Biomedical subjects

E G Holland

Publications and source records attributed to E G Holland.

4 recordsLinked to original sources

PubMed1997

Drug-induced disorders.

Recent estimates suggest that each year more than 1 million patients are injured while in the hospital and approximately 180,000 die because of these injuries. Furthermore, drug-related morbidity and mortality are common and are estimated to cost more than $136 billion a year. The most common type of drug-induced disorder is dose-dependent and predictable. Many adverse drug events occur as a result of drug-drug, drug-disease or drug-food interactions and, therefore, are preventable. Clinicians' awareness of the agents that commonly cause drug-induced disorders and recognition of compromised organ function can significantly decrease the likelihood that an adverse event will occur. Patient assessment should include a thorough medication history, including an analysis of all prescribed and over-the-counter medications, vitamins, herbs and "health-food" products to identify drug-induced problems and potentially reversible conditions. An increased awareness among clinicians of drug-induced disorders should maximize their recognition and minimize their incidence.

Adverse Drug Reaction Reporting Systems↗

PubMed1991

Practical management of stress-related gastric ulcers.

Stress ulcers develop in patients who have been subjected to abnormally elevated levels of stress, especially stress caused by conditions associated with reduced gastric blood flow, such as major burns, hypovolemia, and sepsis. Since a significant, often fatal, upper gastrointestinal hemorrhage is a common sequela of stress ulcers, prevention of progression of the lesions is a sensible goal. In numerous clinical trials, antacids, H2-antagonists, and sucralfate have demonstrated comparable effectiveness in preventing bleeding and the associated life-threatening sequelae. The choice of the ideal agent depends on individual patient factors, concomitant disease states and drug therapy, administration requirements, nursing availability, potential adverse effects, and expense.

Antacids↗

PubMed1991

Glucocorticoids in clinical practice.

The many unique features of glucocorticoids makes therapy with these steroids challenging. The anti-inflammatory potency, relative mineralocorticoid activity, plasma half-life, and route of administration of the synthetic cortisol preparations are compared. Because they produce profound anti-inflammatory and immunosuppressive effects, exogenously administered glucocorticoids are effective therapy for a variety of diseases and conditions. The appropriate dosing regimen is an adequate dose administered for a sufficient period to precipitate an acceptable response. It is impossible to predict the regimen that will suppress the hypothalamic-pituitary-adrenocortical (HPA) axis and thereby increase the risk of developing adrenal insufficiency during periods of stress. Until recovery of the axis is complete, patients require daily physiologic replacement doses; high-dose supplemental therapy may be required during a major illness or surgery. Once there are signs of improvement, the dosing regimen should be adjusted to a single morning dose, then to an alternate-day regimen, and, as soon as possible, the steroid should be discontinued. This tapering process maintains disease suppression while minimizing toxicity; however, it is often complicated by exacerbation of the disease and withdrawal symptoms. Potential complications associated with glucocorticoid therapy are numerous, involve all organ systems, and are potentially more devastating than the HPA axis suppression.

Contraindications↗

PubMed1990

Parenteral iron dextran therapy.

Parenteral iron therapy is indicated in patients with iron-deficiency anemia associated with conditions that interfere with the ingestion or absorption of oral iron. Replacement doses of iron required to replenish iron stores are based on body weight and the observed hemoglobin value. Methods of administering iron dextran are reviewed, including intramuscular and intravenous injections of the undiluted drug, intravenous infusion of a diluted preparation, and as an addition to parenteral nutrition solutions. The overall incidence of adverse reactions associated with the parenteral administration of iron is low, but the potential for an anaphylactic reaction requires that an initial test dose be given followed by careful patient observation.

Humans↗