Surgical Treatment of Bone Metastases in Patients with Breast Cancer

Clinical Orthopaedics and Related Research. Mar, 2002  |  Pubmed ID: 11859243

In this retrospective study, the effect of surgical therapy on a series of 70 patients with breast cancer who were surgically treated for metastasis of the bone was evaluated. At presentation, 19 patients had one osseous lesion, 19 patients had multiple bone lesions, and 32 patients had additional visceral involvement. The surgical procedures included 60 palliative procedures, six radical resections, and four biopsies. In 14 surviving patients, the mean observation period was 35.6 +/- 40.1 months. Of the six patients with radically resected solitary bone lesions, five patients had systemic progression of the disease develop. Of the 19 patients with presumably solitary bone lesions, five currently are free of tumor. Of the 19 patients with multiple bone lesions and initially no visceral tumor spread, only two are alive. Of the 32 patients with additional visceral metastases at surgery, four are alive with the disease. For the entire group, the survival rate was 59% after 1 year, 36% after 2 years, 13% after 5 years, and 7% after 10 years. The only two independent factors that were associated with survival were the extent of the disease and the duration of symptoms from bone metastasis. These findings suggest that in orthopaedic surgery in patients with bone metastases secondary to breast cancer, wide resection is not likely to be necessary. Patients with solitary bone lesions have a 39% chance of living 5 years.

Amiodarone Vs. Sotalol As Prophylaxis Against Atrial Fibrillation/flutter After Heart Surgery: a Meta-analysis

Chest. Apr, 2002  |  Pubmed ID: 11948054

The incidence of supraventricular arrhythmias remains high following open-heart surgery. The most common of these arrhythmias are atrial fibrillation and flutter (AFF), for which treatment is not well defined. Recent studies have focused on prophylactically treating patients in an attempt to reduce postoperative AFF. Several studies have shown that sotalol and amiodarone are both effective in reducing AFF following heart surgery. However, no studies have been done comparing both drugs.

Comparison of Gemfibrozil and Fenofibrate in Patients with Dyslipidemic Coronary Heart Disease

Pharmacotherapy. Dec, 2002  |  Pubmed ID: 12495163

To compare the lipid-lowering effects of gemfibrozil and fenofibrate in patients with dyslipidemic coronary heart disease.

Gabapentin for the Treatment of Tremor

The Annals of Pharmacotherapy. Feb, 2003  |  Pubmed ID: 12549962

To review the use of the antiepileptic drug gabapentin for the treatment of various types of tremor.

Clinical Pharmacokinetics of Antiplatelet Agents Used in the Secondary Prevention of Stroke

Clinical Pharmacokinetics. 2003  |  Pubmed ID: 12885264

Stroke is one of the leading causes of death and debilitation. Several million stroke survivors are alive throughout the world today. Prevention of recurrent stroke is of major importance to stroke survivors. Several pharmacological agents are currently available for use in secondary stroke prevention.Clopidogrel, the combination of immediate-release aspirin and extended-release dipyridamole and aspirin alone are the most widely recommended agents for use in the secondary prevention of strokes. Clopidogrel has shown superiority over aspirin in the combined endpoints of stroke, death and myocardial infarction. The immediate-release aspirin/extended-release dipyridamole combination has shown superiority to aspirin alone in the secondary prevention of stroke. Dipyridamole has been studied as an antiplatelet agent for several decades. Early trials to prove its efficacy compared with aspirin were not favourable, and patients often experienced many adverse effects. Researchers began developing an extended-release formulation in an effort to maintain therapeutic blood concentrations with less frequent daily administration and better adverse effect profile. Pharmacokinetic analysis of this new product showed it to have a more consistent and reproducible absorption compared with immediate-release dipyridamole. The rate of absorption of extended-release dipyridamole is considerably slower than that of immediate-release dipyridamole, while similar plasma concentrations are maintained to optimise antiplatelet efficacy. This allows extended-release dipyridamole to be administered twice daily rather than four times daily.A large-scale randomised trial was conducted with extended-release dipyridamole 200mg in combination with immediate-release aspirin 25mg given twice daily. The combination product showed a greater efficacy at preventing a recurring stroke then either agent administered alone. Indirect comparisons with clopidogrel show that the combination of immediate-release aspirin/extended-release dipyridamole may be more effective than clopidogrel at preventing a recurring stroke.

