bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship between Preadmission Indicators and Basic Math Skills at a New School of Pharmacy
Authors: Grillo Joseph A , Latif David A , Stolte Scott K 
Published: June 2003

OBJECTIVE: To examine the relationship between preadmission indicators of 49 PharmD students entering their first professional year at a new school of pharmacy and their scores on a Basic Math Skills Test (BMST). A secondary objective was to determine what factors, if any, contributed to the successful completion of the BMST. METHODS: This cross-sectional investigation used a convenience sample of PharmD students entering the first professional year at a three-year-old, private, southeastern school of pharmacy. All first-year students who took the mandatory BMST, as part of a math mentor pilot program, were eligible for enrollment. The BMST covered nine different competencies and was validated at the grade-8 level. Math test scores, the student's Pharmacy College Admissions Test (PCAT), and other demographic and scholastic information was obtained from the student's application file in a retrospective manner. All identifiers were removed before the data were submitted to the investigators. RESULTS: Statistical analysis suggested that two preadmission indicators strongly influenced BMST performance: percentile scores on the quantitative section of the PCAT (PCAT—QP) and whether the student attended a private or public university prior to admission to the pharmacy school. In addition, four factors significantly contributed to successful completion of the BMST: math/science grade point average (MS-GPA), PCAT percentile scores, PCAT—QP percentile scores, and the number of BMST items left blank. CONCLUSIONS: A relationship exists between preadmission indicators of PharmD students entering their first professional year and their BMST score. In addition, certain identifiable factors impact BMST scores of first-year PharmD students. Admissions committees may find this useful in identifying students who may need remedial math assistance prior to beginning math-intensive courses such as pharmaceutical calculations and pharmacokinetics.
Treatment of Neuropathic Pain with Venlafaxine
Authors: Sumpton Janice E , Moulin Dwight E 
Published: June 2003

OBJECTIVE: To report a case of successful treatment of neuropathic pain with venlafaxine. CASE REPORT: A 39-year-old white woman presented with neuropathic back pain. The patient obtained 50% pain relief with consecutive use of amitriptyline, desipramine, and imipramine. Anticholinergic effects prompted a switch to extended-release venlafaxine 75 mg/d. Pain relief was as effective with this therapy as with the tricyclic antidepressants. The absence of adverse effects allowed the patient to discontinue all laxatives. DISCUSSION: Venlafaxine is an antidepressant that inhibits reuptake of norepinephrine and serotonin. This is the major mechanism by which tricyclic antidepressants relieve neuropathic pain. Venlafaxine does not bind to muscarinic-cholinergic, histaminic or α1-adrenergic receptors responsible for the common adverse effects seen with tricyclic antidepressants. CONCLUSIONS: This report describes the efficacious use of venlafaxine in the treatment of neuropathic pain. Double-blind, randomized, controlled trials are needed to explore this further.
Subtherapeutic INR Values Associated with a Switch to Generic Warfarin
Authors: Hope Kimberly A , Havrda Dawn E 
Published: June 2003

OBJECTIVE: To discuss the effect on the international normalized ratio (INR) when patients are converted from therapy with Coumadin to generic warfarin. CASE SUMMARY: Two cases at a family medicine center anticoagulation clinic in Oklahoma City, OK, in which subtherapeutic INR values occurred after a switch from Coumadin to generic warfarin, while all other variables were kept consistent demonstrate the need for close monitoring of the INR when patients are switched between brands of warfarin. DISCUSSION: Warfarin is a narrow therapeutic index drug since small changes in systemic concentration can lead to significant variation in pharmacodynamic response. In March 1997, the Food and Drug Administration (FDA) approved generic warfarin based on the FDA and United States Pharmacopeia (USP) standards. Due to different specifications between Dupont Pharma and the USP, content uniformity may differ between brand and generic forms of warfarin. Limited studies have demonstrated bioequivalence between brand and generic. The two cases presented demonstrate the potential for fluctuations in the INR when switching between generic and brand. Thus, these cases illustrate the need for close monitoring if a change is made. CONCLUSIONS: While considered bioequivalent by the FDA, switching between Coumadin and generic warfarin may lead to significant changes in the INR, warranting dose alterations due to different content uniformity specifications between Dupont Pharma and the USP. Patients switching between Coumadin and generic warfarin should have their INR monitored more carefully.
Fluconazole-Induced Torsade de Pointes
Authors: Tholakanahalli Venkatakrishna N , Potti Anil , Hanley James F , Merliss Andrew D 
Published: June 2003

