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Reviews
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Shelf
Drug
information
handbook
Handbook
of
Clinical
Drug
Data.
5th
ed.
Edited
by
James
E.
Knoben
and
Philip
0.
Anderson.
669
pp.
Drug
Intelligence
Publications,
Inc.,
Hamilton,
Illinois,
1983.
$29.50
(US),
paperbound.
ISBN
0-914768-
41-7
How
many
times
a
day
do you
wish
you
had
instant
access
to
drug
infor-
mation?
This
relatively
slim
book
can
be
easily
tucked
away
in
your
bag
or
drawer
and
provides
informa-
tion
on
some
350
drugs.
Mono-
graphs
are
organized
in
general
class
chapters,
such
as
cardiovascu-
lar
drugs
or
anti-infective
agents.
There
is
also
a
generous
number
of
charts
to
contrast
specific
properties
of
related
agents.
The
drugs
are
presented
alphabetically
by
generic
name
within
each
category,
and
an
index
is
provided
at
the
end
of
the
book
for
more
rapid
access.
The
monographs
provide
brief
reviews
on
pharmacologic
aspects,
dosage
indi-
vidualization,
patient
instructions,
pharmacokinetics,
biotransforma-
tion
and
elimination,
as well as
adverse
reaction,
precautions,
con-
traindications
and
data
to
monitor
during
use.
The
information
provided
on each
drug
is
undoubtedly
useful
and
probably
in
large
part
correct,
al-
though
errata
can
be
a
large
prob-
lem,
even
though
this
is
the
fifth
edition.
The
reader
is
invited
to
write
to
the
publisher
to
acquire
a
''Corrections
and
new
information..
sheet.*
There
is,
in
addition,
the
usual
information
time
lag
that
plagues
all
books.
For
example,
it
is
suggested
that
diazoxide
be
adminis-
tered
as
a
bolus
injection
of
5
mg/kg
over
30
seconds
or
less,
whereas
more
recent
work
has
demonstrat-
ed
that
smaller
repeated
bolus doses
or
a
slow
load
administered
by
a
constant
infusion
of
7.5
mg/mm
up
to
a
total
dose
of
7.5
mg/kg
is
safer
and
just
as
effective
in
the
treatment
of
hypertensive
emergencies.
This
book
has
been
written
by
clinical
pharmacists,
and
a
certain
bias
comes
through
at
times.
For
example,
patients
are
admonished
to
report
to
a
pharmacist
if
they
suffer
from
sore
throat,
fever
or
oral
le-
sions
while
taking
propylthiouracil.
In
the
first
240-page
section
"Data
compilation",
there
are
some
useful
outlines
of
drug
use
during
pregnan-
cy
and
breast-feeding,
drug
interac-
tions
and
organ-specific
adverse
ef-
fects,
but
also
some
listing
of
drug
therapeutic
programs
for
emergen-
cies
such
as
anaphylaxis,
cardiac
arrest,
poisoning
and
status
epilep-
ticus.
They
practitioner
will
be
disap-
pointed
in
the
therapeutic
program
lists,
which
are
largely
uncritical.
For
example,
cathartics
are
recom-
mended
for
overdoses,
and
pheny-
tom
is
suggested
for
status
epilep-
ticus
only
if
control
is
not
achieved
*One
such
correction
appeared
in
the
June
15,
1983
issue
of
CMAJ
(128:
1357).
with
diazepam.
In
my
opinion,
both
practices
are
outdated.
Nevertheless,
this
is
a
useful
volume,
if
only
to
be
used
as
a
reminder
to
practitioners
for
areas
in
which
they
are
unsure.
Reference
to
standard
textbooks
is
still
desirable
in
certain
instances.
I
particularly
liked
the
brief
monographs
on
investigational
agents.
I
am
sure
many
practitioners
find
that
their
patients
who
have
just
returned
from
major
centres
have
been
receiving
drugs
not
yet
released
for
general
use,
and
the
practitioners
have
little
access
to
information
about
them.
The
appli-
cability
of
some
of
the
chapters
and
information,
such
as
schedules
of
control
drugs
and
dosage
forms,
may
be
limited
to
the
United
States,
but
this
should
not
be
a
major
handicap
for
the
Canadian
practi-
tioner.
RI.
