bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Acute Renal Failure Associated with Milrinone
Authors: Amin Kamal , Bastani Bahar 
Published: September 2013

Background: Milrinone is a phosphodiesterase type III inhibitor with positive inotropic and vasodilatory effects used in patients with severe congestive heart failure (CHF). Objectives: To determine the incidence rate of acute renal failure (ARF) associated with milrinone therapy. Methods: Medical records of 116 patients with cardiomyopathy/severe CHF who received milrinone were reviewed from January 1993 to January 1996. Twenty-nine patients were excluded, resulting in 87 patients, 4 of whom received milrinone twice. Results: During a 3-year period, 11 of 91 milrinone therapies became complicated with ARF (incidence 12%). The patients' age (mean ± SD) was 52.3 ± 13.6 years, baseline serum creatinine (SCr) was 1.6 ± 1.0 mg/dL, milrinone dose was 0.47 ± 0.16 μg/kg/min, and mean duration of therapy was 6.5 ± 10.6 days. Fourteen treatments were <24 hours, 2 (14%) of which were complicated with ARF; of the remaining 77 treatments (≥24 h), 9 (11.7%) were complicated with ARF. Their peak SCr was 3.2 ± 1.5 mg/dL and time to peak SCr was 4.9 ± 2.8 days. There was no significant difference in the incidence of ARF in patients who received therapy for <24 hours versus ≥24 hours; in the prevalence rate of diabetes mellitus, hypertension, coronary artery disease; or in baseline SCr, milrinone dose, and duration of therapy between patients who did and did not develop ARF. Conclusions: We found a 12% incidence of ARF in patients receiving milrinone therapy for severe CHF, which in the absence of an appropriate control group could be the aggregate effects of milrinone therapy and severe CHF.
Analyzing a Health-System's Use of Unfractionated Heparin to Ensure Optimal Anticoagulation
Authors: Jellinek Samantha P , Cohen Victor , Likourezos Antonios , Goldman William M , Lashley Eustace L 
Published: September 2013

Background: Although unfractionated heparin (UH) dosing nomograms have proven to be superior to standard dosing, the latter remains the mainstay at our institution. We hypothesize that the incorporation of technology integrated with a decision support algorithm will facilitate the use of a UH nomogram by clinicians. Objective: To critically appraise the steps involved with the use of UH, create a decision support algorithm to aid in the management of UH, and determine whether the use of this algorithm can improve achievment of rapid and safe anticoagulation compared with the current standard of care. Methods: We analyzed the steps involved with the use of UH and subsequently reviewed the medical literature for risk factors for bleeding that patients may harbor when initiating UH. Based on this information, we designed a computerized physician order entry (CPOE), factor-based, weight-adjusted decision support algorithm with the primary goal of minimizing the risk of bleeding while optimizing and ensuring optimal anticoagulation. We compared the CPOE strategy with our current standard of care. Results: The CPOE factor–based dosing strategy significantly improved the rates and decreased the time to achieving an initial activated partial thromboplastin time (aPTT) that was ≥60 seconds compared with the control group. At the time of first aPTT measurement, the CPOE factor-based group achieved a 92.9% therapeutic rate compared with the standard heparin dosing group, which achieved a 60.8% therapeutic rate (p < 0.01). Conclusions: The institution of a CPOE factor-based dosing strategy in collaboration with pharmacists' interventions optimizes anticoagulation treatment with UH.
Fatal Acute Pancreatitis in a Patient Chronically Treated with Candesartan
Authors: Gill Christopher J , Jennings Anne E , Newton Jeffrey B , Schwartz David E 
Published: September 2013

