bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dispensing Error Leading to Alendronate Ingestion
Authors: Carrière Benoit , Bailey Benoit , Chabot Gilles , Lebel Denis 
Published: June 2003

OBJECTIVE To report a case of medication dispensing error by administration of similarly packaged drugs. CASE SUMMARY A 6-year-old East Indian boy with asthma was mistakenly given alendronate, a bisphosphonate, for 3 months instead of montelukast, a leukotriene-receptor antagonist. Symptoms of esophageal irritation developed and disappeared on discontinuation of alendronate. DISCUSSION Alendronate and montelukast have very similar packaging and are available in dosages that also can be similar for some patients. Alendronate caused symptoms of irritative gastritis in this child before the error was identified. This case report emphasizes one of the possible sources of medication dispensing errors: a mistaken identification due to similar packaging (confirmation bias). Manufacturers can help to prevent medication errors in many ways; in this case, more distinct packaging would have decreased the risk of error. A standard bar-coding scheme among manufacturers could lead to an important improvement in the safety of medication dispensation. Practitioners are also encouraged to report such errors to the United States Pharmacopoeia Medication Errors Reporting Program. CONCLUSIONS With increased awareness of medication errors, healthcare practitioners, manufacturers, and patients should take precautionary steps to prevent dispensing errors and their consequences.
Pseudodementia Associated with Use of Ibuprofen
Authors: Bernstein Allan L , Werlin Ann 
Published: June 2003

OBJECTIVE To report a case of dementing syndrome resulting from ibuprofen use. CASE SUMMARY A 76-year-old white man with normal mental status became confused, was lost in familiar places, and showed short-term memory loss after beginning a therapeutic regimen of ibuprofen 600 mg 3 times daily for osteoarthritis in anticipation of embarking on a foreign trip. Symptoms of dementia began within 1 week after taking ibuprofen and resolved completely within 1 week after the ibuprofen regimen was stopped. This pattern was repeated 6 months later, when the patient again traveled abroad. Consistently before, during, and after these events, the patient took atenolol, clonidine, lisinopril, aspirin, vitamin C, lecithin, vitamin E, and multivitamins. DISCUSSION Using the Naranjo probability scale, we reasoned that the patient's dementia-like syndrome could be attributed to the use of ibuprofen because pseudodementia appeared after the suspected drug was administered, improved when the drug was discontinued, reappeared when the drug was readministered, had no apparent alternative cause, manifested similarly after each exposure to ibuprofen, and was confirmed by the family's observation after both episodes. Objective causality assessment revealed that the adverse drug reaction was probable. CONCLUSIONS Use of ibuprofen must be considered during clinical evaluation of any patient with new onset of dementing illness. The Naranjo probability scale may be clinically useful for evaluating other pharmaceutical agents that may be contributing to development of dementia-like conditions.
Possible Anaphylaxis after Propofol in a Child with Food Allergy
Authors: Hofer Kristi N , McCarthy Michelle W , Buck Marcia L , Hendrick Anne E 
Published: June 2003

OBJECTIVE: To report a case of anaphylaxis due to propofol in a child with allergies to egg and peanut oil. CASE SUMMARY: A 14-month-old boy with a history of reactive airway disease was hospitalized for treatment of respiratory symptoms. The patient had documented allergies to egg, peanut oil, and mold. Within the first few hours after admission, acute respiratory decompensation occurred, and arrangements were made to transfer the patient to our tertiary-care hospital. Prior to transfer, he was emergently intubated under sedation and paralysis with propofol and rocuronium. When emergency air transport arrived, the patient was hypotensive and tachycardic. His symptoms of anaphylaxis were managed throughout the flight and, upon arrival at our institution, the patient was admitted to the Pediatric Intensive Care Unit. He improved over a 5-day hospital course, and his caregivers were instructed to avoid propofol in the future. The patient's anaphylactic reaction following propofol was rated as a possible adverse drug reaction using the Naranjo probability scale. DISCUSSION: The use of propofol in pediatric patients for procedural sedation has gained increased favor. Since the propofol formulation contains both egg lecithin and soybean oil, its use is contraindicated in patients with hypersensitivities to these components. Several other drugs have a food component, resulting in contraindications and warnings in product labeling. CONCLUSIONS: Propofol should be avoided in patients with allergies to egg and/or soybean oil, if possible. Clinicians should consider the potential for adverse drug events in patients with select food allergies.
Combination Risperidone and SSRI–Induced Serotonin Syndrome
Authors: Karki Shyam D , Masood Gule-Rana 
Published: June 2003

