Ivermectin for the Treatment of Resistant Scabies

The Annals of Pharmacotherapy. Feb, 2003  |  Pubmed ID: 12549961

To assess the clinical literature describing the use of ivermectin in cases of treatment-resistant scabies infestations.

Heterogeneous Patterns of PH Regulation in Glial Cells in the Dorsal and Ventral Medulla

American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. Feb, 2004  |  Pubmed ID: 14525723

We examined pH regulation in two chemosensitive areas of the brain, the retrotrapezoid nucleus (RTN) and the nucleus tractus solitarius (NTS), to identify the proton transporters involved in regulation of intracellular pH (pHi) in medullary glia. Transverse brain slices from young rats [postnatal day 8 (P8) to P20] were loaded with the pH-sensitive probe 2',7'-bis (2-carboxyethyl)-5,6-carboxyfluorescein after kainic acid treatment removed neurons. Cells were alkalinized when they were depolarized (extracellular K+ increased from 6.24 to 21.24 mM) in the RTN but not in the NTS. This alkaline shift was inhibited by 0.5 mM DIDS. Removal of CO2/HCO3- or Na+ from the perfusate acidified the glial cells, but the acidification after Na+ removal was greater in the RTN than in the NTS. Treatment of the slice with 5-(N-ethyl-N-isopropyl)amiloride (100 microM) in saline containing CO2/HCO3- acidified the cells in both nuclei, but the acidification was greater in the NTS. Restoration of extracellular Cl- after Cl- depletion during the control condition acidified the cells. Immunohistochemical studies of glial fibrillary acid protein demonstrated much denser staining in the RTN compared with the NTS. We conclude that there is evidence of Na+-HCO3- cotransport and Na+/H+ exchange in glia in the RTN and NTS, but the distribution of glia and the distribution of these pH-regulatory functions are not identical in the NTS and RTN. The differential strength of glial pH regulatory function in the RTN and NTS may also alter CO2 chemosensory neuronal function at these two chemosensitive sites in the brain stem.

Intrapulmonary Administration of Medications

The Journal of Neuroscience Nursing : Journal of the American Association of Neuroscience Nurses. Aug, 2004  |  Pubmed ID: 15366551

An increasing number of medications are being administered by inhalation. However, proper dosing, frequency, formulation, and the optimal delivery device remain to be determined for many of these agents. Inhalation therapy has many advantages compared with other routes of administration including achieving a high drug concentration in the lung, lack of systemic adverse effects, ease of administration, and patient convenience. A broad range of patients may benefit from this type of drug delivery. Practitioners must keep abreast of emerging drug administration strategies and new formulations in order to continually improve care for their patients.

Linezolid for the Treatment of a Heteroresistant Staphylococcus Aureus Shunt Infection

Pediatric Neurosurgery. Mar-Apr, 2005  |  Pubmed ID: 15942282

The emergence of multidrug-resistant bacteria as the cause of ventriculoperitoneal shunt infections is a disconcerting phenomenon that often requires the use of alternative antimicrobials due to resistance against commonly used agents. The following is a case report describing the successful treatment of a ventriculoperitoneal shunt infection caused by a heteroresistant strain of Staphylococcus aureus with linezolid. Linezolid may have utility in treating pediatric CNS infections due to its tolerability, excellent blood-brain barrier penetration, and activity against multiple resistant Gram-positive organisms such as S. aureus, vancomycin-resistant Enterococcus faecium and Streptococcus pneumoniae.

