British journal of clinical pharmacology
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Br J Clin Pharmacol · Jan 2011
Randomized Controlled TrialImpact of a focussed teaching programme on practical prescribing skills among final year medical students.
Medication errors, and particularly prescribing errors, are common in UK hospitals. Junior doctors make the majority of prescribing errors. Deficiencies in prescribing education and training have been closely linked to the high frequency of medication errors. ⋯ Medical students make significant errors in prescribing. Teaching improves ability and confidence but is insufficient alone in eradicating errors.
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Br J Clin Pharmacol · Jan 2011
The use of antidepressants and the risk of haemorrhagic stroke: a nested case control study.
Selective serotonin re-uptake inhibitors (SSRI) are associated with an increased risk of bleeding disorders at a number of sites. It is currently unclear whether they increase the risk of haemorrhagic stroke, with conflicting results reported. ⋯ We found no evidence that SSRIs are associated with an increased risk of haemorrhagic stroke, regardless of prior history of cerebrovascular events.
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Br J Clin Pharmacol · Jan 2011
Understanding lactic acidosis in paracetamol (acetaminophen) poisoning.
Paracetamol (acetaminophen) is one of the most commonly taken drugs in overdose in many areas of the world, and the most common cause of acute liver failure in both the UK and USA. Paracetamol poisoning can result in lactic acidosis in two different scenarios. First, early in the course of poisoning and before the onset of hepatotoxicity in patients with massive ingestion; a lactic acidosis is usually associated with coma. ⋯ In these patients lactate is elevated primarily because of reduced hepatic clearance, but in shocked patients there may also be a contribution of peripheral anaerobic respiration because of tissue hypoperfusion. In patients admitted to a liver unit with paracetamol hepatotoxicity, the post-resuscitation arterial lactate concentration has been shown to be a strong predictor of mortality, and is included in the modified King's College criteria for consideration of liver transplantation. We would therefore recommend that post-resuscitation lactate is measured in all patients with a severe paracetamol overdose resulting in either reduced conscious level or hepatic failure.
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Br J Clin Pharmacol · Jan 2011
Evaluation of a morphine maturation model for the prediction of morphine clearance in children: how accurate is the predictive performance of the model?
The pharmacokinetics of morphine are well known in pre-term and term neonates, infants, younger and older children, as well as in adults. There are circumstances when a pharmacokinetic study may not be possible in children (especially neonates and infants), and as a result one would like to predict drug clearance in children. Several methods, such as allometric scaling and prediction based on incorporation of physiological parameters, have been suggested. Recently a morphine maturation model has been proposed to predict morphine clearance in the paediatric population. ⋯ The morphine maturation model has a poor predictive power of morphine clearance in preterm and term neonates, infants and very young children and may not be of any practical value for the prediction of morphine clearance in this age group.
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Br J Clin Pharmacol · Dec 2010
Review Case ReportsDextromethorphan, chlorphenamine and serotonin toxicity: case report and systematic literature review.
The aim of this review was to describe a patient with serotonin toxicity after an overdose of dextromethorphan and chlorphenamine and to perform a systematic literature review exploring whether dextromethorphan and chlorphenamine may be equally contributory in the development of serotonin toxicity in overdose. A Medline literature review was undertaken to identify cases of serotonin toxicity due to dextromethorphan and/or chlorphenamine. Case reports were included if they included information on the ingested dose or plasma concentrations of dextromethorphan and/or chlorphenamine, information about co-ingestions and detailed clinical information to evaluate for serotonin toxicity. ⋯ In three of the six eligible cases dextromethorphan and chlorphenamine were the only overdosed drugs. There is substantial evidence from the literature that chlorphenamine is a similarly potent serotonin re-uptake inhibitor when compared with dextrometorphan. Chlorphenamine is a serotonergic medication and combinations of chlorphenamine and dextromethorphan may be dangerous in overdose due to an increased risk of serotonin toxicity.