Showing papers by "American Pharmacists Association published in 1990"

Exacerbation of myasthenia gravis by norfloxacin.

Abstract: (July 1986 through June 1989). Our purpose was to determine the therapeutic equivalence (or lack thereof) of cefotetan and cefoxitin with regard to a specific spectrum of activity (gram-negative rods and Bacteroides jragilis), clinical outcome, and comparative toxicities.' Age, sex, allergies, diagnosis, dose, schedule, duration of therapy, culture and sensitivity tests, and prothrombin time (PT) were evaluated based on preset criteria.P A total of 2135 patientswere reviewed.Of these, 1325patients (62 percent) receivedcefotetanand 810(38 percent)weregivencefoxitin. Bothagents were used for surgical prophylaxis in clean-contaminated surgery (i.e., colorectal andgastroduodenal surgery)and in the treatmentofclinicallyproveninfections (i.e., intraabdominal infection). Cefotetan was administered to 714 patients (54 percent) for surgical prophylaxis; the remaining 611 patients (46 percent) were treated for clinically documented infections. Cefoxitin was administeredto 810patients. Of these 194(20 percent) were dosed for surgical prophylaxis and the remaining 616 patients (76 percent) were treated for clinically documented infections. See Table I for a listing of all dosage regimens. It should be noted that both in surgical prophylaxis and treatment of documented infections cefotetan and cefoxitin were deemed therapeutically equivalent based on the established criteria.' Of the 611 patients receiving cefotetan, only 9 patients (1.47 percent) developed an increase in PT. In those patients treated with cefoxitin, only 7 of 616 patients (1.13 percent) developed an increase in PT (defined as a 30 percent rise from baseline at the completion of three days of therapy). Prophylaxis patients were not included in the hypoprothrombinemia evaluation. There wasnot a statistically significant difference found by the chi-square method of analysis between the two agents relative to hypoprothrombinemia. Bleeding episodes were not documented in any of the evaluable patients. It should be noted that some of the patients had underlying risk factors that may have predisposed them to develop a prolonged PT (e.g., critical illness, renal impairment). These elevations in PT were reversed by the administration of vitamin K. This drug-use review demonstrated clinically insignificant differences between cefotetan and cefoxitin in terms ofclinical effectiveness and drug toxicity. The two antibiotics proved to be comparable when used in the prophylaxis ofclean-contaminated surgery and in the treatment of infection due to susceptible organisms. Although cefotetan is slightly more expensive than cefoxitin on a per-gram basis (Table 2), the longer half-life allows for a twice-daily dosing regimen and a single preoperative dose for surgical prophylaxis. As a result of this study, the pharmacy department realized a costavoidance savings of $11 500 during the first year of this OUR, $20 825 during the second year, and $22 645 during the third year. REFERENCES

Stability of total nutrient admixtures in a dual-chamber flexible container

Abstract: The stability of total nutrient admixtures (TNAs) prepared from dextrose and amino acid injections commercially packaged in a dual-chamber container and a safflower-soybean oil fat emulsion was studied. The admixtures studied were divided into two groups. Group 1 admixtures represented 14 combinations of Aminosyn II, dextrose, and Liposyn II. Group 2 admixtures represented 10 combinations of Aminosyn II with Electrolytes, dextrose, and Liposyn II. Amino acid concentrations of 7, 8.5, and 10%, dextrose concentrations of 10, 20, 40, and 50%, and 10 and 20% fat emulsion were used. After the amino acid and dextrose injections were mixed in their original container (Nutrimix, Abbott Laboratories), the fat emulsion was added. One of two combinations of electrolytes and trace metals was then added. Multivitamins were added to each TNA just before 24-hour storage at room temperature (25 +/- 4 degrees C). Admixtures were tested initially and at the conclusion of storage periods of 24 hours at room temperature or nine days at 5 degrees C followed by 24 hours at room temperature. Measurements of pH, emulsion particle size, and weight percent of oil particles larger than 5 microns in diameter (HIAC) were made after visual inspection of each admixture. In selected admixtures, concentrations of individual amino acids and dextrose were determined by chromatographic techniques initially and at the conclusion of storage. The TNAs retained a uniform milk-like appearance throughout both storage periods. The pH values, particle size, HIAC measurements, and amino acid and dextrose concentrations remained essentially unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Drop Size and Systemic Adverse Effects in Timolol Ophthalmic Solution

