The effect of clinical pharmacy services on family practice residents' attitudes: a nationwide study.

A nationwide study investigated the attitudes of family practice residents toward: interdisciplinary health care teams in family practice; the clinical pharmacist as a member of the health care team; and the utility of clinical pharmacist involvement in private family practice offices. A random sample of 174 family practice residency programs was selected for study. First-year residents comprised the sample population. Based on the response of the directors, programs were assigned to experimental (programs offering clinical pharmacy services) or control (no clinical pharmacy services) groups. Completed attitudinal instruments were received from 158 resident respondents in the experimental group and 153 resident respondents from the control group. The reliability coefficient of the returned questionnaires was 0.901 by the split-halves method. Residents in the experimental group had significantly more favorable attitudes than those residents in the control group on several scales. These scales included the clinical pharmacist's participation on the health care team, utility of a clinical pharmacist in a private practice setting, desirability of hiring a clinical pharmacist, and the desirability of practicing with a multidisciplinary health care team. These results support the hypothesis that exposure to clinical pharmacy services can significantly affect physician resident's attitudes toward clinical pharmacy.

Valorphin: a novel chemical structure with opioid activity.

Valorphin is a semisynthetic derivative of dihydrovaltrate with opioid analgesic activity. In vitro binding studies using brain homogenates from rat and guinea-pig indicate a preference for the mu-receptor site. Bath application to cultured cerebellar Purkinje cells inhibited the spontaneous firing, similar to the effect seen with morphine. Analgesic activity has been demonstrated in the hot plate and the tail flick test in the mouse and the Randall-Selitto test in the rat. In the rhesus monkey valorphin was self-administered, but naloxone challenge induced only mild withdrawal signs. Valorphin is a novel chemical entity, structurally not related to known opioids, which interacts preferentially with opiate mu-receptors.

Trimethoprim-sulfamethoxazole-induced cholestatic hepatitis. Inadvertent rechallenge.

Trimethoprim-sulfamethoxazole is known to produce hepatitis. We report a case involving the inadvertent rechallenge with trimethoprim-sulfamethoxazole (Bactrim) in a patient with a previous episode of drug-induced hepatitis. A liver biopsy specimen showed both cholestatic and cytotoxic changes consistent with drug-induced damage. Comparison with existing cases is presented and an immunologic cause is considered.

The Structure of New Valepotriates from Tissue Cultures of Valeriana wallichii.

Colchicin-treated tissue cultures of VALERIANA WALLICHII produced besides the known valepotriates homovaltrate, isovaltrate, valtrate, acevaltrate and didrovaltrate several unknown substances of diene-valepotriate structure. Nine genuine valepotriates and two degradation products were isolated and their structure elucidated by means of their (13)C-NMR spectra.

On the active agents of Valerian.

(13)C-NMR shifts of valepotriathydrines show a characteristic dependence on type and position of the acyloxy substituents. The structures of well known and of new valepotriathydrines have been clarified.

[The synthesis of valperinol and various 3-aminomethyl derivatives of 2,9-dioxatricyclo[4,3,1,0(3,7)]decane from didrovaltrate]. / Synthese von Valperinol und einigen 3-Aminomethyl-Derivaten des 2,9-Dioxatricyclo[4,3,1,0(3,7)]decans aus Didrovaltrat.

3-Aminomethyl derivatives of 2,9-dioxatricyclo [4,3,1,0(3,7)]decane, can be synthesized via an amination, starting from (1R, 3S, 4S, 6R, 7S, 8R, 10R)-3-iodomethyl-4-acetoxy-8-methoxy-10-methyl-2, 9-dioxatricyclo [4,3,1,0(3,7)]decane or (1R, 3S, 4S, 6R, 7S, 8R)-3-iodomethyl-4-acetoxy-8-methoxy-10-methylen-2,9- dioxatricyclo [4,3,1,0(3,7)]decane, which can be prepared from didrovaltrate.

Unexpected opioid activity in a known class of drug.

Tifluadom, although structurally a 1,4 benzodiazepine, has no affinity for the 3H-flunitrazepam binding site, but is a potent displacer of 3H-bremazocine from its opioid binding site. Tifluadom is characterised as an opiate kappa-receptor agonist in vitro and in vivo with potent analgesic activity in animals and no dependence potential.

[On the active agents of valerian]. / Uber die Wirkstoffe des Baldrians.

C13-NMR-shifts of valepotriates show a quite characteristic dependence on type and position of the acyloxy substituents. The structure of well known and new valepotriates have been clarified.