OBJECTIVE: To present a case of fluconazole-associated torsade de pointes (TDP) and discuss fluconazole's role in causing TDP. CASE SUMMARY: A 68-year-old white woman with Candida glabrataisolated from a presacral abscess developed TDP eight days after commencing oral fluconazole. The patient had no other risk factors for TDP, including coronary artery disease, cardiomyopathy, congestive heart failure, and electrolyte abnormalities. There was a temporal association between the initiation of fluconazole and TDP. The TDP resolved when fluconazole was discontinued; however, the patient continued to have premature ventricular contractions and nonsustained ventricular tachycardia (NSVT) until six days after drug cessation. DISCUSSION: Use of the Naranjo probability scale indicates a probable relationship between the use of fluconazole and the development of TDP. The possible mechanism is depression of rapidly activating delayed rectifier potassium currents. In our patient, there was no other etiology identified that could explain QT prolongation or TDP. The complete disappearance of NSVT and premature ventricular contractions followed by normalization of QT interval after the drug was stopped strongly suggests fluconazole as the etiology. CONCLUSIONS: Clinicians should be aware that fluconazole, even at low doses, may cause prolongation of the QT interval, leading to TDP. Serial electrocardiographic monitoring may be considered when fluconazole is administered in patients who are at risk for ventricular arrhythmias.
Do HMG-CoA Reductase Inhibitors Affect Fibrinogen?
Authors: Song Jessica C , White C Michael 
Published: June 2003

OBJECTIVE: To review commonly used fibrinogen assay methods and the evidence demonstrating an association between fibrinogen and increased risk of coronary artery disease and to review the current literature to determine and assess the impact of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors on fibrinogen. DATA SOURCES: Primary and review articles identified from a MEDLINE search (1966–December 1999); references obtained from these publications were subsequently reviewed for additional relevant articles. STUDY SELECTION AND DATA EXTRACTION: All articles were evaluated, and all relevant information was included in this review. DATA SYNTHESIS: The Clauss method is currently the preferred method for determining plasma fibrinogen concentrations, due to its high degree of accuracy and precision. Furthermore, unlike immunologic methods, its reliability is unaffected by change in triglycerides. The effects of four HMG-CoA reductase inhibitors (atorvastatin, lovastatin, simvastatin, pravastatin) on fibrinogen have been evaluated. Atorvastatin has been shown to induce significant increases in fibrinogen (22% increase; p < 0.05) by using the mmunonephelometric method. This method also demonstrated that lovastatin use was associated with a 24.4% increase (p < 0.0001) in plasma fibrinogen concentration. Simvastatin has been shown in multiple studies using the Clauss method to have a neutral effect on fibrinogen. The majority of studies have revealed significant decreases (7–19%) in fibrinogen following treatment with pravastatin. CONCLUSIONS: Future studies need to be performed evaluating the effects of HMG-CoA reductase inhibitors on fibrinogen, but using direct comparisons and clotting assay methodology.
Life-Threatening Eosinophilic Pleuropericardial Effusion Related to Vitamins B5 and H
Authors: Debourdeau Philippe M , Djezzar Samira , Estival Jean Louis F , Zammit Christine M , Richard René C , Castot Anne C 
Published: June 2003

