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Biomedical subjects

C L Raehl

Publications and source records attributed to C L Raehl.

At least 37 records · Page 2Linked to original sources
PubMed1991

Toxic effects of drugs used in the ICU. Antiarrhythmic agents.

Supraventricular and ventricular arrhythmias remain relatively commonplace in the ICU. Proper pharmacologic treatment requires that the clinician recognize accompanying disease states that may alter the pharmacokinetics and pharmacodynamics of antiarrhythmic drugs. In addition, knowledge of cardiovascular toxicity, noncardiovascular adverse effects, and drug-drug interactions are necessary to optimize antiarrhythmic drug therapy.

Anti-Arrhythmia Agents↗
PubMed1990

Hospital pharmacy services in the Great Lakes region.

The results of a spring 1987 survey of hospital pharmacy services in seven states of the Great Lakes region are reported. The study group (n = 1087) comprised all hospitals in seven states that employed at least one full-time or part-time pharmacist and that had 50 or more licensed beds. The survey had a 63% response rate (681 usable responses). Seventy percent of the hospitals were small (average daily census, less than 200), 20% were medium sized (200-399), and 11% were large (greater than or equal to 400). Some 33% of the hospitals were affiliated with a college of pharmacy. Pharmacy directors who held an advanced degree (master of science or doctor of pharmacy) were more likely to work in larger hospitals and in those affiliated with educational institutions. The extent of unit dose services differed based on hospital teaching affiliation and pharmacy director's education. Provision of i.v. admixture services differed based on hospital teaching affiliation and pharmacy director's education but not hospital size. Pharmacy preparation of six specialty i.v. products differed according to pharmacy director's education and hospital teaching affiliation; however, pharmacy preparation of only three of the specialty products differed based on hospital size. Larger hospitals that were affiliated with an educational institution were more likely to employ a clinical coordinator, drug information specialist, or clinical pharmacist. Home health-care services involving pharmacists were provided by 26% of the hospitals; the most common programs were antimicrobial therapy and total parenteral nutrition therapy. Pharmacists provided services in ambulatory-care clinics in 24% of the hospitals, with the most common services being patient education, pharmacokinetics consultation, and dosage regimen adjustment. Provision of 10 of 12 inpatient clinical pharmacy services differed based on hospital size and teaching affiliation; 11 of the 12 services differed based on education of the pharmacy director. Workload and pharmacist staffing data for the inpatient clinical pharmacy services varied widely. Eleven of these services were expected to undergo a positive net growth, while one service, provision of admission medication histories, was expected to decline. An extensive survey of hospital pharmacy services in the Great Lakes region showed that the provision and scope of many services were related to hospital size, hospital teaching affiliation, and the education of the pharmacy director.

Drug Information Services↗
PubMed1990

A comprehensive measure of pharmaceutical services: the pharmaceutical-care index.

The construction, validation, and use of a numerical index for measuring the provision of pharmaceutical care are described. The 681 respondents to the 1987 Great Lakes Pharmacy Services Survey were randomly divided into two equal groups of hospitals. Data for the first group (n = 341) were used to construct and validate the pharmaceutical-care index (PCI); data for the second group were used for index analysis. Bivariate analysis of 14 major inpatient pharmaceutical services resulted in one service, admission medication histories, being dropped from the index. Multivariate analysis showed that the remaining services contributed equally to the PCI; they were therefore retained. The possible range of PCI scores was -11.166 to 26.518, with a high score indicating greater provision of service. Analysis of data for the second randomly selected group of hospitals (n = 340) showed that PCI scores differed significantly on the basis of hospital size, hospital teaching affiliation, and pharmacy director's education. The correlation between average daily census and PCI score was fair. Higher scores were associated with the presence of a clinical coordinator or a clinical pharmacist. There were weak associations between PCI score and numbers of pharmacists, pharmacy managers, drug distribution pharmacists, and clinical pharmacists. However, the number of decentralized pharmacists and the number of technicians both showed a fair association with PCI score. Hospitals that had pharmacist participation in ambulatory-care clinics or a staff development program had higher PCI scores than hospitals that did not. The provision of inpatient pharmaceutical services, as assessed by the PCI, may be influenced by hospital size, teaching affiliation, the education of the pharmacy director, and other factors. Further research is needed to extend these findings to other hospitals, expose interactions among the factors that affect pharmaceutical care, and refine the PCI.

