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Biomedical subjects

J C Bradberry

Publications and source records attributed to J C Bradberry.

12 recordsLinked to original sources
PubMed1998

Pharmacist compensation for ambulatory patient care services.

UNLABELLED: This activity is designed for pharmacists practicing in ambulatory, community, and managed care environments. GOAL: To discuss issues involved in the transition from product-based to patient-care-based reimbursement and compensation systems for pharmacists. OBJECTIVES: 1. Differentiate between reimbursement and compensation. 2. Describe the limitations of current third-party reimbursement and compensation systems. 3. Describe ways in which compensation for seemingly identical products and services can vary. 4. Discuss the use of Medicare's Resource-Based Value Scale and the relative value unit. 5. Define and differentiate between ICD-9-CM codes and E/M CPT codes. 6. List the three key components needed to determine an E/M CPT code for a new patient seen in the pharmacy. 7. Describe and provide examples of the SOAP method of documentation. 8. Understand why the referral process is an important step in the compensation process. 9. Discuss the importance of Form HCFA-1500 and other documentation in the compensation process.

Abstracting and Indexing↗
PubMed1990

Recovery of phenytoin suspension after in vitro administration through percutaneous endoscopic gastrostomy Pezzer catheters.

Various methods of administering phenytoin suspension through a percutaneous endoscopic gastrostomy (PEG) Pezzer catheter were evaluated in vitro to determine which method resulted in the most complete recovery of phenytoin. To determine the effect of temperature on phenytoin recovery, 12 mL of phenytoin suspension (Dilantin-125, 125 mg/5 mL) was administered through three separate 35.5-cm 20 French latex PEG Pezzer catheters under each of three temperature conditions (suspension 11.8 degrees C and catheter 22 degrees C, suspension and catheter 22 degrees C, and suspension 22 degrees C and catheter 37 degrees C). To determine the effect of the administration method, 12-mL aliquots of phenytoin suspension were injected into the catheter by seven methods that varied with respect to catheter temperature, dilution of suspension, and irrigation of catheter. Each method was tested in triplicate, and samples were assayed by high-performance liquid chromatography. Varying the temperature of the catheter or suspension had little effect on the recovery of phenytoin. There was no appreciable loss of phenytoin when the suspension was undiluted, regardless of whether the catheter was irrigated. The greatest losses were seen when the suspension was diluted before administration. Irrigation also caused a decrease in recovery, but to a lesser extent than dilution. Until the effects of administering multiple doses of phenytoin through PEG Pezzer catheters are investigated, phenytoin suspension should not be diluted before administration because of decreased recovery and increased administration time.

Catheterization↗
PubMed1986

Blood pentobarbital concentrations during thiopental therapy.

The desulfuration of thiopental to pentobarbital has previously been shown to be a relatively minor pathway of thiopental metabolism. In two cases, we observed significant conversion, resulting in blood pentobarbital concentrations up to 50 percent of total blood barbiturate (thiopental and pentobarbital) concentrations. Both patients received continuous infusions of thiopental and had present a condition (hypothermia) or drug (cimetidine) known to inhibit hepatic microsomal enzyme activity. It is suggested that inhibition of hepatic microsomal enzyme activity may prevent thiopental's metabolism to its major metabolite, a carboxylic acid analogue, and increase the amount of thiopental desulfurated to pentobarbital. Inhibition of hepatic microsomal metabolism also decreases the metabolism of pentobarbital. Until further elucidation of the causes of altered thiopental metabolism is available to identify patients more likely to have elevated concentrations of pentobarbital, monitoring of blood drug concentrations in patients receiving thiopental should include determination of both thiopental and pentobarbital concentrations.

Adult↗
PubMed1983

The effects of exchange transfusion on the pharmacokinetics of phenobarbital.