Supplemental Products Used for Weight Loss

Journal of the American Pharmacists Association : JAPhA. Jan-Feb, 2004  |  Pubmed ID: 14965155

To review the scientific literature on several dietary supplements and herbal products commonly promoted for weight loss.

Potential Interactions Between Exercise and Drug Therapy

Sports Medicine (Auckland, N.Z.). 2004  |  Pubmed ID: 15107008

Certain physiological changes caused by aerobic exercise can alter the pharmacokinetics of some drugs. A systematic review of the pharmacokinetic changes that can affect drugs as a result of aerobic exercise is provided. Eleven commonly used drugs are reviewed for their potential interaction with exercising patients. Serum concentrations of two beta-blocking agents, atenolol and propranolol, and one antibiotic, doxycycline, have shown to increase as a result of exercise. No pharmacokinetic changes have been found in exercising patients taking carvedilol or verapamil. Patients who exercise after taking digoxin experience a decreased digoxin serum concentration with an increased skeletal muscle concentration. The clearance of theophylline has been shown to decrease resulting in an increase in plasma half-life during exercise. The risk of hypoglycaemia may increase when patients with diabetes mellitus inject insulin into a muscle just prior to exercising that muscle. Increasing physical activity in patients taking warfarin has been shown to decrease the international normalised ratio. Much is still unknown regarding the interactions that exist between exercise and drug therapy. More studies need to be completed in this area before definite conclusions are made and clinical relevance can be established. Clinicians should be aware that the potential for such interactions exists, especially for drugs with a narrow therapeutic range and in patients who participate in extreme sporting activities.

Amiodarone Versus Sotalol for the Treatment of Atrial Fibrillation After Open Heart Surgery: the Reduction in Postoperative Cardiovascular Arrhythmic Events (REDUCE) Trial

American Heart Journal. Oct, 2004  |  Pubmed ID: 15459595

This prospective, randomized, double-blind, placebo-controlled study compared the efficacy and safety of amiodarone and sotalol in the prevention of atrial fibrillation (AF) following open heart surgery.

Impact of Nesiritide on Health Care Resource Utilization and Complications in Patients with Decompensated Heart Failure

Pharmacotherapy. Sep, 2004  |  Pubmed ID: 15460174

To determine the impact of nesiritide on health care resource utilization and complications in patients hospitalized with decompensated heart failure.

An Improved Nucleic Acid Parameter Set for the GROMOS Force Field

Journal of Computational Chemistry. May, 2005  |  Pubmed ID: 15770662

Over the past decades, the GROMOS force field for biomolecular simulation has primarily been developed for performing molecular dynamics (MD) simulations of polypeptides and, to a lesser extent, sugars. When applied to DNA, the 43A1 and 45A3 parameter sets of the years 1996 and 2001 produced rather flexible double-helical structures, in which the Watson-Crick hydrogen-bonding content was more limited than expected. To improve on the currently available parameter sets, the nucleotide backbone torsional-angle parameters and the charge distribution of the nucleotide bases are reconsidered based on quantum-chemical data. The new 45A4 parameter set resulting from this refinement appears to perform well in terms of reproducing solution NMR data and canonical hydrogen bonding. The deviation between simulated and experimental observables is now of the same order of magnitude as the uncertainty in the experimental values themselves.

Therapeutic Lifestyle Changes and Pharmaceutical Care in the Treatment of Dyslipidemias in Adults

Journal of the American Pharmacists Association : JAPhA. Jul-Aug, 2005  |  Pubmed ID: 16128506

To review each therapeutic lifestyle change (TLC) component listed in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) cholesterol guidelines and discuss how the guidelines can be used by pharmacists in the treatment of patients with dyslipidemias.

Lifestyle Modification Counseling of Patients with Dyslipidemias by Pharmacists and Other Health Professionals

Journal of the American Pharmacists Association : JAPhA. Nov-Dec, 2005  |  Pubmed ID: 16381417

To establish whether patients who are taking lipid-lowering medications receive information on lifestyle modifications from health care providers when originally prescribed and whether they continue to receive follow-up information on lifestyle modifications, and to establish where patients with dyslipidemias are receiving information about lowering their serum cholesterol levels through lifestyle modifications.