An Interaction Between {alpha}v{beta}8 Integrin and Band 4.1B Via a Highly Conserved Region of the Band 4.1 C-terminal Domain

Proceedings of the National Academy of Sciences of the United States of America. Sep, 2005  |  Pubmed ID: 16157875

alphavbeta8 Integrin is highly expressed in the vertebrate CNS, and mice lacking the alphav or beta8 genes develop cerebral hemorrhage due to defective interactions between blood vessels and alphavbeta8-expressing neural cells. Although alphavbeta8 binds many of the same extracellular matrix protein ligands as other integrins, very little is known about the intracellular signal transduction events used by alphavbeta8 to regulate CNS development. Here we identify Band 4.1B as an intracellular factor that interacts selectively with the beta8 cytoplasmic tail. The association with alphavbeta8 occurs via the band 4.1B C-terminal domain, a region highly conserved among the various Band 4.1 family members. Indeed, we show that beta8 integrin interacts directly with the C-terminal domains of several Band 4.1 proteins and colocalizes with them in cultured astrocytes and in the brain. These data identify a previously uncharacterized interaction between an integrin and Band 4.1 family members and suggest an important functional role for alphavbeta8-Band 4.1 interactions in the development and maintenance of the CNS.

Pharmacokinetic Alterations in Obesity

Orthopedics. Nov, 2006  |  Pubmed ID: 17134048

Although some medications have established dosing adjustments for obesity (Table 2), it remains unknown for the majority of medications if dosing adjustment is warranted. It is important to remember dosage adjustments may not be as simple as doubling an antibiotic dose because a patient is morbidly obese. Individualizing drug dosing is imperative in the obese, postoperative patient to ensure they simultaneously have therapeutic serum concentrations without drug toxicity. Much of what has been learned from studies in obese patients is that the pharmacokinetic alterations of medications are variable. Broad application of dosing guidelines even among medications within the same therapeutic class is likely not appropriate. An increased emphasis in researching the effects of obesity on the fate of medications is of paramount importance as the obese population grows. Practitioners should use caution and be vigilant in monitoring pharmacotherapy in obese individuals.

You Can Withdraw from That? The Effects of Abrupt Discontinuation of Medications

Orthopedics. May, 2006  |  Pubmed ID: 16729740

Obtaining complete medication histories from patients and reinitiating home medications on hospital admission or when clinically appropriate will help prevent unnecessary complications secondary to abrupt discontinuation.

Modulation of Rhythmic Motor Activity by Pyrokinin Peptides

Journal of Neurophysiology. Jan, 2007  |  Pubmed ID: 17065249

Pyrokinin (PK) peptides localize to the central and peripheral nervous systems of arthropods, but their actions in the CNS have yet to be studied in any species. Here, we identify PK peptide family members in the crab Cancer borealis and characterize their actions on the gastric mill (chewing) and pyloric (filtering) motor circuits in the stomatogastric ganglion (STG). We identified PK-like immunolabeling in the STG neuropil, in projection neuron inputs to this ganglion, and in the neuroendocrine pericardial organs. By combining MALDI mass spectrometry (MS) and ESI tandem MS techniques, we identified the amino acid sequences of two C. borealis pyrokinins (CabPK-I, CabPK-II). Both CabPKs contain the PK family-specific carboxy-terminal amino acid sequence (FXPRLamide). PK superfusion to the isolated STG had little influence on the pyloric rhythm but excited many gastric mill neurons and consistently activated the gastric mill rhythm. Both CabPKs had comparable actions in the STG and these actions were equivalent to those of Pevpyrokinin (shrimp) and Leucopyrokinin (cockroach). The PK-elicited gastric mill rhythm usually occurred without activation of the projection neuron MCN1. MCN1, which does not contain CabPKs, effectively drives the gastric mill rhythm and at such times is also a gastric mill central pattern generator (CPG) neuron. Because the PK-elicited gastric mill rhythm is independent of MCN1, the underlying core CPG of this rhythm is different from the one responsible for the MCN1-elicited rhythm. Thus neuromodulation, which commonly alters motor circuit output without changing the core CPG, can also change the composition of this core circuit.

Clinical Utility of a Continuous Intravenous Infusion of Valproic Acid in Pediatric Patients

Pharmacotherapy. Apr, 2007  |  Pubmed ID: 17381378

To describe the dose-concentration relationship of a continuous intravenous infusion of valproic acid (VPA) in pediatric patients when a dosing protocol is used.