A 26-month-old child was admitted to the pediatric intensive care unit for treatment of apparent fulminant hepatitis. While hospitalized, he underwent eight exchange transfusions to decrease ammonia concentrations. The patient received intravenous phenobarbital (Pb) for the treatment of cerebral edema. To determine the effects of exchange transfusion on Pb clearance, serum Pb concentrations were obtained before, after, and between exchanges. Preexchange and postexchange serum Pb concentrations were obtained on three separate exchanges. Pb concentrations also were examined between two exchange transfusions. The amount of Pb actually removed during one exchange transfusion was determined by analyzing serum obtained from the discarded blood resulting from the procedure. All Pb concentrations were analyzed by the Emit system. Results indicate that Pb was cleared at a mean rate of 433 ml/h during the exchange periods examined, with a mean overall elimination constant of 0.20 h-1. The Pb actually removed by the exchange transfusion on day 10 of hospitalization was determined to be 17 mg, while the calculated amount was 8 mg. A mean of 22.3 mg of Pb was calculated to be removed over an average exchange time of 2.2 hours. Pb clearance during exchange transfusion has not been reported previously. This case has shown that small amounts of Pb can be removed by exchange transfusion; therefore, patients undergoing this procedure may require serum monitoring after exchange.

Brain Edema↗
PubMed1981

Continuous infusion of naloxone in the treatment of narcotic overdose.

Based on the pharmacokinetic parameters of naloxone and the clinical studies discussed in this paper, it is evident that naloxone infusion may be useful in cases of opiate overdose. The infusion protocol presented in Appendix I was formulated based on the pharmacokinetic data available from the literature including Nelson's animal data. An infusion of naloxone was used with apparent success in the two cases presented. Both patients presented with narcotic overdose; although immediate patient history could not be obtained, the presentations were classic for narcotic overdose. It is of note that it may be possible to keep a patient from relapsing into narcosis after overdose by the use of naloxone infusion. Additionally, the extreme safety of naloxone is certainly an advantage with any administration technique. We feel that the administration of continuous infusion of naloxone is an especially important advance in the overdose treatment of longer-acting agents such as methadone, as well as of other narcotics. Therefore, it is recommended that further clinical trials of naloxone by infusion be undertaken, as suggested by J. Nelson, et al. (A protocol for treatment with continuous infusion of naloxone [Narcan] in selected cases of opiate [narcotic] overdose. Austin: University of Texas; May, 1976, unpublished), to further document the effectiveness of an infusion of naloxone in narcotic overdose.

Adult↗
PubMed1975

Acute psychotic reaction to procaine penicillin.

A case of a 23-year old black female admitted for treatment of an acute psychotic episode 48 hours after being treated with i.m. procaine penicillin G is reported. Literature reports of nonallergic psychotic responses to i.m. injections of aqueous procaine penicillin G are reviewed. Possible mechanisms for the reaction are discussed. Recommended drugs for treatment of the reaction include phenobarbital and chlorpromazine.

Adult↗
PubMedDate not supplied

Effect of pH on the equilibrium dialysis of phenytoin suspension with and without enteral feeding formula.

Significant decreases have been reported in phenytoin absorption when the suspension is combined with continuous enteral feedings. Several theories for this interaction have been proposed including binding of phenytoin to the protein constituents of the enteral formula, phenytoin binding to the calcium in the enteral formula, and inadequate dissolution of the suspension when delivered with the enteral formula due to the high pKa of phenytoin and the acidic nature of the enteral formula. We therefore evaluated the effects of pH levels 2.0, 3.5, 6.0, and 8.0 on the interaction of phenytoin suspension with enteral formula (Osmolite) with equilibrium dialysis using a Spectra/Por 1 (MWCO 6000-8000) molecularporous dialysis membrane. Phenytoin concentrations in the dialysis membrane (internal phase) mimicked the expected stomach concentrations of a 100-mg dose administered in an adult stomach containing 200 ml of gastric fluid. External phase buffers were sampled at 0.5, 1.0, 2.0, 4.0, 8.0, 12.0, and 24.0 hr after the start of the dialysis. The phenytoin concentrations in the external phase were compared between buffer alone or buffer combined with enteral formula at the same pH and time intervals. With pH 2.0 and 3.5 the enteral formula formed an aggregate with suspension whereas no aggregate was formed with pH 6.0 and 8.0. The phenytoin concentrations with pH 2.0 were 26% to 44% lower and with pH 3.5 were 11.5 to 27% lower when phenytoin suspension was combined with enteral solution. However, at 24 hr there was no difference between the two conditions with both pH 2.0 and 3.5.(ABSTRACT TRUNCATED AT 250 WORDS)

Dialysis↗