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PAGE DRUG NAME 21st Ed. ; EFFECTIVE DATE OF ACTION SUPPLEMENT ; DOSAGE FORM, STRENGTH p. 102 GLIPIZIDE Added: 09-08-03 ; Added: 11-07-03 ; Added: Glucotrol XL 09-08-03 ; Added: Glucotrol XL 11-07-03 ; IPRATROPIUM BROMIDE Added: 06-29-03 ; Added: 06-29-03 ; LACTULOSE Added: 10-08-03 ; LISINOPRIL Added: 07-01-03 ; Added: Zestril 07-01-03 ; LITHIUM CARBONATE Added: 08-21-03 ; Added: Escalith CR 08-21-03 ; METFORMIN HYDROCHLORIDE Added: 10-28-03 ; Added: Glucophage XR 10-28-03 ; METHENAMINE HIPPURATE Added: 06-20-03 ; METHOCARBAMOL Added: 06-04-03 ; METRONIDAZOLE Added: 06-27-03 ; Added: 06-25-03 ; Added: Flagyl ER 06-25-03 ; tablet, extended release 5mg tablet, extended release 10mg tablet, extended release 5mg tablet, extended release 10mg spray, metered, nasal 0.021mg spray 0.03% ; spray, metered, nasal 0.042mg spray 0.06% ; solution, oral-rectal 10gm 15ml tablet, oral 30mg tablet, oral 30mg tablet, extended release 450mg tablet, extended release 450mg tablet, extended release 500mg tablet, extended release 500mg tablet, oral 1gm tablet, oral 500mg tablet, oral 250, 500mg tablet, extended release 750mg tablet, extended release 750mg.
His past June, Elizabeth Eisenhauer, MD, FRCP, Director of the Investigational New Drug Program for the National Cancer Institute Canada Clinical Trials Group and Professor at Queen's University, Kingston, Ontario, stepped down as the ASCO Course Director for the Flims Workshop on Methods in Clinical Cancer Research, after serving in this capacity since 2000. Co-sponsored by ASCO, the Federation of European Cancer Societies FECS ; , and the American Association for Cancer Research AACR ; , the purpose of the Flims workshop is to improve training in clinical trials design and to inspire and encourage young oncologists to pursue a career in clinical research. The success of the Flims workshop has been due in large measure to the dedication of the course directors and faculty who oversee the development of the program, and Dr. Eisenhauer is recognized for having brought many unique strengths to the position of Flims Course Director. Kris Vantongelen, FECS Conference and Program Manager, applauds Dr. Eisenhauer's contributions to the workshop, saying, "She has given so much of herself and her time to help develop a cadre of welltrained clinical cancer researchers in Europe. Under Elizabeth's leadership, nearly 400 young European oncologists passed through Flims and took the skills and knowledge she imparted back to their home institutes, where they form the new generation of clinical cancer researchers. This will be Elizabeth's.
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BRAND NAME GENERIC NAME TIER Beta-Adrenergic Blocking Agents BETAPACE sotalol HCL Tier 1 BLOCADREN timolol maleate Tier 1 CORGARD nadolol Tier 1 INDERAL propranolol HCL Tier 1 LOPRESSOR metoprolol tartrate Tier 1 SECTRAL acebutolol HCL Tier 1 TENORMIN atenolol Tier 1 VISKEN pindolol Tier 1 ZEBETA bisoprolol fumarate Tier 1 BETAPACE AF sotalol HCL Tier 2 TOPROL XL metoprolol succinate Tier 2 INDERAL LA propranolol HCL Tier 3 Calcium Channel Blocking Agents ADALAT CC nifedipine ext. rel Tier 1 AFEDITAB CR nifedipine Tier 1 CALAN verapamil HCL Tier 1 CALAN SR verapamil HCL ext. rel Tier 1 CARDENE SR CD nicardipine HCL ext. rel Tier 1 DILACOR XR CARDIZEM diltiazem HCL Tier 1 CARTIA XT diltiazem HCL Tier 1 DILTIA XT diltiazem HCL Tier 1 DILTIAZEM XR diltiazem HCL Tier 1 DILT-XR diltiazem HCL Tier 1 PLENDIL felodipine Tier 1 PROCARDIA nifedipine Tier 1 PROCARDIA XL nifedipine ext. rel Tier 1 TAZTIA XT diltiazem HCL Tier 1 COVERA HS verapamil ext. rel Tier 2 NIMOTOP nimodipine Tier 2 NORVASC amlodipine besylate Tier 2 SULAR nisoldipine Tier 2 VERELAN verapamil HCL ext. rel Tier 2 Hypotensives, Ace Inhibitors CAPOTEN captopril Tier 1 VASOTEC enalapril maleate Tier 1 ZESTRIL lisinopril Tier 1 ALTACE ramipril Tier 2 UNIVASC moexipril HCL Tier 2 ACCUPRIL quinapril Tier 3 Hypotensives, Angiotensin Receptor Antagonist BENICAR olmesartan medoxomil Tier 2 DIOVAN valsartan Tier 2.
