Karen J. Tietze

Factors Affecting Drug Bioavailability in Space

Microgravity‐induced changes in the bioavailability of drugs may influence the efficacy or toxicity of drugs. The bioavailability of orally administered drugs may be altered by changes in dissolution rate, intestinal microflora, intraluminal enzymes, epithelial enzymes, rate of passage across the gastrointestinal epithelium, gastric emptying rate, intestinal transit time, hepatic first pass metabolism, and gastrointestinal and hepatic blood flow. Limited data from antiorthostatic bed rest and inflight studies provide preliminary evidence that the bioavailability of orally administered drugs in space may be decreased or subject to more interindividual variation than expected from ground‐based studies.

Calcium antagonists in cerebral/peripheral vascular disorders. Current status

Calcium antagonists (also known as calcium or slow channel blocking agents) have been well studied in the treatment of supraventricular arrhythmias, ischaemic heart disease and more recently, hypertension (Conti et al. 1985; Somani & Mayhew 1985). In addition, their use in the treatment of cerebral and peripheral vasospastic disorders appears to hold great promise. This article reviews the current status of the use of calcium antagonist drugs in the treatment of the latter disorders.

Nimodipine in the Treatment of Subarachnoid Hemorrhage

Nimodipine, a calcium-channel antagonist with a relatively selective vasodilatory effect on cerebral blood vessels, has recently been approved for improvement of neurologic deficits due to spasm following subarachnoid hemorrhage. Nimodipine has low oral bioavailability (2.7–27.9 percent), a short half-life (2 h), is highly protein bound (98–99 percent), and is hepatically metabolized. Clinical studies have evaluated topical, intravenous, and oral administration of nimodipine for the treatment of cerebral artery spasm associated with subarachnoid hemorrhage. These studies document some benefit of the drug in reducing the occurrence of severe neurologic deficit, although this effect is not universal. Few adverse effects have been noted. Further studies are necessary to evaluate the pharmacologic and pharmacokinetic characteristics, the appropriate dose and route of administration, adverse effects, drug interactions, and the therapeutic efficacy of nimodipine before routine use can be recommended.

Theophylline Pharmacokinetics: Effect of Continuous Versus Intermittent Cimetidine IV Infusion

The comparative effects of continuous versus intermittent cimetidine infusion on theophylline pharmacokinetics were evaluated in 12 nonsmoking healthy male volunteers. Each subject received aminophylline 0.9 mg/kg/hr over 6 hours alone (control) and in random order at 1 week intervals, in combination with intermittent cimetidine (300 mg IV over 15 minutes every 6 hours) and continuous cimetidine (50 mg/hr W) infusions. Both cimetidine regimens were administered for a total of 50 hours. Serial plasma samples were obtained and assayed for theophylline by HPLC. No significant differences existed in mean theophylline clearance and mean volume of distribution among control, intermittent or continuous cimetidine regimens; the power was >80% to detect a 30% change in clearance. Only a minor difference in theophylline half‐life between control and continuous cimetidine infusion (7.59 ± 2.52 vs. 9.05 ± 3.17 hr; P <.05) was observed. These findings do not support a clinically significant interaction between IV aminophylline and cimetidine administered IV either as a low dose continuous infusion or as an intermittent infusion.

Thrombocytopenia and vomiting due to difluoromethylornithine

A 32-year-old Haitian male with acquired immunodeficiency syndrome presented with complications of Isospora belli enteritis. Therapy with the investigational drug difluoromethylornithine was initiated. Severe thrombocytopenia, nausea, and vomiting developed during intravenous drug therapy and recurred upon rechallenge with low-dose oral difluoromethylornithine. Therapy was discontinued because of these severe adverse effects.

Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 18th Edition

Self-Care Components of Selected Chronic Disorders (Chapter 45). Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (17th Edition). Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care up-to-date product availability information, whereas the 17th edition includes some. Pharmacists, firth edition, Robert McCarthy, Jones and Handbook of Nonprescription Drugs: an Interactive. Approach to SelfCare. 17th ed. Washington, DC:.

Nonprescription antihistamines: Geriatric considerations

Nonprescription antihistamines are approved by FDA for temporary relief of allergic rhinitis symptoms.1 Diphenhydramine is also an FDA-approved antitussive, nighttime sleep aid, and antiemetic.1 In addition, nonprescription antihistamines are often self-selected for management of common cold symptoms.

Chapter 2 – Communication Skills for the Pharmacist

T ability to communicate clearly and effectively with patients, family members, physicians, nurses, pharmacists, and other health care professionals is an important skill. Some pharmacists are skilled communicators, comfortable with all types of people; other pharmacists find it difficult to communicate with health care professionals in perceived or actual positions of authority (e.g., physicians) or with patients from different socioeconomic or cultural backgrounds. Fortunately, communication skills can be learned. One incentive for improving communication skills is that pharmacists with excellent communication skills are likely to have very satisfying and successful careers. Another incentive is that the inability to communicate effectively may harm patients. Poor communication between pharmacists and patients may result in an inaccurate patient medication history and inappropriate therapeutic decisions; may contribute to patient confusion, disinterest, and nonadherence; and may add to patients’ frustration with the health care system. Poor communication between pharmacists and physicians, pharmacists and nurses, and pharmacists and pharmacists may harm patients if important information is not exchanged in an appropriate and timely manner.

Honey for cough: Evidence is limited

A large number of honeyavored and honey-containing nonprescription products, including cough syrups and cough drops with and without FDA-approved antitussives, are marketed. Honey, a pleasant avoring agent, is promoted by some as an antitussive. According to the World Health Organization, “soothing substances such as hot tea with honey and lemon, a syrup, or glycerol are harmless and inexpensive.”1 Recipes for homemade lollipops, cough drops, and syrups, and testimonials for honey by the spoonful for the management of cough abound on the Internet. Pharmacists need to understand the limitations of the currently available evidence, potential adverse effects, and contraindications to the use of honey as an antitussive.

Metered dose inhalers: Counting doses for patient safety

T presentations at the 2013 American College of Allergy Asthma & Immunology Annual Scienti c meeting highlighted some of the problems caused by patients not knowing when to discard their metered dose inhalers (MDIs).1,2 In a survey of 366 adults and 224 children with asthma, 48.2% stated that their rescue inhaler was empty when needed; 10.4% went to an emergency department for treatment, and 20% went without treatment.1 In an analysis of 93,980 claims for patients aged 4 years to 64 years with asthma, exercise-induced asthma, and chronic obstructive pulmonary disease, use of rescue MDIs with integrated MDI dose counters was associated with a signi cantly decreased incidence of respiratory-related emergency department visits.2