bluuebunny/crossref_metadata_2025_split huggingface dataset:
Internal Standards: Rationale for Use in a Drug Utilization Review Program
Authors: Huber Stephen L. , Patry Roland A. 
Published: May 2016

The comparison of drug usage data gathered from different institutions would be easier if standardized criteria were employed. There are, however, major difficulties encountered in gaining approval of such criteria from different physician groups. To facilitate the criteria approval process, “internal standards” were developed. These internal standards reflected the acceptable deviations from the standardized criteria, hence, permitting flexibility for innovation in drug therapy. A retrospective drug utilization review was conducted in two hospitals. The internal standards assigned were very similar to the 0 percent-100 percent standards recommended by InterQuar® except for the criteria on monitoring parameters and duration of therapy. It would appear from these preliminary results that the assignment of internal standards enhances the use of standardized criteria which, in turn, will allow comparisons of data.
Clinical Pharmacology of Bleomycin and Cisplatin
Authors: Evans William E. , Yee Gary C. , Crom William R. , Pratt Charles B. , Green Alexander A. 
Published: May 2016

Bleomycin (Blenoxane) and cisplatin (Platinol) are two anticancer drugs, with activity for head and neck tumors, that were introduced into clinical use in the past ten years. Bleomycin is used primarily in the chemotherapy of squamous cell carcinomas, lymphomas, and testicular carcinoma, while cisplatin possesses significant activity against testicular and ovarian carcinoma, head and neck cancer, bladder cancer, and neuroblastoma. Bleomycin is rapidly excreted renally (terminal phase half-life = 2–4 h), although enzymatic inactivation also occurs in many tissues. Cisplatin is nonenzymatically converted to highly protein bound metabolites, which then undergo renal elimination, but total body clearance occurs much more slowly than with bleomycin (terminal phase half-life = 40–50 h). Both agents have acute and chronic toxicities; the acute toxicities are generally reversible but cause a great deal of patient discomfort, while the chronic toxicities are often irreversible and dose-limiting. For bleomycin, the acute toxicities are mucocutaneous and pyretic; severe nausea and vomiting represents the major acute toxicity of cisplatin therapy. Cumulative dose-related pulmonary toxicity is the most serious chronic toxicity of bleomycin. The clinical, radiographic, and pathologic presentations are nonspecific, although identification of high risk patients may be possible with serial pulmonary function tests. Cumulative nephrotoxicity occurs with cisplatin use, and its incidence and severity can be reduced by maintaining adequate hydration and diuresis during and following administration of the drug.
An Assessment of Prescribing Using Drug Utilization Review Criteria
Authors: Helling Dennis K. , Norwood G. Joseph , Donner John D. 
Published: May 2016

Drug utilization review screening criteria were applied to a sample of 30000 prescriptions written by Iowa physicians. Characteristics of the physicians who had high percentages of prescriptions violating the explicit criteria were examined. It was found that the proportion of prescriptions failing the screening criteria did not differ significantly among physicians of differing board certification groups, medical school of graduation, year of graduation from medical school, age, or size of town where the physicians practiced. Regardless of the physicians' demographic characteristics, approximately 50 percent of their prescriptions violated the prescribing criteria. The three categories of screening criteria included irrational mixture, quantity prescribed, and daily dosage. An analysis of the relationship between physician ratings obtained for each of the categories revealed that no relationship existed between a physician's quantity prescribed rating and daily dosage rating, or between a physician's irrational mixture rating and daily dosage rating. A negative relationship was found between a physician's quantity prescribed rating and irrational mixture rating. This tends to indicate that the three categories measure different prescribing patterns and each warrants respective monitoring by pharmacists.
Pharmaceutical Considerations of Nitroglycerin
Authors: Yacobi Avraham , Amann Anton H. , Baaske David M. 
Published: May 2016

