This review examines literature on the efficacy and abuse potential of carisoprodol, makes recomm... more This review examines literature on the efficacy and abuse potential of carisoprodol, makes recommendations for use of this agent in the hospital setting, and outlines applicable federal and state regulations. A Medline search using key words and MeSH terms was conducted. In addition, International Pharmaceutical s (1970–2002), Current Contents (1996–2002), Cochrane Database of Systematic Reviews (1999–2002), and Psych Info (1872–2002) were searched for relevant literature. Articles cited in the bibliographies produced by these searches were included in the review. A Web of Science search was conducted for all citations found in all the searches. Pain is a common physical symptom in patients with musculoskeletal problems, and pharmacologic therapy is often combined with nonpharmacologic measures to treat the pain etiology and symptomatology. Skeletal muscle relaxants (SMRs) and nonsteroidal anti-inflammatory drugs (NSAIDs) represent the most common drug therapy choices in patients with mild-to-moderate somatic pain. Carisoprodol (Soma) is an SMR that has a poorly defined mechanism of action and a high potential for abuse. This literature review produced little evidence to support the use of carisoprodol in pain control. The research also showed that patients with a history of previous substance abuse are more likely to abuse this drug; thus carisoprodol does not meet safety and efficacy standards and should be removed from the market. At the very least, states should reschedule carisoprodol as a schedule IV controlled substance to minimize chronic misuse and abuse. If carisprodol is listed in hospital formularies, it should be handled as a controlled substance regardless of its federal status. Alternative sedatives (eg, phenobarbital) should be used to manage patients experiencing carisoprodol withdrawal symptoms.
This article is the third in a series of studies measuring the impact of cultural diversity on hu... more This article is the third in a series of studies measuring the impact of cultural diversity on human development. We disaggregate cultural diversity into three components: ethnicity, language, and religion. The first study examined the impact of diversity internationally. We found that countries are worse off with greater diversity, especially religious diversity; however, we found that more-prosperous countries with strong institutions benefited from increased diversity. We concluded that strong institutions are essential to maximize the benefits of diversity while mitigating the associated costs. The second study examined the impact of diversity within the United States, where institutional strength was assumed to be relatively great and similar between states. We found an overall negative impact from diversity. Ethnic diversity was negatively associated with human development, while religious and language diversity had a positive impact. We concluded that in the United States, th...
Meperidine (Demerol) is an opiate analgesic that is not considered first-line therapy for most pa... more Meperidine (Demerol) is an opiate analgesic that is not considered first-line therapy for most pain management indications because of concerns about its safety and efficacy. Inpatient data from a 417-bed community teaching hospital revealed high use of meperidine in oral, IM, and IV forms. A multifaceted academic detailing approach was employed to change prescribing behavior and decrease meperidine use. This approach included conducting two concurrent Medication Use Evaluations; Grand Rounds presentations for pharmacy staff, nurses, and medical residents; solicitation of opinion leaders; pocket and table-top cards; newsletter articles; and provision of pharmaceutical care. Comparing the number of meperidine doses dispensed per adjusted patient day before and after the intervention, use was reduced by 0.0966 doses per patient (P < 0.05: 95% CI, 0.0955 to 0.0977). The number of patients receiving meperidine was reduced by 2.43% (P < 0.05: 95% CI, 1.97 to 2.88). This translates i...
Purpose Since IV admixtures of oxytocin in the final working concentrations are not commercially ... more Purpose Since IV admixtures of oxytocin in the final working concentrations are not commercially available, oxytocin admixtures must be prepared immediately before use or compounded in a sterile laminar flow hood and stored until needed. Although published reports indicate short-term stability of oxytocin in Ringer's lactate solution and Ringer's lactate-dextrose 5%, longer-term stability data at various temperatures are lacking. Methods A stability assay was developed, validated, and executed with oxytocin at two different concentrations in Ringer's lactate solution. Stability was assessed at 4 and 25°C over 31 days. Results This study shows that commonly used dilutions of oxytocin in Ringer's lactate solution retain greater than 90% of initial concentrations, when stored at room temperature or refrigerated for 31 days. These data show that oxytocin admixed with Ringer's lactate solution has extended chemical stability after preparation. Conclusions Demonstratio...
