , Pathan Mohammad H , Schwartz Eileen M , Sangster Joe N , Gould-Williams Kathleen A 
Published: July 2017

Objective: To report a case of triazolam withdrawal. Case Summary: A 65-year-old white man was admitted to the hospital for a total left hip arthroplasty. Within 12 hours after the surgery, the patient became agitated and confused, and reported severe chest pain. He was treated for a non-Q-wave myocardial infarction, but continued to experience fluctuating consciousness, confusion, agitation, auditory and visual hallucinations, and memory deficits, which did not respond to treatment with haloperidol and discontinuation of meperidine, which was administered after the surgery. He responded briefly to midazolam. A detailed history of the patient's preoperative medications was obtained from his wife. This led to the diagnosis of triazolam withdrawal, and the patient was successfully treated. Discussion: The covert use and misuse of medications is a common cause of psychosis in otherwise healthy individuals. This case emphasizes how obtaining a detailed medication history from the patient or other sources can prevent serious complications. Conclusions: Benzodiazepine withdrawal can present with psychiatric symptoms. This case highlights the importance of obtaining information from patients and family on the use of medications that can cause acute withdrawal reactions.
Antibiotic Prophylaxis in Acute Necrotizing Pancreatitis
Authors: Segarra-Newnham Marisel , Geber Jean M 
Published: July 2017

Objective: To review the use of antibiotic prophylaxis in acute necrotizing pancreatitis. Background: Acute necrotizing pancreatitis is a complication that occurs in a minority of patients with acute pancreatitis, but has a high incidence of morbidity and mortality. Surgery and supportive care are important in the management of this disease. However, the role of antibiotic prophylaxis has been debated for decades. Data Sources: English-language clinical studies and review articles involving human subjects and appropriate in vitro data were located through a literature search (MEDLINE, January 1966-July 1998). Study Selection and Data Extraction: Relevant studies describing the use of antibiotic prophylaxis in acute necrotizing pancreatitis were reviewed. Data Synthesis: Earlier studies of antibiotic prophylaxis in patients with acute necrotizing pancreatitis did not show any benefit compared with placebo. Newer studies have shown a decrease in mortality and morbidity when antibiotic prophylaxis is given to patients with severe necrotizing pancreatitis. Conflicting results leave many questions unanswered, such as the effect of antibiotic use in resistance patterns, which antibiotic to use, duration of therapy, and cost-effectiveness of this strategy. Conclusions: With the available data, it is adequate to recommend that patients with at least 30% necrosis of the pancreas receive antibiotics to prevent infectious complications and to decrease potential mortality. Use of imipenem/cilastatin is supported by the largest prospective trial to date; however, the drug was compared with no treatment. Cefuroxime is the only drug shown to decrease mortality and should be considered an alternative that may be more cost-effective than therapy with imipenem/cilastatin. A comparison trial is needed before further recommendations are given.
Probable Nafcillin—Warfarin Interaction
Authors: Baciewicz Anne M , Heugel Anne M , Rose Peter G 
Published: July 2017

Objective: To report a case of probable nafcillin—warfarin interaction and to discuss the occurrence of this event. Case Summary: A 74-year-old white woman with stage IV ovarian cancer was given warfarin and nafcillin concurrently for a subclavian venous thrombus and an infected subclavian mediport. After 10 days of therapy, the patient's prothrombin time remained within the range of 11.6–13.8 seconds (control range 10.4–12.8). Her international normalized ratio (INR) ranged from 1.0 to 1.45 and her activated partial thromboplastin time ranged from 49 to 80 seconds (22–34). Nafcillin was discontinued. Continuous intravenous heparin was continued, and the patient was given warfarin 10 mg po for four days. A maintenance regimen of warfarin 5 mg po daily was then initiated. Within seven days of discontinuing nafcillin, the INR increased from 1.08 to 2.10. Discussion: Several cases of nafcillin—warfarin interaction have been reported in the literature. The case reported here is similar to a previously reported one in which a lower dose of nafcillin (6 g/d) was used for a short time (10 d). Therapeutic warfarin doses were started simultaneously with nafcillin. The interaction usually occurs within three to 10 days and abates within one to eight weeks. The postulated mechanism of interaction is induction of hepatic microsomal enzymes by nafcillin, leading to warfarin resistance. Conclusions: When nafcillin is prescribed concomitantly with warfarin, high doses of warfarin are usually required and close monitoring is necessary to keep the patient's INR within a designated range. Clinicians should be aware of a potential nafcillin—warfarin interaction because warfarin has a narrow therapeutic window that may readily lead to therapeutic failure or toxicity. Frequent review of clinical signs and symptoms of bleeding or thromboembolism and warfarin dosage adjustment are necessary if both drugs are used concurrently, and also when nafcillin is discontinued.
Stability of Low-Dose Vancomycin Hydrochloride in Heparin Sodium 100 IU/mL
Authors: Mayer Jennifer LR , Pascale Valentine J , Clyne Lionel P , Malkus Herbert , Santos Florecita S , van Hoff Jack 
Published: July 2017