Some commonly used ace inhibitors are benazepril lotensin ; , captopril capoten ; , enalapril vasotec ; , fosinopril monopril ; , lisinopril prinivil, zestril ; , moexipril univasc ; , perindopril aceon ; , quinapril accupril ; , ramipril altace ; and trandolapril mavik.
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Clamp-technique in a 4-week study with the ACE-inhibitor lisinopril or bisoprolol. Neither drug did exhibit any influence on insulin sensitivity [5]. Nevertheless, the results from this study in a normal clinical setting are encouraging and may indicate that a high degree of beta-1 selectivity, higher than that of metoprolol [6], is favourable from the metabolic point of view in the treatment of non-diabetic patients with primary hypertension. In this context it is also of interest that bisoprolol in antihypertensive doses does not exert the typical dyslipidaemic effects of beta-blockers. On the contrary, small but favourable changes have been demonstrated recently in plasma triglycerides, LDL, and HDL cholesterol [7] and meridia.
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IMPACT OF MORBID OBESITY ON CLINICALLY SIGNIFICANT HEPARIN INDUCED BLEEDS Brittany N. Henak * , Jodi A. Dreiling, Amy M. Rybarczyk Akron General Medical Center, 400 Wabash Avenue, Akron, OH, 44307 bhenak agmc PURPOSE: Therapeutic heparin dosing is typically performed using a weight-based heparin nomogram. However, there is no clear consensus on the appropriate weight to use for dosing morbidly obese patients. The objective of this study is to determine if the odds of clinically significant bleeding is higher in morbidly obese patients compared to non-obese patients when actual body weight is used to dose heparin. METHODS: This retrospective case control study was approved by IRRB. Case patients were identified through adverse reaction reports generated by the pharmacy department and by medical record codes. Cases of clinically significant bleeding were defined as death due to bleeding, retroperitoneal or intracranial bleeding, or a bleed with a decrease in hemoglobin greater than 2 grams per deciliter or requiring transfusion. Included patients were at least 18 years old and treated with heparin per the institution's nomogram. Exclusion criteria included: heparin used for acute coronary syndrome, cardiac catheterization, acute myocardial infarction, or stroke, heparin discontinued before aPTT therapeutic, or unknown patient height. Patients with significant bleeds were matched to a control group of patients treated with therapeutic heparin who did not have a clinically significant bleed. Patients were then categorized as morbidly obese with a body mass index greater than or equal to 40, or non-obese with a body mass index less than 30. The primary outcome was the odds of clinically significant bleeding in heparinized patients who were morbidly obese compared to non-obese patients. Other predictors of bleeding such as age, length of time on heparin, renal function and indication were isolated and compared between the bleeding and non-bleeding groups as secondary outcomes. RESULTS CONCLUSIONS: Data collection is in progress and final results will be presented. Learning Objectives: Identify the odds of bleeding when actual body weight is used to dose heparin in morbidly obese patients. Discuss the risk factors for bleeding while receiving therapeutic heparin. Self Assessment Questions: T or F Heparin's volume of distribution is similar to blood volume. What patient characteristics may increase the risk of bleeding while on heparin? and motrin.
