bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial Utilization Pattern in a Hematologic Intensive Care Unit
Authors: Krivoy Norberto , Mattalon Nurith 
Published: September 2013

Background: Recently, a new method for assessing the quality of prescription — The drug utilization 90% index (DU-90%) — Was introduced. The defined daily dose (DDD) concept is an established parameter in pharmacoepidemiologic studies. Objective: To evaluate antibiotic utilization in a specialized hospital unit where the use of antibiotics in immune-compromised patients undergoing intensive chemotherapy or bone marrow transplantation may be one of the main components in the direct cost of therapy of this type of patient. Methods: The antibiotic utilization pattern and accompanying costs were prospectively measured for 48 patients in a hematologic intensive care unit during a 60-day period, accumulating 896 admission days of follow-up. The DU-90% level is arbitrarily chosen as a reasonable cutoff point; it concentrates on the bulk of the prescribed antibiotics. Results: Of 26 antimicrobial agents prescribed, 14 were included in the DU-90%. Amphotericin B was delivered to 100% of the study population, with a total of 57.99 DDD/100 admission days. Ceftriaxone was the antimicrobial least prescribed, with a total of 0.22 DDD/100 admission days. The DU-90% index showed that 53% of the prescribed medications equal 92% of the total antibiotic cost. A discrepancy between the pharmacy's report and the calculated costs based on DDDs was observed. Failure to have a real-time inventory and costs unification, the use of mean instead of median acquisition costs, and failure to use electronic prescription systems are the main elements affecting and disrupting drug utilization studies. This possibly explains, in part, the difference between the two cost reports.
Multiple NSAID Prescriptions in a Medicare Managed Care Population
Authors: Barnum Karl R , Wertheimer Albert I , Morrison Alan , Straus Walter L 
Published: September 2013

Objective: To describe the use of multiple nonsteroidal antiinflammatory drugs (NSAIDs) and the cost implications in a Medicare managed care population. Design: Retrospective analysis of prescription drug database records. Setting: Three Medicare managed care plans in the West and South. Patients: The population consisted of 22,544 patients who filled prescriptions for one or more different nonaspirin NSAIDs during a six-month period beginning March 1, 1998. Main Outcome Measure: Prescriptions for nonaspirin NSAIDs, misoprostol, proton-pump inhibitors, sucralfate, and analgesic drugs. Results: A total of 12.6% of individuals filled prescriptions for two different NSAIDs, and 2.3% filled prescriptions for between three and five different NSAIDs. As the number of NSAIDs increased from one to five, there was a decrease in the generic:brand-name ratio from 4.3:1 to 0.93:1, an increase in the total days' supply from 39 to 310 days (for the 180-d period), an eightfold increase in the coprescription of misoprostol, a twofold increase in coprescription of analgesics, and an increase in payments per person for all NSAIDs and listed coprescribed drugs from $51.67 to $403.00. Conclusions: A small subset of individuals in Medicare health plans fill prescriptions for multiple NSAIDs, concomitant with increased use of brand-name drugs, increased coprescription of misoprostol and analgesics, and increased drug costs. Healthcare providers should scrutinize this population and consider whether alternative therapeutic approaches might be appropriate.
Implementing Protocol-Based Therapy of Continuous Neuromuscular Blockade Provides Cost Minimization
Authors: MacLaren Robert , Toombs L Kent , Plamondon Johanna M , Rocker Graeme M , Patrick Ward D , Hall Richard I 
Published: September 2013

