bluuebunny/crossref_metadata_2025_split huggingface dataset:
Donepezil Overdose: A Tenfold Dosing Error
Authors: Shepherd Greene , Klein-Schwartz Wendy , Edwards Robin 
Published: March 2004

OBJECTIVE: To report toxicity resulting from donepezil administration following a tenfold dosing error. CASE SUMMARY: A 79-year-old white nursing home patient with a history of Alzheimer disease and hypertension was inadvertently given 50 mg of donepezil instead of her usual 5-mg dose. She presented to the emergency department with nausea, vomiting, and persistent bradycardia (HR in the 40s). Routine laboratory studies were all within normal limits. Basilar rales were noted five hours after arrival. She was treated with atropine 0.2 mg as needed for bradycardia (HR <50 beats/min); a total of 3.0 mg was administered over 18 hours. Each bolus kept her HR >60 beats/min for one-half to two hours. No further vomiting or evidence of pulmonary edema occurred after her initial episodes. She returned to baseline by day 2 (HR in the 70s) and was returned to the nursing home. DISCUSSION: Donepezil is a centrally acting, reversible cholinesterase inhibitor that is used in the treatment of Alzheimer disease. Donepezil is highly specific for neural acetylcholinesterases, preferentially binding acetylcholinesterase by greater than three orders of magnitude over butyrylcholinesterases. This specificity minimizes peripheral adverse effects at therapeutic doses. Our patient mainly experienced bradycardia and had minimal secretory effects compared with what is usually seen with nonspecific cholinesterase inhibition. Medication errors like the one that produced this overdose are a common but preventable cause of morbidity in healthcare facilities. CONCLUSIONS: A tenfold dosing error caused donepezil toxicity. The main effect of this overdose was bradycardia, which responded to atropine therapy.
Lyme Disease Prevention and Vaccine Prophylaxis
Authors: Hayney Mary S , Grunske Mike M , Boh Larry E 
Published: March 2004

OBJECTIVE: To provide a comprehensive review of the epidemiology, diagnosis, and prevention of Lyme disease with a focus on the Lyme disease vaccine. DATA SOURCE: A computerized search of MEDLINE (January 1996–December 1998) was used to identify articles regarding Lyme disease, Borrelia burgdorferi, epidemiology, prevention, and vaccine. DATA SYNTHESIS: Lyme disease is a condition caused by infection with B. burgdorferi. The organism is carried by certain species of Ixodes ticks and is the most common tick-borne disease in the US. In patients with clinical manifestations of Lyme disease, various pharmacotherapeutic approaches have proven effective in treatment of the clinical features. Prevention strategies exist; however, their application is sometimes difficult. A vaccine for the prevention of Lyme disease is available, and another is being considered for approval. The recombinant outer surface protein A (OspA) vaccines to prevent Lyme disease are immunogenic and have an acceptable adverse effect profile. These vaccines are highly efficacious for the prevention of Lyme disease. CONCLUSIONS: Lyme disease is the most common tick-borne disease in the US. The infection, caused by B. burgdorferi, results in dermatologic, neurologic, cardiovascular, and musculoskeletal manifestations. Until recently, tick bite prevention strategies were the only means of decreasing the risk of acquiring the infection. The OspA vaccines are efficacious for the prevention of infection. Although universal immunization with these vaccines is unlikely, the availability of effective vaccines represents an important tool for the prevention of Lyme disease in endemic regions of the US.
Ototoxicity Associated with Vinblastine
Authors: Moss Patrick E , Hickman Scot , Harrison Bruce R 
Published: March 2004

OBJECTIVE: To describe a patient with ototoxicity associated with vinblastine chemotherapy. CASE SUMMARY: A 29-year-old white man with recurrent Hodgkin's disease received doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy once every two weeks for 12 cycles. He reported tinnitus after each treatment, with an onset of about six hours and a duration of seven to 10 days. This interfered with reading, watching television, and general concentration. Symptoms returned to baseline prior to the beginning of each subsequent cycle. Audiograms performed before and after several cycles showed mild sensorineural hearing loss in the high-decibel range, but no loss of speech recognition. DISCUSSION: No reported cases of ototoxicity or tinnitus from ABVD were found. All concomitant medications were eliminated as possible causes either due to lack of temporal association with the symptoms or no reports of ototoxicity in the literature. Vincristine, a more commonly used vinca alkaloid very similar to vinblastine, was noted to have caused several cases of sensorineural hearing loss. CONCLUSIONS: This case suggests that vinblastine may cause ototoxicity.
Once-Daily Aminoglycosides in the Treatment of Gram-Positive Endocarditis
Authors: Tam Vincent H , Preston Sandra L , Briceland Laurie L 
Published: March 2004

