{"title":"Rhabdomyolysis associated with cocaine intoxication.","authors":"H A Skluth, J E Clark, G L Ehringer","doi":"10.1177/106002808802201008","DOIUrl":"https://doi.org/10.1177/106002808802201008","url":null,"abstract":"<p><p>A case of a patient who had an acutely toxic reaction to cocaine ingestion and later developed acute renal failure secondary to rhabdomyolysis is described. Evidence of rhabdomyolysis was noted by the combination of myalgia, urine discoloration, and elevated serum concentrations of muscle enzymes. Although the mechanism of the rhabdomyolysis is unknown, the clinical presentation resembled that of a norepinephrine-induced vasoconstrictive effect that alters the metabolic demands of the muscle in such a way that the muscle is damaged.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"778-80"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14357497","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":"The more pharmacy changes, the more it remains the same.","authors":"H A Whitney","doi":"10.1177/106002808802201015","DOIUrl":"https://doi.org/10.1177/106002808802201015","url":null,"abstract":"","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"797"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359401","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: Neuropharmacology.","authors":"J C Webster, R M Greendyke","doi":"10.1177/106002808802201025","DOIUrl":"https://doi.org/10.1177/106002808802201025","url":null,"abstract":"readmittedto the hospital with lethargyand fever(38.2\"C)of one day's duration. Alllaboratory parameterswerewithinnormal limits,excepta WBCcount of 3.1/mm' witha differentialof 2\"70 segmented neutrophils, 0\"70 band neutrophils, 31\"70 lymphocytes, 18\"70 atypical lymphocytes, 44\"70 monocytes, 3\"70 eosinophils, and 2\"70 basophils. The patient had taken no other medications during the preceding six weeks. Upon hospitalization, vancomycin 500 mg iv q6hwasempirically administered for 19doses until the patient's absolute neutrophil count spontaneously rose to > 1000 (actual count 2064). All cultures werewithout growth. At time of discharge the patient was afebrile and not taking any antibiotics; one week later his WBC count was 4.7/mm' with a differential including27\"70 segmented neutrophilsand 20\"70 band neutrophils. All generations of the cephalosporins have been associated with a drug-induced neutropenia « 1000 neutrophils/mm'). Cephalosporin-induced neutropenia rarely occurs during the first week of treatment. Simultaneous eosinophilia, rash, fever, and/or thrombocytopenia may occur. Its incidence increases with large doses and prolonged therapy of beta-lactam antibiotics. The reaction has been reversible after withdrawal of the drug. '-3 The mechanism of cephalosporin-induced neutropenia remains unclear. Neftel et al. found that beta-lactam antibiotics inhibited in vitro granulopoiesis dose-dependently. Bone marrow aspirates in patients with beta-lactam neutropenia were characterized by a lack of well-differentiated myeloid elements in the presence of numerous granulocyte precursors. These findings were thought to be consistent with a nonimmunological drug-induced neutropenia.' Murphy et al. describes two patients with cephalosporin-induced neutropenia who developed immunoglobulin G cephalosporin antibodies against their neutrophils. This immune neutropenia involved either a drug absorption or immune complex mechanism.\" Neftel et al. also noted six cases of ceftriaxone-induced neutropenia from 17 hospitals in Switzerland and Germany. The mean time to develop neutropenia was 21 days (range 8-25 d) and the mean ± standard deviation of total and daily dose were 51 ±29 and 2.3 ± 1.0 g, respectively. Concomitant symptoms of neutropenia included eosinophilia, thrombocytopenia, reticulocytopenia, rash, and fever. In their literature review, these authors noted that large doses of any betalactam antibiotics induce neutropenia in 5 to > 15 percent of patients treated for ~ 10 days but in <0.1 percent of patients with a shorter duration of therapy.' Baumgartner and Glauser observed that 5 of 153 adult patients (3.3 percent) who received ceftriaxone developed neutropenia possibly related to the antibiotic. These cases appeared with a total ceftriaxone dose of 7-92 g within 2-25 days after initiating treatment and all were reversible within 2-12 days.' In the present case, neutropenia and fever appear to be associated with a high total dose (74 g) and long dura","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"827-8"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359410","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":"Guidelines for warfarin dosage.","authors":"J Zatuchni","doi":"10.1177/106002808802201022","DOIUrl":"https://doi.org/10.1177/106002808802201022","url":null,"abstract":"are suggested. 