Objective: To compare empiric and protocol-based therapies of neuromuscular blockade in terms of cost and control of paralysis. Methods: Data were prospectively collected for nine months before and five months after a protocol was implemented in the 24-bed medical/surgical/neurologic intensive care unit as a physician-initiated, doublesided medication order form. Pancuronium was the preferred agent and vecuronium was an alternative for patients with renal dysfunction, hepatic dysfunction, or hemodynamic instability. Results: Twenty-nine empiric-therapy patients and 17 protocol-based therapy patients were comparatively evaluated. Length of stay in the intensive care unit and duration of neuromuscular blockade were similar between groups. Protocol adherence rate was 76.5%. Protocol-based therapy increased the hourly dose of pancuronium (0.29 ± 0.37 mg vs. 0.02 ± 0.10 mg; p < 0.005) and reduced the mean hourly cost of neuromuscular blockade compared with empiric therapy ($5.11 ± 4.76 Canadian [CDN] vs. $9.03 ± 7.03 CDN; p < 0.05). Vecuronium use did not change, but rocuronium and atracurium were not given after protocol implementation. The proportion of recorded train-of-four measurements representing adequate neuromuscular blockade increased (52.3% vs. 32.7%; p < 0.05) with protocol-based therapy. Conclusions: Compliance with a neuromuscular blocking protocol reduces drug costs and improves control of neuromuscular blockade.
A Review of Valproic Acid–Induced Carnitine Deficiency and Replacement
Authors: Ahluwalia Navneet S , Bernad Peter G 
Published: September 2013

Objective: To review valproic acid–induced carnitine deficiency and subsequent carnitine replacement. Data Sources: Articles indexed in MEDLINE from 1966 to May 2000, as well as other published works and standard references. Data Extraction: Studies investigating clinical epidemiologic and pathologic evidence of the role of valproic acid–induced carnitine deficiency and double-blind clinical trials evaluating the effectiveness of carnitine replacement with anticonvulsant therapy are presented. Data Synthesis: Clinical epidemiologic and pathologic studies provide evidence of valproic acid–induced carnitine deficiency. There is no clear consensus for providing carnitine supplementation to all patients taking valproic acid — It is only indicated for children with valproic acid–induced hepatotoxicity and those with valproic acid overdose. Conclusions: There is evidence that implicates valproic acid in inducing carnitine deficiency. Patients should be evaluated clinically for signs and symptoms of carnitine deficiency before beginning supplementation. Currently, carnitine supplementation should be reserved for children with valproic acid–induced hepatotoxicity and valproic acid overdose until the results of further clinical studies are available.
Pharmaceutical Calculations — A Basic Review
Authors: Russo Nicole M 
Published: September 2013

Objective: To review mathematical topics used in pharmaceutical preparation, specifically ratios and proportions, percentage concentrations, and stock solutions. Data Source: Online pharmaceutics sources and current pharmaceutics textbooks were consulted. Data Synthesis: Ratios and proportions are basic tools for adjusting drug concentrations. Using proportions, medications can be provided in any concentration desired. By extending this technique to percentage concentrations, prescriptions can be interpreted and calculated. In the same manner, the ability to dilute stock solutions provides patient-specific drug delivery. Conclusions: The mathematical concepts of ratios and proportions, percentage concentrations, and stock dilutions are essential for correct medication administration in any setting.
Acyclovir in the Treatment of Bell's Palsy
Authors: Miller Susan M 
Published: September 2013

Objective: To examine the role of acyclovir in the treatment of Bell's palsy. Data Sources: A search was performed using MEDLINE (1966–September 2002) and the Cochrane Database of Systematic Reviews with the search terms acyclovir, antiviral, idiopathic facial paralysis, Bell's palsy, herpes simplex virus, and corticosteroids. Data Synthesis: Treatment of Bell's palsy is controversial. Recent research has indicated that herpes simplex virus type 1 may be the likely causative agent. Clinical trials and review articles focusing on the use of acyclovir in the treatment of Bell's palsy were reviewed and evaluated. Conclusions: More solid evidence is necessary to validate whether herpes simplex virus type 1 causes Bell's palsy. Limited published clinical studies exist that have used acyclovir for the treatment of Bell's palsy. The results of available trials are contradictory. The American Academy of Neurology's practice parameter states that acyclovir, in combination with steroids, is safe and possibly effective for Bell's palsy treatment. Further information is needed from larger prospective, randomized, placebo-controlled trials to clarify the ultimate therapeutic role of acyclovir for Bell's palsy.
Treatment of Very High Triglycerides with Fish Oils: A Review of 2 Cases
Authors: Caron Michael F , Nguyen Isabelle T , Folstad Jon E 
Published: September 2013

