bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part I
Authors: Nice Frank J , DeEugenio Deborah , DiMino Traci A , Freeny Ingrid C , Rovnack Marissa B , Gromelski Joseph S 
Published: September 2013

Objective: To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of common ambulatory care, analgesic, and anesthetic medications during breast-feeding. Data Sources: Primary texts used by the breast-feeding community were searched, as well as Micromedex, MEDLINE, PubMed, Embase, and Embase2 (1984–July 2003). Study Selection and Data Extraction: Multiple sources were utilized whenever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast feeding, lactation, nursing, and medications, as well as specific drug names. Data Synthesis: Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are medications that can be harmful to nursing infants, breast milk concentrations of most drugs are insufficient to cause any harm. Conclusions: Having objective and reliable information on medications enables pharmacists, pharmacy technicians, other healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
The North Dakota Telepharmacy Project: Restoring and Retaining Pharmacy Services in Rural Communities
Authors: Peterson Charles D , Anderson Howard C 
Published: September 2013

Objective: To provide a detailed description of the North Dakota Telepharmacy Project including its overall purpose, goals, and how it works, and provide valuable information and guidelines for pharmacists and rural communities on how to successfully implement a telepharmacy program designed to serve small rural communities that have lost their pharmacy services, are about to lose their pharmacy services, or have had no pharmacy services. Discussion: Ten rural communities in western, northern, and central frontier counties of North Dakota including 4 central pharmacy hub sites serving 6 remote rural telepharmacy spoke sites are described. Through use of audio, video, and computer links, North Dakota has developed a successful statewide telepharmacy program to restore and retain pharmacy services to rural communities that have lost, are about to lose, or have no pharmacy services. North Dakota currently has full-service telepharmacy sites established in the communities of Beach, New England, Maddock, Rolette, and New Town. These remote telepharmacy sites are served by licensed pharmacists in central pharmacies located in Killdeer, Rugby, and Watford City. The distance from the central pharmacy site to the remote telepharmacy site ranges from 31 to 95 miles (average ∼57). The size of the remote telepharmacies ranges from 1,200 to 2,500 square feet (average ∼1,660). The remote telepharmacies are staffed by 2–3 personnel (1 pharmacy technician, 1–2 store clerks). The remote telepharmacy sites dispense 15–55 prescriptions per day (average ∼35). Hours of service of the remote telepharmacy sites are generally 9:00 am to 5:00 pm, Monday through Friday. The remote telepharmacy communities have populations ranging from 498 to 1,367 people (average ∼799). The remote communities have a medical clinic staffed 5 days a week by either a physician, physician's assistant, or nurse practitioner. Conclusions: Through use of telepharmacy technology, pharmacy services can be restored and retained in remote rural communities satisfying all rules and regulations of the state board of pharmacy using the same processes and procedures as traditional pharmacy practice including pharmacist drug utilization review, verification before dispensing, and patient counseling. Telepharmacy services produce the same quality of pharmacy services as the traditional mode of delivery and provide additional value-added features that are not found with traditional pharmacy practice.
Subdural Hematoma Due to Probable Warfarin–Fluorouracil Interaction
Authors: Giunta Giovanni , Velluti Francesca 
Published: September 2013

Objective: To describe the occurrence of a subdural hematoma in a woman undergoing chemotherapy with cyclophosphamide, methotrexate, and fluorouracil combined with warfarin therapy. Case Summary: A 60-year-old white woman with atrial fibrillation underwent radical mastectomy for primary breast cancer with histologically positive axillary lymph nodes. Following surgery, the patient received adjuvant chemotherapy with a CMF 1–8 regimen consisting of cyclophosphamide 100 mg/m2 orally on days 1–14, methotrexate 40 mg/m2 intravenously, and fluorouracil 600 mg/m2 by intravenous bolus on days 1 and 8 every 4 weeks. Warfarin 5 mg/day was administered concomitantly due to atrial fibrillation. Following the second course of concomitant therapy, the patient developed a headache, hemiparesis, and an international normalized ratio (INR) of 7.6, which was highly suggestive of a drug interaction between fluorouracil and warfarin. A computed tomography scan of the brain revealed a left parieto-occipital subdural hematoma. Discussion: This case emphasizes the importance of the potentially fatal drug interaction involving warfarin and fluorouracil. Conclusions: Several adverse interactions between warfarin and fluorouracil have been reported. Considering the severity of this interaction, close monitoring of the INR is recommended in patients receiving these agents concomitantly.
Blood Pressure Elevation with Rofecoxib in Older Adults
Authors: Eng Marty L , Rojas-Fernandez Carlos H 
Published: September 2013

