Showing papers in "Annals of Pharmacotherapy in 2003"
TL;DR: Tamoxifen may reduce the risk of primary breast cancer in women at increased risk and the benefit of tamoxIFen in women who are not at risk is uncertain.
Abstract: OBJECTIVE:To review data on the use of tamoxifen for primary prevention of breast cancer.DATA SOURCES:A literature search was performed through MEDLINE (1992–May 2002) using the key words tamoxifen, breast cancer, and prevention.DATA SYNTHESIS:Breast cancer is the most common malignancy detected in American women. Attempts to reduce morbidity and mortality include early detection programs and chemoprevention. Clinical trials of tamoxifen for reduction of breast cancer risk are reviewed.CONCLUSIONS:Tamoxifen may reduce the risk of primary breast cancer in women at increased risk. The benefit of tamoxifen in women who are not at risk is uncertain. The risks of developing thromboembolic disorders or endometrial cancer must be considered before tamoxifen is prescribed. Women should be given all of the information about the benefits and risks of tamoxifen use so that they can make an informed decision based on the best data available.
359 citations
TL;DR: Patients’ warfarin knowledge, a determinant of anticoagulation control, was generally poor, and more attention should be given to the education of elderly and illiterate patients.
Abstract: OBJECTIVETo evaluate patients’ knowledge of warfarin and its relationship to anticoagulation control.METHODSFrom January to March 1999, 122 patients attending the warfarin clinic of the Prince of Wales Hospital in Hong Kong were interviewed. Their knowledge of warfarin therapy and adherence to medical advice were tested by 9 questions. A score (maximum 1.0) was calculated for each patient. The number of international normalized ratios (INRs) that was within the target range in the 4 most recent clinic visits was noted.RESULTSFifty-six men and 66 women participated in the study (mean ± SD age 58.0 ± 13.0, duration of treatment 43.1 ± 39.8 mo). Patients’ warfarin knowledge was poor, with an overall score of 0.48 ± 0.18. Participants generally knew the colors of their warfarin tablets and took them regularly. They almost always informed their physicians and dentists of their warfarin therapy. Only 40–45% of patients knew the strengths of their warfarin tablets, the reason for taking warfarin, and its effect ...
244 citations
TL;DR: The presence of pictograms was shown to improve the comprehension of more complex information, resulting in significantly more participants in the experimental group obtaining a score for understanding >80% for both the medicine label and PIL.
Abstract: OBJECTIVE:To design, develop, and evaluate a simple, understandable medicine label and patient information leaflet (PIL) for nystatin suspension, and to assess the effect of incorporating pictograms on understanding in low-literate participants.METHODS:Patient information materials were designed and pretested in a pilot study (n = 20), and were subjected to the Fry's readability test. The final evaluation was conducted with 60 low-literate participants who had a maximum of 7 years of formal schooling and for whom English was their second language. Demographic data were collected. Participants were randomly allocated to a control (text-only information) or experimental (text + pictogram information) group, shown the medicine label and PIL, and asked to read them. A series of questions was asked about the instructions and an understanding level was calculated in each case. A second series of questions assessed patient acceptability of the materials. Differences in understanding were determined by χ2 tests.R...
209 citations
TL;DR: Venlafaxine was quite promising in alleviating the pain and disability associated with fibromyalgia, and seems to be independent of its anxiolytic and antidepressant properties.
Abstract: BACKGROUND:Although the pathophysiology of fibromyalgia is unknown, central monoaminergic transmission may play a role. Antidepressants have proved to be successful in alleviating symptoms of fibromyalgia. Medications that act on multiple neurotransmitters may be more effective in symptom management.OBJECTIVE:To assess the efficacy of venlafaxine, a potent inhibitor of both norepinephrine and serotonin reuptake, in the treatment of patients with fibromyalgia.METHODS:Fifteen patients with fibromyalgia were assessed prior to and after treatment with fixed-dose venlafaxine 75 mg/d. Before initiation of pharmacotherapy, patients were interviewed with the Structured Clinical Interview for Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The study lasted for 12 weeks, and patients were evaluated in weeks 6 and 12. The primary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) total score and pain score. The anxiety and depression levels of the patients w...
