Biomedical subjects

M E Ernst

Publications and source records attributed to M E Ernst.

26 records · Page 2Linked to original sources

PubMed1997

Growth medium effect on the antifungal activity of LY 303366.

The impact of growth medium selection on antifungal susceptibility testing has been well documented. Previously we described the antifungal characteristics of LY 303366 via time-kill curve methods using RPMI 1640 buffered with 0.165 M morpholinepropane-sulfonic acid as growth medium. The purpose of the current study was to compare the previously reported kill curve results with results obtained using antibiotic medium number three (AM #3) as growth medium. Antifungal activity was assessed via susceptibility testing and time-kill studies in both media. Two isolates each of Candida albicans, C. glabrata, and C. tropicalis were studied. MICs for the six isolates were found to be 10 to 100 times lower in AM #3. Time-kill studies were conducted with multiples of the MIC ranging from 0.125 x MIC to 16 x MIC. LY 303366 exhibited fungicidal (> or = 3 log10 reduction in CFU) activity against all isolates in AM #3; however, fungicidal activity was noted only for three of the six isolates when tested in RPMI. Furthermore, the rate of fungicidal activity was more rapid when AM #3 was utilized. Not only were the rate and extent of activity influenced by choice of media, but the relationships between LY 303366 concentrations and activity were also found to be media dependent. The findings from this study serve to highlight further the importance of media selection for in vitro evaluation of antifungal activity. In vivo studies need to be conducted with LY 303366 to determine which media provides the best correlation between in vitro and in vivo findings.

Anidulafungin↗

PubMed1997

Tetanus: pathophysiology and management.

OBJECTIVE: To review the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of tetanus and its complications. DATA SOURCES: MEDLINE and Iowa Drug Information Services databases were searched for literature pertaining to tetanus. Additional literature was obtained from the references of selected articles identified in the search. Information from all articles was considered for inclusion in the manuscript. STUDY SELECTION AND DATA EXTRACTION: Articles selected were those considered by the authors to assist in providing the reader an understanding of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of tetanus. DATA SYNTHESIS: While the number of tetanus cases has decreased markedly since data reporting for the disease began in 1947, mortality among those who acquire the disease remains high. Elderly patients are particularly susceptible to tetanus and its complications. Prevention of tetanus focuses on primary immunization and scheduled boosters. Management of tetanus involves initial stabilization of the patient and protection of the airway, prevention of tetanospasmin absorption by administration of human tetanus immune globulin 3000-6000 IU, and eradication of Clostridium tetani with antimicrobial therapy (metronidazole 500 mg q8h). Supportive measures include the administration of neuromuscular blocking agents such as pancuronium in patients requiring artificial ventilation, as well as benzodiazepines (midazolam 5-15 mg/h) for sedation and muscle relaxation. Autonomic dysfunction should be managed with beta-adrenergic blockers such as propranolol or labetalol. CONCLUSIONS: Despite the relative infrequency of tetanus cases, mortality among untreated patients remains significantly high. Clinicians should become knowledgeable in the pathophysiology, clinical manifestations, and management of this potentially fatal disease.

Humans↗

PubMedDate not supplied

Prescription medication costs: a study of physician familiarity.

BACKGROUND: Studies in the past 25 years have suggested that physicians are not familiar with the costs of common prescription medications. OBJECTIVES: To determine physician familiarity with the cost of common prescription medications and to determine the value physicians place on knowing information regarding the cost of medications. DESIGN: Survey. SETTING: Seven community-based family medicine residency teaching clinics in Iowa. PARTICIPANTS: Two hundred five practicing resident and faculty physicians. INTERVENTIONS: From a series of $10 price intervals (range, $0.01-$80.00), physicians were asked to select the interval containing the cash price of the medication to an uninsured patient for 50 medications commonly prescribed in outpatient family medicine clinics. Physicians were also questioned about the value of medication cost information to their practice. MAIN OUTCOME MEASURES: The percentage of correct responses and the mean pricing scores were calculated for each respondent and for all medications. RESULTS: One hundred seventy-eight physicians responded (86.8%). Only 22.9% of the responses correctly identified the cost of the medication. More than two thirds (68.3%) of the responses underestimated the correct price interval. Branded drugs were underestimated in 89.9% of responses, while generic drugs were overestimated in 90.2% of responses. Overall, 64.4% of physicians believed they did not receive sufficient information in their practices regarding prescription drug costs, and nearly all (93.6%) reported that regular information on prescription medication costs would help them prescribe more cost-effectively. CONCLUSIONS: Physicians are unfamiliar with the costs of medications they commonly prescribe, and they report that regular access to information on prescription medication costs would help them prescribe more cost-effectively. Arch Fam Med. 2000;9:1002-1007

