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Biomedical subjects

R L Ruffalo

Publications and source records attributed to R L Ruffalo.

15 recordsLinked to original sources
PubMed1990

Aspiration pneumonitis: risk factors and management of the critically ill patient.

Pulmonary aspiration of gastric contents is a significant source of patient morbidity, mortality, and increased healthcare costs. Prevention by identifying patients at risk for aspiration and initiating prophylaxis is the most effective method of reducing complications associated with aspiration pneumonitis. H2-receptor antagonists are among the best prophylactic agents because of their efficacy in reducing gastric acidity and their convenience of administration.

Antacids↗
PubMed1988

Drug-induced jaundice. An uncommon but puzzling reaction.

Drug-induced jaundice is relatively uncommon but can be a diagnostic puzzle. Because so many pharmaceutical classes and individual agents can produce jaundice, a thorough history of medications taken should be obtained from a patient presenting with jaundice. Jaundice usually resolves when the offending agent is discontinued.

Anti-Infective Agents↗
PubMed1988

Potentiation of the hemodynamic effects of acutely administered nitroglycerin by methionine.

It is believed that nitroglycerin causes vasodilatation by interacting with sulfhydryl groups present in vascular smooth muscle. This study was performed to assess whether methionine, an amino acid capable of increasing sulfhydryl availability, would potentiate the hemodynamic effects of nitroglycerin. Nitroglycerin was initially infused in incremental doses from 1 to 50 micrograms/min in all patients to determine the dose required to reduce mean arterial pressure by 10% and pulmonary capillary wedge pressure by 30%. After a washout period, 10 patients received 5 g methionine i.v. and five patients received an equal volume of 5% dextrose in water (control). Nitroglycerin dose titration was then repeated. Methionine alone induced no hemodynamic effects, but after methionine infusion, there was a significant reduction in the nitroglycerin infusion rate required to reach each hemodynamic endpoint (p less than 0.01). In the control group, there was no significant change in responsiveness to nitroglycerin between infusions. Thus, methionine potentiates the hemodynamic effects of acutely administered intravenous nitroglycerin.

Analysis of Variance↗
PubMed1986

Drug and nutrient interactions.

The pharmacokinetic and pharmacodynamic parameters of many commonly used drugs can be affected by diet. Conversely, nutritional status can be altered by various medications. These interactions become clinically significant when they alter the intended response to a drug or impair the patient's nutritional status.

Absorption↗
PubMed1985

Adverse effects secondary to baclofen withdrawal.

Drug therapy is now the preferred method of treatment for spasticity, and several effective agents have been developed. The safety and efficacy of these drugs has been established in short-term studies. Overall, due to its low incidence of sedation and serious side effects, baclofen appears to be the drug of choice in the treatment of spinal cord-related spasticity. It is, however, not without its side effects due to both its administration and abrupt withdrawal. This case illustrates some significant problems associated with the abrupt withdrawal of long-term baclofen therapy in a patient with multiple sclerosis.

Adult↗
PubMed1985

Patient compliance.

Compliance is a highly individual phenomenon, and the decision to comply is a dynamic process. The physician who wishes to respond to compliance problems must offer behavioral strategies that are tailored to the individual patient and are continuously applied. Compliance behavior is complex and multifactorial. No single compliance-improving strategy is as effective as multiple approaches within the context of a good physician-patient relationship.

Behavior↗
PubMed1985

Retrospective evaluation of a pharmacist-managed warfarin anticoagulation clinic.

The effectiveness of a pharmacist-managed warfarin anticoagulation clinic in maintaining therapeutic prothrombin times and preventing hospitalizations secondary to inadequate control of anticoagulation was evaluated. Patients who had received warfarin sodium for at least one year before being referred to the anticoagulation clinic were studied using retrospective chart reviews. Clinical pharmacists provided patient education, monitored patients for hemorrhagic and thromboembolic complications, and adjusted warfarin sodium dosage to maintain therapeutic prothrombin times. The patients' primary physicians retained responsibility for overall care and were consulted by pharmacists regarding complications of anticoagulation and patient unreliability. The percentage of patients requiring hospitalization (39% versus 4%) and the percentage of prothrombin times outside the therapeutic range (35.8% versus 14.4%) were significantly higher during the preclinic phase (before referral to the clinic) than during the clinic phase. Eight patients were hospitalized for hemorrhagic complications and four for thromboembolism during the preclinic phase; only one hospitalization for hemorrhage occurred during the clinic phase. The warfarin anticoagulation clinic staffed by specially trained pharmacists provided improved therapy compared with treatment received by patients before their referral to the clinic.