Objective: To summarize a case of acute pancreatitis in a patient receiving the angiotensin II receptor blocker (ARB) candesartan. Case Summary: A previously healthy 75-year-old white man presented with acute pancreatitis complicated by anuric renal failure, respiratory failure, circulatory collapse, and died within 24 hours despite resuscitation efforts. He had been receiving candesartan 32 mg/day for more than one year with no apparent adverse effects. Discussion: In recent years, angiotensin-converting enzyme (ACE) inhibitors have been linked with sporadic cases of acute pancreatitis. Recent case reports suggest a similar association between pancreatitis and the related drug class of ARBs. Animal data indicate that the renin–angiotensin system plays an important role in pancreatic hemodynamics and exocrine function and is activated in the setting of acute pancreatitis. Because both ARBs and ACE inhibitors affect angiotensin II, we hypothesize that a common pathophysiologic mechanism might apply to both ARB- and ACE inhibitor–induced pancreatitis. Conclusions: Although acute pancreatitis appears to be a rare complication of both ARBs and ACE inhibitors, the catastrophic outcome in this case mandates that clinicians be aware of this adverse effect. Further research into the role of the renin–angiotensin system in the pathogenesis of acute pancreatitis appears warranted.
Fluoroquinolone- and Methicillin-Resistant Staphylococcus Aureus: Insights from the Antimicrobial Resistance Management Program
Authors: Gums John G , Epstein Benjamin J 
Published: September 2013

Background: Staphylococcus aureus is a frequent cause of infections involving the bloodstream, skin and soft tissue, and lungs in hospitalized patients. These isolates are often multidrug resistant and represent a major therapeutic challenge. Objective: To explore the susceptibilities of S. aureus to nafcillin/oxacillin, a surrogate for methicillin resistance, and the fluoroquinolones and determine whether a relationship might exist between fluoroquinolone use and the prevalence of methicillin-resistant S. aureus (MRSA). Methods: To date, 353 institutions throughout the US and Puerto Rico have enrolled in the Antimicrobial Resistance Management (ARM) Program, and data have been submitted on nearly 5 million isolates of S. aureus. Isolates submitted from 1990 through 2002 were reviewed for sensitivity to nafcillin/oxacillin, clindamycin, erythromycin, and the fluoroquinolones ciprofloxacin and levofloxacin. Results: From 1990 through 2002 inclusive, susceptibility to nafcillin/oxacillin nationally was 64.9% (n = 360,460), ranging from 62.2% in the North Central and Northeast US to 72.8% in the Southwest. Nationally, S. aureus isolates were more resistant to levofloxacin (41.4%, n = 123,868) than ciprofloxacin (38.7%, n = 256,178). The greatest change in susceptibility of S. aureus to nafcillin/oxacillin and ciprofloxacin occurred concurrently from 1998 to 2002, which may implicate fluoroquinolone use with increasing rates of MRSA infection. Conclusions: Resistance to methicillin and the fluoroquinolones has increased in concert during the past 5 years. Collectively, data from the ARM Program, along with several other investigations, support a role of fluoroquinolone use in the emergence of MRSA. These observations, along with increasing resistance among gram-positive and gram-negative pathogens, underscore the need for judicious use of fluoroquinolones.
The Economic and Psychosocial Impact of Migraine before and after Diagnosis and Treatment
Authors: Weitzel Kristin Wiisanen , Levin Gary M 
Published: September 2013

Background: Migraine headache is associated with significant costs. Many patients with migraine do not receive appropriate care. Correct diagnosis of migraine is often elusive, which may impact patient care. Objective: To determine the economic and disability burdens that patients with migraine experience before treatment and after diagnosis and treatment. Methods: This survey was administered to patients in a community pharmacy. Eligible patients were 18–40 years of age with diagnosed migraine who had prescriptions for an ergotamine, triptan, or combination product containing acetaminophen, isometheptene, and dichloralphenazone. Main outcome measures included pre- and postdiagnostic comparison of patient disability measures, migraine medication use, migraine-related patient costs, and physician office visit characteristics and diagnostic testing. Results: Forty-nine patients completed the study (mean ± SD age 38 ± 14 y, 90% female). The average age of symptom onset was 24 ± 13 years, with first presentation to physician at age 28 ± 12 and diagnosis made at age 31 ± 12 years. The mean number of physicians visited was 2.3 ± 4.7, comprising 5.3 ± 7.8 office visits before diagnosis. After diagnosis and treatment, significantly fewer patients experienced attacks lasting ≥16 hours and reported missing ≥5 days of work/month from migraine symptoms. Patients also reported significantly increased effectiveness at work when experiencing symptoms after diagnosis and treatment. Conclusions: This study demonstrated that migraine often eludes formal diagnosis and diagnosis is difficult for the primary care physician to make without expensive tests and/or consultation. Patient outcomes were greatly improved after a formal diagnosis followed by appropriate treatment.
Impact of Increased Copayments on the Discontinuation/Switching Rates of Nonformulary Medications
Authors: Nair Kavita V , Valuck Robert J , Allen Richard R , Lewis Sonya J 
Published: September 2013