OBJECTIVE: To report a case of eosinophilic pleuropericarditis resulting from concomitant use of vitamins B5 and H. CASE SUMMARY: A 76-year-old white woman was admitted to the hospital because of chest pain and dyspnea related to pleurisy and a pericardial tamponade. This patient had no history of allergy and had been taking vitamins B5 and H for two months. Blood tests performed showed an inflammatory syndrome and a high eosinophil concentration (1200–1500 cells/mm3). Pleurocentesis and pericardiotomy yielded a sterile exudative fluid with an eosinophilic infiltrate. There were no nuclear antibodies and no rheumatic factor; screenings for viruses, parasites, bacteria, and malignant tumor were negative. A myelogram, biopsy of the iliac crest bone, and concentration of immunoglobulin E were also normal. After withdrawal of the vitamins, the patient recovered and the eosinophilia disappeared. DISCUSSION: Prolonged hypereosinophilia has marked predilection to damage specific organs, including the heart, but pleuro-pericardial effusion is uncommon. Drug-related pleuropericarditis usually occurs without an increased eosinophil count. Other drugs responsible for eosinophilic pleuropericarditis are cephalosporins, dantrolene, propylthiouracil, and nitrofurantoin. To our knowledge, this is the first case report of pleuropericarditis related to vitamins B5 and H. CONCLUSIONS: This case suggests that vitamins B5 and H may cause symptomatic, life-threatening, eosinophilic pleuropericarditis. Physicians prescribing these commonly used vitamins should be aware of this potential adverse reaction.
Zolpidem for Antipsychotic-Induced Parkinsonism
Authors: Farver Debra K , Khan Mujeeb H 
Published: June 2003

OBJECTIVE: To report a case of antipsychotic-induced parkinsonism that was managed with zolpidem. CASE SUMMARY: A 34-year-old white man who had had antipsychotic-induced parkinsonism with symptoms of repetitive persistent gross tremors of the hands for numerous years was unresponsive to traditional antiparkinsonian medications. With the initiation of zolpidem 10 mg four × daily, the tremors decreased significantly. DISCUSSION: The use of zolpidem for antipsychotic-induced parkinsonian hand tremors in this patient was based on the severity of the symptoms and the lack of response to several trials of traditional medications. When zolpidem was started at 10 mg four × a day, the motor examination score on the Unified Parkinson's Disease Rating Scale decreased from 29 at baseline to a score of 9 after one month of use. After four months of zolpidem use, the patient's mental status decompensated, and clozapine was initiated. As the patient experienced excessive sedation, zolpidem was discontinued while clozapine was maintained to help with the psychosis and, potentially, the tremors. The tremors reemerged with a motor examination score of 30. Zolpidem was reinitiated at 5 mg four × daily, and the patient's tremors have been stable for two years. CONCLUSIONS: Further investigation is needed to study the use of nontraditional medications in patients requiring antipsychotic medications who have refractory parkinsonian symptoms.
Religion and Coping with Serious Medical Illness
Authors: Koenig Harold G , Larson David B , Larson Susan S 
Published: June 2003

OBJECTIVE: To review and discuss some of the research published in the last several decades that has addressed the role that religion plays in helping patients cope with serious medical illness. DATA SOURCES: Although this is not a systematic review of the literature, it provides a sampling of the studies that have examined the relationship between religious involvement, coping with illness, and health outcomes. This sampling of studies reflects the findings of a much larger systematic review of research (MEDLINE, Current Contents, Psychlit, Soclit, HealthStar, Cancerlit, CINAHL, and others) during the past century that was recently completed by the authors. DATA EXTRACTION: Epidemiologic studies published in the English-language literature were reviewed and discussed. DATA SYNTHESIS: A number of well-designed cross-sectional and prospective studies have examined the relationship between religious beliefs and activities and adaptation to physical illness in patients with general medical conditions, neurologic disorders, heart disease, renal failure, AIDS, and a host of other physical disorders. This review demonstrates the widespread use of religion in coping with medical illness and provides circumstantial evidence for the possible benefits of this lifestyle factor. CONCLUSIONS: When people become physically ill, many rely heavily on religious beliefs and practices to relieve stress, retain a sense of control, and maintain hope and their sense of meaning and purpose in life. Religious involvement appears to enable the sick, particularly those with serious and disabling medical illness, to cope better and experience psychological growth from their negative health experiences, rather than be defeated or overcome by them.
L-Arginine in the Management of Cardiovascular Diseases
Authors: Cheng Judy WM , Balwin Stephen N 
Published: June 2003

