American journal of hospital pharmacy
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The incidence, etiology, clinical manifestations, and management of malignant hyperthermia (MH) are reviewed. The syndrome of MH is recognized as one of the causes of anesthesia-related deaths. It is considered pharmacogenetic because both an abnormal gene and precipitating environmental factors are necessary to produce an acute reaction. ⋯ A thorough family history, baseline CPKs, caffeine-halothane contracture tests, and ultramicroscopic examination of muscle biopsy specimens are recommended as screening techniques. The early administration of dantrolene sodium in acute reaction of MH has been shown to rapidly alleviate the symptoms and ensuing severe complications. Individuals with a strong family history of MH or previous episodes may be treated with oral dantrolene sodium before surgery to effectively prevent a crisis, and after surgery to prevent recurrence.
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A case of protamine-associated hypertension in a 76-year-old Caucasian woman with chronic renal failure (CRF) undergoing hemodialysis is reported. Four dialysis runs during March 1977 are described in this report; all involved the i.v. administration of heparin sodium (2500-5000 units) during the five-hour procedures. Protamine sulfate (25-50 mg) was given i.v. at the end of each procedure to neutralize excess heparin. ⋯ In the run where symptoms were most severe, the patient received only 2500 units of heparin but was given 50 mg protamine sulfate. It is concluded that this reaction occurred as a result of administering excess protamine sulfate, which then acted on platelets. The platelets released either histamine or serotonin, which mediated rapid changes in blood pressure, heart rate, and breathing pattern.
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Randomized Controlled Trial Clinical Trial
Effect of telephone follow-up on medication compliance.
This study compared the effectiveness, in improving patient compliance with a 10-14 day course of antibiotic therapy, of the following two strategies: (1) a follow-up telephone call and (2) written instructions and oral consultation by a pharmacist. The 82 study patients were randomly assigned to four groups: 1--control; 2--call-back; 3--written and oral consultation; and 4--written and oral consultation plus a call-back. The follow-up telephone call was made on the fourth or fifth day of the prescription course. ⋯ The compliance in the control group was significantly less than for each of the study groups (p = 0.0295), but the three study groups were not significantly different (p less than 0.05). Patients receiving written and oral consultation had significantly greater knowledge about side effects and what to do if they missed doses (p less than 0.002). After follow-up telephone call was equal to, but did not enhance, written and oral consultation in improving patient compliance.