Background: Patients with chronic diseases are particularly affected by prescription copayment increases, as they are faced with the decision to switch to formulary alternatives or pay more to stay on their current medication. Objective: To evaluate the impact of increased copayments as a result of a change in formulary status on the continuation rates of nonformulary medications in multitiered pharmacy benefit plans. Methods: A retrospective cohort study was conducted on patients with chronic diseases who were part of a health plan in the western US. Individuals were selected if they were taking a medication that was being removed from the health plan's formulary and, thus, experienced increases in their copayments for nonformulary medications (n = 1,244). The time periods before and after the increase in copayments were studied. Adjusting for demographics, chronic comorbidities, medication use, Medicare + Choice status, and percentage increase in copayment for nonformulary medications, Cox regressions were used to assess continuation rates for these drugs. Results: A clear relationship between increasing copayment differentials and continuation rates for nonformulary medications in the period after the copayment increases could not be established. In general, those who experienced higher copayment differentials (50–100%, 100–200%, >200%) were more likely to continue their nonformulary medication than were those who experienced copayment increases of 25–50% and >25%. Conclusions: Individuals confronted with increased copayments often switched their drugs to formulary alternatives. However, a clear relationship could not be established between increasing copayments and continuation behavior. Further research is needed to determine whether these switching behaviors result in inappropriate medication behaviors, such as complete discontinuation of drug therapy due to the increased costs.
New Treatment for Chronic Obstructive Pulmonary Disease: Tiotropium Bromide
Authors: Evans Emily W 
Published: September 2013

Objective: To review chronic obstructive pulmonary disease (COPD) and evaluate the role of tiotropium bromide in its treatment. Data Sources: MEDLINE was searched for articles published between 1990 and June 2004 that contained the terms tiotropium and chronic obstructive pulmonary disease. Study Selection/Data Extraction: Selected studies documented clinical outcomes related to the use of tiotropium bromide and included a complete description of methods and results. These studies were examined to determine the extent of the effect of tiotropium on clinical outcomes involved in COPD. Data Synthesis: Tiotropium bromide has a long duration of action and thus can be dosed just once daily. It was found to improve lung function, reduce symptoms, improve health status, and decrease exacerbations compared with both placebo and other bronchodilator medications. Conclusions: Tiotropium appears to be a valuable addition to the current therapies available for COPD.
A Case Study: Treatment of Refractory Schizoaffective Disorder with Aripiprazole
Authors: Soto Joseph A De , Kazi Aneela , Rivera Alejandro , Muhammad AB Wilson 
Published: September 2013

Objective: To report the use of aripiprazole in the treatment of refractory schizoaffective disorder. Case Summary: A 42-year-old African American male with a 10-year history of schizoaffective disorder decompensated while being treated with haloperidol decanoate 200 mg intramuscularly per month and valproic acid 500 mg twice daily. Upon admission, his Global Assessment of Function scale (GAF) score was 10 and his Mini-Mental State Examination (MMSE) score was 2. He was treated with an initial injection of haloperidol decanoate 100 mg and, thereafter, with haloperidol 5 mg orally twice a day. He remained refractory to haloperidol and, on day 14, chlorpromazine 150 mg/day was added. The patient continued to show no response. On day 20, oral aripiprazole 15 mg was substituted for haloperidol and chlorpromazine. Forty-eight hours later, the GAF score was 30 and the MMSE score was 18. Ninety-six hours after receiving aripiprazole, the GAF and MMSE scores were 40 and 26, respectively. Discussion: Aripiprazole has been approved for the treatment of schizophrenia and bipolar disorder; however, it has not been approved for treatment of schizoaffective disorder. Aripiprazole is a novel drug representing a new class of agents used for the treatment of psychosis. Aripiprazole is a partial agonist at the dopamine D2 and serotonin 5-HT1A receptors, but an antagonist at the serotonin 5-HT2A receptors. Conclusions: Aripiprazole may be useful in treatment of refractory schizoaffective disorder.
Exenatide: A Novel Therapeutic Approach for Type 2 Diabetes Mellitus
Authors: McCord Amie D 
Published: September 2013

