PubMed Health⌕ Search

Biomedical subjects

R L Cramer

Publications and source records attributed to R L Cramer.

At least 19 recordsLinked to original sources
PubMed1994

Agranulocytosis associated with etodolac.

OBJECTIVE: To report a case of probable etodolac-induced agranulocytosis. CASE SUMMARY: A 72-year-old woman who had been taking etodolac 300 mg bid for approximately six weeks presented to the emergency department with symptoms of urosepsis. She was found to be profoundly granulocytopenic. Etodolac was discontinued and broad-spectrum intravenous antibiotic therapy was administered for the next 17 days. Results of bone marrow biopsy revealed marked hypocellularity consistent with drug-induced agranulocytosis. Following etodolac withdrawal, the total white blood cell count reached a low value of 0.9 x 10(9)/L and then returned to a pre-etodolac baseline after 15 days. Her hemoglobin concentration also decreased significantly during hospitalization. DISCUSSION: Agranulocytosis has rarely been reported in association with nonsteroidal antiinflammatory drugs (NSAIDs), and there are no literature reports associating etodolac with agranulocytosis. This case involving etodolac is consistent with the pattern described with other NSAIDs. Factors correlating etodolac as the causative agent are identified. Details of patient history, treatment, follow-up, and assessment are discussed. CONCLUSIONS: Detailed case assessment demonstrated probable etodolac-induced agranulocytosis in our patient. Clinicians should be aware that etodolac, like other NSAIDs, has potential to cause agranulocytosis.

Aged↗
PubMed1990

Prospective surveillance of intravenous amphotericin B use patterns.

Information on amphotericin B use patterns and infusion-related adverse events were prospectively collected from 397 hospitalized adults. The methods of initiating amphotericin B varied greatly, with the majority of patients being gradually titrated to a full maintenance dose over 1-5 days. Overall, 71% of patients experienced at least one episode of an infusion-related adverse event (IRAE) during the first week of therapy. Fever and chills were most commonly observed, with peak frequency on days 1-3, followed by a subsequent decline. A wide variety of pretreatment medications were used to minimize IRAE; the most common regimens included some combination of diphenhydramine, acetaminophen, and corticosteroids, with or without heparin. The majority of patients (84.7%) received a test dose, and although none experienced a severe allergic reaction, one patient subsequently had an anaphylactic episode on the third day of amphotericin B therapy. The use of a test dose and the titration process are attempts to avoid the IRAE frequency associated with large initial doses of amphotericin B, but we observed that they provided little or no benefit. In addition, our study suggests that pretreatment regimens are frequently used in conjunction with the test dose. If the intent of the test dose is to identify patients sensitive to amphotericin B, pretreatment drugs may minimize these adverse events and prevent a complete evaluation of response to the test dose.

Acetaminophen↗
PubMed1986

Drug information residency rotation with pharmaceutical industry.

A drug information rotation in pharmaceutical industry may be elected as a component of a hospital pharmacy residency program. Program objectives include improving communication between the pharmaceutical industry and hospital pharmacy/academia, exposing the resident to the challenges the pharmaceutical industry encounters, improving proficiency in drug information practice, and providing insight into the working relationships of various departments within the company. During the rotation, the resident serves as a member of the Drug Information Service. Resident activities include participating in interviews with corporate professionals, updating pharmacokinetic profiles, responding to drug information requests and participating in other information projects. This rotation enables the resident to better understand pharmaceutical industry's concerns and relate these concerns to clinical pharmacy practice.

Drug Industry↗