bluuebunny/crossref_metadata_2025_split huggingface dataset:
Famotidine-Induced Mixed Hepatocellular Jaundice
Authors: Ament Paul W. , Roth John D. , Fox Carol J. 
Published: January 2017

OBJECTIVE: To report a case of probable famotidine-induced mixed hepatocellular jaundice. CASE SUMMARY: A 55-year-old man presented with a one-month history of mid-epigastric pain. Initial physical examination and laboratory studies, including liver enzyme concentration tests, were unrevealing. A diagnosis of gastritis was made and ranitidine was prescribed. Following one week of therapy, the patient's symptoms had not improved and therapy was changed to famotidine and sucralfate. Approximately one week later the patient presented with jaundice. Liver enzyme concentrations were elevated and the patient was hospitalized for further evaluation. Five days following discontinuation of famotidine, liver enzyme concentrations were normal and jaundice had resolved. Further tests did not reveal any pathologic etiology. DISCUSSION: Hepatic changes have occurred in patients receiving histamine2-antagonists; ranitidine and cimetidine have been cited most frequently. In general, the elevations are mild, transient, and return to baseline with continued therapy. This is one of the first case reports of probable famotidine-induced mixed hepatocellular jaundice. CONCLUSIONS: There was a temporal relationship between the patient's signs and symptoms and initiation of famotidine. No identifiable factors contributed to the elevated liver enzyme concentrations and jaundice.
Alcohol Withdrawal: What is the Benzodiazepine of Choice?
Authors: Bird Rebecca D. , Makela Eugene H. 
Published: January 2017

OBJECTIVE: To review the literature concerning the use of benzodiazepines for treatment of alcohol withdrawal and to determine if the current literature assessment justifies the use of lorazepam as first-line therapy. DATA SOURCES: A thorough review of the literature was performed with an online database (BRS Colleague). Articles directed at the targeted issue were chosen and additional references were obtained from the bibliographies of these articles. STUDY SELECTION: Clinical trials and case reports concerning the use of chlordiazepoxide, diazepam, and lorazepam in alcohol withdrawal treatment were reviewed. DATA SYNTHESIS: Lorazepam is considered by many to be the drug of choice for alcohol withdrawal because it undergoes glucuronidation and has an intermediate half-life. These characteristics have suggested its superiority when treating elderly patients or patients with liver disease. However, some studies suggest that a drug with a longer half-life would provide smoother withdrawal. In addition, the number of patients with liver disease treated for alcohol withdrawal is unknown. These and other factors question the recommendation of lorazepam as the drug of choice. CONCLUSIONS: Well-controlled comparison studies should be performed before recommending the routine use of lorazepam for treating alcohol withdrawal syndrome.
Infection Caused by Mycobacterium Tuberculosis
Authors: Peloquin Charles A. , Berning Shaun E. 
Published: January 2017

OBJECTIVE: To update readers on the clinical management of infections caused by Mycobacterium tuberculosis, to provide a general description of the organism, culture and susceptibility testing, and clinical manifestations of the disease, and to provide several aspects of the treatment of the disease, including historical perspective, current approaches, and research opportunities for the future. DATA SOURCES: The current medical literature, including abstracts presented at recent international meetings, is reviewed. References were identified through MEDLINE, MEDLARS II, Current Contents, and published meeting abstracts. STUDY SELECTION: Data regarding the epidemiology, clinical manifestations, culture and susceptibility testing, and treatment of tuberculosis are cited. Specific attention has been focused on the clinical management of patients with noncontagious infection and potentially contagious active disease (TB) caused by M. tuberculosis. DATA EXTRACTION: Information contributing to the discussion of the topics selected by the authors is reviewed. Data supporting and disputing specific conclusions are presented. DATA SYNTHESIS: The incidence of TB is increasing in the US, despite the fact that available technologies are capable of controlling the vast majority of existing cases. Fueling the fire is the problem of coinfection with HIV and M. tuberculosis. Very few drugs are available for the treatment of TB, and few of these approach the potency of isoniazid and rifampin. Preventive therapy of patients exposed to multiple-drug—resistant M. tuberculosis (MDR-TB) is controversial and of unknown efficacy. Treatment of active disease caused by MDR-TB requires up to four times longer, is associated with increased toxicity, and is far less successful than the treatment of drug-susceptible TB. Strategies for the management of such cases are presented. The rising incidence of TB in the US reflects a breakdown in the healthcare systems responsible for controlling the disease, which reflects the past budgetary reductions. Although TB control is one of the most cost-effective public health strategies, funding has been cut repeatedly despite the fact that TB was never eliminated. This has helped to produce the current crisis, including the spread of MDR-TB in many urban areas. The elimination of TB will now take decades longer, cost hundreds of millions of dollars more, and result in vastly higher morbidity and mortality rates than would have occurred with timely, adequate measures. CONCLUSIONS: Tremendous effort and far more funding will be required to eliminate TB in the US. The selection of drug therapy must be based on the susceptibility data for each isolate. Multipledrug therapy must be continued for 6 to ⩾24 months, and patient adherence to prescribed regimens must be verified in all cases of TB. Significant antimycobacterial drug malabsorption has been documented in AIDS patients with TB, and may result in treatment failure. New agents are needed to improve the clinical outcome in patients with MDR-TB.
Compatibility of Oral Morphine Sulfate Solution with Enteral Feeding Products
Authors: Udeani George O. , Bass Joeby , Johnston Thomas P. 
Published: January 2017