Abstracting and Indexing↗
PubMed1989

Pharmacists' attitudes toward and use of cardiopulmonary resuscitation training received in pharmacy school.

Recent graduates of a pharmacy school were surveyed to determine their attitudes toward and use of cardiopulmonary resuscitation (CPR) and basic life support (BLS) training received as part of their pharmacy school instruction. Questionnaires were mailed to 215 pharmacists who had completed the mandatory CPR-BLS training; only those who had practiced pharmacy for at least 6 of the previous 12 months were asked to respond. Usable questionnaires were received from 187 of the pharmacists surveyed. Of the respondents, 134 (72%) believed that the CPR-BLS program should continue to be mandatory for graduation; 131 (70%) believed their training to be of value in their current practices, and 174 (93%) believed it would be of value in the future. Nine (5%) of the pharmacists had actually performed CPR since their graduation. Pharmacists practicing in small and large hospitals were more likely to participate in CPR than pharmacists in medium-sized hospitals, and such participation was associated with the presence of decentralized and clinical pharmacy services. Recent pharmacy graduates who had received mandatory CPR-BLS training in school had positive attitudes about the value of this training in their professional practices.

Attitude of Health Personnel↗
PubMed1987

Advances in drug therapy of cardiopulmonary arrest.

Advances in the selection and use of drugs during cardiopulmonary resuscitation (CPR) are reviewed. In 1985, the American Heart Association and the National Academy of Sciences-National Research Council revised standards and guidelines for CPR and emergency cardiac care. Algorithms were developed for treatment of (1) ventricular fibrillation and pulseless ventricular tachycardia, (2) ventricular tachycardia with pulse, (3) asystole, (4) electromechanical dissociation, (5) paroxysmal supraventricular tachycardia, (6) bradycardia, and (7) ventricular ectopy. Vasoconstriction, aortic diastolic arterial pressure, and coronary perfusion pressure are the most important determinants of the success of resuscitation. Because coronary perfusion occurs only during diastole, it is essential to maintain an adequate diastolic pressure. Arterial and central venous lines are needed for estimating coronary perfusion pressure, but end-tidal carbon dioxide measurement appears promising as a noninvasive alternative. Arterial blood gas measurements indicate respiratory alkalosis during CPR, but underlying tissue acidosis persists; venous blood gases appear to provide more useful information. A large catheter in a central vein above the diaphragm is the preferred route for drug administration during CPR, but an antecubital venipuncture site can be used to avoid interrupting CPR. Peak drug concentrations are higher and are achieved sooner with central venous than with peripheral venous injection. The endotracheal route can be used safely for administration of epinephrine, lidocaine, or atropine; an adequate volume (5 or 10 mL) of diluent is needed, and several insufflations should follow instillation. Drug distribution during CPR is greater to the brain and myocardium than to peripheral tissues. Epinephrine is administered to all patients in cardiopulmonary arrest; its beneficial effect is due to alpha-mediated vasoconstriction. Epinephrine increases cerebral as well as myocardial blood flow. The currently recommended dose of epinephrine hydrochloride is 0.5 to 1.0 mg i.v. at five-minute intervals. For endotracheal administration, an initial 1.0-mg dose is recommended, and subsequent doses are determined by patient response. Epinephrine has a beta-adrenergic-stimulating effect that may increase myocardial oxygen demand, but pure alpha agonists such as phenylephrine, methoxamine, and metaraminol have not been found superior to epinephrine. Epinephrine has not been proven to make ventricular fibrillation more susceptible to direct-current countershock. (ABSTRACT TRUNCATED AT 400 WORDS)

Cardiovascular Agents↗
PubMed1986

Pharmacokinetic disposition of 14C-glyburide in patients with varying renal function.

The pharmacokinetics of 14C-labeled glyburide were studied in 13 men with varying degrees of renal impairment. Patients received a single, 5 mg oral dose of glyburide as a solution (10 microCi/ml/mg) after a high-carbohydrate breakfast. Serial plasma and breath samples were collected for 48 hours and urine and feces were collected for 5 to 7 days. Patients with normal to moderately impaired renal function (creatinine clearance [CLCR] of 29 to 131 ml/min/1.7 m2) had glyburide plasma t1/2 values of 2.0 to 5.0 hours, with no relationship between CLCR and glyburide clearance. One subject with severe renal impairment (CLCR = 5 ml/min/1.7 m2) had decreased glyburide clearance that resulted in a t1/2 of 11 hours. The elimination of metabolites was more dependent on renal status but was only significantly affected in the patient with severe renal impairment.

