bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Medical Technician/Paramedic's Role in Prehospital Drug Delivery
Authors: Pearson Richard M 
Published: September 2013

Objective: To describe the role of the medical technician/paramedic and review 2 types of drug storage: the emergency department and prehospital emergency medical services (EMS). Data Sources: Information was obtained from personal experience, personal communication with hospitals, prehospital healthcare providers, pharmacy technicians, and pharmacists. Searches of the Internet were conducted for sites reviewing traditional drug storage systems, as well as those utilized specifically for prehospital EMS. Key words used were advanced cardiac life support, crash cart, drug security, drug storage, emergency department, and emergency medical services. Study Selection and Data Extraction: All articles identified from the data sources were evaluated and all information deemed relevant was included for this review. Data Synthesis: Emergency departments traditionally utilize crash carts for their ease of maneuverability over tiled floors and massive storage capabilities. Prehospital EMS are unable to use crash carts for drug storage and transport. Smaller, more compact types of securable and transportable drug storage units are required for prehospital EMS. Conclusions: The concept of bringing the emergency department to the injured is still a relatively young science. With time and experience come innovations that tailor themselves to the needed specialties. The drug box used by the emergency medical technicians/paramedics bridges that gap between the emergency department and the street.
Aripiprazole: An Antipsychotic with a Novel Mechanism of Action
Authors: Lemieux Amy A , Goldman-Levine Jennifer D , Goren Jessica L 
Published: September 2013

Objective: To evaluate aripiprazole in the treatment of schizophrenia, including a comparison of available agents, pharmacology, pharmacokinetics, assessment of clinical trials, and adverse effects. Data Sources: A MEDLINE search (1962–March 2003) was conducted for primary and secondary sources. Search terms included OPC-14597, aripiprazole, typical antipsychotics, atypical antipsychotics, and schizophrenia. The Review and Evaluation of Clinical Data from NDA 21-436 was accessed from the FDA Web site. Study Selection: All articles retrieved were evaluated, and the most appropriate studies were selected. Relevant poster presentations were included. Data Synthesis: Aripiprazole is a potent partial agonist/antagonist at the dopamine D2 receptor, as well as a partial agonist at the serotonin 5-HT1A receptor and an antagonist at the 5-HT2A receptor. Clinical trials were assessed for information on dosing, side effects, and adverse drug reactions. Conclusions: Aripiprazole appears to be superior to placebo for the treatment of schizophrenia, with a favorable adverse effect profile.
Panic Attack Associated with Imatinib Mesylate?
Authors: Malhotra Pankaj , Gupta Nitin , Varma Subhash C 
Published: September 2013

Objective: To report a case of panic attacks in an individual on imatinib mesylate. Case Summary: A 34-year woman developed panic attacks a few days after starting imatinib. Investigations were negative, and the panic episodes were attributed to imatinib and possible interaction with paroxetine. Discussion: As of January 1, 2004, this is probably the first case reporting such an adverse event with imatinib. This adverse reaction was rated as possible based on a probability scale. It could have occurred due to a pharmacokinetic interaction between imatinib and paroxetine. Other possible hypotheses are discussed. Conclusions: Imatinib may be associated with panic attacks as a rare adverse event in predisposed individuals. Recognition of this phenomenon can be important in preventing or treating anxiety problems in patients taking imatinib.
Hypertension Associated with Citalopram
Authors: Saǧduyu Afşin , Şentürk Vesile 
Published: September 2013

Objective: To report a case of hypertension resulting from the therapeutic use of citalopram and review previous reports in the literature. Case Summary: An 87-year-old white woman who had taken a single dose of citalopram 20 mg presented to the hospital on the same day with hypertension (BP 200/100 mm Hg) following a presyncopal episode and headache. Citalopram was discontinued; the hypertension resolved in 24 hours and remained stable for 8 days. She had multiple systemic illnesses, including hypertension; however, they were under control, and no electrocardiogram abnormality shown at this time was different from previous recordings. No other medical or pharmacologic cause was found for the adverse reaction. Discussion: The manufacturer reports hypotension and bradycardia as being infrequent adverse effects of citalopram. To our knowledge, there have been no previous reports of hypertension after the first dose of citalopram. Multiple physical illnesses and drugs used may have interfered with findings obtained in this case. However, an acute increase in blood pressure after the first dose, which had been within normal levels with antihypertensive treatment for 4 years, as well as the low drug interaction profile of citalopram suggest that this adverse drug reaction was probable according to the Naranjo probability scale. Conclusions: Future research should address the cardiovascular and autonomic effects of selective serotonin reuptake inhibitors, including citalopram, in the older population and in persons with any known heart disease. Citalopram should be used with care in elderly patients unless more data are obtained from well-designed studies.
Health Information Web Sites by Therapeutic Category for Healthcare Professionals
Authors: Motl Susannah E , Timpe Erin M , Robinson Melanie , Corsberg Christine , Phillips Keri 
Published: September 2013