OGILVIE,
MD,
FRCP[C]
Director
Divisions
of
cardiology
and
clinical
pharmacology
Toronto
Western
Hospital
Toronto,
Ont.
References
I.
OGILVIE
RI,
NADEAU
JH,
SITAR
DS:
Diazoxide
concentration-response
relation
in
hypertension.
Hypertension
1982;
4:
167-173
2.
HUYSMANS
FTM,
THIEN
T,
KOENE
RA:
Acute
treatment
of
hypertension
with
slow
infusion
of
diazoxide.
Arch
Intern
Med
1983;
143:
882-884
3.
RAM
CV,
KAPLAN
NM:
Individual
titra-
tion
of
diazoxide
dosage
in
the
treatment
of
severe
hypertension.
Am
J
Cardiol
1979;
43:
627-630
The
ageing
nervous
system
The
Neurology
of
Aging.
Edited
by
Robert
Katzman
and
Robert
Terry.
249
pp.
Illust.
F.A.
Davis
Company,
Philadelphia,
1983.
$38
(US).
ISBN
0-8036-5231-3
The
editors
of
this
10-chapter
mono-
graph,
the
chairmen
of
the
depart-
ments
of
neurology
and
pathology
at
the
Albert
Einstein
College
of
Medi-
cine
of
Yeshiva
University,
New
York,
are
eminently
suited
to
com-
pile
an
informative
text
summariz-
ing
normal
and
abnormal
aspects
of
the
ageing
human
nervous
system.
Eleven
of
the
13
contributors
are
also
American
academics
(the
other
2
are
from
Helsinki
and
Vancou-
ver).
Since
the
number
of
people
over
age
75
has
grown
from
less
than
1
million
in
the
United
States
in
1900
to
10
million
in
1980,
the
theme
of
378
CAN
MED
ASSOC
I,
VOL.
129,
AUGUST
15,
1983
Results: Prophylactic, therapeutic, and recreational uses of drugs relevant to mountaineering are presented with an assessment of their risks and benefits. Conclusions: If using drugs not regulated by the World Anti-Doping Agency (WADA), individuals have to determine their own personal standards for enjoyment, challenge, acceptable risk, and ethics. No system of drug testing could ever, or should ever, be policed for recreational climbers. Sponsored climbers or those who climb for status need to carefully consider both the medical and ethical implications if using drugs to aid performance. In some countries (e.g., Switzerland and Germany), administrative systems for mountaineering or medication control dictate a specific stance, but for most recreational mountaineers, any rules would be unenforceable and have to be a personal decision, but should take into account the current best evidence for risk, benefit, and sporting ethics.
The public's need for health and dietary adequacy has been the driving force for their use of Nutraceutical supplements. Moringa oleifera is one of the herbal plants promoted based on its acclaimed of its Nutraceutical benefits. However awareness and adoption are critical issues in the utilization of any product/service. This preliminary survey was conducted to examine the consumption of moringa products for nutraceutical benefits in Ilorin, Kwara state, Nigeria. One hundred adult respondents were interviewed using semi-structured questionnaire. Descriptive statistics, Binary Logistic Regression and non-parametric correlation analyses were employed to achieve the study's objectives. The results indicated that a fairly high proportion of the respondents (48%) had used Moringa products for its claimed Nutraceutical benefits. Lack of awareness was a major barrier to the use of Moringa product: 87% of the non-users indicated lack of awareness as a reason for non-use. Educating non-users on its claimed Nutraceutical benefits led to 85% prospective adoption. However, given knowledge, the major determinant of reticence to its adoption was safety concerns, which is statistically significant (p<0.01). Hence, it is recommended that an awareness of the claimed Nutraceutical benefits of Moringa products should be increased since it could increase adoption with a consequent increase in market share. However, it is paramount that pre-clinical and clinical trials on Moringa products for claimed Nutraceutical benefits should be conducted to assure its safety and efficacy in the immediate and long term. INTRODUCTION Moringa oleifera is one of the species of Moringa tree which is often referred to as "the miracle tree" (Wallis, 2003). The tree is native to India (Coote et al., 1997), but it is currently found in many parts of the world. In Nigeria, it is found in the Northern, Southern, Western and Eastern parts of the country. The plant is known as "Zogale" in Hausa, "Gawara", in Fulani, "Okwe Oyibo" in Igbo, and "Ewe Igbale" in Yoruba (Kadashi, 2008).
