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Biomedical subjects

R E Small

Publications and source records attributed to R E Small.

53 records · Page 3Linked to original sources
PubMed1981

Phenytoin-induced hyperglycemia.

A case of diabetic ketoacidosis in a 64-year-old black woman with maturity-onset diabetes receiving phenytoin for a seizure disorder is reported. The woman was admitted to the hospital with a one-day history of polyuria and polydipsia. For the 10 months before admission, her diabetes was controlled with isophane insulin suspension 27 units daily. She also took phenytoin 100 mg orally three times a day. This was prescribed approximately six weeks earlier for right-sided focal seizures that were detected by electroencephalogram during a previous hospitalization for nonketotic hyperosmolar coma. No other medications were taken. The patient was treated with i.v. fluids and intermittent doses of i.v. insulin. Her condition rapidly improved and insulin zinc suspension 35 units daily was prescribed on discharge. Phenytoin was discontinued because the seizure disorder was considered secondary to the previous episode of hyperosmolar coma. A literature review of phenytoin-induced hyperglycemia is presented, including previous case reports, possible mechanisms of action, monitoring guidelines, and potential therapeutic uses. If hyperglycemia occurs in a patient taking phenytoin, especially after starting phenytoin therapy or increasing the dose, drug-induced hyperglycemia should be considered in the differential diagnosis.

Acidosis↗
PubMed1976

Alpha-methyldopa interference with the phosphotungstate uric acid test.

The effect of alpha-methyldopa on the phosphotungstate method of uric acid analysis was tested using a group of 17 hypertensive patients being treated with only this drug for their elevated blood pressure. The uric acid values of these patients tested by the phosphotungstate method showed no significant difference from the uricase test values, when compared to a control population of 32 normotensive patients tested in the same manner. The proposed interference was further tested by in vitro studies. Both uricase and phosphotungstate analysis of uric acid was performed on serum containing various dilutions of alpha-methyldopa. The concentration of alpha-methyldopa required to clinically affect the uric acid level, whereby a false positive result occurred, was 60 mug/ml. The mean plasma aplha-methyldopa concentration in the study group, however, was found to be only 2.03 mug/ml. The postulated interference of therapeutic levels of alpha-methyldopa on the phosphotungstate uric acid method was invalid.

Adult↗
PubMedDate not supplied

Implementing disease management in community pharmacy practice.

Disease management (DM) is a comprehensive approach to preventing and treating disease that: (1) targets patients with specific diseases; (2) provides integrated services across organizational and professional boundaries; (3) utilizes services based on the best scientific evidence available; and (4) focuses on outcomes. DM differs from pharmaceutical care in that pharmaceutical care targets not only patients with specific diseases but also those with risk factors for drug-related problems, a history of nonadherence, and frequent changes in medication regimens. Steps to starting a DM program include: (1) identifying a target population based on the population's strategic importance to the goals and aims of the organization; (2) assessing the organization's available resources, both internal and external; (3) defining key indicators with which to assess the program for the purposes of internal quality control and of obtaining compensation from third-party payers; (4) implementing the program using the best scientific methods available; and (5) assessing the impact of the program. The development of a smoking cessation program at a nationwide retail pharmacy chain is used as an example of a DM program initiated in community pharmacy practice. Pharmacists are well positioned to take a major role in DM, because they are accessible to the community and because DM frequently involves drug therapy. DM is also widely used in managed care. It is important that community pharmacists be closely involved in the DM approach as it evolves.

Community Pharmacy Services↗
PubMedDate not supplied

Perceptions of pharmacists about adverse effects of corticosteroid therapy: focus on osteoporosis.

OBJECTIVE: To assess the perceptions of pharmacists regarding the adverse effects of corticosteroids, in particular corticosteroid-induced osteoporosis. DESIGN: Mailed survey of a random sample of pharmacists. SETTING: Richmond, Virginia. PARTICIPANTS: 350 community and hospital pharmacists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Respondents' knowledge of adverse effects of corticosteroid therapy in men, premenopausal women, and postmenopausal women; the content of respondents' usual patient counseling for low- and high-dose therapy; and respondents' opinions of regimens for prevention of osteoporosis. RESULTS: Pharmacists associated gastritis, weight gain, and mood changes with corticosteroid use in a hypothetical 45-year-old man or 45-year-old premenopausal woman. For a hypothetical 65-year-old postmenopausal woman, pharmacists more frequently counseled about weight gain, osteoporosis, and gastritis. Patient counseling focused on these adverse effects for both low-dose (5 to 10 mg/day) and high-dose (> or = 30 mg/day) prednisone use. Osteoporosis was considered more likely in patients receiving high-dose corticosteroids on a long-term basis. CONCLUSION: Pharmacists responding to this survey frequently overlooked the association between low- and high-dose corticosteroid use and decreased bone density. Educational efforts are needed so that pharmacists can fulfill their potential for educating patients, monitoring corticosteroid therapy, and detecting drug-induced complications.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Effect of acute and chronic terfenadine on free and total serum phenytoin concentrations in epileptic patients.