10 The suggestions are empirical and are to be modified depending on desired goals and response of the patient. A PT of 14-15 sec corresponds approximately to a PT ratio of 1.21.5, and a PT of 18-20 sec to a PT ratio of 1.5-2.0. In turn, any PT ratio can be converted to the respective INR value obtained from Table I and adjustments made in the dose of warfarin if necessary. In such a manner, important variability in the PT ratio caused by different brands and batches of thromboplastin and instruments may be accounted for; also, the INR scale will facilitate the process of determinating optimal therapeutic ranges.\",12 Finally, it is also important to note that PT is timeand temperature-dependent. Spurious shortening may occur when blood is in contact with glass surfaces for longer than one hour and may lead to unnecessarily larger doses of warfarin.\" Also, potential complications may occur if different preparations of warfarin are employed. I' The warfarin doses suggested above are based on daily results of prothrombin time for inpatients. For outpatients, a reasonable determination is possible based on analysis of dose employed and response, with PT obtained at frequent intervals initially and at longer intervals later, preferably every 3 weeks and perhaps as long as every 12 weeks.\" 10.0 7.5 5.0 2.5 o WARFARIN DOSE (rng)","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"825-6"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359407","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":"Development of Pseudomonas aeruginosa resistance to norfloxacin during therapy.","authors":"R C Rowen, T A Mullenix, J C Arroyo, J C Voris","doi":"10.1177/106002808802201006","DOIUrl":"https://doi.org/10.1177/106002808802201006","url":null,"abstract":"<p><p>Two elderly patients diagnosed with Pseudomonas aeruginosa urinary tract infections were treated with oral norfloxacin in the recommended dose of 400 mg q12h. Initially, antimicrobial susceptibility data indicated the organisms were sensitive to norfloxacin. Six to eight days into therapy urine cultures became positive for P. aeruginosa once again; this time, however, susceptibility reports indicated the organisms were now resistant to norfloxacin. Since cross-resistance among norfloxacin, other quinolones, and cephalosporins can occur, we recommend repeated urine cultures during and after norfloxacin therapy in elderly patients with complicated P. aeruginosa urinary tract infections.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"773-6"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14277231","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}
L G Ott, J J Schmidt, A B Young, D L Twyman, R P Rapp, P A Tibbs, R J Dempsey, C J McClain
{"title":"Comparison of administration of two standard intravenous amino acid formulas to severely brain-injured patients.","authors":"L G Ott, J J Schmidt, A B Young, D L Twyman, R P Rapp, P A Tibbs, R J Dempsey, C J McClain","doi":"10.1177/106002808802201004","DOIUrl":"https://doi.org/10.1177/106002808802201004","url":null,"abstract":"<p><p>Twenty severely brain-injured patients with Glasgow Coma Scale scores of 4-9 were prospectively randomized to receive one of two standard amino acid formulas, starting with the first day of hospital admission up to day 14 postinjury. Formula 2 (patient group 2) had 54 percent more leucine, 53 percent more isoleucine, 74 percent more valine, 28 percent less phenylalanine, 31 percent less methionine, 111 percent more proline, 38 percent less alanine, and 38 percent less glycine than formula 1 (patient group 1). Groups 1 and 2 received statistically equal overall mean parenteral nutrition calories and protein (2173 +/- 147 vs. 2059 +/- 143 kcal, and 77 +/- 12 vs. 83.1 +/- 6 g, respectively). There was a significant difference in overall mean urinary urea nitrogen excretion (group 1 = 24.6 +/- 1.3 vs. group 2 = 18.3 +/- 1.1, p = 0.02) and nitrogen balance (group 1 = -8.0 +/- 2.1 vs. group 2 = +1.8 +/- 1.2, p = 0.01). Mean overall isoleucine values were significantly higher in group 2 (overall mean 77 mumol/L vs. 62 mumol/L, p = 0.04). Phenylalanine levels were significantly higher in group 1 (107 mumol/L) versus group 2 (82 mumol/L) patients (p = 0.01). Arginine levels were significantly higher in group 1 (78 mumol/L) versus group 2 (49 mumol/L) patients (p = 0.0002). This observation suggests that some standard intravenous amino acid formulas may be more apt to promote positive nitrogen balance than others.