Objective: To report 2 cases of serum triglycerides >1000 mg/dL (i.e., very high serum triglycerides) in which fish oil was used because of treatment failure or intolerance with conventional therapeutic modalities. Case Summary: Two individuals with a history of serum triglycerides >1000 mg/dL were referred to a pharmacist-managed lipid clinic by their primary-care provider because of either treatment failure or intolerance to conventional therapeutic modalities. Fish oils were used in lieu of and in addition to conventional treatment modalities in cases 1 and 2, respectively. Both cases demonstrated that fish oil, at doses ranging from 1 to 6 g/d, decrease triglyceride levels to a degree similar to conventional measures. Both patients tolerated fish oil well; however, increases in liver transaminases were observed. Discussion: Published studies have shown that fish oil can reduce elevated plasma triglycerides by an average of 30–52% in subjects with borderline-high (150–199 mg/dL) to high (200–499 mg/dL) triglycerides. Both of our cases reflect similar results in patients with very high triglycerides. Although fish oil has not been reported to induce hepatotoxicity, both of our patients experienced an increase in transaminases while on fish oil therapy. Whether fish oil truly causes hepatic injury remains to be elucidated. Conclusions: Fish oil supplementation is effective and generally well tolerated in patients with very high triglycerides and can be used as either alternative or adjunctive therapy when conventional treatment modalities become ineffective or intolerable.
Evaluation of Anticoagulation Therapy in an Academic Nursing Home
Authors: Karki Shyam D , Lander Susan M 
Published: September 2013

Objective: To evaluate the warfarin management patterns in an academic nursing home and evaluate what predetermined factors are associated with variability in the international normalized ratio (INR). Setting: A 566-bed academic nursing home. Methods: A retrospective chart review of all residents receiving warfarin therapy for >3 consecutive months in a calendar year was conducted. Data were collected regarding the number of times the INR fluctuated during the follow-up period and the degree of fluctuation between each blood sampling. An INR that changed by 0.5–0.99 between samplings was classified as a small fluctuation; a change >0.99 was defined as a large fluctuation. The sample was divided into 2 groups, easy management and difficult management, based on variability in the INR. The easy-management group consisted of residents who had small fluctuations in the INR and who had INRs outside of the therapeutic range ≤10% of the time. The difficult- management group had large fluctuations in the INR, with the ratio outside of the therapeutic range >10% of the time. Results: Thirty-seven patients were taking warfarin (mean ± SD age 71 ± 14 y; mean number of medical illnesses 7.6 ± 3). The mean length of time of warfarin therapy was 10.6 ± 3.2 months. The average dose and INR were 4.0 ± 1.9 mg and 2.0 ± 0.3, respectively. No statistically significant differences were found between age, dose, or INR. For patients who had INR values exceeding the therapeutic range, there was no significant difference between the management groups in length of treatment, age, number of medical illnesses, number of high-risk factors, dose, average monthly INR, number of medication adjustments per year, albumin and creatinine levels, total number of medications, or number of routine medications known to interact with warfarin. The difficult-management group received more medications known to interact with warfarin than the easy-management group. These medications may have caused the INR to increase above the normal range (p = 0.003), as well as producing a large (p = 0.001) or small fluctuation (p = 0.0007) in the INR. Of all the interacting medications, 55% were antibiotics and 28% were analgesics. No statistically significant differences in outcome were seen between groups. Conclusions: Results of this study indicate that large variations (>0.99) in the INR may be due to newly prescribed medications that enhance the anticoagulant effect of warfarin. These variations may be minimized by closely monitoring the INR when a drug known to interact with warfarin is prescribed.
Bioequivalence of Carpine Tablets Containing Carbamazepine
Authors: Hassan Yahaya , Tan Yvonne T , Peh Kok-Khiang , Aziz Noorizan Abd , Rahman Ab Fatah Ab , Mohamed Nornisah , Ismail Omar 
Published: September 2013

