bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rhabdomyolysis and HMG-CoA Reductase Inhibitors
Authors: Omar Mohamed A , Wilson James P , Cox Tamara S 
Published: June 2003

OBJECTIVE: To review rhabdomyolysis and discuss the role of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) and their interactions with other agents in precipitating this condition, and to present case reports of statin-induced rhabdomyolysis. DATA SOURCE: Relevant clinical literature was accessed using MEDLINE (January 1985–October 2000). The following search terms were used: rhabdomyolysis, adverse events, drug interactions, statins, and HMG-CoA reductase inhibitors. DISCUSSION: Rhabdomyolysis occurs when extensive muscle damage results in the release of cellular contents into systemic circulation. Major complications include acute renal failure, cardiac abnormalities, and compartment syndrome. Treatment of rhabdomyolysis is supportive, with the primary aim of preventing renal and cardiac complications. Statin monotherapy or combination therapy may result in myopathy, which rarely progresses to rhabdomyolysis. The mechanism for drug interactions with the statins involves their property of lipid or water solubility. This characteristic determines the degree of hepatoenteric or renal metabolism of the statins. All statins except pravastatin undergo metabolism via the cytochrome P450 enzyme system. Other pharmacologic agents that are also metabolized via this pathway may interact with the statins and cause rhabdomyolysis. The risk of statin-induced rhabdomyolysis is increased significantly when statins are used concomitantly with such drugs as fibrates, cyclosporine, macrolide antibiotics, and azole antifungals. CONCLUSIONS: Rhabdomyolysis is a rare but clinically important adverse event of statin monotherapy or combination therapy. Thorough understanding of this condition may help prevent or minimize adverse health outcomes in patients receiving statin therapy.
Corticotropin for Acute Management of Gout
Authors: Taylor Charles T , Brooks Natalie C , Kelley Kristi W 
Published: June 2003

OBJECTIVE: To evaluate safety and efficacy of corticotropin for acute gout. DATA SOURCES: Clinical literature was accessed through MEDLINE (1966–August 2000). Key search terms included gout, ACTH, adrenocorticotropic hormone, and corticotropin. DATA SYNTHESIS: Joint pain and local signs of inflammation characterize gout. Acutely, colchicine and nonsteroidal antiinflammatory drugs (NSAIDs) are first-line therapy. Adverse effects or concomitant diseases limit therapy and necessitate alternative options. An evaluation of studies involving corticotropin was conducted. CONCLUSIONS: Corticotropin alone or in combination with colchicine was more rapidly effective and associated with fewer adverse effects than indomethacin. This regimen may be considered an alternative, especially for patients with medical problems in which other regimens are contraindicated.
Hepatotoxicity Associated with Carvedilol
Authors: Hagmeyer Kathleen O , Stein Jenny 
Published: June 2003

OBJECTIVE: To report a severe episode of pruritus and elevated serum transaminases in a patient who was receiving carvedilol. CASE SUMMARY: A 40-year-old white man who had been taking carvedilol for the treatment of cardiomyopathy presented to the emergency department with pruritus over his entire body. Laboratory tests showed elevated serum transaminases. Carvedilol was discontinued and the patient received hydroxyzine hydrochloride to relieve symptoms. Liver function test results returned to normal in three weeks. Approximately one year later the patient was started on metoprolol and within 10 days again developed pruritus. The patient was told to discontinue the metoprolol immediately. At the time the metoprolol was stopped the liver function test results were normal. DISCUSSION: To the best of our knowledge, the adverse reaction presented in this case report is rare. The etiology of this adverse reaction remains unknown but suggests a possible adverse reaction that may recur if the patient is switched to another β-adrenergic blocker. The liver function test abnormalities appear to return to normal on discontinuation of carvedilol. CONCLUSIONS: Carvedilol may cause pruritus and elevated liver function test results. This reaction may recur if the patient is changed to an alternative β-adrenergic blocker. Patients taking carvedilol should be monitored for signs and symptoms of hepatotoxicity. If elevated liver function test results are noted, carvedilol should be discontinued.
Amphotericin B — Not So Terrible
Authors: Bishara Jihad , Weinberger Miriam , Lin Annica Y , Pitlik Silvio 
Published: June 2003