OBJECTIVE: To examine the role of L-arginine in the management of cardiovascular diseases. DATA SOURCES: A MEDLINE search (1966–April 2000) of review articles, using the search terms arginine, nitric oxide, and cardiovascular diseases, was conducted. After reviewing these articles, primary studies using the search terms arginine, hypercholesterolemia, hypertension, diabetes, smoking, ischemic heart disease, and heart failure were reviewed. STUDY SELECTION: English-language human studies were selected and evaluated based on quality of review. DATA SYNTHESIS: Small-scale studies have demonstrated that intravenous L-arginine augments endothelial function by enhancing vasodilation and reducing monocyte adhesion. Oral supplementation demonstrated similar effects as well as improvement of exercise ability in patients with cardiovascular diseases. CONCLUSIONS: L-arginine improves the management of multiple cardiovascular diseases. However, most published human studies are small. Before therapy can be routinely recommended, larger, well-designed studies are required to confirm its effect.
Comparison of FDA Reports of Patient Deaths Associated with Sildenafil and with Injectable Alprostadil
Authors: Cohen Jay S 
Published: June 2003

BACKGROUND: Sildenafil (Viagra) has been linked to 240 deaths (128 verified, 112 unverified) reported to the Food and Drug Administration (FDA) during 7.5 months of availability, and to 522 reported deaths after 13 months of availability. To date, no updated information about FDA-reported deaths has emerged, and no comparative analyses have been published. OBJECTIVE: To compare the mortality rates between sildenafil and injectable alprostadil, both of which are used exclusively for treating erectile dysfunction. METHODS: A comparison of the number of deaths per filled prescriptions reported to the FDA involving sildenafil and injectable alprostadil was undertaken to perhaps provide further insight into this issue. Materials included FDA statements on sildenafil adverse event reports to the FDA involving sildenafil and injectable alprostadil, and data on prescriptions filled for sildenafil and injectable alprostadil. RESULTS: The number of deaths per prescriptions filled reported in association with sildenafil was significantly greater (5.15–6.28 times) than in association with injectable alprostadil. DISCUSSION: Previous explanations for sildenafil-associated deaths have been based on the expected attrition within the population of men with erectile dysfunction and its commonly associated disorders, the physiologic stress of renewed sexual activity, and a pharmacologic effect of sildenafil. The results of this analysis may indicate that a pharmacologic effect of sildenafil is responsible for these deaths. However, other factors may also explain these findings: a greater frequency of reporting of sildenafil-associated events by physicians, a difference in the populations using these two drugs, or the number of prescriptions filled may not accurately reflect actual exposure. CONCLUSIONS: Further study should be undertaken to clarify the issues associated with sildenafil-related deaths. In the meantime, reasonable precautions might be considered in prescribing sildenafil, such as initiating treatment with a low test dose of sildenafil.
Psychometric Evaluation of Four HIV Disease—Specific Quality-of-Life Instruments
Authors: Davis Elizabeth Anne , Pathak Dev S 
Published: June 2003

OBJECTIVE: To provide a comparative evaluation of psychometric properties for three or more HIV disease—specific quality-of-life (QoL) instruments. METHODS: Four instruments were selected using the following criteria: multiple publications of instrument, focus of instrument on QoL, psychometric validation publication or comparison with previously validated questionnaire, stages of HIV/AIDS used or evaluated in the study, and inclusion of sample items or the instrument in at least one publication. The four HIV-specific QoL instruments were: HIV/AIDS-Targeted Quality of Life Instrument, Medical Outcomes Study HIV questionnaire (MOS-HIV), Functional Assessment of Human Immunodeficiency Virus Infection, and HIV Overview of Problems — Evaluation System. These instruments were evaluated using combined criteria derived from McHorney and Tarlov and Shumaker et al. The criteria include: administration, content, depth, reliability, validity, and responsiveness. A letter grade scale (A, B, C, D) was used in rating the criteria. RESULTS: No instrument demonstrated ideal psychometric properties. The MOS-HIV questionnaire was the only instrument that published results for seven of the eight categories. Therefore, a decision cannot be made about the best instrument to use for measuring QoL in an HIV-positive patient. CONCLUSIONS: Published data for these questionnaires had common limitations of sample size, study design, and population demographics. Hence, further testing of these questionnaires is recommended before use in any study to determine suitability, reliability, and validity.
Adjunctive Rifampin Therapy for Central Nervous System Staphylococcal Infections
Authors: Brackbill Marcia L , Brophy Gretchen M 
Published: June 2003