Abstract: signs. No organomegalyor abdominal mass was found. Hematocritwas0.39, white blood cell count was 8.21 x 109/L, and erythrocyte sedimentation rate was 35 mm/h. The urine tested positive for protein. Blood glucose was 8.1 mmollL, serum amylase 315 units/L (normal 130), and lipase 285 units/L (normal 190). Prothrombin time; calcium, triglyceride, and electrolyte concentrations; and liver and renal function tests were nonna!. An abdominal ultrasoundexaminationrevealednodilationof pancreaticor hepaticducts and a normal gallbladder. Because of absence of other risk factors, enalapril was stopped on hospital day 5 and the patient's condition improvedover the next severaldays. She has nothadanotherepisodeof pancreatitisduring fivemonths of follow-up, but she has not been rechallenged with enalapri!. It is well known that cough and other adverse reactions to captopril have been reported.P In our case the probability that captopril was responsible for cough was estimated as \"definite\" using an adverse drug reaction scale.' Several toxic effects related to enalapril maleate have been described, but to our knowledge only one case of pancreatitis has been reported.' In our patient, the exclusion of other precipitating factors and the evidence of improvement suggest a close etiologic relation. Therefore, because of the severity of this complication, enalapril-induced pancreatitis should be considered in patients taking this ACE inhibitor who present with abdominal symptoms. Pathogenesis is unclear and there is no information about the mechanism of this adverse drug reaction.

Effects of famotidine and cimetidine on plasma levels of epidurally administered lignocaine.

Abstract: The effects of two H2-receptor antagonists, famotidine and cimetidine, on the plasma levels of epidurally administered lignocaine were studied. Group A (n = 20) received famotidine 20 mg orally the night before surgery and 20 mg intramuscularly 60 minutes before induction of anaesthesia. Group B (n = 15) received cimetidine 200 mg orally the night before the surgery and 400 mg orally 60 minutes before the anaesthetic induction. Group C (n = 20) received neither famotidine nor cimetidine and served as controls. Twelve millilitres of 2.0% lignocaine with adrenaline 1:200,000 was injected into the epidural space in all patients, after the establishment of general anaesthesia with nitrous oxide, oxygen, and enflurane (0.3-0.5%). The patients who received cimetidine showed significantly higher plasma concentrations of lignocaine compared with either group A or group C at all investigation times (p less than 0.01). The mean peak plasma concentrations were 2.4 (SEM 0.1), 3.2 (SEM 0.2) and 2.3 (SEM 0.1) micrograms/ml in group A, B, and C, respectively. This study suggests that famotidine is preferable to cimetidine for control of gastric acidity before the use of lignocaine as the epidural anaesthetic.

Ipecac-induced toxicity in eating disorders.

Abstract: A review of the medical literature provides evidence that ipecac-induced toxicity occurs in patients with eating disorders. However, the reported number of clinical studies is small compared with the number of patients consuming ipecac syrup. The purpose of this article is to inform the healthcare professional of the metabolic consequences, myopathy and death, of ipecac abuse. The patient's medical history, clinical signs and symptoms, laboratory data, and muscle biopsy are important in diagnosing ipecac-induced toxicity. In some clinical situations, the deleterious effects of ipecac syrup are reversible when the patient stops consuming the drug. Thus, the healthcare professional can play an important role by educating these patients about the serious medical problems associated with ipecac abuse.

Replacement of L-T4 suppository in MMI treated rabbits.

Abstract: L-T4 suppositories containing 50, 100 or 200μg of L-T4 were given to rabbits treated with MMI. The serum T4 gradually increased within 3.5 and 6.5 hours following the use of 100 and 200μg of L-T4 suppositories, respectively, without an acute increase in serum T3. The increase in serum T4 continued up to 48 hours. The area under the curve (AUC) for serum T4 was evidently dose-dependent. It is concluded from these results that the T4 suppository will be useful as a replacement therapy for patients with hypothyroidism.