Objective: To compile and evaluate health information Web sites to aid healthcare professionals in locating information on select therapeutic categories. Data Sources: Therapeutic categories were chosen based on questions that pharmacists may receive in the community and institutional setting for which they might lack adequate resources to answer. Categories included adverse drug reactions, alternative medicine, cardiology, drug dosing in renal failure, drug interactions, foreign drug identification, geriatrics, immunology/vaccines, intravenous stability/compatibility, investigational drugs, oncology, pediatrics, pregnancy/lactation, legal and regulatory, monographs/medication usage evaluations, new drug approvals, shortages, tablet/capsule identification, therapy/therapeutics, and toxicology/poisoning. Web sites were chosen by searching www.google.com , as this search engine currently indexes over 3 billion Web pages. Data Synthesis: Resulting Web sites were reviewed, selected, and evaluated using published criteria to assess the quality of each Web site, focusing on the authorship, disclosure, currency, and content. Conclusions: The top Web sites in each category are presented, with details on their quality rating, sponsor, content, and special features or directions.
Therapeutic Options in the Treatment of Clozapine-Induced Adverse Effects
Authors: Iqbal Mohammad Masud , Aneja Alka , Rahman Atiq , Megna James L , Yasmin Laila , Schwartz Thomas L , Osmany Saabry , Alam Mohammed Adnan 
Published: September 2013

Objective: To review the therapeutic options in the management of clozapine-induced adverse effects. Data Sources: A MEDLINE search (from 1966 to present) was conducted, and English-language studies and review articles were retrieved to review the adverse effects of clozapine and their management. Study Selection and Data Extraction: All studies evaluating clozapine's adverse effects, such as agranulocytosis, seizures, neuroleptic malignant syndrome, hypersalivation, weight gain, sedation, fatigue, orthostatic hypotension, eosinophilia, delirium, new-onset diabetes, constipation, nausea, tachycardia, myocarditis, and pancreatitis, and their management were included. Data Synthesis: Clozapine, an atypical antipsychotic that has been proven effective and comparable, as well as superior, to conventional antipsychotics in treatment-resistant schizophrenia, is also being used in the treatment of a wide variety of other psychiatric conditions, including suicidal ideation, tardive dyskinesia, and affective disorders such as depression, bipolar disorders, and schizoaffective disorder. Although clozapine exhibits a markedly low incidence of extrapyramidal symptoms compared with similar medications, it has other adverse effects, some of which are potentially life threatening, requiring careful monitoring. The adverse effects of clozapine range from benign drooling, weight gain, nausea, and constipation, to life-threatening agranulocytosis, seizures, and neuroleptic malignant syndrome (NMS). Mandatory periodic white blood cell monitoring has resulted in dramatic reduction in mortality due to clozapine-induced agranulocytosis, promoting high adherence by patients. Prompt diagnosis and treatment of adverse effects of clozapine has also been effective in reducing complications, including mortality due to other serious adverse effects such as NMS and seizure. Other adverse effects are comparatively benign and can be managed effectively. Conclusions: Clozapine has a wide variety of adverse effects, some of which are potentially life threatening. Clinicians should be aware of possible severe complications and emergency management. Differentiating between minor and major adverse effects and initiating appropriate intervention is essential for a positive therapeutic outcome when prescribing clozapine.
Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part III
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 antiinfectives, vaccines, antiepileptics, benzodiazepines, psychotherapeutic drugs, and radiopharmaceuticals 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, other healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
When Prescription Drugs Go Over-the-Counter: Where are the Boundaries?
Authors: Boothby Lisa A , Doering Paul L , Jaco VIT 
Published: September 2013

Objective: To determine local pharmacists' willingness to recommend/allow the use of OTC ibuprofen when prescription-strength ibuprofen had been prescribed for symptomatic relief of rheumatoid arthritis, to examine the evidence-based medicine supporting the use of ibuprofen for rheumatoid arthritis treatment, and to determine the impact this evidence has for nonprescription ibuprofen drug labeling. Methods: Sixty community pharmacies in the southeastern US were surveyed via the “shopper” method. Then a literature search was conducted using MEDLINE (1966–June 2003), International Pharmaceutical Abstracts (1970–June 2003), Current Contents (1966–June 2003), Lexis-Nexis (2001–2003), and Cochrane Database of Systematic Reviews (2000–June 2003). Articles that examined the efficacy and safety of low-dose ibuprofen (<400 mg every 4–6 h not to exceed 1200 mg/day) were reviewed. Clinical practice guidelines were obtained to determine the standard of care for rheumatoid arthritis treatment. Results: All pharmacists stated that it was completely acceptable to substitute OTC ibuprofen for the prescription formulation. Little to no counseling occurred at the point of service. These recommendations do not coincide with clinical practice guideline recommendations for the use of nonsteroidal antiinflammatory drugs versus disease-modifying antirheumatic drugs for long-term rheumatoid arthritis treatment. Conclusions: Results of this survey and literature review suggest the need for nonprescription educational initiatives regarding the role of nonprescription analgesics geared toward pharmacists. Clarification from the FDA as to the role of nonprescription drug therapy for chronic disease states is needed.
Valacyclovir and Postherpetic Neuralgia
Authors: Segarra-Newnham Marisel , Tagoff Shari S 
Published: September 2013

