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Biomedical subjects

G C Cupit

Publications and source records attributed to G C Cupit.

14 recordsLinked to original sources
PubMed1988

The effect of pneumococcal vaccine on the disposition of theophylline.

Pneumococcal vaccine is frequently given to chronic obstructive airway disease patients who are maintained on theophylline therapy. Several studies demonstrating the effect of viral and bacterial vaccines on drug metabolism prompted our evaluation of the effect of pneumococcal vaccine on theophylline pharmacokinetics. Six healthy volunteers, acting as their own controls, received 250 mg of theophylline every 8 h for 12 days. Plasma area under the concentration-time curves (AUC) were measured on Days 4, 6, and 12. On Day 5 pneumococcal vaccine (0.5 ml) was given intramuscularly. No significant difference in elimination rate constant, AUC, or apparent oral clearance of theophylline was found at one or seven days after vaccine administration. These results indicate that intramuscular pneumococcal vaccine does not alter the pharmacokinetics of theophylline during chronic oral administration.

Adult↗
PubMed1987

Hepatic drug clearance in children with leukemia: changes in clearance of model substrates during remission-induction therapy.

We administered a "cocktail" of three model substrates for hepatic processes: antipyrine for oxidation, lorazepam for glucuronidation, and indocyanine green for hepatic blood flow, to children with acute lymphocytic leukemia (ALL). The plasma clearance of these substrates was determined before and after remission-induction therapy in 14 children with ALL. We found an improvement in clearance of antipyrine (0.65 to 0.95 ml/min/kg; P less than 0.01) and lorazepam (0.93 to 1.20 ml/min/kg; P less than 0.05) in 12 of 14 patients, with a mean increase of 67% and 52%, respectively, from before to after remission. There was no significant difference in mean indocyanine green clearance from before to after induction (14.8 vs. 14.4 ml/min/kg). There were no significant differences in liver function test results (SGOT, prothrombin time, or serum bilirubin) from before to after induction. Plasma concentrations of albumin, alpha 1-acid glycoprotein, and apolipoprotein A changed by a mean of +11.1%, -38.2%, and +68.6%, respectively, from before to after remission. However, these changes did not account for the changes in total plasma clearance of lorazepam, because lorazepam free fraction did not change and lorazepam free clearance increased by a mean of 83%. Our hypothesis is that eradication of hepatic leukemic infiltration by ALL remission therapy resulted in an improvement in microsomal metabolism of antipyrine and lorazepam.

Adolescent↗
PubMed1987

Disposition of phenytoin in critically ill trauma patients.

Estimates of phenytoin pharmacokinetic variables and protein binding were determined in 10 adult critically ill trauma patients. Each study subject received phenytoin sodium as an intravenous loading dose of 15 mg/kg, followed by an initial intravenous maintenance dose of 6 mg/kg/day. Serial blood samples were obtained throughout the seven-day study period and analyzed for total and unbound serum phenytoin concentrations. The concentration data for each patients were fitted to a one-compartment model with elimination defined by the Michaelis-Menten constant Km and the maximum rate of metabolism (Vmax) and to a one-compartment model with first-order elimination. The Michaelis-Menten model used Bayesian parameter estimation while the linear model used weighted non-linear least-squares regression analysis. Unbound phenytoin fraction ranged from 0.073 to 0.25. Free fraction increased 7% to 108% in 9 of 10 patients (median increase 29%) from day 1 to day 7 of therapy. Variable estimates using the Michaelis-Menten model were as follows: volume of distribution, 0.76 +/- 0.15 L/kg (0.58-1.01 L/kg); Vmax, 568 +/- 197 mg/day (350-937 mg/day); and Km, 4.5 +/- 1.8 mg/L (1.8-6.2 mg/L). These estimates fell within the wide range of values obtained in studies using stable patients or healthy volunteers. The Michaelis-Menten model was significantly less biased and more precise than the linear model. Three of four patients who continued to receive their study maintenance dose had substantially lower measured total serum concentrations of phenytoin than predicted using the study variable estimates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Gastrointestinal decontamination in the management of the poisoned patient.

