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Biomedical subjects

M A Munger

Publications and source records attributed to M A Munger.

At least 37 records · Page 2Linked to original sources
PubMed1992

Report of nitropatch explosions complicating defibrillation.

Reports of complications associated with the use of electrical defibrillators have been relatively rare. In two patients, defibrillation performed over a nitroglycerin skin patch resulted in electrical arcing with a resultant flash of light and thermal injuries. Skin burns as a complication of defibrillation over nitropatches has not been previously reported. Such burn injuries respond to standard therapeutic measures. Healthcare professionals who may perform defibrillation should be aware of this potential complication.

Administration, Cutaneous↗
PubMed1991

Drug-induced supraventricular tachycardia: a case report of fluoxetine.

We report the occurrence of supraventricular tachycardia and hypotension in a 54-year-old woman after maintenance therapy with fluoxetine. Although cases of tachycardia and palpitations have been reported, supraventricular tachycardia and hypotension have not been directly attributed to fluoxetine.

Electrocardiography↗
PubMed1991

Medical versus pharmaceutical continuing education: are both appropriate for the pharmacist?

Continuing education (CE) courses in pharmacy and medicine often overlap with regard to their informational content. At the present time, however, it is feasible that two pharmacists could attend the same national meeting that has continuing medical education (CME) approval status and only one of them would receive CE credit from his state board of pharmacy. Therefore, a survey of 51 state board of pharmacy policies regarding acceptance of CME was conducted. Forty-five of the 51 boards of pharmacy require CE for relicensure. Twenty percent of state boards requiring CE accept CME credit without review, 24 percent do not accept CME credit, and the remaining 56 percent review submitted requests for CME credit. A general lack of uniformity exists among state boards regarding policies pertaining to CE credit. If CME credit was universally accepted, pharmacists would benefit from the increased availability of CE, the building of collegial relationships with other healthcare professionals, and the cost savings of combining courses that mutually benefit both pharmacists and physicians.

Accreditation↗
PubMed1990

Assessment of hemodynamic tolerance from a 24-hour intravenous infusion of fenoldopam mesylate in congestive heart failure.

To determine the maintenance of pharmacodynamic effects of fenoldopam mesylate, a dopamine-1 agonist, the invasive hemodynamic profiles of 33 patients with New York Heart Association functional class III to IV congestive heart failure were examined. Fenoldopam mesylate was initiated at 0.1 micrograms/kg/min and titrated to a cardiac index greater than or equal to 25% above baseline. Upon achievement of optimal hemodynamics, maintenance infusion was begun (mean dose 0.6 micrograms/kg/min). Fenoldopam mesylate (baseline vs maximal effect) decreased systemic vascular resistance by 37% (p less than 0.001), left ventricular filling pressure by 16% (p less than 0.05) and mean arterial pressure by 11% (p less than 0.05), with an associated augmentation in cardiac index and stroke volume index by 27% (p less than 0.001). Attenuation of hemodynamic effect (maximal effect vs time) was noted in cardiac index (14% p less than 0.001), systemic vascular resistance (13% p less than 0.05) and stroke volume index (13% p less than 0.05). None of the parameters exhibited complete attenuation to baseline values. Fenoldopam mesylate improves cardiac output and lowers systemic vascular resistance with relative attenuation of pharmacodynamic effect during a 24-hour intravenous infusion.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1990

Assessment of intravenous fenoldopam mesylate in the management of severe systemic hypertension.

To evaluate the acute BP response to iv fenoldopam mesylate (FNP), 14 patients with severe hypertension (diastolic BP 120 to 170 mm Hg) were studied in an open-label trial. Initial infusion rate of FNP was 0.1 microgram/kg.min. Titration to diastolic BP goal (95 to 110 mm Hg) was followed by a constant infusion phase (greater than or equal to 6 h), a detitration phase (2 h), and a postinfusion phase. FNP reduced BP by 27/29 mm Hg (p less than .001) with no significant effect on heart rate. Maintenance of the BP effect was noted through the 6 h of constant rate infusion. Mild, transient vasodilating-associated adverse effects were noted with FNP. We conclude that FNP is an effective, well-tolerated iv antihypertensive agent for acute BP reduction in a severely hypertensive population.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1990

Single-dose effects of ibopamine hydrochloride on renal function in patients with congestive heart failure.

To examine the renal effects of ibopamine HCl we evaluated 15 patients with New York Heart Association Class II-III congestive heart failure and mild renal insufficiency (creatinine clearance [CLcr] = 45-85 ml min-1). Diuretics and vasodilators were withheld and a sodium (Na+)-restricted diet was initiated. All patients exhibited positive Na+ balance at the time of evaluation. Hourly urine volumes, urine chemistries, serum chemistries, PAH and inulin/iothalamate clearances were determined 2 h pre and 4 h post a single 200 mg oral dose of ibopamine. Effective renal plasma flow, creatinine clearance, filtration fraction, and the fractional excretion of sodium and potassium were not significantly altered postdose. A significant increase in urine output and decrease in urine osmolality were seen at all time points postdose. A significant reduction in serum potassium (2 and 3 h) and blood urea nitrogen (1, 3 and 4 h) concentrations occurred. Measurements of glomerular filtration rate by inulin or [125I]-iothalamate produced differing results in the patient groups studied. We conclude that a single dose of ibopamine does not produce significant improvements in renal function in patients with congestive heart failure, mild renal insufficiency and positive sodium balance.

