Drug intelligence & clinical pharmacy最新文献

{"title":"Predicting caffeine plasma concentrations resulting from consumption of food or beverages: a simple method and its origin.","authors":"R W Pfeifer,&nbsp;R E Notari","doi":"10.1177/106002808802201204","DOIUrl":"https://doi.org/10.1177/106002808802201204","url":null,"abstract":"<p><p>Multiple dosage regimens for therapeutic agents are commonly comprised of a constant dosing interval and a constant dose size. This is not true for the ingestion of a pharmacologically active agent that is a component in a dietary source. Caffeine is contained in foods and beverages that are regular components of the diet for many people. Because daily intake is unsystematic, a computer program was written to simulate caffeine plasma concentration-time courses following ingestion of variable amounts on irregular schedules. Literature values for caffeine pharmacokinetics, for the caffeine content in various foods and beverages, and for consumer habits were employed to simulate various caffeine plasma concentration-time courses. By searching for predictable traits in a wide variety of plasma concentration-time courses representing normal adults, a simple noncomputer method was developed to allow individuals to estimate caffeine plasma concentrations based on personal intake habits. Changes in the time courses due to smoking, oral contraceptive use, and liver disease, all of which alter caffeine pharmacokinetics, were also examined.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 12","pages":"953-9"},"PeriodicalIF":0.0,"publicationDate":"1988-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14370237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syringe infusion pump versus gravity-feed minibottle: evaluation of systems.","authors":"R J Baptista,&nbsp;D F Driscoll","doi":"10.1177/106002808802201219","DOIUrl":"https://doi.org/10.1177/106002808802201219","url":null,"abstract":"betes mellitus, and a focal seizuredisorder secondary to a previous infarct of the left frontoparietal region. Her daughters added that she had been unusually lethargic and had not been following a consistent diet. Her chief complaint at the time of admission consisted of seeing worms in her stools as well as having worms \"crawl out her nose and mouth.\" She also noted the presence of \"strange sounds coming from the back of the house\" which were later unsubstantiated. Her medications consisted of captopril ISO mg/d, clonidine 0.6 mg/d, aspirin 325 mg/d, dipyridamole 225 rng/d, glyburide 25 mg/d, and phenytoin 400 mg/d. Due to the patient's mental condition, compliance was difficult to assess. Steady-state phenytoin concentrations were not monitored on an outpatient basis, and there was no evidenceor prior history of alcohol or substance abuse. Upon admission, physical examination revealed a well-developed, mildly obese Mexican-American woman in no acute distress. She was cooperative but complained of seeingworms in her clothes. Blood pressure was 164170mm Hg; pulse 72 beats/min and regular; respiration 16 breaths/min; and temperature 37°C. Laboratory values were phenytoin 36.2I'g/ml (normal 10-20); vitamin B\" 498 pg/ml (normal 220-749); and folic acid 5.6 ng/ml (normal 1.7-15.5). A serial multiple analysis was unremarkable with the exception of a mildly elevated aspartate aminotransferase and alkaline phosphatase. A complete blood cell count was within normal limits and urinalysis was negative. There was no evidenceof nystagmus or ataxia and she denied diplopia. Thyroid function was normal, as well as morning and evening serum cortisol levels. The patient was hospitalized and preadmission medications, other than phenytoin, were resumed. Stool was tested for ova and parasites and was negative. An electroencephalogram recorded no abnormalities and a computed tomography scan of the head recorded the prior infarction. Over the subsequent days her mental status gradually improved. Serum phenytoin concentrations were further evaluated on hospital days 3and 4 with the results reported as 24and 221'g/ ml, respectively. A psychiatric consultation was performed on day 2. The patient did not experience any psychomotor abnormalities. Mood was appropriate and thinking was logical and coherent. There was no evidenceof a psychotic process. She denied auditory and visual hallucinations except for residual delusions regarding worms in her stool. She described psychosocial stressors, including her 81· year-old husband's alcohol abuse and questions of a daughter's drug use. The patient was diagnosed with delerium secondary to phenytoin toxicity with no further treatment indicated. Shewas discharged on day 4 in good condition with follow-up of her mental status to be conducted by the consulting psychiatrist. Phenytoin was withheld on discharge. Reynolds' and Herberg' identified several predisposing factors to chronic phenytoin toxicity, such as multiple drug use, age","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 12","pages":"1004-5"},"PeriodicalIF":0.0,"publicationDate":"1988-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14370232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin-associated exfoliative dermatitis during continuous ambulatory peritoneal dialysis.","authors":"M B Gutfeld,&nbsp;P V Reddy,&nbsp;G D Morse","doi":"10.1177/106002808802201109","DOIUrl":"https://doi.org/10.1177/106002808802201109","url":null,"abstract":"<p><p>Vancomycin is commonly prescribed to patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for catheter-related infections and acute episodes of peritonitis. Although adverse dermatological reactions have been reported secondary to the rapid intravenous infusion of vancomycin, the intraperitoneal route of administration has been used routinely during CAPD without these effects. This case report describes a CAPD patient with systemic lupus erythematosus who developed erythema multiforme that progressed to exfoliative dermatitis during intermittent intraperitoneal vancomycin therapy for a catheter-related exit-site/tunnel infection.