Objective: To report blood pressure elevation associated with rofecoxib use in 2 older adults. Case Summaries: Two patients, aged 75 and 94 years, were prescribed rofecoxib for osteoarthritis pain. After the initiation of therapy, an elevation in systolic blood pressure measurement ≥17 mm Hg was observed. Upon withdrawal of rofecoxib, blood pressure in one patient returned to baseline measurements. In the second patient, sustained rofecoxib use resulted in blood pressure elevation and change in antihypertensive therapy. Discussion: It is well known that even a small elevation in blood pressure can significantly increase a person's risk for cardiovascular events. However, little is known about the potential magnitude of blood pressure elevation with the use of cyclooxygenase-2 inhibitors in the older adult population. In 2 older adults with osteoarthritis and hypertension, rofecoxib potentially led to a substantial elevation in blood pressure. In each case, adjustments of respective therapeutic regimens were made. The Naranjo probability scale indicates a probable relationship in both cases between the rofecoxib and blood pressure elevation. Conclusions: These reports suggest that rofecoxib could produce greater elevation in blood pressure in older hypertensive adults than has been previously reported. Therefore, close monitoring of blood pressure for 1–2 months after initiation of rofecoxib therapy is advisable. Further study is needed to determine the true clinical significance of these findings in older hypertensive adults.
Appearance of Retinal Hemorrhages in Patients on Daily-Dose Anti-Tubercular Therapy
Authors: Sodhi Punita K , Sachdev Mahipal S , Verma Lalit K , Ratan Simmi K 
Published: September 2013

Objective: To report 2 patients who presented with retinal hemorrhages while being treated with a continuous regimen of anti-tuberculous drugs. Case Summaries: Two women, one suffering from tuberculous infection of the lungs and the other from disseminated Koch's, were treated with a daily regimen of anti-tuberculous therapy consisting of rifampin, isoniazid, pyrazinamide, and ethambutol. On initiation of treatment, these patients did not have any systemic or ocular disease, and hematologic investigations, kidney function tests, and liver function tests were normal. Within 2 weeks of initiation of anti-tuberculous therapy, both women had transient renal function deterioration. Additionally, each had a single episode of retinal hemorrhage. While the patients remained under treatment with the same drugs, both of these adverse effects resolved spontaneously within a short period. According to the Naranjo probability scale, this reaction was probable. Discussion: The renal dysfunction and retinal hemorrhages in both of our patients were most probably due to anti-tuberculous drug-induced antibodies. A continuous mode of anti-tuberculous drug administration causes immunologic tolerance due to simultaneous neutralization of drug-induced antibodies. As the antibodies were short-lived, renal impairment, thrombocytopenia, and retinal hemorrhages in both of our patients were transient. Conclusions: The continuous regimen of anti-tuberculous drug administration is safer than intermittent therapy. In patients receiving treatment with these drugs, hepatic, hematologic, renal, and ocular parameters should be regularly monitored.
FDA Adverse Event Reports on Use of Sibutramine: An Exploratory Analysis
Authors: Stavchansky Marcus M , Wilson James P 
Published: September 2013