Acute Kidney Injury↗
PubMed1990

Hyperventilation-induced reduction in cerebral blood flow: assessment by positron emission tomography.

The use of positron emission tomography (PET) has been well documented as a relatively noninvasive method of measuring cerebral blood flow (CBF), both globally and regionally. The utility of readily detecting alterations in CBF is apparent, particularly when applied to the evaluation of therapeutic interventions thought to influence CBF. We report the effects of hypocapnia, an experimental condition of known cerebral vasoconstriction, in ten normal volunteers. Subjects had brain blood flow evaluated utilizing H215O as the positron emitter before and after approximately five minutes of hyperventilation. Baseline CBF was measured as a mean +/- SD of 61.2 +/- 16.3 mL/min/100 g of tissue. Mean baseline arterial blood gas values were PaO2 107.4 +/- 14 mm Hg, PaCO2 37.7 +/- 0.89 mm Hg, and pH 7.39 (calculated from mean [H+]). Post hyperventilation, global CBF was measured as 31.1 +/- 10.8 mL/min/100 g. Mean arterial blood gas values were PaO2 141.7 +/- 21 mm Hg, PaCO2 19.7 +/- 5 mm Hg, and pH 7.63 (calculated from mean [H+]). CBF decreased by a mean of 49.5 +/- 11 percent. Data analysis using the Student's t-test showed a significant change over baseline in PaCO2 (p less than 0.001) and CBF (p less than 0.001), in the hyperventilated state. Correlations were noted between the decrease in CBF and change in PaCO2 (r = 0.81) as well as between hyperventilation PaCO2 and the change in CBF (r = 0.97). We conclude that, as measured by PET, CBF decreases significantly during a state of artificial hyperventilation to a degree consistent with results seen using other methods. PET appears to be a valuable tool in the assessment of interventions that could influence CBF.

Cerebrovascular Circulation↗
PubMed1990

Anistreplase: a new thrombolytic for the treatment of acute myocardial infarction.

The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of anistreplase in the treatment of acute myocardial infarction (AMI) are reviewed. Anistreplase is an acylated form of the streptokinase-plasminogen complex. Acylation makes the complex temporarily inactive but protects it from neutralization by plasmin inhibitors. After deacylation, which begins immediately after injection, the streptokinase-plasminogen complex promotes thrombolysis by speeding the conversion of plasminogen to plasmin. Like other thrombolytic agents, anistreplase induces a systemic fibrinogenolytic state. The plasma half-life of anistreplase, 88-112 minutes, is longer than that of the other thrombolytic drugs marketed in the United States. Anistreplase lyses coronary artery thrombi when given by the intracoronary or i.v. route. I.V. anistreplase is comparable in efficacy to i.v. streptokinase but has not been directly compared with i.v. alteplase. Anistreplase therapy in patients with AMI may help preserve left ventricular function and prolong survival. Anistreplase is comparable in safety to other thrombolytic drugs. Although bleeding has occurred in 4-47% of patients treated with anistreplase, most episodes have been clinically unimportant and have occurred at a vascular puncture site; intracranial hemorrhage has occurred in less than 1% of patients. Cardiac arrhythmia and transient hypotension are common after anistreplase administration. Anistreplase is easy to administer and may be appropriate for use in patients with suspected AMI before hospital admission. The recommended dose is 30 units i.v. given over two to five minutes. Anistreplase is similar in efficacy and safety to other thrombolytic agents in the treatment of AMI. The drug's ease of administration may be an important clinical consideration.

Acute Disease↗
PubMed1989

On the fringes.

The expanded training pharmacists now receive in human pharmacotherapy has led to their increased participation in direct patient care. These activities may be global or specific, and can include drug therapy consultation, pharmacokinetic-based dosing recommendations, drug-use review, participation in nutritional support, and clinical pharmacology research. Such a listing of relatively sophisticated roles makes today's pharmacy practitioners almost unidentifiable with their counterparts of 20 years ago. This rapid transition makes pharmacy somewhat different in the health professions, since in comparison, medicine and nursing have been more stable. Despite these hard-fought advancements, there is a disturbing discrepancy between standards of care in pharmacy and the legal definition of pharmacy practice. Continued and future advancements are tenuous secondary to fear generated from noncompliance with state regulations. The entire profession should strive to develop updated pharmacy acts to prevent individuals from practicing "on the fringes."

Interprofessional Relations↗
PubMed1989

Elucidation of the nifedipine-quinidine interaction.