An Institutional Process to Improve Inpatient Glycemic Control

Quality Management in Health Care. Jul-Sep, 2007  |  Pubmed ID: 17627219

Many institutions are evaluating their inpatient patterns of care for patients with diabetes mellitus and hyperglycemia, based upon compelling evidence that strict glycemic control improves outcomes in a variety of hospital settings. In 2005, a multidisciplinary task force was established at the University of Kentucky Chandler Medical Center in Lexington, Kentucky, to guide a process to improve the quality and safety of inpatients with hyperglycemia. This article describes the stepwise process including an examination of our procedures, adoption of standards, and establishment of common protocols and procedures. Successful implementation of the protocols was preceded by extensive educational efforts. Refinement of the protocols based on early experience and feedback from staff has resulted in improvements in glycemic parameters and less reliance on sliding scale insulin regimens.

Potential Roles for Statins in Critically Ill Patients

Pharmacotherapy. Sep, 2007  |  Pubmed ID: 17723082

The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the most commonly prescribed agents for hypercholesterolemia and have revolutionized the management of hyperlipidemia and the area of cardiovascular risk reduction. However, recent data suggest that their effects go well beyond the lipid lowering seen with long-term use and may include acute antiinflammatory activity, anticoagulation, immunomodulation, as well as promotion of changes in smooth-muscle tone. Because of these data, promising research has begun into the use of these agents in various critical care areas such as the early phases of sepsis, bacteremia, and ischemic stroke. Recent data also show a decrease in cerebral vasospasm after subarachnoid hemorrhage, an area deficient in therapeutic options. More research is necessary to ascertain the true role of statins in the treatment of these various disorders. Nevertheless, the concept of a statin's role as being only a routine preventive therapy with benefits limited to patients undergoing extended treatment is rapidly becoming inaccurate.

Medication-error Reporting and Pharmacy Resident Experience During Implementation of Computerized Prescriber Order Entry

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists. Mar, 2007  |  Pubmed ID: 17322166

The purpose of this study was to compare the number and type of medication errors reported before and after the implementation of computerized prescriber order entry (CPOE); the involvement of a pharmacy resident in the CPOE implementation process will be described.

A Newly Identified Extrinsic Input Triggers a Distinct Gastric Mill Rhythm Via Activation of Modulatory Projection Neurons

The Journal of Experimental Biology. Mar, 2008  |  Pubmed ID: 18310125

Neuronal network flexibility enables animals to respond appropriately to changes in their internal and external states. We are using the isolated crab stomatogastric nervous system to determine how extrinsic inputs contribute to network flexibility. The stomatogastric system includes the well-characterized gastric mill (chewing) and pyloric (filtering of chewed food) motor circuits in the stomatogastric ganglion. Projection neurons with somata in the commissural ganglia (CoGs) regulate these rhythms. Previous work characterized a unique gastric mill rhythm that occurred spontaneously in some preparations, but whose origin remained undetermined. This rhythm includes a distinct protractor phase activity pattern, during which a key gastric mill circuit neuron (LG neuron) and the projection neurons MCN1 and CPN2 fire in a pyloric rhythm-timed activity pattern instead of the tonic firing pattern exhibited by these neurons during previously studied gastric mill rhythms. Here we identify a new extrinsic input, the post-oesophageal commissure (POC) neurons, relatively brief stimulation (30 s) of which triggers a long-lasting (tens of minutes) activation of this novel gastric mill rhythm at least in part via its lasting activation of MCN1 and CPN2. Immunocytochemical and electrophysiological data suggest that the POC neurons excite MCN1 and CPN2 by release of the neuropeptide Cancer borealis tachykinin-related peptide Ia (CabTRP Ia). These data further suggest that the CoG arborization of the POC neurons comprises the previously identified anterior commissural organ (ACO), a CabTRP Ia-containing neurohemal organ. This endocrine organ thus appears to also have paracrine actions, including activation of a novel and lasting gastric mill rhythm.

