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Biomedical subjects

P L Doering

Publications and source records attributed to P L Doering.

At least 37 records · Page 2Linked to original sources
PubMed1986

Effect of concomitant antacid administration on plasma cimetidine concentrations during repetitive dosing.

Previous research has suggested that concurrent administration of antacid and cimetidine results in lower than expected plasma levels of cimetidine. Because these studies were all of single-dose design, this study was undertaken to determine the nature of the interaction after repeated administration of both drugs. There was no statistically significant difference demonstrated for any of the pharmacokinetic parameters evaluated in the study. Based on these findings, the previous recommendation that administration of antacid and cimetidine be separated in time may not be necessary.

Adult↗
PubMed1986

Survey of the professional interrelations between dermatologist and pharmacist.

A national survey of dermatologists and pharmacists was conducted to characterize the involvement of the community pharmacist in the area of skin diseases and to elicit suggestions to improve professional interrelations. The results show the dermatologists' major complaint is pharmacists' inability or unwillingness to compound prescriptions. The study clearly indicates the need for increased communication between the two professions in matters such as inventory control, prescription refill procedures, and substitution guidelines. The pharmacists, in general, admitted a deficiency in their educational preparedness to recognize common skin disorders, thus limiting their ability to assess the severity of patients' complaints.

Dermatology↗
PubMed1986

Treatment of Amanita mushroom poisoning: a review.

Poisoning with mushrooms of the genus Amanita, members of which occur frequently in both North America and Europe, accounts for a significant number of deaths annually. Liver damage is the main clinical feature and death rates are variously reported to be from 11.3% to 51.3% of patients. The amount of mushroom ingested appears to be the main prognostic indicator and a fatal outcome appears inevitable if a large amount is eaten. In sublethal exposures, supportive therapy seems effective; when definitive treatment is considered, hyperbaric oxygen, penicillin and silymarin are indicated in conjunction with careful management of blood glucose concentration. Charcoal hemoperfusion, forced diuresis, hyperbaric oxygen, and thioctic acid may also be considered, although these treatment modalities are not clearly associated with increased survival.

Amanitins↗
PubMed1985

Clinical pharmacy services in Florida hospitals--1984.

To ascertain the progress made in the implementation of clinical services in Florida hospitals, a survey conducted in 1977 was readministered in 1984. Questionnaires were sent to the directors of pharmaceutical services of all 256 Florida hospitals. Nine questions on clinical services were identical to the 1977 survey and two additional questions were included on nutritional support services and pharmacokinetic dosing consultations. The directors were also asked if they had conducted studies to document the cost-effectiveness of their clinical pharmacy services. Questionnaires were returned by 75% of the directors. As in the 1977 survey, approximately half of the hospitals had less than 200 beds. Slightly more than 82% of the hospitals had total unit dose systems and about 7% had partial systems, which was considerably higher than the 58% with either total or partial systems found in the 1977 survey. Services such as patient monitoring, inservice education, and drug-use review were being offered substantially more than in 1977. Conducting patient medication histories, attending rounds with physicians, and providing discharge consultations were the least-performed clinical services. The reasons given for not implementing these services were similar in both surveys. However, while the lack of adequately trained pharmacists was frequently cited in 1977, very few respondents cited it as an obstacle in 1984. Several respondents indicated that they had documented cost savings attributable to their clinical pharmacy services. Clinical pharmacy programs are continuing to grow in Florida hospitals; however, pharmacy administrators appear to be having some of the same problems implementing these services as they did previously.

Costs and Cost Analysis↗
PubMed1984

Effect of antacids on predicted steady-state cimetidine concentrations.

The purpose of this study was to evaluate effects of antacids on predicted steady-state concentrations of cimetidine. Ten healthy volunteers received in random order one week apart, cimetidine and cimetidine and antacid suspension. Blood was obtained at specified times and analyzed for cimetidine. Bioavailability was assessed by comparison of peak concentration, time to peak concentration, area under the curve, and time spent over 0.5 micrograms/ml. Single-dose data were extrapolated to steady-state using computer simulation. Concurrent administration of antacid suspension reduced parameters of bioavailability approximately 30%. When steady-state conditions were simulated, concentrations of cimetidine greater than or equal to 0.5 micrograms/ml were maintained for the entire dosing interval in seven of 10 subjects. These data suggest that temporal separation of cimetidine and antacid suspension may be unnecessary.

Adult↗
PubMed1984

Therapeutic substitution: has its time arrived?