The aim of the study was to compare the efficacy of chamomile versus omeprazole in the treatment of aspirin-induced gastric ulcer in rats. Animals were randomly assigned into three groups A, B and C (n = 10 each). Aspirin (200 mg/kg, intragastric (i.g.)) was administered for three consecutive days, and then, two animals from each group were euthanized and formed the aspirin-induced gastric ulcer control group. The remaining animals (n = 8 in each group) were administered with the following treatments: normal saline 9 % (0/5 mL, i.g.) (group A), omeprazole (2.3 mg/kg, i.p.) (group B) or chamomile decoction (25 mL/kg, i.g.) (group C) daily for 2 weeks. Histological analysis of tissue harvested from rats in groups B and C showed no significant difference, since ulcers in both treatment groups were completely cured. The results of this study suggest that chamomile could be used for the treatment of nonsteroidal anti-inflammatory drug-induced ulcers as an inexpensive alternative to omeprazole.
Intravenous (IV) anti-pseudomonal aminoglycosides (i.e., amikacin and tobramycin) have been shown to be tolerable and effective in the treatment of acute pulmonary exacerbations (APEs) in both pediatric and adult patients with cystic fibrosis. The aim of this review is to provide an evidence-based summary of pharmacokinetic/pharmacodynamic, tolerability, and efficacy studies utilizing IV amikacin, gentamicin, and tobramycin in the treatment of APE and to highlight areas where further investigation is needed. The Cystic Fibrosis Foundation Pulmonary Guidelines recommend that once-daily administration of aminoglycosides is preferred over three times per day in the treatment of an APE. The literature supports dosing ranges for amikacin and tobramycin of 30-35 and 7-15 mg/kg/day, respectively, given once daily, with subsequent doses determined by therapeutic drug concentration monitoring. The literature does not support the routine use of gentamicin in the treatment of APE due to a lack of studies showing efficacy and evidence indicating an increased risk of nephrotoxicity. Further studies are needed to determine the optimal dosing strategy of amikacin in the treatment of an APE, and to further identify risk factors and determinants that influence the development of P. aeruginosa resistance with once-daily administration of tobramycin. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.
- David E Shields
- Jennifer Aclan
- Aaron Szatkowski
The chemical stability of an intrathecally administered analgesic combination may influence the frequency of pump refills necessary to maintain safe and effective analgesia. Previous work has shown that the stability of ziconotide at body temperature is reduced substantially by the presence of morphine sulfate 35 mg/mL. The current study was performed to evaluate the chemical stability of admixtures combining ziconotide with lower concentrations of morphine sulfate during simulated intrathecal infusion under laboratory conditions at 37 deg C. Admixtures containing ziconotide 25 mcg/mL and morphine sulfate 10 mg/mL or 20 mg/mL were stored in implantable intrathecal pumps at 37 deg C and in control vials at 37 deg C or 5 deg C. Samples were obtained over 60 days (admixture containing morphine sulfate 10 mg/mL) or 28 days (admixture containing morphine sulfate 20 mg/mL) and drug concentrations were assessed by high-performance liquid chromatography. Estimates of the time intervals that each admixture retained > or= 90% and > or = 80% of the initial concentrations of both drugs (i.e., the 90% and 80% stabilites) were based on 95% confidence bounds obtained via linear regression. Morphine sulfate 10 mg/mL, the mean ziconotide concentration declined to 81.4% of the initial concentration in 60 days, and 90% and 80% stabilites were maintained for 34 days and 65 days, respctively. In the admixture containing morphine sulfate 20 mg/mL, the mean ziconotide concentration declined to 85.3% of the initial concentration in 28 days, and 90% and 80% stabilities were maintained for 19 days and 37 days, respectively. Decreasing the concentration of morphine in an admixture containing ziconotide improves the stablity of ziconotide.
Amitrityline and its metabolite nortriptiline are tricyclic antidepressant drugs widely used for the treatment of several psychiatric disorders. Several methods have been published for the determination of these two antidepressant drugs in pharmaceuticals, biological materials and environmental samples. In this review some of analytical techniques such as ultraviolet/visible spectrophotometry, fluorimetry, capillary electrophoresis, and chromatographic methods (gaschromatography and high-performance liquid chromatography) were discussed. Although HPLC and capillary electrophoresis methods are extensively employed in spite of that UV/VIS spectrophotometry are still popular because of the inherent simplicity, low cost, and reliability for determination of drugs in pharmaceutical preparations.
