Showing papers by "Timothy J. Craig published in 1996"

Elevation of creatine kinase from skeletal muscle associated with inhaled albuterol.

Abstract: Background Elevations of creatine kinase have been described, but have been associated with high doses of albuterol given by oral or intravenous routes. Most reports have described an elevation of MB isoenzyme fraction from the heart. Elevation of creatine kinase-MM isoenzyme from skeletal muscle rarely appears to be associated with the use of inhaled albuterol. Objective A patient is discussed who presented with severe myalgias and was found to have elevated creatine kinase-MM from albuterol metered dose inhaler. Methods Clinical status, creatine kinase levels, electromyography, enzyme stains, histopathologic and lactate challenge studies were done to evaluate the status of the patient. Results Without exercise or use of albuterol, creatine kinase-MM levels were normal. With the use of albuterol, whether inhaled or by oral therapy, the creatine kinase-MM level increased. When combined with exercise, higher levels occurred. Workup was normal except histopathology revealed a myopathy. Conclusion Patients with myalgias from albuterol with elevated creatine kinase-MM fraction should be investigated for possible myopathy.

Desensitization for fluconazole hypersensitivity

Abstract: These results are very similar to the M I D (approximate ly 0.5) de te rmined for o ther diseasespecific quality of life ques t ionnaires that use 7-point response opt ions (e.g., as thma, pediat r ic as thma, chronic respi ra tory disease, hear t failure). Al though we only tes ted the R Q L Q in this study, the results are p robab ly appl icable to the Rhinitis Quali ty of Life Quest ionnai re , 4 which is a lmost identical to the original ins t rument except that all references to eye symptoms have been removed. In addition, they should be appl icable to the Adolescent Rhinoconjunct ivi t is Quali ty of Life Ques t ionnaire, 5 which is also very similar to the adult version, except that there is no sleep domain and there are addi t ional quest ions concerning ability to concentra te . REFERENCES

Assessment of care of patients with asthma in a family practice training program

Abstract: To determine if primary care physicians have been adhering to guidelines set forth by the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report Guidelines for the Diagnosis and Management of Asthma, the author gauged the use of peak flow meters in a hospital family training program. Specifically investigated were the physicians' response to results from the peak flow meters and their prescribing practices regarding the beclomethasone dipropionate metered-dose inhaler. Overall, the use of peak flow meters among the 20 patients included in this study averaged 70%, up from 10% in earlier studies. Similarly, 45% of these patients received prescriptions for beclomethasone metered-dose inhalers with spacer devices. Although these results appear to indicate that physicians are following the aforementioned guidelines, the author cautions that the peak expiratory flow rate measurement is not a perfect indication of asthma severity. Likewise, the spacer devices are not indicated for all patients with asthma who are taking inhaled corticosteroids. Finally, the author emphasizes that anti-inflammatory agents should be effectively used when indicated.

Use of astemizole in a large group practice.

Abstract: Astemizole was released in 1988. In late 1992, a new warning label was added in response to reports of syncope and death from arrhythmia. Records of patients given new prescriptions for astemizole were reviewed to assess compliance with the warnings in a large multispecialty practice. The indication was appropriate in 89% of cases. Excessive doses were used in 4% of cases. Two percent of prescriptions were given to patients with contraindications. Only two complications were documented. Despite carrying a drug warning, astemizole continues to be used inappropriately and is a medicolegal concern. Education and drug evaluations can be used to enhance compliance and decrease the risk associated with the use of astemizole.