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Biomedical subjects

D H Appleby

Publications and source records attributed to D H Appleby.

11 recordsLinked to original sources
PubMed1985

Quinidine-nifedipine interaction.

Quinidine pharmacokinetics are known to be altered by a number of drugs. We present a case where dose-related increases in quinidine serum concentrations were significantly suppressed by concurrent nifedipine therapy. Clinicians should be alert to the possibility of an alteration in quinidine serum concentrations when instituting or discontinuing nifedipine in patients receiving quinidine.

Aged↗
PubMed1984

Low-dose streptokinase therapy for subclavian vein thrombosis.

We have described the use of low-dose local infusion of streptokinase to treat subclavian vein thrombosis in a 30-year-old woman. Streptokinase was infused at 5,000 units per hour for three days, resulting in complete resolution of the thrombus.

Adult↗
PubMed1983

Reducing lost drug charges by monitoring computer-generated interdepartmental transfers.

The use of computerized interdepartmental transfer records to identify lost drug charges and a program to capture those charges are described. All charges for medications ordered on floor-stock requisitions for the operating room and various intensive-care units in a 400-bed hospital were entered into the pharmacy's computer. Medications ordered on requisitions that were not stamped with a specific patient's name were charged to the patient-care unit using the computer's interdepartmental transfer program. Computer reports itemizing these charges indicated that over $5100 per month was being lost, approximately half of which originated from the operating room. To reduce lost charges, an improved method of drug-inventory control was implemented in the operating room, and two nurses were hired to coordinate the drug-distribution system in this area. In addition, nurses in other intensive-care units were informed about the liabilities associated with failure to charge for medications, and incentive programs were developed to improve compliance with these procedures. During the first six months after implementation of these measures, monthly lost charges were reduced by a mean of 86%. The use of computerized interdepartmental transfer records to identify lost pharmacy charges may help to justify the cost of computer systems.

Computers↗
PubMed1982

Effect of peritoneal dialysis solution on the antimicrobial activity of cephalosporins.

We studied the effect of peritoneal dialysis solution (PDS) on the antibacterial activity of seven cephalosporins, gentamicin, tobramycin and amikacin. The six bacterial species employed in the study survived in a wide range of concentrations of PDS, however, Staphylococcus aureus did not survive beyond 24 h in PDS. There were no physical incompatibilities between any of the antibiotics and PDS. None of the cephalosporins was bactericidal in PDS, whereas, the bactericidal concentrations of the aminoglycosides in PDS approximated those of aminoglycosides in broth. We conclude from these in vitro data that cephalosporins may not be ideal agents for intraperitoneal therapy when they are administered in PDS.

Amikacin↗
PubMed1980

Use, misuse, and cost of parenteral cephalosporins at a county hospital.

We reviewed total usage of parenteral cephalosporins at a county hospital during 1978 with regard to appropriateness, pattern of use, and cost. In addition, we determined the impact of replacing cephalothin with cephapirin in the hospital formulary. During the 12-month study 366 patients received 409 courses of parenteral cephalosporins: 167 received cefazolin, 160 received cephapirin, and 35 received a combination of cefazolin and cephapirin. The surgical service prescribed 87% of the cephapirin and 92% of the cefazolin. Parenteral cephalosporins were used 62% of the time for prophylaxis and 38% of the time for therapy. Usage was judged inappropriate in 47% of all courses based on our criteria; 25% of the therapeutic courses were judged inappropriate, compared to 60% of the prophylactic courses. Pharmacy costs of cefazolin used as prophylaxis were more than twice the cost for cephapirin. Cost of a mean therapeutic course for cefazolin was 43% higher than for cephapirin. Antibiotic audits and continued education combined with judicial substitution of therapeutic equivalents should limit the inappropriate use and expense of parenteral cephalosporins for large as well as small hospitals.

Cefazolin↗