OBJECTIVE: Patients with terminal cancer often receive continuous enteral nutrition and oral medications concomitantly through nasogastric or gastrostomy feeding tubes. This study evaluated in vitro the compatibility of morphine sulfate (MS) solution 2 mg/mL (Roxane Laboratories) with three enteral nutrition products (Jevity [J], Osmolite-HN [O], and Pulmocare [P]) at 22 and 37 °C for 48 hours and J alone at 50 °C for 48 hours. METHODS: Mixtures containing 1 mg/mL MS were prepared with each enteral product: J, O, and P (Ross Laboratories). Serial samples (1 mL) were collected from each mixture and analyzed for morphine by reverse-phase HPLC. An analog pH meter was used to measure the pH of each mixture at scheduled intervals. RESULTS: The addition of MS 2 mg/mL (MS2) to J caused an immediate decrease in pH from 6.24 ± 0.01 to 4.96 ± 0.05 and a noticeable precipitate/phase separation. No phase separation was observed with a 1 mg/mL mixture of MS and J, O, and P when they were prepared with a more concentrated MS solution (20 mg/mL, MS20) (Roxanol Intensol). The pH declined linearly for all three enteral feeding products as the MS20 concentration was increased from 0 to 1 mg/mL. The precipitate observed in the mixture of MS2 with J was probably caused by the decrease in pH, which was caused by the greater volume fraction of MS solution. The concentration of morphine in the supernatant of a MS2/J solution was 0.83 mg/mL, and the concentration of MS in a homogeneous MS20/J solution was 0.86 mg/mL. At 48 hours, there was negligible (<2 percent) morphine decomposition in all MS admixtures at all temperatures. No microbial growth was observed in any admixture at 24 hours. Electrophoretic analysis demonstrated equal protein migration and molecular weight distribution for J and MS/J solutions. CONCLUSIONS: MS is stable in enteral feeding solutions at temperatures from 22 to 50 °C. MS2 is associated with a pH-dependent protein precipitation (but not destruction of the proteins), resulting in disproportionate concentrations of morphine in the supernatant and precipitate. This incompatibility may adversely affect enteral feeding analgesic delivery. We, therefore, recommend MS 20 mg/mL for this method of oral MS delivery, because of its superior compatibility and stability with enteral feeding products.
Acute Renal Failure and Neurotoxicity following Oral Acyclovir
Authors: Johnson Gretchen L. , Limon Lynn , Trikha Gita , Wall Hillary 
Published: January 2017