Objective: To determine the stability of low-dose vancomycin hydrochloride 25 μg/mL and preservative-free heparin sodium 100 IU/mL stored at room temperature versus refrigerated temperature for 100 days. Design: A prospective, controlled pharmacologic study. Materials: The test article (V-H) was prepared by mixing vancomycin hydrochloride 25 μg/mL in heparin sodium 100 IU/mL. The antibiotic control (V) was the same dose of vancomycin in NaCl 0.9% only The heparin control (H) was commercially available 100 IU/mL vials of this agent. Methods: Half of the test and control solutions were stored at room temperature (28 °C) and half were kept in a refrigerator (4 °C). On study days 0, 1, 14, 30, 63, and 100, the concentration of vancomycin was measured by Emit. The functional activity of heparin was determined on identical days by the activated partial thromboplastin time (aPTT) assay. Results: Sixty-three days after preparation, the refrigerated V-H solution maintained over 90% of its original vancomycin concentration; in contrast, the V-H solution kept at room temperature had a 21% reduction in its antibiotic concentration. All V-H and V solutions had a significant (p = 0.01) drop in their vancomycin concentrations after 100 days of storage. There was no significant change in the measured aPTT of the V-H and H solutions stored in the refrigerator versus room temperature for 0 versus 100 days (p = 0.35 and p = 0.41, respectively). Conclusions: An admixture of vancomycin hydrochloride 25 μg/mL and heparin sodium 100 IU/mL is stable for up to 63 days when stored at 4 °C.
Raloxifene: A Selective Estrogen Receptor Modulator for the Prevention of Osteoporosis
Authors: Hagmeyer Kathleen O , Meyer Tamara K 
Published: July 2017

Objective: To review the efficacy and safety of the selective estrogen receptor modulator raloxifene hydrochloride in the prevention of osteoporosis. Data Sources: A MEDLINE search (January 1966–May 1998) and unpublished data obtained from the manufacturer were used to identify relevant studies and review articles. Additionally, bibliographies of selected articles were reviewed. Only English-language articles on human studies were obtained. Study Selection: Literature was reviewed to evaluate the pharmacology, pharmacokinetics, therapeutic use, adverse effects, and drug interactions of raloxifene. Additional relevant citations were used in the introduction material and clinical controversy section. Data Extraction: Clinical trials reviewing raloxifene for the prevention of osteoporosis were evaluated. Data Synthesis: Raloxifene hydrochloride is a partial estrogen agonist that displays both estrogenic and antiestrogenic effects. As a result of binding to estrogen receptors, raloxifene therapy, like estrogen treatment, causes positive changes in biochemical markers of bone turnover such as serum osteocalcin, serum alkaline phosphatase, urinary pyridinoline cross-links, and urinary calcium excretion. In addition, raloxifene increases bone mineral density. Furthermore, raloxifene reduces total serum cholesterol and serum low-density lipoprotein cholesterol. Raloxifene has no effect on serum high-density lipoprotein cholesterol. As a selective estrogen receptor modulator, raloxifene does not display the deleterious effects of estrogen in endometrial or breast tissue. The most common adverse effects are hot flashes and leg cramping. Conclusions: Clinical trials have found that raloxifene is effective in the prevention of osteoporosis, making the drug an alternative choice for the prevention of osteoporosis in patients who are concerned about the proliferative effects of estrogen replacement therapy on the endometrium or breast tissue. Raloxifene may not be a good alternative in women experiencing troublesome hot flushes during menopause. The use of raloxifene in the treatment of osteoporosis and in the prevention of breast cancer is currently being evaluated.
Bupivacaine-Induced Metallic Taste
Authors: Lo Angela B 
Published: July 2017

