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Biomedical subjects

A G Lipman

Publications and source records attributed to A G Lipman.

At least 19 recordsLinked to original sources
PubMed1990

Clinically relevant differences among the opioid analgesics.

The mechanism of action of opioids and clinically relevant differences among the opioid analgesics are described. Both endorphins (endogenous morphine-like substances) and exogenous opioids (opium alkaloids and their derivatives) bind to opioid receptors in the human central nervous system to provide analgesia and other effects. Some drugs, such as morphine, are true agonists, i.e., they bind to and activate receptors. Some are partial agonists, binding to part of the receptor and causing effects that are similar to, but perhaps less pronounced than, the effects produced by agonists. Others are antagonist, i.e., they bind to the receptor but do not cause the associated effects. Some drugs, termed agonist-antagonist opioids, act as antagonists at one type of receptor and agonists at another type of receptor. True agonists tend to have relatively straight-line dose-response curves; in other words, their effect increases with increasing doses over a broad dosage range. Partial agonists and agonist-antagonists tend to have ceiling effects; that is, they do not have the broad dosage range of drugs such as morphine, methadone, hydromorphone, and other "strong" opioids. This fact mediates against the use of partial agonists and agonist-antagonists in cancer patients who have chronic pain that may increase as the disease progresses. Three major factors that should be considered when a drug is selected for clinical use are (1) relative affinities for the different opioid receptor types, (2) pharmacokinetic characteristics that influence onset and duration of action, and (3) whether the opioids are strong or weak. For treatment of cancer pain, drugs with long durations of action are preferable.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1985

Adjunctive antianxiety agents in the management of chronic pain.

We examined the relative clinical efficacy of three commonly used antianxiety medications and a placebo as adjuncts to analgesic treatment of chronic cancer and arthritic pain. Nine patients with chronic pain, including six with malignancy and three with rheumatic diseases, were each exposed to three treatment phases with antianxiety drugs (hydroxyzine, prochlorperazine, and chlordiazepoxide) and one placebo phase in a double-blind, counter-balanced design. Each phase lasted 2 weeks, with analgesic medication given throughout. Pre- and post-phase measures of anxiety, depression, and hostility were taken, together with daily reports by the patients on pain, mood, and medication intake. None of the antianxiety drugs were significantly more effective than the placebo in reducing pain levels, daily medication usage or hostility. Chlordiazepoxide significantly reduced anxiety and depression compared with the placebo, but also produced the most side effects (e.g., drowsiness). The preliminary findings failed to support the efficacy of the three antianxiety medications as analgesic adjuncts.

Adult↗
PubMed1979

An algorithm for the operational assessment of adverse drug reactions. II. Demonstration of reproducibility and validity.

The reproducibility and validity of an algorithm for diagnosis of adverse drug reactions (ADRs) were tested in a clinical spectrum of 30 suspect cases. Using a questionnaire derived from the algorithm the three algorithm developers (nonexperts) agreed on the probability of ADR in 67% of cases, with pair-wise agreement varying from 73% to 87%. The pair-wise agreement of two clinical pharmacologic experts rose from 47% without the algorithm to 63% with the algorithm, with Kw, a chance-corrected index of weighted agreement, increasing from 0.26 to 0.57. The algorithmic assessments of the three nonexperts agreed with expert consensus in 80% to 83% of cases. The ADR algorithm appears to provide a reproducible and valid method of evaluating the likelihood of ADRs in individual patients. Its use can help improve the diagnostic and epidemiologic approach to these important, complex clinical phenomena.

Adult↗
PubMed1979

Decentralization of pharmaceutical services without satellite pharmacies.

The decentralization of pharmaceutical services without the addition of pharmacy satellites is described. Mobile, master medication carts are used by pharmacy personnel in the patient-care areas to fill the unit dose carts used by nurses. A combination medication administration record and patient profile eliminates duplication of effort by pharmacy and nursing. Responsibilities of pharmacists and technicians, the process of hospital-wide implementation of the system, current levels of service, and a clerkship designed to improve staff pharmacists' clinical abilities are described. The ratio of the number of drug doses administered to the number of drug doses handled per patient-day increased after the implementation of the new system. This indicated that individual doses were handled fewer times by pharmacy personnel. This method of decentralization permitted integration of distributive and clinical pharmaceutical services with a minimal personnel cost increase, no additional space requirements nor expenditures for renovation, and only a small cost for master medication carts. Because the pharmacists work in the patient-care areas, they are in more frequent contact with nurses, physicians and patients.

Costs and Cost Analysis↗
PubMed1978

Use review of nutritionally complete liquid diets.

A study was conducted to determine the manner in which semisynthetic fiber-free liquid diets and complete oral liquid diets were being used in a large teaching hospital, and to determine the influence of the establishment of a dietary formulary and guidelines on prescribing. A use review of the dietary formulations was conducted both prior and subsequent to the publication of the formulary and guidelines. Ninety-five patients were monitored on 22 adult medical, surgical, psychiatric and gynecological divisions. The inappropriate or questionable orders for all types of dietary formulations decreased from 65% to 52% after the publication of the formulary and guidelines. There was a significant decrease (p less than 0.005) in orders for semisynthetic fiber-free diets, from 34 to 4, after publication of the formulary and guidelines. The guidelines and formulary appeared to have caused the decreased use of the diet formulations and to have aided in eliminating less than optimal prescribing of the products.

Diet↗
PubMed1977

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

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.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1976

Pharmaceutical group purchasing cuts costs, expands knowledge.

The CHA-CSHP pharmaceutical group purchasing program has provided several benefits to participating hospitals and related institutions in Connecticut. The program is run by pharmacists and staffed by individuals knowledgeable in good purchasing techniques. Pharmacist compliance has been good because of maximum input into program decisions by all participating pharmacy departments. Pharmaceutical industry participation has been excellent, because each bid invitation includes information on the previous year's purchases by participating hospitals and on the committed volume for the contract period. In addition, the program is self-supporting. Thus, larger hospitals, which would often be able to obtain good pricing independently, are not obliged to support the bulk of this program, as is often the case when participating institutions pay dues based on their bed size. As a result of the pharmaceutical group purchasing plan of the Connecticut Hospital Association, hospitals have received significant benefits in cost savings and shared drug information.

Connecticut↗