During the past few years, there have been rapid changes in the pharmaceutical uses of nitroglycerin. New dosage forms and new delivery systems have become available, which have resulted in potential confusion to all concerned with the proper use of these systems. The goal of this review is to prevent confusion and to bring all the relevant information together. The various analytical techniques available for quality control of the dosage forms and for the study of the pharmacokinetics are reviewed, with the intent of enabling the reader to identify pertinent references rapidly. The interaction of nitroglycerin with packaging and plastic delivery devices is also reviewed so that the reader can make informed choices. Finally, the clinical pharmacy and pharmacokinetics are reviewed so as to bring the reader up to date in that area. After reading this article, the areas of nitroglycerin research that still need to be explored should be apparent.
Familial Warfarin Resistance
Authors: Holt Robert J. , Freytes César O. 
Published: May 2016

Warfarin, a coumarin anticoagulant, acts by interfering with the hepatic synthesis of the vitamin-K-dependent clotting factors. It is used clinically in the treatment or prophylaxis of venous thrombosis and embolisms. Resistance to the effects of the coumarin and indanedione anticoagulants has been reported in rats and man, but its incidence has been defined as extremely rare. Resistance has been described as relative, acquired, or hereditary. The first well-documented case was also the first report to identify a genetic basis for this resistance. Since that time, there has been only one other study that strengthened the evidence for a hereditary transmission, and only a few other reports have suggested hereditary influence as a reason for coumarin resistance. In this report, a patient who presented with a familial-type warfarin resistance is described. A discussion of previous reports and possible mechanisms for nonfamilial warfarin resistance is also included.
Nutritional Support of the Critically ILL Patient
Authors: Dasta Joseph F. , Kudsk Kenneth A. , Mirtallo Jay M. 
Published: May 2016

Injury or stress generates a vigorous metabolic response designed to establish the metabolic priorities required for the repair of injured tissues. In this condition, hormones commonly found to be elevated in the plasma include glucagon, catecholamines, glucocorticoids, growth hormone, aldosterone, and antidiuretic hormone. This hormonal profile results in rapid lysis of body protein, an increased rate of fat oxidation, and water and salt conservation. Rates of gluconeogenesis and ureagenesis are accelerated and may result in significant losses in lean body mass, a process that, if allowed to progress, will adversely affect patient survival. Exogenous nutrients provided to the critically ill patient may be poorly tolerated and may result in complications. Dextrose and intravenous fat emulsions provide the major sources of parenteral, nonprotein energy. These energy sources may not be metabolized efficiently in these patients, even though energy expenditure in this condition is increased significantly. Measurement of urinary nitrogen losses yields evidence useful in assessing the patient's degree of stress. In this manner, the patient's energy and protein requirements may be estimated. Formulations of amino acids, including the branched-chain amino acids, in higher concentrations have been reported to have anticatabolic effects and may improve the maintenance of lean body mass in stressed individuals. The stressed patient is prone to metabolic complications and, therefore, requires more careful monitoring of fluid, electrolyte, and acid-base balance, as well as renal, pulmonary, and liver function. Nutritional status is difficult to assess, since negative nitrogen balance may persist and the visceral proteins such as transferrin become altered in stress and, therefore, may not respond to nutritional intervention alone. The goal of nutritional therapy is the preservation of lean body mass by the safe and efficacious provision of metabolic substrate, thus improving patient survival.
A Microcomputer Program for Tobramycin Consult Services, Based on the Two-Compartment Pharmacokinetic Model
Authors: Schentag Jerome J. , Adelman Martin H. 
Published: May 2016

A microcomputer program has been developed to provide assistance to tobramycin clinical pharmacokinetic consult services. Written for the Apple II Plus computer with 64 K memory, one-disk drive, and a dot matrix graphics printer, this software is user-oriented and simple to operate. The program disk contains complete documentation and referenced instructions. Major sections provide empiric dosing recommendations based on population data and allow determination of dosage from measured serum concentrations. The program keeps a record of previous regimens, allows for the entry of the user's own recommendation, and provides complete flexibility for up to 15 dosage and interval changes. In addition to its dosing information and file management capabilities, the program simulates serum concentration profiles based on user-selected one-compartment, two-compartment, or two-compartment prenephrotoxic models. The program prints a consult sheet with concentration vs. time simulation, patient demographic data, and user-entered recommendations and comments. The program provides extensive disk storage capabilities for patient files, with immediate access to facilitate updating and dosing regimen changes as they occur. In addition to providing improvements in empiric dosing capabilities, pharmacokinetic modeling, and data handling, this computer software has been designed to incorporate pharmacokinetic data derived from important subpopulations into the empiric dosing algorithms. This unique aspect enables the program to provide improved empiric dosing regimens for patients who do not fall under the guidelines for any of the conventional aminoglycoside dosing nomograms.
Use of Dimenhydrinate in the Treatment of Green Tobacco Sickness
Authors: Ives Timothy J. 
Published: May 2016