Adult↗
PubMed1984

Clinical pharmacists prescribing drug therapy in a geriatric setting: outcome of a trial.

Clinical pharmacists, under the supervision of a family practitioner physician, assumed responsibility for drug management of geriatric patients in a Los Angeles skilled nursing facility. In a quasi-experimental, pretest-post-test control group design, outcome criteria were measured. Compared with the control group which received traditional patient care, the prescribing clinical pharmacists' group had a significantly lower number of deaths (P = 0.05), a significantly higher number of patients being discharged to lower levels of care (P = 0.03), and a significantly lower average number of drugs per patient (P = 0.04). The lower number of patients hospitalized approached significance (P = 0.06) in the prescribing clinical pharmacists' group. The practice of having clinical pharmacists prescribe drug therapy and render general care, under the supervision of a physician, has the potential for saving the health care system approximately $70,000 per year per 100 skilled nursing facility beds.

Aged↗
PubMed1982

Cimetidine and acetylcysteine as antidote for acetaminophen overdose.

The incidence of acetaminophen overdose, often resulting in hepatotoxicity or even death, steadily increases as its use (instead of aspirin) as an antipyretic and analgesic increases. Acetaminophen-induced hepatotoxicity is though to be dependent on the dose ingested and the activity of the cytochrome P450 enzyme system. The actual hepatotoxic mechanism is believed to be the formation of a toxic tissue arylating metabolite(s). Current therapy attempts to inactivate this toxic metabolite(s) with acetylcysteine, as opposed to inhibiting its production. Because cimetidine can inhibit the cytochrome P450 mixed-function oxidase system, we believe it could decrease the production of the hepatotoxic acetaminophen metabolite(s) providing an effective antidote to be used in conjunction with acetylcysteine.

Acetaminophen↗
PubMed1981

Diazepam-cimetidine drug interaction: a clinically significant effect.

Cimetidine has been shown to inhibit the liver microsomal metabolism of the benzodiazepines diazepam and chlordiazepoxide, resulting in an increase in half-life and decrease in the clearance of these two drugs. Patients receiving the combination of diazepam and cimetidine have been noted to be more sedated than when given an equal dose of diazepam alone. Many benzodiazepines undergo N-dealkylation and hydroxylation via the cytochrome P450 oxidase system. Cimetidine is thought to bind to cytochrome P450 oxidase and to interfere with many drugs using this path way. Oxazepam and lorazepam are two benzodiazepines not oxidatively metabolized by cytochrome P450, but are glucuronidated by glucuronyl transferase and are, therefore, not subject to metabolic inhibition by cimetidine. Thus, when clinically indicated, oxazepam and lorazepam may be the benzodiazepines of choice to use in combination with cimetidine to eliminate the clinically significant drug interaction seen with diazepam and chlordiazepoxide.

Anti-Anxiety Agents↗
PubMed1981

Cimetidine-benzodiazepine drug interaction.

The effect of cimetidine on the metabolism of benzodiazepines is discussed. Studies of cimetidine's inhibition of benzodiazepine metabolism by liver microsomal enzyme pathways are described. Cimetidine is known to have this effect on the metabolism of diazepam and chlordiazepoxide, and because chlorazepate and prazepam are similarly metabolized, cimetidine is likely to have the same effect on the metabolism of these drugs. Oxazepam and lorazepam are two benzodiazepines not metabolized by liver microsomal enzymes, but are thought to be glucuronidated in peripheral tissue by glucuronyl transferase. Cimetidine has been shown not to alter the pharmacokinetics of lorazepam or oxazepam when administered concurrently with either of these benzodiazepines. When it is necessary to treat a patients receiving cimetidine with a benzodiazepine, oxazepam or lorazepam may be the drug of choice.

Animals↗