Osteoporosis in Long-term Care Residents with Multiple Sclerosis

The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists. Feb, 2005  |  Pubmed ID: 16548616

To assess the fracture risk of long-term care residents with multiple sclerosis (MS) using ultrasound heel-scan technology and identification of risk factors and areas where intervention by a pharmacist might affect patient outcomes.

Nesiritide for Heart Failure: Impact on Costs and Complications

Expert Review of Pharmacoeconomics & Outcomes Research. Feb, 2005  |  Pubmed ID: 19807556

Decompensated heart failure accounts for approximately 1 million hospitalizations in the USA each year with an estimated cost of US$11,000 per hospitalization. Despite this prevalence and cost burden, relatively few therapies for decompensated heart failure have been developed over the past 30 years. Although once the mainstay of treatment of decompensated heart failure, the use of positive inotropic agents has fallen into disfavor. Although these agents improve hemodynamics and ejection fraction, there is evidence that the positive inotropes increase the risk of adverse clinical outcomes and mortality. Nesiritide is a naturetic peptide that produces balance vasodilation, inhibits sympathetic nervous system activity, and promotes diuresis and naturesis. At the time the drug received Food and Drug Administration approval for marketing in the USA, it had been shown to produce hemodynamic improvements to an extent greater than placebo or nitroglycerin. However, evidence of benefit in terms of clinical improvement and other outcomes was lacking. Recent trials have found that nesiritide reduces hospital length of stay (although not statistically significant in all trials) and healthcare resource utilization in patients admitted to hospital with decompensated heart failure. In a randomized, controlled trial, nesiritide given in the emergency room reduced hospital admissions for heart failure compared with placebo/usual care. Preliminary data from an outpatient intermittent infusion trial of nesiritide found that patients receiving nesiritide had fewer hospital admissions than patients randomized to standard care. There is currently little objective evidence that therapies used routinely in the management of patients with decompensated heart failure are associated with improved outcomes. Data with positive inotropic agents suggest that they do more harm than good. There is a growing body of evidence that nesiritide is associated with improvements in clinical outcomes in decompensated heart failure including fewer complications, less healthcare resource utilization, and lower costs when compared with standard therapy. Despite this evidence, larger, prospective trials demonstrating the impact of nesiritide on the costs and complications in decompensated heart failure are needed.

An Interprofessional Medication Risk Assessment Program

Journal of Interprofessional Care. Oct, 2006  |  Pubmed ID: 17000484

Using Performance-based Assessments to Evaluate Parity Between a Campus and Distance Education Pathway

American Journal of Pharmaceutical Education. Aug, 2006  |  Pubmed ID: 17136209

To compare the performance of campus-based students with that of distance students during the first 2 years of a doctor of pharmacy program to evaluate parity between the pathways.

2-Aminopurine Flipped into the Active Site of the Adenine-specific DNA Methyltransferase M.TaqI: Crystal Structures and Time-resolved Fluorescence

Journal of the American Chemical Society. May, 2007  |  Pubmed ID: 17455934

We report the crystal structure of the DNA adenine-N6 methyltransferase, M.TaqI, complexed with DNA, showing the fluorescent adenine analog, 2-aminopurine, flipped out of the DNA helix and occupying virtually the same position in the active site as the natural target adenine. Time-resolved fluorescence spectroscopy of the crystalline complex faithfully reports this state: base flipping is accompanied by the loss of the very short ( approximately 50 ps) lifetime component associated with fully base-stacked 2-aminopurine in DNA, and 2-aminopurine is subject to considerable quenching by pi-stacking interactions with Tyr108 in the catalytic motif IV (NPPY). This proves 2-aminopurine to be an excellent probe for studying base flipping by M.TaqI and suggests similar quenching in the active sites of DNA and RNA adenine-N6 as well as DNA cytosine-N4 methyltransferases sharing the conserved motif IV. In solution, the same distinctive fluorescence response confirms complete destacking from DNA and is also observed when the proposed key residue for base flipping by M.TaqI, the target base partner thymine, is substituted by an abasic site analog. The corresponding cocrystal structure shows 2-aminopurine in the active site of M.TaqI, demonstrating that the partner thymine is not essential for base flipping. However, in this structure, a shift of the 3' neighbor of the target base into the vacancy left after base flipping is observed, apparently replicating a stabilizing role of the missing partner thymine. Time-resolved fluorescence and acrylamide quenching measurements of M.TaqI complexes in solution provide evidence for an alternative binding site for the extra-helical target base within M.TaqI and suggest that the partner thymine assists in delivering the target base into the active site.