OBJECTIVE: To describe a patient who developed adverse reactions to two different lipid formulations of amphotericin B: liposomal amphotericin B (AmBisome) and amphotericin B colloidal dispersion (ABCD, Amphocil), yet tolerated amphotericin B deoxycholate (Fungizone) despite renal toxicity. CASE SUMMARY: A 72-year-old woman with acute myelomonocytic leukemia was treated with amphotericin B deoxycholate for suspected pulmonary aspergillosis; the drug was well tolerated but resulted in renal failure. Antifungal therapy was then changed to liposomal amphotericin B. Within 10 minutes of liposomal amphotericin B infusion, the patient developed severe dyspnea, chest pain, and a feeling of imminent death. On the following day, liposomal amphotericin B was switched to amphotericin B colloidal dispersion. Again, within 10 minutes of this infusion, the patient developed fever, chills, hypotension, severe chest pain, dsypnea, and a feeling of imminent death. The patient refused any further treatment with these drugs and insisted on switching back to amphotericin B deoxycholate, which was then administered for 10 days and was well tolerated. DISCUSSION: Severe adverse reactions, such as anaphylaxis, cardiac toxicity, and respiratory failure, following administration of all three lipid formulations of amphotericin B have been reported. In most reported cases, switching to a different lipid formulation of amphotericin B was well tolerated. This is in contrast to our case, where a severe reaction was repeated when another lipid preparation was given, necessitating switching back to amphotericin B deoxycholate despite its nephrotoxicity. CONCLUSIONS: In some patients, paradoxically, lipid formulations of amphotericin B may be less tolerable than conventional amphotericin B.
Newness of Drugs and Use of HMO Services by Asthma Patients
Authors: Horn Susan D , Sharkey Phoebe D , Kelly H William , Uden Donald L 
Published: June 2003

OBJECTIVE: To define newness of drug technology and show associations between two measures of newness and health service utilization. METHODS: Healthcare use and changes in severity at each office visit were assessed for 1309 asthma patients from six health maintenance organizations (HMOs) during 1992. The age of each drug product, derived by subtracting its Food and Drug Administration (FDA) approval date from January 1, 1992, was used to construct two newness measures: the average age of all asthma drugs and, separately, all non-asthma drugs a patient used during the year and the percentages of a patient's asthma drugs from each of four time intervals of asthma drug breakthroughs. Service utilization variables included all primary care provider (PCP) visits, total prescription costs, emergency department (ED) visits, and hospitalizations. RESULTS: Using either measure of drug newness, multivariate analyses showed an association between greater use of newer asthma drugs and lower overall drug costs and fewer PCP visits. A trend was found between greater use of newer asthma drugs and fewer hospitalizations and ED visits. Newer non-asthma medications were associated with fewer ED visits. CONCLUSIONS: After controlling for patient and site variables, greater use of newer asthma drugs was associated with significantly lower drug costs and fewer PCP visits; associations with hospitalization rates and ED visits, although lower, were not significant.
Antimicrobial Cycling: The Future or a Fad?
Authors: Hodges Brian M , White Roger L 
Published: June 2003

OBJECTIVE: To assess the current evidence of the value of cycling of antimicrobials to control the emergence of resistance or to reverse existing resistance to antimicrobials. DATA SOURCES: Articles were obtained through a MEDLINE search of the English-language literature from 1966 to January 2000. Additionally, references from retrieved publications were reviewed to identify further articles. STUDY SELECTION AND DATA EXTRACTION: All investigations of switching between or cycling among antimicrobials were evaluated. Studies switching between or cycling among specific drugs or classes of drugs within institutional settings were included in this review. DATA SYNTHESIS: Studies involving cycling among different aminoglycosides suggest that, although temporary decreases in resistance can be documented, resistance usually rebounds rapidly on completion of the cycle and return to the original agent. Switching between classes of antimicrobials has produced inconsistent results and has been shown to replace resistance to one agent with resistance to another. Mathematical models using both in vitro and clinical data have suggested that, due to residual resistance in the population, cycling among drug classes is unlikely to yield long-term reductions in antimicrobial resistance, especially if a high level of antimicrobial resistance exists. CONCLUSIONS: Cycling among different antimicrobials to reverse resistance trends is currently not supported by published literature. Cycling to prevent the emergence of resistance may ultimately be more useful; however, no studies have evaluated this concept. Well-designed prospective studies are needed to evaluate the potential clinical value of antimicrobial cycling.
Pharmacokinetics of Morphine and its Glucuronidated Metabolites in Burn Injuries
Authors: Perreault Sylvie , Choinière Manon , Souich Patrick B du , Bellavance François , Beauregard Gilles 
Published: June 2003