Hemodynamic Management After Spinal Cord Injury

Orthopedics. Mar, 2008  |  Pubmed ID: 18351045

Successful Enteral Nutritional Support in the Neurocritical Care Unit

Neurocritical Care. 2008  |  Pubmed ID: 18654745

Adequate caloric intake is associated with improved outcome in neurocritical illness, but factors influencing the provision of enteral nutrition (EN) have not been systematically evaluated. The primary goal of the study was to determine the EN intake of neurosurgical intensive care unit (ICU) patients within the first week of illness and investigate the factors contributing to achieving caloric goals.

Rash Associated with Pregabalin Use

The Annals of Pharmacotherapy. Dec, 2008  |  Pubmed ID: 19001532

To report a case of extensive rash induced by orally administered pregabalin in a patient with neuropathic pain.

Integrative Medicine for the Poor and Underserved: a Win-win Situation

Journal of Health Care for the Poor and Underserved. Nov, 2008  |  Pubmed ID: 19029734

Nutrition Considerations in Traumatic Brain Injury

Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition. Dec-2009 Jan, 2008  |  Pubmed ID: 19033220

The provision of adequate nutrition support for patients with traumatic brain injury (TBI) has been a clinical challenge for decades. The primary and secondary injuries create unique metabolic derangements along with accompanying issues such as optimal timing and route of nutrition, appropriate fluid and electrolytes, drug administration, rehabilitation, and dysphagia. Enteral nutrition is clearly established as the preferential route of nutrition support for this population vs parenteral nutrition. There appears to be a consensus on early initiation of enteral nutrition, but less definitive are recommendations on advancement timing and formula components. Nutrition therapies should include exact fluid resuscitation goals specific for TBI and strict electrolyte monitoring to avoid extreme fluid, electrolyte, or glucose shifts that could be detrimental to the patient. While the critical care patient often tolerates small bowel feeding, the long-term rehabilitation patient should transition to and tolerate gastric feeding. Drug-nutrient and adverse drug reactions such as diarrhea should be routinely evaluated in patients receiving enteral nutrition. Monitoring for dysphagia is critical to avoid the costly negative aspects associated with aspiration and to capitalize on quality of life and appropriate oral nutrition. Emphasizing the priority of early nutrition support within a multi-disciplinary team may be the critical key for successful provision and tolerance of nutrition support in the TBI population.

Same Day Endoscopy and Percutaneous Liver Biopsy: Safety and Cost-effectiveness

Digestive Diseases and Sciences. Aug, 2009  |  Pubmed ID: 19034662

Routine upper and/or lower endoscopy and percutaneous liver biopsy in the same patient are rarely performed on the same day. The aim of this study was to determine the safety, cost savings, and patient satisfaction of these same day procedures. A retrospective cohort study of patients undergoing same day endoscopy and percutaneous liver biopsy between February 2003 and July 2006 at Brooke Army Medical Center was performed. Eighty-nine patients were identified as having same day endoscopy and percutaneous liver biopsy during the study period. No study endpoint complications were identified. A cost savings of $333 per patient for a same day diagnostic upper endoscopy, colonoscopy, and percutaneous liver biopsy was found. More patients in both groups preferred same day procedures (P < 0.001). In conclusion, endoscopy and percutaneous liver biopsy can safely be performed in the same patient on the same day, which simultaneously increases patient satisfaction and is cost-effective.

Meta-analysis of Statins for Aneurysmal Subarachnoid Hemorrhage Falls Short

Stroke; a Journal of Cerebral Circulation. Mar, 2009  |  Pubmed ID: 19182076

Pharmacological Management of Hemodynamic Complications Following Spinal Cord Injury

Orthopedics. May, 2009  |  Pubmed ID: 19472960

Damage from spinal cord injury (SCI) may be complicated by concomitant hemodynamic alterations within hours to months of the initial insult. Neurogenic shock, symptomatic bradycardia, autonomic dysreflexia, and orthostatic hypotension are specific conditions occurring commonly with SCI. Early recognition and appropriate management of each disorder may minimize secondary injury to the cord, avert systemic complications, and help alleviate patient discomfort.

