A subtherapeutic international normalized ratio despite increasing doses of warfarin: could this be malabsorption?
*Drug Resistance; Administration; Adult; Anticoagulants/administration & dosage/metabolism/pharmacokinetics/therapeutic use; Area Under Curve; Biological Availability; Dose-Response Relationship; Drug; Female; Humans; Injections; Intestinal Absorption/*physiology; Intravenous; Kidney Transplantation; Oral; Warfarin/*administration & dosage/*metabolism/pharmacokinetics/therapeutic use
OBJECTIVE: To describe a case of warfarin resistance apparently caused by malabsorption and to review the literature regarding warfarin resistance. CASE SUMMARY: A 28-year-old renal transplant patient with systemic lupus erythematosus was admitted for upper extremity thrombophlebitis. Resistance to oral warfarin was demonstrated. Potential causes were investigated. The trapezoidal rule was used to compare the area under the curve for intravenous versus oral dosing of warfarin. The usual bioavailability of warfarin should be 100%. In this patient, warfarin bioavailability after oral dosing was 1.5%. Three potential causes, malabsorption (FF), enzymatic degradation (FG), and first-pass extraction in the portal circulation (FH), are discussed. CONCLUSION: This case demonstrates resistance to warfarin presumably caused by malabsorption.
Lara L F; Delgado L L; Frazee L A; Haupt K M; Rutecki G W
The American journal of the medical sciences
2000
2000-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0002-9629(15)40823-7" target="_blank" rel="noreferrer noopener">10.1016/s0002-9629(15)40823-7</a>
Utilization of a reminder mailing to improve blood glucose log reporting in an outpatient diabetes clinic.
Adult; Female; Male; Aged; Prospective Studies; Patient Compliance; Human; Middle Age; Retrospective Design; Mail; Reminder Systems; Ambulatory Care – Methods; Hypoglycemic Agents – Therapeutic Use; Blood Glucose Self-Monitoring – Methods; Diabetes Mellitus – Drug Therapy
Self-monitored blood glucose (SMBG) offers a strategy used to achieve glycemic control in diabetic patients. However, if SMBG readings are unavailable to clinicians, this strategy will have a limited effect. This study assessed the impact of a reminder mailing on response rates to requests for SMBG logs. Patients were asked to mail completed SMBG logs to the clinic in 2 weeks. For the intervention, a reminder mailing was sent to each patient 1 week before SMBG logs were to be returned. Compliance rates pre and postinterventions were compared. The primary outcome was the percentage of all SMBG logs returned on time. Secondary outcomes included the percentage of SMBG logs returned, percentage fulfilled, percentage of clinic appointments kept, percentage of SMBG logs brought to follow-up appointments, and number of interventions made to antidiabetic therapy. Twenty SMBG requests were made in the preintervention cohort versus 19 in postintervention cohort. A trend toward more on time and fulfilled SMBG requests was observed post vs. preintervention. Overall return rates were similar between groups. A nonsignificant increase in clinic appointments kept and a nonsignificant decrease in interventions made were observed postintervention. Receipt of a reminder mail was not a significant predictor of patients bringing an SMBG log to follow-up appointments. In conclusion, the use of a reminder mail was not associated with an increase in the return rate of SMBG logs, although there were nonsignificant trends toward more on time and fulfilled SMBG logs received during the postintervention period.
Moorman JM; Frazee L A; Dillon ML; Chomo DL; Myers NA
American Journal of Therapeutics
2012
2012-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e3181f94c16" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3181f94c16</a>
Cinacalcet for the treatment of primary hyperparathyroidism.