Journal of Liquid Chromatography & Related Technologies, 2006
... and its Application in Stability Analysis Vipul Kumar, Rajanikanth Madabushi, and Hartmut Der... more ... and its Application in Stability Analysis Vipul Kumar, Rajanikanth Madabushi, and Hartmut Derendorf Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA Lisa A. Boothby and Burnis ...
Attention-deficit/hyperactivity disorder is a highly diagnosed psychiatric disorder in children. ... more Attention-deficit/hyperactivity disorder is a highly diagnosed psychiatric disorder in children. This widespread and complex condition requires extensive evaluation involving clinicians, parents and teachers. Proper management involves individual assessment and treatment. Psychostimulants remain the primary medication of choice as they have been shown to be efficacious for this condition. Newer, long-acting medications are providing expanded options for children and their caregivers. Failure to assess and treat can lead to serious long-term effects later in life.
Although preventability criteria have been assessed for all adverse drug reactions (ADRs) investi... more Although preventability criteria have been assessed for all adverse drug reactions (ADRs) investigated at our institution over the past 12 years, a systematic evaluation of the data had not been performed. This project analysed preventability data previously collected to identify the potential areas for process improvements. A 3-year retrospective analysis was performed. All ADRs were categorised by drug, drug class, severity, probability of causality and preventability. Factors involved in preventability were assessed and tallied. Descriptive statistics was used to analyse the data. Most ADRs occurred prior to admission. In the outpatient setting, anticoagulants and anticonvulsants were associated with more preventable ADRs (pADRs) than other drug classes, followed by cardiotonic agents and non-steroidal anti-inflammatory drugs (NSAIDs). For ADRs that occurred in hospitalised patients, antibiotics and opiates were associated with approximately half of all pADRs. The preventability categories most frequently associated with ADRs prior to admission were presence of a toxic drug level and drug-drug interactions, while inappropriate dose, route or frequency was the most common preventability category for inpatient ADRs. The majority of pADRs were moderate in severity in both the in- and outpatient settings. Drugs and drug classes involved in pADRs differ in the in- and outpatient settings. Preventability categories also differ by setting. Most pADRs occur prior to admission in our healthcare system. This presents a challenge in terms of implementing the process changes to reduce the pADRs, as patients in the community are outside our control.
... Lisa Anne Boothby, PharmD,BCPS* Paul L. Doering, MS, FAPhA, and Randy C. Hatton, PharmD, BCP... more ... Lisa Anne Boothby, PharmD,BCPS* Paul L. Doering, MS, FAPhA, and Randy C. Hatton, PharmD, BCPS, FCCP ... to be no compelling rea-son to have this product available in the hospital, the Pharmacy and Therapeu-tics (P&T) Committee reviewed the pol-icy to determine if ...
OBJECTIVE To evaluate the literature on supplemental vitamin C and vitamin E therapy in the preve... more OBJECTIVE To evaluate the literature on supplemental vitamin C and vitamin E therapy in the prevention and treatment of Alzheimer's disease (AD). DATA SOURCES Literature retrieval was accessed through MEDLINE (1966–March 2005) using the key words antioxidants, vitamin C, vitamin E, Alzheimer's disease, and dementia. International Pharmaceutical s (1970–March 2005), Current Contents (1996–March 2005), Cochrane Database of Systematic Reviews (1994–March 2005), and Ebsco's Academic Search Elite (1975–March 2005) were searched with the same key words. STUDY SELECTION AND DATA EXTRACTION Articles related to the objective that were identified through PubMed were included. DATA SYNTHESIS Oral supplementation of vitamin C (ascorbic acid) and vitamin E (D-alfa-tocopherol acetate) alone and in combination have been shown to decrease oxidative DNA damage in animal studies in vivo, in vitro, and in situ. Recent results of a prospective observational study (n = 4740) suggest that the...