157 citations
TL;DR: Linezolid resistance remains rare, with only 8 isolates among 9833 monitored isolates identified between January 1, 2001, and June 30, 2002, and resistance, however, was no longer limited to enterococci.
Abstract: BACKGROUND:The oxazolidinone class of antimicrobials has demonstrated remarkable activity against gram-positive cocci. Linezolid has proven to be a first-line therapeutic option for vancomycin-resistant strains. Linezolid clinical trial results and subsequent published case reports cite rare resistance emerging in patients receiving prolonged therapy.OBJECTIVE:To report the initial linezolid-resistant organisms from cases obtained through the SENTRY Antimicrobial Surveillance Program, after screening >40 000 gram-positive cocci without resistance between 1998 and 2000.METHODS:During 2001–2002, 8 resistant strains (from 8 different patients) located in 6 states from 7 different participating SENTRY institutions in the US were identified among bloodstream, respiratory, skin and soft tissue, and urinary tract infection isolates of Enterococcus faecalis, Enterococcus faecium, Staphylococcus epidermidis, and Streptococcus oralis. Resistance was detected by reference broth microdilution methods and confirmed by...
156 citations
TL;DR: Pharmacist intervention can modify factors affecting adherence, improve adherence, and reduce BP levels in patients treated with antihypertensive agents in a controlled study involving 9 community pharmacies.
Abstract: BACKGROUND:Pharmaceutical care programs have been shown to improve outcomes in hypertension. However, most programs required direct access to patient medical chart and patient consultation sessions by appointment.OBJECTIVE:To follow the current practice of community pharmacy, exploring the effect of an intervention program on blood pressure (BP) and factors affecting BP.METHODS:Treated hypertensive patients were enrolled in a 9-month controlled study involving 9 community pharmacies. The PRECEDE–PROCEED model was used as conceptual framework to identify factors affecting BP, to incorporate those factors in an intervention program, and to evaluate the impact of the program. A computerized decision-aid tool was used by pharmacists from 4 pharmacies to provide pharmaceutical care to subjects (n = 41); pharmacists from the 5 other pharmacies performed usual care (n = 59). As there was a statistically significant interaction due to family income in describing the impact of pharmacists' intervention on BP, popu...
144 citations
TL;DR: There appear to be 2 distinct mechanisms for linezolid-induced cytopenias, secondary to a chloramphenicol-like suppression of erythropoiesis and immune-mediated thrombocytopenia, which may help treat critically ill patients with few therapeutic options.
Abstract: BACKGROUND:Linezolid has been associated with anemia and thrombocytopenia. Mechanisms for neither have been elucidated.OBJECTIVE:To propose mechanisms for linezolid-induced anemia and thrombocytopenia.CASE SUMMARY:A 78-year-old white woman with Staphylococcus epidermidis endocarditis was treated with linezolid after developing resistance to multiple antibiotic regimens. After 7 days of linezolid therapy, she developed thrombocytopenia, while an anemia present since admission remained unchanged. A bone marrow biopsy was performed, primarily looking for a mechanism for the thrombocytopenia. Histopathology revealed adequate megakaryocytes, ringed sideroblasts, and vacuolated pronormoblasts. A course of immune globulin (IVIG) was administered, with slowing in the rate of decline in platelets. She died 24 hours after her last dose of IVIG of congestive heart failure.DISCUSSION:The presence of ringed sideroblasts and vacuolated pronormoblasts suggests that linezolid-induced anemia is secondary to a chlorampheni...
141 citations
TL;DR: Although hyponatremia can be a serious condition, appropriate measures for the management of at-risk and affected patients will lead to full recovery in most cases.
Abstract: OBJECTIVE:To review clinical information on the incidence and causes of hyponatremia (defined as a serum sodium level <130 mEq/L), the most common electrolyte abnormality seen in general hospital patients, and to discuss the diagnosis and treatment of hyponatremia in relation to these factors.DATA SOURCES:Primary sources and review articles were identified via MEDLINE (1981–July 2003) for entries on hyponatremia. We limited the search to specific topics including incidence, risk factors, diagnosis, treatment, and clinical disorders and medications associated with hypotonic hyponatremia.STUDY SELECTION AND DATA EXTRACTION:All of the articles identified were evaluated, and relevant and representative information was included in this review.DATA SYNTHESIS:Hyponatremia can result from several disease states, injury, surgery, physical exercise, or the administration of certain drugs (e.g., antidepressants, antiepileptics) and is associated with advanced age. Drug-induced hyponatremia is often asymptomatic and ...
