Showing papers in "American Journal of Health-system Pharmacy in 1977"

Absolute bioavailability of oral theophylline.

Abstract: The absolute bioavailability of theophylline was investigated by comparing the areas under concentration-time curves for intravenous theophylline with a plain uncoated anhydrous theophylline tablet and a theophylline solution. Twenty asthmatic adults received approximately 7.5 mg/kg theophylline intravenously over 30 minutes; either seven days before or after the i.v. dose, 10 of these patients received tablets and the remainder solution in a similar dose. Blood samples were obtained at 0, 10, 20, 30, 45, 60, 90, 120, 180 and 240 minutes and then every two hours for at least 12 hours. Theophylline concentration was measured in serum by high-pressure cation exchange chromatography. The fraction of the dose absorbed averaged 0.96 +/- 0.03 for the tablet while the value for the solution was 0.99 +/- 0.02. The time of peak absorption averaged 2 +/- 0.3 hours for the tablets and 1.4 +/- 0.3 hours for the solution. The maximum serum concentration attained was 15.3 +/- 0.7 microng/ml after a dose of 7.6 +/- 0.4 mg/kg of the tablet, and 14.6 +/- 0.6 microng/ml after a dose of 7.3 +/- 0.2 mg/kg of the solution. Absorption of the tested theophylline tablets and solution approached 100% of the available drug.

Double-blind study to investigate methods to prevent cephalothin-induced phlebitis

Abstract: Methods which might be useful in preventing cephalothin-induced phlebitis following intravenous administration of the buffered drug were investigated. One hundred and twenty adult orthopedic patients were assigned randomly to either a control group or one of five treatment groups. The treatment regimens studied were: addition of hydrocortisone phosphate 10 mg to each liter of intravenous fluid; addition of heparin 1,000 units to each liter of intravenous fluid; addition of heparin 500 units and hydrocortisone phosphate 1 mg to each liter of intravenous fluid; addition of heparin 1,000 units and hydrocortisone phosphate 10 mg to each liter of intravenous fluid; and filtration of intravenous solutions through a 0.22-mum inline filter. All patients in the study received intravenous buffered cephalothin at a dosage of 1 g every six hours for a minimum of 48 hours. Phlebitis was assessed every 12 hours according to predetermined criteria. Significant differences were found in the incidence of phlebitis at 48 hours between the control group and the last three study groups (see above). It is concluded that postinfusion phlebitis following cephalothin administration can be reduced by the concomitant addition of heparin and hydrocortisone to the intravenous solution or by the use of an inline 0.22-mum final filter.

Antimicrobial and other properties of a new stabilized alkaline glutaraldehyde disinfectant/sterilizer.

Abstract: The properties of stabilized alkaline 2% glutaraldehyde solution (SGS) are discussed. SGS is discussed with regard to its chemistry, antimicrobial properties, organic soil resistance, toxicity, corrosivity and chemical stability. SGS retains the maximum antimicrobial activity of alkaline glutaraldehyde solutions and the chemical stability heretofore observed only with acidic glutaraldehyde solutions. These improvements, along with the inherent resistance of glutaraldehyde to neutralization by organic soil, allow SGS to be continuously used for 14 days in situations of high dilution, or 28 days in situations of low dilution.

The clinical pharmacist in emergency medicine.

Abstract: The function of a pharmacist in emergency medicine, encompasing clinical practice, education and research, are described, and an evaluation of physicians' and nurses' attitudes toward pharmacist involvement in these areas is presented. In July 1974, a pharmacist joined the staff of a department of emergency health services in a medical center. In June 1976, a 14-item questionnaire was administered to physicians and nurses associated with the department. Seventy-two percent of the questionnaires were completed and returned. All respondents felt the pharmacist was an important component of the department and a benefit to its patient care and educational programs. Eighty-seven percent of the physicians stated that the pharmacist is capable of offering primary care to certain patients once the diagnosis has been made by a physician; 95% felt the role of the pharmacist is transferrable to other emergency room facilities and 83% were willing to have their patients charged for his services.

Drug therapy reviews: Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics--part 4: aminoglycosides.

