bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethnic Differences in Antihypertensive Medication Use in the Elderly
Authors: Raji Mukaila A , Kuo Yong-Fang , Salazar Joel A , Satish Shiva , Goodwin James S 
Published: January 2004

BACKGROUND Determining the optimal treatment for hypertension in very old patients requires better understanding of interethnic differences in patterns and predictors of antihypertensive drug use in this population. OBJECTIVE To investigate interethnic variations in antihypertensive drug use in a triethnic sample of community-dwelling adults aged ≥77 years. METHODS We performed a cross-sectional study of non-Hispanic white, black, and Hispanic adults ≥77 years old residing in Galveston County, TX. In-home interviews in 1997 and 1998 assessed blood pressures and antihypertensive medication use in 281 subjects who reported having hypertension or who had a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. RESULTS Of the population evaluated, 62.9% of non-Hispanic whites, 60.2% of blacks, and 45.2% of Hispanics with hypertension were on antihypertensive medications (p < 0.027 across the ethnic groups). After adjusting for age, gender, years of education, household income, Medicaid insurance, number of physician visits, and cognitive function, Hispanic ethnicity, unlike black ethnicity, continued to be significantly associated with lower use of antihypertensive drugs compared with non-Hispanic whites (OR 0.41; 95% CI 0.19 to 0.90). Characteristics associated with the lower use of antihypertensive drugs included older age and low income in whites, poor cognition and infrequent physician visits in blacks, and lack of Medicaid insurance in Hispanics. CONCLUSIONS In the elderly, Hispanic ethnicity, unlike black ethnicity, is significantly associated with lower use of antihypertensive drug therapy compared with non-Hispanic white ethnicity, adjusting for relevant sociodemographic and health factors.
Ginger-Associated Overanticoagulation by Phenprocoumon
Authors: Krüth Patricia , Brosi Eberhard , Fux Richard , Mörike Klaus , Gleiter Christoph H 
Published: January 2004

OBJECTIVE To report a case of ginger–phenprocoumon interaction resulting in an elevated international normalized ratio (INR) and epistaxis. CASE SUMMARY A 76-year-old white European woman on long-term phenprocoumon therapy with an INR within the therapeutic range began using ginger products. Several weeks later, she developed an elevated INR up to 10 and epistaxis. The INR returned to the normal range after ginger was stopped and vitamin K1 was given. DISCUSSION There have been a number of investigations resulting in conflicting opinions on the effect of ginger on hemostasis, specifically, platelet inhibition. Nevertheless, based on these investigations, recommendations have been issued to refrain from ingesting ginger and other herbals like garlic or ginkgo biloba in situations where bleeding may be critical. An objective causality assessment revealed that the adverse drug event as a result of the phenprocoumon and ginger interaction was probable. CONCLUSIONS As of writing, this was the first case report that may support an interaction between an oral anticoagulant and ginger together with a brief review of the literature on ginger and hemostasis. As this interaction was observed only by chance, this case highlights the importance of self-control of anticoagulation with coumarins particularly for the detection of unknown interactions.
Measurement, Correlates, and Health Outcomes of Medication Adherence Among Seniors
Authors: Vik Shelly A , Maxwell Colleen J , Hogan David B 
Published: January 2004

OBJECTIVE To provide a comprehensive review of the literature on the measurement, correlates, and health outcomes of medication adherence among community-dwelling older adults. DATA SOURCES Searches of MEDLINE, PubMed, and International Pharmaceutical Abstracts databases for English-language literature (1966–December 2002) were conducted using one or more of the following terms: elderly, adherence/nonadherence, compliance/noncompliance, medication/drug, methodology/measurement, and hospitalization. STUDY SELECTION AND DATA EXTRACTION From the above search, studies of medication adherence in community-dwelling seniors were selected for review along with relevant publications from the reference lists of articles identified in the initial database search. DATA SYNTHESIS Although several methods are available for the assessment of adherence, accurate measurement continues to be difficult. The available evidence suggests that polypharmacy and poor patient–healthcare provider relationships (including the use of multiple providers) may be major determinants of nonadherence among older persons, with the impact of most sociodemographic factors being negligible. There is little consensus regarding other determinants of nonadherence. Relatively few high-quality investigations have examined the associations between nonadherence and subsequent health outcomes. Available data provide some support for increased health risks with nonadherence. However, interventions to improve adherence have seldom demonstrated positive effects on health outcomes. CONCLUSIONS There are few empirical data to support a simple systematic descriptor of the nonadherent patient. The inconsistencies across studies may be attributable, in part, to the inherent difficulties involved in the measurement of a behavioral risk factor such as nonadherence. Future research in this area would be strengthened by incorporation of detailed assessments of patient-reported reasons for nonadherence, the appropriateness of drug regimens, and the effect of nonadherence on health outcomes.
Involvement of Immunization-Certified Pharmacists with Immunization Activities
Authors: Neuhauser Melinda M , Wiley Danielle , Simpson Lynn , Garey Kevin W 
Published: January 2004