132 citations
TL;DR: Substantial proportions of adolescents used medicine for common health problems and the prevalence of use differed between type of symptom for which the medicine was used, between countries, and between gender and age groups.
Abstract: OBJECTIVE:To examine gender, age, and country variations in adolescents' self-reported medicine use.DESIGN:Cross-sectional school surveys of representative samples of 11- to 15-year-old girls and boys were used. The 1997-1998 Health Behaviour in School-aged Children study was referenced. A standardized questionnaire was completed during school hours.SETTING:Canada, US, Greenland, Israel, and 24 European countries.PARTICIPANTS:123 227 participants equally distributed by gender and by 3 age groups (mean 11.7, 13.6, 15.6 y).MAIN OUTCOME MEASURES:Self-reported medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness during the past month.RESULTS:The magnitude of the adolescents' medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness varied substantially across countries. In each of the 28 countries, more girls than boys used medicine for pain. Use of medicine for headache increased by age; use of medicine for stomachache increased by age amon...
128 citations
TL;DR: Simultaneous administration of a β-blocker and a calcium-channel blocker may produce synergistic effects and the importance of education and communication among nurses, physicians, and pharmacists regarding the mechanism of action of controlled-release medications and their administration needs to be emphasized.
Abstract: ObjectiveTo report a case in which a crushed extended-release (XL) nifedipine tablet contributed to a patient fatality.Case SummaryA 38-year-old woman with multiple medical problems presented to the hospital in acute respiratory distress and was diagnosed with acute pulmonary edema and pneumonia. After initial stabilization, her medications were changed to oral hydralazine, labetalol, and nifedipine XL. These medications were crushed and administered through a nasogastric tube. The patient developed worsening bradycardia with hypotension and experienced asystolic cardiac arrest. She was resuscitated; however, the following morning, another dose of labetalol and nifedipine XL was crushed and administered through the nasogastric tube. She again developed worsening bradycardia with hypotension and ultimately died.DiscussionThe administration of a crushed nifedipine XL tablet resulted in the patient's severe hypotension. The concurrent administration of labetalol prevented a compensatory heart rate increase. ...
125 citations
TL;DR: Voriconazole is at least as effective as amphotericin B in the treatment of acute invasive aspergillosis in immunocompromised patients and has similar efficacy as fluconazole in treatment of esophageal candidiasis.
Abstract: OBJECTIVE:To review the pharmacology, in vitro susceptibility, pharmacokinetics, clinical efficacy, and adverse effects of voriconazole, a triazole antifungal agent.DATA SOURCES:A MEDLINE search, restricted to English language, was conducted from 1990 to June 2002. Supplementary sources included program abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America from 1996 to 2001 and manufacturer information available through the Food and Drug Administration's Web site.DATA EXTRACTION:All published and unpublished trials and abstracts citing voriconazole were selected.DATA SYNTHESIS:Voriconazole has shown in vitro activity against many yeasts and a variety of mold and dermatophyte isolates. Voriconazole can be administered either orally or parenterally. It exhibits good oral bioavailability, wide tissue distribution including distribution into the central nervous system, and hepatic metabolism. Drug interactions occur through inhibitio...
TL;DR: Clinical data demonstrate that ECG interval changes are a class effect of the 5-HT3 receptor antagonists, and the significant benefits of these agents outweigh the theoretical small risk of meaningful cardiovascular events.
Abstract: OBJECTIVE:To review the electrocardiographic (ECG) and cardiovascular effects of 5-hydroxytryptamine3 (5-HT3) receptor antagonists preclinically, in healthy volunteers, and in patients undergoing chemotherapy or surgery.DATA SOURCES:A MEDLINE search was performed of clinical trials and preclinical data published between 1963 and December 2002 assessing the ECG and cardiovascular effects of 5-HT3 receptor antagonists, supplemented with reviews and secondary sources.STUDY SELECTION AND DATA EXTRACTION:All of the articles identified were evaluated and all information deemed relevant was included in this review.DATA SYNTHESIS:There are no clinically relevant differences in efficacy and safety among the available 5-HT3 receptor antagonists for prevention and treatment of chemotherapy-induced and postoperative nausea and vomiting. As a class, they have well-defined electrophysiologic activity. Changes in ECG parameters (PR, QRS, QT, QTc, JT intervals) are small, reversible, clinically insignificant, and indepen...
