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Biomedical subjects

P Gal

Publications and source records attributed to P Gal.

At least 91 records · Page 5Linked to original sources
PubMed1982

Efficacy of phenobarbital monotherapy in treatment of neonatal seizures -- relationship to blood levels.

Seventy-one neonates were observed for the relationship between phenobarbital plasma concentrations and elimination of seizures. Sixty neonates (85%) had seizures controlled by phenobarbital alone. Effective plasma concentrations were 10.1 to 46.4 mg per liter. Although 36 neonates had seizures controlled by phenobarbital concentrations below 20 mg per liter, 7 neonates required levels above 30 mg per liter. We recommend that plasma phenobarbital concentrations should equal or surpass 40 mg per liter before additional anticonvulsants are used for neonates with seizures.

Humans↗
PubMed1980

Theophylline-induced seizures in accidentally overdosed neonates.

Theophylline-induced seizures are reported in two neonates. The serum theophylline concentration during seizures were 51.0 mg/liter and 54.0 mg/liter. Toxic symptoms prior to seizures may be absent or undetected, suporting the necessity of blood level monitoring during theophylline therapy.

Female↗
PubMed1978

Theophylline disposition in obesity.

Theophylline disposition was examined in 14 obese subjects and 57 normal subjects. A single oral dose of aminophylline solution was given and serum and saliva samples were collected over several hours and assayed by high-pressure liquid chromatography. The apparent volume of distribution (Vd) and body clearance (ClB) were analyzed for total body weight (TBW) and ideal body weight (IBW). The Vd averaged 0.482 (SD = 0.084) L/kg TBW in normals vs 0.382 (0.069) L/kg TBW and 0.77 (0.189) L/kg IBW in obese subjects. The ClB averaged 63.0 (28.5) ml/hr/kg IBW in normals compared to 32.8 (11.1) ml/hr/kg TBW and 64.1 (20.8) ml/hr/kg IBW in obese subjects. Similar Vd values between the two groups when TBW is used indicates that loading dose is best calculated based on TBW. Similar ClB based on IBW in normal and obese subjects indicates that IBW should be used to calculate maintenance doses for theophylline. Mean half-lives were longer in obese subjects than in normals, 8.6 (2.0) and 6.0 (2.1) hr, respectively, suggesting that obese patients may need less frequent dosing.

Adult↗
PubMed1978

Consultant approach to improving drug-related services to chronic hemodialysis patients.

A consultant role for the pharmacist in solving a drug-related problem of another hospital department is described. The head of a 16-patient-per-day hemodialysis unit requested assistance from the pharmacy to improve the medication records for hemodialysis patients. Investigation uncovered several additional problems such as contradictory medication orders, poor patient compliance and evidence of drug abuse. The pharmacy devised and assisted in the implementation of new mechanisms for initiating, recording and charting medications. A patient education program and a system for assuring availability of medications for self-administration were also instituted. After nursing personnel were trained by the pharmacy, responsibility for maintaining the revised services was transferred to the hemodialysis staff. Documentation of medication orders, drug knowledge of the hemodialysis staff and patient compliance improved as a result of the revisions instituted by the pharmacy.

Consultants↗
PubMedDate not supplied

Anticonvulsant therapy after neonatal seizures--how long should it be continued? I. A case for early discontinuation of anticonvulsants.

The risk of epilepsy or afebrile seizures after convulsions in the neonatal period is compared with the benefits and risks of chronic use of anticonvulsants in infants. The best predictor of later seizures appears to be the presence of moderate to severe neurologic damage. In the absence of such deficits, the risk is below 10%, but increases to 50-70% when damage is severe. A comparison of reports indicates no difference in seizure recurrence rates when anticonvulsants are stopped early in the neonatal period or when treatment is longer, even in the high-risk group. After phenobarbital is discontinued and the plasma concentration falls below the therapeutic range, seizures usually recur within a few days or not for several months. Only 50% of these seizure types are expected to be controlled with phenobarbital. Long-term phenobarbital use is associated with impaired cognitive function in infants and toddlers, and retarded brain growth in rodent studies.

