A structure for pharmacy specialization.
Explore the source record for details and available documents.
Drug Therapy↗
Biomedical subjects
B L Carter
Publications and source records attributed to B L Carter.
Potential use of aldose reductase inhibitors to prevent diabetic complications.
Reviewed are (1) the biochemical basis and pathophysiology of diabetic complications and (2) the structure-activity relationships, pharmacology, pharmacokinetics, clinical trials, and adverse effects of aldose reductase inhibitors (ARIs). ARIs are a new class of drugs potentially useful in preventing diabetic complications, the most widely studied of which have been cataracts and neuropathy. ARIs inhibit aldose reductase, the first, rate-limiting enzyme in the polyol metabolic pathway. In nonphysiological hyperglycemia the activity of hexokinase becomes saturated while that of aldose reductase is enhanced, resulting in intracellular accumulation of sorbitol. Because sorbitol does not readily penetrate the cell membrane it can persist within cells, which may lead to diabetic complications. ARIs are a class of structurally dissimilar compounds that include carboxylic acid derivatives, flavonoids, and spirohydantoins. The major pharmacologic action of an ARI involves competitive binding to aldose reductase and consequent blocking of sorbitol production. ARIs delay cataract formation in animals, but the role of aldose reductase in cataract formation in human diabetics has not been established. The adverse effects of ARIs include hypersensitivity reactions. Although the polyol pathway may not be solely responsible for diabetic complications, studies suggest that therapy with ARIs could be beneficial. Further research is needed to determine the long-term impact and adverse effects of ARIs in the treatment of diabetic complications.
Aldehyde Reductase↗
Pharmacotherapy and the primary care physician.
Clinical pharmacy services and pharmacotherapy specialists did not begin in primary care settings. Rather, the initial interdisciplinary teams took root in large hospitals and tertiary medical center inpatient services during the middle 1960s. By the early 1970s, however, numerous papers appeared that described a unique and exciting practice model that incorporated primary care physicians and clinical pharmacists. The sole purpose of the interdisciplinary concept was to allow each member to contribute their own expertise to improve patient care. In my experience, primary care physicians have been eager to consult clinical pharmacists and other health professionals. I believe that the reason for this is a fundamental philosophy that distinguishes these physicians from other medical specialists. Ingrained in their philosophy are concepts such as continuity of care and care of the entire patient. The latter relates, not only to multiple organ systems, but also the spiritual and behavioral characteristics of the person. The primary care physician is also viewed as the coordinator for all health care services required by their patients. Most primary care physicians welcome others' expertise as long as they continue to be the health care coordinator for the patient. The health care structure of the United States continues to shift to ambulatory care. This will provide additional opportunities for the types of group models described in this article. After 20 years, the positive impact that physician and pharmacotherapist teams can have on drug therapy is being recognized on a broader scale. These models should continue to move from the academic laboratory to private group practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Drug Therapy↗
Therapy for hypercholesterolemia.
For most patients, hypercholesterolemia can be effectively lowered with drug therapy but only after several issues have been considered. First, drug therapy should never be considered without adequate dietary intervention. Dietary therapy may be effective for many patients with mild to moderate elevations in cholesterol. None of the drugs used to treat lipid disorders are benign agents. There is still debate about the interpretations of recent studies, the ability to generalize from studies to the whole population, and the cost effectiveness of drug treatment. Within the framework of the AHA and NCEP guidelines, an individualized approach to therapy is prudent. This should be initiated with maximal patient education because drug therapy will be maintained for the long-term or for life. The LDL and HDL levels, age, sex, other CHD risk factors, cost of treatment, patient awareness, and motivation must all be assessed when making treatment decisions. When drug therapy is considered for patients with isolated hypercholesterolemia, bile acid sequestrants are the drugs of choice.
Anticholesteremic Agents↗
Once-daily propranolol for hypertension: a comparison of regular-release, long-acting, and generic formulations.
This randomized, single-blind, crossover study compared three formulations of propranolol, each given once daily for hypertension. After an initial titration phase, subjects randomly received regular-release, long-acting, or a generic propranolol formulation. Each drug was given for 4 weeks and each active treatment was separated by a washout phase to allow blood pressure to return to baseline. Twelve subjects received all three active treatments. Systolic and diastolic blood pressures and pulses were significantly reduced from baseline by all formulations. There was no significant difference among drugs. Examination of diastolic blood pressures suggested some loss of antihypertensive control at the end of the dosing interval. These results indicate that it may be possible to administer propranolol once daily for hypertension and that there is no advantage for using the long-acting form.
Adult↗
Initial drug therapy for hypertensive patients with hyperlipidemia.
