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Biomedical subjects

M L Gora

Publications and source records attributed to M L Gora.

13 recordsLinked to original sources
PubMed1994

Meperidine in conjunction with cholescintigraphy to diagnose acute cholecystitis in a patient allergic to morphine.

Cholescintigraphy with morphine augmentation is used routinely to expedite the differential diagnosis of acute from chronic cholecystitis. A patient with hepatic dysfunction and an allergy to morphine received intravenous meperidine in conjunction with cholescintigraphy. The gallbladder was not visualized 30 minutes after administration of the drug. However, the activity accumulated in the initial photon deficient gallbladder at 4 hours after meperidine administration (6.5 hours after radiopharmaceutical administration). These findings may be explained in part by prolongation of meperidine bioavailability because of impairment of hepatic function.

Acute Disease↗
PubMed1993

Sorbitol content of selected oral liquids.

OBJECTIVE: Excipients in pharmaceuticals usually are considered inert, and may be overlooked in the differential diagnosis of diarrhea. Sorbitol-containing medicinal liquids are capable of inducing osmotic diarrhea. We reviewed the oral liquids in our formulary to determine their sorbitol content and to evaluate the availability of this information. DESIGN: The oral liquids stocked by our hospital were determined through a computer search and manual inspection of the pharmacy storeroom. Three common sources of drug information were consulted to determine each product's sorbitol content: manufacturers' product information, American Hospital Formulary Service (AHFS) Drug Information 91, and Facts and Comparisons Drug Information. We then contacted each manufacturer by mail or telephone to verify the information. SETTING: The study was conducted at the University of Cincinnati Hospital, a tertiary-care, teaching hospital. RESULTS: A total of 129 products (98 chemical entities) were reviewed. Fifty-four (42 percent) of the products examined contained sorbitol. The frequency of sorbitol presence by liquid type was: solutions (33 percent), suspensions (43 percent), syrups (59 percent), elixirs (43 percent), concentrates (67 percent), drops (33 percent), tinctures (0 percent), and emulsions (0 percent). The percentage of listings indicating the presence of sorbitol was: manufacturer's product information (79 percent), Facts and Comparisons (52 percent), and AHFS Drug Information 91 (13 percent). Only three of the 54 products had the exact sorbitol content stated in any source.

Administration, Oral↗
PubMed1993

Nicotine transdermal systems.

OBJECTIVE: To review the role of transdermal nicotine as an aid to smoking cessation. DATA SOURCES: A MEDLINE search was performed that included clinical studies published in English involving transdermal nicotine; references used in those articles were screened for additional published information. STUDY SELECTION: Published clinical trials were reviewed with particular emphasis on controlled trials that evaluated safety and efficacy. DATA SYNTHESIS: Transdermal nicotine therapy has been shown to be a safe and effective pharmacologic aid in a smoking cessation program when used in conjunction with a psychologic or behavior support system. Habitrol, Nicoderm, Nicotrol, and PROSTEP differ in some characteristics (i.e., delivery systems, total nicotine content and amount absorbed, rate of delivery, recommended duration of application); however, the clinical implication of these differences has not been determined. CONCLUSIONS: Transdermal nicotine is effective for patients who are motivated to quit smoking and receive concomitant behavior support.

Administration, Cutaneous↗
PubMed1993

Methods used by pharmacy departments to identify drug interactions.

The results of a survey evaluating the methods that pharmacy departments use to manage drug interactions, and their satisfaction with those methods, are reported. A random sample of 300 hospitals with more than 200 beds was selected, and a questionnaire was mailed in January 1991 to the directors of the pharmacy departments of these hospitals. Of the 300 questionnaires mailed, 167 were completed and returned. Thirty-seven percent of the hospitals offered pharmacy services through a central location only, whereas 63% offered such services through a combination of central and decentral locations. The majority of hospitals (83%) detected drug interactions through the knowledge of the pharmacist processing orders. Nearly all central pharmacies had AHFS Drug Information and Facts and Comparisons available for drug interaction information, but these resources were available in only slightly more than half of all decentral pharmacies surveyed. Fifty-four percent of the responding institutions had a computerized drug distribution system with a drug interaction component; 56% of these classified their system as "indispensable" or "helpful," while 44% classified their system as "somewhat helpful but sometimes a hindrance." Sixty-eight percent of all respondents believed that the availability of a drug interaction computer program increased the number of drug interactions identified. Sixty-eight percent of respondents perceived that pharmacists provided proper follow-up. Overall, 66% of respondents were not satisfied with their method for detection and follow-up of interactions. Of those who were satisfied, 79% had a computerized drug interaction program. Respondents who reported departmental audits or quality assessment procedures were also more likely to be satisfied.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Information Services↗
PubMed1991

Stability of dobutamine hydrochloride in peritoneal dialysis solutions.

