bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glimepiride: Role of a New Sulfonylurea in the Treatment of Type 2 Diabetes Mellitus
Authors: Campbell R Keith 
Published: March 2004

OBJECTIVE: To review the clinical pharmacology data regarding the sulfonylurea glimepiride, and to summarize the clinical trials of glimepiride efficacy and safety alone and in combination with insulin for the treatment of type 2 diabetes mellitus. DATA SOURCES: A MEDLINE database search (English language, January 1985–April 1997) was performed to identify relevant published articles, including reviews and abstracts; the manufacturer (Hoechst Marion Roussel, Kansas City, MO) provided unpublished data. STUDY SELECTION: Pharmacology information was taken from representative original research articles. Eight clinical studies were selected for analysis on the basis of large enrollment, appropriate study design, and publication of results. DATA EXTRACTION: All clinical trials, published and unpublished, were reviewed. DATA SYNTHESIS: Glimepiride is a sulfonylurea that is pharmacologically distinct from other sulfonylureas because of differences in receptor-binding properties and potentially selective effects on ATP-sensitive K+ channels. The pharmacokinetic and pharmacodynamic profile of glimepiride makes it suitable for once-daily dosing. The safety and efficacy of glimepiride have been confirmed in studies involving more than 5000 patients with type 2 diabetes. In one study, once-daily doses of 1–8 mg reduced fasting plasma glucose from baseline by 43–74 mg/dL more than did placebo (p < 0.001), and hemoglobin (Hb) A1C values decreased by 1.2–1.9% more than with placebo (p < 0.001). Two-thirds of patients achieved tight control (i.e., HbA1C ≤ 7.2%). Glimepiride was as effective as second-generation sulfonylureas. The most common adverse events were dizziness and headache, but no single adverse event occurred in more than 2% of patients. CONCLUSIONS: Glimepiride appears to be a useful option for patients with type 2 diabetes not controlled by diet and exercise and who want to achieve tight glucose control. Glimepiride can be used alone, in combination with other antihyperglycemic agents, or in patients with secondary sulfonylurea failure, as an adjunct to insulin therapy.
Role of Propofol in Refractory Status Epilepticus
Authors: Brown Leigh Anne , Levin Gary M 
Published: March 2004

OBJECTIVE: To provide a review of the proposed mechanism of action, clinical efficacy, adverse effects, and therapeutic considerations associated with the use of propofol in the management of patients with refractory status epilepticus. DATA SOURCES: A MEDLINE database (January 1966–April 1998) was searched for literature pertaining to status epilepticus and propofol. Additional literature was obtained from the references of selected articles identified in the search. Information from all articles published in English was considered for inclusion in the article. DATA SYNTHESIS: Propofol is a unique, nonbarbiturate, anesthetic agent possessing anticonvulsant properties, although the exact anticonvulsant mechanism is unknown. Several case reports and two small, open, uncontrolled studies have described the efficacy of propofol in refractory status epilepticus. Most of these clinical reports discuss the utility of propofol after traditional treatment regimens have failed or are not tolerated. Initiation of propofol usually resulted in termination of seizure activity and/or electroencephalographic burst suppression within seconds that was sustained during the drug's use. Additionally, propofol was well tolerated. Advantages of propofol compared with traditional barbiturate anesthetic agents include better cardiovascular tolerability and a more favorable pharmacokinetic profile, allowing for rapid assessment of efficacy and neurologic assessment upon drug withdrawal. Propofol has been associated with a variety of neuroexcitatory adverse events such as opisthotonos, muscle rigidity, and choreoathetoid movements. Additionally, although the data are inconclusive, propofol has also been reported to cause seizures. CONCLUSIONS: Propofol has shown promising results in the management of refractory status epilepticus when traditional therapies have failed or were not tolerated; however, controlled clinical trials are needed to better assess the comparative efficacy, neurologic adverse effects, and clinical outcome to better define its role in refractory status epilepticus.
A Critical Review of Selected Pharmacoeconomic Analyses of Antidepressant Therapy
Authors: Conner Therese M , Crismon M Lynn , Still Daniel J 
Published: March 2004