Hypertension and hyperlipidemia are cardiovascular risk factors that commonly coexist. Studies have indicated that it is important to control both risk factors to achieve significant reductions in morbidity and mortality. Recent debate has focused upon whether traditional step I antihypertensive agents can substantially lower these risks because of their effects on plasma lipids. This debate continues to be unresolved. However, for the patient with elevated lipid levels, diuretics and beta-blockers may make the management of the lipid disorder more difficult. Therefore it may be desirable to select alternative step I antihypertensive agents that will not interfere with the therapy for hyperlipidemia. Alternative step I agents include alpha 1-blockers, ACE inhibitors, and calcium channel blockers. These agents either have no effect on plasma lipids or they improve the lipid profile. Generally, these drugs are well tolerated and provide good alternatives for patients with hyperlipidemias. The initial drug of choice can be chosen depending upon other patient variables such as age, race, or concomitant diseases.
Adrenergic alpha-Antagonists↗
Evaluation of a Bayesian regression program for predicting warfarin response.
The ability of a Bayesian regression program (Warfcalc) to predict warfarin response was evaluated retrospectively in 48 inpatients and prospectively in 10 inpatients. The prothrombin ratio (PR) on the last day of inpatient therapy was predicted using zero (naive) to five sequential, daily PR feedbacks. Bias and precision were measured using mean error (ME) and mean absolute error (MAE), respectively. Root mean squared error (RMSE) was used as a combined measure of bias and precision. In the retrospective group, the use of five PR feedbacks yielded the lowest ME, MAE, and RMSE (0.22, 0.30, and 0.45, respectively). The use of two and three daily PR feedbacks resulted in larger prediction errors compared with the use of naive parameters. Further evaluation of the retrospective patient data indicated that deletion of PR feedbacks associated with an activated partial thromboplastin time greater than 100 s and exclusion of metabolic inhibitors in the estimation of warfarin clearance resulted in more reliable predictions (ME = 0.07, MAE = 0.20, RMSE = 0.28). Similarly, deletion of such PR feedbacks and metabolic inhibitors from the prospective data and use of PRs for the first 5 days of therapy yielded ME, MAE, and RMSE values of 0.07, 0.21, and 0.27, respectively. The variance for prothrombin complex activity (PCA) as a function of the variance in the prothrombin time (PT) was investigated using Monte Carlo simulation assuming four different random error models for the PT measurements. These error models yielded functions that exhibit a maximum coefficient of variation at PCA values of 40-70%.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Are you an academician?
Explore the source record for details and available documents.
Education, Pharmacy↗
Antihypertensive drug-prescribing patterns of internists and family physicians.
Surveys that evaluated antihypertensive drug-prescribing patterns were mailed to 150 family physicians and 150 primary care internists. The initial mailing was followed by a telephone follow-up and a second mailing. Forty-seven percent of family physicians and 41.9% of the internists who were still in practice returned the questionnaire. When asked about their choice of antihypertensive drug therapy for specific patients (based upon age, race, sex, and coexisting disease), the responses of the two specialties were similar. The only statistically significant difference was observed in the responses for a 58-year-old obese white woman with diabetes and renal impairment. In this example, the family physicians were more likely than internists to recommend an angiotensin converting enzyme inhibitor or a beta-blocker (P = .036). This study demonstrates that the majority of physicians individualized initial therapy for hypertension to the specific patient rather than strictly following a stepped-care approach with diuretics or beta-blockers as initial therapy.
Adrenergic beta-Antagonists↗
Antihypertensive therapy in the elderly.
Control of hypertension in the elderly has been shown to reduce cardiovascular morbidity. Although it is not known if this is also true for isolated systolic hypertension, drug treatment should be considered for systolic pressures over 170 mm Hg that cannot be controlled with nondrug therapy. The diuretics, calcium channel blockers, and the ACE inhibitors are very effective and generally well-tolerated therapy for the elderly. It may be necessary to combine two of these agents for some patients. Beta blockers are particularly useful for patients with ischemic heart disease or prior myocardial infarction. Beta blockers are the only agents which have been shown to be cardioprotective. For all antihypertensive agents, the elderly should be started on low doses. The drugs should then be titrated slowly if necessary. It is common for the elderly to respond to lower dosages than younger patients, and they should be monitored carefully for adverse reactions to medications. Antihypertensives should be administered once or twice daily whenever possible. If these principles are considered, most patients can be effectively controlled with a minimum of side effects.
Aged↗
Amplification of plasmid copy number by thymidine kinase expression in Saccharomyces cerevisiae.