A case of green tobacco sickness (GTS) in a 37-year old male migrant worker and the use of dimenhydrinate in its treatment/prophylaxis is presented. A brief discussion of the etiology and symptomatology of GTS is included. Dimenhydrinate is a useful over-the-counter product for the treatment of this occupational illness in the tobacco-growing states of the Southeast.
Toward a Rational Approach to the Issue of Prescribing Authority for Pharmacists
Authors: Covington Timothy R. 
Published: May 2016

The issue of expanded prescriptive authority for pharmacists has been gaining momentum for some time and has resulted in legislation in California and Washington and clarification of legislation in Oregon allowing expanded prescribing prerogatives for pharmacists. In April 1982, the American Pharmaceutical Association Policy Committee on Professional Affairs recommended that a policy statement be adopted endorsing the concept that pharmacists have the independent authority to select and dispense pharmaceutical and therapeutic alternates. The importance of the pharmacist as a health professional strategically placed and generally qualified to contribute significantly to the optimization of drug therapy outcomes cannot be denied. The advocacy of independent authority for all pharmacists to select pharmaceutical alternates, and particularly therapeutic alternates, appears to be premature, however. Orderly transition and constructive evolution of expanded prescriptive authority for pharmacists requires: (1) a comprehensive, introspective self-analysis of the current status of pharmacy practice; (2) establishment of a communication system between pharmacist and physician that will optimize drug therapy; (3) improved recognition by pharmacy of the complexity involved in drug selection and patient monitoring; and (4) development of a process for establishing credentials that would certify the competency of pharmacists to perform defined prescribing functions.
Ranitidine Hydrochloride
Authors: Gaginella Timothy S. , Bauman Jay H. 
Published: May 2016

Ranitidine is a selective, competitive histamine H2-receptor antagonist recently approved by the Food and Drug Administration for use in the short-term treatment of active duodenal ulcers and gastric hypersecretory conditions. Ranitidine is four to ten times more potent than cimetidine on a molar basis in inhibiting stimulated gastric acid secretion. Clinical studies have demonstrated that ranitidine is as effective as cimetidine and is similarly well tolerated. Based on available literature (approximately 700 publications), this article reviews the pharmacology, safety profile, and clinical efficacy of ranitidine in duodenal ulcers and gastric hypersecretory conditions.
Aminoglycoside Inactivation by Penicillins and Cephalosporins and its Impact on Drug-Level Monitoring
Authors: Tindula Robert J. , Ambrose Peter J. , Harralson Arthur F. 
Published: May 2016

The degree of in vitro inactivation of gentamicin, tobramycin, and amikacin by various penicillins and cephalosporins was investigated. Serum samples were prepared that contained one aminoglycoside and one penicillin or cephalosporin. Each aminoglycoside was combined with each of the following: penicillin, ampicillin, nafcillin, carbenicillin, ticarcillin, cephapirin, cefazolin, cefoxitin, and cefamandole. Each sample contained a final concentration of 10 μ/ml of gentamicin or tobramycin, or 35 μ/ml of amikacin, with 400 μg/ml of the β-lactam antibiotic. Control samples containing only the aminoglycoside were used for comparison. Half of each mixture was frozen at −20°C and the remainder was left at room temperature for 24 hours. The samples were assayed for aminoglycoside content by a radioimmunoassay and each combination was compared with its control value. Based on the results, the β-lactams can be divided into three groups: (1) cefazolin and cefamandole, which cause little inactivation; (2) nafcillin, cephapirin, and cefoxitin, which cause moderate inactivation; and (3) penicillin, ampicillin, carbenicillin, and ticarcillin, which cause marked inactivation. In general, tobramycin was the most reactive of the three aminoglycosides studied and amikacin the most stable. The frozen samples were much less affected than those left at room temperature. Freezing samples, if there will be a delay in assaying, and choosing aminoglycoside sampling times when the β-lactam concentration is at a trough are recommended to minimize spurious aminoglycoside level determinations due to in vitro inactivation.
Hydrochlorothiazide-Induced Pulmonary Edema
Authors: Levay Ilona D. 
Published: May 2016

