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Biomedical subjects

R Sagraves

Publications and source records attributed to R Sagraves.

At least 19 recordsLinked to original sources
PubMed1997

Prenatal use of medications by women giving birth at a university hospital.

Medication use during pregnancy has changed over time because of various factors: new products have been marketed, concerns have arisen regarding safety and efficacy, public education has increased, and some prescription medications have been granted nonprescription status by the Food and Drug Administration. The purpose of this investigation was to determine overall medication and substance use by prenatal patients whose infants were delivered at our tertiary university hospital. Within 96 hours after delivery, 100 women were evaluated by a personal interview and medical record review. The medications most commonly used during pregnancy were vitamins, analgesics, calcium and iron preparations, and antibiotics. The mean numbers of medications consumed during the second and third trimesters (3.32 +/- 1.87 and 4.13 +/- 2.46) were significantly higher than the mean number taken before pregnancy (2.65 +/- 1.95). Over-the-counter medications accounted for 54% of the total products taken during pregnancy. Percentages of women using caffeine, tobacco, alcohol, and illicit drugs decreased during pregnancy.

Adult↗
PubMed1995

Estrogen therapy for postmenopausal symptoms and prevention of osteoporosis.

Menopausal symptoms are noted as estrogen deficiency affects target tissues during the climacteric and after menopause. With estrogen replacement therapy (ERT), clinical signs, such as vasomotor symptoms and genitourinary atrophy, abate. Estrogen replacement therapy protects against the development of osteoporosis and is used in its treatment. In addition, ERT has a positive effect on serum lipids and appears to be protective against coronary heart disease. More than 75% of all women experience troublesome vasomotor symptoms during the climacteric years, and osteoporosis is a major cause of morbidity and mortality in postmenopausal women. In the United States, the current annual cost of treating patients with osteoporosis is $10 billion dollars. With the aging of the baby boom generation, it is estimated that osteoporosis-associated costs may double in the next 30 years if interventions are not undertaken to reduce the incidence of osteoporosis. It is therefore important for pharmacists and other health care practitioners to educate women about ERT after menopause to reduce the risks of vasomotor symptoms, osteoporosis, and other problems. The incidence, etiology, symptoms, and therapeutic measures used to reduce vasomotor symptoms are discussed, and updates on pathophysiology, risk factors, prevention, and treatment of osteoporosis, with an emphasis on ERT, are reviewed.

Aged↗
PubMed1994

Therapy of acute otitis media. Clinical and economic aspects.

Acute otitis media is a common health problem worldwide that accounts for significant morbidity, primarily among pre-school-age children, for which antimicrobial therapy is currently the treatment of choice. Approximately 25% of all prescriptions written in the US for children under the age of 10 years are for children diagnosed as having acute otitis media. Until adequately designed studies with appropriate patient populations are conducted, clinicians must base their decisions to treat acute otitis media with antimicrobial therapy, and their choice of drug, on local susceptibility patterns (if known), in vitro and in vivo studies, adverse effect profiles, tolerability, and affordability. Such studies will hopefully answer questions about selecting an antimicrobial for acute otitis media and address the comprehensive cost of using various antimicrobials for the condition. Because of the human and economic costs associated with acute otitis media, healthcare practitioners should also be aware of the epidemiology, pathophysiology and various treatment options for children with acute otitis media.

Anti-Bacterial Agents↗
PubMed1993

Update on otitis media. Part 2. Treatment.

Currently the treatment of choice for OM is an oral antimicrobial agent, but selecting a specific agent should include consideration of efficacy, adverse effect profile, compliance, and cost. The use of adjunctive medications like decongestants for specific subtypes of OM has been debated in the literature, but efficacy has not been proven. As knowledge about the pathogenesis of OM is further refined, new treatment modalities for OM will be introduced. Because pharmacists are involved daily with pediatric patients who experience OM, they have an important role in making sure that patients receive appropriate therapy. A patient's profile should be checked for allergies and concurrent medications when a prescription for an antimicrobial agent is presented for a child with OM. The parents should be counseled about the administration, storage, and general product use as well as potential adverse effects, duration of use, and the need for compliance. An administration device for drug delivery like an oral syringe should be provided. Parents need advice from the pharmacist in making sure their children receive the best possible pharmaceutical care.

Anti-Bacterial Agents↗
PubMed1991

Evaluation of three theophylline dosing methods in pediatric patients.