OBJECTIVE: To review the published clinical data assessing the role of adjunctive rifampin therapy for the treatment of staphylococcal central nervous system (CNS) infections. DATA SOURCES: A MEDLINE search (January 1966–March 2000) of English-language literature pertaining to CNS staphylococcal infections and rifampin was performed; tertiary sources were also used. DATA EXTRACTION: Human data and case reports were included, as no clinical trials have been published. DATA SYNTHESIS: Retrospective reviews of rifampin used in combination with other antibiotics for serious bacterial infections show conflicting results. Few case reports have described clinical successes with adjunctive rifampin therapy for CNS infections. CONCLUSIONS: The routine use of adjunctive rifampin for CNS infections cannot be justified.
Unanticipated Plasma Concentrations in Two Clozapine-Treated Patients
Authors: Alfaro Cara L , McClure Robert K , Vertrees Julia E , Benavides Ray 
Published: June 2003

OBJECTIVE: To report two cases of lower than anticipated clozapine plasma concentrations despite near maximum recommended doses of clozapine 800–900 mg/d in two medication-compliant schizophrenic inpatients. CASE SUMMARIES: Clozapine therapy was initiated in two male schizophrenic inpatients for treatment of psychotic symptoms refractory to other typical and atypical antipsychotics. Despite receiving adequate doses of clozapine for at least two months, these patients remained symptomatic. Therapeutic drug monitoring was used to target a clozapine plasma concentration of ≥250 ng/mL, the minimum value reported in the literature to be associated with increased clinical response. Clozapine plasma concentrations remained at 200 ng/mL in one patient despite dosage increases from 600 to 800 mg/d. In the second patient, administration of the maximum recommended dose resulted in concentrations between 200 and 250 ng/mL. Increasing the clozapine dosage to 1000 mg/d did not increase the clozapine plasma concentration. Evaluation of the ratio of clozapine plasma concentration clozapine to dose yielded lower than expected values compared with those reported in the literature. DISCUSSION: These two patients exhibited lower than anticipated clozapine plasma concentrations despite receiving high doses of clozapine. Several studies evaluating clozapine serum concentrations and clinical response have suggested threshold concentrations of ≥350 ng/mL, ≥370 ng/mL, or ≥420 ng/mL. The only study that randomized patients to three concentration ranges found that patients who achieved a clozapine serum concentration in a medium range (mean 251 ng/mL) responded better than patients in a low range (mean 91 ng/mL) and similar to patients in a high range (mean 396 ng/mL). However, attaining plasma concentrations in this range for these patients proved difficult. Reasons for the low concentrations are unclear and may be related to increased metabolic activity at several cytochrome P450 isoenzymes involved in the metabolism of clozapine. CONCLUSIONS: These cases illustrate lower than anticipated clozapine plasma concentrations despite high-dose clozapine therapy. Strategies to increase clozapine plasma concentrations in such patients might include adding a drug to partially inhibit the metabolism of clozapine. If those strategies are unacceptable based on risk assessment, patient compliance, or other reasons, clinicians may consider addition of a low-dose typical or other atypical antipsychotic drug to augment clozapine response. PharmD, Clinical Pharmacy Specialist for the National Institute of Mental Health; Clinical Center Pharmacy Department, National Institutes of Health, Bethesda, MD