OBJECTIVE: To report 2 cases of serotonin syndrome associated with combined therapy of risperidone and selective serotonin-reuptake inhibitors (SSRIs) in elderly patients. CASE SUMMARIES: An 86-year-old white man was admitted to the emergency department because of increased confusion and generalized weakness over the past several days. His medication history indicated paroxetine 10 mg/d and risperidone 0.25 mg/d. The patient's confusion worsened and underwent acute changes that resembled delirium. He was placed in a geri chair and he became extremely agitated. He was then treated with escalating doses of risperidone. The patient died on day 5 of admission, at which time he was being treated with risperidone 2–3 mg/d. A 78-year-old white female nursing home resident was admitted to the emergency department because of increased confusion and generalized weakness. She was being treated with paroxetine for depression and risperidone for agitation. Her risperidone dose was increased to manage agitation. The patient's agitation worsened with increasing doses of risperidone; she developed tremor, dizziness, and muscle incoordination. After psychopharmacologic consultation, the risperidone and paroxetine were discontinued and she was treated with lorazepam. The patient recovered, returned to baseline status in 2 days, and was later transferred back to the nursing home. DISCUSSION: We believe that in both cases, serotonin syndrome was precipitated by risperidone in combination with SSRI antidepressants. A literature search indicated one report of serotonin syndrome with a combination of risperidone and paroxetine. CONCLUSIONS: An objective causality assessment revealed that the adverse drug event was probable in the first patient and definite in the second patient. We caution clinicians treating elderly patients with combined risperidone and SSRIs to include serotonin syndrome in differential diagnosis if the patient is showing signs of increasing agitation with escalating doses of risperidone.
Flumazenil and Dialysis for Gabapentin-Induced Coma
Authors: Butler Toni C , Rosen Raquel M , Wallace Allison L , Amsden Guy W 
Published: June 2003

OBJECTIVE To describe a case of gabapentin-induced coma that was reversed with flumazenil and hemodialysis. CASE SUMMARY We describe an 83-year-old dialysis-dependent white man who became comatose after a single dose of gabapentin for phantom limb pain. The patient was successfully revived from the coma with administration of flumazenil, which was then followed by hemodialysis. Serum concentration data before and 4 hours after dialysis document the effectiveness of hemodialysis for gabapentin toxicity. DISCUSSION An objective causality assessment revealed that this adverse event was probably related to the gabapentin that the patient received. To our knowledge, this is the first documented case of not only gabapentin-induced coma, but also the effectiveness of flumazenil for treatment of this type of coma. Although therapeutic hemodialysis has been previously described, our case report is strengthened by the serum concentration monitoring accompanying it. CONCLUSIONS This report underscores the importance of initiating gabapentin therapy at low doses in dialysis-dependent patients and introduces a novel treatment for those who experience toxicity.
Ramipril for the Prevention and Treatment of Cardiovascular Disease
Authors: Vuong April D , Annis Laura G 
Published: June 2003

OBJECTIVE: To evaluate the effectiveness of ramipril in the prevention and treatment of cardiovascular disease and determine its need for inclusion on a formulary. DATA SOURCES: A MEDLINE and PubMed database search was conducted (1987–May 2002). Only journals written in the English language were selected for review. DATA EXTRACTION AND STUDY SELECTION: Articles reporting the use of ramipril in humans were evaluated. Emphasis was placed on randomized, controlled trials assessing efficacy. DATA SYNTHESIS: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor that exerts its effects through inhibition of the renin–angiotensin–aldosterone system. It exhibits a safety profile that is similar to that of other ACE inhibitors and is comparable in cost to the majority of the available agents. Clinical trials have proven the effectiveness of ACE inhibitors in the treatment of hypertension, heart failure, and nephropathy. Ramipril, however, is the only ACE inhibitor currently approved for the prevention of cardiovascular events in high-risk patients without evidence of left-ventricular dysfunction or heart failure, based on the results of the HOPE (Heart Outcomes Prevention Evaluation) trial. Whether this effect is specific to ramipril has yet to be proven. This article emphasizes the major trials involving ramipril including the AIRE (Acute Infarction Ramipril Efficacy), REIN (Ramipril Efficacy in Nephropathy), and HOPE trials. CONCLUSIONS: Although similar to other ACE inhibitors in many aspects, it cannot be assumed that the benefits shown with ramipril in the HOPE trial are a class effect. Ongoing trials should help to clarify this matter. Until this time, current evidence justifies the inclusion of ramipril on a formulary.
Ipratropium Treatment of Acute Airways Disease
Authors: Peterson Gregory M , Boyles Peter J , Bleasel Martin D , Vial Janet H 
Published: June 2003