And not initialed as given. No further entries were made as to why the medications had not been administered as ordered or any follow up procedures. On November 2, 2004, client #4 had an order change for Seroquel 25mg at bedtime. On December 6, 2004, during a random medication audit, the registered nurse noted that the 8PM dose of Seroquel for December 5, 2004 was initialed as given but medication was not punched out of bubble pack card. Notation was made on the back of the medication administration record on December 6, 2004, that Seroquel for December 5, 2004 was " not punched out and thus not given". No further entry was made as to why the medication had not been administered as ordered or any follow up procedures. Client #5 had physician orders signed October 19, 2004, which are effective October 1, 2004 through March 31, 2005 for Dyazide- one capsule daily, Aricept 10mg.- once daily, Lisinoprkl 10mg.- every morning, Norvasc 10mg.daily, Seroquel 25mg. -twice daily, and Oyster Shell with Vitamin D-one tablet twice daily. On October 18, 2004, the caregiver noted that she had not given all of the 8AM medications on October 16, 2004. The medications listed as not given were Dyazide, Aricept, Lisinopril, Norvasc, Seroquel, and Oyster Shell with Vitamin. D. All of the 8AM medications for October 16, 2004 were circled as not given with notation on the back of the medication administration record "all meds not given". No further entry was made as to why the medication had not been administered as ordered or any follow up procedures. Client #6 had physician orders, for Seroquel 25mg.- two tablets 50mg. ; three times daily. On October 23.
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Lists at the end of the booklet give the generic name and the trade name of the most commonly prescribed medications and note the section of the booklet that contains information about each type and naprosyn.
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Table 4: Reducing non-compliance rates could dramatically increase sales of some drugs No.of Patients at Start of Year Patient Attrition from NonCompliance Sales Lost through NonCompliance US$ bn ; Cost of Compliance Programme US$ bn, for example, lisinopril grapefruit.
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Avoid combined use with antiretroviral HIV ; agents: delavirdine, nevirapine, and all protease inhibitors see page 24 ; . Decreases their effectiveness. Rifampin decreases serum levels and effectiveness of: beta-blockers metoprolol, propranolol ; , ACE inhibitors lisinopril, et al. ; , azoleantifungals, clarithromycin, corticosteroids, cyclosporine, dapsone, diazepam, digoxin, disopyramide, doxycycline, fluvastatin, haloperidol, methadone, oral anticoagulants, oral contraceptives, progestins, phenytoin, quinidines, sulfonylureas oral hypoglycemics ; , tacrolimus, theophylline, tocainide, triazolam, tricyclics. Rifampin converts INH to toxic hydrazine. TMP SMX increases rifampin levels.
III. Laboratory Test Comments: 1. 2. 3. Newborn Panel Hemoglobin or Hematocrit 9 mos. & 11-20 yr. ; Urinalysis 5 yr. & 11-20 yr. ; Lead Level 12 mos. & 24 mos. ; Lead Level Drawn Due to + High Risk Assessment 5. Cholesterol Test if Indicated ; 6. TB Test If Indicated ; 7. STD Screening If indicated ; IV. Health Education Counseling V. Vision Testing VI. Hearing Language Testing Yes: Yes: Yes: No: No: No and soma.
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Health Provider Discussion Questions: 1. What would you do in this situation to promote effective communication and collaboration? 2. Are there any system impediments that influence your collaborative practice in family centred care? Parent Discussion Questions: 1. What do you think about this family story? 2. What role can families play if they are involved in similar situations? and sonata and lisinopril, for example, drug lisinopril more use.