OBJECTIVE: To examine the role of once-daily aminoglycosides (ODA) in the treatment of gram-positive endocarditis. DATA SOURCES: A MEDLINE search was conducted from January 1984 to August 1998, and a Current Contents search was performed from September 1998 to December 1998, using endocarditis or aminoglycoside as key words. In addition, relevant articles were cross-referenced to screen for additional information. DATA EXTRACTION: Data published in English regarding the use of aminoglycosides in endocarditis are cited. Emphasis was placed on animal and human studies, but in vitro studies and review articles are also included. DATA SYNTHESIS: Endocarditis and the pharmacology of aminoglycosides are briefly reviewed. ODA is an alternative to conventional dosing in the treatment of endocarditis. Extensive work in endocarditis has been done recently in animals and humans to add to our understanding. Limited clinical data exist to support the theoretical advantages of increased efficacy, reduced toxicity, and potential cost savings versus traditional synergistic aminoglycoside dosing. Optimal monitoring of ODA remains undefined. CONCLUSIONS: Routine use of ODA for the treatment of endocarditis is not yet advocated. Promising supporting evidence and speculation of success of ODA in gram-positive endocarditis justify well-designed trials to further define its role in therapy.
Sibutramine: A Serotonin–Norepinephrine Reuptake-Inhibitor for the Treatment of Obesity
Authors: Luque Carla A , Rey Jose A 
Published: March 2004

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy data, adverse effects, and drug interactions of sibutramine as a treatment for obesity. DATA SOURCES: English-language clinical studies, abstracts, and review articles were identified using MEDLINE, EMBASE, and a manual search from January 1980 through December 1998. References were also obtained from the reference section of published articles. STUDY SELECTION AND DATA EXTRACTION: All articles identified were evaluated for possible inclusion in this review. Evaluative and comparative data from prospective, open-label, double-blind, and controlled studies were reviewed. DATA SYNTHESIS: Sibutramine is a serotonin–norepinephrine reuptake-inhibitor effective in the treatment of obesity. It does not act as a releasing agent of these neurotransmitters. Sibutramine undergoes extensive metabolism in the liver via CYP3A4, forming two pharmacologically active metabolites. This agent has demonstrated efficacy superior to placebo in reducing weight when used as part of an integrated regimen involving behavior modification, physical activity, and a reduced-calorie intake. The most frequently reported adverse effects include dry mouth, anorexia, headache, insomnia, and constipation. Sibutramine has also been shown to substantially increase blood pressure and heart rate in some patients. CONCLUSIONS: Based on anorectic efficacy data, sibutramine, a serotonin–norepinephrine reuptake-inhibitor, is a viable therapeutic option for the treatment of obesity. Recommended candidates for this medication are patients with a body mass index (BMI) ≥30 kg/m2 without concomitant risk factors or patients with a BMI ≥27 kg/m2 with concomitant risk factors. Sibutramine should be used with caution in patients with a history of hypertension and should not be used in those with uncontrolled hypertension and concomitant cardiovascular disease. Further studies need to be conducted in order to identify long-term outcomes beyond one year.
Concomitant Digoxin Toxicity and Warfarin Interaction in a Patient Receiving Clarithromycin
Authors: Gooderham Melinda J , Bolli Peter , Fernandez Peter G 
Published: March 2004

