Medication problems handled by a consumer-oriented drug information center.
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Colorado↗
Biomedical subjects
C S Conner
Publications and source records attributed to C S Conner.
Consultations with attorneys as a funding source for drug information centers.
The provision of legal consultations to attorneys as a method of generating income for a drug information center is described. The center established a formal, fee-based consultation service for lawyers after receiving several calls a month on a regular basis. During a six-month trial period, approximately 60% of the calls from lawyers were simple requests for information, such as the identification of a drug, drug dosage, or product availability. The remainder of the calls required formal written consultations, which had to be individualized to meet the attorneys' needs. The average length of these consultations was 2-3 pages including patient data, the request, response, conclusions, and 10-15 citations from the medical/pharmaceutical literature. No fees were charged for the requests that could be handled on the phone. For the preparation of a written consultation with references, the lawyers were billed +100/hr. Conferences with attorneys before preparing a request were also billed at +100/hr. If a deposition was required after the consultation services in the state's law journals and various legal publications. The majority of the attorneys who used the service indicated that they would probably use it again. The center found the provision of legal consultations to attorneys to be an effective mechanism for generating additional revenue.
Drug Information Services↗
Cimetidine: adverse reactions and acute toxicity.
Recent reports of cimetidine toxicity are summarized. Summaries of specific cases and categorized according to cardiovascular, central nervous system, dermatologic, endocrine, gastrointestinal, hematologic, or renal toxicity, or overdosage. Adverse reactions reported secondary to cimetidine during its investigational period and shortly after marketing were minimal. In several studies in which over 1200 patients were treated with cimetidine, the incidences of adverse clinical symptoms was no higher than in the nearly 500 placebo-treated patients. However, subsequent reports indicate that elderly patients, patients with impaired renal function, and patients with liver disease appear quite susceptible to mental confusion. Potentially serious hematologic depression, cardiac depression, and hypersensitivity-type hepatitis have also been reported. As a result of the reports of impotence and oligospermia, controlled trials evaluating the effect of cimetidine on fertility in young men are needed.
Cardiovascular Diseases↗
Podophyllum: suspected teratogenicity from topical application.
A case demonstrating suspected teratogenic effects of topical podophylium is presented. Podophyllum resin was applied five times for a duration of 4 hr from the 23rd to the 29th week of pregnancy. At birth a simian crease on the left hand and a preauricular skin tag were noted. It is suggested that podophyllum be avoided during pregnancy. Alternative treatment for warts of the vaginal, perineal, or anal area are presented.
Abnormalities, Drug-Induced↗
Naloxone: underdosage after narcotic poisoning.
A case of propoxyphene hydrochloride (Darvon) poisoning was unresponsive to therapeutic doses of naloxone hydrochloride in a 2 1/2-year-old girl. Following prolonged coma and artificial ventilation for three hours, the patient responded immediately to the intravenous administration of 2 mg of naloxone hydrochloride, which is 20 times the manufacturer's recommended dosage. Naloxone is the agent of choice in reversing the effects of narcotics and synthetic opiate derivatives, such as propoxyphene and pentazocine. The manufacturer's present recommended dosage may not be sufficient to reverse the effects of large narcotic ingestions. We therefore recommend that if there is no response within two minutes of the initial 0.01 mg/kg dosage of naloxone hydrochloride, a second dose 0.1 mg/kg (ten times the manufacturer's suggested dose) be given.
Child, Preschool↗
Drug information services for consumers and health professionals.
Provision of drug information services to both health professionals and consumers is described. The Rocky Mountain Drug Consultation Center (RMDCC) has been available to health professionals at Denver General Hospital since 1977. In April 1979, the RMDCC began promotion of combined health-professional- and consumer-oriented services. The service operates 8 a.m. to 6 p.m., Monday through Friday, with 24-hour on-call service. It is staffed by pharmacists who devote 70 man-hours per week to it. Training is primarily on the job. Most of the $80,500 budget is funded through a public health grant from the State of Colorado. a nine-member physician advisory board periodically reviews quality of responses. During a one-year period (April 1979-March 1980), 2264 calls were received from consumers and 1762 calls from health professionals--an increase of 197% over the previous year. Approximately 90% of consumer calls were not considered serious problems or were informational requests; 10% were considered potentially serious or serious drug-related problems. Less than 1% of consumers' questions required the use of anything more than basic drug information references. Of 76 follow-up calls made to consumers for serious or potentially serious problems, 73 were successfully recontacted, and 70 said they either followed RMDCC's recommendations or contacted their physician. The authors believe that combined consumer-oriented and health-professional-oriented drug information services help prevent misuse of medications by consumers.