- Duangchit Panomvana
- Napanan Khummuenwai
- Supasil Sra-ium
-
![Somchai Towanabut]()
Background: When phenytoin is prescribed for administration via nasogastric tube, immediate-release OR) phenytoin tablets are crushed before use and extended-release (ER) phenytoin capsules are opened and only the granules are used. However, it is unknown whether the same dose of these 2 different formulations will result in the same steady-state serum phenytoin concentration. Objective: The aim of this study was to determine whether ER phenytoin capsules can be used interchangeably with IR phenytoin tablets for prophylaxis of posttraumatic seizures. Methods: Inpatients at the neurosurgical ward at Prasat Neurological Institute, Bangkok, Thailand, between October 2004 and October 2005 were enrolled in the study. All patients were initially prescribed IR phenytoin tablets 300 mg/d as a maintenance dose for prophylaxis of posttraumatic seizures. The serum phenytoin concentration was measured after ≥5 days of treatment with IR phenytoin tablets 300 mg/d (two 50-mg tablets every 8 hours) that had been crushed before being administered concomitantly with a blenderized diet through the nasogastric tube. Without a washout period, the dosage form was changed to ER phenytoin capsules (three 100-mg capsules QD). The capsules were opened and the contents were administered concomitantly with the blenderized diet through the nasogastric tube for ≥5 days. The serum phenytoin concentration was again determined. The patients were closely monitored for seizures and adverse events (AEs). Results: Thirty-three patients enrolled in the study and 17 (10 women, 7 men; mean [SD] age, 62.94 [15.94] years [range, 18-89 years]) completed the study. The mean (SD) serum phenytoin concentrations after administration of phenytoin tablets and capsules were 6.03 (5.92) μg/mL and 3.80 (2.71) μg/mL, respectively (P = 0.019). The mean serum phenytoin concentrations, adjusted for low serum albumin concentrations after administration of tablets and capsules, were calculated and reported to be 10.33 (11.60) μg/mL and 6.28 (4.76) μg/mL, respectively (P = 0.035). The maximum phenytoin metabolic rate (Vmax) (assuming the substrate concentration at which the rate of metabolism is one half Vmax = 4 mg/L) after the administration of phenytoin tablets and capsules was 8.37 (2.42) mg/kg · d(-1) and 10.38 (6.48) mg/kg · d(-1), respectively. These values were not significantly different. All patients were seizure-free and no AEs were observed. Conclusion: The steady-state serum phenytoin concentration was significantly lower with ER phenytoin capsules 300 mg/d than IR phenytoin tablets 300 mg/d administered via nasogastric feeding tube concomitantly administered with a blenderized diet in these neurosurgical patients. Key words: phenytoin nasogastric tube feeding extended-release capsule immediate-release tablet.
- Burl Beasley
- Edna Patatanian
Purpose Describe the development, implementation, and outcomes of a pharmacy fall prevention program (PFPP) that incorporates medication profile review and a medication fall risk score to identify high-risk patients. Summary Falls are a common cause of morbidity and mortality among elderly patients in the United States. Injury-related falls may contribute to frequent visits to emergency departments (EDs) and hospitals, as well as functional and emotional decline. Falls account for more than 10% of ED visits and more than 5% of hospital visits. Numerous reports describe common risk factors associated with falls of hospitalized patients and which safety measures should be taken to prevent or eliminate falls. The fall prevention program has a positive financial impact by reducing injury falls in hospitalized patients. During the first 2 years of implementation, the injury fall rate decreased from 2.06 to 1.07 per 1,000 patient-days (48%). The total falls rate decreased from 5.13 to 3.59 per 1,000 patient-days (30%). This program showed a savings of $217,000 per year in prevented falls. Conclusion Incorporating medications and their related adverse effects into a fall prevention program is an integral part of a multidisciplinary approach to reduce total falls and related injuries. The decrease in falls has improved patient safety and quality of care.