Objective: To review the pharmacology, pharmacokinetics, clinical efficacy and safety studies, adverse effects, drug interactions, and dosage and administration of exenatide, a novel incretin mimetic agent recently approved for the treatment of type 2 diabetes mellitus. Data Sources: Information was obtained from MEDLINE searches of the English-language literature (1990–November 2004). Search terms included exenatide, synthetic exendin-4, exendin-4, AC2993, and GLP-1 agonist. Study Selection and Data Extraction: All available data were reviewed, including animal and human data disseminated as abstracts, clinical trials, review articles, and press releases. Data Synthesis: Exenatide is a novel therapeutic agent recently approved for the treatment of type 2 diabetes. The unique pharmacologic profile of exenatide offers a promising adjunctive treatment option for this patient population. Conclusions: While the long-term safety and efficacy of this agent are not well documented, the available data indicate the efficacy and safety of exenatide in combination with various oral antidiabetic agents in reducing postprandial glucose concentrations, glycosylated hemoglobin values, and potentially body weight without increasing the risk of hypoglycemia.
Factors Associated with Ribavirin-Induced Anemia
Authors: Friedenberg Frank K , Gollamudi Satya P , Chang Alan W , Guatam Manjushree , Schmutz Joan K , Skole Kevin S , Thomas Rebecca M , Black Martin 
Published: September 2013

Background: During treatment of hepatitis C, ribavirin-induced anemia (RIA) requires reduction of the ribavirin dose or initiation of erythropoietin in up to 20% of patients. RIA usually occurs in the first 8 weeks of treatment, and a decrease >3 g/dL or a nadir <10 g/dL is considered significant. Objective: To prospectively examine factors associated with RIA in a population of patients with hepatitis C. Methods: Consecutive patients with hepatitis C (hepatitis B virus and HIV negative) underwent treatment with pegylated interferon and weight-based ribavirin. Prospectively gathered data included demographics, alcohol consumption, and hepatitis C virus risk factors. Patients underwent laboratory studies at baseline and at intervals of 4–8 weeks after starting treatment. Results: One hundred eight patients were enrolled. Of these, 30 (27.8%) experienced a >3 g/dL fall in hemoglobin levels in the first 8 weeks; in 10 (33%) patients, the change occurred by week 4. The initial hemoglobin level was higher in those with a decrease compared with those without a fall (15.3 vs 14.1 g/dL; p < 0.001). In addition, for patients with a decrease, the iron saturation was higher (44.6% vs 30.1%; p = 0.002). Finally, those with fibrosis stage 6/6 (cirrhosis) had a greater percent fall in hemoglobin (27.0% vs 14.0%; p = 0.009) than those with less severe fibrosis. By logistic regression analysis, only iron saturation was associated with RIA (p = 0.002). Conclusions: In our patients, initial hemoglobin, serum iron, and fibrosis were associated with a potentially clinically important decrease in hemoglobin. In approximately one-third of the population, RIA occurred in the first 4 weeks of treatment. No patient had a severe complication.
Argatroban in Post-Cardiovascular Surgery Patient with Heparin-Induced Thrombocytopenia Requiring Hemodialysis and Continuous Hemofiltration
Authors: Lau Keith K , Escue Eric J , Ault Bettina H , Jones Deborah P , Storgion Stephanie A 
Published: September 2013

Objective: To describe the use of argatroban in a postoperative cardiovascular surgery patient with heparin-induced thrombocytopenia (HIT) requiring hemodialysis and continuous veno-veno hemofiltration (CVVH). Case Summary: A 23-year-old white woman with HIT developed acute renal failure after cardiovascular surgery. Argatroban was used as a substitute for heparin during hemodialysis and CVVH. Both activated partial thromboplastin time (aPTT) and activated clotting time (ACT) were used to guide the dosage of argatroban. The patient was successfully dialyzed without clotting of the circuit. The dosage required in our patient was much lower than the manufacturer's recommendation. Discussion: Argatroban is a selective thrombin inhibitor that does not cross-react with heparin-induced antibodies. It is metabolized by the liver, and dosage adjustment is recommended in patients with severe hepatic impairment. The correct dosage for patients with unstable hemodynamics is not known. Our patient had apparently normal hepatic function at the initiation of therapy, but the dosage of argatroban recommended by the manufacturer resulted in prolonged elevation of the aPTT and ACT with associated gastrointestinal bleeding. This may be due to hepatic congestion secondary to poor cardiac function and/or severe generalized edema. Conclusions: When argatroban is considered for therapy in place of heparin for CVVH, it needs to be used with extreme caution since the correct initial dosage in patients with mild hepatic impairment and unstable hemodynamics is unclear.
Understanding the Perceptions and Attitudes of Pharmacy Students on Administering Adult Vaccines
Authors: Akala Folasade O , Powers Mary F 
Published: September 2013