OBJECTIVE: To examine the use of ipratropium bromide in adults with acute exacerbation of either asthma or chronic obstructive pulmonary disease (COPD) during admission and at discharge from 3 teaching hospitals. METHODS: An extensive range of clinical and demographic data was retrospectively extracted from the medical records of consecutive patients aged ≥12 years admitted to the medical wards of the hospitals during 1999–2001 with acute exacerbations of asthma or COPD, either as a primary diagnosis or as a major comorbidity. RESULTS: Data were gathered for 302 patients (97 with asthma, 205 with COPD). Almost 90% of all patients received ipratropium bromide during their hospital admission. The indication for using ipratropium bromide during hospitalization was considered appropriate in 84% of the asthma patients and 68% of the COPD patients. Over 20% of the patients with asthma had been using ipratropium bromide prior to the hospital admission, and almost one-third of the patients with asthma were discharged with ipratropium bromide, even though its role in chronic asthma is limited. More than 90% of the patients received nebulized drug therapy during their hospital stay, with 41% being prescribed nebulized therapy at discharge. This was often considered inappropriate, given that >50% of all patients had been using inhaler devices and nebulizers concurrently while hospitalized. CONCLUSIONS: In the majority of cases, ipratropium bromide had been used during hospitalization in accordance with guidelines for the management of acute exacerbations of asthma or COPD. However, there was also evidence of potentially inappropriate prolonged use of the agent in the community setting, particularly for asthma. Also of concern was the relatively high use of nebulized drug therapy when delivery via other means was appropriate.
Psychosis Associated with Interferon Alfa Therapy for Chronic Hepatitis B
Authors: Tamam Lut , Yerdelen Deniz , Ozpoyraz Nurgul 
Published: June 2003

OBJECTIVE: To report a case of persistent psychosis that developed during interferon alfa (IFN-α) therapy for chronic hepatitis B. CASE SUMMARY: A 26-year-old man who was diagnosed with active chronic hepatitis B began treatment with IFN-α. Five months after initiation of therapy, he developed acute psychosis with prominent persecutory delusions and auditory hallucinations. Despite discontinuation of IFN-α therapy and addition of antipsychotic drug treatment, only partial recovery from psychosis was observed after 4 months of hospitalization. DISCUSSION: Unlike many previously reported cases, this patient showed only partial recovery from psychosis, despite the discontinuation of IFN therapy. Except for receiving a relatively high dose of IFN-α (10 million units 3 times/wk), the patient did not have any previously proposed risk factors for developing psychiatric adverse effects. The Naranjo probability scale indicates a probable relationship between the acute psychosis and IFN therapy. CONCLUSIONS: Despite its rare occurrence, psychosis can emerge during IFN-α therapy. This adverse effect may persist for several months, even after appropriate medical management. IFN-α should be used with careful monitoring of patients' psychiatric status during all stages of therapy.
Recurrent Cholestasis Due to Ampicillin
Authors: Köklü Seyfettin , Yüksel Osman , Filik Levent , Üsküdar Oğuz , Altundağ Kadri , Altiparmak Emin 
Published: June 2003

