Amiodarone has been reported to cause asymptomatic increases in liver function tests in 15-55% of patients. Clinically apparent, symptomatic hepatic disease occurs less frequently, but patients have been reported to have hepatomegaly, jaundice, cirrhosis, or chronic active hepatitis. Less well recognized is the fact that amiodarone has been attributed to six deaths. We cared for a patient with amiodarone hepatotoxicity, which led us to review the literature associated with this serious condition.

Aged↗

PubMed1989

Lisinopril: a new angiotensin-converting enzyme inhibitor.

Lisinopril is a synthetic, nonsulfhydryl, angiotensin-converting enzyme inhibitor. Its bioavailability is approximately 25% and is not affected by food. Hepatic metabolism is not required for pharmacologic effect, which occurs 1 hour after administration. Peak serum concentration and effect are delayed, occurring 6-8 hours after a single dose and lasting for at least 24 hours. The drug is eliminated primarily by the kidneys. The elimination half-life is 12.6 hours and is prolonged in renal impairment. Lisinopril 10-80 mg once a day is effective in lowering blood pressure in all grades of essential and renovascular hypertension. It is as effective as hydrochlorothiazide, atenolol, metoprolol, and nifedipine. Combining lisinopril with hydrochlorothiazide produces a greater degree of blood pressure reduction. Patients with congestive heart failure have demonstrated immediate and prolonged beneficial hemodynamic effects and increased exercise tolerance. Lisinopril is well tolerated. Clinically significant drug interactions have not been reported, but caution should be used when lisinopril is administered with diuretics, nifedipine, or agents that may increase concentrations of potassium. The usual initial oral dosage of lisinopril is 10 mg once a day (range 20-40 mg/day). Lower dosages may be necessary in patients with renal impairment or congestive heart failure, elderly persons, and those receiving diuretics.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1989

Trimethoprim inhibition of the renal clearance of procainamide and N-acetylprocainamide.

To test the effect of trimethoprim (an antibiotic commonly administered with sulfamethoxazole) on the disposition of the antiarrhythmic procainamide hydrochloride and its active metabolite N-acetylprocainamide, 10 healthy men received 1 g of procainamide hydrochloride orally on two occasions, coadministered with placebo or trimethoprim (100 mg twice a day for 2 days before and then 200 mg with the procainamide dose). Trimethoprim decreased the mean (+/- SD) renal clearance by 45% after the dose of procainamide was administered (487 +/- 129 vs 267 +/- 123 mL/min) and that of N-acetylprocainamide by 26% (275 +/- 78 vs 192 +/- 82 mL/min) compared with placebo. The mean area under plasma concentration--time curve 0 to 12 hours after dosing increased 39% for procainamide (19.8 +/- 4.8 vs 27.6 +/- 7.2 mg.h/L) and 27% for N-acetylprocainamide (9.1 +/- 2.1 vs 11.4 +/- 2.8 mg.h/L). The corrected QT electrocardiographic interval at 2 hours after the procainamide dose was 0.40 +/- 0.02 second with placebo and 0.43 +/- 0.03 second with trimethoprim. Trimethoprim may increase procainamide and N-acetylprocainamide plasma concentrations, resulting in increased pharmacodynamic response apparently caused by the competition for renal tubular cationic secretion.

Acecainide↗

PubMed1989

Use of a proprietary database to examine lengths of hospital stay of patients who received drug therapy for acute myocardial infarction.

Lengths of hospital stay of patients who received streptokinase therapy and of patients who received conventional i.v. heparin or nitroglycerin therapy for acute myocardial infarction (AMI) were determined using the International Health Services, Ltd., (IHS) database. Patients in all IHS-participating hospitals who had received streptokinase in conjunction with an AMI between October 1985 and September 1986 were identified from the database. Diagnosis-related groups (DRGs) 121 and 122 were found to contain patients who potentially could serve as the study population. Based on examination of length-of-stay data from the medical record database at the study hospital, the IHS study population was refined to include AMI patients 75 years of age or younger with stage 2 disease (intermediate severity) in DRG 121 or stage 1 disease (least severe) in DRG 122 and a length of stay of at least seven days. Patients who met those criteria and had been treated with heparin, nitroglycerin, or both served as a control group. The mean length of stay of patients treated with streptokinase (113 patients) was significantly shorter than that of patients treated with heparin (1332 patients) or nitroglycerin (752 patients). Patients treated with streptokinase had a length of stay 1.2 days shorter than patients treated with heparin and 1.3 days shorter than patients treated with nitroglycerin. The database proved to be useful for determining lengths of patient stay associated with thrombolytic and conventional medical therapy for AMI. Thrombolytic therapy may be a cost-effective treatment for AMI because length of stay may be somewhat shorter.

Data Collection↗

PubMed1988

Treatment of oral candidiasis with amphotericin B solution.

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Aged↗

PubMed1988

Pharmacy-nursing discharge counseling program for cardiac patients.

A cooperative pharmacy-nursing program for discharge medication counseling for cardiac patients that uses printed medication teaching cards is described. A pharmacy-nursing working group had determined that a formal program for discharge medication counseling was needed, and a pilot program was implemented on the cardiopulmonary-care units. Medication teaching cards were developed for commonly prescribed cardiac medications. Because the cardiologists who reviewed the completed cards were worried that widespread dissemination of the cards would cause some patients to suffer undue anxiety about adverse effects, a standard order form was developed so that physicians could order specific cards for patients. Patients who receive medications included in the program are counseled by a registered nurse; pharmacists occasionally are called upon to answer specific questions or to actually provide the counseling. In the first six months of the program, 86 patients received an average of three cards each. Although no formal evaluation of the program has been performed, feed-back from patients has been favorable and plans to expand the program to include more drugs and other types of patients are in effect. A cooperative pharmacy-nursing program for discharge medication counseling using printed information has proved to be an effective and efficient way of sharing necessary drug information with patients.

Drug Information Services↗

PubMed1987

Encainide hydrochloride and flecainide acetate: two class 1c antiarrhythmic agents.

The chemistry, electrophysiology, pharmacokinetics, clinical use and efficacy, adverse effects, drug interactions, and dosage of encainide hydrochloride and flecainide acetate are reviewed. Encainide and flecainide are class 1c antiarrhythmic agents that slow myocardial conduction and mildly prolong the duration of repolarization. Both agents block anterograde conduction over accessory pathways and prolong the effective refractory period of the accessory pathway. Bioavailability of encainide ranges from 7% to 82%, whereas that of flecainide is 90% to 95%. Encainide is metabolized by the liver to two major active metabolites that are slowly eliminated in the urine. About 23% of flecainide's total body clearance is dependent on renal elimination, and drug excretion is slowed in patients with renal dysfunction, requiring dosage adjustments. Both agents are effective in the suppression and prevention of ventricular arrhythmias, including premature ventricular contractions and sustained and nonsustained ventricular tachycardia. These agents may also be valuable in controlling supraventricular arrhythmias. The most common adverse effects of both agents involve the central nervous system and include dizziness, blurred vision, and headache. The potential for proarrhythmic effects is a concern with these agents. The risk is greater in patients with more severe arrhythmias, poor ventricular function, or high serum concentrations of drug. The usual initial oral dosage of encainide hydrochloride is 25 mg three times a day, with a usual dosage range of 100-200 mg/day. Flecainide acetate should be initiated at 100 mg every 12 hours and may be increased up to 400 mg/day. Encainide and flecainide could become useful therapeutic options in the treatment of a variety of arrhythmias.

Anilides↗

PubMed1971

Shaping continuing education to meet your needs.

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Education, Nursing, Continuing↗