OBJECTIVE: To evaluate the pharmacoeconomic benefits of treating depression and compare the available therapies by reviewing the current literature on economic analyses of depression. DATA SOURCES: A MEDLINE search (January 1966–June 1998) of English-language literature relating to economic analyses of depression was conducted. Key search terms included depression, antidepressant, economics, pharmacoeconomics, outcomes, and costs. Additional literature was collected from reference lists of articles found through the MEDLINE search. STUDY SELECTION AND DATA EXTRACTION: A MEDLINE search was performed using the above key words. Search and evaluation were limited to pharmacoeconomic evaluations of major depressive disorder. All available studies were considered for inclusion in the review. DATA SYNTHESIS: The advent of newer, brand-name antidepressants as well as increased concern regarding healthcare costs has raised interest in the costs associated with treating depression. Although the selective serotonin-reuptake inhibitors (SSRIs) and other newer antidepressants have higher acquisition costs, both modeling and naturalistic studies have shown that the total cost of treating depression is no higher with SSRIs than with the tricyclic antidepressants. These differences are primarily due to increased patient adherence with the newer agents and lower costs secondary to physician visits, laboratory monitoring, and hospitalization. CONCLUSIONS: The economic aspects of treating depression are becoming more frequently evaluated as newer antidepressant medications become available and as healthcare entities attempt to address increasing costs. In general, most pharmacoeconomic research on depression has been conducted on one of the SSRIs in comparison with various tricyclic antidepressants. These studies frequently use simulation techniques and rely heavily on data from clinical trials. Few studies have compared the newer antidepressants, and no clear evidence exists that any one of these agents is more cost-effective than others. Even fewer studies have addressed the pharmacoeconomics of medication management of depression in various healthcare environments (e.g., public mental health care vs. private psychiatry vs. primary care).
Nicotine Replacement Therapy
Authors: Thompson Gwendolyn H , Hunter Dee A 
Published: March 2004

OBJECTIVE: To review the literature on nicotine dependence, nicotine pharmacology, health consequences associated with the use of nicotine, and nicotine replacement therapies used to aid smokers who are nicotine dependent. DATA SOURCES: A review of articles, book bibliographies, and published studies identified by a search of the MEDLINE database from 1982 to 1996 on nicotine dependence, nicotine addiction, nicotine withdrawal, smoking, smoking cessation, smoking intervention, nicotine pharmacology, nicotine pharmacokinetics, nicotine pharmacodynamics, and nicotine replacement therapies. STUDY SELECTION AND DATA EXTRACTION: Inclusion criteria were published randomized, double-blind trials of at least 12 weeks' duration, meta-analyses, and panel consensus guidelines. DATA SYNTHESIS: Cigarette smoking and tobacco use have met the surgeon general's primary criteria as well as additional criteria for drug dependence. Drug dependence requires that the drug produce psychoactive effects. Nicotine has been identified as the cause of tobacco dependence. First, nicotine provides positive reinforcement by stimulating nicotinic receptors to promote high self-administration rates. Second, nicotine causes a negative reinforcement in the form of withdrawal symptoms when nicotine is withheld after chronic use. Nicotine replacement therapy reduces the severity of withdrawal symptoms in smokers abstaining from tobacco. Nicotine replacement therapy allows the smoker to focus on psychosocial aspects of tobacco abstinence while receiving relief from withdrawal symptoms. The long-term effectiveness and health benefits of nicotine replacement therapy coupled with nonpharmacologic approaches have been clearly established. Smoking cessation has received wide attention from the public and medical communities; it is complex and has several interwoven factors to be considered. The psychological, behavioral, and physical components have to be understood before designing a treatment plan. The most successful approaches to smoking cessation involve multicomponent, multisession behavioral treatment programs as a foundation coupled with pharmacologic intervention. Pharmacists can play a key role in initiating behavior change and ensuring the safe and proper use of nicotine replacement in order to produce the desired outcome. CONCLUSIONS: The optimum choice in nicotine replacement depends on the individual's needs and coping abilities. Individualized nicotine replacement coupled with nonpharmacologic interventions produces the highest rate of success for abstinence from nicotine.
Seizure Associated with Olanzapine
Authors: Lee Jerry W , Crismon M Lynn , Dorson Peter G 
Published: March 2004

