Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Tolmetin/analogs & derivatives , Administration, Oral , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Drug Administration Schedule , Humans , Ketorolac , Male , Tolmetin/administration & dosage , Tolmetin/adverse effectsABSTRACT
Although guidelines are available for conversion from intravenous (IV) theophylline to twice-daily, oral, controlled-release theophylline, the optimal method for conversion to Uniphyl, a chronotherapeutically formulated, once-daily theophylline preparation, has not been previously evaluated. The present study was designed to prospectively evaluate a method for converting patients from IV theophylline to Uniphyl, to formulate simple, practical dosage recommendations for use in clinical practice. Ten patients with acute exacerbation of asthma receiving IV theophylline for > or = 48 hours and with steady state serum theophylline concentrations (STCs) between 4.5 and 15.5 mg/L (25 and 86 mumol/L) were enrolled into the study. Patients with STCs > or = 4.5 and < 12 mg/L (> or = 25 and < 66 mumol/L) and those with STCs > or = 12 and < or = 15.5 mg/L (> or = 66 and < or = 86 mumol/L) received their first Uniphyl dose immediately following termination of IV theophylline (No Time Lapse [NTL] group) and after a 4-hour delay (Time Lapse [TL] group), respectively. The differences in the area under the curve values between Uniphyl dosing and IV theophylline were 11% in the NTL group (1214.6 +/- 247.9 mumol/h.L-1 vs 1370.4 +/- 148.1 mumol/h.L-1, 95% confidence interval, 74% to 103%; P = 0.068) and 10% in the TL group (1959.4 +/- 165.1 mumol/h.L-1 vs 1784.6 +/- 119.4 mumol/h.L-1, 95% confidence interval, 103% to 117%; P = 0.013).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Asthma/drug therapy , Theophylline/administration & dosage , Theophylline/blood , Administration, Oral , Adult , Asthma/metabolism , Delayed-Action Preparations , Female , Humans , Infusions, Intravenous , Male , Metabolic Clearance Rate , Middle Aged , Prospective Studies , Theophylline/pharmacokineticsABSTRACT
Two adults and two children with life-threatening asthma refractory to maximal standard therapy were treated with the inhalational anesthetic agent isoflurane. In each case, the temporal response to the initiation of therapy was striking. All patients survived and none experienced adverse reactions attributable to the drug. Rapid therapeutic benefit, minimal side effects, absence of cumulative toxicity, and ease of administration are factors supporting the use of isoflurane for patients with severe asthma.
Subject(s)
Asthma/drug therapy , Isoflurane/therapeutic use , Status Asthmaticus/drug therapy , Adolescent , Adult , Blood Gas Analysis , Bronchial Spasm/drug therapy , Child , Child, Preschool , Female , Humans , Inspiratory Capacity/drug effects , Lung Compliance/drug effects , MaleABSTRACT
2,4-D, an extensively used herbicide, was intentionally ingested by a 61-year-old woman. An initial serum 2,4-D concentration of 392 mg/L was measured. The prominent clinical feature was marked central nervous system depression; primary laboratory abnormalities were extreme elevation of creatine kinase activity, and transitory elevation of AST and lactate dehydrogenase enzyme activities. Alkaline diuresis was initiated early and decreased the half-life of the drug from an initial 39.5 to 2.7h. It is concluded that alkaline diuresis to produce urine pH in the range of 7.5 to 8.5 should be considered in the management of an overdose patient with central nervous system depression and a history of 2,4-D ingestion.
Subject(s)
2,4-Dichlorophenoxyacetic Acid/poisoning , 2,4-Dichlorophenoxyacetic Acid/administration & dosage , Administration, Oral , Adult , Female , Half-Life , Humans , Therapeutic IrrigationABSTRACT
Agranulocytosis associated with spironolactone administration is described in a 57-year-old man. Four days after initiation of spironolactone, leukocyte counts decreased from 8.2 to 2.3 X 10(9)/L with 6% neutrophils. Spironolactone, domperidone, and prochlorperazine were discontinued. Domperidone and prochlorperazine were reintroduced and there was concomitant improvement of the leukocyte and neutrophil counts. Substitution of triamterene for spironolactone was not associated with recurrent leukopenia. The potential association of spironolactone with granulocytopenia warrants increased awareness of this rare but serious adverse drug reaction.
Subject(s)
Agranulocytosis/chemically induced , Spironolactone/adverse effects , Agranulocytosis/blood , Humans , Leukocyte Count/drug effects , Male , Middle AgedABSTRACT
Pharmacy directors of 126 Alberta Hospitals were sent a survey requesting information on their attitudes and hiring practices of residency graduates. Sixty completed surveys were returned for a response rate of 48 percent. Seventy percent of the directors indicated that completion of a residency program was a favourable prerequisite prior to hiring. However, pharmacists with previous hospital experience were ranked with a higher preference for hiring than pharmacists with only a residency certificate. The main reason for directors hiring residency graduates was their comprehensive hospital pharmacy background. The initial starting salary for residents was equivalent to a starting salary for a pharmacist with one to two years of previous hospital experience. A residency certificate was not seen as a requisite for the director's position by the majority of the directors.
