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Biomedical subjects

P Gal

Publications and source records attributed to P Gal.

At least 73 records · Page 4Linked to original sources
PubMed1986

Effect of pharmacist intervention on control of resistant hypertension.

The effect of a pharmacist's clinical intervention on blood pressure control in ambulatory adults with resistant hypertension was studied. Twenty patients of an internal medicine clinic who had diastolic blood pressures greater than 96 mm Hg on two consecutive visits and antihypertensive regimens consisting of two or more agents were entered in the study between November 1, 1980, and February 1, 1981. After asking each patient 15 questions about hypertension and its treatment, the pharmacist counseled the patient about antihypertensive therapy, obtained a medication history, and discussed diet. The patient's blood pressure was measured, and the pharmacist evaluated the appropriateness of the patient's antihypertensive regimen (based on compliance, adverse reactions, and regimen complexity) and possible reasons for the poor response to treatment. The pharmacist then recommended drug therapy to the physician; stepped care including hydrochlorothiazide, reserpine, and hydralazine was used when possible. Patients' mean age was 56 years. Most did not know the names of their medications or understand their dosage schedules. Eight patients had severe hypertension (193/124 +/- 23/4 mm Hg), five had moderate hypertension (161/109 +/- 20/2 mm Hg), and seven had mild hypertension (171/100 +/- 29/0 mm Hg). Factors contributing to poor blood pressure control were noncompliance and adverse drug effects. After five to eight months of follow-up, mean blood pressures for patients with severe, moderate, and mild hypertension were, respectively, 140/92 +/- 23/10 mm Hg, 131/92 +/- 8/6 mm Hg, and 137/88 +/- 26/3 mm Hg; the mean for each group was significantly different from baseline. In this study, pharmacists intervened successfully with patients and physicians to enhance blood pressure control through drug therapy.

Antihypertensive Agents↗
PubMed1985

Carbamazepine and carbamazepine-epoxide serum protein binding in newborn infants.

To evaluate the serum protein binding of carbamazepine (CBZ) and its active metabolite carbamazepine-10, 11-epoxide (CBZ-E) in newborns, cord serum was obtained from 20 infants at the time of birth. Each of the samples was spiked to concentrations of CBZ 12 + CBZ-E 3 micrograms/ml, and CBZ 4 + CBZ-E 1 micrograms/ml and then subjected to analysis for total and free drug concentrations. Total drug concentrations were determined by high pressure liquid chromatography (HPLC), and free drug concentrations were determined by ultrafiltration and subsequent HPLC. The mean percentage of CBZ unbound, calculated as (free drug concentration divided by total drug concentration) X 100, was 30.6 and 29.8% at the high and low concentrations, respectively. Results for CBZ-E were 52.0 and 47.5% at the high and low concentrations, respectively. Compared with previously published values for protein binding in older children and adults, neonates appear to bind CBZ to a lesser degree and CBZ-E to the same degree. The lower binding of CBZ suggests that the therapeutic range of total CBZ in neonates may differ from that in older patients; however, this will have to be determined through clinical study. As previously demonstrated in older patients, CBZ and CBZ-E binding was variable. Monitoring of free CBZ serum concentrations in neonates appears advisable because of this variability.

Blood Proteins↗
PubMed1985

Effects of clorazepate on breathlessness and exercise tolerance in patients with chronic airflow obstruction.

Five patients with severe chronic lung disease were given placebo or 7.5 mg of clorazepate, a benzodiazepine, at bedtime for two weeks using a double-blind cross-over study design. Exercise tolerance, arterial blood gases, pulmonary function tests, self-rated breathlessness, and self-administered depression and anxiety scores were similar during drug treatment, placebo treatment, and washout periods. Higher doses of clorazepate were not tolerated by three of five patients. Nonanxious patients with chronic lung disease seem not to benefit subjectively or objectively from a low-dose benzodiazepine regimen.

Aged↗
PubMed1984

The influence of asphyxia on phenobarbital dosing requirements in neonates.

phenobarbital dosing requirements and plasma clearance were examined for asphyxiated and nonasphyxiated neonates. The gestational age, postnatal age, duration of phenobarbital therapy and plasma phenobarbital concentrations were similar for the two groups. The plasma phenobarbital clearance was 4.1 +/- 1.0 (SD) and 8.7 +/- 3.9 (SD) ml/kg/h for asphyxiated and nonasphyxiated neonates, respectively. Asphyxiated neonates only require about half the maintenance dose of nonasphyxiated neonates to achieve similar plasma concentrations.

Aging↗
PubMed1984

Fetal drug exposure-behavioral teratogenesis.

This paper reviews the neurobehavioral and developmental effects of fetal drug exposure. The drugs most commonly associated with adverse developmental outcome include alcohol, anticonvulsants (particularly phenytoin and trimethadione), narcotics, and some environmental toxins. Major limitations of studies examining the consequences of prenatal drug exposure on development include inadequate control of other confounding factors, uncertain accuracy of drug histories, and outcome criteria that provide insufficient delineation of subtle developmental delays.

Abnormalities, Drug-Induced↗
PubMed1983

Usefulness of theophylline saliva levels in neonates.

In order to establish an alternative means for monitoring serum theophylline concentrations in neonates, the reliability of salivary theophylline concentrations was investigated. Eight premature neonates with apnea of prematurity were studied. Neonates received between 1.25 and 2.5 mg/kg of intravenous aminophylline every 12 h. Simultaneous samples of blood (0.25 ml) and unstimulated saliva (0.25-0.50 ml) were obtained 4 and 8 h after drug administration. Serum and salivary theophylline concentrations statistically correlated (r = 0.98, p less than 0.01). The mean serum/saliva ratio was 1.02 +/- 0.09, with an 8.9% interpatient variation. Serum theophylline concentrations can be predicted from the equation: serum concentration = 1.069 x saliva concentration - 0.193. The data suggest that theophylline serum and saliva concentrations in the apneic neonate are approximately equal. Salivary theophylline concentrations may be clinically useful when serum is not readily available.