Cyclosporine A for Neuroprotection: Establishing Dosing Guidelines for Safe and Effective Use

Expert Opinion on Drug Safety. Jul, 2009  |  Pubmed ID: 19548859

Numerous neuroprotective compounds have been investigated to ameliorate secondary changes and the progression of injury after the primary insult in traumatic brain injury (TBI). This cascade of events is complex and difficult to abate once initiated following the primary injury. The clinical consequences of this secondary injury are unpredictable and often permanently incapacitating. Cyclosporine A (CsA) interrupts the endogenous mediators of secondary insult through inhibition of the mitochondrial permeability transition pore and prevention of subsequent mitochondrial dysfunction. This drug may have a role in neuroprotection but has several pharmacologic effects that must be considered when using it in the TBI population. This review discusses the physiologic responses following TBI that may affect CsA efficacy and safety when used for neuroprotective indications. So far, CsA seems to be safe in the TBI population. The role of CsA after acute TBI will be better defined after the completion of upcoming planned clinical trials.

Intracerebroventricular Administration of Drugs

Pharmacotherapy. Jul, 2009  |  Pubmed ID: 19558257

Intracerebroventricular drug administration is a method that bypasses the blood-brain barrier and other mechanisms that limit drug distribution into the brain, allowing high drug concentrations to enter the central compartment. Instillation of drugs directly into the ventricles of the brain must be done carefully and with full consideration of factors affecting the efficacy and safety of this route of administration. These factors include the osmolarity, pH, volume, and presence of preservatives and diluents of the drug solution being administered. Very few studies have formally investigated intraventricular therapies, and dosing recommendations may vary widely depending on the agent and the patient. Many antimicrobials have been given intraventricularly, although very few prospective studies have evaluated this strategy. There are wide variations among the reports regarding dosage regimens and the pharmacokinetics of the antimicrobials used. Guidance on appropriate formulations and their use is lacking. Clinicians should be aware of their patients' ongoing disease processes and neurologic status, as well as pertinent physiochemical properties of drugs when formulating them for intracerebroventricular administration; a high index of suspicion should be maintained when monitoring patients for adverse drug events after instillation.

Pharmacists' Role in Facilitating Evidence-based Prescribing for Unlabeled Use of Medications

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists. Oct, 2009  |  Pubmed ID: 19767380

Conducting Drug Abuse Investigations in Natural Environments: Potential Directions for Medical Toxicology Research

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology. Mar, 2010  |  Pubmed ID: 20195814

Physician-scientists, in the eyes of the National Institutes of Health (NIH), are crucial to the biomedical research enterprise since the development of evidence-based practice based on cutting-edge research. At the same time, NIH has heightened the importance of research mentorship by permitting investigators to revise an application a single time. The current NIH approach, therefore, narrows the margin of error allowable in a proposal and requires that investigators fully develop research protocols for initial submission. The purpose of this manuscript, therefore, is to provide medical toxicologists with a proven research methodology that can be applied to substance abuse investigations. A secondary aim is to provide successful grant language that can be used in subsequent applications for research funding.

Role of Intraarterial Therapy for Cerebral Vasospasm Secondary to Aneurysmal Subarachnoid Hemorrhage