Humans↗

PubMedDate not supplied

Antifungal dynamics of LY 303366, an investigational echinocandin B analog, against Candida ssp.

Two isolates each of Candida albicans, Candida tropicalis, and Candida glabrata were selected for time-kill curve testing against LY 303366 at concentrations ranging from 0.125 x MIC to 16 x MIC. RPMI 1640 buffered morpholinepropanesulfonic acid (MOPS) was utilized as growth medium. Samples were obtained at predetermined time points over 24 hours and streaked for colony count determination. Against C. albicans (one strain) and C. glabrata isolates, LY 303366 exhibited fungicidal (> or = three log10 reduction in CFU) activity. In contrast, fungistatic activity was observed with LY 303366 against C. albicans (one strain) and C. tropicalis isolates at all of the multiples of the MIC tested. With the exception of one C. glabrata strain, the rate and extent of activity against test isolates was not enhanced with concentrations exceeding the MIC. Our data indicate that maximal antifungal activity with LY 303366 may be achieved by optimizing the time of fungal exposure to the drug. Additionally, these data suggest that use of the current interpretive endpoint for MICs in RPMI may underestimate the antifungal activity of LY 303366. Thus, the MIC endpoint may need to be re-evaluated, or perhaps an alternative media, such as antibiotic medium #3, should be utilized for determination of LY 303366 MICs.

Anidulafungin↗

PubMedDate not supplied

Implementation of a community pharmacy-based influenza vaccination program.

OBJECTIVE: To increase accessibility of influenza vaccine in a rural community by establishing a community pharmacy-based influenza vaccination program. SETTING: An independent pharmacy in a rural eastern Iowa community of 5,000 people. PRACTICE DESCRIPTION: Protocols for identification and screening of patients, administration of vaccine, and treatment of emergencies were developed by the pharmacist and approved by the county health department medical director. Administration of vaccine began October 15, 1996, and was completed on December 6, 1996. PRACTICE INNOVATION: Patients were prospectively and retrospectively identified to receive the vaccination. Informed consent was obtained. Vaccine was administered by the pharmacist after screening for contraindications and counseling the patient. Weekly vaccination records were forwarded to the collaborating physician to update patient charts. MAIN OUTCOME MEASUREMENTS: To determine whether accessibility of influenza vaccine in the community was increased through pharmacist administration, the proportion of patients immunized in the pharmacy who were not vaccinated the previous year was determined. RESULTS: The pharmacist administered 343 doses of vaccine. Two-thirds of the immunized patients (67.9%) reported also being immunized the previous year. These patients were generally older (65 years of age +/- 13) than the previously nonimmunized patients (54 years of age +/- 16). However, 60.8% of the patients not immunized the previous year reported either they would not have gone elsewhere for the immunization (45.3%), or were unsure (25.5%). CONCLUSION: The data collected suggest that pharmacist administration of influenza vaccination in a rural community pharmacy increases access and, possibly, immunization rates. This may be especially true among high-risk younger adults who are often overlooked and would not normally have received the immunization.

Adolescent↗

PubMedDate not supplied

Patients' acceptance of traditional and nontraditional immunization providers.