OBJECTIVE: To report a case of a clarithromycin-associated warfarin interaction and digoxin toxicity in a patient. CASE SUMMARY: A 72-year-old white woman with chronic atrial fibrillation receiving long-standing therapy with digoxin 0.25 mg/d and warfarin 22.5 mg/wk was prescribed clarithromycin 500 mg three times daily for eradication of Helicobacter pylori. The patient presented to the emergency department with gastrointestinal symptoms, weakness, dizziness, and visual changes 12 days after initiation of clarithromycin. Laboratory results revealed a serum digoxin concentration of 4.6 ng/mL (normal 1.0–2.6) and an international normalized ratio of 7.3 (2.0–3.0). Digoxin, warfarin, and clarithromycin were discontinued and the patient was admitted to the hospital for treatment to resolve the symptoms and to return laboratory values to a safe range. Reduced dosages of digoxin (0.125 mg/d) and warfarin (17.5 mg/wk) were restarted on day 7 of hospitalization. The patient was discharged on day 11 in good condition. DISCUSSION: Several reports of clarithromycin-induced drug interactions with digoxin and with warfarin have been published. Previously, case reports of macrolide-associated interactions mainly involved erythromycin, but more recently have implicated clarithromycin. The interaction between clarithromycin and warfarin is thought to occur from an inhibition of the cytochrome P450 drug metabolizing system. Clarithromycin is thought to cause digoxin toxicity by an alteration of the digoxin-metabolizing gut flora, thereby causing an increase in the digoxin concentration in susceptible individuals. Drug interactions can occur by different mechanisms in the same patient. CONCLUSIONS: Potential drug interactions can occur between commonly prescribed medications. It is important to monitor patients for symptoms and alterations in laboratory values to prevent not only serious complications, but also unnecessary hospitalizations.
The Use of Alteplase in a Newborn Receiving Extracorporeal Membrane Oxygenation
Authors: Glover Mark L , Camacho Maria T , Wolfsdorf Jack 
Published: March 2004

OBJECTIVE: To present a case of the use of alteplase for the successful resolution of an upper extremity occlusion in a newborn receiving extracorporeal membrane oxygenation (ECMO). CASE SUMMARY: A two-day-old full-term Hispanic girl receiving ECMO support developed a left upper extremity occlusion distal to the brachial artery. Alteplase therapy was initiated with a bolus dose of 0.48 mg/kg followed by a continuous infusion of 0.27 mg/kg/h for three hours. A repeat Doppler ultrasound revealed little improvement, resulting in continuation of alteplase therapy at an infusion rate of 0.27 mg/kg/h for an additional three hours. At the completion of the infusion, perfusion was greatly improved with palpable radial pulse present. While remaining on ECMO support, a brain ultrasound approximately 13 hours after alteplase therapy revealed a grade I right caudate head hemorrhage with normal ventricles. ECMO support was discontinued during the next 24 hours, with a repeat brain ultrasound three days later indicating no acute hemorrhage, normal ventricles, and almost complete resolution of the intraventricular hemorrhage. The neonate was discharged 19 days after discontinuing ECMO support. DISCUSSION: Patients receiving ECMO support are at risk of hematologic complications, including thrombi formation. Moreover, limited information is available regarding the most appropriate thrombolytic therapy for patients receiving ECMO support. Alteplase is an attractive thrombolytic agent given its antigenicity, clot specificity, and pharmacokinetic profile. However, both ECMO support and thrombolytic therapy are risk factors for the development of intraventricular hemorrhage, which our patient developed. Therefore, close monitoring of patients receiving ECMO support and alteplase therapy is essential given the potential for hematologic adverse effects. CONCLUSIONS: Alteplase is an effective thrombolytic agent in neonates receiving ECMO support. Additional experience with alteplase is necessary to determine the optimal dose and duration of therapy in this patient population.
Absorption of Rectally Administered Phenytoin: A Pilot Study
Authors: Chang Sandra W , da Silva Jack H , Kuhl David R 
Published: March 2004

