Operational experiences during medical residency: perspectives from the Walter Reed Army Medical Center Department of Medicine.

The preparation of military primary care physicians for practice in operational environments has taken on greater importance during the past decade. The Department of Defense military-unique curriculum identifies the elements that should be incorporated into residency training programs to accomplish comprehensive training in operational matters. We describe efforts to integrate the military-unique curriculum into internal medicine residency, including obstacles encountered, so that other programs may learn from our experience.

Bioavailability of pseudoephedrine and triprolidine from combination and single-ingredient products.

The bioavailability of pseudoephedrine and triprolidine from combination and single-ingredient products was evaluated in a randomized, four-way crossover study. Healthy men volunteers received single doses of a tablet containing triprolidine hydrochloride and pseudoephedrine hydrochloride, a syrup containing the same two drugs, and single-ingredient tablets of each drug. Blood samples were collected before each dose and at 13 sampling times over 24 hours for determination of drug concentrations by radioimmunoassay. Observed peak concentration (Cmax), corresponding observed peak time (tmax), area under the plasma drug concentration-time curve from dosing to time infinity (AUC), and the ratio between plasma clearance and extent of bioavailability (CL/F) were determined. Nonlinear regression analysis was used to obtain estimates of lag time for absorption, first-order rate constant for absorption, first-order rate constant for elimination, and ratio between volume of distribution and extent of bioavailability. Data were analyzed for 19 of 20 men entering the study; data were complete for 16 of these. Pseudoephedrine concentrations were significantly different for the combination tablet and the syrup at four sampling times; no significant differences were found between pseudoephedrine concentrations for the combination tablet and single-ingredient tablet. Cmax, tmax, AUC, and CL/F for pseudoephedrine were not significantly different for the three formulations. Triprolidine concentrations at 8 hours were significantly higher for the combination tablet than for the single-ingredient tablet, and tmax for triprolidine was significantly higher for the combination tablet than for the syrup. For both pseudoephedrine and triprolidine, the combination tablet was bioequivalent to the syrup and to the single-drug tablets.

Comparison of pseudoephedrine and triprolidine, alone and in combination in preventing nasal congestion in subjects with allergic rhinitis using nasal histamine challenge.

The abilities of triprolidine 2.5 mg and pseudoephedrine 60 mg, alone and in combination, to protect against an increase in nasal airway resistance (NAR) after histamine challenge were determined in eighteen individuals with grass pollen allergy. The study was conducted outside the pollen season using a double-blind, placebo controlled crossover design. The prior administration of pseudoephedrine 60 mg and triprolidine 2.5 mg alone or in combination was superior to placebo in reducing the increase in NAR after challenge with 1.0% histamine. However, such NAR measurements did not differentiate between pseudoephedrine 60 mg and triprolidine 2.5 mg administered alone or in combination. Challenge with 0.1% histamine failed to discriminate between any of the test medications.

A study of sustained action pseudoephedrine in allergic rhinitis.

A single capsule of sustained release pseudoephedrine (SUDAFED S.A., Burroughs Wellcome Co.) was shown by objective and subjective measurements to be superior to placebo in relieving nasal congestion associated with allergic rhinitis. The drug had no discernible effect on (1) the degree of wetness perceived in the mouth or nose, (2) a complex of symptoms which included sneezing, coughing, sniffing, swallowing, itching of eyes and nose or (3) number of nose blows. The study was marked by an absence of serious adverse reactions.

A double-blind controlled evaluation of Actifed and its individual constituents in allergic rhinitis.

Pseudoephedrine and triprolidine, administered every 6 hours as a combination, made separate and distinct contributions to the treatment of allergic rhinitis. Furthermore, the combination was perceived by the patients as being clinically superior to either of its components or placebo.

An evaluation of triprolidine and pseudoephedrine in the treatment of allergic rhinitis.

A double-blind, parallel, placebo-controlled study was performed to assess the efficacy of a combination drug product containing the antihistamine, triprolidine, and the sympathomimetic, pseudoephedrine, in the treatment of allergic rhinitis. Allergic rhinitis was defined on the basis of coexistent nasal congestion and an aggregate symptom complex score which exceeded a pre-established value. Pseudoephedrine and triprolidine were shown to make distinct and separate contributions to the treatment of allergic rhinitis defined in this manner.

Hepatic blood flow and metabolism.

The relationship between liver blood flow and hepatic metabolism remains unclear. An animal model as well as a methodology that permits simultaneous assessment of both of these functions are proposed. Several fractions of inspired oxygen were used to produce arterial oxygen levels commonly seen in clinical practice; these ranged from hyperoxemia to established hypoxemia. Over this range there were no considerable changes in transhepatic blood flow, but there were considerable changes in hepatic metabolism as shown by measurements of the hepatic parenchymal pH, transhepatic oxygen consumption, and lactic acid use. Of these, the parenchymal pH seems to be the most sensitive indicator of metabolic events.