Support the campaign against pediatric tobacco use.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
S R Guharoy
Publications and source records attributed to S R Guharoy.
A prospective dosage adjustment program in a geriatric population.
This article describes the successful implementation of a prospective drug dosage adjustment program that has achieved cost-containment, improved quality of patient care, and optimum usage of clinical pharmacy services. It has significantly reduced the number of unnecessary doses administered and lowered the possibility of adverse drug reactions.
Aged↗
Serum sickness secondary to ciprofloxacin use.
Although serum sickness-like reactions are uncommon, various drugs have recently been implicated to manifest the reaction. The following case report is of a possible serum sickness-like reaction secondary to ciprofloxacin use, a commonly prescribed antibiotic in the US. A 62-y-old female developed polyarthralgias, myalgia and a generalized urticarial rash following 5 d use of ciprofloxacin. On admission to the hospital, patient was placed on cefazolin and gentamicin for suspected bacteremia. However, the regimen was discontinued after 72 h because of worsening clinical condition. Patient was placed on iv methylprednisolone therapy, and within 18 h a significant improvement was noted in her myalgias and rash. Over the next 72 h the steroid therapy was changed to a po regimen and the patient became asymptomatic 5 d after the initiation of steroid therapy. Patient was discharged on day 9 of hospital admission. Though serum sickness-like reactions have been reported with various drugs, only 1 case has been reported implicating ciprofloxacin. Clinicians should be aware of this potential adverse event secondary to ciprofloxacin use.
Arthralgia↗
Adult respiratory distress syndrome associated with amitriptyline overdose.
Adult respiratory distress syndrome (ARDS) from overdose of tricyclic antidepressants (TCA) has been rarely reported in the literature. We describe a case report of ARDS secondary to amitriptyline overdose. A 39-y-old comatose female was admitted to the emergency department after ingesting approximately 2 g of amitriptyline 1-12 h prior to arrival. Patient was intubated and physostigmine was administered. There was only minimal level of improvement in the patient's consciousness. Gastric lavage was followed by charcoal and magnesium citrate; no material was recovered from the stomach. The patient was transferred to the intensive care unit and placed on a ventilator. Chest radiographic study on day 2 of hospital admission revealed bilateral diffuse opacity typical of ARDS. In the intensive care unit the patient developed metabolic acidosis and hypotension, and they were treated aggressively. The patient's chest radiograph was normal after 5 d; she was discharged from the hospital after 12 d. Though there are few reports of ARDS secondary to TCA, clinicians should be aware of this potential.
Adult↗
Suspected nafcillin-induced interstitial nephritis.
OBJECTIVE: To present a case of nafcillin-induced interstitial nephritis. METHODOLOGY: Case report and literature review. SETTING: Hospital. RESULTS: Three days following initiation of nafcillin therapy for staphylococcal pneumonia, an 80-year-old woman developed allergic manifestations and progressive renal impairment suggestive of acute allergic interstitial nephritis. These manifestations were completely reversed within 96 hours of cessation of nafcillin therapy. CONCLUSIONS: In the clinical setting of acute renal failure in a patient on nafcillin therapy, acute interstitial nephritis should be considered. Prompt cessation of nafcillin therapy has generally been associated with reversal of symptoms and an improvement in renal function.
Acute Disease↗
Clinical pharmacy interventions: an optimum way to accomplish positive patient care outcome.
In this age of demand for optimum quality of care and shortened length of patient stay in the hospital, the opportunities for clinical pharmacy interventions are enormous. Pharmacists, with their unique background in clinical therapeutics, can make a significant difference in patient outcome. As in our case, initially there may be some skepticism among some of the physicians about the intent of pharmacy interventions. However, pharmacists' continual striving for improvement of quality of care can persuade skeptical physicians to consider pharmacists as their allies in achieving optimum quality of care. At our institution, our consistent approach has resulted in support from our physicians. Continuous feedback from managers to staff pharmacists (our monthly performance review feedback program) also helps to continue consistency of the program. The recent focus of the Joint Commission on optimum quality of care has also created an arena of tremendous opportunities for pharmacists to work with the physicians and other health care professionals to accomplish excellence in quality of care.
California↗
A pharmacy-coordinated, multidisciplinary approach for successful implementation of an adverse drug reaction reporting program.
Explore the source record for details and available documents.
Adverse Drug Reaction Reporting Systems↗
Streptokinase versus recombinant tissue-type plasminogen activator.
Explore the source record for details and available documents.
Humans↗
Twenty-four-hour controlled substance documentation system: the optimal way to monitor use in the nursing units.