TL;DR: The risk/benefit ratio of administered drugs could be improved with better knowledge of the patients’ medical history and the risk factors of ADEs.
Abstract: OBJECTIVETo increase the knowledge base on the frequency, causality, and avoidability of adverse drug events (ADEs) as a cause for admission in internal medicine or when occurring during hospitalizationMETHODSA prospective study was performed for 6 periods of 8 days each Epidemiologic data (eg, age, gender, medical history), drug utilization, and adverse drug reactions on patients hospitalized during these periods were collected by a pharmacy studentRESULTSA total of 156 patients (70 men and 86 women) were included in the study The patients’ mean age ± SD was 665 ± 181 years and mean length of stay was 132 ± 9 days Renal and hepatic insufficiency and previous history of drug intolerance were observed in 179%, 102%, and 2% of the hospitalized patients, respectively Thirty-eight ADEs occurred in 32 patients; in 15 cases, ADEs were identified as the reason for admission, 10 cases occurred during hospitalization, and 13 cases were present at admission, but were not the cause of admission The mos
TL;DR: WDI has the potential to impact consumers positively and negatively, and although not widely investigated, a number of factors can potentially influence the use of WDI by consumers.
Abstract: OBJECTIVE:To provide an overview of the use and impact of written drug information (WDI) on consumers, and to review the literature on the factors influencing the use of WDI by consumers.DATA SOURCES:Relevant articles published in English since the late 1970s were identified based on searches of on-line databases, texts, and cited references in published articles.STUDY SELECTION:Articles reporting findings on the origin, use, and impact of WDI were included. Due to limited literature, articles reporting findings on factors influencing the use of written drug as well as disease information were included.DATA EXTRACTION:Due to the lack of design consistency between studies and the comparatively small volume of work, subjective assessment rather than a criteria-based objective review was deemed more appropriate.DATA SYNTHESIS:To date, research on WDI has focused on its use and impact. WDI has the potential to increase patients' knowledge, compliance, and satisfaction. However, there is also the potential for...
TL;DR: In this community cohort, patients reported few adherence barriers and very high medication adherence rates, and the high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors.
Abstract: OBJECTIVE:To improve medication adherence by reducing self-reported adherence barriers, and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimensDESIGN:Prospective, randomized, controlled trialSETTING AND PARTICIPANTS:A single academically affiliated community health center Eligible patients had type 2 diabetes, had undergone laboratory testing in the year preceding the study, and had visited the clinic in the 6 months preceding the studyINTERVENTION:A pharmacist administered detailed questionnaires, provided tailored education regarding medication use and help with appointment referrals, and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care providerMEASUREMENTS:Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview Intervention patients with medication discrepancies at baseline were asses
TL;DR: Patients with inadequate FHL have worse health status, problems communicating with healthcare providers, poorer knowledge of their chronic disease state, are at increased risk of hospitalization, and are more likely to be confused about medications.