There is therefore a need to explore alternative interventions in order to reduce the burden of the microvascular complications of diabetes. Systemic blood pressure BP ; is one such modifiable risk factor. BP is positively correlated with the prevalence of retinopathy, 9 and is also a powerful determinant of incidence.11 The EURODIAB Controlled trial of Lisinipril in Insulin-dependent Diabetes EUCLID ; and UK Prospective Diabetes Study UKPDS ; studies are the largest and most robust to date, exploring the impact of treatment with antihypertensive drugs on retinopathy in Type 1 and Type 2 diabetes, respectively.12, 13 EUCLID showed a 50% reduction in the progression of retinopathy on a 5-level scale over a two-year period in normotensive people with Type 1 diabetes treated with lisinopril. Progression to proliferative retinopathy was also significantly reduced. Importantly, there were indications that both incidence and regression of retinopathy were favourably influenced by lisinopril, though neither effect was statistically significant.12 Similarly, atenolol and captopril in the UKPDS demonstrated a reduction in the need for retinal photocoagulation in hypertensive people with Type 2 diabetes.13 The DIabetic Retinopathy Candesartan Trials DIRECT ; Programme has been designed to answer some of the questions which remain from EUCLID and the UKPDS. The original idea and study design was conceived by key members of the EUCLID Study Group, and further developed into the current protocol by the Steering Committee. Materials and methods Programme objectives The DIRECT Programme is designed to determine the effects of blocking the angiotensin II Type 1 AT1 ; receptor on retinopathy in normoalbuminuric patients with Type 1 and Type 2 diabetes.The Type 1 patients are exclusively normotensive at randomisation, whilst Type 2 patients include both treated hypertensive and normotensive patients. The primary objectives include: G To examine the effect of treatment on the incidence of retinopathy in Type 1 diabetic patients. G To examine the effect of treatment on progression of retinopathy in Type 1 and Type 2 diabetic patients. The secondary objective is to examine the effect of treatment on albumin excretion rate.
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Half a year later he had daily, but mild, attacks of angina pectoris. The ultrasound cardiography showed an ejection fraction of 60 %. A myocardial scintigram combined with an exercise test showed a marked exercise- induced ischemia in a moderately large inferior area. The coronary angiography showed that the LIMA graft was open with a probably significant stenosis just distal to the anastomosis. The venous graft to the right artery was open with an ostial stenosis and another stenosis was found just before the anastomosis and, distal to that, several additional stenosis were seen as well as an occluded PDA. Since his angina pectoris was rather mild, no reoperation was recommended. Over the last six years of intensive medical therapy his angina pectoris has improved and he seldom suffers chest pain. Six months before the CABG-operation he was referred to the Diabetes Centre at the hospital. At that time, his glucose level was high HbA1c 10.1 % MonoS HPLC method, normal 3.95.3 % in spite of treatment with metformin 500 mg b.i.d. and glibenclamide 7 mg a day. Other medications were metoprolol 200 mg, felodipin 5 mg, lisjnopril 20 mg, isosorbidnitrate 60 mg, acetylsalicylic acid 75 mg a day, cerivastatin 200 mg a day and bezafibrate 200 mg t.i.d. Through life-style intervention, body weight decreased from 122 to 118 kg in six months and HbA1c was improved to 7.0 %. Prescription of orlistat 120 mg t.i.d. further helped to reduce body weight to 98.3 kg. Glibenclamide was discontinued when HbA1c was 5.8 %. His most recent body weight is 96.5 kg, HbA1c is 5.6 % and he is using a low dose of repaglinide together with metformin 1 g b.i.d. The initial HDL-cholesterol level was extremely low, 0.27 mmol l, total cholesterol was 5.3 mmol l and triglycerides 7.7 mmol l, respectively, in spite of cerivastatin 200 mg and bezafibrate 200 mg t.i.d. During the subsequent seven years, HDL-cholesterol has been at 0.44-0.78 mmol l. The most recent values are triglycerides 1.21 mmol l, total cholesterol 3.61 mmol l, HDL-cholesterol 0.95 mmol l and LDL-cholesterol 2.42 mmol l. Cerivastatin and bezafibrate have has been exchanged to simvastatin and fenofibrate since 4 and 2.5 years, respectively. His blood pressure is well regulated with values in the standing position of around 130 80 mm Hg. The adipokine, adiponectin, was measured and found to be very low 5.26 g ml; "normal" around 10 g ml ; and with extremely low high molecular weight HMW ; form. CASE 2 Diabetes with both macrovascular and prominent microvascular disease At the age of 47 years in 1994, this previously healthy man was diagnosed with type 2 diabetes mellitus and glibenclamide treatment was initiated. A routine fundoscopy at that time demonstrated diabetic maculopathy with pre-proliferative features and laser treatment was started. In 1997, the patient was referred to the Diabetes Centre at the hospital due to "surprisingly rapid progression of diabetic retinopathy" and unsatisfactory risk factor control. The patient had a BMI of 25.3, HbA1c was 6.8 %, blood pressure 160 100 mg Hg, urinary albumin excretion 51 g min normal 20 g min ; and he exhibited a moderate dyslipidemia total cholesterol 5.5 mmol l, serum triglycerides 1.4 mmol l, HDL-cholesterol 1.1 mmol l and LDL-cholesterol 3.8 mmol l ; . The glibenclamide dose was increased and treatment with enalapril and furosemide added leading to a lowering of the blood pressure to 143 86 mm Hg. Subsequently, the risk factor control slowly deteriorated, including an increasing urinary albumin excretion rate as well as progressive retinal changes. In 1999, treatment with premixed insulin b.i.d as well as a low dose of atorvastatin was started.
