Biomedical subjects
Publications and source records attributed to J Santora.
The paper is submitted as one of the recommendations for diagnostic and therapeutic care in nuclear medicine meant in particular for the clinical need of physicians indication treatment of thyroid carcinoma with iodide. The author presents a brief review of principles, indications, the procedure proper, clinical interpretation and possible risks and contraindications, incl. the clinical and socioeconomic impact.
The paper is presented as one of recommendations of diagnostic and therapeutic care in the field of nuclear medicine intended especially for the clinical needs of physicians indicating palliative treatment of metastases into bones using radiopharmaceuticals. It provides a brief review of principles, indications, the very performance of interventions, clinical interpretations, possible risks and contraindications including the clinical and social-economic meaning.
Granulocytopenia is a complication of human immunodeficiency virus disease, as well as a toxic manifestation of zidovudine therapy. To evaluate pharmacokinetic and pharmacodynamic relationships, 11 AIDS-AIDS-related complex patients who had developed zidovudine-associated granulocytopenia (mean absolute neutrophil count, 1,077/mm3) were examined after addition of granulocyte-macrophage colony-stimulating factor (GM-CSF) to zidovudine. GM-CSF was administered as a daily (1.0 or 0.3 micrograms/kg) or every-other-day (0.3 micrograms/kg) subcutaneous dose over a 28-day period. Zidovudine was continued at the same daily dosage as was previously being administered. Of 11 patients, 7 (1.0 micrograms/kg, n = 5; 0.3 micrograms/kg, n = 2) had a pharmacologic response to GM-CSF with an increase to a mean absolute neutrophil count of 3,189 cells per mm3 at 4 weeks (P < 0.05). The peak concentration of GM-CSF in plasma ranged from 11.5 to 84.4 pg/ml, and the time to peak ranged from 1 to 3 h. No correlation between GM-CSF disposition and hematologic response was noted. A decreased plasma zidovudine-glucuronide/zidovudine ratio was noted after 1 week of GM-CSF, and an increase in the area under the plasma concentration-versus-time curve for zidovudine was found in three patients after 4 weeks. Low doses of GM-CSF can raise the granulocyte count in patients with zidovudine-induced neutropenia. The use of GM-CSF and zidovudine may represent a viable treatment option for persons with human immunodeficiency virus infection who develop neutropenia while receiving zidovudine but do not tolerate alternative nucleoside analogs. Further studies are needed to assess the complex interaction between these two agents.
A staff pharmacist intervention program designed to modify inappropriate dosage intervals for i.v. ranitidine and promote timely conversion to oral therapy is described. Records of patients who were receiving i.v. ranitidine were reviewed for eight weeks to determine whether the dosage interval was appropriate and whether they began receiving oral ranitidine within 24 hours of an order for an oral diet or other oral medications. Pharmacists were then asked to determine the proper i.v. ranitidine dosage interval based on creatinine clearance and the oral dosage that would be appropriate when i.v. therapy was no longer indicated. The information was used to complete an intervention form that was placed in the patient's chart. During the baseline phase the i.v. dosage interval was inappropriate for 49 of 139 patients; 617 i.v. doses costing $4214 were administered to 62 patients for whom oral therapy was indicated; conversion to oral therapy occurred appropriately for 39 of 68 patients (57%). In the intervention phase 138 patients received i.v. ranitidine. Pharmacists made 51 recommendations for adjusting the i.v. dosage interval, and 18 were implemented within 24 hours. All six recommendations to convert immediately to oral therapy were also implemented within 24 hours. A total of 280 inappropriate i.v. doses costing $1912 were given to 30 patients for whom oral therapy was indicated. Conversion to oral therapy occurred appropriately for 53 of 76 patients (70%). A simple program of monitoring and intervention by staff pharmacists when i.v. ranitidine therapy is begun can save money and promote the appropriate use of this drug.
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