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Biomedical subjects

Darren M Triller

Publications and source records attributed to Darren M Triller.

12 recordsLinked to original sources
PubMed2006

Recurrent acute nitrofurantoin-induced pulmonary toxicity.

Nitrofurantoin may be used for prophylaxis of recurrent urinary tract infections in women; however, this agent has been associated with acute, subacute, and chronic pulmonary adverse reactions. The acute reaction occurs in about 1/5,000 women after their first exposure to the drug. We report the occurrence of two successive, highly probable (by Naranjo score) nitrofurantoin-induced acute pulmonary reactions in the same patient. On day 4 of prophylaxis with nitrofurantoin 100 mg/day (to prevent urinary tract infections), the patient developed intense substernal pain and pressure. On day 8, she experienced intense substernal burning. She went to the emergency department, where she vomited and was hypotensive and febrile. Her chest radiograph showed bilateral infiltrates. The patient was diagnosed with pneumonia and was prescribed levofloxacin; she stopped taking the nitrofurantoin. Her symptoms subsided over the next 3 days. Ten days later, the patient restarted the nitrofurantoin, and she returned to the emergency department after again experiencing sudden intense substernal burning, nausea, vomiting, shivering, and weakness. Nitrofurantoin was discontinued; her symptoms resolved quickly, and prophylaxis with trimethoprim-sulfamethoxazole was begun. After 1 year, the patient had experienced no further pulmonary symptoms or urinary tract infections. Drug toxicity must be considered in patients who develop pulmonary symptoms while taking nitrofurantoin. Symptoms are often misdiagnosed as other ailments, potentially subjecting patients to unnecessary treatments and delaying discontinuation of nitrofurantoin. Patients should be advised to contact a physician if breathing difficulties or unusual symptoms develop while taking nitrofurantoin, as this could result in earlier recognition of this drug reaction.

Anti-Infective Agents, Urinary↗
PubMed2005

Risk of adverse drug events by patient destination after hospital discharge.

PURPOSE: The prevalence of risk factors for adverse drug events (ADEs) in patients discharged from the hospital to various care settings was studied. METHODS: Data on patient risk characteristics for ADEs were collected for hospital discharges for 2000. Differences in the prevalence of 10 risk characteristics among home health care (HHC), self-care (SC), and long-term-care (LTC) patients at the point of discharge were determined. RESULTS: Data for 4250 discharges were analyzed. The three groups differed significantly in the distribution of risk characteristics. HHC patients had the highest prevalence of heart failure, cardiovascular medication use, and polypharmacy, and LTC patients had the highest prevalence of hypoalbuminemia, cognitive impairment, and psychiatric drug use. CONCLUSION: The risk of ADEs in patients discharged to HHC appeared to be comparable to or higher than that in patients discharged to LTC.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Travel-related savings through a rural, clinic-based automated drug dispensing system.

For rural patients, access to pharmacies is often impeded by geographical and financial factors. The number of available pharmacies may be limited, and the extensive travel needed to access them is time consuming, potentially dangerous and, due to rising fuel prices, increasingly expensive. We describe the benefits of a clinic-based, automated medication dispensing system (ADDS) implemented in two rural communities in the Adirondack Mountain region of New York State. To estimate distance saved by utilizing the ADDS at the clinic, data from 268 consecutive patient encounters was imported into a mapping software package. Clinic Trip and Pharmacy Trip distances were calculated, with Miles saved estimated as the difference. Cost savings estimates were generated, with results reported as percentage of median per capita money income by county. Patients lived significantly closer to both clinics than to nearest traditional pharmacies, and saved an average travel distance of 32.6 and 18.0 miles per encounter. Cost estimates suggest travel-related savings of dollar 12.23 and dollar 6.75 per encounter, or 3.4% and 1.7% of weekly income. Considering the median out of pocket expense (dollar 13.31) for acquiring a prescription, patients traveling more than 35 miles round trip to obtain medications spent more on travel than on the medication itself. Placement of ADDS can significantly reduce the travel distances required for drug procurement in rural communities, and can provide acutely needed medications without travel-related delay. Such systems can provide considerable travel-related savings to the rural poor, where travel-related costs can exceed average drug costs.

Automation↗
PubMed2005

Medication management model as experiential education tool for students of pharmacy.

A visiting nurse association (VNA) and a college of Pharmacy sought cost-effective models by which consultant pharmacy services could be offered at a rural branch office to improve medication management for high-risk patients. Through a collaborative relationship with the Albany College of Pharmacy, the Eddy VNA used the structure and support of the Partners In Care Foundation (The Model) Medication Management Model to simultaneously provide patient services and train Doctor of Pharmacy candidates. The Model brings the pharmacist into the homecare team to provide pharmaceutical care and can provide the framework by which pharmacist preceptors and interns can effectively provide services to high-risk patients identified through the agency's CQI process. Results from program implementation with 100 Medicaid waiver patients indicate positive staff response and an overall 43% acceptance rate with prescribers and suggest that this is a cost-effective medication management service with implications for adaptation by other HHAs.

Education, Pharmacy↗
PubMed2004

Gemifloxacin: a new fluoroquinolone approved for treatment of respiratory infections.

