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P R Casner

Publications and source records attributed to P R Casner.

At least 19 recordsLinked to original sources
PubMed1997

Self-medication.

Explore the source record for details and available documents.

Anti-Bacterial Agents↗
PubMed1996

Inability to attain oral anticoagulation: warfarin-rifampin interaction revisited.

The warfarin-rifampin interaction is a well-described but underappreciated drug interaction. A case is reported in which therapeutic anticoagulation could not be achieved after nearly 4 weeks of warfarin therapy because of simultaneous administration of rifampin. This patient had the highest warfarin clearance ever reported in the literature. The world's literature describing warfarin-rifampin interactions for the past 32 years was reviewed to suggest guidelines for warfarin dosage when rifampin is given simultaneously.

Adult↗
PubMed1996

Prevalence of associated infections in community-acquired spontaneous bacterial peritonitis.

OBJECTIVES: The frequency with which other infections occur in association with spontaneous bacterial peritonitis is not known, but has implications for both pathogenesis and management. Spontaneous bacterial peritonitis that occurs in hospitalized patients is mainly a nosocomial infection, the study of which must take into account multiple confounding factors. We conducted a prospective study to compare the clinical features and the frequency of associated infections in patients with community-acquired spontaneous bacterial peritonitis to those of cirrhotic patients with ascites but without spontaneous bacterial peritonitis. Previous studies of spontaneous bacterial peritonitis have not found an infection consistently present at some other site, but those studies did not separate community-acquired from hospital-acquired spontaneous bacterial peritonitis. METHODS: Over a 5-yr study period, 176 cirrhotic patients with ascites were enrolled and were followed. There were 68 patients who had 83 admissions with spontaneous bacterial peritonitis and 108 patients with 124 admissions without spontaneous bacterial peritonitis. Of the 68 patients with spontaneous bacterial peritonitis, 56 had single episodes of peritonitis and 12 had 27 episodes of recurrent bacterial peritonitis. All episodes of spontaneous bacterial peritonitis were diagnosed within 24 h of admission. All subjects had cultures of ascitic fluid, blood, and urine. RESULTS: Patients with spontaneous bacterial peritonitis were more often symptomatic than the nonspontaneous bacterial peritonitis patients. Ascites cultures were positive in 63 (76%) episodes of spontaneous bacterial peritonitis. The frequency of bacteremia in the spontaneous bacterial peritonitis group was significantly higher than that of the nonspontaneous bacterial peritonitis (56.6% vs. 4.8%, p < 0.0001). Bacteriuria occurred in 51 episodes of spontaneous bacterial peritonitis compared with only nine in nonspontaneous bacterial peritonitis patients (61.4% vs. 7.3%, p < 0.0001). Bacteriuria was observed even more often in recurrent bacterial peritonitis patients than in single episode bacterial peritonitis patients (77.8% vs. 53.6%, p < 0.0001). Most patients with bacteriuria had no urinary tract symptoms. There was no significant difference between the frequency of pneumonia in spontaneous bacterial peritonitis patients compared with nonspontaneous bacterial peritonitis patients (8.4% vs. 10.5%, p = 0.17). CONCLUSIONS: Asymptomatic bacteriuria occurs often in association with community-acquired spontaneous bacterial peritonitis.

Bacteremia↗
PubMed1994

Medicine residents' practices in cancer screening in a Hispanic population.

Cancer screening is a valuable intervention to reduce breast cancer mortality and the incidence of invasive cervical carcinoma. We conducted a retrospective survey to determine the residents' compliance with use of mammography and Pap smear in Hispanic women. A total of 280 charts that met the inclusion criteria were reviewed. According to the guidelines, 784 mammograms and 714 Pap smears were indicated. The residents' compliance with mammography was 10.6% (+/- 9.16) and with Pap smear, 6.6% (+/- 7.68). The study demonstrates an unacceptable level of cancer screening practice by the medicine residents caring for this Hispanic population.

Adult↗
PubMed1993

A randomized controlled trial of computerized pharmacokinetic theophylline dosing versus empiric physician dosing.

This study was undertaken to determine if a computerized pharmacokinetic program for adjusting theophylline infusion rates could attain a goal serum theophylline level more accurately than physician-derived adjustments and what clinical impact this would have. Thirty-five patients with diagnoses of asthma or chronic obstructive pulmonary disease were randomized to a control group (empiric) or experimental group (kinetic) after initial theophylline levels were drawn from each group. After second levels were drawn, patients in the kinetic group had their infusion rates adjusted by the computerized pharmacokinetic program to achieve a level of 15 mg/L, whereas patients in the empiric group had their infusions adjusted empirically by the primary care physicians to achieve a serum theophylline level of 15 mg/L. A final theophylline level was obtained just before the infusion was discontinued. The kinetic group was closer to the goal level of 15 mg/L than the empiric group, but this was not statistically significant (14.8 +/- 4.4 versus 12.6 +/- 4.1; p > 0.05). The total number of days that patients were receiving intravenous theophylline was slightly longer for the kinetic group (4.1 +/- 3.3 versus 3.2 +/- 1.5; p > 0.05) as was the total number of hospital days, but neither of these were statistically significant (11.4 +/- 21.6 versus 8.8 +/- 15.4 days; p > 0.05). There were no differences between the two groups in the number of subtherapeutic or toxic levels, and there were no significant differences in arterial blood gas measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Rapid response of AIDS-related bacillary angiomatosis to azithromycin.