Objective: To report the adverse events associated with sibutramine per the Adverse Event Reporting System (AERS) database. Methods: A retrospective database analysis of all domestic and foreign reports of adverse events associated with sibutramine use from September 1997 to March 2002 was conducted. Outcome measures included the total numbers of reports (initial plus follow-up), the mean age of the uniquely identified cases or patients, the number of cases reported as a serious adverse event, the length of therapy prior to serious adverse event, and the mean dose for all outcomes reported. Results: There were 4,898 unique reports of adverse events associated with sibutramine use representing 4,749 patients between September 1997 and March 2002 in the AERS database. Of those unique reports, there were 12,081 different adverse events associated with sibutramine use during the 56-month period. The mean ± SD age was 44.39 y ± 12.56 years, while the majority of patients were female (4,153, 87.4%). Uniquely reported outcomes totaled 740 cases, 389 (52.6%) of which were termed serious as a result of the adverse event. Death was listed in 43 (7.8%) reports as the outcome. Twenty-two of those deaths were reported as due to myocardial infarction or cardiac arrest. Many of the adverse event reports were submitted by healthcare professionals (614, 8%), with the majority of reports being periodic (90%). Sibutramine was listed as the primary suspect of the adverse event in 4,433 (83.6%) cases. The average dose of sibutramine was 15 mg, while the median length of therapy was 30 days. Conclusions: Although valuable information comes from the AERS database, with so many other variables (risk factors, comorbid conditions, reporting bias, multiple medications) along with the number of persons taking sibutramine (>8 million worldwide), establishing a relationship between sibutramine consumption resulting in various adverse events is difficult. Because of the various limitations of the AERS database, caution must be taken when interpreting the cases reported to the database.
Mydriasis, Hypertension, and Tachycardia Possibly Associated with Venlafaxine Augmentation of Mirtazapine
Authors: Zullino Daniele F , Cucchia Gianni 
Published: September 2013

Objective: To report a case of mydriasis and hypertension resulting from concomitant use of mirtazapine and venlafaxine. Case Summary: A 36-year-old man had been treated for 7 weeks with mirtazapine up to 60 mg/day without satisfactory therapeutic effects. Venlafaxine extended-release up to 150 mg/day was added with the aim to boost the antidepressant effect. After 5 days of venlafaxine treatment, the patient developed apparent mydriasis, and after 9 days of therapy, the patient's blood pressure peaked at 200/120 mm Hg. While he remained under mirtazapine therapy, both symptoms resolved within 24 hours after venlafaxine discontinuation. Discussion: A rise in blood pressure is a well-known phenomenon with venlafaxine. As of September 27, 2004, this is the first case of hypertension after venlafaxine augmentation of mirtazapine and the first case to report a preceding mydriasis. We propose an excess of noradrenergic activity due to the combination of venlafaxine and mirtazapine to be the most probable cause. Conclusions: Whereas the mirtazapine/venlafaxine combination seems a promising approach in the treatment of refractory depression, this strategy may be associated with adverse drug events not observed with either of the drugs when given alone. Mydriasis may be a good premonitory sign for hypertension.
Peanut Allergy Treatment: Past, Present, and Future
Authors: Keller Tracey A , Amsden Guy W 
Published: September 2013

Objective: To review the current and future treatments for peanut allergy. Data Sources: Literature review was conducted via MEDLINE (1996–October 2003) using OVID and PubMed. The following terms were used: food allergy, peanut allergy, anti-IgE, antihistamine, anaphylaxis, and epinephrine. Data Synthesis: Peanut allergy is an immunoglobulin (Ig) E–mediated type I reaction, which is the leading cause of fatal and near-fatal food allergy. Proper diagnosis and treatment plans for patients with peanut allergy are essential. Many patients who have a known life-threatening allergy are far too often unprepared. New treatments aimed at reduction or prevention of anaphylactic reactions are in development. Conclusions: Education on the understanding of how to avoid peanut proteins and how to identify signs and symptoms of food allergy is the number one tool in treatment of peanut allergy. The second tool is an easily accessible physician-ordered treatment plan, which includes signs and symptoms of anaphylaxis, proper medications with dosing and administration instructions, and contact numbers. Medications must be available at all times.
Recently Approved Medicare Provisions for Prescription Drugs and Medication Management Services
Authors: Powers Mary F 
Published: September 2013