Background: Community pharmacy practice is changing to include pharmacist-administered immunization. As this change occurs, there is a need to understand pharmacy students' attitudes and interests regarding this new role. Objective: To examine the attitudes and interests of pharmacy students in administering immunizations and to use the information obtained to design and implement an immunization training program within an existing course in the PharmD curriculum at a college of pharmacy. Methods: A survey questionnaire was distributed to the first- and second-year PharmD students during the fall semester of the 2003–2004 academic year. Descriptive statistics, including mean and standard deviation, were used to report the data. Results: Two hundred nine surveys were distributed to first- and second-year students, and 172 were completed, yielding a response rate of 82%. Survey results showed that 76.7% of the students were aware that pharmacists can legally administer adult immunizations in Ohio, 94.2% think pharmacist-administered adult immunization is an important healthcare service, and 93.6% indicated they would be willing to administer adult immunizations after graduating. Conclusions: With the incorporation of an immunization training program into the curriculum, students can be well prepared and confident in administering adult immunizations. The immunization training program can also provide students with an opportunity to become involved in immunization as advocates or facilitators.
Treatment of Hypercholesterolemia in Pregnancy: Risks versus Benefits
Authors: Zaiken Kathy , Raval Kalindi D 
Published: September 2013

Objective: To identify treatment options for hypercholesterolemia in pregnant women. Data Sources: A search was conducted of MEDLINE (1966–March 2004), EMBASE (1980–March 2004), and International Pharmaceutical Abstracts (1970–March 2004). Key terms included fibric acid derivatives, plant stanol/sterols, niacin, ezetimibe, vitamin E, LDL-apheresis, and fish oil. Study Selection and Data Extraction: The articles evaluated described hypercholesterolemia during pregnancy and lipid therapy options. Data Synthesis: Elevated lipid levels in pregnant women may have a negative impact on the fetus. Case reports and clinical trials from 1966 to March 2004 were evaluated for information regarding the impact of various cholesterol-lowering agents on both the mother and fetus. These case reports and trials conclude that additional studies are needed to determine their overall safety in pregnant women. Conclusions: Lipid-lowering therapies have differing levels of safety and efficacy and are not well studied in pregnant women. Therefore, a diet low in cholesterol and fat is the recommended treatment for hypercholesterolemia during pregnancy.
Exploring the Professional Expertise of Pharmacy Technicians
Authors: Wilson Debbie L , Kimberlin Carole L , Brushwood David B 
Published: September 2013

Objective: To investigate whether the adapted model of professional expertise for pharmacy fits the opinions of pharmacists about pharmacy technicians, explore the qualities of professional expertise that pharmacists feel pharmacy technicians have, and generate ideas to encourage pharmacy technician professional expertise. Methods: An adapted model of professional expertise was used in this investigation of pharmacy technicians and included 4 constructs: Knowledge, Patient Assessment and Education, Reasoning and Judgment, and Virtues. Four one-on-one interviews and one focus group with 10 pharmacists were conducted. Content analysis was conducted of verbatim transcriptions of the interviews using a tree of codes that incorporated the concepts of the adapted model. Results: The model fit 179 (65%) of the 276 text units and included 43 concepts. The pharmacists employed narrations, stories, lists, and simple responses in the comments that the model fit. Conclusions: The adapted model of professional expertise for pharmacy aligned with the pharmacists' comments on pharmacy technicians. Pharmacists reported that pharmacy technicians possess many qualities of professional expertise. These qualities were used to make recommendations for encouraging pharmacy technician professional expertise.