Absorption↗
PubMed1986

Procainamide pharmacokinetics in patients on continuous ambulatory peritoneal dialysis.

The pharmacokinetics of procainamide in patients on continuous ambulatory peritoneal dialysis have been studied. A mean peak plasma concentration of 3.2 +/- 0.6 microgram/ml was achieved about 2 h after a single 500-mg oral procainamide hydrochloride dose. The procainamide elimination half-life ranged from 6.1 to 15.3 h. Apparent oral clearance, 183.7 +/- 63.2 ml/min, was less than half that observed in healthy adults suggesting markedly reduced dosage requirements. Continuous ambulatory dialysis patients exhibit similar procainamide pharmacokinetic parameters as do end stage renal disease patients, most notably a prolonged elimination half-life and reduced oral clearance.

Acecainide↗
PubMed1986

Endotracheal drug therapy in cardiopulmonary resuscitation.

Use of endotracheal drug therapy during cardiopulmonary resuscitation (CPR) is reviewed. Endotracheal drug therapy--instillation of a drug solution directly into an endotracheal tube for absorption into the circulation via the alveoli--may be used during CPR when venous access is limited. Administration of drugs via a central vein is the most efficient route, but a central i.v. line may not be present and peripheral venous administration may not be possible because of vasoconstriction, trauma, other patient-related factors, or absence of personnel trained to insert i.v. catheters. An endotracheal tube is usually inserted during CPR; in most cases, this procedure can be performed outside the hospital by emergency medical personnel. Basic life-support measures are not interrupted during endotracheal administration as they are in intracardiac drug administration. Drugs that may be administered by the endotracheal route include epinephrine, atropine sulfate, lidocaine hydrochloride, naloxone hydrochloride, and metaraminol bitartrate. Endotracheal delivery of calcium salts, sodium bicarbonate, and bretylium tosylate is not recommended. Pharmacokinetic data for drugs administered endotracheally are lacking; therefore, dosage recommendations are empirical. Usually, the same dose is administered endotracheally as by the i.v. route. Little is known about choice and volume of diluent and the best anatomic site of application. Endotracheal drug administration may replace intracardiac injection as the second-line alternative to intravenous drug injection during CPR.

Atropine↗
PubMed1981

Pharmacist involvement in institutional review of clinical trials.

The establishment of an institutional review committee (IRC) for investigational clinical trials in a large community hospital is reported. After the need for an IRC was identified, the pharmacy and therapeutics committee charged the director of pharmacy with drafting a protocol for establishing an IRC. Following a literature review, guidelines were written for the IRC in the form of a committee manual. These guidelines were approved, and composition of the nine-member committee was set as follows: three members of the trustee medical education and research committee, three members of the medical staff, one member each of the clergy staff and the pharmacy staff, and one nonaffiliated community representative. The IRC reviews, approves or denies, and supervises all proposed clinical investigations. Risk/benefit ratios, purpose, recruitment and selection procedures, financial support, and informed consent documents of the proposed study are among the factors considered in the approval process. Guidelines for written policies and procedures governing IRC structure and activities are presented. The involvement of the pharmacist in the establishment and subsequent functions of the committee is described. IRC membership is an opportunity for the pharmacist to work with other professionals in protecting the rights and welfare of human research subjects.

Clinical Trials as Topic↗
PubMed1980

Legal and ethical issues in clinical pharmacy research--informed consent, Part I.

The continued growth of hospital and clinical pharmacy should be paralleled by the development of sound research methods justifying innovative practices. Such research will, on occasion, require experimentation involving human subjects. The principal means of assuring that the welfare of research participants is not compromised is through the procurement of effective informed consent. Pharmacists, like many other health professionals, have had relatively little exposure to methodology involved in the writing of an informed consent instrument. A comprehensive document must not only conform to the requirements of federal regulatory agencies, but must also satisfy various institutional guidelines. Past instances of unethical human experimentation are discussed, and a format for preparation of an informed consent instrument is examined. Circumstances requiring informed consent and identification of the basic elements of consent are also explained.