Accountability for the use of controlled substances in the nursing units is a top priority for nursing and pharmacy administration in any health-care institution. After several discrepancies were found in inventory at the John F. Kennedy Memorial Hospital in Indio, California, the pharmacy department revised the controlled substance handling system in the hospital and implemented a 24-hour controlled substance recording system. The system provided greater accountability and allowed follow-up on any discrepancy within the next shift. The system has been highly successful. There had been six discrepancies in 12 months before implementing the system. There has been no incident of discrepancy in the last 31 months. The authors conclude that 24-hour controlled substance documentation system is very effective in providing greater accountability and control over controlled substance use in the nursing units.
California↗
Pulmonary edema possibly developing secondary to the intravenous administration of oxytocin.
Oxytocin, a posterior pituitary hormone, is commonly used for induction of labor, stimulation or reinforcement of labor, management of incomplete or inevitable abortion and control of post partum bleeding. We describe a case of acute pulmonary edema possibly developing secondary to the administration of iv oxytocin. Clinicians should be aware of the potential for pulmonary edema secondary to iv oxytocin. Close hemodynamic monitoring should be done during oxytocin therapy.
Adolescent↗
Atropine intoxication from the ingestion and smoking of jimson weed (Datura stramonium).
Anticholinergic effects occur due to jimson weed intoxication. The most common intoxication involves teenagers desiring mind-altering properties from the plant. We report 4 cases of jimson weed intoxication due to ingestion and inhalation (smoking) of jimson weed. Clinicians should be aware of the potential abuse of botanicals such as jimson weed.
Adolescent↗
Probable anaphylactic reaction to corn-derived dextrose solution.
Secondary to the i.v. administration of a corn-derived dextrose solution, a 23-y-old pregnant female patient admitted to the hospital at term gestation developed an anaphylactic reaction. Orofacial swelling, difficulty in breathing, hypotension, cardiac arrhythmia, voice hoarseness, total body warmth and flushing occurred within 8 min of initiation of a 5% dextrose Lactated Ringer's solution. The i.v. solution was discontinued and plain lactated Ringer's solution was begun with no sequelae. The patient delivered a viable male infant with a post-operative course being unremarkable. A sample of suspect solution was sent to the manufacturer but no contamination was reported. Although the reaction elicited in this patient was rare, clinicians should be aware of the possibility of corn allergy due to the administration of i.v. fluids containing corn-derived dextrose.
Adult↗
Quinidine-induced hepatotoxicity revisited.
Although quinidine has been widely used since the beginning of the century, quinidine-induced hepatotoxicity has been recently reported in the literature. We describe a reversible case of quinidine-induced hepatotoxicity. A 62-y-old male with a past medical history of atrial flutter and adult onset diabetes was admitted to the hospital with a 3-d history of diarrhea, nausea, fever, chills and palpitations. Past medications included 7.5 mg glyburide daily for 4 y, 0.25 mg digoxin daily for 3 w, 324 mg quinidine gluconate 3 times daily for 2 w, and 150 mg papaverine daily for 2 y. On admission, liver enzyme levels were elevated (SGOT 606, SGPT 1104). Quinidine was considered an etiologic agent and was discontinued after administration of 1 dose. The patient became afebrile within 48 h, liver enzyme levels gradually decreased, and the patient was discharged on day 6 of hospitalization. Repeat enzyme levels obtained 12 d after discharge were mostly within normal limits. The symptoms were atypical as described in the literature. We conclude that unexplained fever or elevated liver enzyme levels should alert the clinician to the possibility of quinidine-induced hepatotoxicity.
Chemical and Drug Induced Liver Injury↗
Impact of a multidisciplinary, collaborative approach to implement and enforce an automatic stop order policy.
Although an automatic stop order (ASO) policy is mandated by the Joint Commission on Accreditation of Healthcare Organizations, the policy remains unenforced or exists only "on paper" in some hospitals. Strict enforcement of an ASO can lead to improvement of patient care by requiring physicians and other healthcare professionals to periodically review a patient's drug regimen. Following the approval of an ASO policy by our facility's pharmacy and therapeutics (P&T) committee, an audit of 160 orders of controlled substances revealed that 75 orders (47 percent) were continued for more than one dose without a physician's renewal order. This problem was then brought to the attention of the P&T committee where a decision was made to resolve the situation using a multidisciplinary, collaborative approach. With the help of all of the healthcare professionals involved in this issue, as well as our computer network, a system for strict enforcement of the ASO policy was subsequently implemented and has proven to be successful.
Accreditation↗