Colorado↗
Acute poisoning from over-the-counter sleep preparations.
All cases received by the Rocky Mountain Poison Center involving over-the-counter (OTC) sleep preparations were studied during an 18-month period to elucidate 1) the range of toxicity; 2) characteristic symptoms, and 3) the time of onset of symptoms. In 155 cases reviewed retrospectively, the three most commonly ingested agents were Sominex, Nytol and Sleepeze. Multiple ingestions were also involved. Symptomatology was equally divided among no symptoms, mild symptoms and possible life-threatening symptoms. The least amount taken to produce possible life-threatening symptoms was 16 Sominex, 18 Nytol and 15 Sleepeze, although the average amount producing the same symptoms was approximately twice that. These symptoms were seen within six hours in all but three of the 39 cases presenting with these symptoms. There were no deaths.
Adolescent↗
Drug information--the problems and some solutions.
Several problems evident in the drug information delivery process and some solutions are presented. Major problems with current sources of drug information are accessibility of data, completeness of data, validity of information, appropriateness in the clinical setting, and currency. Better drug information sources are needed to provide rapid answers to patient-related questions routinely occurring in the clinical setting. Currently available mechanisms described to solve existing drug information problems are clinical pharmacologists and specialists, clinical pharmacists, drug information centers, and a computer-output microfiche drug information system (DRUGDEX).
Anticoagulants↗
Clonidine overdose: a review.
The pharmacology and pharmacokinetics of clonidine and the symptoms and treatment of acute clinidine overdosage are reviewed. Clonidine, a relatively safe and effective antihypertensive agent when used at therapeutic dosages, reduces blood pressure through a centrally mediated reduction in vasomotor tone. The primary symptoms of clonidine overdosage are central nervous system depression, bradycardia, hypotension, miosis, hypotonia, respiratory depression and possibly seizures. Gastric lavage followed by administration of activated charcoal is used to decrease absorption following acute oral ingestion. Intravenous fluid therapy and dopamine infusion are recommended for severe hypotension, and atropine sulfate is used to manage persistent bradycardia. Treatment of hypotension with alpha-adrenergic blocking agents (e.g., tolazoline) is not recommended unless patients fail to respond to dopamine infusion and administration of i.v. fluids.
Adolescent↗
Errors in the de Haen Drugs-in-Use Drug Information System.
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Abstracting and Indexing↗
Acetaminophen poisoning: a case report of the use of acetylcysteine.
Acetylcysteine treatment of acetaminophen overdose (24--30 g) in a 31-year-old female is reported. Acetylcysteine was used to prevent acetaminophen-induced hepatotoxicity. An oral loading dose of 7 g of acetylcysteine was followed with oral administraton of 3.6 g every four hours for 17 doses. Liver enzymes were elevated on the fourth day after overdose. Phytonadione was administered on days four through six for elevated prothrombin time ratios. Only mild elevations of liver enzymes still were present on day seven. Previous case reports and studies of acetaminophen-induced hepatotoxicity and acetylcysteine therapy are reviewed. The use of acetylcysteine in this case appeared to be beneficial.
Acetaminophen↗
Labetalol: an alpha- and beta-blocker.
Labetalol is an investigational alpha- and beta- adrenoreceptor antagonist. The ratio of effective beta: alpha-blockade is approximately 7:1. Labetalol, administered intravenously or orally, has been effective in treatment of hypertension, with minimal effects on cardiac output. Labetalol will offer advantages over propranolol due to its more potent antihypertensive effects and less potent effects on left ventricular function at both rest and exercise in patients with coronary artery disease. The drug will be utilized in patients unresponsive to other beta-blocking agents and in patients with congestive heart failure and concomitant hypertension, angina, or arrhythmias when other beta-blockers are contraindicated. The drug appears to be safe in obstructive airway diseases and offers advantages over other beta-blockers in long-term treatment after myocardial infarction.
