Diane Nykamp

Possible Association of Acute Lateral-Wall Myocardial Infarction and Bitter Orange Supplement:

OBJECTIVE To report a possible incidence of acute lateral-wall myocardial infarction (MI) coinciding with the use of a Citrus aurantium L. (bitter orange)—containing dietary supplement in a patient with undetected coronary vascular disease. CASE SUMMARY A 55-year-old white woman presented to the emergency department with symptoms of dull aching shoulder and chest pain. A review of medications during cardiac rehabilitation revealed the patient had ingested a multicomponent dietary supplement for weight loss containing 300 mg of bitter orange (Editas Skinny Pill) for the past year. Although the patients past medical history did not include hypertension, coronary disease, or hyperlipidemia, an arteriogram revealed a lesion in the left main coronary artery. She did have a smoking history. She was diagnosed with acute lateral-wall MI and hospitalized for 4 days. DISCUSSION Consumers generally consider dietary supplements safe. However, some supplements taken for weight loss contain ingredients that have been associated with cardiovascular events. Although consumers are becoming more aware of the serious adverse effects secondary to products containing ingredients such as Ma huang and ephedra, reports involving other ingredients are increasing. Bitter orange or synephrine, found in bitter orange, has been associated with adverse cardiovascular reactions. Based on the Naranjo probability scale, C. aurantium is possibly associated with this cardiovascular event. CONCLUSIONS The use of C. aurantium—containing supplements may present as a risk for cardiovascular toxicity; however, additional studies/case reports are needed to validate this conclusion.

Pharmacy Students' Participation in a Research Experience Culminating in Journal Publication

Objectives. To examine factors that influenced doctor of pharmacy (PharmD) students to collaborate with faculty members, preceptors, or others on scholarly activities that resulted in publication of an article in a pharmacy journal, and whether this experience influenced their consideration of a career in academic pharmacy. Methods. A 17-question survey instrument was e-mailed to student authors of papers published between 2004 and 2008 in 6 pharmacy journals. Responses were analyzed to determine factors influencing student participation in research and whether the experience led them to consider a career in academic pharmacy. Results. Factors about their participation in the scholarly activity that respondents found valuable included personal fulfillment and making a contribution to the literature. Respondents indicated they were more interested in a career in academic pharmacy after their participation in the scholarly experience (p < 0.001). Conclusions. Participation in scholarly activities and student authorship of a peer-reviewed journal manuscript during pharmacy school may lead to increased interest in a career in academic pharmacy.

Olmesartan Medoxomil–Induced Angioedema

Objective: To report a case of olmesartan medoxomil-induced angioedema in an angiotensin-converting enzyme (ACE) inhibitor–naïve patient. Case Summary: A 61-year-old white woman with hypertension experienced significant swelling of her face, neck, and lips 10 days after initiation of olmesartan medoxomil 20 mg/day. After discontinuation of the drug, symptoms resolved within 10 days. Use of the Naranjo probability scale indicated a probable association between angioedema and olmesartan medoxomil. Discussion: An angiotensin receptor blocker (ARB) is, in many cases, considered a safe alternative to an ACE inhibitor since serum bradykinin is thought not to be affected. However, angioedema has been reported with the use of ARBs, suggesting alternative pathways or mechanisms that result in this adverse reaction. Although not proven in humans, one explanation is that a secondary stimulation of angiotensin II AT2 receptors produces an increase in tissue bradykinin, resulting in angioedema. Conclusions: As of February 26, 2007, this is the first published reported case of olmesartan medoxomil–induced angioedema. Practitioners should be aware of this rare but potentially serious adverse event.

Cost of medication therapy in ambulatory HIV-infected patients

Objective To examine the use and cost associated with prescribed medications as well as the use of over-the-counter medications and nontraditional therapies among ambulatory HIV-infected patients at Ryan White Title IIIb grantee centers. Methods Study participants (n = 223) were enrolled from eight centers across the US and Puerto Rico. Data were collected by a nurse, pharmacist, or physician through review of medical records and medication profdes. Information on the use of over-the-counter drugs and alternative therapies was obtained from the patients. Results Two hundred eleven (94.6%) patients received a mean ± SD of 5.3 ± 3.8 prescription medications during a consecutive 90-day period. The cost of medication was

Impact of Abbreviated Lecture with Interactive Mini-Cases vs Traditional Lecture on Student Performance in the Large Classroom

1237.62 ±

Risk of Adverse Drug Events Related to Ibuprofen Use in a Community Sample

1751.49 per patient. Patients with a diagnosis of AIDS received a greater number of prescription drugs: an average of 6.6 compared with 3.4 among HIV-positive patients and 3.5 among asymptomatic patients. Anti-retroviral agents were used by 143 (68.7%) patients. Zidovudine and stavudine had the highest cost (

Comparison of H1-Antihistamines for Pruritus in End-Stage Renal Disease

611.81 ±

Effect of Cimetidine on Oral Digoxin Absorption

254.10 and

Hypertension: Focus on Olmesartan Medoxomil

596.96 ±

High-Dose Insulin in the Treatment of Antihypertensive Overdose

352.80, respectively). Eighty-one (40.9%) patients reported the use of at least one over-the-counter product (range 0–11) and 11.8% reported use of alternative therapies. Conclusions This study shows the cost of drug treatment for HIV-infected patients has remained stable since the early 1990s. However, it is anticipated this will change due to the introduction of new anti-HIV agents, greater use of combination therapies, greater use of prophylactic therapies, and increased survival times.