Female; Hormone Replacement Therapy; Hydrocarbons – Therapeutic Use; Bone Density – Drug Effects; Calcitonin – Therapeutic Use; Diphosphonates – Therapeutic Use; Estrogens – Therapeutic Use; Hormone Antagonists – Pharmacodynamics; Hormone Antagonists – Therapeutic Use; Hydrocarbons – Pharmacodynamics; Hyperparathyroidism – Complications; Hyperparathyroidism – Drug Therapy; Osteoporosis – Drug Therapy; Osteoporosis – Etiology; Raloxifene – Therapeutic Use
The objective of this article is to review the literature regarding the treatment of primary hyperparathyroidism (PHPT) with a focus on cinacalcet. A MEDLINE (1965-June 2009) and bibliographic search of the English-language literature was conducted using the search terms cinacalcet, calcimimetics, primary hyperparathyroidism, and treatment. All articles identified in the search were included. Parathyroidectomy is curative for patients with PHPT; however, there are few options for patients who are not surgical candidates, who refuse surgery, or those with refractory PHPT after parathyroidectomy. Possible treatment options include estrogens, raloxifene, bisphosphonates, calcitonin, and cinacalcet. Cinacalcet has been shown to decrease serum calcium and parathyroid hormone serum levels in patients with PHPT. These trials, however, have not studied the effect of cinacalcet on patient-oriented outcomes such as bone mineral density, nephrolithiasis, or other complications of PHPT. Cinacalcet may be considered to reduce serum calcium and parathyroid hormone serum levels in patients with PHPT who cannot or will not undergo surgery and those with refractory PHPT after parathyroidectomy. Because the effects of cinacalcet on bone mineral density are uncertain, more frequent monitoring of bone mineral density may be required along with a medication proven to improve bone mineral density. Future studies should evaluate the effect of cinacalcet on complications of PHPT.
Dillon ML; Frazee L A
American Journal of Therapeutics
2011
2011-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/mjt.0b013e3181bdc3d0" target="_blank" rel="noreferrer noopener">10.1097/mjt.0b013e3181bdc3d0</a>
Comparison of short-acting intramuscular antipsychotic medication: impact on length of stay and cost.
Adult; Female; Male; Prospective Studies; Health Care Costs; Injections; Middle Age; Retrospective Design; Intramuscular; Antiinfective Agents; Length of Stay – Statistics and Numerical Data; Schizophrenia – Drug Therapy; Heterocyclic Compounds – Therapeutic Use; Antianxiety Agents; Antipsychotic Agents – Administration and Dosage; Antipsychotic Agents – Economics; Antipsychotic Agents – Therapeutic Use; Benzodiazepine – Economics; Benzodiazepine – Therapeutic Use; Haloperidol – Economics; Haloperidol – Therapeutic Use; Heterocyclic Compounds – Economics; Length of Stay – Economics; Psychomotor Agitation – Drug Therapy; Quinolone – Economics; Quinolone – Therapeutic Use; Thiazoles – Economics; Thiazoles – Therapeutic Use
A retrospective cohort study was conducted to determine if there is an association between short-acting intramuscular (SAIM) antipsychotics used for acute agitation and length of stay (LOS). Patients with a diagnosis of schizophrenia or schizoaffective disorder who were dispensed at least one dose of a SAIM antipsychotic were divided into groups based on the initial SAIM antipsychotic received once admitted to a psychiatric unit. Electronic records were used to gather demographic information, LOS, and number of injections received during an admission. Cost was calculated from the number of injections received. One-hundred and thirty-six patients were enrolled. When comparing the haloperidol group to the second generation antipsychotic group, there was no statistically significant difference, in LOS 16.98 ± 9.56 days versus 17.59 ± 11.52 days (P = 0.75), respectively. There was a statistically significant difference in both cost and number of injections between groups, favoring the haloperidol group. Ziprasidone was associated with a shorter LOS compared with olanzapine, 13.57 and 19.10 days, respectively (P = 0.026). Patient characteristics should be evaluated when determining an agent for acute agitation. However, because literature indicates second generation SAIM antipsychotics are only noninferior to haloperidol; other factors should also be evaluated; including impact on LOS and impact on hospital resources. This study indicates use of a second generation SAIM antipsychotic for acute agitation is more costly, requires more injections, and was not associated with a shorter length of stay when compared with SAIM haloperidol.