Objective: To describe a case of bupivacaine-induced metallic taste. Case Summary: A 48-year-old white woman admitted with scleroderma necrosis of the finger was given bupivacaine via an axillary catheter for pain relief. She experienced a metallic taste that abated on discontinuation of bupivacaine and recurred on rechallenge. Discussion: The close temporal sequence of bupivacaine-induced metallic taste has not been previously reported in the literature. This supports the existence of a causal relationship between bupivacaine and development of a metallic taste disturbance. Conclusions: Alterations in taste are an underrecognized effect of many drugs. This case illustrates this adverse drug reaction.
Low Dose of Dicyclomine Associated with Respiratory Distress and Death in an Infant
Authors: Aziz Noorizan Abdul , Teja Muhammad Bayu , Hassan Yahaya , Rujhan Muhammad Roziha , Jaalam Kamaruddin 
Published: July 2017

Objective: To report a case of a low dose of oral dicyclomine associated with respiratory distress and death in an infant. Case Summary: A 35-day-old Malay boy was given a total of 1.0 mL of Colimix syrup (per 5 mL containing dicyclomine HCl 5 mg and simethicone 50 mg) by a general practitioner for vomiting. About 24 hours later, the boy was referred to the hospital because of abdominal distension and difficulty in breathing. On admission to the intensive care unit, the patient was unconscious, hypotensive, tachycardic, apneic, and cyanotic. His condition continued to deteriorate despite acute treatment and resuscitation, and the patient died about 72 hours later. Discussion: Metabolic disorder and septic shock were not likely and not convincing diagnoses considering the laboratory data and other patient information. Furthermore, this patient's condition deteriorated within a short time and did not respond to antibiotics and other drug treatments. Dicyclomine is highly suspected because the respiratory distress began after he was given the drug. This drug is contraindicated in children younger than six months and has been reported to cause respiratory distress and death. Most of the cases reported occurred after the patient received one to two oral doses (5–10 mg) of dicyclomine. Unfortunately, in our patient, respiratory distress developed even with a very low dose (0.5–1 mg). The causal relationship of this incident was classified as “probable” based on the Naranjo method. Conclusions: A low dose of oral dicyclomine was probably the cause of respiratory distress and death in this infant. Drugs that are contraindicated should not be administered, even at very small doses.
Pharmacy Litigation Review: Hospital Administration and the Pharmacy Department
Authors: Brushwood David B 
Published: July 2017

Objective: To review some essential legal points in the relationship between hospital administration and pharmacists, and outline some of the responsibilities both groups have to one another and to the institution that employs them. Case Summaries: Issues discussed in the seven case summaries presented include whether: (1) a hospital can be liable for negligence if an error is made by a nonpharmacist and it is likely the error would not have occurred if a pharmacist had been on staff; (2) nurses may routinely compound intravenous admixtures for administration by other nurses when this practice is the responsibility of pharmacists; (3) practices falling below the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) guidelines automatically fall below standards of care applicable in malpractice cases, negating the need for expert testimony; (4) a hospital is liable for failure to meet the standard of care when no expert has testified to such standards, and the plaintiff has relied solely on JCAHO standards, the Physicians' Desk Reference, and the drug package insert; (5) a hospital's formulary system establishes a standard of practice for medical staff practicing at the hospital; (6) the responsibility of a hospital to control drug distribution within the hospital extends to purchases of nonprescription drugs by patients in the hospital gift shop; and (7) state statutes or public policy shield quality assurance activities from discovery in malpractice litigation brought against a hospital. Conclusions: Institutional responsibilities have become a significant focus of pharmacist attention. When institutions have responsibilities related to drug distribution or the use of medicines, they turn to pharmacists to find ways of meeting these responsibilities. As these case studies show, the legal ramifications of both groups individually and to each other within an institution are complex and require continued study.