Abstract: The aminoglycoside antibiotics are reviewed with regard to mechanism of action, bacterial resistance, antimicrobial spectrum, combinations with other agents, pharmacology, dosages in patients with normal and impaired renal function, adverse reactions, therapeutic use, prophylatic use and selection. Streptomycin is suggested in the therapy of tuberculosis, brucellosis, tularemia and yersinia infections; several of these require the coadministration of another agent. The choice between streptomycin and gentamicin for combination therapy of enterococcal endocarditis may be simplified by knowledge of the prevalence of high-level streptomycin-resistant strains in the hospital or by use of an in vitro screening test. Neomycin is the agent used orally in the treatment of hepatic encephalopathy. Paromomycin is indicated only for the treatment of amebic infections. The major difference among gentamicin, tobramycin and amikacin lies in the low but increasing prevalence of gram-negative bacilli which are resistant to gentamicin and tobramycin and susceptible to amikacin. In those institutions in which gentamicin-resistant strains are of concern, amikacin is the aminoglycoside of choice in high-risk patients until the infecting bacterium has been determined.

Comparative study of prospective surveillance and voluntary reporting in determining the incidence of adverse drug reactions

Abstract: The results of a hospitalwide voluntary reporting program for adverse drug reactions (ADRs) was compared with the results of a short-term, intensive, prospective surveillance program conducted by a pharmacist on a medical and a surgical patient care unit of a large teaching hospital. Data generated by the voluntary system were collected for a 45-day period; for the prospective surveillance, data were collected for 21 days. Strict definitions on the categories of probability, severity and mechanism of adverse reactions were employed. The incidence of definite and probable ADRs in the voluntary system was 0.08%; for prospective surveillance, the incidence was 7.2% (5.9% of 85 surgical patients and 9.0% of 67 medical patients). The incidence of ADRs in the prospective study, based on patient-drug exposures, was 1.0%. In the prospective study, patients experiencing ADRs received significantly more medications than those not experiencing ADRs. The operation of an ADR monitoring and reporting system for the purpose of maintaining incidence data was not judged to be cost effective. Periodic prospective surveillance programs on representative patient population samples may be valuable in determining true incidence figures.

Apparent theophylline half-life fluctuations during treatment of acute left ventricular failure.

Abstract: The administration of theophylline in a 63-year-old man with arteriosclerotic heart disease and chronic bronchitis is discussed to illustrate the pharmacokinetics of theophylline in an abnormal host state. The case demonstrates that clearly acute congestive heart failure and its treatment may dramatically affect the kinetics of theophylline elimination. Possible explanations for this phenomenon are presented, and the therapeutic implications are discussed.

Pharmacotherapy of Parkinson's disease.

Abstract: The pathophysiology, anticholinergic therapy and dopaminergic therapy of Parkinson's disease are reviewed; an emphasis is placed on the structure and function of the basal ganglia because of their importance in understanding the pharmacotherapy of parkinsonism. The pharmacologic management of Parkinson's disease is limited primarily to manipulation of the dopamine-acetylcholine system. Levodopa, with or without a peripheral dopa decarboxylase inhibitor, is the current drug of choice in the management of idiopathic and postencephalitic Parkinson's disease. Modification of the serotonin-histamine system via the use of antihistamines may be useful in some patients. There are also many adjunctive agents which may be employed in combination with or in place of levodopa. Levodopa clearly has no place in the treatment of neuroleptic-induced Parkinson's disease; anticholinergics and antihistamines are the agents of choice.

Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics. Part 1: tetracyclines.

Abstract: The mode of action, bacterial resistance, in vitro activity, pharmacology, dosage, adverse reactions, interactions and indications for tetracyclines are reviewed. Suggestions for the selection of a particular tetracycline are provided. It is concluded that there is only one pertinent difference among the tetracyclines, namely, that doxycycline, and probably minocycline, can be given in full dosage and with minimal risk to patients with renal impairment.

Intramuscular injections and bioavailability.

Abstract: Bioavailability of drugs following intramuscular injection is reviewed, with particular emphasis on diazepam, chlordiazepoxide, phenytoin, digoxin and lidocaine. Clinical experience with these drugs has shown that i.m. absorption may be slow, erratic or incomplete. Factors which play a role in the bioavailability of i.m. medications include the water solubility of the drug, dispersion of the injected solution and blood flow at the muscle site. For many drugs, intravenous injection is the parenteral route of choice, and oral administration may be more efficacious than i.m. injection.