OBJECTIVE: To investigate the effects of major thermal burn injury and continuous intravenous morphine infusion on the disposition of morphine and its glucuronidated metabolites, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) once a week for three weeks. CASE SUMMARIES: Five patients with major first-, second-, or third-degree burn injuries received long-term intravenous morphine infusion. The required dose varied greatly (from 4 to 39.5 mg/h). The steady-state concentrations of morphine, M3G, and M6G ranged from 20 to 452, 29 to 3436, and 20 to 1240 μmol/L, respectively. The systemic clearance (Cls) of morphine ranged from 14.8 to 40.3 mL/min/kg and did not change over time. The ratios of M6G and M3G to morphine were not affected by dose, even with the wide variation of intravenous dosage. Morphine kinetics appeared to be first-order. Mean recovery of morphine, M3G, and M6G in urine was 1.7 ± 1.0%, 42.0 ± 16.8%, and 11.8 ± 3.2%, respectively, and renal clearance ranged from 8 to 64, 26 to 325, and 59 to 589 mL/min, respectively. Mean pain intensity ratings at rest remained low and stable (0.7 ± 0.9 on day 7, 0.4 ± 0.3 on day 14, 0 ± 0 on day 21). DISCUSSION: To our knowledge, this is the first published report describing morphine, M3G, and M6G disposition in patients with major thermal burn injury. The Cls of morphine is similar to that observed in other patient populations and healthy subjects, suggesting that the presence of major burn injuries or a continuous morphine infusion over a three-week period may not contribute significantly to the variability among individuals. In these cases, the renal clearance of morphine and its glucuronides was within the range of values reported for other populations of patients and healthy subjects. Recovery of morphine and its glucuronides in urine was also similar to that in healthy individuals. CONCLUSIONS: These cases suggest that the effects of major burn injuries and of long-term intravenous infusion of morphine did not seem to modify morphine, M3G, and M6G disposition. Among patients with burn injuries, the severity of burns or duration of administration are not a cause of nonlinear kinetic of morphine or of morphine resistance. The morphine infusion rate was substantially variable and not directly related to its clearance, suggesting that monitoring of morphine should be focused on the clinical response.
Cilostazol for Prevention of Thrombosis and Restenosis after Intracoronary Stenting
Authors: El-Beyrouty Claudine , Spinler Sarah A 
Published: June 2003

OBJECTIVE: To evaluate the potential use of cilostazol in intracoronary stenting. DATA SOURCES: Clinical literature was accessed through MEDLINE (1966–March 2001). Key search terms included cilostazol, intracoronary stenting, and coronary angioplasty. Abstracts of clinical trials presented at major cardiology professional association meetings were also reviewed. DATA SYNTHESIS: Intracoronary stent placement represents the fastest growing medical device implant. Complications of stent implantation include acute and subacute vessel closure, as well as late restenosis. Currently, antiplatelet agents are used for preventive therapy. Cilostazol is a vasodilating antiplatelet agent that reversibly inhibits platelet aggregation induced by many factors. In seven randomized trials comparing cilostazol with either aspirin or ticlopidine, cilostazol was found to be superior to aspirin and equivalent to ticlopidine in decreasing both cardiac events and rates of restenosis. In addition, cilostazol was found to be well tolerated, with no reports of adverse hematologic events. CONCLUSIONS: Although further comparative trials are required, cilostazol appears to be a safe and effective alternative to clopidogrel and glycoprotein IIb/IIIa receptor antagonists following intracoronary stent implantation.
Effects of Soy Phytoestrogens Genistein and Daidzein on Breast Cancer Growth
Authors: de Lemos Mário L 
Published: June 2003