Objective: To review recent changes in Medicare affecting the practice of pharmacy. Data Sources: Articles were identified through searches of MEDLINE (2003–March 2004), LEXISNEXIS ACADEMIC (2003–March 2004), and LEXISNEXIS CONGRESSIONAL databases (2003–March 2004), using the key words Medicare, pharmacist, pharmacy, and drug costs. Additional references were located through review of the bibliographies of the articles cited and through searches of the Web sites for Medicare, Social Security, and the American Pharmacists Association. Study Selection and Data Extraction: Reports about Medicare and Medicare Part D were selected. Articles describing the history of Medicare and changes that impact pharmacy were included. Data Synthesis: The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MPDIMA) provides an optional prescription drug benefit for Medicare beneficiaries in 2006 as Medicare Part D. Before its full implementation, eligible Medicare beneficiaries may qualify for a temporary Medicare-approved Drug Discount Card. The prescription drug benefits will be administered by private entities. Other provisions of the MPDIMA affect pharmacy, including a provision for medication therapy management services to ensure that the covered Part D drugs are appropriately used. This will be the first time that Medicare provides for payment of pharmacist-administered patient care services. Conclusions: Recent changes in Medicare provide Medicare beneficiaries with optional coverage for prescription drugs. Full implementation of the Medicare prescription drug benefit will occur in 2006, with an interim Drug Discount Card available through December 2005.
Azithromycin Extravasation in a Pediatric Patient
Authors: Hey Diana M , Koontz Susannah E 
Published: September 2013

Objective: To report a case of azithromycin infiltration and extravasation in a pediatric patient. Case Summary: A 12-month-old African American male, between chemotherapy cycles for acute myelogenous leukemia, self-dislodged his central venous catheter. A peripheral catheter was placed in the right dorsal hand and, 2 days later, azithromycin for injection infiltrated at the infusion site. Several bullae formed in the first web space and a few areas of epidermolysis, each <2 cm wide, later appeared on the forearm. Treatment included warm compresses, adaptee dressing, topical antibiotics, splint placement, and arm elevation. Four months after the incident, there was no visible impairment or restriction to the toddler's use of the right hand or arm. The only residual finding was an area of hypopigmented skin in the dorsal web between the first and second fingers. Discussion: As of February 10, 2005, this is the first case published in the English-language literature describing intravenous azithromycin infiltration and extravasation. Infiltration occurs generally by 3 mechanisms. These include the catheter dislodging or causing a hole in the vessel wall, intravenous fluid irritating the vessel wall leading it to rupture or leak, or backflow of intravenous fluid through the catheter insertion site. Conclusions: Complications can occur secondary to intravascular therapy, including extravascular extravasation. In this case, infiltration and extravasation injury were probably related to azithromycin. Immediate detection and treatment are critical to decrease morbidity associated with infiltration events.
Atorvastatin: An Update of Recent Clinical Trial Experience
Authors: Mendys Philip M , Simpson Ross J 
Published: September 2013