A patient with probable hydrochlorothiazide-induced pulmonary edema is described. A 70-year-old woman experienced nausea, diaphoresis, and severe respiratory distress approximately ½ hour after taking an Aldactazide tablet. She had experienced a flu-like syndrome after taking a single tablet two weeks previously. The patient was mildly tachycardic with a blood pressure of 74/0 mm Hg. A chest X-ray revealed cardiomegaly and bilateral pulmonary edema suggestive of congestive heart failure. The pulmonary capillary wedge pressure was normal. It was felt that the patient had developed a noncardiac pulmonary edema possibly secondary to hydrochlorothiazide ingestion. Nine other cases reported in the literature also are described. Pharmacists should be aware of this potential life-threatening reaction and avoid patient reexposure to the drug.
Medical Education Provided by a Clinical Pharmacist: Impact on the Use and Cost of Corticosteroid Therapy in Chronic Obstructive Pulmonary Disease
Authors: Self Timothy H. , Smith Steven L. , Boswell Richard L. , Miller William A. 
Published: May 2016

The impact of medical education provided by a clinical pharmacist on the use and cost of corticosteroid therapy in acute exacerbations of chronic obstructive pulmonary disease was evaluated. Three separate two-month audits of corticosteroid use were conducted on the pulmonary medicine service (PMS) of a teaching hospital. For the first audit period, no education was given and no clinical pharmacist was on the PMS. During the second audit period, no education was given, but a clinical pharmacist was on-service. For the third audit period, education (brief discussion and a handout) was given to new house staff members by the clinical pharmacist on the PMS. A significant reduction in the mean number of intravenous steroid doses, steroid cost per day, and patient steroid charges per day occurred in the third vs. the first period. Steroid cost per day and patient steroid charges per day were lower in the third period than the second, but the difference was not statistically significant.
Tobacco Smoking and Drugs: A Clinically Important Interaction?
Authors: D'Arcy P.F. 
Published: May 2016

Tobacco smoking may interact with the metabolism of a number of drugs. This has been demonstrated clearly in pharmacokinetic studies in animals and man. However, tobacco smoking as a variant has been studied with relatively few clinically essential drugs and these studies do not always demonstrate a consistent effect of smoking. This review therefore not only records what data have emerged from pharmacokinetic or other studies, but it also attempts to determine whether such interactions have clinical significance. The main finding of this review is that, in the majority of examples, there is little evidence that there is a recognizable hazard from the interaction per se. The exceptions to this general conclusion are limited to four drugs: insulin, propoxyphene, propranolol, and theophylline preparations. With these drugs, there is some evidence of clinical importance of an interaction with tobacco smoking.
Establishing a Pharmacy Clinic in a City-County Health Department
Authors: Tiggelaar John M. , Love David W. , Pahl Ricky C. 
Published: May 2016

During a one-year rotation at an urban-county health department, a pharmacy resident implemented a pharmacy clinic to serve three major purposes: (1) to provide health care to patients with selected chronic illnesses, (2) to expand the revenue base of the health department pharmacy, and (3) to make possible the clinical instruction of Doctor of Pharmacy students and pharmacy residents. The resident's activities in the clinic included conducting interviews, performing physical examinations, initiating and adjusting therapy, and counseling patients. During the first four months of operation, 36 patients were seen in the clinic a total of 98 times. Seven chronic illnesses, along with a number of minor acute disorders, were evaluated and treated by the pharmacist. The pharmacist billed $1740.00 for patient care activities. The success of this initial program indicates that similar pharmacy clinics would be of benefit to other colleges of pharmacy as well as other institutional ambulatory health care providers.
Clinical Pharmacy Services in Family Practice: Cost-Benefit Analysis
Authors: Chrischilles Elizabeth A. , Helling Dennis K. , Rowland Clayton R. 
Published: May 2016