OBJECTIVE: To test the hypothesis that rectally administered phenytoin is absorbed in healthy volunteers. DESIGN: This single-center, open-label crossover pilot study compared rectal absorption with intravenous administration of phenytoin injectable solution (7 mg/kg) in healthy volunteers. Twelve serial blood samples were taken from each volunteer beginning at time zero until 36 hours following administration. These were analyzed for presence of phenytoin by immunoassay. SETTING: The study took place at St. Paul's Hospital, a tertiary care center. PARTICIPANTS: Funding permitted for a sample size of five healthy participants, two men and three women, aged 21–45 years. Selection was by volunteer sample. Inclusion criteria were as follows: no known medical conditions, not receiving medication, no history of adverse drug reactions or allergies, not known to be pregnant, and normal liver function as determined per study protocol. MAIN OUTCOME MEASURES: Signs of absorption as indicated by presence of phenytoin in blood samples, maximum concentrations (Cmax), time to Cmax (tmax), AUC, and apparent bioavailability. RESULTS: Maximum mean concentrations of 2.4 ± 1.1 mg/L (mean ± SD) following rectal administration and 11.2 ± 1.6 mg/L following intravenous administration were achieved during the first one to two hours (tmax in both treatment arms). Mean apparent bioavailability of the rectally administered phenytoin was 24.4 ± 13.4% (15.8–44.1%). CONCLUSIONS: Results from this pilot study demonstrate that rectal absorption of phenytoin begins within 30 minutes following single-dose administration and was reported by four out of five volunteers to be the preferred route. Further studies are required before extrapolation can be made to the patient population.
Stability of Cefepime in Peritoneal Dialysis Solution
Authors: Williamson John C , Volles David F , Lynch PL Mark , Rogers P David , Haverstick Doris M 
Published: March 2004

OBJECTIVE: To determine the stability of cefepime in peritoneal dialysis solution. DESIGN: Cefepime HCl was added to premade bags of Delflex peritoneal dialysis solution with 1.5% dextrose to produce a cefepime concentration of approximately 100 μg/mL. Peritoneal dialysis solution bags were stored at 4, 25, and 37 °C to simulate refrigeration, room temperature, and body temperature, respectively. Samples were drawn at scheduled times up to 336, 168, and 48 hours, respectively, after the addition of cefepime HCl. Cefepime concentrations were measured by HPLC. SETTING: This study was performed at a university-affiliated tertiary care hospital. OUTCOME MEASURE: If the mean concentration of the samples at a given time and condition was >90% of the initial concentration, cefepime was considered stable at that time and condition. RESULTS: The mean HPLC results for samples drawn at each time and condition were all >90%. CONCLUSIONS: Cefepime is stable in peritoneal dialysis solution with dextrose 1.5% for 14 days refrigerated, seven days at room temperature, and 48 hours at 37 °C.
An Interdisciplinary Mock Trial Involving Pharmacy, Law, and Ethics
Authors: Broeseker Amy E , Jones Melissa M 
Published: March 2004

OBJECTIVE: To describe an innovative, interdisciplinary approach to illustrate the relationship between healthcare ethics and law. METHODS: A mock trial was created for students enrolled in the Samford University McWhorter School of Pharmacy and Department of Paralegal Education. The trial served as the starting point to discuss confidentiality in health care in general and pharmacy in particular. Students from both programs served on the jury and rendered a verdict after the case had been presented. The Alabama statute concerning exceptions to confidentiality is reviewed. The students' assignment and lessons learned are also described. SUMMARY: Students thoroughly enjoyed this method of teaching and learning. The mock trial provided an interesting way to exemplify the often complex relationship between healthcare ethics and law.
Role of Anagrelide in the Treatment of Thrombocytosis
Authors: Brooks Wesley G , Stanley Dennis D , Goode Jean-Venable “Kelly” R 
Published: March 2004

OBJECTIVE: To review the role of anagrelide in the management of essential thrombocythemia. DATA SOURCES: A MEDLINE search (January 1966–August 1998) was performed using the key terms anagrelide, thrombocytosis, and essential thrombocythemia. In addition, the package insert, product monograph, and patient information pamphlets were reviewed. DATA SYNTHESIS: Recently, there has been a trend toward the use of anagrelide in the management of thrombocythemia. Anagrelide lacks leukemogenic and mutagenic potential and possesses a more favorable adverse effect profile compared with other therapeutic agents. At recommended doses, anagrelide induces thrombocytopenia in thrombocythemic patients with a concomitant reduction in the incidence of disease-related symptoms. CONCLUSIONS: Although the treatment of choice for thrombocythemia is still an area of debate, anagrelide has distinct advantages over alternative therapies. Anagrelide represents an important therapeutic option in the treatment of patients with thrombocythemia.
Lamotrigine — An Effective Mood Stabilizer?
Authors: Maidment Ian D 
Published: March 2004

