Drug intelligence & clinical pharmacy最新文献

{"title":"Carbamazepine-induced severe systemic hypersensitivity reaction with eosinophilia.","authors":"M J Robbie,&nbsp;J P Scurry,&nbsp;P Stevenson","doi":"10.1177/106002808802201010","DOIUrl":"https://doi.org/10.1177/106002808802201010","url":null,"abstract":"<p><p>Skin rash, fever, and eosinophilia developed in a previously healthy 35-year-old woman three weeks after starting carbamazepine. Fulminant respiratory and renal failure ensued. Autopsy showed pneumonitis, nephritis, serositis, pancreatitis, hepatitis, and carditis, characterized by an infiltrate of eosinophils and lymphocytes. The severity, duration, and extensive organ involvement of the reaction make this case unique.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"783-4"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359399","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":"Ceftriaxone-associated neutropenia.","authors":"A M Baciewicz,&nbsp;D J Skiest,&nbsp;E L Weinshel","doi":"10.1177/106002808802201024","DOIUrl":"https://doi.org/10.1177/106002808802201024","url":null,"abstract":"TO THE EDITOR: Protein binding of quinidine has been noted to be pH-dependent with equilibrium dialysis;' however, this relationship has not been examined using ultrafiltration to separate free from protein-bound quinidine. Thus, the implication of pH dependency on protein ultracentrifugation from experiments run at unphysiological or unknown pH may be irrelevant to the in vivo conditions. The pHdependent protein binding in human serum is also found with other drugs including warfarin,\" lidocaine,\" propranolol,\" and disopyramide.\" Weused pooled serum from patients with normal liverand renal functions, and spiked the serum with either 2 or 10 mg/L of quinidine sulfate. After adjusting the pH of 10 ml of pooled serum, according to the procedure of Ponganis and Stanski,' with 0.5 M phosphoric acid (15-120I'L), the total and free quinidine concentrations were determined by fluorescence polarization immunoassayon theTDx. Freequinidineanalysiswasperformedbyultrafiltration method using an Amicon centrifree filter. The pH was determined by a Corning pH meter model 10,whichwascalibrated at 22°C. The pH dependence of serum binding of quinidine is shown in Figure I. The free fraction decreased with increasing pH. For the spiked total 10 mg/L quinidine concentration, the free fraction percentages were 25.6 ±0.69, 2.2 ± .05, 14.8 ±0.64, and 8.80 ± 0.38 percent REFERENCES","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"826-7"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359409","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":"Management of congestive heart failure in the elderly.","authors":"M J Malloy,&nbsp;L M Lopez","doi":"10.1177/106002808802201013","DOIUrl":"https://doi.org/10.1177/106002808802201013","url":null,"abstract":"<p><p>A universally accepted description of appropriate therapy for treatment of congestive heart failure (CHF) has yet to be agreed upon, especially in the elderly. Numerous studies have provided data that question use of a digitalis glycoside as the agent of choice in treatment of chronic CHF. Several clinicians have suggested that diuretics, particularly thiazide diuretics, be used as initial agents in the treatment of this condition. Evidence now demonstrates that drug therapy with enalapril or the combination of hydralazine and isosorbide dinitrate reduces the mortality related to chronic CHF. Additional studies are required to clarify respective roles of diuretics, digitalis glycosides, and vasodilators in the management of chronic CHF.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"788-92"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14199913","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 and clinical research.","authors":"J M Nappi,&nbsp;J A Bosso","doi":"10.1177/106002808802201019","DOIUrl":"https://doi.org/10.1177/106002808802201019","url":null,"abstract":"IN THE SUMMER OF 1987, one of the authors (IN) was asked to react to a paper presented by Hepler at the annual meeting of the American Association of Colleges of Pharmacy that involved an overview of the history of pharmacy. I She was specifically asked to address the relationship between clinical pharmacy and clinical research. Those initial considerations plus a major amount of afterthought addressing this issue on a broader basis form the basis for this editorial.","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"804-6"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14199914","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 method for meta-analysis of epidemiological studies.","authors":"T R Einarson,&nbsp;J S Leeder,&nbsp;G Koren","doi":"10.1177/106002808802201021","DOIUrl":"https://doi.org/10.1177/106002808802201021","url":null,"abstract":"<p><p>This article presents a