OBJECTIVE: To review the drug therapy for the treatment of itching associated with intrahepatic c... more OBJECTIVE: To review the drug therapy for the treatment of itching associated with intrahepatic cholestasis of pregnancy (ICP). DATA SOURCES: A comprehensive literature search was conducted in MEDLINE (1966–July 2002) using the following MeSH terms: pregnancy, itching, intrahepatic cholestasis, cholestyramine, ursodeoxycholic acid, and phenobarbital. Current Contents (1966–July 2002), International Pharmaceutical s (1970–June 2002), and Cochrane Database were also searched using those terms. Web of Science search was used to search references found in articles. DATA SYNTHESIS: Eight clinical trials and several observational studies were identified evaluating the safety and efficacy of ursodeoxycholic acid (UDCA) in the treatment of ICP. Although these studies were small and inconsistent, improvement in maternal and fetal morbidity was demonstrated. Observational studies suggest that cholestyramine may be associated with improved maternal morbidity without a documented improvement in fetal outcome. Two observational studies evaluated the efficacy of phenobarbital for ICP treatment. Phenobarbital use was not associated with improved maternal or fetal morbidity/mortality. CONCLUSIONS: Data from large, well-designed, randomized, controlled trials of treatment of ICP are lacking. Data that are available support the use of UDCA as a first-line agent and cholestyramine as a second-line agent for treatment of ICP. There is little evidence to recommend phenobarbital in the treatment of itching associated with that condition.
Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Société canadienne des sciences pharmaceutiques
Gamma-hydroxybutyrate (GHB) intoxication is a significant cause of morbidity and mortality in pat... more Gamma-hydroxybutyrate (GHB) intoxication is a significant cause of morbidity and mortality in patients taking the drug for recreational purposes. Due to the recent increase in emergency room visits, hospital admissions, and deaths, it has become necessary to re-examine the pharmacology, pharmacokinetics, pharmacodynamics, clinical manifestations, and potential adverse effects associated with GHB use. We present an important pharmacologic and clinical update on GHB.
This review examines literature on the efficacy and abuse potential of carisoprodol, makes recomm... more This review examines literature on the efficacy and abuse potential of carisoprodol, makes recommendations for use of this agent in the hospital setting, and outlines applicable federal and state regulations. A Medline search using key words and MeSH terms was conducted. In addition, International Pharmaceutical s (1970–2002), Current Contents (1996–2002), Cochrane Database of Systematic Reviews (1999–2002), and Psych Info (1872–2002) were searched for relevant literature. Articles cited in the bibliographies produced by these searches were included in the review. A Web of Science search was conducted for all citations found in all the searches. Pain is a common physical symptom in patients with musculoskeletal problems, and pharmacologic therapy is often combined with nonpharmacologic measures to treat the pain etiology and symptomatology. Skeletal muscle relaxants (SMRs) and nonsteroidal anti-inflammatory drugs (NSAIDs) represent the most common drug therapy choices in patients with mild-to-moderate somatic pain. Carisoprodol (Soma) is an SMR that has a poorly defined mechanism of action and a high potential for abuse. This literature review produced little evidence to support the use of carisoprodol in pain control. The research also showed that patients with a history of previous substance abuse are more likely to abuse this drug; thus carisoprodol does not meet safety and efficacy standards and should be removed from the market. At the very least, states should reschedule carisoprodol as a schedule IV controlled substance to minimize chronic misuse and abuse. If carisprodol is listed in hospital formularies, it should be handled as a controlled substance regardless of its federal status. Alternative sedatives (eg, phenobarbital) should be used to manage patients experiencing carisoprodol withdrawal symptoms.
This article is the third in a series of studies measuring the impact of cultural diversity on hu... more This article is the third in a series of studies measuring the impact of cultural diversity on human development. We disaggregate cultural diversity into three components: ethnicity, language, and religion. The first study examined the impact of diversity internationally. We found that countries are worse off with greater diversity, especially religious diversity; however, we found that more-prosperous countries with strong institutions benefited from increased diversity. We concluded that strong institutions are essential to maximize the benefits of diversity while mitigating the associated costs. The second study examined the impact of diversity within the United States, where institutional strength was assumed to be relatively great and similar between states. We found an overall negative impact from diversity. Ethnic diversity was negatively associated with human development, while religious and language diversity had a positive impact. We concluded that in the United States, th...