Three methods used for individualizing theophylline dosing were prospectively evaluated in 34 pediatric patients to compare the methods' ability to accurately predict steady-state serum theophylline concentrations (STCs) from non-steady-state data. Methods evaluated included a Bayesian weighted sum of squares regression program, an algebraic method developed by Chiou, and a commonly used population-based pediatric dosing algorithm. An expanded retrospective evaluation was also done to further compare the Bayesian and Chiou methods. Patients (aged 1-11 y) admitted to the hospital for acute bronchospasm refractory to inhaled beta agonists and with physician's orders to receive intravenous aminophylline were eligible for participation. Study patients received a 6-mg/kg loading dose aminophylline, followed by a 0.8-1.0 mg/kg/h constant aminophylline infusion. STCs were obtained 0.5 and 5.5 hours postinfusion. Subjects were randomized to one of three dosing method groups (Bayesian, Chiou, or pediatric algorithm). Doses were calculated using the assigned method to attain a target steady-state STC. Predictions from each dosing method were compared with actual serum concentrations for bias and precision. Additionally, analysis of fit-to-the-line-of-identity for predicted versus observed STCs was evaluated for each method. Precision of methods was also compared with regard to their ability to predict within 20 percent of their observed steady-state STC. Results from the prospective evaluation showed no significant difference between the three methods tested. Predicted STCs fell within 20 percent of their observed steady-state concentrations for 18 percent (2/11) of patients in the algorithm group, and 45 percent (5/11) of patients in the Chiou group and 17 percent (2/12) of the patients in the Bayesian group met this criterion. Retrospective analysis of all 34 patients demonstrated that the Bayesian and Chiou methods had similar bias and precision and no statistical difference was found between them. The results from this evaluation suggest that the pediatric dosing algorithm is equivalent in predictive bias and precision to the Bayesian and Chiou methods as well as in its ability to identify doses that result in steady-state STCs within 20 percent of their target values. Given the relative inaccuracy of these methods, cautious use of these techniques is recommended when evaluating non-steady-state STCs obtained from children during the acute stages of reactive airway disease.

Algorithms↗
PubMed1990

Osmolality of small-volume i.v. admixtures for pediatric patients.

The osmolalities of pediatric i.v. admixtures were measured to identify drug concentrations in selected vehicles that would conserve fluid while maintaining osmolality values of 400 mOsm/kg or less. Test solutions were prepared by diluting appropriate volumes of freshly reconstituted powdered drug products or commercially diluted drug products with 5% dextrose injection, 0.9% sodium chloride injection, or both to provide 5 mL of each admixture at desired drug concentrations. To reduce their osmolalities, trimethoprim-sulfamethoxazole and ampicillin sodium were also diluted in 0.45% sodium chloride injection; ticarcillin disodium was diluted only in 0.45% sodium chloride injection. A vapor pressure osmometer was used to measure osmolalities in triplicate for three solutions prepared for each admixture. Of the 63 different admixtures prepared with 5% dextrose injection or 0.9% sodium chloride injection or both, 47 (75%) had osmolalities of 400 mOsm/kg or less. At least one concentration of each selected drug diluted in these vehicles had an osmolality of less than 425 mOsm/kg, except for trimethoprim-sulfamethoxazole and ampicillin sodium. Selected concentrations of the latter two drugs and ticarcillin disodium in 0.45% sodium chloride injection resulted in acceptable osmolalities. For most drugs diluted to the same concentration in 5% dextrose injection and 0.9% sodium chloride injection, osmolalities were lower in the dextrose solutions. Selection of an appropriate vehicle and drug concentration can control the osmolality of i.v. admixtures when the volume of fluid must be minimized, as for pediatric patients.

Anti-Bacterial Agents↗
PubMed1988

Flucytosine interference with serum creatinine determinations.

A patient receiving intravenous amphotericin B and oral flucytosine was found to have falsely elevated serum creatinine values. Flucytosine has been reported to interfere with serum creatinine determinations when measured by the Kodak Ektachem-700 analyzer but not when the Jaffe reaction is employed. Serum creatinine values were determined by the two methods on six serum samples obtained from this patient at various times throughout her hospitalization. Flucytosine can cause clinically significant false elevations in serum creatinine when measured by the Kodak Ektachem-700 analyzer.

Amphotericin B↗
PubMed1983

The effects of exchange transfusion on the pharmacokinetics of phenobarbital.

A 26-month-old child was admitted to the pediatric intensive care unit for treatment of apparent fulminant hepatitis. While hospitalized, he underwent eight exchange transfusions to decrease ammonia concentrations. The patient received intravenous phenobarbital (Pb) for the treatment of cerebral edema. To determine the effects of exchange transfusion on Pb clearance, serum Pb concentrations were obtained before, after, and between exchanges. Preexchange and postexchange serum Pb concentrations were obtained on three separate exchanges. Pb concentrations also were examined between two exchange transfusions. The amount of Pb actually removed during one exchange transfusion was determined by analyzing serum obtained from the discarded blood resulting from the procedure. All Pb concentrations were analyzed by the Emit system. Results indicate that Pb was cleared at a mean rate of 433 ml/h during the exchange periods examined, with a mean overall elimination constant of 0.20 h-1. The Pb actually removed by the exchange transfusion on day 10 of hospitalization was determined to be 17 mg, while the calculated amount was 8 mg. A mean of 22.3 mg of Pb was calculated to be removed over an average exchange time of 2.2 hours. Pb clearance during exchange transfusion has not been reported previously. This case has shown that small amounts of Pb can be removed by exchange transfusion; therefore, patients undergoing this procedure may require serum monitoring after exchange.

Brain Edema↗