Leung JG; Benedetti AM; Frazee L A; Myers N; Leung Jonathan G; Benedetti Amanda M; Frazee Lawrence A; Myers Nancy
American Journal of Therapeutics
2011
2011-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e3181d48320" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3181d48320</a>
Screening for nephropathy and antiangiotensin use among diabetic patients in an academic community medical center.
Female; Male; Aged; Age Factors; Drug Utilization; Academic Medical Centers; Diabetes Mellitus; Human; Middle Age; Practice Guidelines; Retrospective Design; Professional Compliance; Type 2 – Drug Therapy; Type 2 – Complications; Hypertension – Diagnosis; Coronary Arteriosclerosis – Diagnosis; Angiotensin-Converting Enzyme Inhibitors – Therapeutic Use; Angiotensin II Type I Receptor Blockers – Therapeutic Use; Diabetic Nephropathies – Diagnosis; Diabetic Nephropathies – Epidemiology; Diabetic Nephropathies – Etiology; Hypertension – Drug Therapy; Proteinuria – Diagnosis; Type 1 – Complications; Type 1 – Drug Therapy
The American Diabetes Association recommends routine screening for albuminuria to detect early nephropathy in all patients with diabetes mellitus. If nephropathy is identified, treatment with an antiangiotensin agent decreases progression and improves renal outcomes. Concordance with guidelines for nephropathy screening and antiangiotensin therapy among diabetic patients in a primary care setting of an academic community medical center was evaluated. Medical charts of adult patients with diabetes mellitus from February 2000 through January 2003 were retrospectively reviewed. In part 1 of the study, whether patients were screened for nephropathy at least once was recorded. In part 2 of the study, antiangiotensin prescribing was assessed in all patients and in subgroups stratified by screening. In both parts of the study, patient characteristics and comorbidities were assessed using multivariate analysis to determine their impact on the odds that a patient was screened and that antiangiotensin therapy was prescribed. Among the 329 patients included, 182 patients (55.3%) were screened for nephropathy. Patients who were screened were younger (OR=0.83 for 10-year increase, 95% CI: 0.69-0.99), less likely to have congestive heart failure (OR=0.42, 95% CI: 0.20-0.90), and more likely to be cared for by a resident physician directly supervised by an attending physician (OR=3.03; 95% CI: 1.82-5.03). A total of 215 patients (65.3%) were prescribed antiangiotensin therapy. Hypertension was a predictor of antiangiotensin therapy among all patients who were screened (OR=10.34, 95% CI: 4.45-24.01), those who were screened and negative (OR=15.46, 95% CI: 5.56-42.98), and those who were not screened (OR=10.79, 95% CI: 4.39-26.52). Among patients screened for nephropathy, coronary artery disease (OR=3.01, 95% CI: 1.05-8.63), and the presence of proteinuria (OR=4.26, 95% CI: 1.61-11.24) were predictors of antiangiotensin use. This study found that the likelihood of screening for nephropathy among diabetic patients was inversely associated with a diagnosis of congestive heart failure and increasing age. Conversely, care by a resident physician directly supervised by an attending physician increased the odds that patients would be screened. A diagnosis of hypertension and the presence of albuminuria were each associated with increased use of an antiangiotensin agent.
Frazee L A; Samandari S; Tanphaichitr N; Bourguet C C; Pfister EW
American Journal of Therapeutics
2006
2006-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.mjt.0000174345.59177.9b" target="_blank" rel="noreferrer noopener">10.1097/01.mjt.0000174345.59177.9b</a>
Drug-induced acute renal failure: keys to recognizing and treating intrarenal toxicity.