Meperidine (Demerol) is an opiate analgesic that is not considered first-line therapy for most pa... more Meperidine (Demerol) is an opiate analgesic that is not considered first-line therapy for most pain management indications because of concerns about its safety and efficacy. Inpatient data from a 417-bed community teaching hospital revealed high use of meperidine in oral, IM, and IV forms. A multifaceted academic detailing approach was employed to change prescribing behavior and decrease meperidine use. This approach included conducting two concurrent Medication Use Evaluations; Grand Rounds presentations for pharmacy staff, nurses, and medical residents; solicitation of opinion leaders; pocket and table-top cards; newsletter articles; and provision of pharmaceutical care. Comparing the number of meperidine doses dispensed per adjusted patient day before and after the intervention, use was reduced by 0.0966 doses per patient (P < 0.05: 95% CI, 0.0955 to 0.0977). The number of patients receiving meperidine was reduced by 2.43% (P < 0.05: 95% CI, 1.97 to 2.88). This translates i...
Purpose Since IV admixtures of oxytocin in the final working concentrations are not commercially ... more Purpose Since IV admixtures of oxytocin in the final working concentrations are not commercially available, oxytocin admixtures must be prepared immediately before use or compounded in a sterile laminar flow hood and stored until needed. Although published reports indicate short-term stability of oxytocin in Ringer's lactate solution and Ringer's lactate-dextrose 5%, longer-term stability data at various temperatures are lacking. Methods A stability assay was developed, validated, and executed with oxytocin at two different concentrations in Ringer's lactate solution. Stability was assessed at 4 and 25°C over 31 days. Results This study shows that commonly used dilutions of oxytocin in Ringer's lactate solution retain greater than 90% of initial concentrations, when stored at room temperature or refrigerated for 31 days. These data show that oxytocin admixed with Ringer's lactate solution has extended chemical stability after preparation. Conclusions Demonstratio...
Journal of Liquid Chromatography & Related Technologies, 2006
... and its Application in Stability Analysis Vipul Kumar, Rajanikanth Madabushi, and Hartmut Der... more ... and its Application in Stability Analysis Vipul Kumar, Rajanikanth Madabushi, and Hartmut Derendorf Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA Lisa A. Boothby and Burnis ...
Attention-deficit/hyperactivity disorder is a highly diagnosed psychiatric disorder in children. ... more Attention-deficit/hyperactivity disorder is a highly diagnosed psychiatric disorder in children. This widespread and complex condition requires extensive evaluation involving clinicians, parents and teachers. Proper management involves individual assessment and treatment. Psychostimulants remain the primary medication of choice as they have been shown to be efficacious for this condition. Newer, long-acting medications are providing expanded options for children and their caregivers. Failure to assess and treat can lead to serious long-term effects later in life.
Although preventability criteria have been assessed for all adverse drug reactions (ADRs) investi... more Although preventability criteria have been assessed for all adverse drug reactions (ADRs) investigated at our institution over the past 12 years, a systematic evaluation of the data had not been performed. This project analysed preventability data previously collected to identify the potential areas for process improvements. A 3-year retrospective analysis was performed. All ADRs were categorised by drug, drug class, severity, probability of causality and preventability. Factors involved in preventability were assessed and tallied. Descriptive statistics was used to analyse the data. Most ADRs occurred prior to admission. In the outpatient setting, anticoagulants and anticonvulsants were associated with more preventable ADRs (pADRs) than other drug classes, followed by cardiotonic agents and non-steroidal anti-inflammatory drugs (NSAIDs). For ADRs that occurred in hospitalised patients, antibiotics and opiates were associated with approximately half of all pADRs. The preventability categories most frequently associated with ADRs prior to admission were presence of a toxic drug level and drug-drug interactions, while inappropriate dose, route or frequency was the most common preventability category for inpatient ADRs. The majority of pADRs were moderate in severity in both the in- and outpatient settings. Drugs and drug classes involved in pADRs differ in the in- and outpatient settings. Preventability categories also differ by setting. Most pADRs occur prior to admission in our healthcare system. This presents a challenge in terms of implementing the process changes to reduce the pADRs, as patients in the community are outside our control.