Abstract: 1726 ■ The Annals of Pharmacotherapy ■ 2003 November, Volume 37 www.theannals.com A66-year-old man comes to the urgent care unit experiencing shortness of breath. He is found to be in rapid atrial fibrillation and is admitted to the hospital. Once his heart rate is controlled, he is started on warfarin. He is discharged home with verbal and written instructions to take three 1-mg warfarin tablets alternating with four 1-mg tablets daily. He does not show up for his clinic appointments, and 2 weeks later presents to the emergency department with melena and syncope, an international normalized ratio (INR) of 39, and a hematocrit of 21%, and is admitted to the intensive care unit. His primary physician discovers that the patient had been taking both sets of warfarin tablets daily. The patient states that he did not ask questions at discharge because “everyone was so busy.” The patient did not tell anyone that he could not read the medication instructions or his clinic appointment slips. At a clinic visit, a physician instructs a young mother to give her 2-year-old daughter 12 1/2 mL of prednisone liquid daily. The pharmacy instructions on the medication label read “Give 2 1/2 teaspoons of prednisone daily.” The mother returns to the pharmacy in a couple of days for more medication and the pharmacy staff discovers that she has been giving her daughter 12 1/2 teaspoons of prednisone daily. The 1993 National Adult Literacy Survey reported that 40 million Americans could be considered illiterate and another 50 million had marginal literacy skills and could be considered functionally illiterate.1 The cases described above illustrate medication errors that occurred either because the patients could not read well and/or they did not comprehend the instructions of how to take or administer prescribed medications. For the purposes of this article, it is important to distinguish the differences between literacy and functional health literacy (FHL). The National Literacy Act of 1991 defines literacy in the US as “an individual’s ability to read, write, and speak English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and to develop one’s knowledge and potential.”2 FHL is a measure of a person’s ability to perform basic reading and numeric tasks in the healthcare context, such as reading insurance forms and medication labels, and performing mathematical tasks associated with taking medications (numeracy).3,4 The Test of Functional Health Literacy in Adults (TOFHLA) is a validated measure of literacy skills in the healthcare context, used primarily in clinical research.5 Patients with adequate FHL are more likely than patients with inadequate FHL to read, comprehend, and act on written healthcare information as intended by their provider. FHL may also be a marker of how well a patient can successfully navigate the demands of the current healthcare system. The prevalence of inadequate FHL is reported to be particularly high in elderly, low-income, and minority patients, with rates of over 50% in public hospitals and clinics and over 33% among Medicare recipients.6,7 A body of research exists demonstrating that patients with inadequate FHL have worse health status, problems communicating with healthcare providers, poorer knowledge of their chronic disease state, are at increased risk of hospitalization, and are more likely to be confused about medications.8-14 The purposes of this article are to (1) discuss what is known about the relationship between FHL and medication use, (2) describe the challenges of inadequate FHL and medication adherence assessment, (3) discuss the importance of FHL and promoting medication adherence, and (4) describe the role of pharmacists in addressing this issue. Functional Health Literacy and Medication Use: the Pharmacist’s Role
TL;DR: Baclofen therapy was effective in treating both the PTSD symptoms and accompanying depression and anxiety in patients with chronic PTSD due to combat.
Abstract: OBJECTIVE:Previous studies have shown the efficacy of γ-aminobutyric acid B (GABAB) receptor agonists in treating anxiety in patients with panic disorder and in treating depression and anxiety in alcoholic patients. We hypothesized that baclofen, a GABAB agonist, would be an effective treatment in the symptomatic management of veterans with chronic posttraumatic stress disorder (PTSD).METHODS:Fourteen male veterans with chronic, combat-related PTSD were enrolled in an open-label, 8-week, monotherapy trial of baclofen titrated to a maximum of 80 mg/d in 3 divided doses. The primary outcome measure was the Clinician-Administered PTSD Scale (CAPS), and secondary outcome measures included the Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, the Global Assessment of Functioning Scale, and the Clinical Global Impressions.RESULTS:In the 11 patients who completed the 8-week trial, the mean total CAPS score decreased significantly from baseline (from 82.9 ± 16.1 to 63.5 ± 21.2). The avo...
TL;DR: Infliximab is an effective new agent for the treatment of Crohn's disease and RA and its apparent unique mechanism of action makes infliximab an important addition to therapy.
Abstract: OBJECTIVE:To review the pharmacology, pharmacokinetics, efficacy, safety, and pharmacoeconomic impact of infliximab in the treatment of Crohn's disease (CD) and rheumatoid arthritis (RA).DATA SOURCES:MEDLINE and Pre-MEDLINE (1966–June 2002) and manufacturer prescribing literature were employed to find English-language articles on infliximab. Additional studies and abstracts were identified from the bibliographies of reviewed literature and conference proceedings.STUDY SELECTION/DATA EXTRACTION:All articles identified from data sources were evaluated, and all information deemed relevant was included in this review. Information regarding basic pharmacology was collected from studies in animals. Pharmacokinetic data were collected from human trials. Safety data were extracted from clinical trials and postmarketing surveillance. Priority was given to randomized, double-blind, placebo-controlled studies for the assessment of efficacy. All available economic evaluations were included.DATA SYNTHESIS:Infliximab i...
TL;DR: The etiology, diagnosis, and clinical presentation of Graves disease is reviewed and an overview of the standard and adjunctive treatments are provided, focusing on current controversies.