OBJECTIVE: To review the literature regarding the use of lamotrigine as a mood stabilizer, and to discuss its efficacy in treating this condition. DATA SOURCES: Data were obtained from MEDLINE, Micromedex, and Cochrane collaboration searches from January 1985 to July 1998. DATA SUMMARY: There are insufficient data to confirm that lamotrigine is an effective mood stabilizer. There are no controlled studies, and the current evidence is from case studies and open trials. Furthermore, only one study shows any evidence of effectiveness in the manic phase, although this may be because the data tend to relate to a treatment-refractory population. CONCLUSIONS: From the current evidence, lamotrigine cannot be recommended as a mood stabilizer except when conventional therapies have failed.
Angioedema Due to Losartan
Authors: Cha Yoon Ju , Pearson Vincent Earl 
Published: March 2004

OBJECTIVE: To report a case of angioedema associated with the angiotensin II receptor antagonist losartan. CASE SUMMARY: A 62-year-old African-American woman was admitted to the hospital for acute renal failure and uncontrolled hypertension. After attempting blood pressure control with three different agents, captopril was combined with metoprolol. The patient noted swelling of the lips combined with shortness of breath after four days of captopril. Losartan was substituted for captopril, which then produced similar swelling of the lips (without shortness of breath) after only one dose. These symptoms resolved after discontinuation of losartan and administration of antihistamines. DISCUSSION: Losartan, like other angiotensin II receptor antagonists, blocks the action of angiotensin II at the receptor level. Five published case reports involved patients with a prior history of intolerance to the angiotensin-converting enzyme inhibitors. Two published case reports of similar reactions also occurred in patients with renal compromise. The mechanism for this reaction from losartan is not known, but may not be due to bradykinin excess. CONCLUSIONS: Clinicians should be aware that angiotensin receptor antagonists may not be safe alternatives in patients who have a history of angioedema secondary to the angiotensin-converting enzyme inhibitors.
Fatal Status Epilepticus Associated with Olanzapine Therapy
Authors: Wyderski Richard J , Starrett W Grant , Abou-Saif Alaa 
Published: March 2004

OBJECTIVE: To report a case of fatal status epilepticus in a patient using olanzapine with no known underlying cause or predisposing factor for seizure. CASE SUMMARY: A 41-year-old white woman developed witnessed seizures at home that progressed to status epilepticus. She subsequently died from secondary rhabdomyolysis and disseminated intravascular coagulation. She had been taking olanzapine for five months prior to the event. No other toxic, metabolic, or anatomic abnormalities were identified pre- or postmortem to explain the seizures. Her seizures were a probable adverse drug reaction based on the Naranjo scale. DISCUSSION: This is the first case of fatal status epilepticus described that has been associated with the use of olanzapine. The pharmacodynamics of olanzapine are similar to those of clozapine, which has been described to induce seizures in 1–4% of patients. It is possible that this patient may have suffered seizures due to a similar effect. Alternate explanations include neuroleptic malignant syndrome and alcohol or benzodiazepine withdrawal seizures, although her clinical history does not suggest these etiologies. CONCLUSIONS: Although olanzapine has infrequently been associated with seizures in premarketing studies, its potential to induce them exists. Postmarketing surveillance should continue to determine how significant this effect may be.
Serum Sickness Induced by Bupropion
Authors: Yolles Jennifer C , Armenta Wendy A , Alao Adekola O 
Published: March 2004

OBJECTIVE: To describe the first reported case of serum sickness induced by exposure to bupropion. CASE SUMMARY: Bupropion was administered to a 45-year-old white man being treated for depression with psychosis. Within 24 hours after his first dose of bupropion, the patient became delirious and then developed fever, myalgia, arthralgia, and a rash. Bupropion was discontinued after the second dose. With supportive measures, symptoms remitted over two weeks. DISCUSSION: A thorough search for other etiologies of the patient's symptoms was unrevealing, and a clinical diagnosis of serum sickness was made. Given the temporal association between the illness and the introduction of bupropion, this was felt to be the causal agent. No previous reports of serum sickness induced by bupropion were found in the literature. CONCLUSIONS: The previously unreported adverse drug reaction of serum sickness associated with the use of bupropion is demonstrated by this case, based on the temporal relationship and the results of stopping the drug, in light of no other identifiable etiology.