Equipotent dosing of estrogens

Abstract: devices, a hospital pharmacy often desires to prepare these solutions in quantity, when dosages are relatively standard and the drug or drugs involved are stable in the final solution. An antibiotic that might be administered in one of three standard doses and prepared in the type of solutions described above is c1indamycin phosphate. However, data reflecting long-term stability of clindamycin phosphate in varying concentrations and under different storage conditions are limited. We conducted a study, therefore, to determine the stability of clindamycin phosphate in two dosage levels (300 and 900 mg) when diluted in glass containers with 20 mL of dextrose 10% in water for injection and stored under refrigerated conditions. C1indamycin solutions for stability testing were prepared by adding one of twoamountsof c1indamycin phosphate(300 and900 mg)solutions(Upjohnlot numbers664PKand 291DM)to 30-mL multidosesterile bottlescontaining20 mLof dextrose 10% injection. Each solution was prepared in triplicate. Two bottles of each concentration were used for testing purposes while the third served as a backup. All bottles were stored in a refrigerator (10°C) and only removed on days samples wereacquired for testing. On the day of preparation andat 2. 4. 7. 14, 21. and30days later.each solutionwasvisuallyinspectedfor clarity and the concentration of c1indamycin was determined by a previously described. stability-indicating HPLC method.' with the modification that a 1-1-Bondapak, 10-1-1column (Waters Associates. Milford. MA) was used. With this column. retention times for c1indamycin and the internal standard (propylparaben) were8.5 and 12 minutes. respectively. Each solution wasassayed induplicate.On each dayof analysis, a five-point standardcurve wasprepared. The intrarun and day-to-day coefficentof variation were less than ten percent for the concentration reflected in the standard curve. Data were analyzed by comparingthe mean c1indamycin concentrationsfor any givenday of analysis to the meanoriginal concentrationdeterminedon the day of preparation. The standard definition of stability (retention of ;e:90 percent of original concentration)was used for the interpretationof results. Using these methods we found that c1indamycin concentrations were maintained within ten percent of the original concentration at all subsequent sampling times. No changes in color or clarity were observed. Clindamycin phosphate in doses of 300 and 900 mg. when diluted in 20 mL of dextrose 10% injection, is stable for at least 30 days when stored under refrigeration at 10°C.

Intracranial Hypertension Associated with Stanozolol

Abstract: available after oral administration. Peak time ranges from 0.5 to 6.0 hours with an average peak serum concentration of 0.71 urnol/L after a 200-mg dose.' This closely correlates with the peak serum concentration of 0.38 umol/L at one hour after the initial IOO-mgrectal dose in case I. The rectal solution in case I was rapidly absorbed, with the 0.5hour serum concentration 78 percent of that of the one-hour concentration. The elimination half-life of flecainide averages 20 hours and steadystate is reached in three to five days. 2 The elimination half-life in case I was estimated to be approximately 19 hours. Repeated rectal dosing led to drug accumulation and serum concentrations within the therapeutic range (0.42-2.1 urnol/L), Switching to the nasogastric route maintained therapeutic flecainide concentrations and produced concentrations similar to those of the rectal route. The dosage formof a drug can be a critical factor in the rapidity and extent of rectal absorption.' This was evidenced in a case demonstrating excellent rectal bioavailability offlecainide in a patient with a subtotal gastric resection.' A single 200-mg dose when given as an aqueous solution was 100 percent bioavailable with an absorption half-life of 35 minutes, compared with 80 percent and 52 minutes, respectively, for a polyethylene glycol suppository. Although case I demonstrated good rectal absorption, case 2 showed poor absorption, perhaps related to administration problems. With the available information, rectal flecainide administration should only be considered in patients with serious arrhythmias, unresponsive to maximal parenteral therapy, and in whom ora1lnasogastric administration is not feasible.

An aminoglycoside dosing regimen in a morbidly obese patient.

Abstract: We report our experience in designing a dosing regimen for tobramycin in a morbidly obese patient admitted with severe diabetic foot ulcers