Abstract: OBJECTIVE:To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, β-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies.DATA SOURCES:Primary articles were identified through a MEDLINE search (1966–July 2000). Key word searches included β-blockers, Graves disease, inorganic iodide, lithium, methimazole, and propylthiouracil. Additional articles from these sources and endocrinology textbooks were also identified. We agreed to include articles that would highlight the most relevant points, as well as current areas of controversy.DATA SYNTHESIS:Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, ther...
TL;DR: This report is the first to measure tacrolimus concentrations in established human milk using tandem-mass spectrometry to detect drug while the infant was exclusively breast-fed by the mother, and in which the infant's growth and development were reported.
Abstract: OBJECTIVE:To report the first case of tacrolimus measurement in human milk following maternal dosing in a woman who breast-fed while taking the medication.CASE REPORT:A 32-year-old white woman who had taken tacrolimus 0.1 mg/kg/d throughout pregnancy contacted the Motherisk Program at 35 weeks' gestation inquiring about the safety of breast-feeding during maternal tacrolimus therapy. After benefit–risk assessment, the mother decided to breast-feed the baby.METHODS:Manually expressed milk samples were collected over 12 hours following the first tacrolimus dose of the day; pre-dosing and 1-hour post-dosing blood concentrations were also determined. The samples were analyzed for tacrolimus by tandem-mass spectrometry. Breast milk and blood samples were collected at steady-state.RESULTS:The highest and mean concentrations of tacrolimus in milk were 0.57 and 0.429 ng/mL, respectively. From these measurements, the exclusively breast-fed infant would ingest, on average, 0.06 μg/kg/d, which corresponds to 0.06% o...
TL;DR: Propofol should be avoided in patients with allergies to egg and/or soybean oil, if possible, and Clinicians should consider the potential for adverse drug events in Patients with select food allergies.
Abstract: OBJECTIVE:To report a case of anaphylaxis due to propofol in a child with allergies to egg and peanut oilCASE SUMMARY:A 14-month-old boy with a history of reactive airway disease was hospitalized for treatment of respiratory symptoms The patient had documented allergies to egg, peanut oil, and mold Within the first few hours after admission, acute respiratory decompensation occurred, and arrangements were made to transfer the patient to our tertiary-care hospital Prior to transfer, he was emergently intubated under sedation and paralysis with propofol and rocuronium When emergency air transport arrived, the patient was hypotensive and tachycardic His symptoms of anaphylaxis were managed throughout the flight and, upon arrival at our institution, the patient was admitted to the Pediatric Intensive Care Unit He improved over a 5-day hospital course, and his caregivers were instructed to avoid propofol in the future The patient's anaphylactic reaction following propofol was rated as a possible advers
TL;DR: Evidence from human trials favors the use of AUIC values >250 for rapid bactericidal action, regardless of whether the organism is gram-negative or gram-positive, as well as in vitro experiments and humans when the endpoints are clearly not equivalent.
Abstract: ObjectiveTo review clinical trials with fluoroquinolones and the pharmacokinetic and pharmacodynamic parameters predictive of clinical and microbiologic outcomes and resistance. Data on fluoroquinolones are summarized and the premise that a single AUIC target >125 may be used for all fluoroquinolones against all target organisms is examined.Data SourcesPrimary articles were identified by a MEDLINE search (1966–February 2002) and through secondary sources.Study Selection And Data ExtractionAll of the articles identified from the data sources were evaluated and all information deemed relevant was included.Data SynthesisThe fluoroquinolones exhibit concentration-dependent killing. This effect clearly depends upon concentrations achieved and outcomes depend upon endpoints established by individual investigators. With AUIC values <60, the actions of fluoroquinolones are essentially bacteriostatic; any observed bacterial killing is the combined effect of low concentrations in relation to minimum inhibitory conc...
TL;DR: Aripiprazole currently demonstrates comparable efficacy and safety for use in schizophrenia and can maintain remission of schizophrenia, according to long-term studies.