Availability of Insulin From Parenteral Nutrient Solutions

Abstract: The effect of the following variables on insulin loss from total parenteral nutrient solutions was examined: (1) time of infusion sample; (2) insulin concentration; (3) amino acid or polypeptide source; (4) electrolytes and vitamins; (5) inline filters; (6) glass and polyvinyl chloride (PVC) infusion containers; and (7) human albumin. I125-tagged insulin was added to various parenteral nutrient solutions in liter containers. These solutions were prepared and drained to simulate actual clinical use. The drained solutions were collected and measured for radioactivity, and the percent of insulin remaining in the infusion container was calculated. Basic solutions of amino acids and protein hydrolysates in dextrose with 30 units of insulin failed to deliver approximately 44 to 47% of the added insulin. Varying the concentration of insulin had a small but statistically significant effect on the degree of insulin loss. The use of inline filters and PVC bags caused an even greater loss of insulin. The addition of albumin or electrolytes and vitamins decreased the insulin loss.

Drug product advertising and prescribing: a review of the evidence

Abstract: A review of the effect of advertising drug products in medical journals on the prescribing of drugs is presented. The scope of advertisiig, the content of advertising, the latent effects of advertising, the effects of advertising on prescribing, and the social costs and benefits of advertising are discussed. Advertising for antibiotic and psychotropic drug products is reviewed in some detail. It is concluded that there is inconclusive evidence that the pharmaceutical industry, through journal advertising, is persuading physicians to prescribe drugs too often or unwisely, or both. It is suggested that pharmacists study the information needs of health care practioners and provide good drug information services.

Use and abuse of laxatives.

Abstract: Colon physiology, the causes of constipation, an approach to management of constipation, and the features of various laxatives are reviewed. The categories of individual agents discussed include the bulk-forming laxatives, stimulant cathartics, saline laxatives, hyperosmotic laxatives, surfactant laxatives, emollient laxatives, enemas and suppositories. Dietary change and attention to proper bowel habits are frequently the only therapy necessary for the treatment of constipation. When laxative intervention is necessary, one of the milder agents should be employed over a short period of time. The chronic abuse of stimulant cathartics, often deeply rooted in family or ethnic traditions, is a significant problem and difficult to treat.

Pharmacist impact on drug use in an institution for the mentally retarded

Abstract: Pharmacist involvement on a team developed to monitor drug use in an institution for the mentally retarded is described, and the results of the team's efforts are reported. The behavioral review committee consisted of a physician, pharmacist(s), nurses, psychologists, sociologists and therapists. The pharmacists reviewed the patients' charts and pharmacy records to compile a complete drug history on a special "drug calender" form. The pharmacist visited the patient to determine current problems, the effectiveness of therapy and the presence of adverse drug reactions. Recommendations were than made to the committee. During the two-year study period, the use of antipsychotic drugs was reduced 18%; antianxiety-antidepressant drugs, 50%; sedative-hypnotics, 58%; and miscellaneous agents, 65%. The net savings in drug expenditures was more than $10,000 per year, Maladaptive behaviorial test results implied that the decreased drug use did not change behavior significantly. The study shows that the pharmacist, through a team approach, can help reduce the overuse of medications in institutions for the mentally retarded.

Toxic reactions and side effects of glucocorticoids in man

Abstract: The toxic reactions and side effects of glucocorticoids in humans are discussed. The effects reviewed include metabolic (muscle and skin, carbohydrates and lipids), cardiovascular, cellular, immunologic, skeletal and growth, gastrointestinal, nervous system, ocular, and hypothalmic-pituitary-adrenal.

Drug therapy reviews: tricyclic antidepressant and monoamine oxidase inhibitor combination therapy.

Abstract: Combinations of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) are discussed with regard to general toxicity, drug interactions, animal studies, clinical reports, efficacy of combination therapy and usage conditions. Although MAOI-TCA combinations are usually considered contraindicated, informed opinion has shifted to cautious recommendation for the combination. Only refractory patients in whom less hazardous treatment has failed should be considered for combination therapy. The preferred dosage regimen is administration of the MAOI t.i.d. during the day and the entire TCA dose at bedtime. Patients should be informed of the immediate need for medical advice should side effects occur. It is concluded that the simultaneous administration of these agents is potentially efficacious and safe is carefully monitored and controlled.

