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Biomedical subjects

J O Covinsky

Publications and source records attributed to J O Covinsky.

At least 19 recordsLinked to original sources
PubMed1988

Systolic blood pressure response in three subgroups of hypertensives treated with sustained-release diltiazem.

Data from a long-term, open-label diltiazem trial were analyzed to test the hypothesis that the magnitude of systolic blood pressure (SBP) response to diltiazem is dependent on pretreatment levels. The study design included a 2- to 4-week placebo period to establish stable qualifying pressures. Patients devoid of significant coexisting diseases with diastolic blood pressures (DBPs) greater than or equal to 95 mm Hg or SBPs greater than or equal to 160 mm Hg were titrated on sustained-release diltiazem (60-180 mg b.i.d.) over 2-6 weeks. Titration goals were greater than or equal to 10% drop in DBP or greater than or equal to 15% in SBP. Patients were followed up to 20 months. Based on pretreatment blood pressure, patients were divided into three subgroups: isolated systolic hypertension (ISH) (SBP/DBP; greater than or equal to 160/less than 95 mm Hg), isolated diastolic hypertension (IDH) (less than 160/greater than or equal to 95 mm Hg), and combined systolic and diastolic hypertension (CSDH) (greater than or equal to 160/ greater than or equal to 95 mm Hg). SBP changed significantly from baseline for all three groups. However, the percent reduction in SBP was significantly greater for patients with baseline SBP greater than or equal to 160 mm Hg when compared with patients with baseline SBP less than 160 mm Hg (-10.3 +/- 0.7% vs. -4.4 +/- 0.6%). In comparing the ISH and CSDH patient groups, the CSDH group required a larger diltiazem dose to achieve a SBP response similar to the ISH group. Diltiazem was well tolerated with only a 5% dropout due to adverse effects of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

New therapeutic modalities for the treatment of elderly patients with ischemic heart disease.

In developing a treatment plan for elderly patients with ischemic heart disease, it is important to appreciate that the pathophysiologic process and aging influence the type of response produced by various drugs. The aging process also alters the way drugs are absorbed, distributed, and eliminated. Each of these variables must be considered in deciding which drugs should be used and how they should be administered.

Adrenergic beta-Antagonists↗
PubMed1987

Esmolol: a novel cardioselective, titratable, intravenous beta-blocker with ultrashort half-life.

Esmolol is an ultrashort-acting, cardioselective, intravenous beta-blocker with an elimination half-life of about nine minutes. After administration of a loading dose, its full therapeutic effect is evident within five minutes. Its efficacy in treating supraventricular arrhythmias is equal to that of propranolol, but unlike propranolol, the action of esmolol is titratable and is largely reversed within 10 to 30 minutes after stopping its administration. Esmolol is also effective in attenuating life-threatening perioperative tachycardia and hypertension caused by adrenergic stimulation in high-risk patients.

Adrenergic beta-Antagonists↗
PubMed1986

A seizure induced by concurrent lidocaine-tocainide therapy--is it just a case of additive toxicity?

A 79-year-old white male was admitted to the hospital for treatment of a right-lower-lobe pneumonia. His past medical history included: mild congestive heart failure, asymptomatic ventricular tachycardia, and ethanol abuse. He was initially treated with furosemide for his heart failure, lidocaine for his arrhythmias, and Bactrim for his pneumonia. On day 13 of hospitalization he experienced a tonic-clonic seizure during the time he was being converted from lidocaine to tocainide. At the time of the seizure both tocainide and lidocaine were well within their respective therapeutic ranges. Since the seizure, the patient has tolerated treatment with each drug separately, and at serum concentrations similar to those preceding the seizure, without neurological complications, indicating the possibility of a tocainide-lidocaine induced seizure.

Aged↗
PubMed1986

Effect of protein on renal function and drug disposition.

Studies in animals have indicated that increasing dietary protein intake could increase renal blood flow, glomerular filtration rate, and kidney size and weight. More recent literature suggests that similar findings may be seen in humans with an oral protein load and continuous infusion of amino acids. This paper reviews this body of literature, and examines potential mechanisms involved in producing the observed changes in renal function seen with protein and amino acid administration and potential alterations in drug disposition.

Dietary Proteins↗
PubMed1981

The role of the clinical pharmacist in medical education.

The clinical pharmacist is an integral member of the Docent team at the University of Missouri--Kansas City School of Medicine with duties in both teaching and patient care. These doctoral-level clinical pharmacists have sole responsibility for providing instruction in basic pharmacology and pharmacokinetics and for teaching pharmacotherapeutics to medical students and house officers at the Truman Medical Center. The pharmacology programs have been well received and are successful. Student evaluations have been positive, and acquisition of knowledge as measured by the computer-generated objective exam referred to as the Quarterly Profile Examination indicate progressive acquisition of basic pharmacologic information during periods of exposure to the clinical pharmacist. Analysis of part I of the National Boards of Medical Examiners Test shows that medical students with this instruction achieved higher scores in pharmacology than their mean performance on part I. House officers working with these clinical pharmacists also show progressive acquisition of basic pharmacologic knowledge as measured by the Quarterly Profile Exam. Preliminary evaluation of this nontraditional method of providing pharmacologic instruction indicates that the program is effective.

Education, Medical↗
PubMed1980

A look at the educational responsibilities and cost impact of the docent clinical pharmacist.

One innovation at Truman Medical Center, the primary teaching hospital of the University of Missouri-Kansas City, is the addition of the clinical pharmacist as a full-time member of the patient-care and educational teams. These practitioner-educators share responsibility for the patients' drug therapies and for the provision of instruction in basic pharmacology and pharmacotherapeutics in the medical school. Examination of the cost impact of these practitioners in separate studies indicates that they reduce drug costs. The unique pharmacology program provided solely by these clinical pharmacists is both well received and successful.

Cost-Benefit Analysis↗
PubMed1979

Doctor of pharmacy.

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Drug Information Services↗