BACKGROUND Immunization certification courses allow pharmacists to directly administer vaccines to their patients. However, the demographics and level of immunization involvement of immunization-certified pharmacists compared with those noncertified are unknown. OBJECTIVE To document the demographics, professional activities, and job satisfaction of immunization-certified pharmacists compared with pharmacists not certified for immunization. METHODS In a cross-sectional pilot study, immunization-certified pharmacists were compared with noncertified pharmacists via a postal-mailed questionnaire. The questionnaire consisted of demographic and practice site characteristics, involvement in immunization services, and a job satisfaction survey. RESULTS Response rates were 48% (n = 101) and 36% (n = 158) for immunization-certified and noncertified pharmacists, respectively. Significantly more certified pharmacists were involved in immunizations (99% vs 24%; p < 0.001). Desire to improve the health care of the public and personal satisfaction were important factors that encouraged pharmacists to become certified to administer vaccines. Seventy-four percent of immunization-certified pharmacists directly administered the vaccines, primarily influenza (96%), pneumococcal (77%), hepatitis (55%), and diphtheria, pertussis, tetanus (19%). Adequate training, time, support from management and staff, and liability coverage were important factors that allowed pharmacists to incorporate immunizations into their practice. No significant differences in job satisfaction were observed between immunization-certified and noncertified pharmacists. CONCLUSIONS Immunization-certified pharmacists are using their skills to administer vaccines to patients within their communities. Efforts to increase the number of these pharmacists throughout the US should be undertaken.
Warfarin Initiation and Monitoring with Clotting Factors II, VII, and X
Authors: Trask Ashley S , Gosselin Robert C , Diaz Jaime A , Dager William E 
Published: January 2004

OBJECTIVE To report a case of a patient with antiphospholipid antibody syndrome and multiple thromboses who developed heparin-induced thrombocytopenia (HIT) and subsequent international normalized ratio (INR) prolongation possibly due to antiphospholipid antibodies. CASE SUMMARY A 56-year-old white woman with a history of antiphospholipid antibody syndrome and thrombosis taking chronic warfarin was admitted for gastrointestinal concerns and found to have an INR >14. Warfarin was discontinued, vitamin K was administered, and a heparin infusion was initiated. Over the next 2 days, thrombocytopenia, hypotension, tachycardia, hyponatremia, and progressive abdominal pain developed. Upon transfer to a tertiary care center, HIT was diagnosed, and a lepirudin infusion was initiated. Subsequently, a sudden elevation of the INR occurred (>14) with low prothrombin (factor II) activity. After INR values declined to 2–3, warfarin was reinitiated with dosing adjusted using factor X and II activity levels. Clotting factors II and X activities were measured to monitor long-term warfarin therapy, with no evidence of complications after 7 months. DISCUSSION Typically, the INR is used to assess the intensity of anticoagulation. The INR value represents the reduction of clotting factors II, VII, and X. In rare circumstances, an independent inhibitor or interfering substance can interfere with the process of measuring the INR. In such situations, an alternative approach can be direct measurement of clotting factor concentrations. CONCLUSIONS Factor II and/or factor X activity levels provided an alternative means for measuring the anticoagulant effects of warfarin in the presence of a significant inhibitor (antiphospholipid antibodies) that biased the INR measurements.
Acenocoumarol-Induced Henoch-Schönlein Purpura
Authors: Borrás-Blasco Joaquín , Girona Eva , Navarro-Ruiz Andrés , Matarredona Jaime , Giménez María Encarnación , Gutiérrez Ana , Enriquez Ricardo , Martinez Antonio 
Published: January 2004