Propoxyphene: A Review

Abstract: A critical analysis of information on propoxyphene that has been published since the drug's introduction is presented. Propoxyphene is discussed with regard to its chemistry, metabolism and pharmacokinetics, analgesic efficacy, analgesic efficacy of combination products, nonanalgesic uses, adverse effects, overdosage, and dependence and abuse. Both the hydrochloride and napsylate salts are covered. It is doubtful that propoxyphene hydrochloride 65 mg provides an analgesic effect equal to that of aspirin 650 mg. There is no conclusive evidence that combinations of propoxyphene with other analgesics are more effective than propoxyphene or other analgesics alone.

Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics. Part 3: cephalosporins

Abstract: Various aspects of the cephalosporin antibiotics are reviewed, including mode of action and mechanisms of bacterial resistance, antibacterial activity, clinical pharmacology, adverse reactions, and therapeutic use. There are no important therapeutic differences between the two oral agents, cephalexin and cephradine. For intramuscular injection, cephaloridine has largely been replaced by cefazolin which is equally well tolerated and not as nephrotoxic; further, cefazolin has a relatively long half-life which permits its administration three or four times daily. There are no substantial therapeutic differences among the cephalosporins most commonly used intravenously--cephalothin, cefazolin and cephapirin. However, cefazolin is administered in a lower dosage and somewhat less frequently.

Effect of refrigeration on bactericidal activity of four preserved multiple-dose injectable drug products.

Abstract: The influence of refrigeration on the bactericidal capability of preservative systems in multiple-dose injectable drug products was studied. Commercially available multiple-dose injectable drug products containing preservatives--atropine/phenol, lidocaine/methylparaben, cyanocobalamin/benzyl alcohol and diphenhydramine/benzethonium chloride--were divided into two groups, one to be maintained under refrigeration (5C) and the other to be maintained at room temperature (25C). In separate tests the multiple-dose vials (MDVs) were individually inoculated with the following organisms: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Serratia marcescens, and cultured to establish bacterial concentrations at 0, 1, 2, 4, 8 and 24 hours. Bacteria in the preservative systems tested remained viable significantly longer under refrigeration. (Data for diphenhydramine/benzethonium were not obtainable with the methodology used.) It is recommended that sterile medications maintained in preserved MDVs be stored at romm temperature after initial use (i.e., after exposure to possible contamination) unless drug stability considerations dictate otherwise.

Effect of inline filtration on the potency of drugs administered intravenously.

Abstract: The binding of cephalothin sodium, phenobarbital sodium, dexamethasone sodium phosphate, isoproterenol hydrochloride, digoxin, dactinomycin and phenytoin sodium to three intravenous inline filters--a 5-micrometer stainless steel depth filter, a 0.2-micrometer cellulose ester membrane and a 0.2-micrometer polycarbonate membrane--was studied. The experiments were conducted simulating inline i.v. filtration of these drugs in three i.v. solutions--lactated Ringer's, 5% dextrose and normal saline. Cephalothin was assayed colorimetrically, phenobarbital and phenytoin spectrophotometrically, and the other drugs by radiotracer technique. Binding of the drugs to the filter was found to be insignificant from a therapeutic standpoint, except for dactinomycin which bound to the 0.2-uicrometer filters. The binding of dactinomycin was approximately 13% of the amount administered through cellulose ester and polycarbonate membranes, respectively. The binding occurred during the initial period of filtration of the drug solution. It was concluded that inline filtration of drugs administered in relatively high does should not present any problem concerning the reduction of the therapeutic potency because of filtration.

Community-hospital pharmacist detection of drug-related problems upon patient admission to small hospitals.

Abstract: A method was developed to increase community-hospital pharmacist consultation on patient drug use in order to detect drug-related problems upon patient admission to the hospital. A medication history was takenon criteria-selected patients admitted to two hospitals in distant, but similar, geographically small and isolated areas. Tho total number of patients selected was 392. Information about prior drug use was obtained from participating community pharmacists and their patient prescription records and medication profiles. It was found by pharmacist-acquired drug histories that one of five criteria-selected patients had a preexisting drug-related problem that the admitting physician acknowledged probably contributed to the admission and necessitated professional and patient communication. These problems included: adverse response to prescribed therapy, misuse of medication or noncompliance, effect of diet on therapy, patient treatment by more than one prescriber, and therapeutic ineffectiveness or inappropriateness of prescribed therapy. Drug histories were not obtainable in 25.6% of the patients.