Objective: To demonstrate how evaluative studies of atorvastatin have progressed from surrogate markers to more complex head-to-head clinical experiments. Data Sources: A search of MEDLINE was conducted (1994–April 2004), and an extensive manual review of journals was performed using the key search terms atorvastatin, coronary heart disease, and lipid-lowering therapy. Study Selection and Data Extraction: All articles identified from the data sources were evaluated. Studies were selected to track both sponsor-supported and non–sponsor-funded experiments designed to evaluate atorvastatin. Data Synthesis: Originally introduced in 1997, atorvastatin was considered to be a potent addition to the hydroxymethylglutaryl coenzyme A reductase inhibitors (statins). Atorvastatin significantly reduces low-density lipoprotein cholesterol and triglyceride levels with a starting dose of 10 mg/day. Broad acceptance and utilization of the statin class was still evolving at that time. Pfizer/W-L directed a comprehensive clinical trial program. Currently, there are >400 ongoing and completed clinical experiments with <80,000 patients involved. Along with an extensive safety record, atorvastatin will likely continue to change the way in which statin therapy is applied in various clinical settings. Conclusions: The experimental and clinical trial data with atorvastatin demonstrate a broad database supporting how atorvastatin impacts cardiovascular risk. As studies within the atorvastatin clinical program continue, we will undoubtedly gain additional insight on how patients can benefit from statin therapy.
Allergic Cross-Sensitivity between Penicillin and Carbapenem Antibiotics
Authors: Greanya Erica D , Chua Doson 
Published: September 2013

Objective: To review the literature evaluating the cross-hypersensitivity between carbapenem and penicillin antibiotics. Data Sources: Primary literature was accessed through MEDLINE (1980–June 2004), EMBASE (1980–December 2004), International Pharmaceutical Abstracts, PubMed, and references of reviewed articles. Key search terms were carbapenem, imipenem, meropenem, ertapenem, drug hypersensitivity, and penicillin allergy. Study Selection and Data Extraction: All articles describing clinical studies involving the use of carbapenem antibiotics in patients allergic to penicillin were reviewed. Data Synthesis: Four studies assessed carbapenem hypersensitivity in penicillin-allergic patients. Original estimates deemed the cross-reactivity to be 50% based on skin testing in a small number of patients; however, 3 more recent retrospective analyses indicate the overall incidence to be approximately 10%. The retrospective nature and presence of confounding factors in the more recent studies make it difficult to apply the lower estimates of carbapenem cross-sensitivity to a general patient population. The majority of cross-reactivity reactions reported was the development of a rash or hives. Conclusions: With minimal data available, the incidence of allergic reaction to carbapenem antibiotics in patients with self-reported penicillin allergy is likely less than the original skin test–determined estimates of 50%. However, caution should be used in patients with previously reported anaphylactic reactions to penicillin. A detailed allergy history is important in determining the clinical consequences of the potential cross-reactivity of carbapenem antibiotics in penicillin-allergic patients.
Thrombosis Secondary to Medroxyprogesterone in Patient at Risk for Thromboembolism
Authors: Ward Michael C , King Devin A , Link Mirranda , Gloria Rodel R , Taylor James R , Weitzel Kristin Wiisanen 
Published: September 2013

Objective: To report a case in which a young woman receiving medroxyprogesterone acetate injections developed deep vein thrombosis (DVT) after prolonged travel. Case Summary: An obese 27-year-old African American woman who had been receiving medroxyprogesterone acetate injections 150 mg intramuscularly every 3 months for 6 years experienced DVT after a 56-hour car ride. The patient's known risk factors for DVT included immobility, obesity (140 kg), and medroxyprogesterone acetate therapy. Family and personal history for thrombotic events were denied. Tests were performed after detection of the DVT to assess the patient for anticoagulation defects; results revealed an unidentified underlying protein S deficiency. All other test results were within normal limits. Discussion: Based on the Naranjo probability scale, it is possible that the DVT experienced by our patient was due to medroxyprogesterone acetate. Although she did have other risk factors for DVT, her underlying protein S deficiency was diagnosed after the thrombosis. Literature describing the relationship between the injectable form of contraception and thrombosis is limited. Therefore, this report reviews protein S deficiency, the relationship between oral contraceptives (OCs) and thrombosis, the influence of immobility on thrombosis development, and the clinical implications of evaluating patients for underlying inherited clotting abnormalities before initiating OCs. Conclusions: When considering whether to prescribe contraceptives, clinicians should assess the patient's risk factors for thrombosis, such as family or personal history. Although generally not recommended, prescreening tests may be considered if there is a positive family or personal history.