OBJECTIVE To report a probable case of Henoch-Schönlein purpura associated with acenocoumarol therapy. CASE SUMMARY A 76-year-old white woman was prescribed acenocoumarol for chronic atrial fibrillation. Two months after starting therapy, the patient came to our hospital's emergency department because of abdominal pain associated with vomiting. Physical examination revealed multiple round, confluent, purpuric lesions with some vesicles and an area of residual pigmentation. Lesions were present predominantly on the legs and gluteus, and also on the abdomen and arms. Skin biopsy of the lesions was compatible with leukocytoclastic vasculitis with deposition of immunoglobulin A. An upper intestinal endoscopy was done and identified purpuric mucosal lesions in the fundus, body, and antrum of the stomach and the duodenal bulb. Renal function was not affected, although proteinuria (1.26 g/day) was found and microscopic hematuria was observed. DISCUSSION The most likely cause of the Henoch–Schönlein purpura in this case was considered to be acenocoumarol because of the close temporal relationship between exposure to the drug and onset of symptoms, as well as the rapid resolution of the symptoms and signs after acenocoumarol was discontinued. The oral anticoagulant was the only identifiable precipitant that the patient encountered before the Henoch–Schönlein purpura developed. An objective causality assessment revealed that the adverse drug event was probable. CONCLUSIONS This case report illustrates a probable association between Henoch–Schönlein purpura and acenocoumarol. As of December 2003, this reaction had not been previously reported. Clinicians should be aware of this potential adverse effect of a widely used drug.
Metabolic Bone Disease After Chronic Antacid Administration in an Infant
Authors: Robinson Renee F , Casavant Marcel J , Nahata Milap C , Mahan John D 
Published: January 2004

OBJECTIVE To describe a case of hypophosphatemia and metabolic bone disease (MBD) due to aluminum-containing antacids. CASE SUMMARY An 8-month-old white boy was brought to the emergency department due to irritability and pain with movement. Upon examination, the infant was irritable, unable to bear weight, had palpable clavicular bony lesions, point tenderness of the hips, and poor head control. The infant had lost several developmental milestones over the past 4 months (eg, ability to roll over) and had decreased appetite and minimal weight gain. Skeletal survey revealed multiple rib fractures, osteoporosis, and Ricketts. Hypophosphatemia (2.3 mg/dL; normal 3.2–6.3) and an elevated serum aluminum level (14 μg/L, normal 0–9) were noted. Past medical history was positive for gastroesophageal reflux. He had been started on ranitidine and aluminum hydroxide (1/2 teaspoonful per 6-ounce bottle) at 2 months of age. The infant's formula contained elevated aluminum levels. Further investigation showed that 1/2 tablespoonful instead of 1/2 teaspoonful of antacid had been added to each 6-ounce formula bottle for the prior 6 months; only 1 month of antacid therapy had been recommended. An objective causality assessment revealed a probable adverse drug event. DISCUSSION Phosphate-binding substances such as aluminum-containing antacids can bind large amounts of phosphorus, causing hypophosphatemia and MBD. CONCLUSIONS We report this case to increase awareness of the risk of hypophosphatemia and MBD (likely aluminum related) with use of over-the-counter aluminum-containing antacids in pediatrics, as well as the hazards of prescribing doses in “spoonful” units.
Rhabdomyolysis and Renal Failure Associated with Gemfibrozil Monotherapy
Authors: Layne Richard D , Sehbai Aasim S , Stark Linda J 
Published: January 2004