Therapeutic Lifestyle Strategies Taught in U.S. Pharmacy Schools

Preventing Chronic Disease. Oct, 2007  |  Pubmed ID: 17875271

Several organizations representing pharmacy and other health professions stress the importance of teaching public health topics as part of training future practitioners. The objective of our study was to assess the number of U.S. pharmacy schools that incorporate lifestyle modification topics into their curricula.

An Elective Course on Lifestyle Modifications in Pharmacotherapy

American Journal of Pharmaceutical Education. Oct, 2007  |  Pubmed ID: 17998989

Develop and implement a pharmacy course explaining basic lifestyle modification components and assess changes in student knowledge, skills, beliefs, and confidence after completing the course.

Lifestyle Modifications for Patients with Hypertension

Journal of the American Pharmacists Association : JAPhA. Jul-Aug, 2008  |  Pubmed ID: 18653408

To review the lifestyle modification components listed in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) from the National Heart, Lung, and Blood Institute (NHLBI) and discuss how the guidelines can be used by pharmacists in the treatment of patients with hypertension.

Use of a Multidisciplinary Tool to Achieve Target Outcomes in Native American Patients with Diabetes: Treat-to-target

Journal of Multidisciplinary Healthcare. 2008  |  Pubmed ID: 21197336

Our purpose was to test a communication tool used in a multidisciplinary setting to more effectively achieve the recommended goals for glucose, blood pressure, lipids, and prophylactic aspirin use in a Native American population with type 2 diabetes.

Synthesis of S-adenosyl-L-homocysteine Capture Compounds for Selective Photoinduced Isolation of Methyltransferases

Chembiochem : a European Journal of Chemical Biology. Jan, 2010  |  Pubmed ID: 20049756

Understanding the interplay of different cellular proteins and their substrates is of major interest in the postgenomic era. For this purpose, selective isolation and identification of proteins from complex biological samples is necessary and targeted isolation of enzyme families is a challenging task. Over the last years, methods like activity-based protein profiling (ABPP) and capture compound mass spectrometry (CCMS) have been developed to reduce the complexity of the proteome by means of protein function in contrast to standard approaches, which utilize differences in physical properties for protein separation. To isolate and identify the subproteome consisting of S-adenosyl-L-methionine (SAM or AdoMet)-dependent methyltransferases (methylome), we developed and synthesized trifunctional capture compounds containing the chemically stable cofactor product S-adenosyl-L-homocysteine (SAH or AdoHcy) as selectivity function. SAH analogues with amino linkers at the N6 or C8 positions were synthesized and attached to scaffolds containing different photocrosslinking groups for covalent protein modification and biotin for affinity isolation. The utility of these SAH capture compounds for selective photoinduced protein isolation is demonstrated for various methyltransferases (MTases) acting on DNA, RNA and proteins as well as with Escherichia coli cell lysate. In addition, they can be used to determine dissociation constants for MTase-cofactor complexes.

Faculty and Student Expectations and Perceptions of E-mail Communication in a Campus and Distance Doctor of Pharmacy Program

American Journal of Pharmaceutical Education. Dec, 2010  |  Pubmed ID: 21436932

To examine faculty members' and students' expectations and perceptions of e-mail communication in a dual pathway pharmacy program.

Teaching Heart Failure Treatment Guidelines and Assessing Heart Failure Therapy

American Journal of Pharmaceutical Education. Aug, 2010  |  Pubmed ID: 21045945

To determine the effectiveness of the heart failure screening form in teaching heart failure treatment guidelines and prompting students to evaluate patients' medications to initiate patient education and provider intervention.

