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D S Sherman

Publications and source records attributed to D S Sherman.

30 records · Page 2Linked to original sources
PubMed1988

Psychoactive medication use in intermediate-care facility residents.

Despite the large number of elderly patients in nursing homes and the intensity of medication use there, few current data are available on patterns of medication use in this setting. We studied all medication use among 850 residents of 12 representative intermediate-care facilities in Massachusetts. Data on all prescriptions and patterns of actual use were recorded for all patients during one month. On average, residents were prescribed 8.1 medications during the month (interquartile range, 7.4 to 8.8) and actually received 4.7 (range, 4.2 to 5.4) medications during this period. More than half of all residents were receiving a psychoactive medication, with 26% receiving antipsychotic medication. Twenty-eight percent of patients were receiving sedative/hypnotics during the study month, primarily on a scheduled rather than an as-needed basis. Of patients receiving a sedative/hypnotic, 26% (range, 14% to 41%) were taking diphenhydramine hydrochloride, a strongly anticholinergic hypnotic. Of those receiving one of the benzodiazepines, 30% were receiving long-acting drugs, generally not recommended for elderly patients. The typical benzodiazepine dose was equivalent to 7.3 mg per patient per day of diazepam. The most commonly used antidepressant was amitriptyline hydrochloride, the most sedating and anticholinergic antidepressant in common use. These data indicate that despite growing evidence of the risks of psychoactive drug use in elderly patients, the nursing home population studied was exposed to high levels of sedative/hypnotic and antipsychotic drug use. Suboptimal choice of medication within a given class was common, and use of standing vs as-needed orders was often not in keeping with current concepts in geriatric psychopharmacology. Additional research is needed to assess the impact of such drug therapy on cognitive and physical functioning, as well as to determine how best to improve patterns of medication use in this vulnerable population.

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PubMed1987

Cimetidine use in nursing homes: prolonged therapy and excessive doses.

Patterns of cimetidine use were identified in a survey of 3032 patients in 31 nursing homes. Of these, 60 (2%) were receiving cimetidine. For these patients, ages ranged from 63 to 102 years (mean, 81 years). The patients received a range of 1 to 11 regularly scheduled medications (mean, 5.6 medications). Duration of cimetidine treatment averaged 19.6 months for 48 patients (81%) receiving the drug for longer than an eight-week course of therapy. Prescribing indications appeared unjustified in 54 of 60 patients (90%). Doses were rarely appropriately reduced for patient age, despite established reasons to do so and the well-known potential for adverse effects of cimetidine in the elderly. The risks associated with prolonged drug-induced suppression of gastric acid are not known. This study suggests that use of cimetidine without justifiable indication and for extended periods of time is common in nursing home patients. Studies are needed concerning the safety of long-term cimetidine use in elderly patients.

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PubMed1981

Radiation and chemical injury in the bone marrow.

Hematopoietic system toxicity is a major limiting factor in the use of aggressive combined modality therapy in the treatment of malignant disease. In this review, the known drug-x-ray interactions using tissue culture systems are extended to the bone marrow compartment. Two hypotheses prevail for late bone marrow failure: (1) stromal damage to the vasculature with subsequent fibrosis and (2) irreversible stem cell depletion in the irradiated site. Clinical extensions of the experimental data for bone marrow kinetics in the animal model have not proven successful to date. The future strategies for therapy of malignancies in which both radiation and chemotherapy are employed may require dose modification or treatment planning to limit bone marrow toxicity.

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Cidofovir.

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Anti-HIV Agents↗