Ipecac syrup is the agent of choice to promote emesis in awake, alert, and cooperative patients who have ingested poison. Lavage is a reasonable alternative when ipecac fails or emesis is contraindicated. Activated charcoal is effective in minimizing absorption of ingested toxins, and saline cathartics may be useful to hasten the elimination of activated charcoal and possibly of enteric-coated or sustained release medications.

Animals↗
PubMed1982

High-dose pentobarbital pharmacokinetics in hypothermic brain-injured children.

The pharmacokinetics of pentobarbital were examined in 11 children with Reye syndrome, hypoxic encephalopathy, or acute head injury. Nine of these patients were hypothermic (less than 32 degrees C). The total systemic clearance and volume of distribution at steady state of pentobarbital were significantly reduced in these patients when compared to previous data in normothermic adult volunteers following intravenous doses of pentobarbital. Pentobarbital elimination half-life was not significantly different from control values. The diminished systemic clearance of pentobarbital may result from decreases in intrinsic enzyme activity that accompany hypothermia, as well as hepatic dysfunction in patients with Reye syndrome. Less extensive distribution of pentobarbital is likely the result of either differences in body fat composition or hypothermia-induced decreases in regional blood flow. The reduced clearance and distribution of pentobarbital may partially explain the enhanced reduction in cerebral metabolism that occurs on addition of hypothermia to barbiturate therapy in patients with elevated intracranial pressure.

Adolescent↗
PubMed1982

The use of non-prescription analgesics in an older population.

Older patients are frequent users of aspirin and acetaminophen, either recommended by physicians or self-prescribed, for the aches and pains that accompany aging. These mild analgesics provide effective pain relief when used appropriately. Aspirin and acetaminophen are equianalgesic on a milligram-for-milligram basis for most indications. Both are safe for most patients. Aspirin use may be associated with salicylate intoxication or salicylate interactions with other agents. There have been reports of an association of hepatotoxicity with acute massive overdosages of acetaminophen.

Acetaminophen↗
PubMed1972

Antacids.

Explore the source record for details and available documents.

Antacids↗
PubMedDate not supplied

The overdosage and/or poisoning information gap.

The availability of poisoning information from the pharmaceutical industry was evaluated. Manufacturers of the top 50 drugs were surveyed. Information that was received was classified by established criteria for evaluation. Compendia on poisoning information was evaluated based on 11 components ranging from toxicity information to information available in the PDR. Additional information on emergency telephone numbers for after-hours service was accumulated. The results showed that much of the information available is incomplete and/or outdated. A concerted effort to establish a central source for manufacturers' poison information needs to be begun.

Drug Industry↗
PubMedDate not supplied

The role of the clinical pharmacist in the institutional setting.

The role of the clinical pharmacist in the institutional setting has been expanding at an ever increasing rate. His role as a clinical consultant with the rounding team has become firmly established. This is supplemented with rational product selection utilizing a hospital formulary. Both clinical pharmacokinetics and nutrition are services that benefit the patient directly in his inpatient environment. Toxicology and drug information provided directly to the consumer has also become accepted. Services provided to institution-wide committees allow a comprehensive understanding of the selection, delivery, and follow-up of medication administration to the patient. Many of these services described have become reimbursable by third-party carriers and other appropriate agencies. As other services are reimbursed, the role of the clinical pharmacist will expand beyond the limited scopes discussed in this paper.

Drug Information Services↗
PubMedDate not supplied

Resin hemoperfusion for chloramphenicol intoxication.

A case report of a three kilogram, four month infant who received excessive doses of chloramphenicol for the treatment of bacterial meningitis is presented. The child was treated with resin hemoperfusion (XAD-4) to reduce her serum chloramphenicol concentration. Her treatment was complicated by hypocalcemia and thrombocytopenia. During hemoperfusion a mean clearance of chloramphenicol of 27.4 ml/min was achieved. This represents a significant improvement over normal body clearance (4.7 ml/min/kg) in pediatric patients. We conclude that using hemoperfusion is an effective modality which may be used as an adjunct to supportive therapy when there is a need to increase the body clearance of chloramphenicol.

Chloramphenicol↗