The Annals of pharmacotherapy
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To report 2 cases of lactic acidemia associated with the use of metformin in patients with normal renal function. ⋯ Metformin therapy can be associated with subclinical elevation of lactic acid concentration in the absence of renal insufficiency or other contraindications to using this agent in patients with type 2 diabetes. Periodic monitoring of basic metabolic panels may prevent this potentially serious complication of metformin therapy.
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To briefly discuss the changing epidemiology of fungal infections and review currently available agents; provide a review of caspofungin; and discuss its pharmacology, pharmacokinetics, dosing guidelines, safety and efficacy, and role in the treatment of invasive fungal infections as it relates to current antifungal therapy. ⋯ Caspofungin has activity against Aspergillus spp. as well as a variety of Candida spp. Clinical data support its usefulness in the treatment of invasive aspergillosis and select candida infections. As additional clinical data become available, it seems likely that the therapeutic role of caspofungin will expand.
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Comparative Study Clinical Trial
Pain and distress from bone marrow aspirations and lumbar punctures.
To compare the efficacy of 3 different pharmacologic regimens to relieve pain and distress in children with cancer undergoing bone marrow aspirations (BMAs) and lumbar punctures (LPs). ⋯ Children receiving propofol/fentanyl general anesthesia experienced significantly less procedure-related pain and distress than did those receiving either EMLA or oral midazolam/EMLA.
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To compare the relative delivery of 2 methods for providing continuously nebulized albuterol (CNA): a small-volume nebulizer plus infusion pump versus a large-volume nebulizer. ⋯ The large-volume nebulizer evaluated in this study maintains consistent output up to 8 hours and provides an acceptable method for delivering CNA through an infant ventilator circuit.
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Comparative Study
Alteplase versus urokinase for occluded hemodialysis catheters.
The use of central venous catheters as a source of vascular access in patients undergoing hemodialysis may be complicated by thrombosis. Frequently, thrombolytics are used in an attempt to reestablish blood flow through partially or completely occluded catheters. ⋯ Alteplase, administered via the 30-minute push-protocol, is an effective thrombolytic for restoring hemodialysis catheter patency. In our study sample, alteplase was generally more effective than urokinase in restoring blood flow through catheters, especially those that were completely occluded.