Probing Small Molecule-protein Interactions: A New Perspective for Functional Proteomics

Journal of Proteomics. Dec, 2011  |  Pubmed ID: 21835278

The isolation of proteome subsets on the basis of the interactions of small molecules with proteins is an emerging paradigm in proteomics. Depending on the nature of the small molecule used as a bait, entire protein families can be monitored in biological samples, or new functions can be attributed to previously uncharacterized proteins. With pharmaceutical compounds as baits, drug targets and toxicity-relevant off-targets can be discovered in an unbiased proteomic screen. At the heart of this strategy are synthetic bi- or trifunctional small molecule probes. These probes carry the small molecules of interest as baits (selectivity function), as well as a sorting function for the isolation of small molecule-protein complexes or conjugates from complex protein mixtures. In some designs, a covalent linkage of the bound protein to the probe is established through a separate reactivity function or a combined selectivity/reactivity function. The covalent linkage allows for isolation or detection of probe-protein conjugates also under harsh or denaturing conditions. Ultimately, specifically isolated proteins are commonly identified by mass spectrometry. This review summarizes probe designs, workflows, and published applications of the three dominant approaches in the field, namely affinity pulldown, activity-based protein profiling, and Capture Compound Mass Spectrometry.

Making Your Pharmacy Practice Department "in-dispense-able"

American Journal of Pharmaceutical Education. Aug, 2011  |  Pubmed ID: 21931461

Implementation of a Tool to Modify Behavior in a Chronic Disease Management Program

Advances in Preventive Medicine. 2011  |  Pubmed ID: 21991432

Chronic diseases like diabetes, hypertension, and dyslipidemia continue to be a significant burden on the US health care system. As a result, many healthcare providers are implementing strategies to prevent the incidence of heart disease and other chronic conditions. Among these strategies are proper drug therapy and lifestyle modifications. Behavior change is often the rate-limiting step in the prevention and maintenance of lifestyle modifications. The purpose of this paper is to describe a tool used to guide the progression and assess the effectiveness of a cardiovascular risk reduction program. The tool uses the Transtheoretical Model of Behavior Change to determine the readiness and confidence to change specific lifestyle behaviors pertinent to cardiovascular health. The tool aids the practitioner in developing a patient-centered plan to implement and maintain lifestyle changes and can be tailored to use in any situation requiring a behavior change on the part of the patient.

Pay-for-performance Model of Medication Therapy Management in Pharmacy Practice

Journal of the American Pharmacists Association : JAPhA. May-Jun, 2011  |  Pubmed ID: 21555297

To use an existing pharmacist-run medication therapy management (MTM)/lifestyle medicine program to propose a new model of reimbursement for pharmacists that is based on pay for performance (P4P) rather than product-based dispensing or fee for service.

An Evidence-based Review of Fat Modifying Supplemental Weight Loss Products

Journal of Obesity. 2011  |  Pubmed ID: 20847896

Objective. To review the literature on fat modifying dietary supplements commonly used for weight loss. Methods. Recently published randomized, placebo-controlled trials were identified in PubMed, MEDLINE, International Pharmaceutical Abstracts, Cochrane Database, and Google Scholar using the search terms dietary supplement, herbal, weight loss, obesity, and individual supplement names. Discussion. Data for conjugated linoleic acid (CLA), Garcinia cambogia, chitosan, pyruvate, Irvingia gabonensis, and chia seed for weight loss were identified. CLA, chitosan, pyruvate, and Irvingia gabonensis appeared to be effective in weight loss via fat modifying mechanisms. However, the data on the use of these products is limited. Conclusion. Many obese people use dietary supplements for weight loss. To date, there is little clinical evidence to support their use. More data is necessary to determine the efficacy and safety of these supplements. Healthcare providers should assist patients in weighing the risks and benefits of dietary supplement use for weight loss.