Adult; Female; Male; Aged; Risk Factors; Kidney Function Tests; Kidney Failure; Physiologic; Monitoring; Nephrotoxicity; Antiinflammatory Agents; Non-Steroidal – Adverse Effects; Acute – Chemically Induced; Acute – Diagnosis; Acute – Therapy; Aminoglycosides – Adverse Effects; Amphotericin B – Adverse Effects; Contrast Media – Adverse Effects; Drugs – Adverse Effects; Nephrotoxicity – Prevention and Control
Drug-induced acute tubular necrosis is a primary cause of acute renal failure (ARF); it may result from the use of such agents as aminoglycosides, amphotericin B, and radilocontrast media. To reduce the risk of aminoglycoside toxicity, prescribe the shortest course possible, use once-daily dosing, monitor serum concentrations, and avoid using these agents altogether in patients with known risk factors. Radiocontrast media-associated ARF is most likely to occur with preexisting renal damage, especially in a patient with diabetes mellitus. Since sodium depletion is the most important risk factor for nephrotoxic injury with amphotericin B use, saline loading is recommended both before and during drug administration. Drug-induced acute interstitial nephritis, another important cause of ARF, has been associated with a number of antibiotics, especially penicillin and ampicillin; many patients recover with the removal of the offending agent.
Frazee L A; Rutecki G W; Whittier F C
Consultant (00107069)
1997
1997-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Drug-induced acute renal failure: recognizing and treating prerenal, postrenal, and pseudorenal injury.
Female; Male; Aged; Risk Factors; Hemodynamics; Physical Examination; Inpatients; Middle Age; Kidney Function Tests; Kidney Failure; Nephrotoxicity; Antiinflammatory Agents; Acute – Etiology; Angiotensin-Converting Enzyme Inhibitors – Adverse Effects; Antineoplastic Agents – Adverse Effects; Non-Steroidal – Adverse Effects; Acute – Chemically Induced; Acute – Diagnosis; Acute – Therapy; Enzyme Inhibitors – Adverse Effects; Renal Circulation – Drug Effects
Angiotensin-converting enzyme (ACE) inhibitors and NSAIDs are among the drugs most commonly associated with acute renal failure (ARF). Patients at risk for ACE inhibitor-induced ARF include those with congestive heart failure (CHF) or compromised left ventricular (IV) function and those receiving diuretics. In these settings, discontinue the ACE inhibitor and direct therapy toward correcting volume or improving the ineffective circulation (by appropriately reducing afterload, by ensuring adequate IV filling pressures, and by treating ischemia). Risk factors for NSAID-included ARF include CHI, poor renal perfusion, and recent hospitalization. Postrenal ARF may be precipitated by drugs that are highly insoluble in addic urine, such as antineoplastic agents and HmG-CoA reductase inhibitors. Alkalinization of urine and hydration are the cornerstones of management of this type of ARF.
Frazee L A; Rutecki G W; Whittier F C
Consultant (00107069)
1997
1997-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Management of asymptomatic bacteriuria in patients with diabetes mellitus
bacteriuria; diabetes mellitus; Pharmacology & Pharmacy; urinary-tract infections; women
OBJECTIVE: To review the literature regarding the management of asymptomatic bacteriuria (ASB) in patients with diabetes mellitus. DATA SOURCES: A MEDLINE (1967-June 2003) and bibliographic search of the English-language literature was conducted using the search terms diabetes mellitus, asymptomatic, bacteriuria, and urinary tract infection. DATA SYNTHESIS: ASB occurs in diabetic women more commonly than in non-diabetics and is associated with an increased risk of symptomatic urinary tract infection (UTI) among patients with type 2 diabetes. Symptomatic UTIs tend to follow a more complicated course in diabetics. Despite these independent observations, antimicrobial therapy has not been shown to reduce symptomatic UTIs, pyelonephritis, or hospitalization for UTI. CONCLUSIONS: Available evidence does not support antimicrobial treatment of ASB among patients with diabetes mellitus.