OBJECTIVE: To present a single case of ampicillin-induced recurrent cholestasis and a literature review. CASE SUMMARY: A 23-year-old man was hospitalized due to recurrent and self-limited cholestatic symptoms. He had used ampicillin before each cholestatic attack. He became well clinically and biochemically each time after cessation of the drug. One year after his recovery and discontinuance of ampicillin, the patient has had no recurrence of cholestasis. An objective causality assessment revealed that the adverse drug reaction was probable. DISCUSSION: Ampicillin-related hepatotoxicity is very rare, with injury being mainly hepatocellular. To our knowledge, there is only 1 case report in the literature referring to chronic cholestatic-type hepatotoxicity related to ampicillin. CONCLUSIONS: Ampicillin, which is one of the most widely used antibiotics, may cause recurrent cholestatic hepatitis. Clinicians should be aware of this adverse effect, and it should be kept in mind during diagnostic workup of liver injury.
Bioterrorism Web Sites for Pharmacists
Authors: Misita Caron P , Boosinger Andrea B , Kendrach Michael G 
Published: June 2003

OBJECTIVE To identify Internet Web sites for ease of accessibility to bioterrorism-related information, comprehensive provision of bioterrorism-related information, and provision of bioterrorism information that specifically pertains to the pharmacy profession. DATA SOURCES Web sites of national pharmacy organizations, US government agencies, and medical organizations, as well as Web sites related to bioterrorism. DATA SYNTHESIS Pharmacists need access to relevant bioterrorism information in a timely manner. An evaluation of Web sites was performed to identify those that include a discussion of the potential infectious microorganisms and prevention and treatment methods, as well as unique features for pharmacy practice. RESULTS The American Society of Health-System Pharmacists and American Pharmaceutical Association Web sites provide pharmacy-specific recommendations. The Centers for Disease Control and Prevention provides biological agent information and health department contact numbers. Additional agent-specific data are provided by the American Medical Association, The Johns Hopkins University, and the Food and Drug Administration (FDA) Web sites. Information addressing food safety is provided by the FDA. CONCLUSIONS Pharmacy-specific bioterrorism information is available only at selected national pharmacy organization Internet Web sites. However, other Web sites provide comprehensive bioterrorism information useful for pharmacists.
Possible Captopril-Induced Toxic Epidermal Necrolysis
Authors: Alkurtass Delal A , Al-Jazairi Abdulrazaq S 
Published: June 2003

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) possibly induced by captopril. CASE SUMMARY: An 11-week-old boy was referred to our hospital for tetrology of fallot surgical repair, performed on admission day 2. On day 3, the patient developed third-degree heart block, necessitating pacemaker connection and oral theophylline 3 mg/kg 3 times daily. Captopril 1 mg orally twice daily, intravenous furosemide 7 mg every 12 hours, and oral aldactone 7 mg twice daily were started. On day 5, the patient developed scaling erythematous skin lesions. On day 7, his temperature spiked to 37.8 °C, and pus discharge from the pacing wire site was noticed. Intravenous vancomycin 80 mg 3 times daily and intravenous ceftazidime 200 mg 3 times daily were initiated. On the same day, captopril was discontinued because we suspected that it had induced the skin reaction. On day 15, the infant's skin problem progressed. The dermatologist diagnosed partial TEN. On that day, theophylline and furosemide were also discontinued. On day 16, the patient still had some blisters, but the skin started to show signs of healing, until complete healing occurred on day 22. The infant was discharged on oral medications: furosemide 7 mg twice daily, aldactone 7 mg twice daily, and enalapril 0.1 mg twice daily. Three weeks later, he was followed up. No recurrences were observed. CONCLUSIONS: This case suggests captopril induces TEN when combined with other sulfonamide medications. An objective causality assessment revealed that the adverse drug event was possible. Although it is a rare complication, healthcare providers should be familiar with its potential to occur and take appropriate treatment and prevention measures.
Self‐discrepancy in body dysmorphic disorder
Authors: Veale David , Kinderman Peter , Riley Susan , Lambrou Christina 
Published: June 2003

