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Biomedical subjects

W S Burkle

Publications and source records attributed to W S Burkle.

At least 19 recordsLinked to original sources
PubMed1990

Development and implementation of clinical pharmacokinetic services.

The basic issues involved in the development and implementation of pharmacokinetic dosing services are presented. A quality pharmacokinetic dosing service is activated by pharmacists immediately upon receipt of a consultation request or medication order. The patient's status is assessed, and recommendations are made for initial dosage, timing of blood sampling, and laboratory tests. Serum drug concentration data are interpreted and a maintenance dosage recommended. The patient is then monitored. The personnel selected for a dosing service need not have advanced pharmacy degrees but must be highly trainable. Their training should address basic pharmacokinetic concepts, the pharmacokinetics of specific drugs, and details on running the service and should be reinforced by extensive on-the-job training. As with other services, staffing should be tailored to workload. Continuous oral and written communication among the dosing service pharmacists and between the pharmacists and the medical and nursing staffs is essential to the smooth and expeditious operation of the service, as are complete and well-written policies and procedures. A quality dosing service cannot exist without commitment from hospital administration and the director of pharmacy and responsiveness of the nursing department and laboratory to the service's exacting requirements. Ongoing research is necessary to evaluate the pharmacokinetic models and software packages used and to find ways of conserving time. High-quality pharmacokinetic dosing services enhance patient care and the image of hospital pharmacy.

Communication↗
PubMed1985

Cyclosporine pharmacokinetics and blood level monitoring.

Although monitoring plasma or whole blood concentrations of cyclosporine has been promoted as a means of limiting toxicity while ensuring adequate immunosuppression, no consensus has been reached with regard to the assay, the specimen to be assayed, the frequency of monitoring, the therapeutic range, or even the necessity of monitoring cyclosporine concentrations. The failure to reach such a consensus can be attributed to a great extent to the complex pharmacokinetic profile of cyclosporine and the inconsistencies in the assay methodology and results used to generate is pharmacokinetic profile. This article places the subject of monitoring cyclosporine concentrations in perspective by reviewing the pharmacokinetics of cyclosporine, the assay methodology, and the published clinical experience with blood level monitoring.

Biological Availability↗
PubMed1984

Videotaped patient medication instruction program using closed-circuit television.

A program is described in which hospital patients receive videotaped medication instruction that is reinforced by printed information. In a 940-bed hospital, the pharmacy department developed a series of videotapes for closed-circuit television. Each tape covers a medication or drug class and includes use of the drug, precautions, administration instructions, and adverse effects. Pharmacists developed the basic test, and the patient education department revised the language to meet the needs of patients. Pharmacists presented the information on the tapes, which were produced by the hospital's video production department. File cards that paraphrased the script were designed to give patients written information to take home. Each tape is shown once daily. The tape includes the pharmacy phone number and encourages patients to call the pharmacy to obtain a card. A pharmacist delivers the cards and reviews the information. In this program, information can be presented to a large number of patients with minimal use of pharmacists' time.

Drug Therapy↗
PubMed1983

Gentamicin and tobramycin dosing guidelines: an evaluation.

The provision of pharmacokinetic dosing services has become a cornerstone of clinical pharmacy practice in many institutions. As these services expand, more pharmacists will become involved, and the need for a structured, uniform approach to the provision of these services may be necessary. Therefore, this article discusses specific approaches (i.e., guidelines) to the most common clinical conditions that the pharmacist may encounter. The goal is to promote consistent interpretation and application of clinical and kinetic data by the members of our aminoglycoside dosing service. The guidelines provide a structured yet adaptive approach to the clinical use of gentamicin and tobramycin. The major areas of controversy that were encountered in developing these guidelines are discussed, and the guidelines are presented. These guidelines currently are used to standardize our pharmacokinetic dosing service and as a tool for educating new pharmacists to their role and responsibilities as members of the pharmacokinetic consultation team. Additionally, these guidelines are being used as criteria for the assessment of quality assurance in the area of clinical pharmacokinetics.

Adult↗
PubMed1982

Advances in thrombolytic therapy.

Streptokinase and urokinase are the two thrombolytic agents currently available in the United States. These drugs promote dissolution of thrombi by stimulating the conversion of plasminogen to plasmin, resulting in an overall "lytic state" in the blood. Recent clinical trials in patients with pulmonary emboli, deep vein thrombosis, arterial thrombosis, and arteriovenous cannula occlusions demonstrated significantly greater lysis with thrombolytics than with heparin alone. However, because of the increased risk of bleeding, the use of these agents is reserved for patients in whom the therapeutic advantages outweigh the disadvantages. Contraindications are numerous and include any preexisting condition that may render the patient more susceptible to bleeding.

Clinical Trials as Topic↗
PubMed1981

Evaluation of "toxic" serum theophylline concentrations.

The relationships between excessively high theophylline doses, the incidence of theophylline toxicity, and toxic serum theophylline concentrations in hospitalized patients were investigated. During a 24-month period, the medical records of patients whose serum theophylline content was above 20 micrograms/ml were studied. Demographic and medical information was recorded, including symptoms attributable to theophylline toxicity, and concurrent disease states and medications. A total of 3112 serum theophylline determinations were made during the study (January 1978 through December 1979); 17% were above 20 micrograms/ml. The medical records of 128 patients were available; 87 of these were studied. The patients were divided into three groups: Group 1--serum theophylline concentrations between 20 and 29.9 micrograms/ml (42 patients); Group 2--30-39.9 micrograms/ml (26 patients); Group 3--above 40 micrograms/ml (19 patients). In Group 1, 81% of the patients had at least one symptom of toxicity. In the other groups, all patients had one or more symptoms of toxicity. Tachycardia was the most common symptom. Four patients had seizures attributable to theophylline toxicity; all four had serum theophylline concentrations above 40 micrograms/ml. Of the 87 study patients, 77 (89%) had received theophylline doses above recommended guidelines. It is concluded that serum theophylline concentrations above 20 micrograms/ml result in a high incidence of toxic symptoms. Serum theophylline determinations should be obtained when treating patients with theophylline.

Heart Failure↗
PubMed1980

Development of competency standards for quality assurance in clinical pharmacokinetics.

In response to an editorial in Hospital Pharmacy which called for "in-house credentialling" of pharmacists engaged in the application of clinical pharmacokinetics, a method of introducing quality assurance in pharmacokinetics is presented. The evolution of a pharmacokinetic dosing service in which each pharmacist is responsible for the provision of dosage recommendations on his/her patient care area is discussed, along with the difficulties which had to be overcome in order to establish uniform guidelines for our clinical pharmacy staff to follow when providing this service. Finally, the establishment of acceptable levels of competence, means of obtaining those levels, and methods for the determination of competence are presented.

Aminoglycosides↗
PubMedDate not supplied

Evaluation of the Chiou method for determining theophylline dosages.

The Chiou method for predicting maintenance dosages of theophylline using individual patient data was evaluated. Eighty patients receiving continuous infusions of aminophylline were studied. Each patient's theophylline clearance was predicted using two serum theophylline concentrations obtained at least six hours apart after starting the aminophylline infusion. This clearance value was then used to calculate a new infusion rate designed to achieve a target steady-state serum theophylline concentration. A follow-up concentration was obtained at steady state and used to determine a steady-state theophylline clearance for each patient. The mean predicted and calculated theophylline clearance and the mean predicted and measured serum theophylline concentration for the study population were very similar. Mean prediction errors for theophylline clearance and serum theophylline concentrations were not significantly different among any of the five subgroups of patients with factors that influence theophylline disposition. The Chiou method, using relatively few serum samples, provides a rapid and accurate means of individualizing aminophylline infusion requirements for patients with a wide range of theophylline disposition characteristics.

Adolescent↗