Therapeutic substitution refers to substitution by the dispenser of a drug product that is not chemically identical but is therapeutically equivalent to the product prescribed, pursuant to guidelines established by the hospital P & T Committee. Until recently, the extent to which this concept has been adopted by hospitals across the country was unknown. Late in 1980, we conducted a nationwide survey of hospital pharmacies to learn more about therapeutic substitution. This paper reviews some of the issues involved, some of the findings of our study, and the pros and cons of therapeutic interchange. It also provides an update as to some of the recent changes that are occurring in therapeutic substitution procedures.

Data Collection↗
PubMed1982

Trolamine salicylate cream in osteoarthritis of the knee.

Twenty-five patients with symptomatic osteoarthritis (OA) of the knee were treated topically for one week with either 10% trolamine salicylate cream or placebo cream in a randomized double-blind crossover study. No significant difference was found in subjective or objective measures of pain relief between the treatment and control groups. Eight patients preferred "active" test cream, six preferred placebo, and 11 had no preference. No side effects were reported. Topically applied 10% trolamine salicylate cream did not relieve the pain of OA of the knee any more than did placebo.

Administration, Topical↗
PubMed1982

A comparison of various types of patient instruction in the proper administration of metered inhalers.

The administration technique employed by 42 inpatients using metered inhalers were observed. Proper performance of the six steps recommended by the manufacturer provided the guidelines for correct administration. The degree of compliance with proper technique was defined as the number of steps correctly executed by the patient. The mean number of steps correctly performed was 2.9 out of the possible six (48.3 percent). Twenty-four patients were then randomized into one of three groups. Group I received the manufacturer's instruction sheet, Group 2 received counseling from a pharmacist, and Group 3 received both the manufacturer's instruction sheet and counseling from a pharmacist. There was a significant improvement in the postinstruction technique in Groups 2 and 3, while Groups 1 failed to demonstrate any significant improvement. Comparisons were then made among the three groups. No significant difference was found between Group 2 and Group 3. However, both Groups 2 and 3 were found to be significantly different (p less than 0.05) from Group 1. This study shows that pharmacist counseling can significantly improve the degree of patient compliance in the administration of metered inhalers.

Aerosols↗
PubMed1982

Prenatal drugs: patient information and its source.

Pregnant women consume numerous medications, some of which are potentially harmful to the fetus. It is especially important that these women are provided with information about these drugs. This study was undertaken, in part, to document the amount of information pregnant women have about the drugs they consume and the sources of their information. Study participants were 304 women selected at random from the postpartum inpatients at a teaching hospital. Mothers were interviewed to obtain drug exposure data and to determine what, if any, information they had about the drugs. The source of information for each drug consumed was also determined. Results show that pregnant women have little information for each drugs they consume. Mothers most often cited primary medical personnel (physicians and nurses) as sources of information about specific drugs. In contrast, only six patients cited the pharmacist as a source of information about specific drugs. However, patients ranked the pharmacist high as a source of general drug information. This report emphasizes the need for more drug information for pregnant women and highlights the role of the pharmacist in providing such information.

Drug Information Services↗
PubMed1982

Therapeutic substitution practices in short-term hospitals.

Hospital policies concerning the automatic interchange of therapeutically equivalent drugs were examined. A questionnaire was sent to the chief pharmacists at 6326 shot-term hospitals throughout the United States. The survey items solicited demographic data and formulary policies on generic and therapeutic substitution. A total of 2437 (39%) usable questionnaires were returned. Approximately 40% of the hospitals reported that their formulary system allows the stocking of a single product to represent a given therapeutic category. A total of 751 hospitals reported that their formulary system allows automatic dispensing of the therapeutically equivalent drug product without contacting the physician for permission. Therapeutic substitution was found particularly prevalent in federally owned hospitals. There were regional variations in the existence of therapeutic substitution. Factors that appeared to be associated with therapeutic substitution were: drug use review activity, medical school affiliation, existence of a formulary system, perceptions of favorable view by the state board of pharmacy, and favorable perception of the savings generated through bid purchasing. Reasons for not engaging in therapeutic substitution included the following: (1) would not be accepted by the physicians, (2) interferes with physicians' right to select the drug, (3) unnecessary risk of civil liability, (4) violation of laws, and (5) expected benefits do not justify the cost. Most respondents thought that physicians are usually aware of therapeutic substitutions that occur. Although they were a minority, a large percent of the respondents had a formulary system that allowed automatic interchange of generically inequivalent products within a therapeutic class of drugs. The influence of therapeutic substitution on drug therapy outcomes and cost savings need to be evaluated.

