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Biomedical subjects

A G Lipman

Publications and source records attributed to A G Lipman.

At least 19 recordsLinked to original sources
PubMed1990

Clinically relevant differences among the opioid analgesics.

The mechanism of action of opioids and clinically relevant differences among the opioid analgesics are described. Both endorphins (endogenous morphine-like substances) and exogenous opioids (opium alkaloids and their derivatives) bind to opioid receptors in the human central nervous system to provide analgesia and other effects. Some drugs, such as morphine, are true agonists, i.e., they bind to and activate receptors. Some are partial agonists, binding to part of the receptor and causing effects that are similar to, but perhaps less pronounced than, the effects produced by agonists. Others are antagonist, i.e., they bind to the receptor but do not cause the associated effects. Some drugs, termed agonist-antagonist opioids, act as antagonists at one type of receptor and agonists at another type of receptor. True agonists tend to have relatively straight-line dose-response curves; in other words, their effect increases with increasing doses over a broad dosage range. Partial agonists and agonist-antagonists tend to have ceiling effects; that is, they do not have the broad dosage range of drugs such as morphine, methadone, hydromorphone, and other "strong" opioids. This fact mediates against the use of partial agonists and agonist-antagonists in cancer patients who have chronic pain that may increase as the disease progresses. Three major factors that should be considered when a drug is selected for clinical use are (1) relative affinities for the different opioid receptor types, (2) pharmacokinetic characteristics that influence onset and duration of action, and (3) whether the opioids are strong or weak. For treatment of cancer pain, drugs with long durations of action are preferable.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1985

Adjunctive antianxiety agents in the management of chronic pain.

We examined the relative clinical efficacy of three commonly used antianxiety medications and a placebo as adjuncts to analgesic treatment of chronic cancer and arthritic pain. Nine patients with chronic pain, including six with malignancy and three with rheumatic diseases, were each exposed to three treatment phases with antianxiety drugs (hydroxyzine, prochlorperazine, and chlordiazepoxide) and one placebo phase in a double-blind, counter-balanced design. Each phase lasted 2 weeks, with analgesic medication given throughout. Pre- and post-phase measures of anxiety, depression, and hostility were taken, together with daily reports by the patients on pain, mood, and medication intake. None of the antianxiety drugs were significantly more effective than the placebo in reducing pain levels, daily medication usage or hostility. Chlordiazepoxide significantly reduced anxiety and depression compared with the placebo, but also produced the most side effects (e.g., drowsiness). The preliminary findings failed to support the efficacy of the three antianxiety medications as analgesic adjuncts.

Adult↗
PubMed1982

Analysis of information provided by clinical pharmacists.

Data were collected to characterize the interactions between clinical pharmacists and other health professionals in a university hospital with decentralized pharmaceutical services. A self-report data collection form was developed. Six faculty pharmacists participated in the study. Each pharmacist collected data by recording all clinical interactions that occurred in his normal activities for a one-month period. the pharmacists' practice sites were inpatient internal medicine, inpatient pediatrics (two pharmacists), family practice clinic, pediatric clinic, and inpatient physical medicine and rehabilitation. A computer program was written to provide correlation data among the locations, contents, and participants of the interactions. Data were collected on the time required for a literature search and on the outcomes of the interactions. Four hundred ninety-nine interactions were documented. Work rounds were the most common location for these interactions, and the housestaff physicians were the most frequent participants. Patients' dosage schedule was the most common topic discussed (17%). Pharmacokinetics accounted for only 6% of the communications; drug interactions, only 3%. Ninety-six percent of the pharmacists' recommendations were adopted within 24 hours. More than half of the interactions (56%) required no literature search by the pharmacists and nearly half (249) required less than one minute of pharmacist time.

Drug Information Services↗
PubMed1980

Lidocaine anesthesia: comparison of iontophoresis, injection, and swabbing.

The duration and depth of anesthesia produced by lidocaine with three methods of administration were studied. To test duration of anesthesia, either lidocaine or placebo was administered by iontophoresis, subcutaneous infiltration, or swabbing to each of three sites 3 cm apart on the flexor surface of each forearm of 27 subjects. To test for feeling, the tip of a 21-gauge hypodermic needle was pressed on each application site every five minutes until feeling returned. The depth of anesthesia achieved with iontophoresis or infiltration of lidocaine was tested on the flexor surface of each forearm of 12 subjects, with a random assignment of application methods to each arm. Lidocaine iontophoresis produced local anesthesia of significantly longer duration (p less than 0.001) than topical application of lidocaine or placebo by any route of administration, but of significatnly shorter duration (p less tahn 0.001) than lidocaine infiltration. The results showed that lidocaine iontophoresis is an effective method of producing local anesthesia for about five minutes without requiring the use of a hypodermic needle and syringe.

Administration, Topical↗
PubMed1979

An algorithm for the operational assessment of adverse drug reactions. II. Demonstration of reproducibility and validity.

The reproducibility and validity of an algorithm for diagnosis of adverse drug reactions (ADRs) were tested in a clinical spectrum of 30 suspect cases. Using a questionnaire derived from the algorithm the three algorithm developers (nonexperts) agreed on the probability of ADR in 67% of cases, with pair-wise agreement varying from 73% to 87%. The pair-wise agreement of two clinical pharmacologic experts rose from 47% without the algorithm to 63% with the algorithm, with Kw, a chance-corrected index of weighted agreement, increasing from 0.26 to 0.57. The algorithmic assessments of the three nonexperts agreed with expert consensus in 80% to 83% of cases. The ADR algorithm appears to provide a reproducible and valid method of evaluating the likelihood of ADRs in individual patients. Its use can help improve the diagnostic and epidemiologic approach to these important, complex clinical phenomena.

Adult↗
PubMed1979

Decentralization of pharmaceutical services without satellite pharmacies.

The decentralization of pharmaceutical services without the addition of pharmacy satellites is described. Mobile, master medication carts are used by pharmacy personnel in the patient-care areas to fill the unit dose carts used by nurses. A combination medication administration record and patient profile eliminates duplication of effort by pharmacy and nursing. Responsibilities of pharmacists and technicians, the process of hospital-wide implementation of the system, current levels of service, and a clerkship designed to improve staff pharmacists' clinical abilities are described. The ratio of the number of drug doses administered to the number of drug doses handled per patient-day increased after the implementation of the new system. This indicated that individual doses were handled fewer times by pharmacy personnel. This method of decentralization permitted integration of distributive and clinical pharmaceutical services with a minimal personnel cost increase, no additional space requirements nor expenditures for renovation, and only a small cost for master medication carts. Because the pharmacists work in the patient-care areas, they are in more frequent contact with nurses, physicians and patients.

Costs and Cost Analysis↗
PubMed1978

Use review of nutritionally complete liquid diets.

A study was conducted to determine the manner in which semisynthetic fiber-free liquid diets and complete oral liquid diets were being used in a large teaching hospital, and to determine the influence of the establishment of a dietary formulary and guidelines on prescribing. A use review of the dietary formulations was conducted both prior and subsequent to the publication of the formulary and guidelines. Ninety-five patients were monitored on 22 adult medical, surgical, psychiatric and gynecological divisions. The inappropriate or questionable orders for all types of dietary formulations decreased from 65% to 52% after the publication of the formulary and guidelines. There was a significant decrease (p less than 0.005) in orders for semisynthetic fiber-free diets, from 34 to 4, after publication of the formulary and guidelines. The guidelines and formulary appeared to have caused the decreased use of the diet formulations and to have aided in eliminating less than optimal prescribing of the products.

Diet↗