Ooi S T; Frazee L A; Gardner W G
Annals of Pharmacotherapy
2004
2004-03
Journal Article
<a href="http://doi.org/10.1345/aph.1D355" target="_blank" rel="noreferrer noopener">10.1345/aph.1D355</a>
Retrospective Evaluation Of A Method To Predict Fresh-frozen Plasma Dosage In Anticoagulated Patients
anticoagulation reversal; dose prediction; efficacy; factor viia; fresh-frozen plasma; hemostasis; Pharmacology & Pharmacy; prothrombin complex concentrate; therapy; transfusion; urgent reversal; warfarin
Frazee L A; Bourguet C C; Gutierrez W; Elder-Arrington J; Elackattu A E P; Haller N A
American Journal of Therapeutics
2008
2008-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/MJT.0b013e3180ed4345" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3180ed4345</a>
Duration Of Anticoagulant Therapy After Initial Idiopathic Venous Thromboembolism
anticoagulation; antiphospholipid syndrome; deep-vein thrombosis; duration of therapy; factor-v-leiden; first episode; heterozygous carriers; idiopathic venous thromboembolism; intensity warfarin therapy; long-term; medical progress; Pharmacology & Pharmacy; pulmonary-embolism; risk; warfarin
Frazee L A; Chomo D L
Annals of Pharmacotherapy
2003
2003-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1345/aph.1C486" target="_blank" rel="noreferrer noopener">10.1345/aph.1C486</a>
Use Of Intravenous Valproic Acid For Acute Migraine
headache; migraine headache; Pharmacology & Pharmacy; sodium valproate; valproic acid
Frazee L A; Foraker K C
Annals of Pharmacotherapy
2008
2008-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1345/aph.1K531" target="_blank" rel="noreferrer noopener">10.1345/aph.1K531</a>
Long-term Prophylaxis Of Spontaneous Bacterial Peritonitis In Patients With Cirrhosis
1st episode; antibiotic-prophylaxis; antimicrobial; ascites; ascitic fluid; cirrhosis; double-blind; gastrointestinal hemorrhage; infection; opsonic activity; peritonitis; Pharmacology & Pharmacy; predictive factors; prevention; randomized-trial
Frazee L A; Marinos A E; Rybarczyk A M; Fulton S A
Annals of Pharmacotherapy
2005
2005-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1345/aph.1E585" target="_blank" rel="noreferrer noopener">10.1345/aph.1E585</a>
Update On Prostate Cancer Chemoprevention
5-alpha-reductase inhibitors; antigen; beta-carotene; chemoprevention; clinical trial; dutasteride; finasteride; men; nonsteroidal antiinflammatory drugs; over-expression; PCPT; Pharmacology & Pharmacy; prevention; prostate cancer; REDUCE trial; REDUCE trial; risk; SELECT; selenium level
Lowe J F; Frazee L A
Pharmacotherapy
2006
2006-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1592/phco.26.3.353" target="_blank" rel="noreferrer noopener">10.1592/phco.26.3.353</a>
Subtherapeutic International Normalized Ratio Despite Increasing Doses Of Warfarin: Could This Be Malabsorption?
azathioprine; drug-interaction; General & Internal Medicine; patient; resistance; therapy; warfarin malabsorption; warfarin resistance
Objective: To describe a case of warfarin resistance apparently caused by malabsorption and to review the literature regarding warfarin resistance. Case Summary: A 28-year-old renal transplant patient with systemic lupus erythematosus was admitted for upper extremity thrombophlebitis. Resistance to oral warfarin was demonstrated. Potential causes were investigated. The trapezoidal rule was used to compare the area under the curve for intravenous versus oral dosing of warfarin. The usual bioavailability of warfarin should be 100%. in this patient, warfarin bioavailability after oral dosing was 1.5%. Three potential causes, malabsorption (FF), enzymatic degradation (FC), and first-pass extraction in the portal circulation (FH), are discussed. Conclusion: This case demonstrates resistance to warfarin presumably caused by malabsorption.
Lara L F; Delgado L L; Frazee L A; Haupt K M; Rutecki G W
American Journal of the Medical Sciences
2000
2000-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00000441-200009000-00015" target="_blank" rel="noreferrer noopener">10.1097/00000441-200009000-00015</a>