Pharmacotherapy. Apr, 2010  |  Pubmed ID: 20334460

Aneurysmal subarachnoid hemorrhage (SAH) accounts for a significant percentage of morbidity and mortality among patients admitted to neurosurgical centers throughout the world. Even for individuals surviving beyond the initial presentation and intervention for aneurysmal SAH, the occurrence of cerebral vasospasm has the potential to induce a second tier of complications that can be just as devastating as the inciting event. However, despite numerous studies and some initial advancements in management, therapeutic modalities are limited to help prevent or treat this complex entity. Historically, the mainstay of treatment for cerebral vasospasm has been a combination of hypervolemia, hemodilution, and hypertension. In addition, other systemic therapies such as oral nimodipine, statins, and intravenous magnesium, as well as intensive glucose control, appear to have some promise, although they are limited at times by adverse effects. To avoid these adverse consequences and perhaps gain some modicum of efficacy, attempts have been made to use endovascular techniques to physically dilate vessels or to administer drugs directly to the site of action and thus avoid many of the untoward effects of systemic pharmacotherapy. Controversy still remains over the success of intraarterial therapy, the drugs or techniques to be used, and the best timing of this therapy. Based on the currently available literature, it is impossible to assess the most effective intraarterial therapy. Randomized controlled trials that can control for baseline factors and technical expertise are needed to provide more conclusive data. Clinical pharmacists should be actively involved in assisting interventional radiologists and neurosurgeons in providing safe and appropriate pharmacotherapy in this promising but controversial arena of intraarterial drug delivery.

Potential Benefits of High-dose Methylprednisolone in Acute Spinal Cord Injuries

Orthopedics. Apr, 2010  |  Pubmed ID: 20415351

High-dose Methylprednisolone in Acute Spinal Cord Injuries: Proceed with Caution

Orthopedics. May, 2010  |  Pubmed ID: 20507035

Pharmacologic Options for Reducing the Shivering Response to Therapeutic Hypothermia

Pharmacotherapy. Aug, 2010  |  Pubmed ID: 20653360

Recent literature has demonstrated significant improvements in neurologic outcomes in patients who have received induced hypothermia in the setting of out-of-hospital cardiac arrest. Through multiple metabolic mechanisms, the induction of hypothermia slows the progression and devastation of transient cerebral hypoxia. Despite these benefits, the desired reduction in core temperature is often a challenging venture as the body attempts to maintain homeostasis through the induction of thermoregulatory processes aimed at elevating body temperature. Shivering is an involuntary muscular activity that enhances heat production in an attempt to restore homeostasis. For successful induction and maintenance of induced hypothermia, shivering, as well as other thermoregulatory responses, must be overcome. Several pharmacologic options are available, either used alone or in combination, that safely and effectively prevent or treat shivering after the induction of hypothermia. We conducted a PubMed search (1966-March 2009) to identify all human investigations published in English that discussed pharmacologic mechanisms for the control of shivering. Among these options, clonidine, dexmedetomidine, and meperidine have demonstrated the greatest and most clinically relevant impact on depression of the shivering threshold. More research in this area is needed, however, and the role of the clinical pharmacist in the development and implementation of this therapy needs to be defined.

Contemporary Pharmacologic Issues in the Management of Traumatic Brain Injury

Journal of Pharmacy Practice. Oct, 2010  |  Pubmed ID: 21507847

Traumatic brain injury (TBI) is a major cause of death and disability in the United States. While there are no pharmacotherapeutic options currently available for attenuating the neurologic injury cascade after TBI, numerous pharmacologic issues are encountered in these critically ill patients. Adequate fluid resuscitation, reversal of coagulopathy, maintenance of cerebral perfusion, and treatment of intracranial hypertension are common interventions early in the treatment of TBI. Other deleterious complications such as venous thromboembolism, extremes in glucose concentrations, and stress-related mucosal disease should be anticipated and avoided. Early provision of nutrition and prevention of drug or alcohol withdrawal are also cornerstones of routine care in TBI patients. Prevention of infections and seizures may also be helpful. Clinicians caring for TBI patients should be familiar with the pharmacologic issues typical of this vulnerable population in order to develop optimal strategies of care to anticipate and prevent common complications.

