American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Mar 1997
Pharmacokinetics of aztreonam in critically ill surgical patients.
The pharmacokinetics of aztreonam in critically ill surgical patients with serious gram-negative infections were studied. Blood samples were taken before and at 30 minutes, 2.5 hours, and 5 hours after a dose of aztreonam 2 g i.v. every six hours. All patients had received at least two aztreonam doses before the dosage interval being studied. ⋯ A slightly higher than normal mean V, 0.22 L/ kg, was seen in a subset of six patients whose infection occurred earlier in their intensive care and who had lower APACHE II scores. While with some antibiotics the elevated V would imply difficulty in achieving therapeutic drug levels, 99 (89%) of the 111 concentrations were at or above the in vitro susceptibility breakpoint of 8 micrograms/mL. Despite observations of markedly increased and highly variable V in critically ill surgical patients, a standard dosage of aztreonam was usually sufficient to maintain adequate serum drug levels.
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Am J Health Syst Pharm · Feb 1997
Randomized Controlled Trial Clinical TrialTetracaine versus lidocaine-prilocaine for preventing venipuncture-induced pain in children.
The efficacy of tetracaine cream versus that of lidocaine-prilocaine cream for the prevention of pain in children undergoing venipuncture was studied. Hospital inpatients 1-15 years of age received, on the back of each hand, a 30-minute application of tetracaine 4% cream or a 60-minute application of lidocaine-prilocaine cream (EMLA, Astra) before undergoing scheduled venipuncture. The phlebotomists in this open, randomized trial evaluated the efficacy of the cream at the moment of venipuncture as adequate, inadequate, or inconclusive. ⋯ The only adverse effects observed were mild local erythema in the tetracaine group and local skin blanching in the lidocaine-prilocaine group. No tetracaine could be detected in serum, and the serum concentrations of N-butyl-p-aminobenzoic acid ranged from 0 to 1.8 mg/l. Statistically, lidocaine-prilocaine cream was more efficacious than tetracaine 4% cream, but the difference is of minor clinical significance and is outweighed by the practical advantages of tetracaine 4% cream, namely the shorter application time, vasodilation and lower cost.
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The stability of meropenem in various i.v. fluids stored in various containers for i.v. use was studied. Solutions of meropenem were prepared in a variety of i.v. diluents in polyvinyl chloride (PVC) bags, glass vials, and commercial easy-to-prepare infusion systems. Solutions for storage in PVC bags were prepared with meropenem concentrations of 1 and 20 mg/mL; in glass vials, 2.5 and 50 mg/mL; and in commercial easy-to-prepare infusion systems, 2.5 and 20 mg/mL (Baxter Minibag Plus system) and 1, 5, and 20 mg/mL (ADD-Vantage system, Abbott). ⋯ Stability was also influenced by storage temperature; the drug was stable for a longer time in solutions stored at 4-5 degrees C than in solutions stored at 21-26 degrees C. Meropenem was stable for the longest time in sterile water for injection and in 0.9% sodium chloride injection. The stability of meropenem in solutions in PVC bags, glass vials, Baxter Minibag Plus containers, and ADD-Vantage bags was influenced by the i.v. fluid used to reconstitute the drug, the concentration of the final solution, and the storage temperature.
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Am J Health Syst Pharm · Feb 1997
Arden Syntax: the emerging standard language for representing medical knowledge in computer systems.
The Arden Syntax for Medical Logic Modules standard language for knowledge-based computer systems is described. Knowledge systems can use computerized patient data in decision-making. Although they have the potential to reduce adverse drug events and infection rates, improve drug dosing, and decrease the cost of care, knowledge systems have not yet reached the average patient. ⋯ An MLM contains maintenance slots (title, file name, version, originating institution, author, date, specialist, validation information), library slots (stating the MLM's purpose and providing keywords for searching), and knowledge slots (containing the "essence" of the MLM). Arden Syntax is receiving growing support from the medical and information systems communities as the standard language for medical knowledge systems, but legal, ethical, regulatory, and ownership issues remain. If pharmacy is to grow and prosper as a knowledge profession, it should adopt an accepted standard language for representing active, applied knowledge in computer systems.