OBJECTIVE: To report a case of seizures in a patient who started receiving olanzapine, and to review seizure risk associated with antipsychotic use. CASE SUMMARY: A 31-year-old African-American woman with multiple psychiatric and medical disorders, including generalized seizure disorder, experienced seizure activity when switched from haloperidol to olanzapine. Olanzapine was discontinued, haloperidol was quickly titrated to the previous dose, and the patient was started on oral phenytoin with no further seizure activity noted. The patient remained seizure free and phenytoin was discontinued without complications. DISCUSSION: Determining causality in this case is complicated by the number of confounding factors that may have contributed to the occurrence of seizures in this patient. These factors include: (1) diagnosis of generalized seizure disorder, (2) diagnosis of organic mental disorder, (3) concurrent pharmacotherapy with medications implicated in lowering the seizure threshold, and (4) abrupt change in pharmacotherapy. The likelihood that a significant drug interaction precipitated seizure activity is doubtful. CONCLUSIONS: Considering all factors related to causality, the likelihood that olanzapine was responsible for precipitating seizure activity in this patient was judged possible. Although premarketing studies have indicated that olanzapine may be associated with minimal seizure liability, this case serves as a reminder that postmarketing surveillance of newly released medications is essential.
ACE Inhibitor—Versus Angiotensin II Blocker–Induced Cough and Angioedema
Authors: Pylypchuk George B 
Published: March 2004

OBJECTIVE: To compare the tolerability of angiotensin-converting enzyme (ACE) inhibitors with that of angiotensin II (AII)-receptor blockers and the incidence of cough and angioedema associated with their use through review of published data. DATA SOURCES: References were identified through a MEDLINE search of articles published between January 1975 and April 1997. Bibliographies of pertinent references were also reviewed. RESULTS: Results of placebo-controlled and comparative trials of the AII blockers demonstrate that they are at least as effective as ACE inhibitors for hypertension, but exhibit an incidence of cough and absent or rare angioedema like that of placebo. CONCLUSIONS: In the 10 comparative trials described, all reported a lower incidence of cough with AII blockers than with ACE inhibitors. Angioedema was not reported in the comparative trials described.
Compatibility and Stability of Paclitaxel Combined with Doxorubicin Hydrochloride in Infusion Solutions
Authors: Trissel Lawrence A , Xu Quanyun A , Gilbert Doward L 
Published: March 2004

OBJECTIVE: To evaluate the physical compatibility and chemical stability of paclitaxel at concentrations of 300 and 1200 μg/mL with doxorubicin hydrochloride 200 μg/mL in NaCl 0.9% injection and dextrose 5% injection over 7 days at 4, 23, and 32 °C. DESIGN: The test samples were prepared in polyolefin bags of the infusion solutions at the required drug concentrations. Evaluations were performed initially and after 4 hours, and 1, 3, 5, and 7 days of storage at 4, 23, and 32 °C for physical and chemical stability. Physical stability was assessed by using visual observation in normal fluorescent light and a high-intensity monodirectional light beam. In addition, turbidity and particle content were measured electronically. Chemical stability of the two drugs was evaluated by using two stability-indicating HPLC analytic techniques. RESULTS: All samples were physically stable through 1 day. However, microcrystalline precipitation of paclitaxel occurred within 3 days in some samples and within 5 days in all samples. Paclitaxel concentrations remained at more than 97% in all samples throughout the study. Doxorubicin hydrochloride also was stable throughout the study period, remaining above 90% in all samples at all storage temperatures. CONCLUSIONS: Admixtures of paclitaxel 300 and 1200 μg/mL with doxorubicin hydrochloride are limited in their utility time by paclitaxel microcrystalline precipitation. All combinations were physically and chemically stable for at least 24 hours at 4, 23, and 32 °C.
Novel Antipsychotics and Patient Care in State Hospitals
Authors: Buckley Peter F 
Published: March 2004

