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Biomedical subjects

J E Dugas

Publications and source records attributed to J E Dugas.

12 recordsLinked to original sources
PubMed1985

Idiosyncratic pharmacokinetics complicating treatment of major depression in an elderly woman.

A 64-year-old woman with major depression developed toxic symptoms while on a regimen of 150 to 200 mg/day of desipramine. Her elimination half-life for desipramine was found to be greatly prolonged, at approximately 150 hours. Her ability to metabolize diphenhydramine and lorazepam was found to be impaired as well. Study of the elimination kinetics of desipramine in three of the patient's sisters provided some support for the existence of a genetically determined metabolic defect. Knowledge of those idiosyncratic pharmacokinetics had important implications for diagnosis and treatment in this case.

Depressive Disorder↗
PubMed1985

Nonlinear desipramine pharmacokinetics: a case study.

A case of nonlinear desipramine pharmacokinetics is described. During routine clinical monitoring serum desipramine concentrations appeared to change disproportionately with dose. Following a series of controlled dosage decreases, from 400 to 50 mg/day, the patient's steady state serum concentrations fit a nonlinear pharmacokinetic model. This curvilinear serum concentration-dose relationship suggests saturation of hepatic metabolism and signals the need for caution when predicting or titrating doses against serum drug concentrations. The implications of this new finding are discussed.

Aged↗
PubMed1982

Amoxapine (Asendin, Lederle Laboratories).

Amoxapine is a tricyclic antidepressant agent, which is chemically related to the antipsychotic agent loxapine, but which appears to block selectively the neuronal reuptake of norepinephrine; it is qualitatively similar to desipramine. In studies of patients with mixed depressive illnesses, amoxapine is at least as effective as amitriptyline and imipramine and probably more effective than placebo in ameliorating depressive symptoms. Claims of more rapid onset of therapeutic effects are based on group mean data obtained from small samples of depressed patients with heterogeneous and imprecisely defined diagnostic types. Amoxapine has yet to be compared with desipramine or maprotiline, the most pharmacologically similar antidepressants. Biopharmaceutical and pharmacokinetic data are limited, and a relationship between serum concentrations and efficacy has not yet been shown. Acute toxicity and drug interaction documentation are also lacking. At this time, amoxapine represents a chemical alternative to traditional tricyclic antidepressants. There are no consistent data indicating superiority of amoxapine over any other antidepressant agent for any specific symptom constellation, in rate or extent of improvement, or in any particular diagnostic or demographic population. Studies in which amoxapine is compared with pharmacologically similar agents at therapeutically equivalent doses in diagnostically homogeneous groups are needed to establish the drug's true place in the treatment of depressions.

Amoxapine↗
PubMed1979

Screening and selecting candidates for a hospital pharmacy residency program.

An applicant screening and selection procedure for a hospital pharmacy residency program which (1) efficiently processes a large number of applicants while minimizing the subjective nature of the review process and (2) ranks candidates for submission to the ASHP Residency Matching Program is described. A screening and selection committee consisting of five staff members of the hospital pharmacy department was created. Goals of the residency program and qualities of the optimal resident were defined prior to development of the screening and selection program. Two forms were used by staff in the screening process: a screening worksheet for the preinterview screen, and an evaluation chart for the interview phase. Each form outlined the criteria which serve as indicators of academic, professional and personal development in a format that allows easy extraction of data. By carefully defining program goals and identifying specific human qualities most compatible with those goals, the likelihood of successful applicant selection through use of a systematic screening process is increased.

Education, Pharmacy, Graduate↗
PubMedDate not supplied

Evaluation of a new lithium dosage-prediction technique.

The accuracy of a lithium dosage prediction technique was studied retrospectively. The dosage-prediction technique evaluated is based on lithium body clearance. The medical records of 71 psychiatric patients (30 men, 41 women) were reviewed. Age, sex, height, weight, serum creatinine, and one-compartment intravenous dosage equations were used. The lithium dose that would produce steady-state concentrations equal to those actually attained clinically was calculated. Forty-five (64%) of the predictions were within one capsule/day of the actual dose. There were 42 episodes (59%) of underprediction and 10(14%) of overprediction by one or more capsules per day. Underprediction occurred significantly more often in women than in men (31/41 versus 11/30). Predictions differed from actual doses by three or more capsules per day in 10 cases, nine of which were underpredictions. These patients did not differ significantly from the rest of the study group in age, sex, weight, serum creatinine, creatinine clearance, concurrent medical problems, or other medications. This lithium dosage prediction technique may be reliable, rapid, and inexpensive, but further refinement and prospective evaluation are necessary.

Adult↗