The Effects of High Physical Activity on Pharmacokinetic Drug Interactions

Expert Opinion on Drug Metabolism & Toxicology. Mar, 2011  |  Pubmed ID: 21244343

INTRODUCTION: With the development of new drugs, it is common practice for drug manufacturers to measure their pharmacokinetic parameters. This testing involves the discovery of the absorption, distribution, metabolic, excretory and toxicological properties of drugs. The testing is usually done in non-stressful conditions at rest, however, this does not necessarily tell the entire picture as there is increasing knowledge about the effects that high levels of physical activity can have on the pharmacokinetics of some medications. AREAS COVERED: This review discusses the alterations that physical activity can have on the absorption, distribution, metabolism and elimination parameters of commonly used medications, and clinical outcomes data are reported when known, demonstrating that an interaction exists between exercise and certain medications. This drug-exercise pharmacokinetic interaction alters the performance of medications especially under conditions where exercise is performed for a long period of time. Particular medications that may be affected are those with a narrow therapeutic dosing range, such as digoxin, theophylline and warfarin. Other important medications include insulin and those administered via a transdermal patch drug delivery system. For this review, a literature search was performed between 1966 and 2010. EXPERT OPINION: Patients and healthcare providers should be aware that exercise can adversely affect the way some medications are intended to work. Patients taking certain medications should be closely monitored when performing high amounts of physical activity.

Implementing Lifestyle Medicine with Medication Therapy Management Services to Improve Patient-centered Health Care

Journal of the American Pharmacists Association : JAPhA. Mar-Apr, 2011  |  Pubmed ID: 21382808

To describe a patient-centered medication therapy management (MTM) program that focuses on lifestyle medicine.

Transdermal Patch Drug Delivery Interactions with Exercise

Sports Medicine (Auckland, N.Z.). Mar, 2011  |  Pubmed ID: 21395361

Transdermal drug delivery systems, such as the transdermal patch, continue to be a popular and convenient way to administer medications. There are currently several medications that use a transdermal patch drug delivery system. This article describes the potential untoward side effects of increased drug absorption through the use of a transdermal patch in individuals who exercise or participate in sporting events. Four studies have been reported that demonstrate a significant increase in the plasma concentration of nitroglycerin when individuals exercise compared with rest. Likewise, several case reports and two studies have been conducted that demonstrate nicotine toxicity and increased plasma nicotine while wearing a nicotine patch in individuals who exercise or participate in sporting events compared with rest. Healthcare providers, trainers and coaches should be aware of proper transdermal patch use, especially while exercising, in order to provide needed information to their respective patients and athletes to avoid potential untoward side effects. Particular caution should be given to individuals who participate in an extreme sporting event of long duration. Further research that includes more medications is needed in this area.

Labeling and Enrichment of Arabidopsis Thaliana Matrix Metalloproteases Using an Active-site Directed, Marimastat-based Photoreactive Probe

Bioorganic & Medicinal Chemistry. Jan, 2012  |  Pubmed ID: 21775155

Matrix metalloproteases (MMPs) are secreted or membrane-bound zinc-containing proteases that play diverse roles in development and immunity in plants and in tissue remodeling in animals. We developed a photoreactive probe based on the MMP inhibitor marimastat, conjugated to a 4-azidotetrafluorobenzoyl moiety as photoreactive group and biotin as detection or sorting function. The probe labels At2-MMP, At4-MMP, At5-MMP, and likely other plant MMPs in leaf extracts, as shown by transient At-MMP expression in Nicotiana benthamiana, protein blot, and LC-MS/MS analysis. This MMP probe is a valuable tool to study the post-translational status of MMPs during plant immunity and other MMP-regulated processes.

Profiling of Methyltransferases and Other S-Adenosyl-L-homocysteine-binding Proteins by Capture Compound Mass Spectrometry

Methods in Molecular Biology (Clifton, N.J.). 2012  |  Pubmed ID: 22065221

There is a variety of approaches to reduce the complexity of the proteome on the basis of functional small molecule-protein interactions. We describe a generic approach based on trifunctional Capture Compounds, in which the initial equilibrium-driven interaction between a small molecule probe and target proteins is irreversibly fixed upon photo-crosslinking between an independent photo-activable reactivity function of the Capture Compound and the surface of the target protein(s). Subsequently, Capture Compound - protein conjugates are isolated from complex biological mixtures via the sorting function of the Capture Compound. Here, we describe the application of a trifunctional Capture Compound that carries the methyltransferase product inhibitor S-Adenosyl-L -homocysteine as the selectivity function for the isolation of methyltransferases from a complex lysate of Escherichia coli DH5α cells. Photo-activated crosslinking enhances yield and sensitivity of the experiment, and the specificity can be readily tested for in competition experiments using an excess of free S-Adenosyl-L -homocysteine.