stepwise approach for conducting a meta-analysis of epidemiological studies based on proposed guidelines. This systematic method is recommended for practitioners evaluating epidemiological studies in the literature to arrive at an overall quantitative estimate of the impact of a treatment. Bendectin is used as an illustrative example. Meta-analysts should establish a priori the purpose of the analysis and a complete protocol. This protocol should be adhered to, and all steps performed should be recorded in detail. To aid in developing such a protocol, we present methods the researcher can use to perform each of 22 steps in six major areas. The illustrative meta-analysis confirmed previous traditional narrative literature reviews that Bendectin is not related to teratogenic outcomes in humans. The overall summary odds ratio was 1.01 (chi 2 = 0.05, p = 0.815) with a 95 percent confidence interval of 0.66-1.55. When the studies were separated according to study type, the summary odds ratio for cohort studies was 0.95 with a 95 percent confidence interval of 0.62-1.45. For case-control studies, the summary odds ratio was 1.27 with a 95 percent confidence interval of 0.83-1.94. The corresponding chi-square values were not statistically significant at the p = 0.05 level.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"813-24"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359406","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: Tocolysis in placenta previa.","authors":"M A Celayeta","doi":"10.1177/106002808802201027","DOIUrl":"https://doi.org/10.1177/106002808802201027","url":null,"abstract":"above which the study drug must demonstrate improvement. For the specific study question of the effectiveness of propranolol (or another beta-blocker) in the management of frequently occurring negative behaviors that are not adequately controlled by psychotropic agents, the following criteria should be met: I. Patients who are severely disabled and require long-term hospitalization are the most suitable candidates for the studies. Sixto 12month studies would be feasible in this subpopulation. 2. A lengthening of the individual blocks of the study design, perhaps in the range of 6-12 weeks, would allow adequate time for the observation of the slowly changing outcome measure. 3. Carryover effects can be handled in a manner similar to that of Greendyke et al. in their A-B design case study, which is very much in the model we are advocating.' In essence, one builds in upward and downward titration periods for introduction and removal (washout) of the study drug. In summary, aside from the difficulty of maintaining staff interest in the quantitative measurement of negative behaviors, there seem to be only advantages for applying rigorous standards to the evaluation of drug effects in individual patients.","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"828"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359411","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":"Paresthesia and back pain in a patient receiving vancomycin during hemodialysis.","authors":"L G Cohen,&nbsp;P F Souney,&nbsp;S J Taylor","doi":"10.1177/106002808802201011","DOIUrl":"https://doi.org/10.1177/106002808802201011","url":null,"abstract":"<p><p>A 36-year-old woman was admitted for initiation of hemodialysis for chronic renal failure. Two days after catheter placement the patient developed a fever that persisted and resulted in subsequent removal of the catheter. Although blood cultures were negative, cultures of the catheter tip were positive for Staphylococcus epidermidis. An initial vancomycin dose was well tolerated, but the patient later experienced numbness and tingling of her lower back accompanied by pain ten minutes after initiation of the second dose. Symptoms abated when the vancomycin infusion was discontinued, and the drug was subsequently well tolerated when reinstituted at a slower infusion rate. Similar symptoms were observed five minutes into a vancomycin infusion a week later that also resolved after decreasing the infusion rate. Patients on hemodialysis receiving vancomycin should be carefully monitored during drug administration for the development of paresthesia and spasmodic lower back pain.