Drug Prescriptions↗
PubMed1981

Effect of magnesium citrate on the in vitro adsorption of aspirin by activated charcoal.

The objective of this study was to determine if magnesium citrate solution given concurrently with activated charcoal would affect charcoal's in vitro ability to bind aspirin. Aspirin and charcoal were mixed in simulated gastric fluid and simulated intestinal fluid, and then magnesium citrate solution was added in proportions simulating those encountered clinically. Results indicate that no clinically significant interaction occurs between magnesium citrate and activated charcoal in either fluid, and that these two agents can be given simultaneously without decreasing the binding capacity for aspirin.

Adsorption↗
PubMed1981

Rapid infusion of phenytoin sodium loading doses.

The use of rapid intravenous infusions of phenytoin sodium to achieve prompt plasma therapeutic concentrations of phenytoin was studied in adult epileptic patients. Six adult patients who experienced recent tonic-clonic seizures were selected for study. Four of them had not been treated with phenytoin before the study; two were on chronic phenytoin therapy but had subtherapeutic serum levels. A leading dose of phenytoin sodium (15 mg/kg in 100 ml of 0.9% sodium chloride injection) was infused at 30-50 mg/min. Blood samples were drawn before phenytoin administration, every five minutes during the infusion, and at 1, 2, 4, 8, 12, 18, and 24 hours after completion of the infusion. Adverse effects were monitored during the infusion. Pharmacokinetic variables were calculated. Patients received from 750 to 1500 mg phenytoin sodium (mean +/- S.D. = 1040.8 +/- 297.3 mg). From 5 to 30 minutes were required to reach therapeutic (10-20 micrograms/ml) serum phenytoin concentrations; concentrations peaked at 31.1 +/- 10.0 micrograms/ml. Four of the six patients had therapeutic serum concentrations at 18 hours after completion of the infusion. Adverse effects were minimal and not severe; no cardiotoxicities were noted. Phenytoin half-life was 31.2 +/- 8.4 hours, total plasma clearance was 47.2 +/- 10.7 ml/kg/hr, and volume of distribution was 1.96 +/- 0.46 liters/kg. It is concluded that rapid intravenous infusion of phenytoin appears to be a reasonably safe and effective method of rapidly reaching therapeutic phenytoin concentrations.

Blood Pressure↗
PubMed1981

State regulatory positions concerning therapeutic substitutions in hospitals.

State regulatory agencies were surveyed to determine their views concerning hospital policies that allow therapeutic substitution. A questionnaire consisting of 10 close-ended questions was sent to the executive secretary of each board of pharmacy in the 50 states and District of Columbia. Agencies were contacted by telephone in four weeks if they did not respond. Of the 51 jurisdictions surveyed, 34 answered all of the questions, 13 answered some, and 4 did not respond. None of the 13 partial respondents expressed their views concerning the legality of therapeutic substitution in the institutional setting. Fifteen agencies indicated they would view this practice as illegal, 17 said it is in accordance with policies established by the P & T committee and therefore not subject to state or federal regulation, and two agencies gave qualified responses. Seven agencies indicated enforcement procedures would be initiated if they were to learn that therapeutic substitution was being practiced in a hospital within their jurisdiction. Three states were uncertain about what action would likely be taken, 23 indicated no action would be taken, and two gave qualified responses. All 39 agencies responding to the question indicated they had never taken action against the practice of a formulary system that allows therapeutic substitution. Few state laws address the practice of therapeutic substitution, and opinions of regulatory agencies vary. Moreover, the opinions rendered have not been tested in the courts.

Government Agencies↗
PubMed1981

Therapeutic substitution and the hospital formulary system.

Physicians consent and statutory regulations relating to therapeutic substitution are discussed. Some hospitals have adopted policies allowing the interchange of a chemically inequivalent product deemed therapeutically identical by the P & T committee. In the absence of statutory regulation, hospital pharmacists usually refer to (1) the physician's agreement to abide by hospital bylaws (including the formulary system) when joining the hospital staff, or (2) prescription blanks and order sheets preprinted with the statement "substitution permitted unless otherwise indicated" as the legal authority for therapeutic substitution. Only two states have addressed the legality of therapeutic substitution. An opinion of the Oregon Attorney General and a Washington state statute both authorize therapeutic substitution under certain circumstances if the prescriber has given prior consent. Neither of the states specifies, however, whether the agreement of prescribers to abide by hospital bylaws constitutes authorization of therapeutic substitution. It is proposed that state boards of pharmacy and state legislatures draft laws that address therapeutic substitution and specify acceptable methods of consent.

Formularies, Hospital as Topic↗