Objective: To develop a suitable assay method for carbamazepine and to use this method in the evaluation of a Malaysian-made generic tablet and a commercially available tablet containing carbamazepine for bioequivalence after a single-dose, randomized, 2-period, 2-treatment, 2-sequence crossover study. Method: Eighteen healthy men participated in the bioequivalence study. Each treatment was given as a single 2 × 200-mg dose. Plasma concentrations of carbamazepine were collected for up to 168 hours and assayed using HPLC. Results: The test to reference ratios were found to be 1.05 for maximum concentration (Cmax), 1.02 for AUC(0-t), 0.96 for AUC(t-∞), 1.01 for AUC(0-∞), and 0.99 for elimination half-life. The 90% confidence intervals of the AUC and Cmax parameters were within the range of 0.80–1.25. Wilcoxon signed-rank test for paired samples showed no statistically significant difference between the tmax results. Conclusions: All of the parameters evaluated showed bioequivalence between the 2 formulations.
Moxifloxacin-Induced Seizures in an Epileptic Patient
Authors: Unzurrunzaga Ainhoa , Ruiz Javier , Garcia Monserrat , Aguirre Carmelo , Garcia-Monco Juan C 
Published: September 2013

Objective: To report a patient with seizures probably related to the use of moxifloxacin, a fourth-generation quinolone. Case Summary: A 79-year-old white man developed status epilepticus after a 4-day course of moxifloxacin for respiratory infection. He had experienced seizures 2 years before presentation. The patient was currently receiving warfarin, theophylline 400 mg/d, albuterol; furosemide, potassium, and digoxin; and omeprazole for chronic obstructive pulmonary disease, atrial fibrillation with mild heart failure, and heartburn, respectively. He also had moderate renal failure. Despite aggressive therapy, the patient developed progressive respiratory insufficiency and died. Discussion: Quinolone use is associated with a variety of central nervous system (CNS) adverse effects in approximately 1–2% of patients. In fact, CNS adverse effects represent the second most frequently encountered form of quinolone toxicity after gastrointestinal involvement. Occasionally, quinolones induce seizures, but, as of October 17, 2003, none have been reported in the literature. Use of the Naranjo probability scale indicated a probable relationship between seizures and moxifloxacin administration in this patient. Seizures may be mediated by CNS stimulation secondary to quinolone binding to γ-aminobutyric acid receptors. Coexisting medical conditions and concurrent medications also facilitate seizure appearance. Risk factors include seizure history, hypokalemia, alkalosis, renal failure, and concomitant treatment with agents that lower the seizure threshold. These factors were not present in this patient except for a prior history of seizures and mild renal failure. Conclusions: Seizures with quinolones, albeit rare, need to be considered in certain populations, particularly patients who have had prior seizures, the elderly, patients with renal dysfunction, and patients on multiple medications.
Paralytic Ileus Possibly Associated with Nebulized Ipratropium Bromide
Authors: Poquet-Jornet Jaime E , Hosta-Mateu Victor , Misis-Del-Campo Maite 
Published: September 2013