Objectives: According to self‐discrepancy theory (SDT), depression, social anxiety, eating disorders and paranoia result from different types of conflicting self‐beliefs. Body dysmorphic disorder (BDD) consists of a preoccupation with imagined or slight defects in one's appearance, which is often associated with a depressed mood and social anxiety. SDT was therefore applied to BDD patients to further understand their beliefs about their appearance.Design: Using a comparative group design, BDD patients were compared against a non‐patient control group.Method: A sample of 149 participants, consisting of three groups ‐ BDD (72), BDD preoccupied with their weight and shape (35), and controls (42) ‐ completed a modified version of the Selves Questionnaire (Higgins, Bond, Klein, & Strauman, 1986) requiring them to list and rate physical characteristics according to the following standpoints: (a) self‐actual; (b) self‐ideal; (c) self‐should; (d) other‐actual; and (e) other‐ideal.Results: BDD patients displayed significant discrepancies between their self‐actual and both their self‐ideal and self‐should. However, there were no significant discrepancies in BDD patients between their self‐actual and other‐actual or other‐ideal domains. Analysis of variance using depression and social anxiety scores as covariates revealed a significant difference for both the self‐ideal and self‐should discrepancy.Conclusion: The results suggest that BDD patients have an unrealistic ideal or demand as to how they should look. BDD patients are more like depressed patients (rather than social phobics or bulimics), being more concerned with a failure to achieve their own aesthetic standard than with the perceived ideals of others.
Effects of Rofecoxib or Naproxen vs Placebo on Alzheimer Disease Progression
Authors: Aisen Paul S. , Schafer Kimberly A. , Grundman Michael , Pfeiffer Eric , Sano Mary , Davis Kenneth L. , Farlow Martin R. , Jin Shelia , Thomas Ronald G. , Thal Leon J. ,   for the Alzheimer's Disease Cooperative Study
Published: June 2003

ContextLaboratory evidence that inflammatory mechanisms contribute to neuronal injury in Alzheimer disease (AD), along with epidemiological evidence, suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) may favorably influence the course of the disease.ObjectiveTo determine whether treatment with a selective cyclooxygenase (COX) -2 inhibitor (rofecoxib) or a traditional nonselective NSAID (naproxen) slows cognitive decline in patients with mild-to-moderate AD.DesignMulticenter, randomized, double-blind, placebo-controlled, parallel group trial, with 1-year exposure to study medications.SettingForty ambulatory treatment centers affiliated with the Alzheimer's Disease Cooperative Study consortium.ParticipantsParticipants with mild-to-moderate AD (Mini-Mental State Examination score of 13-26) were recruited from December 1999 to November 2000 using clinic populations, referrals from community physicians, and local advertising. Stable use of cholinesterase inhibitors, estrogen, low-dose aspirin, and vitamin E was allowed. Participants with inflammatory diseases that might respond to the study medications were excluded. Of 474 participants screened, 351 were enrolled.InterventionsOnce-daily rofecoxib, 25 mg, or twice-daily naproxen sodium, 220 mg, or placebo.Main Outcome MeasuresThe primary outcome measure was the 1-year change in the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score. Secondary outcome measures included the Clinical Dementia Rating scale sum-of-boxes, the Neuropsychiatric Inventory, the Quality of Life-AD, and the time to attainment of significant end points (4-point decline from baseline ADAS-Cog score, 1-step worsening on the global Clinical Dementia Rating scale, 15-point decline on the ADCS activities of daily living inventory, institutionalization, or death).ResultsThe 1-year mean (SD) change in ADAS-Cog scores in participants treated with naproxen (5.8 [8.0]) or rofecoxib (7.6 [7.7]) was not significantly different from the change in participants treated with placebo (5.7 [8.2]). Results of secondary analyses showed no consistent benefit of either treatment. Fatigue, dizziness, and hypertension were more commonly reported in the active drug groups, and more serious adverse events were found in the active treatment group than in the placebo group.ConclusionThe results of this study indicate that rofecoxib or low-dose naproxen does not slow cognitive decline in patients with mild-to-moderate AD.
Ultra‐Low‐Loss Acrylate Polymers for Planar Light Circuits
Authors: Shacklette L.W. , Blomquist R. , Deng J.M. , Ferm P.M. , Maxfield M. , Mato J. , Zou H. 
Published: June 2003

AbstractWe have developed a materials system composed of liquid multifunctional fluorinated acrylate monomers that achieves very low absorption losses within both datacom and telecom wavelength ranges. Identified structure–property relationships have guided the design of polymers that are optimized with respect to their inherent materials properties and their ability to be processed into low‐loss optical waveguides. Together these co‐developed materials and processes combine to produce waveguides that have propagation losses equivalent to planar glass guides, and significantly reduced polarization dependence and improved thermal response needed for the performance of thermo‐optic devices. Extensive environmental studies have demonstrated robustness well beyond that required for normal operating conditions.