摘要:

Over the past 15 years stereoselectivity has become a well‐recognized consideration in clinical pharmacology. Drugs that have an asymmetric center or plane of symmetry within their molecular structure are said to be chiral. They are available as pairs of nonsuperimposable mirror images, called enantiomers, that share essentially the same physicochemical properties. These three‐dimensional structural differences, however, can translate into enantiospecific pharmacologic or pharmacokinetic properties, which may be important in understanding the clinical pharmacology of chiral drugs. Most chiral drugs are available as the racemate, in which equal proportions of the two enantiomers are administered concurrently. The pharmacologic and disposition properties of many chiral drugs are documented to be stereo‐specific, and this has influenced the regulatory requirements for the approval of new drug candidates. Due to this influence on new drug development, the possible issues surrounding racemic drugs will undoubtedly affect the types of pharmaceuticals that are used clinically in the next century. Accordingly, considerable advances have been made in producing optically pure drug. It should be emphasized, however, that stereochemically pure drugs are not necessarily superior to the respective race

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02863.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Study Objective. A validation study was conducted first to test assumptions about the effect of saturated and unsaturated dietary fat supplements. The second study was conducted to determine the effect on blood cholesterol levels of saturated and unsaturated fat supplements in patients who followed a low‐fat diet and were administered lovastatin.Design. Randomized, crossover design, with three periods in the first study and four in the second study, each lasting 6 weeks.Setting. Cholesterol Research Center.Patients. The first study evaluated adults with total cholesterol levels between 200 and 280 mg/dl (5.172 and 7.241 mmol/L). The second study included adults with low‐density lipoprotein (LDL) cholesterol levels above 160 mg/dl (4.138 mmol/L).Interventions. Fat supplements with either coconut or canola oil were delivered to patients in oatmeal‐raisin cookies.Measurements and Main Results. In the validation study, patients' mean prerandomization total cholesterol level of 222 mg/dl was reduced to 213 mg/dl with canola oil and increased to 233 mg/dl with coconut oil cookies (p=0.0038). In the second study the mean prerandomization total cholesterol level of 214 mg/dl was decreased to 199 mg/dl with canola oil and to 208 mg/dl with coconut oil cookies (p=0.2342). The LDL cholesterol levels changed in a similar fashion in both studies.Conclusions. Changes in total and LDL cholesterol levels in the validation study were expected based on established effects of saturated and unsaturated fatty acids, but changes in these levels in lovastatin‐cookie study were not expected. They could have occurred because lovastatin reversed the effect of saturated fats and enhanced the effect of unsaturated fats. Alternatively, they may have been due to enhanced bioavailability of lovastatin when administered with a high‐fat diet. These findings must be

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02864.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Study Objective. To determine the short‐term effects of antihypertensive therapy on cerebral blood flow (CBF).Design. Prospective, observational study.Setting. A university‐affiliated teaching hospital.Patients. Twenty‐four patients (age range 53–85 yrs) with chronic hypertension, nine of whom had carotid artery occlusive disease (CAOD).Interventions. The CBF (xenon‐133 inhalation technique) and blood pressure were measured before and at 60 minutes after administration of antihypertensive therapy.Measurements and Main Results. Age was inversely related to the change in CBF in patients with CAOD (p>0.01). In all patients, the change in CBF after taking antihypertensive drugs was significantly inversely associated with baseline CBF (p>0.01). Changes in regional CBF, measured by asymmetry scores, were significantly greater in patients with CAOD than in those without CAOD (p<0.05).Conclusions. Elderly patients with occlusive extracranial cerebrovascular disease are at risk of drug‐induced changes in both mean and regional CBF, and may benefit from a CBF assessment before being prescribed antihypertens

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02865.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Increasing reports of vancomycin resistance have raised concerns about the future effectiveness of this drug in treatment of critically ill patients with gram‐positive infections. Due to these concerns the Centers for Disease Control and Prevention (CDC) recently published criteria that delineate the prudent use of vancomycin. Using these criteria, we attempted to determine the appropriateness of vancomycin prescribing patterns at our institution. A retrospective chart review was performed for 135 hospitalized patients treated between May 1993 and April 1994. Inappropriate empiric vancomycin use was documented in 81 (60%) of these patients. When culture results were available, 28 (21%) patients inappropriately received the drug. Results of this study are similar to those of other studies of vancomycin use in hospitals based on non‐CDC criteria. If CDC criteria are to have a positive impact on physicians' vancomycin prescribing patterns, significant educational efforts will be requi

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02866.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Several worldwide initiatives involve pharmacy education and practice; however, the International Pharmaceutical Federation is the only worldwide pharmacy organization currently in existence. This is the first report of the good pharmacy practice initiative published in the United States. We hope that it will stimulate interest in international pharmacy.