Abstract: OBJECTIVE:To review the pharmacology, pharmacokinetics, clinical efficacy, and safety profile of aripiprazole for the treatment of schizophrenia.DATA SOURCES:Information was selected from MEDLINE (1995–August 2002). Abstracts, scientific posters, and presentations were also used.STUDY SELECTION/DATA EXTRACTION:All published information regarding the pharmacokinetic, pharmacodynamic, and clinical characteristics of aripiprazole was considered. Studies providing a comprehensive description of aripiprazole were selected.DATA SYNTHESIS:Aripiprazole is a dopamine partial agonist and a serotonin-2A antagonist; it is dosed 10–30 mg/d, with no initial titration necessary. Short-term clinical trials demonstrated efficacy in acute exacerbations, and long-term studies showed that aripiprazole can maintain remission of schizophrenia. Most adverse events were mild. The incidence of extrapyramidal symptoms was low, with akathisia being the most common.CONCLUSIONS:Aripiprazole currently demonstrates comparable efficacy ...
TL;DR: Formal pharmacokinetic studies of argatroban are needed in critically ill patients in order to optimize therapy and demonstrate the potential over-anticoagulation that can occur in this patient population despite relatively normal hepatic function.
Abstract: OBJECTIVE:To report 4 patients who became excessively anticoagulated with the recommended or lower starting doses of argatroban during treatment for heparin-induced thrombocytopenia type II (HIT-II) in a cardiothoracic intensive care unit.CASE SUMMARY:Four patients were treated with argatroban after confirmation of HIT-II after cardiac surgery. In 3 patients, argatroban was initiated at the recommended starting dose of 2 μg/kg/min; in 1 patient, therapy was initiated at 1 μg/kg/min. All patients had relatively normal hepatic function. In all cases, the resulting activated partial thromboplastin time was supertherapeutic and exceeded 100 seconds in 3 patients. Additionally, argatroban clearance appeared to be prolonged upon discontinuation.DISCUSSION:Argatroban pharmacokinetics in critically ill patients have not been investigated. Our case series demonstrates the potential over-anticoagulation that can occur in this patient population despite relatively normal hepatic function. An objective causality asse...
TL;DR: Each pathway, via varied and often overlapping mechanisms, contributes to altered microvascular function that leads to the development of retinopathy, neuropathy, and nephropathy, the major microv vascular complications associated with diabetes.
Abstract: OBJECTIVE:To review the current biochemical theories on how diabetes contributes to microvascular disease.DATA SOURCES:MEDLINE search (1980–June 2003) and bibliographies of articles obtained on this topic.STUDY SELECTION AND DATA EXTRACTION:Articles identified from the data sources were evaluated and those deemed relevant to this review were incorporated.DATA SYNTHESIS:The prevailing biochemical theories on how diabetes leads to microvascular disease include increased polyol (sorbitol/aldose reductase) pathway flux, production of advanced glycation end-products, generation of reactive oxygen species, and activation of diacylglycerol and protein kinase C isoforms. These pathways contribute to endothelial damage and dysfunction and may alter gene functioning.CONCLUSIONS:Each pathway, via varied and often overlapping mechanisms, contributes to altered microvascular function that leads to the development of retinopathy, neuropathy, and nephropathy, the major microvascular complications associated with diabetes.
TL;DR: Clinicians in ambulatory care settings with similar patient populations can use a modified form of the questionnaire to screen for patients who should receive a medication review to identify patients potentially at increased risk of MRPs.
Abstract: OBJECTIVE:To evaluate and validate a 10-item self-administered questionnaire for use by elderly patients to identify who is at increased risk of potentially experiencing a medication-related problem (MRP).METHODS:Forty participants aged ≥60 years who took ≥2 prescription drugs regularly completed the questionnaire. Data collection was based on patient interviews, review of pharmacy or medical records, and drug regimen reviews (DRRs). Outcome measures included feasibility, inter-rater reliability, test–retest reliability, internal consistency, and validity of the questionnaire. DRR severity scores were determined for each participant based on published guidelines for appropriate use.RESULTS:The questionnaire was easily administered to this group of older adults. Overall inter-rater reliability was high (r = 0.847). Nine of 10 individual questions matched well between the investigator and participants (κ 0.4–0.6 for 3 questions; >0.6 for 6 questions). Test–retest reliability was significant for all 10 quest...
TL;DR: Evidence from in vitro and animal models favors the use of AUIC values >250 for rapid bactericidal action, regardless of whether the organism is gram-negative or gram-positive.