Anticonvulsants↗
PubMedDate not supplied

Hospital charges for antibiotics.

Hospital charges for intravenous antibiotics were obtained in a survey of 71 hospitals in 25 U.S. cities. Only 56.3% of the hospitals used their actual drug acquisition cost to calculate patient charges; the remainder used a base price derived from one of the wholesale price guides, which often seriously overstate the cost of antibiotics. Sixty-eight percent added a markup, averaging 134.5%, and 63.4% added a dispensing fee, averaging $5.47. A relatively high-dose, single-antibiotic regimen costs patients $50-$150 per day, independent of dose-preparation charges (average, $9.09 per dose) for a piggyback-type system or intravenous line-related charges. Antibiotics were least expensive in large hospitals and in those located in the northeastern United States. Charges for antibiotics are often inconsistently calculated, vary enormously among hospitals, and may be unfair to patients and confusing to physicians. Cost-conscious prescribing of antibiotics by physicians would be facilitated by a more consistent relationship between charges and true costs.

Anti-Bacterial Agents↗
PubMedDate not supplied

Neonatal thrombosis: treatment with heparin and thrombolytics.

Thrombotic events are a serious and potentially fatal complication during the neonatal period. Despite clinically serious thromboses in up to one percent of neonates and less severe complications (e.g., catheter malfunction secondary to clots) in a much higher percentage, well-designed studies on prevention and treatment of thromboses are lacking. Treatment approaches are largely anecdotal and involve the use of heparin and, occasionally, thrombolytics. Proper monitoring of anticoagulant and thrombolytic effects is difficult because of the limited blood volumes available from neonates and the relatively large sample volumes needed for most coagulation studies. Activated clotting times (ACTs) are preferred because they use low blood volume and are a rapid bedside test. Heparin should be administered with an initial loading dose of 50-100 units/kg followed by a continuous infusion of 20 units/kg/h. Further doses should then be adjusted based on the ACT, targeting a value of 1.5-2.5 times the control. Thrombolytics also have been used in several case reports and are guided by both clinical response and serial D-dimer values. We prefer urokinase 100 units/kg/h for local infusion to the thrombus and urokinase 1000-10,000 units/kg/h for systemic therapy.

Fibrinolytic Agents↗
PubMedDate not supplied

Interference of new penicillins and cephalosporins with urine glucose monitoring tests.

The possibility that three new penicillins (mezlocillin, pipericillin, and azlocillin) and two new cephalosporins (ceftazidime and cefoperazone) might give false positive urine glucose testing results was studied. High and low concentrations of antibiotics were dissolved in urine and tested with Clinitest (Ames Division, Miles Laboratories, Elkhart, Indiana) and Tes-Tape (Eli Lilly and Company, Indianapolis, Indiana) at four different concentrations of glucose. None of the antibiotics interfered with the accuracy of Tes-Tape readings. All antibiotics interfered with Clinitest readings; the greatest interference was noted at high concentrations of antibiotics and low concentrations of glucose, and with the two cephalosporins. A summary of all reported cephalosporin interactions with Clinitest urine glucose testing is included.

Azlocillin↗
PubMedDate not supplied

Use of antiepileptic drugs in the elderly population.

Medical records for 572 patients in two extended care facilities were reviewed to study seizure disorders and antiepileptic drug use. Seventy patients (12.2 percent) were receiving antiepileptic drugs. Of this group, 43 patients (61.4 percent) had a diagnosis of epilepsy or documented seizures, 2 were being treated for neuralgia, and 25 (35.7 percent) had no reason given for antiepileptic use. The most common cause was cerebrovascular accident (38.9 percent), and no associated etiology was found in 29.2 percent. Phenytoin was the most commonly used agent. Thirty-two (45.7 percent) were taking two or more antiepileptic drugs. Thirteen patients had had no serum concentration monitoring in the last year. Thirty-seven patients (52.9 percent) had had at least one serum concentration outside of the therapeutic range.

Aged↗