OBJECTIVE: To review and highlight the opportunities and challenges of pharmacologic advances in the use of antipsychotics for the state hospital system. METHODS: A critical review was performed of studies published either as articles or abstracts, on the use of novel antipsychotics, particularly as they relate to the patient population within the state mental hospital system. FINDINGS: The recent availability of new antipsychotic medications within state facilities has resulted in more progressive treatment, reduced recidivism (and consequently cost savings), and preliminary evidence of preferential and superior treatment response in specific patient subgroups (e.g., those with aggression). At the same time, inpatient pharmacy budget increases and uncertainty in guiding the use of novel antipsychotics have influenced the availability of these agents in state hospitals. CONCLUSIONS: State hospital services have, by and large, embraced the developments in pharmacotherapy of schizophrenia. Optimal use of these new agents in this population requires additional information on their relative efficacy in specific patient subgroups.
Successful Vancomycin Desensitization in a Patient with End-Stage Renal Disease and Anaphylactic Shock to Vancomycin
Authors: Sorensen Suellyn J , Wise Steven L , Al-Tawfiq Jaffar A , Robb Jon L , Cushing Herbert E 
Published: March 2004

OBJECTIVE: To report successful desensitization in a patient with a history of end-stage renal disease (ESRD) and anaphylactic shock after receiving vancomycin. CASE SUMMARY: A 47-year-old white woman with a history of ESRD was admitted to the hospital reporting persistent nausea, vomiting, and diffuse abdominal pain. She had developed anaphylactic shock after exposure to vancomycin 3 years prior to this hospitalization. The patient's hospital course was complicated by septic shock and positive blood cultures for methicillin-resistant Staphylococcus epidermidis. The patient tolerated vancomycin desensitization and received intravenous vancomycin 100 mg/d for 21 days. DISCUSSION: The desensitization protocol used in this report allows for gradual increases in vancomycin serum concentrations, avoiding peak and trough concentrations that occur with intravenous boluses. Maintaining the desensitized state is dependent on the continuous presence of the antigen with a return of clinical sensitivity after drug discontinuation. The vancomycin desensitization protocol and subsequent dosing strategy was used to ensure the continuous presence of vancomycin at steady-state concentrations to prevent the return of anaphylactic sensitivity. CONCLUSIONS: Desensitization was successful in a patient with ESRD and history of anaphylactic shock to vancomycin.
The Medication Information Line for the Elderly: An 8-Year Cumulative Analysis
Authors: Grymonpre Ruby E , Steele John W 
Published: March 2004