Objective: To report a case of paralytic ileus possibly associated with nebulized ipratropium bromide. Case Summary: A 43-year-old man fell from a wall and was admitted to the intensive care unit (ICU) for the resulting thoracic trauma. An epidural thoracic catheter was placed for pain control using bupivacaine 0.25% and methadone 0.2 mg/mL. On hospital day 4, he developed purulent bronchiole constriction, and treatment with nebulized mesna and ipratropium bromide was started. Six hours after the first nebulization, the patient developed abdominal pain and bowel distension. An abdominal X-ray showed intestinal gas retention and dilated loops of large bowel. Paralytic ileus was diagnosed. Nebulized ipratropium bromide treatment was stopped and, during the following 24 hours, the patient gradually improved. Discussion: Nebulized ipratropium bromide–induced paralytic ileus is an uncommon adverse event that may be of considerable clinical relevance. Nebulized ipratropium bromide is predominantly deposited in the oropharynx, but some amount of the drug may be swallowed with resultant systemic adverse effects. Ipratropium bromide is a nonselective muscarinic antagonist and may inhibit contraction of the gastrointestinal tract. Paralytic ileus could not be attributed to an electrolyte disturbance or abdominal injury. The patient's paralytic ileus resolved when nebulized ipratropium bromide was stopped. An objective causality assessment showed that the paralytic ileus was possibly associated with this drug. Conclusions: This case report indicates that ipratropium bromide should be considered capable of inducing paralytic ileus.
Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part II
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 cardiology and general medications during breast-feeding. Data Sources: Primary texts used by the breast-feeding community ( Medications and Mothers' Milk, Drugs in Pregnancy and Lactation, Drugs and Human Lactation) were searched, as well as Micromedex, MEDLINE, PubMed, EMBASE, and EMBASE2 (1984–February 2004). Study Selection/Data Extraction: Multiple sources were used wherever 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 drugs 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, healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
Defining “Pharmacy Technician”
Authors: Wilson Debbie L 
Published: September 2013

Background: Legal definitions of “pharmacy technician” vary by state. Also, many pharmacy organizations have definitions of “pharmacy technician.” There is no consensus on the definition. Objective: To explore the legal definitions of a pharmacy technician and use of the term “professional judgment” in those definitions and develop an empirically and theoretically based definition of a pharmacy technician. Methods: Definitions of a pharmacy technician from the state statutes and regulations were found using LexisNexis State Capital and entered into an N-4 Classic database. The database was then coded through an iterative process of content analysis. A definition was developed using the content analysis and literature-based theory. Results: Definitions were found for 42 states (84%). Five main concepts were found to exist in the definitions: credentialing, designation, functions, practice site, and supervision. An empiric and theoretically based definition of a pharmacy technician was developed. Conclusions: Statutory and regulatory definitions of a pharmacy technician tend to define technicians in terms that preserve the dispensing role for pharmacists. Definitions of a pharmacy technician should focus on the types of services pharmacy technicians provide and the types of credentials they must have, rather than what they may not do and who they are not. The use of the term “professional judgment” in defining a pharmacy technician lacks precision and is therefore not helpful in defining “pharmacy technician.”
Topiramate Effective in the Treatment of Intractable Glossodynia
Authors: Lampl Yair , Gilad Ronit 
Published: September 2013

Objective: To report effective treatment with topiramate in 2 cases of glossodynia (burning tongue and mouth syndrome). Case Summaries: Two women, 52 and 53 years old, suffered from intractable unilateral burning mouth syndrome. In both cases, the activities of daily living were severely restricted. Previous treatment with diverse medications had failed. Administration of topiramate 200–350 mg/day stopped the attacks completely in one patient and reduced the frequency by 50–60% in the second. Discussion: Glossodynia may present as unilateral intractable pain syndrome with characteristics of neuralgic pain. It is defined as a burning pain in the tongue and mucous membranes of the mouth. There is some research on possible effective medications for treatment, but few data on the beneficial effects of this therapy have been reported. Topiramate has been previously shown to have an antineuralgic effect in trigeminal neuralgia. In the cases of intractable glossodynia presented here, this medication led to significant improvement in the symptoms of this uncommon neuralgic pain. Conclusions: Topiramate has a beneficial effect in intractable burning mouth and tongue syndrome. Taking these positive results into consideration, the practitioner can give hope to disabled patients for returning to acceptable activities of daily living.