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"881-2"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14112599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral administration of IgG in marrow transplant recipients.","authors":"E A Copelan,&nbsp;T Bechtel,&nbsp;N C Featheringham,&nbsp;M M Grose,&nbsp;D D Sedmak,&nbsp;N Kapoor,&nbsp;P J Tutschka","doi":"10.1177/106002808802201119","DOIUrl":"https://doi.org/10.1177/106002808802201119","url":null,"abstract":"TOTHE EDITOR: Infection is an important obstacle to the long-term survival of many bone marrow transplant (BMT) recipients. Yolken et al. demonstrated that 40 percent of transplant patients were infected with enteric pathogens including adenovirus, rotavirus, coxsackie virus, and Clostridium difficile.' The mortality among the infected patients was 55 percent compared with 13 percent among the noninfected patients. In addition, the gastrointestinal tract is a common entry site for agents that cause systemic infection. Measures that could prevent or treat such infections might reduce the mortality associated with bone marrow transplantation. Although it has been reported that orally administered immunoglobulin G (IgG) is rapidly degraded in the normal gastrointestinal tract, Snodgrass et al. have demonstrated that IgG is effective when given orally to rotavirus-infected Iambs.' Other studies have demonstrated effectiveness in modifying rotavirus infection when gamrnaglobulin is administered to low birthweight infants.' The oral administration of an IgA-lgG preparation lowered the incidence of necrotizing enterocolitis in low birthweight infants.t It appears that IgG exerts a protective effect through its opsonizing and antitoxic properties.' We report here the results of a pilot study of orally administered gammaglobulin in allogeneic BMT recipients. Thirty patients, aged 15-50 years, undergoing allogeneic marrow transplantation for leukemia or lymphoma were consecutively entered into the study. All patients received immune serum globulin 50 mg/kg/body weight po (Sandoglobulin, Sandoz Pharmaceuticals) reconstituted with NaCl 0.9\"70 in 4 divided doses daily beginning 2 days following transplantation and continuing for 28 days posttransplantation. Aliquots of stool were collected 8 days prior to transplantation (I day prior to beginning a conditioning regimen of busulfan and cyclophosphamide), on the day following transplantation, and then weekly until day 36. Stool was routinely cultured for viral pathogens and tested by enzymelinked immunosorbent assay for rotavirus. Approximately 2 ml of buffer (barbital sodium pH 8.8) was mixed with I ml of stool in an ultracentrifuge tube, mixed well, and placed on a blood rocker for 30 minutes. The specimen was ultracentrifuged for 45 minutes at 20 000 rpm at 4°C. The supernatant was placed into a 12 x 75 mm glass tube. IgG was quantitated on a Beckman rate nephelometer. Only two patients missed more than a single day's administration of IgG due to nausea. No other toxicity was noted. As expected, none of the patients studied had stool IgG detected prior to initiation of the preparative regimen or immediately following completion of the regimen prior to IgG administration. During the period of administration, 20 of the 27 patients demonstrated stool IgG. Eighteen had a stoollgG concentration >20 mg/dL during the course of IgG administration. The highest stoollgG concentration among these patients ranged from 6","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"912"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14201197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carboplatin: a new cisplatin analog.","authors":"D M Woloschuk,&nbsp;J M Pruemer,&nbsp;R J Cluxton","doi":"10.1177/106002808802201101","DOIUrl":"https://doi.org/10.1177/106002808802201101","url":null,"abstract":"<p><p>Carboplatin, a new antineoplastic agent with a spectrum of antitumor activity similar to cisplatin, has shown appreciable activity in patients with ovarian carcinoma, head and neck cancer, and small-cell lung cancer. This platinum complex is less nephrotoxic, ototoxic, and neurotoxic than cisplatin. Myelosuppression may be severe and dose-limiting. Carboplatin distributes into a volume approximating total body water, and is slowly bound to plasma proteins; its elimination is a biphasic process. Renal clearance of free platinum from carboplatin correlates highly with creatinine clearance in patients with normal or impaired renal function. The recommended iv dose of carboplatin as a single agent in previously untreated patients is 400-500 mg/m2; dosage must be reduced in patients with decreased renal function, low initial platelet count, or extensive prior chemotherapy or radiation therapy. Carboplatin will be most useful in patients with decreased renal function and those who cannot tolerate high-volume hydration regimens. Patients at higher risk for development of cisplatin-related ototoxicity or neurotoxicity (e.g., patients expected to receive cumulative cisplatin doses exceeding 600-800 mg/m2) may be ideal candidates for carboplatin as initial therapy. Large-scale comparative trials are needed before carboplatin can be recommended as a replacement for cisplatin.