Catching the Seizure Culprit: Drugs on the Differential

Orthopedics. Sep, 2010  |  Pubmed ID: 20839747

Pharmacy Resident Participation with a 24-hour Multidisciplinary Stroke Response Team

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists. Nov, 2010  |  Pubmed ID: 21048206

Pharmacologic Treatment of Neuropathic Pain Following Spinal Cord Injury

Orthopedics. Mar, 2011  |  Pubmed ID: 21410102

Pharmacokinetics of Intravenous Levofloxacin Administered at 750 Milligrams in Obese Adults

Antimicrobial Agents and Chemotherapy. Jul, 2011  |  Pubmed ID: 21576432

The physiochemical properties of levofloxacin suggest that it is an agent which may exhibit altered pharmacokinetics in obese individuals. The purpose of this study was to describe the pharmacokinetics of a single 750-mg intravenous dose of levofloxacin in both hospitalized and ambulatory obese individuals. The hypothesis was that a standard dose of levofloxacin in obese individuals would achieve serum concentrations likely to be therapeutic. A single levofloxacin dose of 750 mg was infused over 90 min, and seven serial serum samples were subsequently obtained to evaluate the pharmacokinetics after the first dose. The peak concentrations of levofloxacin were comparable to those seen with normal-weight individuals. However, the area under the concentration-time curve and clearance were quite variable. Accelerated clearance was evident in the ambulatory obese individuals. Further investigation of the effects of obesity on the pharmacokinetics of levofloxacin is necessary to ensure optimal dosing.

A Web-based Experiential Rotation Platform

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists. Jul, 2011  |  Pubmed ID: 21690424

Drug Shortages: Causes and Cautions

Orthopedics. Sep, 2011  |  Pubmed ID: 21899237

Drug shortages have increasingly been a problem for pharmacists and clinicians over the past decade. Clinicians need to be aware of the various causes of drug shortages and the issues that may arise as a result, particularly as they relate to medication safety. Numerous resources and strategies are available to mitigate the effects of drug shortages, and clinicians should work with their health care team and the patient to determine the best option when faced with a drug shortage that affects patient care.

Duty Hours for Pharmacy Residents

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists. Dec, 2011  |  Pubmed ID: 22095805

Discovery and Functional Study of a Novel Crustacean Tachykinin Neuropeptide

ACS Chemical Neuroscience. Dec, 2011  |  Pubmed ID: 22247794

Tachykinin-related peptide (TRP) refers to a large and structurally diverse family of neuropeptides found in vertebrate and invertebrate nervous systems. These peptides have various important physiological functions, from regulating stress in mammals to exciting the pyloric (food filtering) rhythm in the stomatogastric nervous system (STNS) of decapod crustaceans. Here, a novel TRP, which we named CalsTRP (Callinectes sapidus TRP), YPSGFLGMRamide (m/z 1026.52), was identified and de novo sequenced using a multifaceted mass spectrometry-based platform in both the central nervous system (CNS) and STNS of C. sapidus. We also found, using isotopic formaldehyde labeling, that CalsTRP in the C. sapidus brain and commissural ganglion (CoG) was up-regulated after food-intake, suggesting that TRPs in the CNS and STNS are involved in regulating feeding in Callinectes. Using imaging mass spectrometry, we determined that the previously identified CabTRP Ia (APSGFLGMRamide) and CalsTRP were co-localized in the C. sapidus brain. Lastly, our electrophysiological studies show that bath-applied CalsTRP and CabTRP Ia each activates the pyloric and gastric mill rhythms in C. sapidus, as shown previously for pyloric rhythm activation by CabTRP Ia in the crab Cancer borealis. In summary, the newly identified CalsTRP joins CabTRP Ia as a TRP family member in the decapod crustacean nervous system, whose actions include regulating feeding behavior.

Acute Intrathecal Baclofen Withdrawal: a Brief Review of Treatment Options

Neurocritical Care. Feb, 2011  |  Pubmed ID: 20717751

Acute baclofen toxicity and withdrawal can present with a constellation of symptoms making differentiation between these two entities and other potential diagnoses challenging. Baclofen withdrawal is associated with numerous complications which may require neurocritical care expertise such as respiratory failure, refractory seizures, delirium, and blood pressure lability.