Drug intelligence & clinical pharmacy最新文献

{"title":"Failure of single-dose kinetics to predict steady state.","authors":"D A Graves","doi":"10.1177/106002808802201128","DOIUrl":"https://doi.org/10.1177/106002808802201128","url":null,"abstract":"1. MONTGOMERY AB, DEBS RJ, LUCE JM, et aJ. Aerosolized pentamidine as sole therapy for Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome. Lancet 1987;2:480-3. 2. GOLDEN JA, HOLLANDERH, CONTE JE, Jr. Inhaled pentamidine or low-dose intravenous pentamidine as novel therapy for Pneumocystis carinii pneumonia (PCP) in the acquired immunodeficiency syndrome (AIDS) (abstract). Am Rev Respir Dis 1987;135:AI68. 3. MONTGOMERY AB, DEBSRC, LUCE JM, et aJ. Concentration of pentamidine in bronchoalveolar lavage fluid after aerosol and intravenous administration (abstract). Am Rev Respir Dis 1987; 135:AI67. 4. DEBSRJ, BLUMENFELDW,BRUNETTEEN, et aJ. Successful treatment with aerosolized pentamidine of Pneumocystis carinii pneumonia in rats. Antimicrob Agents Chemother 1987;31:3741. 5. DEBS RJ, STRAUBINGER RM, BRUNETTE EN, et aJ. Selective enhancement of pentamidine uptake in the lung by aerosolization and delivery of liposomes. Am Rev Respir Dis 1987; 135:731-7. 6. CONTE JE, HOLLANDER H, GOLDEN JA. Inhaled or reduceddose intravenous pentamidine for Pneumocystis carinii pneumonia. Ann Intern Med 1987;107:495-8. 7. MONTGOMERY AB, CORKERYKJ. Protocol for aerosolization of pentamidine for treatment and prevention of Pneumocystis carinii pneumonia in patients with AIDS. University of California, San Francisco, California, 1987. 8. Package insert. Pentam 300 (pentamidine isethionate). Melrose Park, IL: LyphoMed, Inc., 1987.","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"917-8"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14363272","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":"Flucytosine interference with serum creatinine determinations.","authors":"M L Santeiro,&nbsp;D F Thompson,&nbsp;R Sagraves","doi":"10.1177/106002808802201108","DOIUrl":"https://doi.org/10.1177/106002808802201108","url":null,"abstract":"<p><p>A patient receiving intravenous amphotericin B and oral flucytosine was found to have falsely elevated serum creatinine values. Flucytosine has been reported to interfere with serum creatinine determinations when measured by the Kodak Ektachem-700 analyzer but not when the Jaffe reaction is employed. Serum creatinine values were determined by the two methods on six serum samples obtained from this patient at various times throughout her hospitalization. Flucytosine can cause clinically significant false elevations in serum creatinine when measured by the Kodak Ektachem-700 analyzer.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"879-80"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364318","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":"Professional liability for pharmacists: a focus on pharmacy practice acts.","authors":"M A Munger,&nbsp;J A Green,&nbsp;P A Greve,&nbsp;L S Lovejoy","doi":"10.1177/106002808802201111","DOIUrl":"https://doi.org/10.1177/106002808802201111","url":null,"abstract":"<p><p>The increased complexity of pharmacotherapeutics and the expanded role of pharmacists in the drug-use process may bring about an increased liability exposure for failure to conform to a professional standard of care. Therefore, a survey of 51 state pharmacy practice acts was conducted: (1) to establish a nationwide statutory definition of pharmacy practice, and (2) to outline possible use of the statutes in civil and administrative law. Twenty percent of state statutes contain no definition of pharmacy practice. Of the remaining 41 states, dispensing (97.5 percent), compounding (92.5 percent), interpretation and evaluation of prescriptions (68.2 percent), and consultation (73 percent) are legally defined. Pharmacokinetic consultation, drug administration, pharmacist prescribing, and pharmaceutical research are defined in one, seven, four, and one state(s), respectively. Pharmacists may face legal responsibilities from both the courts and state boards of medical and pharmacy practice. Aggressively updating the statutes and regulations to reflect contemporary pharmacy practice may provide a mechanism for a defense in court litigation and regulatory action.