Objective: To describe the role of valacyclovir in the treatment of acute herpes zoster pain and its effect in postherpetic neuralgia. Data Sources: A literature search was conducted on MEDLINE (1980–October 2003). Search terms included valacyclovir, postherpetic neuralgia, treatment, acyclovir, and valacyclovir. Study Selection and Data Extraction: Articles describing use of valacyclovir in the treatment of herpes zoster, with focus upon alleviation of acute zoster pain and postherpetic neuralgia, and articles describing use of valacyclovir for this indication in comparison with other antivirals were evaluated. Data Synthesis: Four studies discussing the use of valacyclovir in the treatment of herpes zoster with focus on herpetic pain and postherpetic neuralgia were identified. All of these studies reported that valacyclovir is an effective treatment for herpes zoster and alleviates associated pain significantly faster than acyclovir, presumably due to its greater bioavailability. Valacyclovir likely results in a higher adherence rate than acyclovir because it is dosed 3 versus 5 times daily. Interestingly, the severity of pain was not significantly different between the 2 treatments, only the duration. Finally, one study showed that valacyclovir is equally as effective as famciclovir in alleviating pain associated with herpes zoster. Conclusions: Valacyclovir 1 g given orally 3 times a day for 7 days is effective in the treatment of herpes zoster. It is superior to acyclovir 800 mg given orally 5 times a day for 7 days and equivalent to famciclovir 500 mg given orally 3 times a day for 7 days in alleviating acute zoster pain and postherpetic neuralgia.
Improved Stability of Treprostinil Sodium with Proper Vial Puncture Technique and Adapter Use
Authors: Phares Kenneth R , Wade Michael , Weiser William E , Miller Stephen P , Pan Wei 
Published: September 2013

Background: Treprostinil sodium has an expiration date of 14 days following initial vial puncture. Objective: To extend the expiration date of treprostinil sodium after initial vial entry and determine its stability after daily versus every 3-day vial entry. Stability and compatibility of treprostinil sodium with a Clave connector device was assessed. Methods: An initial study considered treprostinil vials punctured daily without regard to proper vial puncture technique. A second study considered treprostinil sodium vials punctured every 3 days with proper technique. Vials in these studies were stored in a stability chamber at 25 °C and 60% relative humidity up to 30 days. Treprostinil stability was assessed with a Clave connector adapter up to 84 days with the vials inverted. Vials were analyzed for treprostinil and m-cresol content, pH, appearance, particulate matter, and sterility. Results: Initial data indicated 14 days as the expiration date after initial vial entry and daily vial puncture. The parameter influencing stability was particulate matter, which was significantly reduced with proper vial puncture technique and vial entry every 3 days. Particulate matter counts remained low up to 84 days using a Clave adaptor and withdrawal every 7 days. Other stability parameters were acceptable throughout the stability study. Conclusions: These data indicate that the number of vial entries influenced treprostinil stability rather than time after initial vial entry. Two methods were identified to extend the expiration date of treprostinil sodium after initial vial puncture: proper vial puncture technique and use of a Clave adapter to withdraw the vial contents.
A Complex Interaction between Clozapine and Phenytoin
Authors: Shad Mujeeb U 
Published: September 2013

Objective: As of July 9, 2004, to report the first case of potential pharmacodynamic and pharmacokinetic interactions between clozapine and phenytoin occurring simultaneously in a patient. Case Summary: A 60-year-old African American female treated with clozapine and phenytoin developed neutropenia after the clozapine dose was increased from 650 to 900 mg/day. The neutropenia resolved after phenytoin was discontinued, and the clozapine dose was decreased from 900 to 300 mg/day without any significant change in clozapine levels. Discussion: Neutropenia can be explained on the basis of a potential pharmacodynamic interaction between clozapine and phenytoin. However, neutropenia did not occur until the clozapine dose was increased from 650 to 900 mg/day, corresponding to an increase in clozapine levels from 90 to 114 ng/mL. Neutropenia resolved after phenytoin was discontinued, even though the clozapine concentrations achieved after phenytoin discontinuation (137 ng/mL) were almost the same as those when phenytoin was coadministered (114 ng/mL). This finding suggests that neutropenia was precipitated not only by an increase in the clozapine dose, but also by the concomitant use of phenytoin. On the other hand, the decrease in clozapine concentrations can be explained on the basis of a pharmacokinetic interaction between clozapine and phenytoin. Phenytoin has the potential to decrease clozapine concentrations by inducing the activity of CYP1A2, which provides a primary metabolic pathway for clozapine. Conclusions: Concomitant use of phenytoin may not only decrease clozapine concentrations and compromise its efficacy, but can also precipitate neutropenia. Although based on a single case report, these findings warrant caution when coadministering clozapine and phenytoin.
Erythropoietin for Prevention and Treatment of Anemia in the Intensive Care Unit
Authors: Deal Eli N , Marken Patricia A , Manley Harold J , Garvin Cory G 
Published: September 2013