OBJECTIVE To report a case of rhabdomyolysis and acute renal failure associated with gemfibrozil monotherapy of hyperlipidemia. CASE SUMMARY A 30-year-old white man with hypertension, type 1 diabetes mellitus, and hyperlipidemia was hospitalized due to myalgias, nausea, and vomiting that began after he started working as a jackhammer operator 4 days previously. His medications were lisinopril, aspirin, insulin, and gemfibrozil. Creatine kinase and creatinine, which previously had been mildly elevated and normal, respectively, were markedly elevated, consistent with rhabdomyolysis with acute renal failure. DISCUSSION As of December 8, 2003, this is the only report of a patient with normal baseline creatinine level who developed rhabdomyolysis with acute renal failure associated with gemfibrozil monotherapy. Strenuous exertion, hypovolemia, and lisinopril use may have contributed to the severity of illness. An objective causality assessment revealed that an adverse drug reaction to gemfibrozil was possible. CONCLUSIONS Gemfibrozil monotherapy of hyperlipidemia may predispose to rhabdomyolysis with acute renal failure. Patients using gemfibrozil should be cautioned regarding strenuous exertion, dehydration, and the need for prompt evaluation of myalgias.
Low-Molecular-Weight Heparin–Induced Thrombocytopenia in a Child
Authors: Dager William E , White Richard H 
Published: January 2004

OBJECTIVE To report a case of probable acute venous thrombosis caused by heparin-induced thrombocytopenia (HIT) in a pediatric patient with a normal platelet count after prolonged enoxaparin therapy. CASE SUMMARY An 11-year-old African American female with Crohn's disease developed extensive vena cava thrombosis. Her deep vein thrombosis (DVT) was treated with intravenous unfractionated heparin followed by extended outpatient warfarin therapy. Four months later, the warfarin was stopped and subcutaneous enoxaparin 1.5 mg/kg once daily was substituted prior to an elective colonoscopy. She was readmitted 6 weeks later with acute DVT with a platelet count of 233 × 10 3 /mm 3 , significantly lower than the count of 550–700 × 10 3 /mm 3 5 months previously and the count of 433 × 10 3 /mm 3 3 months earlier. An enzyme-linked immunosorbent assay for heparin-platelet factor 4 antibodies was strongly positive and a d-dimer was elevated at 2.9 mg/L (normal <1.5). She was treated with lepirudin followed by warfarin when repeat d-dimer on day 3 was normal. An ultrasound at that time showed no clot extension, and the platelet count had risen to >300 × 10 3 /mm 3 . Over the next 4 months, there was no further thrombosis. DISCUSSION HIT appears to be rare in the pediatric population, and only a few cases treated with a direct thrombin inhibitor have been reported. This is the first case report to our knowledge of a pediatric patient developing HIT secondary to enoxaparin. An interesting feature of this case is the development of HIT in the face of a normal platelet count, which is rare but has been reported in adults. CONCLUSIONS Pediatric patients receiving low-molecular-weight heparin are still at risk for developing HIT. Treatment of HIT should involve the initial use of a direct thrombin inhibitor to manage thrombosis until the platelet count returns to higher values. Once the platelet count returns, warfarin can be used for long-term thrombosis management.
Herbals and Asthma: Usage Patterns Among a Border Population
Authors: Rivera José O , Hughes Harold W , Stuart Armando González 
Published: January 2004

BACKGROUND The use of herbal products (HP) is rising in the US. Higher rates of HP use have been documented in the US/Mexico border population, as well as increasing concerns about herbal-related adverse events. OBJECTIVE To evaluate the prevalence of HP use in adult asthmatic patients requiring hospitalization and the frequency of HP documentation in medical records. METHODS We conducted a retrospective chart review of admissions for asthma to determine the frequency of HP documentation. Additionally, during a 12-month period, a bilingual interviewer conducted prospective, semistructured interviews with patients with asthma exacerbations to record data on HPs used specifically for the treatment of asthma. RESULTS A total of 67 cases were chart-reviewed retrospectively; 60 patients were interviewed prospectively. We found no documentation of HP use by chart review, while prospective interviews showed that 42% of patients reported using HPs for the treatment of asthma. The most common HPs used were oregano 28%, chamomile 20%, garlic 16%, eucalyptus 12%, and lime 12%. Ten patients reported taking an HP that could potentially exacerbate their asthma and 18 patients reported using an HP that could interact with other medications or cause other types of adverse events. CONCLUSIONS An obvious lack of documentation for HP use was observed in the medical records reviewed. Because a number of HPs that are commonly used by residents along the border can interact with antiasthmatic agents and/or result in compromised asthma control, questions about HP use should be included in routine history taking.
Transfer of Risperidone and 9-Hydroxyrisperidone into Human Milk
Authors: Ilett Kenneth F , Hackett L Peter , Kristensen Judith H , Vaddadi Krishna S , Gardiner Sharon J , Begg Evan J 
Published: January 2004