Terfenadine is a unique H1-receptor antagonist devoid of adverse central nervous system (CNS) effects. Terfenadine is highly protein bound and has been shown to stimulate hepatic microsomal enzymes, making an interaction with phenytoin (PHT) possible. After assuring constant PHT levels for 7 days, 12 epileptic patients were studied with PHT alone, after a single daily dose of terfenadine (60 mg twice daily), and again after 2 weeks of chronic terfenadine therapy. Samples for PHT were drawn over 24 h, and urine was collected for determination of the PHT metabolite 5-(p-hydroxyphenyl)-5-phenylhydantoin (HPPH). The pharmacokinetic parameters calculated for total and free PHT and HPPH were area under the time concentration curve (AUC), the maximum serum concentration (Cmax), the minimum serum concentration (Cmin), and the percentage of fluctuation between maximum and minimum concentrations. A factor analysis was used to clarify interrelationships. Five dependent variables were found to represent the data. These were assessed by multi-variate analysis of variance (MANOVA); p less than 0.05 was considered significant. No significant differences were observed for any of the parameters for the acute or chronic effects of terfenadine. We conclude that terfenadine does not interfere with PHT.

Adult↗
PubMedDate not supplied

Obesity: managing comorbidities of the disease.

Obesity poses a serious health risk and is associated with a wide range of comorbid conditions. Obese patients with comorbid conditions such as type 2 diabetes and hypertension should be educated about the potential benefits of weight loss therapy. Pharmacists can offer consultative weight loss programs either on their own or by forming multidisciplinary teams with other practitioners, such as dietitians.

Humans↗
PubMedDate not supplied

Effect of sucralfate on ibuprofen absorption in normal volunteers.

The effect of the concurrent administration of sucralfate on the absorption of a single dose of ibuprofen was studied in nine normal volunteers using a random crossover design. Each participant received a single 600-mg dose of ibuprofen for the control phase, and a 600-mg dose of ibuprofen following 5 g of sucralfate given in 1-g divided doses for the treatment phase. Blood samples were obtained at regular intervals for 12 hours following the administration of ibuprofen, and pharmacokinetic and statistical analyses were performed. Analysis of time to peak serum concentration, maximum serum concentration, elimination rate constant, and half-life showed no significant difference between the control and treatment phases. Mean total area under the curve for ibuprofen decreased by 11.8% in the treatment phase, but this decrease was not statistically significant. The concurrent administration of sucralfate did not significantly alter the absorption of a single 600-mg dose of ibuprofen in healthy subjects.

Adult↗
PubMedDate not supplied

Effects of three antacids on the bioavailability of valproic acid.

The effects of three antacid products on the bioavailability of valproic acid were evaluated. Each of seven normal, healthy volunteers received a 500-mg dose of valproic acid alone on one occasion and then with each of three commonly used antacids. Specifically, equal neutralizing capacity doses of 160 meq of Maalox (62 ml), Trisogel (97 ml), or Titralac (42 ml) were administered one and three hours after meals and at bedtime on the same day. Blood samples were obtained at 0, 1, 2, 4, 6, 8, 10, 24, and 32 hours and analyzed for valproic acid by gas liquid chromatography. There was a significant increase in total area under the curve (AUC) (range 3% to 28%, mean 12%) when valproic acid was administered with Maalox (p = 0.026 for total AUC and p = 0.009 for AUC to 32 hours). There was an insignificant trend toward an increase in AUC when valproic acid was administered with the other two antacids. No differences were observed in time to peak serum concentration, height of peak serum concentration, volume of distribution, half-life, or first order elimination rate constant. Caution should be exercised if valproic acid and antacids are administered concomitantly.

Adult↗
PubMedDate not supplied

Chemistry, pharmacology, pharmacokinetics, and clinical applications of mesalamine for the treatment of inflammatory bowel disease.