During admission to the geriatric ward an important goal is the optimisation of pharmacotherapy and we showed a primary role for preventive therapy, for example vitamin supplementation. It is known that an inadequate folate status is associated with an increased risk for chronic diseases that may have a negative impact on the health of the aging population7. Studies showed a relative risk of 6.8 for folate deficiencies in elderly living at home versus elderly living in institutions8 and its prevalence increases with age9. Elderly populations aged over 65 and residents of nursing homes showed prevalence of vitamin D deficiencies between 25 and 54%. This deficiency is an important risk factor for osteopenia and bone fractures. Supplementation of 800IE vitamin D daily showed substantially reduced risks of osteoporotic fractures10. The risk of developing gastroduodenal ulcers or complications is recognised as a problem in patients using NSAIDs. Important risk factors are increasing age and a past history of upper gastrointestinal ulcer or bleeding11. Once daily pantoprazole that showed efficacy in preventing peptic ulcers12, is often co-prescribed with NSAIDs in our setting. Optimisation by means of an ACE inhibitor, for example lisinopril, is favourable in type 1 diabetes mellitus with microalbuminuria, because blood pressure control is a key element in slowing the progression of diabetic nephropathy13. ACE inhibitors are also of primary importance after acute decompensated heart failure because of proven prolonged life expectance14. Geriatric health care has changed. In 1985, the geriatric ward of our hospital counted 108 beds6 compared to only 24 beds in 2002. However, the geriatric day clinic counted 702 first-time visitors in 2002 and plays an important role in diagnostics resulting in less and shorter durations at the ward. In 2002, patients used almost twice as much medication as the studied population in 1985. This can be explained by the introduction of new medication groups since 1985, introduction of more guidelines and guidelines advising drug combinations. For example, patients with heart failure resulting from left ventricular dysfunction are now often treated with a combination of an ACE inhibitor, diuretic, a beta blocker and spironolactone15.
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Appendix B Therapeutic Equivalence of ACE inhibitors7 SUMMARY OF REVIEW QUESTION AND METHODS: A systematic review was conducted to determine if individual Angiotensin Converting Enzyme Inhibitors ACEs ; available in Canada for oral use are therapeutically equivalent i.e. equivalent with respect to morbidity, mortality and major adverse effects ; in the treatment of hypertension and congestive heart failure. MEDLINE and EMBASE were searched from 1980 to October 1999 using a sensitive search strategy described below ; . Any meta-analyses of head to head RCT of ACEs were also reviewed for additional information. References of each retrieved article and recent review articles 1998- ; were also manually searched. An additional search was carried out between 1999 and March 2001 to identify if there were new studies available that could add information to this review. Included studies were all English language studies done in humans that were randomized controlled trials carried out in patients with hypertension measured by office method or ambulatory blood pressure monitoring ; or congestive ; heart failure independent of the severity of the disorder addressing the outcomes of interest. Articles pertaining to diabetic nephropathy or use of ACEs after myocardial infarction were not included. Reviews except for the purpose of locating references as discussed above ; , placebo controlled randomized trials with a single ACE, other uses of ACEs for purposes not identified here, other research questions, editorials, and letters to the editor, and studies examining parenteral dosage forms of ACEs were not included. All citations reviewed by one person to determine if each met the inclusion criteria and to complete data extraction. The analysis of the literature was done qualitatively. RESULTS: 1710 abstracts were found and reviewed from MEDLINE and EMBASE searches. 77 articles 56 from MEDLINE and EMBASE and 21 from other sources ; were identified as potential meeting the inclusion criteria. 38 studies were included in the final analysis. One study was reported twice. 1, 2 23 studies3-25 evaluated ACE in the treatment of hypertension and 15 studies1, 26-39 evaluated ACE in the treatment of CHF. The majority of studies compared captopril or enalapril to other agents Table B1 ; HYPERTENSION: The majority of studies did not find any differences among the ACE evaluated for lowering blood pressure Table B2, Table B3 ; . When lisinopril was compared to enalapril using the same per milligram dose, two studies4, 6 found no significant differences while 2 studies3, 19 found that while there were no differences between the agents during the first 12 hours of the 24-hour dosing period, lisinopril was more effective in maintaining a lower blood pressure during the later half of the 24-hour dosing period. Another comparison of lisinopril with enalapril showed that lisinopril 10-40mg was more effective that enalapril 5-20mg, a result that is most likely and meridia.