OBJECTIVE: To report a case of acute renal failureand neurotoxicity following administration of oral acyclovir. DATA SOURCES: Medical record of the patient, case reports identified by MEDLINE. DATA EXTRACTION: Data were abstracted from relevant published data by Johnson and reviewed by the remaining authors. CASE SUMMARY: A 69-year-oldwoman was diagnosed with herpes zoster and oral acyclovir was prescribed by her local physician. After approximately two days the patient was taken to the emergency department of a local hospital with signs of acute confusion and acute renal failure. Medications included oxycodone/acetaminophen, al prazolam, prazepam, and digoxin. Pertinent laboratory abnormalities included serum digoxin 4.1 μmol/L, white blood cell count 17.6 × 109/L, blood urea nitrogen (BUN) 24 mmol/L of urea, and serum creatinine 305 μmol/L (patient baseline is 11 mmol/L of urea and 91.5 serum creatinine μmol/L, respectively). Because of increasing lethargy and a focal seizure, she was transferred to our institution. Despitean extensive workup, no organiccause of her altered mental status and acute renal failure was identified. Four days after discontinuation of the acyclovir, without specific intervention, the patient's mental status improved and her BUN and serum creatinine concentrations had decreased to 21 mmol/L of urea and 190.6 μmol/L, respectively. On day 5, the patient was alert and oriented to name, place, year, and month, On day 9, her renal function and mental status had returned to baseline and she was discharged. CONCLUSIONS: Acute renal failure and neurotoxicity are usually associated with intravenous acyclovir. The temporal relationship between the initiation of oral acyclovir therapy and the onset of adverse events, supported by published data of a few similar cases, strongly implicateoral acycloviras the cause of this patient's acute renal failure and neurotoxicity. This case suggests that elderly patients with mild increased serum creatinine concentrations may be at increased risk and should be monitored closely for signs and symptoms of acute renal failure and neurotoxicity.
Is There a Role for Albumin Administration in Nutrition Support?
Authors: D'Angio Richard G. 
Published: January 2017

OBJECTIVE: To review the administration of exogenous albumin in patients receiving nutritional support and determine if the use of albumin is supported by controlled trials. DATA SOURCES: MEDLINE search of English-language literature using the key terms albumin, parenteral nutrition, and enteral nutrition. The references of articles identified were also searched. STUDY SELECTION: Studies examining the administration of exogenous albumin to hypoalbuminemic patients receiving nutrition support. DATA EXTRACTION: Results from prospective randomized trials are presented in detail. Data from noncontrolled and animal studies are presented in areas where human controlled trials are limited. DATA SYNTHESIS: Albumin is a marker of malnutrition and numerous studies have demonstrated that a low serum albumin concentration is associated with increased morbidity and mortality. Investigators have attempted to improve outcome through the administration of exogenous albumin. The results of controlled trials examining exogenous albumin administration have been equivocal. One study demonstrated a significant decrease in overall complications, pneumonia, and sepsis. In two other controlled trials, albumin administration failed to decrease complications. None of the studies demonstrated a significant decrease in mortality or length of stay. A low serum albumin concentration has also been linked to intolerance to enteral feedings. Although case reports and one study support the administration of albumin, two prospective controlled trials have failed to demonstrate improved tolerance to enteral feeding in hypoalbuminemic patients receiving exogenous albumin. CONCLUSIONS: Evidence to date is insufficient to support the routine administration of exogenous albumin to hypoalbuminemic patients receiving nutrition support.
Attitudes of Healthcare Professionals toward Patient Counseling on Drug-Nutrient Interactions
Authors: Teresi Mary E. , Morgan Douglas E. 
Published: January 2017

OBJECTIVE: To evaluate the attitudes of healthcare providers on drug—nutrient interaction (DNI) counseling. DESIGN: A mail survey. SETTING: Random sample of healthcare providers with interest in nutrition, practicing in Iowa or Nebraska. METHODS: A 48-item questionnaire was constructed on the basis of a review of DNI literature. The survey was sent to 100 pharmacists, 50 registered dietitians, 25 registered nurses, and 25 physicians identified from culled mailing lists of the American Society of Parenteral and Enteral Nutrition and the Iowa Nebraska Society of Parenteral and Enteral Nutrition. Assessed variables included the amount of DNI counseling provided, who is in the best position to provide DNI counseling, and what information should be included in instructional materials on DNIs for patients. Data were entered into a relational database for evaluation and comparison. RESULTS: The usable response rate was 49.5 percent (n=99): 49 pharmacists, 29 dietitians, 18 nurses, and 3 physicians. Only 12 respondents provided DNI counseling in >50 percent of patient interactions. Seventy-one respondents (72 percent) felt pharmacists were in the best position to discuss DNIs with patients. More than half of the respondents felt a new DNI pamphlet should be developed to replace an existing Food and Drug Administrationsponsored pamphlet. Although 70 percent felt the new pamphlet should be organized according to specific drugs, many felt the format should also include specific populations and disease states. Eighty-six percent indicated that a chart on ONIs geared toward healthcare professionals would be useful. CONCLUSIONS: Patient-oriented resources should be developed to enhance DNI counseling. Pharmacists are in a uniquely advantageous position to provide DNI counseling.
Treatment of Cyclophosphamide-Induced Hemorrhagic Cystitis with Prostaglandins
Authors: Miller Lisa J. , Chandler Sonja W. , Ippoliti Cindy M. 
Published: January 2017