... Lisa Anne Boothby, PharmD,BCPS* Paul L. Doering, MS, FAPhA, and Randy C. Hatton, PharmD, BCP... more ... Lisa Anne Boothby, PharmD,BCPS* Paul L. Doering, MS, FAPhA, and Randy C. Hatton, PharmD, BCPS, FCCP ... to be no compelling rea-son to have this product available in the hospital, the Pharmacy and Therapeu-tics (P&T) Committee reviewed the pol-icy to determine if ...
OBJECTIVE To evaluate the literature on supplemental vitamin C and vitamin E therapy in the preve... more OBJECTIVE To evaluate the literature on supplemental vitamin C and vitamin E therapy in the prevention and treatment of Alzheimer's disease (AD). DATA SOURCES Literature retrieval was accessed through MEDLINE (1966–March 2005) using the key words antioxidants, vitamin C, vitamin E, Alzheimer's disease, and dementia. International Pharmaceutical s (1970–March 2005), Current Contents (1996–March 2005), Cochrane Database of Systematic Reviews (1994–March 2005), and Ebsco's Academic Search Elite (1975–March 2005) were searched with the same key words. STUDY SELECTION AND DATA EXTRACTION Articles related to the objective that were identified through PubMed were included. DATA SYNTHESIS Oral supplementation of vitamin C (ascorbic acid) and vitamin E (D-alfa-tocopherol acetate) alone and in combination have been shown to decrease oxidative DNA damage in animal studies in vivo, in vitro, and in situ. Recent results of a prospective observational study (n = 4740) suggest that the...
OBJECTIVE: To review the drug therapy for the treatment of itching associated with intrahepatic c... more OBJECTIVE: To review the drug therapy for the treatment of itching associated with intrahepatic cholestasis of pregnancy (ICP). DATA SOURCES: A comprehensive literature search was conducted in MEDLINE (1966–July 2002) using the following MeSH terms: pregnancy, itching, intrahepatic cholestasis, cholestyramine, ursodeoxycholic acid, and phenobarbital. Current Contents (1966–July 2002), International Pharmaceutical s (1970–June 2002), and Cochrane Database were also searched using those terms. Web of Science search was used to search references found in articles. DATA SYNTHESIS: Eight clinical trials and several observational studies were identified evaluating the safety and efficacy of ursodeoxycholic acid (UDCA) in the treatment of ICP. Although these studies were small and inconsistent, improvement in maternal and fetal morbidity was demonstrated. Observational studies suggest that cholestyramine may be associated with improved maternal morbidity without a documented improvement in fetal outcome. Two observational studies evaluated the efficacy of phenobarbital for ICP treatment. Phenobarbital use was not associated with improved maternal or fetal morbidity/mortality. CONCLUSIONS: Data from large, well-designed, randomized, controlled trials of treatment of ICP are lacking. Data that are available support the use of UDCA as a first-line agent and cholestyramine as a second-line agent for treatment of ICP. There is little evidence to recommend phenobarbital in the treatment of itching associated with that condition.
Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Société canadienne des sciences pharmaceutiques
Gamma-hydroxybutyrate (GHB) intoxication is a significant cause of morbidity and mortality in pat... more Gamma-hydroxybutyrate (GHB) intoxication is a significant cause of morbidity and mortality in patients taking the drug for recreational purposes. Due to the recent increase in emergency room visits, hospital admissions, and deaths, it has become necessary to re-examine the pharmacology, pharmacokinetics, pharmacodynamics, clinical manifestations, and potential adverse effects associated with GHB use. We present an important pharmacologic and clinical update on GHB.
Uploads
Papers by Lisa Boothby