OBJECTIVE: To determine whether genistein and daidzein, the major phytoestrogens in soy, can stimulate breast cancer growth. DATA SYNTHESIS: Systematic search through primary English-language literature on MEDLINE (1966–January 2001), EMBASE (1982–January 2001) and Current Contents (1998–January 2001). DATA SOURCES: Genistein and daidzein at low concentrations were found to stimulate breast tumor growth in in vitro and in vivo animal studies, and antagonize the antitumor effect of tamoxifen in vitro. At high concentrations, genistein inhibited tumor growth and enhanced the effect of tamoxifen in vitro. CONCLUSIONS: Genistein and daidzein may stimulate existing breast tumor growth and antagonize the effects of tamoxifen. Women with current or past breast cancer should be aware of the risks of potential tumor growth when taking soy products.
Pharmacotherapy Consultation on Polypharmacy Patients in Ambulatory Care
Authors: Jameson John P , VanNoord Glenn R 
Published: June 2003

OBJECTIVE: To investigate actual cost and adverse effect outcomes associated with a pharmacotherapy consultation in ambulatory care patients receiving polypharmacy. METHODS: Patients receiving five or more chronic medications were randomized to receive pharmacotherapy consultation or usual medical care. Outcomes measured were changes in drug costs, medical costs, and drug-related symptoms six months after the consultation. Data were analyzed with unpaired Student's t-test for continuous data. χ2 Analysis was used for categorical data. Patients and physicians were surveyed about their perceptions of the consultations after the study period. RESULTS: Drug and medical costs did not differ before and after the consultation. More patients in the consultation group had adverse symptom scores improve by two or more points, and fewer had symptom scores worsen by two or more points than in the control group. Seventy percent of patients and 76% of physicians believed that the consult was beneficial. CONCLUSIONS: Polypharmacy patients are the most likely to have drug-related problems and require intervention. Of all the interventions performed in this study, 73% of the original problems were recognized only through a patient interview, suggesting that an interpersonal relationship remains critical to the provision of pharmaceutical care. Although patients and physicians see intuitive value in pharmaceutical care, pharmacists need to exert more energy in the direction of marketing the profession. Finally, there are numerous difficulties in measuring the benefits of these interventions, possibly making broad-based interventions in complicated patients too difficult to assess accurately. Future studies should focus on patients with limited, specific problems or on interventions with narrow goals.
Amphotericin B—Induced Seizures in a Patient with AIDS
Authors: Aruna Augustine S , AL-Samarrai Shatha A , AL-Humaidan Abdullah S 
Published: June 2003

OBJECTIVE: To report a case of multiple episodes of seizure activity in an AIDS patient following amphotericin B infusion. CASE SUMMARY: A 46-year-old African-American man experienced recurrent grand mal seizures during intravenous infusion of amphotericin B, then petit mal seizures as the infusion was stopped and the drug concentrations decreased with time. The patient's concurrent medications included didanosine, hydroxyzine, promethazine, hydrocortisone, and prochlorperazine. Despite administration of phenytoin and lorazepam, the seizures persisted and occurred only during amphotericin B administration. DISCUSSION: AIDS and cryptococcal meningitis, both of which the patient had, can potentially cause seizures. The patient had a history of alcohol abuse; alcohol intake as well as withdrawal can also cause seizures. Didanosine also has a potential for inducing seizures. However, these other potential causes of seizure were ruled out. The time course of events suggested that amphotericin B was the cause of the seizures in this AIDS patient. CONCLUSIONS: Amphotericin B seems to be the probable cause of the seizures. To date, only three cases of seizures associated with amphotericin B have been reported in the literature, but healthcare providers should be aware of the potential for this rare adverse effect.
Tacrolimus in Dermatologic Disorders
Authors: Skaehill Penny A 
Published: June 2003