OBJECTIVE: To report a case of cyclophosphamide-induced hemorrhagic cystitis. discuss prevention, and review treatment options, particularly the use of intravesicular prostaglandins. DATA SOURCES: Literature obtained through a computerized search, with subsequent bibliography scanning. Information on the individual case was obtained from the patient's medical record and the Pharmacy Clinical Research Specialist. CASE SUMMARY: A 29-year-old woman who had a postallogeneic bone marrow transplantation was hospitalized because of graftversus-host disease. During hospitalization, she developed a cyclophosphamide-induced hematuria that, despite hydration and transfusions of blood products, progressed to refractory hemorrhagic cystitis. A response was prompted ultimately by a regimen consisting of continuous bladder irrigation and intermittent intravesical instillation of carboprost. DISCUSSION: The best treatment for hemorrhagic cystitis remains prevention. Therapies for established cystitis are varied; the choice depends on the degree of hematuria present. Therapies are often temporary or ineffective, and themselves cause significant morbidity. One promising treatment option involves the intravesicular administration of prostaglandins. Reports in the literature discuss a variety of products, dosages, and treatment schedules that have been used with some success. The available data on this technique are presented. CONCLUSIONS: Prostaglandins appear to be effective in resolving established hemorrhagic cystitis; however, their place in therapy remains unclear. Before this class can be employed routinely, several basic issues remain. These include optimal dosage, dosing schedule, duration of treatment, and comparative efficacy with other agents.
Benzocaine-Induced Methemoglobinemia: Report of a Severe Reaction and Review of the Literature
Authors: Rodriguez Luis F. , Smolik Lynn M. , Zbehlik Alicia J. 
Published: January 2017

OBJECTIVE: To report a case of benzocaine-induced inethemoglobinemia and present a review of the related literature. CASE REPORT: An 83-year-old man received benzocaine topical anesthesia 600 mg prior to intubation for resection of a thyroid adenoma. The patient became severely cyanotic after induction of anesthesia. After a negative workup for common causes of cyanosis, blood co-oximetry analysis revealed a methemoglobin concentration of 54.1 percent. Intravenous methylene blue reversed the methemoglobinemia, although delayed recurrence 20 h later necessitated readministration of intravenous methylene blue. The patient developed cardiovascular instability and severe neurologic depression requiring prolonged ventilatory support. DISCUSSION: Methemoglobinemia can result from exposure to a number of drugs including benzocaine. Cyanosis, neurological and cardiac dysfunction may result when methemoglobin concentrations exceed 30 percent. Clinical diagnosis is made on the presentation of cyanosis unresponsive to oxygen administration and a distinctive arterial blood brown color; laboratory confirmation is by co-oximetry. Treatment of symptomatic methemoglobinemia is by intravenous methylene blue (1–2 mg/kg) administration. Fifty-four cases of benzocaine-induced methemoglobinemia have been reported in the literature. Intubation, endoscopy/bronchoscopy, and ingestion were the most common procedures in which benzocaine administration produced methemoglobinemia. Infants and the elderly were more likely to develop toxic methemoglobinemia after benzocaine exposure. Other risk factors included genetic reductase deficiencies, exposure to high doses of anesthetic, and presence of denuded skin and mucous membranes. CONCLUSIONS: Because of the potential for severe complications, methemoglobinemia should be corrected promptly in compromised patients and those with toxic benzocaine concentrations. The possibility of masking symptoms during general anesthesia carries special risk of use of this agent in the preanesthesia setting.
Clinical Interventions Provided by Doctor of Pharmacy Students
Authors: Slaughter Richard L. , Erickson Steven R. , Thomson Peter A. 
Published: January 2017