The benefits, decreased referral rate and increased kept-appointment rate, and the costs that a family practice clinic could expect to incur by including a clinical pharmacist in the clinic are discussed. By using a clinical pharmacist as a consulting partner, the physician would have a decreased need to refer patients to specialists not affiliated with the medical practice. The benefit to the practice is the revenue from office and hospital visits that would not have been received had these patients been referred elsewhere. Involvement of a clinical pharmacist in providing drug therapy management for patients with selected chronic diseases results in an increase in office appointment compliance rates. The benefit to the practice is the revenue generated by the increased number of office visits per year. Costs that would be incurred by the practice include: physician time spent due to the increased number of office visits generated by the decreased referral rate and increased appointment compliance; increased operating expenses, including the clinical pharmacist's salary and fringe benefits; and the developmental expense of establishing a reference library for the clinical pharmacist.
Effect of Nitrogen Intake on Urea Appearance in Patients Receiving Total Parenteral Nutrition and Hemodialysis
Authors: Mirtallo Jay M. , Fabri Peter J. 
Published: May 2016

Hemodialysis results in significant amino acid and protein losses and increases the patient's need for, and tolerance to, standard doses of protein. Since urea accumulation increases proportionately with increasing doses of protein in patients with normal renal function, urea accumulation may result when protein intake is increased to offset losses occurring in the dialysate. As a consequence, an increased requirement for dialysis may occur that might be poorly tolerated by the critically ill patient. This study was designed to determine the relationship between nitrogen intake and urea appearance in five patients requiring hemodialysis and total parenteral nutrition. Daily caloric and nitrogen intakes were determined. Urea appearance was calculated from measures of urine urea nitrogen excretion and daily body urea accumulation. Results of 108 measurements in treatment courses ranging from 23–79 days found that the average caloric intake (1984 ± 55 calories/d) and nitrogen intake (11.0 ±0.4 g/d) resulted in a positive nitrogen balance (0.8±0.4 g/d) and a urea appearance rate of 9.4±0.8 g/d. Nitrogen intake correlated both with urea appearance (r = 0.59, p<0.001) and nitrogen balance (r = 0.49, p<0.001). Positive nitrogen balance was associated with improvements in measures of total iron binding capacity (p<0.05). Nitrogen intake directly relates to urea appearance, and positive nitrogen balance can be achieved without increasing dialysis requirements. In this group of patients, 28.3 calories per kg ideal body weight and 0.8 g of protein per kg ideal body weight were required to achieve nitrogen equilibrium.
Effect of Ten New β-Lactam Antibiotics on Urine Glucose Test Methods
Authors: LeBel Marc , Paone Robert P. , Lewis George P. 
Published: May 2016

The effect of ten new β-lactam antibiotics (cefoperazone, cefotaxime and its metabolite desacetylcefotaxime, ceftazidime, ceftizoxime, ceftriaxone, aztreonam, azlocillin, mezlocillin, piperacillin, and ticarcillin) on the accuracy of Clinitest, Diastix, and Tes Tape determinations of glycosuria was investigated. Solutions of each of the antibiotics were prepared in urine over a range of clinically obtainable drug concentrations. Urine samples from a healthy subject were used to prepare simulated diabetic urine by adding dextrose to achieve concentrations of 0.5%, 1%, and 2%. With penicillin derivatives, falsely elevated Clinitest readings generally were observed at lower glucose concentrations. When no glucose was present, cephalosporins and the monobactam, aztreonam, gave a dark green-black color that could only be interpreted as 0% on the Clinitest color chart. At higher urine glucose concentrations (1% and 2%), no interaction with Clinitest could be demonstrated, with the exception of a few falsely reduced readings. All urine solutions containing β-lactam antibiotics were estimated accurately by both Diastix and Tes Tape. The unpredictability of the Clinitest-β-lactam antibiotics interaction should discourage the use of this urine glucose test in patients who receive these drugs. The glucose-oxidase tests, Diastix and Tes Tape, may be used as qualitative tests for glycosuria in patients treated with β-lactam antibiotics.