OBJECTIVE: To review the data surrounding the use of tacrolimus for skin disorders. DATA SOURCES: Articles were obtained through a MEDLINE search of English-language literature (1990–May 2000); references of the retrieved publications were further reviewed for relevant literature. STUDY SELECTION: Original studies in humans regarding the use of tacrolimus for skin disorders were included. DATA EXTRACTION: The major outcomes extracted from the literature involved patient response to therapy and adverse effects. DATA SYNTHESIS: Tacrolimus offers an additional therapeutic approach to the treatment of immunologically based skin disorders. Controlled trials and case reports indicate topical tacrolimus is a safe and effective alternative treatment in patients with atopic dermatitis. Case reports document efficacy in recalcitrant pyoderma gangrenosum, mucosal lichen planus, and ichthyosis linearis circumflexa. Controlled trials and case reports indicate oral tacrolimus is effective in recalcitrant plaque psoriasis. Case reports document efficacy in recalcitrant pyoderma gangrenosum and leukocytoclastic vasculitis. The clinical utility of oral tacrolimus in skin disorders is limited due to potentially severe adverse effects such as infections, hypertension, hyperglycemia, hyperkalemia, nephrotoxicity, neurotoxicity, and increased risk of neoplasia. CONCLUSIONS: Most of the available data indicate short-term (3 wk to 3 mo) topical tacrolimus is a safe and effective treatment alternative for inflammatory skin disorders. Further study is needed to evaluate long-term safety and efficacy and to determine the best dosage regimen. Although oral tacrolimus has demonstrated efficacy in inflammatory skin disorders, the potential for serious adverse effects limits its utility to third-line therapy for patients who are resistant to, or intolerant of, conventional therapies.
Intravenous Itraconazole
Authors: Slain Douglas , Rogers P David , Cleary John D , Chapman Stanley W 
Published: June 2003

OBJECTIVE: To review the pharmacology, mycology, chemistry, pharmacokinetics, efficacy, safety, tolerability, dosage, administration, and economic issues of intravenous itraconazole. DATA SOURCES: A MEDLINE search from 1978 to June 2000 of the English-language literature and an extensive review of meeting abstracts was conducted. Due to the paucity of published information concerning the pharmacokinetics, efficacy, and safety of the intravenous formulation of intravenous itraconazole, additional information was obtained from the manufacturer. DATA EXTRACTION: Data from in vitro and preclinical studies, as well as Phase II and III clinical trials, were included. DATA SYNTHESIS: The triazole antifungal agent itraconazole is available in a cyclodextrin-based intravenous formulation. Intravenous itraconazole is indicated for the treatment of pulmonary and extrapulmonary blastomycosis; histoplasmosis, including chronic cavitary pulmonary disease and disseminated, nonmeningeal histoplasmosis; and pulmonary and extrapulmonary aspergillosis in patients who are intolerant of or who are refractory to amphotericin B. This formulation provides quicker and more consistent therapeutic concentrations than the oral formulations. Clinical data comparing the efficacy of intravenous itraconazole with that of amphotericin B are lacking. CONCLUSIONS: Intravenous itraconazole offers a less toxic alternative for patients with pulmonary and extrapulmonary blastomycosis, histoplasmosis, and aspergillosis who cannot receive oral medications or who are intolerant of or refractory to amphotericin B.
Topical Phenytoin Treatment of Stage II Decubitus Ulcers in the Elderly
Authors: Rhodes Richard S , Heyneman Catherine A , Culbertson Vaughn L , Wilson Susan E , Phatak Hemant M 
Published: June 2003

OBJECTIVE: To compare the healing of stage II decubitus ulcers with topically applied phenytoin sodium with two other standard topical treatment procedures in a long-term care setting; and to assess the extent of systemic absorption after topical application in the phenytoin group. METHODS: Forty-seven nursing home patients with stage II decubitus ulcers were chosen for this study. The patients were matched for age, gender, and size and severity of wounds, and randomly assigned to each treatment group. Clinical assessment of decubitus ulcers was performed at the beginning of treatment and at each dressing change. Ulcers were examined for the presence of healthy granulation tissue, reduction in surface dimensions, and time to healing. Two phenytoin sodium plasma concentrations were to be obtained on all patients in the phenytoin group. RESULTS: Topical phenytoin therapy resulted in a shorter time to complete healing and formation of granulation tissue when compared with DuoDerm dressings or triple antibiotic ointment applications (p ⩽ 0.05). The mean ± SD time to healing in the phenytoin group was 35.3 ± 14.3 days compared with 51.8 ± 19.6 and 53.8 ± 8.5 days for the DuoDerm and triple antibiotic ointment groups, respectively. Healthy granulation tissue in the phenytoin group appeared within two to seven days in all subjects. Patients in the standard treatment groups required six to 21 days to produce new granulation tissue. Serum phenytoin sodium concentrations were nondetectable. No patient withdrew from the study secondary to adverse treatment effects. CONCLUSIONS: Both the phenytoin and standard treatment groups showed progress over the study period. However, the phenytoin group demonstrated more rapid results in all aspects of ulcer healing.