OBJECTIVE To quantify the transfer of risperidone and its active metabolite 9-hydroxyrisperidone into breast milk, estimate the amount the infant receives, measure infant plasma concentrations, and clinically assess the safety of breast feeding during maternal risperidone administration. CASE SUMMARIES The transfer of risperidone and 9-hydroxyrisperidone into milk was studied in 2 breast-feeding women and one woman with risperidone-induced galactorrhea. Plasma samples were available from 2 of the women and from both breast-fed infants. The milk/plasma concentration ratio determined in 2 women was <0.5 for both compounds. The calculated relative infant “doses” were 2.3%, 2.8%, and 4.7% (as risperidone equivalents) of the maternal weight-adjusted doses. Risperidone and 9-hydroxyrisperidone were not detected in the plasma of the 2 breast-fed infants studied, and no adverse effects were noted. DISCUSSION Risperidone therapy is sometimes necessary in breast-feeding women, raising the issue of safety in the exposed infants. Our study shows that the relative infant dose is lower than the arbitrary 10% level of concern. The data provide clear guidance on infant exposure for the cases presented. CONCLUSIONS Maternal risperidone therapy is unlikely to be a significant hazard for the breast-fed infant in the short term. Nevertheless, decisions on whether a woman may breast-feed should be made as an individual risk-benefit analysis.
Recurrent Ibuprofen-Induced Aseptic Meningitis
Authors: Nguyen Huy TV , Juurlink David N 
Published: January 2004

OBJECTIVE To report a case of recurrent aseptic meningitis temporally associated with the use of ibuprofen. CASE SUMMARY A previously well 51-year-old white man presented with acute confusion and aphasia 7 days after taking a variety of nonprescription medications, including ibuprofen. Imaging of the brain was unremarkable, and lumbar puncture revealed lymphocytic pleocytosis with an elevated protein level. The symptoms improved shortly after admission, and no infectious cause was identified. Two weeks later, the patient was readmitted with similar symptoms beginning immediately after resumption of ibuprofen. His symptoms resolved promptly after ibuprofen was discontinued. DISCUSSION Drug-induced aseptic meningitis is an unusual complication of drug therapy. Nonsteroidal antiinflammatory drugs (NSAIDs), particularly ibuprofen, are among the most commonly implicated agents, but rechallenge with the suspected agent is uncommon. Use of an objective causality tool indicated a probable relationship between ibuprofen and development of aseptic meningitis in our patient. CONCLUSION Clinicians should consider NSAIDs as potential causes of aseptic meningitis, especially in patients with recurrent illness and no obvious infectious cause. A detailed drug history is invaluable in the assessment of such patients, with particular attention to nonprescription medications such as ibuprofen.
Possible Gatifloxacin-Induced Seizure
Authors: Quigley Carrie A , Lederman Janet R 
Published: January 2004

OBJECTIVE To report a case of seizure activity following gatifloxacin administration during treatment of urosepsis in an intensive care unit. CASE SUMMARY An 86-year-old African American male nursing home resident with a history of hypertension and cerebrovascular accident with aphasia was initiated on gatifloxacin therapy for treatment of urosepsis. After 2 intravenous doses (400 mg followed 24 h later with 200 mg), he developed 2 generalized seizures lasting <2 minutes each. Gatifloxacin was discontinued, and the patient was switched to ceftazidime. Phenytoin was initiated, and no recurrent seizures were witnessed. DISCUSSION Fluoroquinolones have been shown to induce seizures or decrease seizure threshold. The majority of reports include older-generation fluoroquinolones such as ofloxacin. The incidence of seizures associated with fluoroquinolones varies among the individual agents and is relatively rare. Risk factors include increased age, compromised renal function, history of seizures, and coadministration with theophylline or nonsteroidal antiinflammatory drugs. Application of an objective causality scale indicates the seizures in our patient were possibly associated with gatifloxacin. CONCLUSIONS This case of gatifloxacin-induced seizures may reflect a class-effect phenomenon versus an effect caused by an individual fluoroquinolone. Caution is warranted when using these agents in patients at risk for drug-induced seizures.