The Annals of pharmacotherapy
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Case Reports
Diazepam by continuous intravenous infusion for status epilepticus in anticonvulsant hypersensitivity syndrome.
To report a case of status epilepticus in a patient with anticonvulsant hypersensitivity syndrome (AHS) that was controlled successfully using continuous intravenous infusion diazepam. AHS and alternatives for treatment of status epilepticus are also reviewed. ⋯ Continuous intravenous infusion diazepam is a reasonable therapeutic choice for the management of status epilepticus in a patient with AHS when traditional therapy such as phenytoin and phenobarbital cannot be used.
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To document the number of opened, dated, and expired multiple-dose vials (MDVs) in patient-care areas and to determine what proportion of MDVs were contaminated with bacteria or cellular debris. ⋯ Transmission of infection via contaminated MDVs has been well documented and contamination with red blood cells raises concerns about potential for transmission of bloodborne pathogens. Recommendations include dating MDVs after opening, emphasizing the need for proper aseptic technique, and discarding MDVs on the manufacture's date of expiration.
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To review the most current information pertaining to hepatic drug metabolism in patients with cystic fibrosis (CF) and to explore the possible association between CF and specific pathways for the hepatic biotransformation of xenobiotics. ⋯ Investigations of drug biotransformation in CF have revealed disease-specific increases in the formation of drug metabolites. Future application of techniques in molecular biology and biochemical pharmacology will need to characterize the mechanistic basis for altered drug metabolism in CF and expand our knowledge of the relationship between drug metabolism phenotype and genotype; the impact of growth, development, and disease severity on drug metabolism; the potential role of CF gene products (i.e., CFTR) on intrahepatic drug transport and biotransformation; and the pharmacogenetic determinants of substrate specificity for hepatic drug metabolism in CF.
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To report a case of a perforated gastric ulcer associated with the use of injectable ketorolac tromethamine. ⋯ Although ketorolac is an effective analgesic, it is a nonsteroidal antiinflammatory agent and thus has the propensity for causing GI ulceration. Caution should be used when administering this drug and patients should be monitored for GI adverse effects.
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Comment Letter
Comment: selective decontamination of the digestive tract.