Humans↗
PubMed1983

Variables affecting creatinine clearance prediction.

Patient data were analyzed retrospectively to evaluate the relationship between several body-weight variables and creatinine production and clearance. Data from 722 creatinine clearance determinations in 627 patients older than 12 years were analyzed. Weight variables were actual body weight (ABW), lean body weight (LBW), ideal body weight (IBW), and lean body mass (LBM). Weight-independent and weight-dependent clearance prediction methods were evaluated. Actual creatinine clearance values were compared with these predictions. Use of LBW and IBW produced equivalent estimates of creatinine clearance that were closer to measured values than those obtained with ABW. The use of LBW or IBW was not appropriate in patients less than 60 inches tall nor in morbidly obese patients. Weight-dependent clearance estimation was superior to weight-independent predictions in morbidly obese patients. A new LBM-based clearance estimation formula was derived; it may be useful for patients less than 60 inches tall. The use of LBM, particularly in patients less than 60 inches tall, should be investigated further.

Adult↗
PubMed1982

Effect of food on the bioavailability and pattern of release of a sustained-release theophylline tablet.

The effect of food on the bioavailability, time to peak level, and pattern of release of a sustained-release theophylline preparation was examined in six normal volunteers. The average bioavailability for the 100- and 300-mg tablets was 98 +/- 0.03% (S.E.M.). This is consistent with previously published data. Food decreased measured theophylline concentration during the first 4 hours for the 100-mg tablets and at the fourth-hour sample following the 300-mg tablets. The decreased rate of absorption resulted in a shift of the absorption curve to the right with a delay in the time to peak level. Peak serum concentrations for tablets given with a meal occurred 6 hours after the 100-mg tablets and 8 hours after the 300-mg tablets, as opposed to 4 and 6 hours, respectively, for tablets in the fasting state. The release pattern of the theophylline preparation approximated zero-order kinetics for all fasting and food treatments.

Adult↗
PubMed1982

A multicenter evaluation of variables affecting the predictability of creatinine clearance.

Data from 722 urine collections (627 patients) from 14 medical facilities were used to compare measured creatinine clearance values with clearance estimates calculated using three "urine-free' mathematical formulas. The influence of two patient weight variables (actual weight, lean body weight) and the level of renal function on clearance prediction was assessed. In addition, site parameters (region, facility), time parameters (month, day, day of the week), and patient parameters (age, sex, height, weight, diagnoses) were evaluated for their statistical influence on the relationship between measured clearance and estimates calculated with one of the methods. Strong, statistically significant correlations were observed between clearance values estimated with each prediction method and measured clearances. Although statistical differences were noticed between mean values predicted with each method, these differences were clinically insignificant. Use of lean body weight for calculation of creatinine excretion produced clearance estimates that were significantly lower than those obtained with actual weight and substantially closer to measured clearance values. Among patient variables, age and two specific diagnoses (congestive heart failure and pregnancy), were statistically associated with variability in the relationship between measured and predicted clearance. Interregional and interfacility differences in the measured-predicted clearance relationship, variability associated with the day of the week of collection, and tendency of the urine-free formulas to over-predict clearance support potential inaccuracy of measured clearance determination. The results suggest that inaccuracies in clearance determination, rather than inadequacies of urine-free prediction methods, account for the majority of the observed variability in the relationship.

Age Factors↗
PubMed1982

Early discontinuation of anticonvulsants after neonatal seizures: a preliminary report.

Seizures in the neonatal period generally respond well to anticonvulsant therapy, but exposure to anticonvulsant medication during the first few months of life may have a detrimental influence on growth and development. The optimal length of therapy is not known, though there are indications that treatment can be discontinued shortly after seizure control. We report a protocol in which anticonvulsant agents are discontinued before discharge from our neonatal unit. Follow-up of these infants has shown no recurrence of seizures.

Child Development↗
PubMed1982

Effect of asphyxia on theophylline clearance in newborns.

The effect of asphyxia on theophylline clearance was studied in 30 newborns who were matched for gestational age, postnatal age, and the presence or absence of asphyxia. Asphyxiated newborns cleared theophylline at approximately half the rate of nonasphyxiated newborns. We found that, in order to achieve a steady-state plasma concentration of 8 mg/L of theophylline, asphyxiated neonates should receive 2.1 mg/kg/day, while nonasphyxiated neonates should receive 3.9 mg/kg/day.

Asphyxia Neonatorum↗
PubMed1982

Neonatal seizures: a survey of current practice.

A nationwide survey of neonatologists and pediatric neurologists was conducted to ascertain their methods of evaluating and managing neonatal seizures. Of the sampled 750 physicians, 284 (38%) responded to the single mailing. Most respondents use a routine for seizure workup which includes glucose, calcium and electrolyte determinations, and a lumbar puncture. On the other hand, there was a great variation in the use of an EEG, CT scan skull x-ray, and a drug and metabolic screen. Phenobarbital was the initial drug of choice and phenytoin usually the second drug. Neurologists used higher loading doses for phenobarbital and phenytoin. Most physicians monitored blood levels to adjust maintenance doses. Drug therapy was usually continued for two months to one year after seizure control. Criteria for discontinuation were often arbitrary but included a normal electroencephalogram and the absence of seizures. The results demonstrate a lack of consensus in the evaluation and management of neonates with seizures.

Blood Glucose↗