A 28-year-old male with AIDS and a CD4 cell count of 100/mm3 presented with fever, hepatosplenomegaly, weight loss, and multiple, polypoid, angiomatous lesions on his face. It was determined by means of biopsy that the lesions were due to bacillary angiomatosis. The patient was treated with oral azithromycin (1 g daily as a single dose). Rapid resolution of the skin lesions was noted. After 1 week of therapy, diminution in the size of the liver and spleen was noted. The only significant side effect noted was diarrhea, which was controlled with symptomatic therapy.

AIDS-Related Opportunistic Infections↗
PubMed1992

Purchasing prescription medication in Mexico without a prescription. The experience at the border.

Prescription medication can often be purchased in Mexico without a physician's prescription. United States residents living along the border may have access to dangerous medications by crossing the border and purchasing them in Mexican pharmacies. We sought to determine the extent and frequency of this behavior in a sample of our ambulatory clinic population. Patients from the Texas Tech University Internal Medicine Clinic were surveyed to collect information about their use of medications, use of alternative sources of health care in Mexico, and purchasing of prescription medication in Juarez, Mexico. More than 80% of patients stated they had purchased prescription-type medication at a pharmacy without a physician's prescription. The most common reasons for buying prescription medication in Mexico were because it was less expensive or because a prescription was not necessary. These data indicate a potential for US residents along the border to take medications in an unregulated manner, a practice that could pose problems for health care providers on both sides of the border.

Adult↗
PubMed1990

A comparison of the anti-hypertensive effectiveness of two triameterene/hydrochlorothiazide combinations: Maxzide versus Dyazide.

The hydrochlorothiazide component of Maxzide (Lederle Laboratories, Pearl River, NY) has been shown to be more bioavailable than the hydrochlorothiazide component of Dyazide (Smith, Kline and French Laboratories, Philadelphia, PA). The authors compared the antihypertensive effectiveness of a half-tablet of Maxzide (25 mg of hydrochlorothiazide and 37.5 mg of triamterene) to one capsule of Dyazide (25 mg of hydrochlorothiazide and 50 mg of triamterene) to determine if the difference in bioavailability would be reflected in differences in blood pressure control and metabolic changes. Thirty patients were studied in a randomized open-label crossover design study. There was a significant reduction in systolic blood pressure for both treatments although there was no difference in blood pressures at any time during the study between the two agents. There were no statistically significant differences between Maxzide and Dyazide in terms of metabolic changes for potassium, magnesium, glucose, cholesterol, triglycerides, uric acid, or calcium. Although the hydrochlorothiazide component of Maxzide is more bioavailable than that of Dyazide this did not translate into enhanced hypotensive efficacy.

Adult↗
PubMed1988

The Clinical Pharmacology Consultation Service: results of a physician survey before and after implementation.

A total of 175 physicians were surveyed by questionnaire before a Clinical Pharmacology Consult Service was started. Of those that responded, 72% thought the service would be helpful, although 40% said they would use the service no more than once a month. Most physicians (75%) preferred self-initiated consultations to automatic surveillance. Ninety-two percent believed a physician should be involved in making drug recommendations. A second questionnaire was circulated 30 months later. Actual use of the service closely paralleled the results of the first survey. There was an increased preference for automatic surveillance (5% vs 32%) and many physicians (48%) indicated they felt comfortable accepting drug consultations from a pharmacist or clinical pharmacist. Despite a general attitude of acceptance, the majority of respondents ranked the Clinical Pharmacology Consult Service last as a source of drug information.

Pharmacology, Clinical↗
PubMed1988

Insulin-glyburide combination therapy for non-insulin-dependent diabetes mellitus: a long-term double-blind, placebo-controlled trial.

Sixty-four patients with non-insulin-dependent diabetes mellitus were treated with a combination of insulin and oral sulfonylurea therapy in a double-blind, placebo-controlled trial during a 12-month period. Combination therapy lowered fasting glucose levels significantly only at the third and fourth months of treatment. Glycohemoglobin levels were significantly lower than control at 3 and 6 months whereas C-peptide levels were significantly increased at 3 and 9 months. Responders exhibited as much as a 50% reduction in total insulin dose compared with nonresponders or control subjects. These results suggest that combination therapy affords transient metabolic improvement in certain patients with non-insulin-dependent diabetes. Improvement in fasting glucose levels appears to be mediated by enhanced insulin secretion. Combination therapy may increase the cost of treatment by nearly 50% and appears warranted only in selected patients.

Blood Glucose↗