- Carisoprodol Soma
Baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol and orphenadrine all have the indication to treat muscle spasm. For most of the agents used to treat muscle spasm, use should be limited to two or three weeks. It is important to encourage proper utilization of these agents because skeletal muscle relaxants such as carisoprodol have been associated with abuse potential and addiction. Baclofen, dantrolene and tizanidine have the indication to treat spasticity. These agents, in particular, may be used for longer periods of time and play an integral role in managing the symptoms associated with spasticity as well as improving the functional status of patients.
- Frans T. M. Huysmans
• We have treated 81 patients who had hypertension with slow intravenous infusion of diazoxide (15 mg/min; 5 mg/kg of body weight). Blood pressure was reduced effectively both in patients with severe hypertension (n = 40) and in patients with a hypertensive crisis (n=34); the decrease of mean arterial pressure (△MAP) being -17.0%±1.2% (mean±SEM) and -19.7%±1.5%, respectively. However, the △ MAP was significantly greater in patients with preeclampsia (-26.0%±3.0%). In all Instances BP fell gradually and then decreased only slightly after discontinuation of the infusion. Thus, the potentially hazardous, steep, and exaggerated fall of BP, observed after bolus injections, can be avoided. Electrocardiographic signs of myocardial ischemia were seen in two patients. No other serious side effects were observed. We conclude that, even in patients with a hypertensive crisis, slow infusion is a safe and effective procedure for the reduction of BP. (Arc/i Intern Med 1983;143:882-884)
-
![C Venkata S Ram]()
- Norman M. Kaplan
Diazoxide, 300 mg as a single bolus injection, is widely used to treat severe hypertension. Although usually effective, this standard dosage may decrease the blood pressure too much, inducing hypotensive problems. In this study 32 patients with a diastolic blood pressure above 125 mm Hg were treated with smaller bolus injections, 105 or 150 mg, which were repeated every 5 minutes as needed to reduce the diastolic pressure to 110 mm Hg or less. Seven patients of the 32 patients needed only one injection of 150 mg; only one patient needed more than three injections. This individual titration with mini-bolus injections of diazoxide was effective and did not induce hypotension or other side effects.
The pharmacokinetic disposition and antihypertensive response of bolus infusions of diazoxide, 1, 2, or 4 mg/kg over 5, 10, or 20 seconds, were examined in seven patients with chronic stable essential hypertension and mean arterial pressures (MAP) between 122 and 155 mm Hg off therapy. Maximal reductions in MAP were noted 2 minutes after each dose, and a linear correlation was obtained in all patients between dose or plasma diazoxide concentration and maximal change in MAP. Individual concentration-time curves were analyzed to determine the apparent volume of distribution at steady state (Vdss range, 0.178 to 0.250 liter/kg), beta t 1/2 (range, 32 to 62.5 hours), and plasma clearance rate (Clp range, 2.2 to 5.3 ml/kg . hour-1) for the calculation of loading and maintenance doses designed to produce steady-state concentrations within 0.5 hours. These infusions resulted in steady-state reductions in MAP (16% to 30%) which could be predicted from the concentration-response curves of each patient after bolus infusions. With the use of kinetic principles, a diazoxide dose regimen (average load, 7.5 mg/kg at 7.5 mg/min; average maintenance, 10% of loading dose every 6 hours) produced gradual and predictable reductions in MAP in patients with accelerated hypertension, since the response was proportional to plasma diazoxide concentrations.
Diazoxide concentration-response relation inhypertensionHypertension 167-173 Acute treatment of hypertension with slow infusion of diazoxide Individual titra-tion of diazoxide dosage in the treatment of severe hypertension The ageing nervous system The Neurology of Aging
- I Ogilvie
- Thien T Ftm
- Ram Cv
I. OGILVIE Diazoxide concentration-response relation inhypertension.Hypertension 167-173 HUYSMANS FTM, THIEN T, KOENE RA: Acute treatment of hypertension with slow infusion of diazoxide. Arch Intern Med 1983; 143: 882-884 RAM CV, KAPLAN NM: Individual titra-tion of diazoxide dosage in the treatment of severe hypertension. Am J Cardiol 1979; 43: 627-630 RI,NADEAU JH,SITARDS: 1982; 4: The ageing nervous system The Neurology of Aging. Edited by Robert Katzman and Robert Terry
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