Mesalamine is the therapeutically active moiety of sulfasalazine used to treat inflammatory bowel disease. A controlled-release mesalamine capsule (Pentasa) is designed to release the agent continuously, and largely unaffected by intestinal pH, throughout the small and large bowel due to a diffusion-dependent, semipermeable ethylcellulose coating. It is a safe and efficacious single agent for inducing remission and producing therapeutic benefit in patients with mild to moderately active ulcerative colitis (UC) (2 or 4 g/day) or Crohn's disease (4 g/day), as well as for significantly enhancing quality of life for patients with mild to moderately active UC (2 or 4 g/day). It is also effective for maintaining remission in patients with quiescent UC and Crohn's disease (4 g/day). Disease location (left-sided UC or pancolitis) did not affect the agent's effect in active disease or maintaining remission. Fewer treatment-related adverse events were reported with mesalamine than with placebo in treating UC. In the treatment of active Crohn's disease, data showed no statistically significant differences in response for patients with ileitis, ileocolitis, or Crohn's colitis. This formulation of mesalamine may also be a possible steroid-sparing agent for patients with either active or quiescent Crohn's disease.

Aminosalicylic Acids↗
PubMedDate not supplied

The effect of flurbiprofen on steady-state plasma lithium levels.

STUDY OBJECTIVE: To evaluate the effects of flurbiprofen therapy on the pharmacokinetics of lithium. DESIGN: Placebo-controlled, single-blind, crossover study. SETTING: University-affiliated hospital. PATIENTS: Eleven healthy women with bipolar disorder. INTERVENTIONS: The subjects received therapeutic doses of lithium administered as an immediate-release capsule every 12 hours. In addition, they received one placebo tablet every 12 hours during phase I and flurbiprofen 100 mg every 12 hours during phase II of the study. MEASUREMENTS AND MAIN RESULTS: Steady-state pharmacokinetic parameters were measured for each phase. Lithium trough plasma concentration (Cmin) and area under the curve were statistically significantly increased (p < 0.05) when patients received flurbiprofen. Flurbiprofen also caused decreases in lithium clearance and 24-hour lithium urine excretion, although the changes did not reach statistical significance. Clinically significant increases in Cmin appeared to be associated with a greater than 1000-microgram/24 hour decrease in urinary excretion of prostaglandin E2. CONCLUSION: Patients with clinically normal renal function may experience an increase in lithium levels with the initiation of flurbiprofen therapy.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Evaluation of the total cost of treating elderly hypertensive patients with ACE inhibitors: a comparison of older and newer agents.

We compared total costs and adherence to the regimen of older versus newer angiotensin-converting enzyme (ACE) inhibitors for the treatment of elderly patients with hypertension. A computer search using the data base of a health care insurer identified 6176 subjects age 65 years or older who had ICD-9 coding for hypertension only and had a new prescription for an ACE inhibitor dispensed between April 1, 1992, and January 31, 1993. Subjects receiving concurrent antihypertensive drugs were included. Total cost of therapy included acquisition costs for the ACE inhibitors and concurrent antihypertensive agents, and nondrug costs. Other costs were laboratory tests, hospitalization, and clinic visits associated with monitoring outcomes of antihypertensive therapy. Total median cost per month was greater for older than for newer agents, $59.82 versus $53.09 (p<0.0009). The mean percentage of patients complying with therapy as determined by refill data was greater with newer than with older agents, 66% versus 58% (p<0.0001). Based on our results, newer ACE inhibitors should be first-line antihypertensive therapy in elderly patients. They also should be considered for elderly patients who are unresponsive to older ACE inhibitors.

Aged↗
PubMedDate not supplied

The role of academia in community-based pharmaceutical care.

Developing models of pharmaceutical care (PC) for educating students and practitioners represents a fundamental role for schools of pharmacy. Virginia Commonwealth University has sought to facilitate the implementation of PC in the community by hiring faculty to practice in this setting. The mission of the faculty is to implement PC in a community pharmacy practice, to develop clerkship sites for Pharm.D. students, and to evaluate the impact of PC services in the community. Examples of an independent pharmacy model, a grocery chain model, and a retail chain model of care may serve a dual purpose for faculty members, that is, define responsibilities for the academic institution and for the community practice environment.

Community Pharmacy Services↗
PubMedDate not supplied

Budesonide inhalation powder: a review of its pharmacologic properties and role in the treatment of asthma.

Budesonide inhalation powder, available as Pulmicort Turbuhaler, is a corticosteroid with a high ratio of local to systemic effects that is administered to treat persistent asthma. The Turbuhaler achieves lung deposition approximately twice that of a metered-dose inhaler (MDI) with or without a spacer device. Budesonide inhalation powder has clinical efficacy equivalent to that of fluticasone and beclomethasone, but it has lower systemic bioavailability and fewer systemic side effects. As with other inhaled corticosteroids, dysphonia and oral candidiasis are the most frequent adverse effects, and systemic effects are infrequent. The initial starting dosage is 200 microg (1 puff) twice/day and may be increased to 800 microg twice/day in adults or 400 microg twice/day in children. Patients prefer the Turbuhaler to the MDI, Diskhaler, and Rotahaler because it is easier to use and more convenient to carry.

Administration, Inhalation↗