Pharmacotherapy
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Clinical Trial
Pain evaluation in patients receiving intravenous patient-controlled analgesia after surgery.
To evaluate the effectiveness of intravenous patient-controlled analgesia (PCA) in patients after surgery. ⋯ Successful postoperative pain management using PCA is difficult to achieve on a consistent basis unless treatment is individualized. Our data support the hypothesis that small fixed doses fail to achieve adequate relief in many patients.
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Epinephrine overdose induces many negative complications in adults because of its alpha- and beta-adrenoreceptor activity. However, complications in newborns or children are rarely described. A 4-day-old, 2004-g female newborn was inadvertently given epinephrine at 100 times the usual dose; she developed hypokalemia and rhabdomyolysis. ⋯ No obvious long-term sequelae were observed. Effective ventilation, proper hydration, electrolyte maintenance, and early detection were assumed responsible for the positive outcome. Medication errors are common with pediatric inpatients, and efforts to reduce them are needed.
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The Accreditation Council for Pharmacy Education and the Canadian Council for Accreditation of Pharmacy Programs state that their respective programs should provide a curriculum appropriate to produce general practitioners of pharmacy. Millions of prescriptions are written for infants and children each year, and relatively few pharmacists practice in environments devoid of pediatric patients. To fulfill the stated mandate, professional pharmacy curricula must include adequate content dedicated to pharmaceutical care of the pediatric patient. ⋯ Pharmaceutical care of pediatric patients can also be improved by offering pediatric rotations to all pharmacy practice residents and encouraging their participation. However, a change in attitude may be most important. The contention that pediatric pharmacy practice is an isolated subspecialty can no longer be supported.
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To evaluate the pharmacodynamics of four intravenous antimicrobial regimens-ceftriaxone 1 g, gatifloxacin 400 mg, levofloxacin 500 mg, and levofloxacin 750 mg, each every 24 hours-against recent Streptococcus pneumoniae isolates. ⋯ Ceftriaxone maintained high probability of target attainment over a broad range of pharmacodynamic targets regardless of penicillin susceptibility (%T > MIC 0-60%). Levofloxacin 500 mg maintained high probability of target attainment for AUC:MIC ratios 0-30; whereas, levofloxacin 750 mg and gatifloxacin maintained high probability of target attainment for AUC:MIC ratios 0-60. Rate of decline in the pharmacodynamic curve was most pronounced for the two levofloxacin regimens and more gradual for gatifloxacin and ceftriaxone.