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"784-5"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14110128","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":"Pharmaceutical education: a ticket to professional survival or extinction?","authors":"J E Goyan","doi":"10.1177/106002808802201017","DOIUrl":"https://doi.org/10.1177/106002808802201017","url":null,"abstract":"","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 10","pages":"799-800"},"PeriodicalIF":0.0,"publicationDate":"1988-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802201017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14359403","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":"Phenytoin dosing in obese patients: two case reports.","authors":"G M de Oca,&nbsp;J G Gums,&nbsp;J D Robinson","doi":"10.1177/106002808802200915","DOIUrl":"https://doi.org/10.1177/106002808802200915","url":null,"abstract":"<p><p>Phenytoin is used extensively in the treatment of various forms of epilepsy, and remains the drug of choice in partial and generalized tonic-clonic seizures. Because it demonstrates saturable, Michaelis-Menten pharmacokinetics, dosing of phenytoin within the therapeutic range can be very challenging, especially so in obese patients. We present case reports of two obese patients each requiring very large doses of phenytoin sodium (1000 mg/d) to sustain therapeutic serum concentrations and seizure control. There are very few reports in the literature regarding phenytoin pharmacokinetic changes in the obese. We can only theorize possible changes in these parameters. Further investigation in the form of controlled research trials need to be performed before final dosage recommendations can be given.</p>","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 9","pages":"708-10"},"PeriodicalIF":0.0,"publicationDate":"1988-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802200915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14342975","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: peptic ulcer H2-receptor antagonist therapy.","authors":"A Kinniry,&nbsp;L Antell,&nbsp;A S Murabito","doi":"10.1177/106002808802200929","DOIUrl":"https://doi.org/10.1177/106002808802200929","url":null,"abstract":"times; 7.5 percent switched three or more times. Generally, the mean number of tablets prescribed per day correlated with the recommended dosing schedules of each of the products. The two qid products, ibuprofen and tolmetin 200 mg, were prescribed at an average of 3.4 and 3.9 tablets per day, respectively. Naproxen sodium, indomethacin, and fenoprofen, according to their labeling, may be prescribed either-qidor tid, and were prescribed at an average of 3.6,3.0, and 3.1 tablets pet day, respectively. Tolmetin 400 rng, with tid dosing recommended, was written at an average of 2.9 tablets per day. The bid products, sulindac and naproxen, were written at an average of 2.1 and 2.5 tablets per day, respectively. Of prescriptions written for sustained-release indomethacin, 60.5 percent were written at one capsule per day, as were 94.9 percent of piroxicam prescriptions. We examined the relationship among patient demographics, diagnosis, and compliance rate. Patients <:50 years of age were found to be more compliant with their medication than were younger patients (mean compliance rate = 0.69 vs. 0.59, p <0.001). Males were found to be more compliant than females (0.71 vs. 0.65, p<O.OOI), and whites more compliant than nonwhites (0.72 vs. 0.65, p<O.OOI). Patients with RA were more compliant than other arthritis patients (0.71 versus 0.65, p<O.OOI). Refilled prescriptions were stratified by prescribed dosage. Compliance with qd dosing was greater than that of any other schedule. The mean compliance rate for refilled qd prescriptions was 0.78. By contrast, the mean compliance rates for the other dosing schedules decreased consistently: bid 0.72; tid 0.64; qid 0.60; more than qid 0.44. We also examined the rate at which patients achieved selected levels of compliance: 65 percent of qd-prescribed patients consumed three-quarters of the prescribed dosage, compared with 55 percent of bid patients, 44 percent of tid patients, and only 37 percent of qid patients. The overall trend is toward greater compliance with less frequent dosing (all differences, p<O.OOl). Compliance was measured here as the percentage of prescribed amount consumed by the patient per day. A patient will seem compliant if he or she was prescribed 2 tablets per day and consumed 4 one day and none the next. There is no reason to believe, however, that such activity would bias the study results in one direction or another. Using these Medicaid claims data, patient compliance in a real-world setting may be examined. The patients studied did not have their pills counted, nor were they interviewed concerning compliance with medication. In short, the testing bias so often associated with studies of patient compliance has been avoided. At issue in this study is patient behavior vis-a-vis dosing instruction. Whether the physician is concerned with achieving analgesia or maximum antiinflammatory effect, disease management may best be achieved when patients take medication as prescribed. When a compl","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 9","pages":"728-30"},"PeriodicalIF":0.0,"publicationDate":"1988-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802200929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14041299","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}