Clinical pharmacy
-
The chemistry, pharmacology, and pharmacokinetics of cocaine are described, and the medical complications of illicit cocaine use are reviewed. Cocaine is readily absorbed from mucous membranes, the gastrointestinal tract, and the vascular beds of the lungs. Thus there are a number of routes for illicit cocaine administration, with the most popular one being intranasal. ⋯ The treatment of cocaine-related toxicities is supportive and is based on the organ system affected. Drugs such as propranolol, labetalol, and nitrendipine have been advocated for treating the cardiovascular complications, and measures such as maintaining arterial blood pH, monitoring core body temperature, and diazepam therapy have been used to manage seizures. As the number of case reports of cocaine toxicity increases and the underlying mechanism is conclusively defined, management of the medical complications will improve.
-
Review Case Reports
Management of glucose abnormalities in patients receiving total parenteral nutrition.
A patient who developed extreme fluctuations in serum glucose concentrations while receiving total parenteral nutrition (TPN) is described, and etiologies of hyperglycemia and hypoglycemia, as well as a rational approach to preventing and managing these disorders in patients receiving TPN, are presented. A 40-year-old white man with a 29-year history of insulin-dependent diabetes mellitus was hospitalized after he had an episode of rejection related to a cadaveric kidney transplant. During the hospitalization, his right leg was amputated because of cellulitis, and he developed septicemia with respiratory failure. ⋯ Patients receiving parenteral nutrition are subject to widely varying serum glucose concentrations related not only to the nutrition support provided but also to various underlying metabolic and physiologic complications commonly present. Common etiologies of, and ways to prevent and manage, hypoglycemia and hyperglycemia are reviewed. Clinicians should be aware of the risk of hyperglycemia and hypoglycemia in patients receiving TPN and monitor patients appropriately for alterations in glucose homeostasis.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of heparin and 0.9% sodium chloride injection in the maintenance of indwelling intermittent i.v. devices.
Heparin sodium 10 units/mL was compared with 0.9% sodium chloride injection as a flush solution for indwelling intermittent i.v. devices, or i.v. locks (IVLs), in a prospective, randomized, double-blind study. The heparin and 0.9% sodium chloride injections were prepared in the pharmacy using aseptic technique. Most of the IVLs were inserted by an i.v. therapy team member. ⋯ The groups were well matched, except that the sodium chloride group received more vancomycin and dextrose-containing i.v. solutions, while the heparin group received more penicillins. There was no significant difference in the incidence of phlebitis or lost patency between the groups. When locks through which vancomycin, penicillins, and dextrose-containing i.v. solutions were administered were excluded, there was still no significant difference between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)