RESUMEN
Adverse drug reactions are a major source of complications in the intensive care unit. Drug interactions contribute significantly to the incidence of adverse drug reactions. The intensive care unit clinician must remain aware of the major mechanisms for drug interactions, which are reviewed in this article.
Asunto(s)
Enfermedad Crítica/terapia , Interacciones Farmacológicas , Distribución por Edad , Anciano , Sistema Enzimático del Citocromo P-450/metabolismo , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Farmacocinética , Medición de RiesgoRESUMEN
Development of institutional guidelines for use of high-cost biotechnology drugs, such as antithrombin III, is a valuable tool in formulary management. This article describes the process by which the University of California Davis Medical Center used an ad hoc committee to the P & T Committee to develop guidelines for antithrombin III use. Performing an objective analysis of available literature to address the appropriate role of a biotechnology agent is necessary to develop consensus guidelines. Approval of use guidelines by the P & T Committee provides the necessary structure for optimal use of biotechnology agents, such as antithrombin III.
Asunto(s)
Antitrombina III/uso terapéutico , Biotecnología/normas , Hospitales Universitarios/normas , Comité Farmacéutico y Terapéutico , Guías de Práctica Clínica como Asunto , Deficiencia de Antitrombina III , California , Ensayos Clínicos como Asunto , Enfermedades Carenciales/tratamiento farmacológico , Hospitales Universitarios/organización & administración , Humanos , Farmacéuticos , Médicos , Desarrollo de ProgramaRESUMEN
The relative bioavailability of single oral doses of prednisone with and without sucralfate administration was determined in 12 healthy male volunteers. Each subject participated in a randomized three-way cross-over study consisting of the following three phases: treatment A, prednisone given alone; treatment B, 2 days pretreatment with sucralfate with a concomitant dose of sucralfate administered with prednisone; and treatment C, 2 days pretreatment with sucralfate with a sucralfate dose administered 2 h after the oral prednisone dose. Plasma prednisolone concentrations (active moiety of prednisone) were determined by a specific and sensitive high-performance liquid chromatographic assay and unbound prednisolone concentrations were determined by equilibrium dialysis. Bioavailability was assessed by comparing the areas under the plasma prednisolone concentration-time curves as well as peak concentrations, time to peak concentration, elimination rate constant, and half-life. No significant differences were noted in any of the treatment phases for any of the parameters except for the time of peak concentration which was slightly delayed from 1.0 +/- 0.6 to 1.7 +/- 0.9 h when sucralfate was concomitantly administered with the prednisone. Thus, the data from this study indicate that sucralfate does not have a clinically significant effect on the bioavailability of orally administered prednisone. The use of these two drugs in combination does not result in an interaction requiring dosage regimen alteration.