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02867.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We analyzed the adequacy of pain control for 17 trauma patients during the initial part of their stay in the intensive care unit, and assessed reasons for inadequate analgesia, if it occurred. Patients, and physicians, and nurses were interviewed. A verbal pain intensity scale was used to determine whether patients received adequate analgesia. Patients were asked if the pain hindered their activities, and whether they requested pain medication from their caregivers. Caregivers were questioned whether patients received adequate analgesia. Prescribed morphine regimens and the amount of narcotic administered were analyzed. Twenty‐seven percent of patients rated pain intensity as moderate and 47% as severe. Ninety‐five percent of housestaff and 81% of nurses reported the patients received adequate pain control. Forty‐seven percent of the patients who had moderate or severe pain asked their physician for more pain medication, and 65% asked the nurse. Thirteen residents did not order a larger dose of morphine due to concern about respiratory depression or hypotension. Morphine dosages ranged from 1–8 mg intravenously every 1–2 hours as necessary. Nurses administered less than the maximum amount ordered 58% of the time. The mean dosing interval was 2.3 hours. Barriers to adequate pain management were disparity in the perception of pain between patients and caregivers; patients not requesting more analgesia despite despite the presence of moderate to severe pain; and physician and nurse concerns about patients' adverse physiologic response to increase

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02868.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We compared health‐related quality of life (HQL) measures in 210 patients with metastatic colorectal cancer who were receiving equitoxic regimens of weekly 5‐fluorouracil (5‐FU) plus leucovorin (LV) or 5‐FU alone in a multicenter, placebo‐controlled, double‐blind, randomized trial. The HQL was assessed during the first 120 days of treatment by the patient‐generated functional living index‐cancer (FLIC) questionnaire. Also assessed were clinician‐generated measures to evaluate physical functioning and suffering: Karnofsky performance status (KPS), body weight, disease symptoms, and hospitalization. No significant difference was detected between treatment groups in HQL or in any measurement of efficacy or toxicity. The number of patients hospitalized was similar in both groups, 35 patients receiving 5‐FU‐LV, 32 receiving 5‐FU‐placebo, but those receiving 5‐FU‐LV were hospitalized longer (450 vs 315 total days). The KPS improved or stabilized in 23% and 37% of patients, respectively. Overall, FLIC scores significantly improved in 27% or remained stable in 62% of all patients; disease symptoms improved in 19–49%; a weight increase of 2 kg or more occurred in 27%. A change in FLIC was not associated with tumor response or improvement in pain, but a decline in FLIC was associated with improved survival. An improvement in KPS or weight was associated with tumor response and strongly correlated with survival. Improvement of pain was associated with a stable or increase in weight, and worsening of pain correla

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02869.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The costly treatment of peptic acid diseases at a Veterans Affairs ambulatory care clinic prompted the development of clinical practice guidelines (CPGs) for the disorders. A committee consisting of a clinical pharmacist, the chiefs of ambulatory care and medicine, and a gastroenterologist guided the process. A consensus‐style conference format involving medical staff and residents, pharmacists, and other health providers was chosen to develop the CPGs. Before the conference each participant received a list of key issues and literature on practice guidelines, and on peptic acid diseases and their treatment. At the conference the participants were divided int6 four groups; each group discussed specific key issues using a modified nominal group process. Recommendations from each group were made to the entire conference. Final recommendations were compiled into what was adopted and readily received as the CPGs for the institutio

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02870.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In an effort to optimize limited resources, a community‐based clinical pharmacy program was initiated to promote service, teaching, and research. This program sponsored the recruitment of pharmacy personnel to carry out distributive and clinical functions. This service enabled the development of new clinical attachment sites for pharmacy students. Students on these attachments carried out supervised projects that enhanced their learning while providing essential services to the community. This program resulted in the enhancement of stock levels of drugs and medical equipment, improvement in the drug budget through on‐site manufacturing and proper stock management, and the creation of a favorable working partnership with other health professionals as well as the community. A number of research projects were initiated and completed, and a teaching program was established. This program demonstrated that integration of the triple functions of clinical pharmacy service, teaching, and research is feasible in a rural setting and can achieve goals that are mutually beneficial to all facets of the pharmacy profess

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02871.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Charcoal hemoperfusion is effective in the treatment of theophylline overdose. Estimation of the time required for charcoal hemoperfusion has been based on personal experience and judgment. We used pharmacokinetic data from a patient and from case reports to generate a formula for predicting treatment time. Pharmacokinetic parameters were calculated using model‐independent analysis of concentration‐time curves from two treatments of charcoal hemoperfusion. These values were compared with published data and incorporated into a formula that was derived from the elimination rate constant to estimate treatment time of charcoal hemoperfusion:Time (min) = (ln conci‐ ln concd)/0.0057where the concentration of theophylline is in μmol/L. The formula may be valid in patients in whom the serum theophylline concentration is less than or equal to 516 μmol/L or 92 mg/L. It may be used as a guide to estimate the length of charcoal hemoperfusion in the treatment of theophylline toxicity. Its validation requires implementation and evaluation in futur

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb02872.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY