doi: 10.1093/ajhp/53.12.1378pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
Carter, Barry, L.;Roccella, Edward, J.
doi: 10.1093/ajhp/53.12.1381pmid: 8781682
Article PDF first page preview Close This content is only available as a PDF. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
doi: 10.1093/ajhp/53.12.1387pmid: 8781683
Article PDF first page preview Close This content is only available as a PDF. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
doi: 10.1093/ajhp/53.12.1388pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
doi: 10.1093/ajhp/53.12.1393pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
doi: 10.1093/ajhp/53.12.1393apmid: 8781684
Article PDF first page preview Close This content is only available as a PDF. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
Spahn, Gail, Rosen;Perdue, Beulah, E.
doi: 10.1093/ajhp/53.12.1394pmid: 8781685
Article PDF first page preview Close This content is only available as a PDF. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
doi: 10.1093/ajhp/53.12.1401pmid: 8781686
Abstract The pharmacology, pharmacokinetics, efficacy, safety, and dosage and administration of lansoprazole and omeprazole are reviewed. Lansoprazole and omeprazole are proton-pump inhibitors (PPIs). These agents bind covalently to hydrogen/potassium-exchanging adenosine triphosphatase in gastric parietal cells, rendering the molecule nonfunctional and inhibiting the secretion of gastric acid. The bioavailability of lansoprazole is 85%; that of omeprazole is 54%. Although lansoprazole and omeprazole have a plasma half-life of less than 2 hours, the duration of action is more than 24 hours. Clinical trials have shown lansoprazole and omeprazole to be effective in the treatment of duodenal ulcers, gastric ulcers, peptic ulcer disease involving Helicobacter pylori infection, recurrent ulcers, ulcers induced by nonsteroidal anti-inflammatory drugs, reflux esophagitis, Barrett esophagus, and Zollinger-Ellison syndrome. In many cases, these PPIs were more effective than histamine H2-receptor antagonists or worked when the latter failed. Lansoprazole and omeprazole have similar adverse-effect profiles and are well tolerated in both long- and short-term therapy. The dosage and duration of therapy vary with the condition being treated or the individual patient. Dosage adjustments should be considered only in the case of lansoprazole in patients with severe liver disease. Lansoprazole and omeprazole are highly specific in blocking a critical step in gastric acid production and have been found to be safe and effective in the treatment of many acid peptic disorders. CTwts, Dosage, Gastrointestinal drugs, Unsoprazole, Omeprazole, Pharmacokinetics, Toxicity, Lflcers This content is only available as a PDF. Author notes Funded in part by an unrestricted grant from Discovery International. This is article 204-000-96-OOS-H01 in the ASHP Continuing Education System; it qualifies for 1.0 hour of continuingeducation credit. See page 1446 for learning objectives and test questions. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
Schneitman-McIntire,, Orinda;Farnen, Tracy, A.;Gordon,, Nancy;Chan,, Jim;Toy, William, A.
doi: 10.1093/ajhp/53.12.1416pmid: 8781687
Abstract Medication misadventures resulting in visits to the emergency department of a health maintenance organization (HMO) were studied. The records of patients who visited the emergency department at a California HMO between August 1992 and August 1993 were evaluated for evidence of medication misadventures brought to the department. The definition of misadventure included noncompliance and inappropriate prescribing but excluded intentional overdoses and substance abuse. If it seemed probable that a misadventure occurred, a pharmacist interviewed the patient by telephone. During the 12-month study, 1,074 (1.7%) of 62,216 visits to the emergency department were due to medication misadventures. The patients who had had a misadventure were predominantly female (62%); 38% were 15-44 years of age and 33% were 65 or older. Interviews were possible with 962 patients. Only 30.6% of the patients had a good understanding of the potential adverse effects of their regimen, and only 29.0% had a good understanding of the potential interactions. Misadventures were most often due to allergies or medication underuse among patients < or = 14 years of age and to adverse effects and inappropriate dosage in elderly patients. Of the 1,074 misadventures, 152 (14.1%) resulted in hospital admission. Three areas of particular concern were identified (1) noncompliance with respiratory agents in the young, (2) nonsteroidal anti-inflammatory use leading to hospital admission, and (3) the frequency of problems in the elderly. Medication misadventures accounted for 1.7% of emergency department visits and 1.0% of hospital admissions at an HMO medical center. Age, Allergies, Compliance, Errors, medication, Geriatrics, Health maintenance organizations, Hospitals, Patient information, Patients, Rational therapy, Sex, Toxicity This content is only available as a PDF. Author notes The assistance of Jill Deuser, M.B.A., and the Medical Editing Department, Kaiser Foundation Research Institute, is acknowledged Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
Dennehy, Cathi, E.;Kishi, Donald, T.;Louie,, Clifton
doi: 10.1093/ajhp/53.12.1422pmid: 8781688
Abstract Drug-related illnesses (DRIs) associated with visits to a hospital emergency department (ED) were identified and classified, and the cost of these DRIs was analyzed. A pharmacist reviewed all available ED log forms on file at a 560-bed teaching hospital for October 1994. The following information was collected from these forms and, for patients with documented or suspected DRI, the medical record: medication and allergy history, drug involved in and cause of DRI, diagnosis, patient compliance, serum drug concentrations, and length of hospital stay. A patients was identified as having had a DRI if he or she was taking a drug before the ED visit and if a DRI was documented on the ED log form or suspected by the pharmacist. DRIs were classified as having been caused by inappropriate prescribing, patient noncompliance, an adverse drug reaction (ADR), or a drug interaction. DRIs were considered preventable if they could have been avoided through appropriate prescribing, outpatient monitoring, or compliance. A cost analysis was performed. Of 1260 ED log forms reviewed, 565 (45%) described patients receiving drugs before the ED visit. A total of 50 DRIs were discernible in 49 log forms (3.9% of all 1260 forms, and 8.6% of the 565 forms describing patients taking medication before the visit). Noncompliance, inappropriate prescribing, and ADRs accounted for 58%, 32%, and 10% of the DRIs, respectively. The drugs most frequently involved were albuterol, insulin, and warfarin. Thirty-three (66%) of the DRIs were considered to have been preventable; these DRIs accounted for an estimated $391,342 in annual ED and hospital costs. Many DRIs seen in the ED patients were preventable, and these preventable illnesses contributed substantially to ED and hospital costs. Albuterol, Anticoagulants, Compliance, Costs, Hospitals, Insulin, Insulins, Patient information, Pharmacists, hospital, Rational therapy, Respiratorssmooth-muscle relaxants: Toxicity, Warfarin This content is only available as a PDF. Author notes The assistance of James Bennan is acknowledged. Copyright © 1996, American Society of Health-System Pharmacists, Inc. All rights reserved.
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