OBJECTIVE: To evaluate the microbiology, pharmacokinetic parameters, drug interactions, and results of the available clinical trials of gemifloxacin for the treatment of community-acquired pneumonia (CAP) and acute exacerbation of chronic bronchitis (AECB). DATA SOURCES: MEDLINE (1966-September 2003) was searched for primary and review articles. Data from the manufacturer were also included. Key words included adverse effects, clinical trials, drug interactions, gemifloxacin, and pharmacokinetic parameters. STUDY SELECTION AND DATA EXTRACTION: All articles and product labeling concerning gemifloxacin, a fluoroquinolone antibiotic recently approved by the Food and Drug Administration for treatment of CAP and AECB, were included for review. DATA SYNTHESIS: Compared with currently available fluoroquinolones, gemifloxacin demonstrated improved in vitro activity against Streptococcus pneumoniae (minimum inhibitory concentration for 90% eradication 0.03 microg/mL) and similar activity against gram-negative respiratory pathogens (Haemophilus influenzae, Moraxella catarrhalis) and atypical pathogens such as Chlamydia pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae. Gemifloxacin, consistent with other available fluoroquinolones, has insufficient activity against methicillin-resistant Staphylococcus aureus to allow clinical use for such infections. Gemifloxacin has adequate bioavailability and a favorable drug interaction profile. Gemifloxacin was comparable to commonly employed nonfluoroquinolone regimens for treatment of CAP and AECB, although the studies were designed to demonstrate equivalence. Gemifloxacin once daily for 5-7 days was well tolerated in controlled and uncontrolled clinical studies. Available clinical data, however, are insufficient to draw clinical or toxicologic distinctions between gemifloxacin and other fluoroquinolones. CONCLUSIONS: Gemifloxacin may be a suitable choice for empiric treatment of CAP or AECB. However, due to the significant history of fluoroquinolone-induced hepatic failure and dermatologic complications, the use of this drug should be closely monitored.

Anti-Bacterial Agents↗
PubMed2004

Hazardous medications.

Explore the source record for details and available documents.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Conforming to HIPAA regulations and compilation of research data.

PURPOSE: A set of deidentified patient data compliant with the Health Information Portability and Accountability Act (HIPAA) was compiled, the data lost as a function of unique data elements (UDEs) were measured, and the deidentified data were tested for potential for reidentification. METHODS: After approval by the institutional review board of an integrated health system, a limited-data set was created by querying the health system's pharmacy, administrative, and financial files for patients discharged between January 1 and December 31, 2000. Using the HIPAA "safe-harbor" method, this limited-data set was converted into a deidentified-data table for future statistical analysis, and UDEs in both data sets were identified and quantified. Unique combinations of commonly available data were also identified. RESULTS: The limited-data set, representing 4,738 patient discharges, contained 810,456 UDEs in 322,657 records organized into four data tables (demographics, diagnoses, medication orders, and laboratory test results). The deidentified-data table, representing 4,722 discharges, contained 562,171 UDEs in 128 data-type columns in a single data table. About 31% of the data volume was lost. Much of the information lost was of the type that is of special interest to researchers (e.g., time between episodes of care, ages of >89 years). CONCLUSION: A study suggested that deidentified patient data with a reasonable degree of protection against reidentification were less complete than may be necessary for good research.

Guideline Adherence↗
PubMed2003

Resolution of drug-related problems in home care patients through a pharmacy referral service.

A referral-based, pharmacist-conducted medication management program designed to identify, categorize, and resolve drug-related problems (DRPs) in a home health care (HHC) population was studied. A clinical pharmacy service model was developed to identify patients at high risk for adverse health events resulting from DRPs. Policies and procedures were developed for this service model, including explicit referral criteria, patient-consent documentation, and physician orders. All identified DRPs were categorized, and pharmacist activities relating to the discovery and resolution of DRPs were tabulated. From July 1, 2001, through March 29, 2002, 80 patients were referred for and received clinical pharmacy services, and pharmacists identified 271 DRPs. Every patient referred had a DRP, and 32% of DRPs were identified by a visit to the patient's home. Nearly 65% of pharmacist recommendations were implemented. Using a referral-based practice model in an HHC setting, pharmacists were able to identify and resolve DRPs for every patient referred.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2002

Clonidine-induced hypertension in a patient with a spinal lesion.

OBJECTIVE: To report a case of possible clonidine-induced hypertension (by Naranjo score) in a patient with a C4 spinal lesion. BACKGROUND: Clonidine is a medication long used to treat hypertension, and it is still used in the treatment of refractory hypertension. Although effective, clonidine use is hindered by adverse effects and its dual mechanism of action. CASE SUMMARY: A 39-year-old white, quadriplegic man with poorly controlled pain displayed many characteristics consistent with autonomic dysfunction (e.g., C4 spinal lesion, orthostatic hypotension, hypertension). The patient was routinely receiving transdermal clonidine and also received transdermal nitroglycerin paste as needed for control of acute hypertensive episodes. On the recommendation of the home healthcare pharmacists, clonidine was discontinued. Since that time, the patient's blood pressure and the use of emergent antihypertensive treatment have decreased significantly (maximum systolic and diastolic BP by approximately 50 and 25 mm Hg, respectively). CONCLUSIONS: Many of the characteristics of autonomic dysfunction, such as refractory hypertension, can seem selective for the use of clonidine and, because of its reliance on central alpha(2)-activity for its hypotensive effects, clonidine may induce hypertension in patients with autonomic dysfunction. Clonidine should be used with great caution when autonomic dysfunction is suspected.

Adrenergic alpha-Agonists↗