OBJECTIVE: To assess the types, perceived benefit, and cost impact of the interactions provided by two-year post-B.S. Pharm.D. students on clerkship rotations. DESIGN: Information was obtained through voluntary reporting by students on a standardized data collection form. Cost analysis and peer review were performed on a subset of interventions. SETTING: The setting of the study included hospital clerkship sites (general medicine and specialty rotations) and an ambulatory care site (general medicine). PARTICIPANTS: Six second-year Pharm.D. students. RESULTS: Reports that were completed totaled 951, including 612 intervention, 335 information, and 4 unknown events. Most events were drug related and student initiated. Follow-up was predominantly to physicians. Intervention events primarily involved changes in drug therapy regimens (63.5 percent), changes in dose (29.5 percent), and identification of potential adverse drug reactions (7 percent). Acceptance rate of recommendations was 78.7 percent. Antibiotics, cardiovascular agents, and central nervous system drugs accounted for 55.5 percent of all interventions. Almost 80 percent of disease states encountered included cardiovascular, infectious, neurologic, pulmonary, gastrointestinal, and endocrine diseases. Overall, peer review scores tended to show a positive impact, with physician scoring higher than pharmacy faculty scoring. Medication-related costs were reduced modestly by accepted student interventions. CONCLUSIONS: This study demonstrates substantial clinical involvement of two-year post-B.S. Pharm.D. students on clerkships. The results indicate that the curriculum of Pharm.D. programs should emphasize cardiology, infectious disease, neurology, and gerontology.
Assessing the Accuracy of Drug Information Responses from Drug Information Centers
Authors: Beaird Sandra L. , Coley Rebecca M.R. , Blunt Jeffrey R. 
Published: January 2017

OBJECTIVE: To evaluate the accuracy of response to a request among a sample of drug information centers and to determine the association between accuracy of response and individual center characteristics. DESIGN: A randomized telephone investigation. SETTING: College of Pharmacy drug information center located in a 500-bed tertiary care teaching hospital. PARTICIPANTS: Fifty-nine drug information centers randomly selected from 154 centers that had responded to a survey. INTERVENTION: Each center received a telephone request requiring identification of Videx (didanosine), at that time a Phase II investigational product. Each center correctly identifying Videx was presented a patient case and questioned concerning adverse effect management. A written protocol of conversation was followed. Center confidentiality was maintained during data analysis. MAIN OUTCOME MEASURES: The association between correct information regarding Videx and individual drug information center characteristics was evaluated. RESULTS: Fifty-six evaluable responses were received. Videx was correctly identified by 16 centers (28.6 percent). Two centers (3.6 percent) made an incorrect identification and 38 centers (67.9 percent) could not make an identification. Of the 16 centers correctly identifying Videx, four successfully linked the product with described adverse effects, but none offered therapeutic management recommendations. Factors significantly associated with accurately identifying Videx included possession of a center policy and procedure manual (p=0.011) and on-line searching capability (p=0.021). CONCLUSIONS: These results identify an inconsistency in accuracy of responses among drug information centers. Although standardized operating policies/procedures and on-line searching capability may contribute to increased accuracy, there is clearly a need for enhanced quality assurance efforts.
Oxaprozin-Induced Fulminant Hepatitis
Authors: Purdum Preston P. , Shelden Stacey L. , Boyd John W. , Shiffman Mitchell L. 
Published: January 2017

OBJECTIVE: To report oxaprozin-induced fulminant hepatic failure. CASE SUMMARY: A 56-year-old woman was admitted with fulminant hepatic failure. Work-up for potential etiologies was negative except for the use of oxaprozin for the preceding two months. Results of premortem liver biopsy were consistent with drug-induced hepatic injury similar to that previously reported with diclofenac. DISCUSSION: Although the literature describes elevation in hepatic transaminase concentrations associated with oxaprozin, fulminant hepatic failure has not been described previously. CONCLUSIONS: Elevations in hepatic transaminase concentrations and now fulminant hepatic failure have been shown to occur with oxaprozin, as previously seen with other nonsteroidal antiinflammatory drugs (NSAIDs). Transaminitis is a known adverse effect of NSAID use, but is usually mild and reversible with discontinuation of drug. Transaminitis may be more likely to occur in the elderly, in patients receiving concurrent potentially hepatotoxic medications, and possibly with the newer long-acting NSAIDs. The existence of fulminant hepatitis, although rare, supports the need for monitoring liver function enzymes during NSAID therapy.