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"843-9"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14202379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sucralfate--warfarin interaction.","authors":"S E Braverman,&nbsp;M T Marino","doi":"10.1177/106002808802201121","DOIUrl":"https://doi.org/10.1177/106002808802201121","url":null,"abstract":"","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"913"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Algorithms for dosage and therapeutic monitoring of theophylline.","authors":"M A Mangues,&nbsp;J Bonal,&nbsp;R Farré,&nbsp;J Francesc Massó","doi":"10.1177/106002808802201114","DOIUrl":"https://doi.org/10.1177/106002808802201114","url":null,"abstract":"<p><p>Theophylline is widely prescribed in Spain. Because this drug has a narrow therapeutic range and high interindividual pharmacokinetic variability, it is essential to adapt the dosage to each patient. In order to simplify the drug individualization we are proposing three algorithms to apply to intravenous loading and maintenance doses and to oral doses. The initial recommended dosages have been established using the pharmacokinetic parameters obtained from patients treated with theophylline in our hospital. Because the pharmacokinetic behavior of theophylline may be different in other populations, dosage requirements may not be the same. A minimum number of blood sample collections is proposed in an attempt to improve the cost-benefit relationship in theophylline therapy.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"893-4"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical pharmacy administration.","authors":"T R Einarson","doi":"10.1177/106002808802201117","DOIUrl":"https://doi.org/10.1177/106002808802201117","url":null,"abstract":"<p><p>Clinical pharmacy administration has emerged as a separate discipline, but this new field has not been functionally defined. This article defines clinical pharmacy administration from an academic point of view and provides a framework within which it may be understood. It is an applied field of study that deals with the research, evaluation, and management of the patient, the drug, and the health care practitioner as they all relate to patient care. These entities and relationships are studied at the micro, macro, and global levels from financial, economic, managerial, legal, ethical, social, behavioral, educational, and historical perspectives. It is intended that this paper generate debate and discussion in order to refine and develop the field.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"903-5"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14201196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of diclofenac and evaluation of its place in therapy as a nonsteroidal antiinflammatory agent.","authors":"V A Skoutakis,&nbsp;C A Carter,&nbsp;T R Mickle,&nbsp;V H Smith,&nbsp;C R Arkin,&nbsp;J Alissandratos,&nbsp;D E Petty","doi":"10.1177/106002808802201102","DOIUrl":"https://doi.org/10.1177/106002808802201102","url":null,"abstract":"<p><p>Diclofenac sodium is a nonsteroidal antiinflammatory drug (NSAID) that has been used in 120 countries since its introduction in Japan in 1974. It is currently the eighth largest-selling drug and the most frequently used NSAID in the world. Diclofenac, a phenylacetic acid derivative, is a potent inhibitor of cyclooxygenase enzyme activity, and may also interact with the lipoxygenase enzyme pathway, and with the release and reuptake of arachidonic acid. Diclofenac is almost completely absorbed, highly protein-bound, penetrates well into synovial fluid, and is extensively metabolized. Comparative studies have shown that diclofenac is at least equivalent in efficacy to aspirin and other NSAID when used for the treatment of rheumatic diseases such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Diclofenac also possesses potent analgesic properties. Clinical trials suggest that diclofenac has a favorable side-effect profile, excellent patient tolerability, and a lower patient dropout rate when compared with aspirin and other NSAID.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"850-9"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14202380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral etoposide.","authors":"N C Phillips","doi":"10.1177/106002808802201103","DOIUrl":"https://doi.org/10.1177/106002808802201103","url":null,"abstract":"<p><p>Etoposide, a semisynthetic derivative of podophyllotoxin, has been commercially available for intravenous use for a number of years, and has been used as part of first-line combination chemotherapy programs for small cell lung cancer (SCLC). It has also been used to treat testicular cancer, non-small cell lung cancer, and a variety of other malignancies. Etoposide for oral use has become commercially available and is approved for use in the treatment of SCLC. Although no clinical trials comparing intravenous and oral etoposide in SCLC have been reported, several pharmacokinetic studies have been described. These studies have demonstrated a mean bioavailability of 50 percent, with a wide range among patients. Other pharmacokinetic parameters are similar for both the intravenous and oral methods of administration. Based on these results, the recommended dose of oral etoposide is twice the intravenous dose. Oral etoposide has been demonstrated to be effective in the treatment of SCLC. It offers a reasonable and cost-effective outpatient alternative for this group of patients.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"860-3"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14202381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}