Abstract: OBJECTIVE:To review in vitro and animal model studies with fluoroquinolones and the pharmacokinetic and pharmacodynamic relationships that are predictive of clinical and microbiologic outcomes and resistance. Data on fluoroquinolones are summarized and examine the premise that a single area under the inhibitory concentration–time curve (AUIC) target >125 may be used for all fluoroquinolones with concentration-dependent killing actions and against all target organisms.DATA SOURCES:Primary articles were identified by MEDLINE search (1966–February 2002) and through secondary sources.STUDY SELECTION AND DATA EXTRACTION:All of the articles identified from the data sources were evaluated, and all information deemed relevant was included.DATA SYNTHESIS:The fluoroquinolones exhibit concentration-dependent killing. This effect clearly depends on concentrations achieved, and outcomes depend on endpoints established by individual investigators. With AUIC values <60, the actions of fluoroquinolones are essentially ba...
TL;DR: In this article, the authors examined the association between adherence and ethnicity or specific medication used after controlling for other factors, such as ethnicity, region, comorbid mental health conditions, and prior medication and healthcare resource use.
Abstract: BACKGROUND:Clinicians treating schizophrenia face increasingly diverse ethnic populations. Ethnic groups may have different approaches to the management of schizophrenia, which could impact antipsychotic medication adherence.OBJECTIVE:To examine the association between adherence and ethnicity or the specific medication used after controlling for other factors.METHODS:Texas Medicaid claims were retrieved for persons aged 21–65 years, diagnosed with schizophrenia or schizoaffective disorder, after initiating treatment with olanzapine (n = 1875), risperidone (n = 982), or haloperidol (n = 726) between January 1997 and August 1998. The association between ethnicity (African American, Mexican American, white) or medication and days' use of the medication in the year following initiation was assessed using multivariate linear regression. Covariates included other patient demographics, region, comorbid mental health conditions, and prior medication and healthcare resource use.RESULTS:African American and Mexican...
TL;DR: Supportive care and the use of antitoxin have been effective in the treatment of botulism from food-borne, intestinal, and wound exposure, however, the effectiveness of antit toxin in thereatment of inhaled C. botulinum has not been proven.
Abstract: OBJECTIVETo provide a concise review of the presentation and treatment of botulism.DATA SOURCESSearches of MEDLINE (1966–November 2001), tertiary references, and public and government Internet sites were conducted.STUDY SELECTIONAll articles and additional references from those articles were thoroughly evaluated.DATA SYNTHESISClostridium botulinum toxin blocks acetylcholine release in a dose-dependent fashion, resulting in acute symmetric diplopia, dysarthria, dysphonia, dysphagia, and possible neurologic sequelae despite the route of exposure (i.e., food-borne, wound, intestinal, inhalation). Disease secondary to genetically engineered C. botulinum may differ from that of inadvertent exposure. Present treatment is primarily supportive care, respiratory support, rapid decontamination, and antitoxin administration (i.e., trivalent, pentavalent, heptavalent antitoxin). Early initiation of antitoxin limits the extent of paralysis, but does not reverse it.CONCLUSIONSSupportive care and the use of antitoxin ha...
TL;DR: Although in daily practice these medications are frequently prescribed concomitantly, the results underscore the contraindication of concomitant use of NSAIDs and coumarin derivatives.
Abstract: OBJECTIVETo investigate the risk of bleeding complications during the combined use of coumarin derivatives and nonsteroidal antiinflammatory drugs (NSAIDs) compared with the use of coumarin derivatives alone.SUBJECTS AND METHODSIn this 1-year observational study, the local outpatient anticoagulation office detected all coumarin users with bleeding complications. These patients were sent questionnaires regarding the type and consequences of the bleeding as well as previous NSAID use. The local pharmacists detected patients with concomitant coumarin and NSAID prescriptions (but no bleeding). The relative risk for bleeding due to concomitant coumarin and NSAID use was estimated.RESULTSDuring 1 year, 738 hemorrhages were identified in 681 coumarin users. In 12.2% of these cases, an NSAID was involved. In contrast, in the whole population of coumarin users, 2.5% were prescribed an NSAID. Therefore, the relative risk of NSAID use with regard to bleeding complications was 5.8 (95% CI 2.3 to 13.6).CONCLUSIONSNSAI...