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"886-8"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364319","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":"Unexpected cocaine-induced fatalities: a possible cause.","authors":"A H Anton","doi":"10.1177/106002808802201123","DOIUrl":"https://doi.org/10.1177/106002808802201123","url":null,"abstract":"CASE I An 18-year-old Hispanic man with drug-resistant pulmonary metastases of osteosarcoma received ifosfamide 1.6 g/m'/d iv for five days with mesna 400 mg/m' iv 15 minutes, 4 and 6 hours after each dose of ifosfamide. Treatment courses were given at threeto four-week intervals. After treatment with mesna on day I of his second course he developed generalized urticaria which required symptomatic treatment with dexamethasone and diphenhydramine. Continuation of ifosfamide/mesna over the remaining four days of treatment was not associated with recurrence of urticaria.","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"914"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364324","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":"Analysis of methotrexate in cerebrospinal fluid by fluorescence polarization immunoassay.","authors":"G B Glasco,&nbsp;E H Taylor,&nbsp;W M Chadduck,&nbsp;A A Pappas","doi":"10.1177/106002808802201120","DOIUrl":"https://doi.org/10.1177/106002808802201120","url":null,"abstract":"","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"912-3"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14201198","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":"Comment: anticholinesterase insecticide reactions.","authors":"G P Wedin","doi":"10.1177/106002808802201130","DOIUrl":"https://doi.org/10.1177/106002808802201130","url":null,"abstract":"was the major disqualifying factor. Perhaps this was a function of the patients' ages, as there were many elderly patients in both groups. Because at both institutions patients must be able to give informed consent, those patients not of sound mind were excluded from study participation. Numerous patients had received prior antibiotics either at home or at outlying hospitals before admission to Duke. Many patients at both institutions had multiple exclusion factors, but the percentage of these patients was higher at the tertiary care center. According to a survey of members of the Infectious Diseases Society of America, approximately 70 percent of respondents (primarily in academic centers) are involved in conducting trials with investigational antibiotics.\" Therefore, it appears that most Phase II and III antibiotic protocols are conducted in academic centers which traditionally house more seriously ill patients and, therefore, where fewer numbers of patients are eligible for inclusion. Nonetheless, in our study, a much lower number of community hospital patients were deemed eligible for protocol enrollment than would be expected. These data are disturbing. A consequence of the low numbers of patients in both community and teaching hospitals eligible for investigational antibiotic protocols is that most seriously ill, debilitated patient groups who will be receiving the marketed drug never will have been exposed to it during the drug approval process. Food and Drug Administration guidelines suggest that patients for whom new drugs are intended (especially the elderly) should be included in clinical trials. 5 Without the inclusion of these patients in Phases II and III studies, we will have little premarketing data on antibiotic efficacy and safety in these groups. We have other clues with which we can make intelligent judgments on patient response or failure to respond to antibiotics, such as in vitro activity, pharmacokinetics, and host defense status, but little data on toxicity and adverse effect profiles in these patient populations will be available. Because these patients are more complicated, they are likely to be at higher risk for developing adverse effects. We have seen how these toxicities tend to surface once the drugs are used in the intended populations: for example, the bleeding problems seen when antibiotics containing the N-methylthiotetrazole side chain are administered to malnourished, debilitated patients\" and the incidence of seizures reported with imipenemcilastatin.\" We see no easy solution to this problem, and agree with other authors that better designed trials that include more complex patients stratified by severity of infection and underlying diseases are needed. These investigations will be more complicated and will take longer to complete, and the industry is not likely to welcome this situation. We can only hope that the present system of drug approval is not ultimately compromising drug efficacy and safety in the ","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"919-20"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14363273","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":"Ranitidine-induced confusion with concomitant morphine.","authors":"M Martinez-Abad,&nbsp;F Delgado Gomis,&nbsp;J M Ferrer,&nbsp;F J Morales-Olivas","doi":"10.1177/106002808802201124","DOIUrl":"https://doi.org/10.1177/106002808802201124","url":null,"abstract":"CASE I An 18-year-old Hispanic man with drug-resistant pulmonary metastases of osteosarcoma