Clinical Trials as Topic↗
PubMed1980

Legal and ethical issues in clinical pharmacy research--informed consent, Part II.

Preparation of an effective informed consent document presents significant problems to those investigators not familiar with federal and institutional requirements. This article examines a detailed format for preparation of an informed consent instrument. Prepared by the authors and supplied to potential clinical investigators by a university institutional review committee, the guidelines incorporate Department of Health, Education, and Welfare regulations. An example consent form is provided.

Clinical Trials as Topic↗
PubMed1980

Disulfiram-like reaction associated with a parenteral cephalosporin.

A disulfiram-like reaction attributed to cefoperazone, an investigational cephalosporin, is reported. Cefoperazone (T-1551, Pfizer Pharmaceuticals, Inc.), a semisynthetic, parenteral cephalosporin undergoing clinical trials in the United States, was administered in single 1-, 2-, and 3-g doses to 12 healthy volunteers. The drug was administered as a 5% solution by constant infusion over a five-minute period, and one week was allowed between doses. Approximately 25 hours after receiving the 3-g dose, one subject experienced facial flushing after drinking 12 fluid ounces of beer. A second ingestion of 24 ounces of beer eight hours later produced facial flushing, tachycardia, diaphoresis, and pounding headache; the symptoms lasted 1.5-2 hours. A subsequent rechallenge with beer five hours later produced an identical reaction, but the symptoms subsided rapidly. Further rechallenge 60 hours after receiving the drug produced no ill effects. No such reaction appears to have been reported previously as being associated with the administration of a cephalosporin.

Adult↗
PubMedDate not supplied

International pharmacy.

Several worldwide initiatives involve pharmacy education and practice; however, the International Pharmaceutical Federation is the only worldwide pharmacy organization currently in existence. This is the first report of the good pharmacy practice initiative published in the United States. We hope that it will stimulate interest in international pharmacy.

Drug Utilization↗
PubMedDate not supplied

Drug-induced torsade de pointes.

Three patients who developed torsade de pointes associated with antiarrhythmic or psychotropic drugs are described, and the electrocardiographic characteristics, clinical presentation, predisposing factors, and management of this form of ventricular tachycardia are reviewed. The first patient was a 56-year-old schizophrenic man receiving thioridazine hydrochloride, trifluoperazine hydrochloride, and benztropine mesylate who was admitted to a hospital after a syncopal episode. Subsequently, the patient experienced several episodes of ventricular tachycardia combined with multifocal premature ventricular contractions (PVCs) and torsade de pointes; the arrhythmias were attributed to antipsychotic therapy. The second patient was a 69-year-old man who experienced ventricular tachycardia that progressed to ventricular fibrillation 41 days after surgery. Quinidine sulfate probably induced the ventricular tachycardia, which was identified as torsade de pointes. The third patient was a 71-year-old man admitted to the hospital for treatment of refractory ventricular arrhythmias. Previous drug therapy with quinidine sulfate and procainamide hydrochloride had been associated with torsade de pointes. Despite unsuccessful treatment of ventricular ectopy, the patient was discharged on maintenance therapy with pindolol, topical nitrates, and phenytoin. No additional episodes of torsade de pointes have been observed. Torsade de pointes is characterized by polymorphous electrocardiographic appearance and delayed repolarization (prolonged QT interval). It may occur in association with a number of disease states and also as a complication of treatment with therapeutic doses of drugs that affect repolarization (quinidine, disopyramide, procainamide, and phenothiazines). Clinical outcomes range from asymptomatic, self-terminating arrhythmias to ventricular fibrillation resulting in cardiac arrest. The definitive emergency therapy for torsade de pointes is overdrive pacing; cautious isoproterenol administration can also be used. Lidocaine and bretylium are often ineffective in treating this form of ventricular tachycardia. Potassium and magnesium repletion appear to be essential in abolishing drug-induced torsade de pointes. Drug-induced torsade de pointes is best prevented by avoiding agents known to induce arrhythmias in patients with a pre-existing prolonged QT interval. Periodic serum electrolyte assessment is warranted, and new drugs that prolong the QT interval should be considered potential causative agents of torsade de pointes.

Acecainide↗