Four case reports have been published that document a clinically significant drug interaction between nifedipine and quinidine in patients with left ventricular dysfunction. To define the population at risk and the mechanisms involved in manifestations of this interaction, 12 patients currently treated with quinidine for either ventricular or supraventricular arrhythmias were stratified into two groups based on left ventricular ejection fraction (EF) measurements (group A greater than 35%; group B less than 35%). The interaction was conducted through two phases: oral quinidine (Q) and oral quinidine plus nifedipine (N + Q). Pharmacokinetic modeling of total body clearance (CL) and AUC were assessed for each phase. One patient (group A, 70% EF) exhibited the interaction with a 41% decrease in steady-state serum quinidine concentrations. The patient's AUC and CL were 48.2 micrograms/ml.hr (Q) versus 28.6 micrograms/ml.hr (N + Q) and 94.4 ml/min (Q) versus 159.1 ml/min (N + Q), respectively. There was no difference in AUC or CL between the Q and N + Q phases or between groups A and B for the entire population. The N + Q interaction is not hemodynamically mediated. Clinical consideration of the possibility of this low-frequency interaction should be noted.

Adult↗
PubMed1988

Amoxapine cardiotoxicity.

Prolongation of the QRS interval, cardiopulmonary arrest, and death in a 31-year-old woman following an overdose of 2 g amoxapine, a tricyclic antidepressant, is reported. The patient's QRS interval prolonged to beyond 100 ms throughout hospitalization. Thirty-three hours after admission she suffered a bradycardiac-hypotensive event, followed by electromechanical dissociation and subsequent death. Cardiotoxicity has not been directly related to amoxapine; a 2-g acute ingestion is the lowest reported lethal dose.

Adult↗
PubMed1988

The role of calcium channel blocking agents in the prevention of migraine.

Vascular headache pathophysiology and manifestations are reviewed along with the role that calcium channel blocking agents play in prevention of these vascular headaches. Of the calcium channel blockers presently marketed in the U.S., verapamil has been the most widely studied. Verapamil has been shown to produce a significant improvement in frequency and duration of migraine as compared with placebo. Calcium channel blocking agents that have been studied and used outside of the U.S. are flunarizine and nimodipine, both of which provide significant improvement in measures of migraine severity, duration, frequency, and other pain and severity indices. There have been no controlled trials comparing these agents with each other as with beta-blocking agents and other prophylactic agents presently marketed in the U.S. Calcium channel blocking agents may become the drugs of first choice in migraine prophylaxis due to their effectiveness and mild side effect profile.

Calcium Channel Blockers↗
PubMed1988

Professional liability for pharmacists: a focus on pharmacy practice acts.

The increased complexity of pharmacotherapeutics and the expanded role of pharmacists in the drug-use process may bring about an increased liability exposure for failure to conform to a professional standard of care. Therefore, a survey of 51 state pharmacy practice acts was conducted: (1) to establish a nationwide statutory definition of pharmacy practice, and (2) to outline possible use of the statutes in civil and administrative law. Twenty percent of state statutes contain no definition of pharmacy practice. Of the remaining 41 states, dispensing (97.5 percent), compounding (92.5 percent), interpretation and evaluation of prescriptions (68.2 percent), and consultation (73 percent) are legally defined. Pharmacokinetic consultation, drug administration, pharmacist prescribing, and pharmaceutical research are defined in one, seven, four, and one state(s), respectively. Pharmacists may face legal responsibilities from both the courts and state boards of medical and pharmacy practice. Aggressively updating the statutes and regulations to reflect contemporary pharmacy practice may provide a mechanism for a defense in court litigation and regulatory action.

Licensure, Pharmacy↗
PubMed1988

Effect of clinical pharmacy services on appropriateness of serum digoxin concentration monitoring.

The effects of four levels of clinical pharmacy services on increasing the appropriate ordering of serum digoxin concentration (SDC) determinations for cardiothoracic surgery patients were studied. During four equivalent four-month periods from 1983 to 1986, the pharmacist on the cardiothoracic surgery service provided four different levels of clinical services: no services (Period 1), participation in ward rounds only (Period 2), participation in ward rounds supplemented by the regular provision of inservice education programs (Period 3), and participation in ward rounds only (Period 4). Explicit criteria for the appropriate monitoring of digoxin therapy were developed from published criteria and an extensive literature review; all SDC determinations that did not meet one of these criteria were deemed inappropriate. All adult patients who received digoxin therapy were included in the study; data collected for each patient included the time and amount of the daily digoxin dose and the route of administration, the time at which blood was drawn for each SDC determination, and the assay results. Data were collected through a retrospective chart review for Period 1 and concurrently thereafter. The number of appropriate SDC determinations in Period 1 were compared with the total number of appropriate SDC determinations in Periods 2, 3, and 4; Periods 2 and 4 were compared with Period 3; and Period 2 was compared with Period 4. The costs avoided as the result of decreased numbers of SDC determinations ordered were calculated as the differences between the cost of inappropriate SDC determinations in Period 1 and the costs in Periods 2, 3, and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