Adrenergic alpha-Antagonists↗
Hypophosphatemia.
Hypophosphatemia, defined as serum phosphate levels less than 2.5 mg%, is a relatively common disorder that can affect virtually every organ system. Phosphate deficiency can result from decreases in phosphate intake or absorption, increased loss from renal and nonrenal pathways, and transcellular phosphate shifts. Optimum therapy is directed at recognizing patients at greatest risk, correcting the underlying abnormality, and supplementing phosphate intake. Intravenous phosphate therapy is indicated for severe hypophosphatemia (serum phosphate less than 1 mg%) with close monitoring of serum phosphate, calcium, potassium, and magnesium levels. Indications for phosphate therapy and suggestions for empirical iv therapy in severe hypophosphatemia are presented.
Adult↗
Withered Yang: a review of traditional Chinese medical treatment of male infertility and erectile dysfunction.
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Acupuncture Therapy↗
Ranitidine: a new H2-receptor antagonist.
The pharmacology, pharmacokinetics, clinical efficacy, adverse reactions, drug interactions, and dosage of ranitidine are reviewed; specific comparisons are made of this new H2-receptor antagonist with the older agent, cimetidine. Ranitidine is a potent inhibitor of gastric acid secretion whose chemical structure lacks the imidazole group previously believed to be essential for H2-receptor blocking activity. The new agent does not bind substantially to the cytochrome P-450 mixed-function oxidase system and does not penetrate the cerebrospinal fluid appreciably. Peak serum ranitidine concentrations occur within one to two hours after oral administration; approximately 50% of an oral dose reaches systemic circulation. There are at least three metabolites of ranitidine, but substantial fractions of both i.v. and oral doses are recovered unchanged in the urine. Ranitidine's duration of action is 8-12 hours. Controlled clinical trials have shown ranitidine to be effective in the treatment of duodenal and gastric ulcers, Zollinger-Ellison syndrome, and prophylaxis against aspiration during anesthesia. Ranitidine has been effective in patients unresponsive to or intolerant of cimetidine. In clinical trials, the incidence of adverse effects from ranitidine has been low; certain rare but serious side effects that have been noted with cimetidine have not been associated with ranitidine therapy. There is no evidence thus far that certain drug-drug interactions observed with cimetidine therapy will occur with ranitidine. Oral adult daily doses of ranitidine are likely to be 300 mg given as the hydrochloride salt in two divided doses. Ranitidine is similar to cimetidine in efficacy but has an apparently safer adverse-effects profile. Ranitidine is likely to be the preferred agent in certain clinical situations.
Anesthesia↗
Managing acute toxicity from nonprescription stimulants.
The symptomatology and management of toxicity caused by nonprescription stimulants is reviewed. Nonprescription stimulants contain (singly or in combination) the same basic active ingredients: caffeine 100-200 mg, phenylpropanolamine 25-50 mg, and ephedrine 25 mg. Generally, toxic reactions involve excessive CNS stimulation (e.g., increased motor activity, anxiety, and agitation) and mildly elevated pulse rate and blood pressure that resolve in six to eight hours without specific treatment. However, reactions following the ingestion of these stimulants have included severe hypertension, possible renal failure, cerebral hemorrhage, and cardiac arrhythmias. Neither ephedrine nor caffeine ingested as single entities have been reported to produce increases in blood pressure associated with end-organ damage; however, severe hypertension has followed therapeutic doses of phenylpropanolamine. General management in the overdosed patient involves establishing respiration, initiating emesis, administering activated charcoal and a cathartic, and monitoring the patient's blood pressure, ECG, fluid intake, and urinary output. The increased availability of tablets and capsules containing substantial quantities of phenylpropanolamine, caffeine, and ephedrine creates a potential for drug-induced morbidity and mortality.
Adolescent↗