OBJECTIVE: To examine patients' acceptance and reported use of traditional and nontraditional immunization providers and settings. DESIGN: Survey. SETTING: Stratified sample of private family physician clinics, family medicine residency training programs, community pharmacies that provide immunizations under standing order protocols, and nonimmunizing community pharmacies, all located in Iowa. PATIENTS OR OTHER PARTICIPANTS: Individuals presenting for medical care or pharmacy services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sources of past immunizations, 'access to immunizations, importance of immunization records, and future use of different health care providers and settings for immunizations. Univariate and multivariate analyses were performed to examine the relationships between patient demographics and recruitment site on the question responses. RESULTS: 420 surveys were returned (67% response rate). Respondents frequently received immunizations at sites other than physician offices. Younger patients and those living in smaller towns were more likely to report receiving an immunization from a nonphysician. Patients recruited in immunizing pharmacies more often reported previous immunization by a pharmacist (P < .001), most often for influenza. Respondents often reported that it was more convenient to receive an immunization outside a physician office. Greater support was noted for receiving adult immunizations from nonphysicians and in nontraditional settings, whereas traditional settings and providers (physician offices, community health departments) were preferred for childhood immunizations. CONCLUSION: Iowans report accessing different health care providers and settings for their routine immunizations. In general, they are more likely to support using traditional immunization providers and settings for childhood immunizations but are less exclusive about where they receive adult immunizations. Pharmacists should consider focusing initial efforts on administering adult immunizations, due to greater patient acceptance of nontraditional immunizers for adult immunizations.

Adult↗

PubMedDate not supplied

Current perspectives on the management of seasonal affective disorder.

OBJECTIVE: To concisely review the etiology and current treatment modalities of seasonal affective disorder (SAD). DATA SOURCES: A MEDLINE search (1966-1999) was performed using the search term "seasonal affective disorder." The search was subsequently focused to "drug therapy" with limits of human studies and English-language papers. The search term "light therapy" was combined with "seasonal affective disorder." STUDY SELECTION AND DATA EXTRACTION: Articles discussing the epidemiology and treatment of SAD were independently examined by each author. Additional literature was reviewed from selected references identified by the original articles. DATA SYNTHESIS: SAD most likely results from a deficiency in serotonin. Light therapy remains the therapeutic intervention with the most experience and success. Selective serotonin reuptake inhibitors (SSRIs) have also shown benefit in treating the disorder. CONCLUSION: SAD is an important subtype of major depressive disorder. Clinicians should remain vigilant for signs and symptoms of the illness. Successful treatment may include light therapy or antidepressants, particularly SSRIs.

Antidepressive Agents↗

PubMedDate not supplied

Mibefradil, a pharmacologically distinct calcium antagonist.

Mibefradil is the prototype of a new class of calcium antagonists that selectively block T-type voltage-gated plasma membrane calcium channels in vascular smooth muscle. The drug is structurally and pharmacologically different from traditional calcium antagonists. It does not have negative inotropism at therapeutic concentrations, and is not associated with reflex activation of neurohormonal and sympathetic systems. In clinical studies of hypertension, mibefradil 50 and 100 mg/day reduced trough sitting diastolic and systolic blood pressures in a dose-related manner. Dosages exceeding 100 mg/day generally did not result in significantly greater efficacy, but were associated with a higher frequency of adverse events. No first-dose hypotensive phenomenon was observed. Mibefradil has antiischemic properties resulting from dilation of coronary and peripheral vascular smooth muscle, and a slight reduction in heart rate. In clinical studies of chronic stable angina pectoris, dose-related increases in exercise duration, time to onset of angina, and time to 1-mm ST-segment depression during exercise tolerance tests occurred. Mibefradil reduced the number and duration of ischemic events recorded by 48-hour ambulatory electrocardiograph (ECG) monitoring, as well as number of anginal episodes and nitroglycerin consumption. Favorable hemodynamic and clinical profiles are reported, including high trough:peak ratios (> 80%), high oral bioavailability, and long elimination half-life (17-25 hrs) permitting once/day dosing. Dizziness, headache, leg edema, and lightheadedness are frequently reported, but overall the agent is well tolerated. First-degree atrioventricular block and sinus bradycardia are the most frequent ECG changes caused by the drug. In vitro studies indicate mibefradil inhibits cytochrome P450 1A2, 2D6, and 3A4, resulting in elevated plasma concentrations of drugs metabolized by those isoenzymes. Therefore, it is contraindicated in patients receiving terfenadine, astemizole, cisapride, lovastatin, or simvastatin.

Angina Pectoris↗