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"763-8"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14357495","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":"A fatal case of propranolol poisoning.","authors":"D E Amundson, S K Brodine","doi":"10.1177/106002808802201009","DOIUrl":"https://doi.org/10.1177/106002808802201009","url":null,"abstract":"<p><p>Propranolol hydrochloride is a beta-adrenergic blocking drug used in a variety of clinical conditions. Overdoses can result in severe hypotensive states usually associated with bradycardia or asystole or with profound myocardial depression. We report on an 18-year-old man who ingested a massive dose of propranolol HCl in a suicide attempt. The patient was brought to the hospital in an unresponsive state within 30 minutes of ingestion. He was initially stabilized but subsequently died nine hours after the drug was ingested. Invasive monitoring during this period revealed the shock to be secondary to marked depression of his systemic vascular resistance. Cardiac rhythm and left ventricular output were maintained throughout the attempted resuscitation. This hemodynamic picture suggests that decreased systemic vascular resistance may be another mechanism of shock in significant propranolol HCl overdoses.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"781-2"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359398","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":"Octreotide: a synthetic analog of somatostatin.","authors":"J M Rosenberg","doi":"10.1177/106002808802201001","DOIUrl":"https://doi.org/10.1177/106002808802201001","url":null,"abstract":"<p><p>Octreotide is an investigational synthetic peptide exhibiting actions similar to those of endogenous somatostatin. It has a longer half-life than the native hormone and can be administered by subcutaneous injection. Octreotide inhibits the secretion of growth hormone and numerous regulatory peptides of the gastroenteropancreatic system. Trials evaluating the clinical utility of octreotide indicate efficacy in the management of symptoms associated with acromegaly and hypersecretory neuroendocrine tumors, and in the control of nontumoral secretory diarrheas. Octreotide therapy is well tolerated. This agent should prove useful in the symptomatic control of a number of rare hypersecretory disorders.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"748-54"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14199910","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}
W A Kradjan, L D Hudson, D M Harris, G A Emmick, D J Pierson
{"title":"Single-dose efficacy and safety of zindotrine, a new oral bronchodilator.","authors":"W A Kradjan, L D Hudson, D M Harris, G A Emmick, D J Pierson","doi":"10.1177/106002808802201003","DOIUrl":"https://doi.org/10.1177/106002808802201003","url":null,"abstract":"<p><p>Zindotrine, a new bronchodilator, may be an alternative to theophylline in treating reversible airflow obstruction. Efficacy and cardiovascular effects of a single 300 mg oral dose of zindotrine were compared with placebo in a two-period, double-blind, crossover trial. Twelve subjects with airflow obstruction reversible after isoproterenol and theophylline completed the trial. Improvement in pulmonary function (forced vital capacity [FVC], forced expiratory volume in one second, and forced expiratory flow rate from 25 to 75 percent of FVC) was greater after zindotrine than with placebo. Pulmonary function tests increased 15 percent or more over baseline in 30 minutes after active drug, lasting up to 6 hours. Mild decreases in heart rate and mean blood pressure occurred after both treatments, with changes equal in both treatment groups. Six subjects had mild subjective side effects after zindotrine (headache, dizziness, vertigo, flushing, and heartburn) compared with one report of lightheadedness after placebo. A single dose of zindotrine 300 mg provides effective bronchodilator action with a relatively prolonged response and tolerable side effects.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"760-3"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14357494","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}
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