OBJECTIVE: To present an 8-year (1985–1992) cumulative analysis of the 12 743 calls received by the Medication Information Line for the Elderly (MILE), a consumer-oriented drug information service. DESIGN: Data on all calls received by MILE were documented using a standard format. Certain calls were selected by the pharmacist for follow-up based on the nature and predicted severity of the inquiry. SETTING: MILE is located within the Faculty of Pharmacy of the University of Manitoba and staffed by experienced, practicing pharmacists. Calls were received from the elderly and their care providers. Calls were initially taken on a local Winnipeg line, although in 1987 a toll-free number was made available to rural Manitoba residents. RESULTS: The majority of the calls received by MILE were from women aged 65 years or older who accessed MILE on their own initiative. Ninety-one percent of the calls were rated as not serious. Only 6% of calls were from outside Winnipeg. Although 94% of the older consumers reported having a regular pharmacist, they commonly never thought of using their pharmacist for inquiries. The drugs cited most often by consumers, nurses, physicians, and dentists were the nonsteroidal antiinflammatory agents, cardiac drugs, diuretics, antihypertensives, benzodiazepines, and antidepressants. The types of inquiries most frequently involved adverse drug reactions, drug interactions, and therapeutic use. The drugs cited and inquiries made by pharmacist callers were more diverse than those of consumers and other healthcare professionals. CONCLUSIONS: Many older drug consumers have medication information needs that are not being met. Since a large proportion of the callers appeared to be self-motivated women, MILE may not be accessing all older consumers in need of information. This analysis also suggests that many older consumers are not aware that the pharmacist is available and capable of providing drug information.
Health Behaviors and Pharmacotherapy
Authors: Kehoe William A , Katz Roger C 
Published: March 2004

OBJECTIVE: To review factors related to health beliefs and behavior that affect treatment adherence, and to suggest behavioral strategies for improving adherence. DATA SOURCES: We conducted MEDLINE and PSYHLIT (January 1966–October 1997) searches of English-language literature pertaining to behavioral medicine and health behavior as they relate to treatment adherence. Additional articles from these sources and reference texts were identified. DATA EXTRACTION: All articles and chapters identified were considered. The most pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: Health care is moving into an era of disease management, and practitioners will be called upon to help patients change health-related behaviors and to improve adherence to treatment. Fundamental to this new paradigm of practice is an understanding of behavior, its relationship to health, and methods by which it can be altered. Current concepts of health behavior have been heavily influenced by social learning theory, self-efficacy theory, and a biopsychosocial view of health and disease. The intent of this review is to provide clinicians with an overview of factors that affect health-related behaviors, as well as suggestions for helping patients to improve them. As illustrations, behavioral interventions used in patients with asthma are presented. CONCLUSIONS: Adherence to treatment recommendations depends on a complex interplay of many psychological variables. An understanding of these factors, and how behavioral techniques may be used, will help healthcare providers to assist patients in improving adherence.
Medication Bezoars: A Literature Review and Report of a Case
Authors: Taylor James R , Streetman Daniel S , Castle Sharon S 
Published: March 2004

OBJECTIVE: To describe a case of a medication bezoar and to review the clinical presentation, diagnosis, risk factors, pathogenesis, complications, and treatment of medication bezoars. DATA SOURCES AND STUDY SELECTION: A MEDLINE search (January 1966–December 1997) of the English-language literature pertaining to bezoars was performed. These articles were scanned, and literature specifically discussing medication bezoars was selected. Additionally, the reference sections of pertinent review and case reports were scanned for additional relevant literature. DATA SYNTHESIS: Bezoars are concretions of foreign material within the body. In the case of medication bezoars, these concretions occur within the digestive tract and are composed of medications and/or medication vehicles. Rarely, however, is bezoar formation solely due to a medication. In nearly all reported cases the patient had one or more significant risk factors that contributed to bezoar formation. The exact method by which medication bezoars form is dependent on the particular type or combination of medications involved. Bezoar formation may be associated with significant complications for the patient due to the presence of the bezoar and because of the effects of the medication within the bezoar. Treatment of medication bezoars depends largely on the location and the cause of the bezoar. CONCLUSIONS: Medication bezoars are a rare but potentially serious complication of medication use in certain patients. These patients often present with signs and symptoms consistent with an obstruction of the gastrointestinal tract and represent an even greater diagnostic challenge due to the rarity of this complication. These patients also face significant complications from both the bezoar and the medication within the bezoar. To date, treatment of medication bezoars involves mainly physical manipulation of the bezoar through lavage, endoscopic removal, or, in most cases, surgical removal.