received ifosfamide 1.6 g/m'/d iv for five days with mesna 400 mg/m' iv 15 minutes, 4 and 6 hours after each dose of ifosfamide. Treatment courses were given at threeto four-week intervals. After treatment with mesna on day I of his second course he developed generalized urticaria which required symptomatic treatment with dexamethasone and diphenhydramine. Continuation of ifosfamide/mesna over the remaining four days of treatment was not associated with recurrence of urticaria.","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"914-5"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364325","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":"Cost justification of clinical pharmacy services on a general surgery team: focus on diagnosis-related group cases.","authors":"K E Bertch,&nbsp;H T Hatoum,&nbsp;M S Willett,&nbsp;K W Witte","doi":"10.1177/106002808802201118","DOIUrl":"https://doi.org/10.1177/106002808802201118","url":null,"abstract":"<p><p>We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated. The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"906-11"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14278766","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":"Disposition of cefonicid in orthopedic surgery patients.","authors":"B H Ackerman,&nbsp;J M Trang,&nbsp;C L Nelson,&nbsp;C E Pearce,&nbsp;J T Manning,&nbsp;B H Harrison","doi":"10.1177/106002808802201104","DOIUrl":"https://doi.org/10.1177/106002808802201104","url":null,"abstract":"<p><p>Ten patients undergoing hip reconstructive procedures were given a single prophylactic dose of cefonicid 15 mg/kg to evaluate intraoperative and perioperative drug disposition in the surgical setting. Timed postinfusion serum samples were collected over 24 hours and resulting concentration versus time data were subjected to noncompartmental pharmacokinetic analysis. Bone samples were obtained in eight of ten patients with mean bone concentrations of 13.3 micrograms/g (range 8.2-25.1). Postinfusion serum concentrations at five minutes postinfusion ranged from 200.8 to 316.7 micrograms/ml; the 12-hour mean was 19.1 micrograms/ml (range 4.0-48) and the 24-hour mean was 4.3 micrograms/ml (range 0.0-13.8). Protein binding at three sampling times ranged from 88 to 96.5 percent, increasing over time as total cefonicid concentrations fell. The mean half-life in our patients was 3.5 hours, compared with 4.8 hours in our four controls. These data indicate that altered protein binding and intraoperative events alter the disposition of cefonicid. Although differences in disposition parameters between patients and controls were not statistically significant, suboptimal serum cefonicid concentrations were observed in four orthopedic patients.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"864-8"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364314","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":"Compatibility and stability of cefazolin sodium, clindamycin phosphate, and gentamicin sulfate in two intravenous solutions.","authors":"A S Zbrozek,&nbsp;D A Marble,&nbsp;J A Bosso","doi":"10.1177/106002808802201106","DOIUrl":"https://doi.org/10.1177/106002808802201106","url":null,"abstract":"<p><p>We studied the compatibility and stability of clindamycin phosphate admixed with gentamicin sulfate and cefazolin sodium in small-volume diluents under specific storage conditions. In two replicate 100 ml dilutions of NaCl 0.9% injection and dextrose 5% (D5W) injection, clindamycin phosphate 900 mg was admixed with gentamicin sulfate 80 mg and cefazolin sodium 1 g. Drug concentrations were determined at the time of preparation and at 1, 4, 8, 12, 24, and 48 hours. Clindamycin and cefazolin were assayed by high-performance liquid chromatography and gentamicin was assayed by fluorescence polarization immunoassay. Visual inspections and pH determinations of each solution were performed at each assay time. Test solutions were maintained at constant room temperature and fluorescent lighting. Concentrations of clindamycin and gentamicin remained greater than 90 percent of the original concentrations throughout the study. Cefazolin concentrations dropped below 90 percent in D5W injection at 4 hours after admixture and at 12 hours after admixture in NaCl 0.9% injection. Visual analyses and pH changes revealed no significant changes. The combination of clindamycin phosphate 900 mg, gentamicin sulfate 80 mg, and cefazolin sodium 1 g in D5W 100 ml was found to be compatible for up to 4 hours. The duration of compatibility for these three drugs in 100 ml of NaCl 0.9% was 12 hours.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 11","pages":"873-5"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14364316","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}