Objective: To evaluate and summarize the data on erythropoietin (EPO) use to prevent anemia in intensive care unit (ICU) patients. Data Sources: A literature search was performed using MEDLINE (1966–December 2003) using the key words erythropoietin, intensive care unit, anemia, and critically ill. Data Synthesis: Attempts to decrease the complications associated with anemia in ICU patients have recently focused on EPO use. Two comprehensive studies found that EPO significantly reduced the cumulative number of blood transfusions as compared to that of placebo. The assessing outcomes found no difference between the groups with respect to mortality rates, ventilation days, or length of stay. Conclusions: Available trials demonstrate reduced blood transfusions in ICU patients when EPO is administered. However, this result has not carried over as a defined clinical benefit. EPO use should be reserved for patients with longer hospital stays who are at risk for frequent blood transfusions as a comprehensive blood conservation strategy in the ICU.
Prevalence of Smoking and Attitude toward Smoking Cessation among Community Pharmacists, Saudi Arabia
Authors: Al-Arifi Mohammed Nasir 
Published: September 2013

Background: Although the percentage of the population that smokes has declined in the US and other countries, it is increasing in Third World countries. In Saudi Arabia, despite warnings on every packet of cigarettes indicating health hazards related to smoking, this habit is increasing rapidly, particularly among the younger population. Objective: To assess the prevalence and risk factors of smoking among community pharmacists and explore their attitudes toward issues related to smoking cessation. Methods: A survey was conducted in November 2003 in community pharmacies in Riyadh City, Saudi Arabia. Community pharmacies were randomly selected from the Ministry of Health Registers List. A self-administered questionnaire was used for data collection. Results: The survey revealed a 19.9% prevalence rate of cigarette smoking among community pharmacists. Lung diseases, including cancer, and cardiovascular diseases were mentioned as the main risk factors of cigarette smoking. The majority of the surveyed pharmacists agreed with banning smoking in common places, and they are willing to support patients who want to quit smoking. They also believe that the pharmacist can play a positive role in smoking cessation. Conclusions: Although pharmacists who participated in this survey were fully aware of the health hazards related to smoking, we found that their activities in promotion of smoking cessation were far from exemplary. Based on these findings, there is a need to put more emphasis on pharmacists to devote time for anti-smoking counseling.
Atypical Antipsychotics and Diabetes: Discussion and Monitoring Recommendations
Authors: Suehs Brandon T , Bettinger Tawny L , Hall Catherine S 
Published: September 2013

Objective: To discuss the relationship between atypical antipsychotics (AAPs) and diabetes and to report new monitoring recommendations for patients being prescribed AAPs. Data Sources: Articles were identified through searches of MEDLINE and PubMed (1966–March 2004). Search terms included hyperglycemia, diabetes, glucose, atypical antipsychotics, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Only articles published in the English language were included in the search. Additionally, bibliographies of articles cited were used to identify additional articles. Study Selection and Data Extraction: All available articles identified by the data sources were reviewed and those deemed relevant to the review were included. Data Synthesis: Information pertaining to diabetes/hyperglycemia risk in case reports and submissions to the Medwatch system prompted the FDA to require labeling changes for all AAPs. The exact relationship between AAPs and diabetes remains unclear. The association is clouded by the fact that patients with schizophrenia are, in general, at higher risk for diabetes mellitus. Sedentary lifestyle and poor dietary intake are 2 possible contributing causes of diabetes in patients with schizophrenia. Weight gain or other metabolic effects of AAPs may put patients at further risk of developing diabetes. The American Diabetes Association, American Psychiatric Association, American Association of Clinical Epidemiologists, and North American Association for the Study of Obesity have released a joint consensus statement addressing some of the concerns related to AAP use. Conclusions: Because of the apparent increased risk of diabetes in patients taking AAPs, monitoring weight, fasting blood glucose, blood pressure, and lipids should be a part of the baseline assessment and ongoing care.