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1. Candelaria LM, Huttula CS. Angioedema associated with angiotensin-converting enzyme inhibitors. J Oral Maxillofacial Surg 1991; 49: 1, Jain M, Armstrong L, Hall J. Predisposition to, and late onset of upper airway obstruction following angiotensin-converting enzyme inhibitor therapy. Chest 1992; 102: 871-3. Finley C, Silverman M, Hunez A. Angiotensin-converting enzyme inhibitor induced angioedema: still unrecognized. J Emerg Med 1992; 10: 550-2. Rees RS, Bergman J, Ramirez-Alexander R. Angioedema associated with lisinopril. J Emerg Med 1992; 10: 321-2. Hedner T, Samuelson 0, Lunde H, Lindholm L, Andren L, Weholm BE. Angioedema in relation to treatment with angiotensin-converting enzyme inhibitors. Br Med J 1992; 304: 941-5. Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensinconverting enzyme inhibitor therapy: a review of the literature and pathophysiology. Ann Intern Med 1992; 117: 234-42. Ulmer JL, Garvey MJ. Fatal angioedema associated with lisinopril. Ann Pharmacotherapy 1992; 26: 1, Robert H. Dolin, MD1; Liora Alschuler2; Fred Behlen, PhD3; Paul V. Biron, MLIS1; Sandy Boyer, RPh; Dan Essin, MD4; Lloyd Harding5; Tom Lincoln, MD6, 7; John E. Mattison, MD1; Wes Rishel8; Rachael Sokolowski9; John Spinosa, MD, PhD10; Jason P. Williams, MS11 1 Kaiser Permanente; 2The Word Electric; 3U. of Chicago; 4USC; 5Information Assembly Automation Inc.; 6Rand Corp.; 7U. of Illinois at Chicago; 8Wes Rishel Consulting; 9 Magnolia Technologies; 10Scripps Health, PMG; 11Oceania Inc.
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Drug Regimen Diuretics Hydrochlorothiazide 25mg QD Furosemide 40mg QD Bumetanide 2mg QD Zaroxyln 5mg QD Spironolactone 50mg BID Beta Blockers Atenolol 50mg QD Metoprolol 50mg BID Toprol XL 100mg QD Propranolol 80mg BID Inderal LA 120mg QD ACEI Lisinopril 20mg QD Enalapril 20mg QD Accupril 20mg QD Altace 5mg QD ARBs Diovan 160mg QD Cozaar 100mg QD Benicar 20mg QD CCBs Norvasc 10mg QD Cartia XT 240mg QD Verapamil SA 240mg QD Plendil 10mg QD Nifedipine ER 60mg QD Alpha Blockers Terazosin 5mg QD Doxazosin 4mg QD Central Acting Antiadrenergic Agents Clonidine 0.1mg BID Clonidine 0.2mg BID Catapres-TTS-1 Q Week Catapres-TTS -2 Q Week Combination Agents Lisinopril HCTZ 20mg 25mg QD Hyzaar 50mg 12.5mg QD Lotrel 10 20mg QD AWP for 30 day Supply1 $1.60 $1.80 $12.00 $49.50 $19.50 $4.30 $5.65 $37.80 $12.80 $59.40 $8.48 $6.60 $40.80 $46.50 $56.70 $67.80 $45.90 $68.10 $35.75 $10.20 $75.90 $48.35 $13.50 $7.80 $5.63 $9.14 $60.68 $102.20 $14.36 $49.80 $87.00.
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