A 2 micron circle-based chimaeric plasmid containing the yeast LEU2 and the Herpes Simplex Virus type 1 thymidine kinase (HSV-1 TK) genes was constructed. Transformants grown under selective conditions for the LEU2 gene harboured the plasmid at about 15 copies per cell whilst selection for the HSV-1 TK gene led to an increase to about 100 copies per cell. Furthermore, the plasmid copy number could be controlled by the stringency of selection for the TK gene, and the increase in TK gene dosage was reflected in an increase in intracellular thymidine kinase activity. The mitotic stability of the plasmid in "high-copy" and "low-copy" number cells was determined. "High-copy" number cells showed a greater mitotic stability. The relationship of TK expression to plasmid copy number may be useful for the isolation of plasmid copy number mutants in yeast and the control of heterologous gene expression.
Gene Amplification↗
Imaging modalities for the study of the paranasal sinuses and nasopharynx.
Disease entities affecting the paranasal sinuses and nasopharynx are now evaluated primarily by computed tomography (CT) and magnetic resonance imaging (MRI). Cortical bone is best seen by CT, particularly with thin sections and high-resolution bone mode. Bone marrow and various soft-tissue structures are best evaluated by MRI. This article is a demonstration of the normal anatomy of the area as depicted by both CT and MRI.
Diagnostic Imaging↗
Warfarin dosage predictions assisted by the analog computer.
This paper describes an analog computer program used to predict warfarin dosages following an initial three daily doses of 10 mg. The program simulates the patient's response to warfarin and suggested dosages can be entered into the program daily to predict the dose necessary for the patient. Warfarin dosage predictions were made for 29 patients. There was a statistically significant correlation between predicted prothrombin time (PT) response and actual PT response (p less than 0.005) for all predictions made. However, when actual and predicted responses were compared with a paired t test, they were significantly different (p less than 0.05). The program described here has been useful for predicting initial warfarin requirements for the majority of patients. Continued research is necessary to identify useful computer methods for predicting warfarin dosages.
Computers, Analog↗
The secretion and post translational modification of interferons from Saccharomyces cerevisiae.
Studies with three interferon molecules, IFN-alpha 2, IFN-beta 1, and a "hybrid" interferon, IFNX-430 are described which illustrate that both the expression and secretion characteristics of heterologous proteins in yeast cells reflect properties of the proteins themselves. Recombinant DNA techniques have also been used to demonstrate that the efficient processing of mature heterologous proteins from the yeast alpha factor secretion leader can be affected by sequences on the carboxyl side of the initial cleavage site. Secretion studies with heterologous proteins in S. cerevisiae are aimed at maximising yield, the percentage of extracellular product and correct amino terminus sequence. The results presented here show that all three factors are susceptible to currently unpredictable properties of the foreign sequence. This situation, in turn, means that heterologous proteins can be used as tools in the biochemical dissection of the yeast secretion process.
Amino Acid Sequence↗
Elevated serum carbamazepine concentrations following diltiazem initiation.
A case of carbamazepine neurotoxicity following the addition of diltiazem is reported. A patient with previously stable carbamazepine serum concentrations was treated with diltiazem for atrial fibrillation and a rapid ventricular response. After three days on the combined regimen, the patient developed neurological symptoms resulting in hospitalization. After a review of the patient's medication usage and carbamazepine concentrations, an interaction between diltiazem and carbamazepine was suspected. Carbamazepine's elimination appears to have been decreased, resulting in neurotoxicity. The toxicity resolved when the carbamazepine dosage was decreased 62 percent.
Aged↗
Gastrointestinal side effects with erythromycin preparations.
This study was designed to determine the incidence and severity of gastrointestinal (GI) side effects in patients taking erythromycin. More patients complained of GI side effects with the enteric-coated tablet (70.8 percent) than with the stearate (51.4 percent) or the ethylsuccinate (48.9 percent) salts. The enteric-coated tablet was associated with a higher incidence of individual adverse reactions; more patients discontinued it because of adverse GI effects. These data demonstrate a high incidence of GI side effects to erythromycin. Additionally, GI side-effect incidence appears to be higher with the enteric-coated tablet.
Adolescent↗
Commonly used chemotherapeutic agents.
The primary care physician is often responsible for the management of cancer patients who may be receiving complex chemotherapeutic regimens. The World Health Organization has recommended standard approaches to recording baseline data and reporting treatment results (see Table 4, pp 252-253). These standards are intended for international use to compare results from various centers or investigators. Most antineoplastic agents have a number of serious toxicities or adverse effects associated with their use. By recognizing and quickly diagnosing drug-induced adverse effects of antineoplastic agents, morbidity or early mortality may be avoided.
Antineoplastic Agents↗
Anticoagulant therapy when pregnancy is complicated by osteoporosis.
Explore the source record for details and available documents.
Female↗