Biomedical subjects

P W Ament

Publications and source records attributed to P W Ament.

6 recordsLinked to original sources

PubMed2000

Clinically significant drug interactions.

A large number of drugs are introduced every year, and new interactions between medications are increasingly reported. Consequently, it is no longer practical for physicians to rely on memory alone to avoid potential drug interactions. Multiple drug regimens carry the risk of adverse interactions. Precipitant drugs modify the object drug's absorption, distribution, metabolism, excretion or actual clinical effect. Nonsteroidal anti-inflammatory drugs, antibiotics and, in particular, rifampin are common precipitant drugs prescribed in primary care practice. Drugs with a narrow therapeutic range or low therapeutic index are more likely to be the objects for serious drug interactions. Object drugs in common use include warfarin, fluoroquinolones, antiepileptic drugs, oral contraceptives, cisapride and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Many other drugs, act as precipitants or objects, and a number of drugs act as both. Regularly updated manuals of drug interactions and CD-ROM-formatted programs are useful office references.

Drug Antagonism↗

PubMed1997

Prophylaxis and treatment of NSAID-induced gastropathy.

Because the gastrointestinal complications of nonsteroidal anti-inflammatory drug (NSAID) use may be responsible for over 10,000 deaths each year, clinicians should consider limiting use of these agents. Risk factors such as previous ulcer disease, high dosage, concomitant corticosteroid use, age greater than 60 years and use of more than one NSAID concomitantly should be reviewed. If a patient has two or more risk factors, prophylaxis with misoprostol is indicated. In low-risk patients, prophylaxis with misoprostol is not indicated because of the risk of gastrointestinal side effects and high cost. Although it is common clinical practice to treat NSAID-induced dyspepsia with prophylactic antiulcer therapy, clinical studies do not support this approach. If an ulcer develops during NSAID therapy, treatment with a histamine H2 antagonist should be started. Discontinuation of the NSAID is recommended but is not necessary for ulcer healing. It is recommended that, once the ulcer heals, the patient also take misoprostol if NSAID usage is continued.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1997

Drug interactions with the nonsedating antihistamines.

The nonsedating antihistamines are frequently prescribed agents. Well-documented drug-drug interactions with two of these agents, terfenadine and astemizole, may result in serious adverse effects, including death, when they are prescribed along with macrolide antibiotics and/or the antifungal agents itraconazole or ketoconazole. Fexofenadine and loratadine appear to be the least likely nonsedating antihistamines to interact with other medications and to result in a life-threatening interaction. This article reviews the known drug-drug interactions involving nonsedating antihistamines and provides a basis from which the clinician can predict potential interactions.

Cytochrome P-450 Enzyme System↗

PubMed1994

Famotidine-induced mixed hepatocellular jaundice.

OBJECTIVE: To report a case of probable famotidine-induced mixed hepatocellular jaundice. CASE SUMMARY: A 55-year-old man presented with a one-month history of mid-epigastric pain. Initial physical examination and laboratory studies, including liver enzyme concentration tests, were unrevealing. A diagnosis of gastritis was made and ranitidine was prescribed. Following one week of therapy, the patient's symptoms had not improved and therapy was changed to famotidine and sucralfate. Approximately one week later the patient presented with jaundice. Liver enzyme concentrations were elevated and the patient was hospitalized for further evaluation. Five days following discontinuation of famotidine, liver enzyme concentrations were normal and jaundice had resolved. Further tests did not reveal any pathologic etiology. DISCUSSION: Hepatic changes have occurred in patients receiving histamine2-antagonists; ranitidine and cimetidine have been cited most frequently. In general, the elevations are mild, transient, and return to baseline with continued therapy. This is one of the first case reports of probable famotidine-induced mixed hepatocellular jaundice. CONCLUSIONS: There was a temporal relationship between the patient's signs and symptoms and initiation of famotidine. No identifiable factors contributed to the elevated liver enzyme concentrations and jaundice.

Cholestasis, Intrahepatic↗

PubMed1994

Enoxaparin in the prevention of deep venous thrombosis.

Enoxaparin, a low-molecular-weigth heparin, has recently been approved for use in the prevention of deep venous thrombosis following elective hip replacement surgery. Clinical trials have demonstrated enoxaparin to be superior to placebo, dextran and unfractionated heparin in deep venous thrombosis prophylaxis. However, no published studies have compared the efficacy of enoxaparin with that of warfarin in the prevention of deep venous thrombosis. Advantages of enoxaparin include less frequent dosing, reduced need for laboratory monitoring and a lower incidence of adverse effects, including hemorrhage. Although enoxaparin is more expensive than unfractionated heparin, its potential benefits may offset its higher cost.

Clinical Trials as Topic↗

PubMed1993

Setting up an automatic pharmacist-initiated pharmacokinetic dosing service.

At Latrobe Area Hospital, a 300-bed teaching-community hospital, a unique pharmacokinetic program is in place that permits the pharmacist to initiate and adjust an aminoglycoside or vancomycin regimen and schedule serum drug concentrations and renal function lab tests without contacting a physician for verbal approval. To avoid the perception of pharmacist prescribing, a detailed policy and procedure protocol was written that defined each step conducted in the pharmacokinetic evaluation. Using this approach, the service was readily approved by the medical staff and put into practice. The program has been operational for more than 1 year and has met with high physician and nursing acceptance. Although not specifically studied, the quality of patient care was thought to be improved.

Aminoglycosides↗