The stability of dobutamine hydrochloride in peritoneal dialysis solutions at 4, 26, and 37 degrees C was determined. Dobutamine (as the hydrochloride salt) was added to dialysis solutions containing 1.5% or 4.25% dextrose to concentrations of 2.5, 5.0, and 7.5 mg/mL. Samples were stored at 4, 26, and 37 degrees C to mimic refrigerator, room, and body temperature, respectively. At 0, 4, 8, and 24 hours, the samples were analyzed in triplicate by stability-indicating high-performance liquid chromatography to determine the percentage of drug remaining. More than 90% of the drug was retained under all storage conditions in 1.5% dextrose dialysate containing an initial dobutamine hydrochloride concentration of 5.0 or 7.5 micrograms/mL. The mean concentration in the samples containing an initial dobutamine hydrochloride concentration of 2.5 micrograms/mL and stored at room temperature remained greater than 90% of the initial concentration for the first four hours and then decreased to less than 90%. Dobutamine was stable in 4.25% dextrose dialysate regardless of the initial concentration or the storage condition. Dobutamine hydrochloride 5.0 and 7.5 micrograms/mL in 4.25% dextrose dialysis solution was stable under all the test conditions. Dobutamine hydrochloride 2.5 micrograms/mL was stable in 1.5% dextrose dialysate for only four hours at room temperature.

Dialysis Solutions↗
PubMed1989

Considerations of drug therapy in patients receiving enteral nutrition.

Some basic principles to consider in giving medications to patients receiving enteral nutrition include: 1. If the patient is able to take medication by mouth, this is the preferred route. 2. Liquid medications are the preferred dosage form. 3. The use of oral medications that are not meant to be crushed for enteral tube administration should be avoided. 4. For individual doses of most medications, the tube should be flushed with at least 30 ml of water before and after administration of medications. 5. Highly concentrated solutions should be diluted with 60 ml of water. 6. When several medications are to be administered to the same patient, all medications should be delivered separately and the tube flushed with at least 5 ml of water after each dose. 7. Medications should not be added directly to the feeding formulation. 8. Drug-nutrient interactions should be considered. 9. GI side effects are the most common adverse effects that occur with enteral feedings, and treatment depends on the cause.

Dosage Forms↗
PubMedDate not supplied

Pleural effusions: pathophysiology and management.

OBJECTIVE: To review the pathophysiology and management of pleural effusions, including available agents for pleural sclerosis. DATA SOURCES: A MEDLINE search (1966 to present) was performed that included clinical studies in the English language involving the pathophysiology and management of pleural effusions; references used in those articles were screened for additional published information. STUDY SELECTION: All clinical trials were considered for potential inclusion in the review. DATA SYNTHESIS: Pleural effusion is an accumulation of fluid in the pleural space that results when homeostatic forces that control the flow into and out of the area are disrupted. The management of transudative pleural effusions is primarily directed at treatment of the underlying disease. There are several treatment options for pleural effusions, including chemical pleurodesis. Many of the trials that examine the use of talc, bleomycin, and doxycycline have poorly described study designs and end points, with inconsistent evaluation of patients. Each agent is considered to be generally effective and safe, with fever and pain as the most frequently reported adverse effects. The use of talc requires sterilization, and many clinicians use general anesthesia with instillation, which increases the risk associated with the procedure. Bleomycin is generally safe; however, it should not be used in doses exceeding 40 mg/m2. Only uncontrolled trials support the use of doxycycline; however, it provides an effective, safe, and relatively inexpensive alternative. CONCLUSIONS: Pleural effusions are defined as an accumulation of fluid in the pleural space. Treatment is generally palliative. Intrapleural administration of talc, bleomycin, and doxycycline are effective sclerosing agents for treatment of recurrent, symptomatic pleural effusions. Although the most cost-effective agent has not been determined, doxycycline is an inexpensive alternative to bleomycin, and may have fewer adverse effects than talc.

Bleomycin↗