Pharmacy and Pharmaceutical Sciences Commons^™

Does The Quantity Of Enteral Nutrition Affect Outcomes In Critically Ill Trauma Patients?, Jennifer L. Ash, Jane M. Gervasio, Gary P. Zaloga, George H. Rodman Jr.

Scholarship and Professional Work – COPHS

Abstract from Clinical Nutrition Week, Orlando, FL, January 29-February 2, 2005.

Chronic Outpatient Sildenafil Therapy For Pulmonary Hypertension In A Child After Cardiac Surgery, Chad A. Knoderer, E. S. Ebenroth, J. W. Brown

Scholarship and Professional Work – COPHS

We report the case of a 14-month-old male with d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension successfully treated with long-term sildenafil following cardiac surgery. To our knowledge, this is the first published report of long-term sildenafil treatment in a child after corrective cardiac surgery.

Anabolic Agents: Adjuncts To Nutrition Support, Jane M. Gervasio

Scholarship and Professional Work – COPHS

Anabolic agents as adjuncts to nutrition support therapy have been used to improve malnutrition and establish anabolism. Growth hormone, insulin-like growth factor, and anabolic steroids have been studied for their potential to reverse the catabolic process and promote anabolism. This paper reviews several anabolic agents and their possible role in nutrition support therapy.

Clinical Issues Surrounding Once-Daily Aminoglycoside Dosing In Children, Chad A. Knoderer, Julie A. Everett, William F. Buss

Scholarship and Professional Work – COPHS

Aminoglycoside antibiotics are first-line treatment for many infectious diseases in the pediatric population and are effective in adults. The traditional dosing interval in children is every 8–12 hours. Studies in adults reported equivalent efficacy and equal or less toxicity with once-daily regimens. Despite many studies in the adult population, this approach has yet to become standard practice in most pediatric hospitals. Reasons for lack of acceptance of this strategy in children include rapid aminoglycoside clearance, unknown duration of postantibiotic effect, safety concerns, and limited clinical and efficacy data.

Pulmonary Embolism As An Adverse Drug Event Of Intravenous Immunoglobulin Therapy, Katasha S. Butler, Deborah S. Zeitlin

Scholarship and Professional Work – COPHS

TO THE EDITOR: Intravenous immunoglobulin (IVIG) therapy has gained popularity for the treatment of neuromuscular diseases (i.e., myasthenia gravis, inflammatory myopathy, chronic inflammatory demyelinating polyneuropathy), although adverse events are associated with high-dose IVIG infusions.^1,2 Common adverse reactions to IVIG therapy are anxiety, headache, fever, chills, chest pain, dyspnea, nausea, and abdominal pain.³ More serious adverse events include anaphylaxis, hemolytic anemia, hepatitis C, and thrombosis.³ Studies have shown documented effects of IVIG on blood rheology. It increases plasma viscosity in a dose-related response and may also activate platelets.^2–4 High-dose IVIG therapy is approximately 24–54 g/d.⁴

Accuracy Of Predictive Methods To Estimate Resting Energy Expenditure Of Thermally-Injured Patients, Roland N. Dickerson, Jane M. Gervasio, Marti L. Riley, James E. Murrell, William L. Hickerson, Kenneth A. Kudsk, Rex O. Brown

Scholarship and Professional Work – COPHS

Background

The purpose of this study was to evaluate the bias and precision of 46 methods published from 1953 to 2000 for estimating resting energy expenditure (REE) of thermally injured patients.

Methods

Twenty-four adult patients with ≥20% body surface area burn admitted to a burn center who required specialized nutrition support and who had their REE measured via indirect calorimetry (IC) were evaluated. Patients with morbid obesity, human immunovirus, malignancy, pregnancy, hepatic or renal failure, neuromuscular paralysis, or those requiring a FiO2 >50% or positive end expiratory pressure (PEEP) ≥10 cm H2O were excluded. One steady-state measured REE measurement (MEE) …

Herbal Product Use Among Anticoagulation Patients, Ilene H. Zuckerman, Eileen K. Steinberger, Priscilla T. Ryder, Stuart Haines

Scholarship and Professional Work – COPHS

Warfarin interacts with many conventional drug products and herbal products,^1-3 Given the incompleteness of information on drug-herbal product interactions and the potential for health care practitioners to be unaware of their patients' utilization of herbal products, we surveyed the use of such products among patients receiving warfarin through an anticoagulation clinic. Patients at the University of Maryland Medical System Anticoagulation Clinic were asked to complete an anonymous written questionnaire during their regularly scheduled appointments over one month.

A Comparison Of Renal Phosphorus Regulation In Thermally-Injured And Multiple Trauma Patients Receiving Specialized Nutrition Support, Roland N. Dickerson, Jane M. Gervasio, Justin J. Sherman, Kenneth A. Kudsk, William L. Hickerson, Rex O. Brown

Scholarship and Professional Work – COPHS

To compare phosphorus intake and renal phosphorus regulation between thermally injured patients and multiple trauma patients, 40 consecutive critically ill patients, 20 with thermal injury and 20 with multiple trauma, who required enteral tube feeding were evaluated. Phosphorus intakes were recorded for 14 days from the initiation of tube feeding which was started 1 to 3 days post-injury. Serum for determination of phosphorus concentrations was collected at days 1, 3, 7, and 14 of the study period. A 24-hour urine collection was obtained during the first and second weeks of nutrition support for urinary phosphorus excretion, fractional excretion of phosphorus, …

Accuracy Of Predictive Formulas To Estimate Resting Energy Expenditure Of Thermally Injured Patients, Roland N. Dickerson, Jane M. Gervasio, Marti L. Riley, James E. Murrell, William L. Hickerson, Kenneth A. Kudsk, Rex O. Brown

Scholarship and Professional Work – COPHS

Abstract from the 25th Clinical Congress of the American Society for Parenteral and Enteral Nutrition, Chicago, IL, January 21-24, 2001.

Oxandrolone In Trauma Patients, Jane M. Gervasio, Roland N. Dickerson, Jessica Swearingen, Mary E.D. Yates, Ceaminia Yuen, Timothy C. Fabian, Martin A. Croce, Rex O. Brown

Scholarship and Professional Work – COPHS

Study Objective

To determine the effect of oxandrolone administration on nutritional and clinical outcomes after multiple trauma.

Design

Prospective, randomized, double-blind, placebo-controlled study. Setting. Level 1 trauma center in a university teaching hospital.

Patients

Sixty-two patients requiring enteral nutrition, 60 of whom completed the study.

Intervention

Patients were randomized to receive either oxandrolone 10 mg or placebo twice/day for a maximum of 28 days.

Measurements and Main Results

Total urinary nitrogen, prealbumin, nitrogen balance, total body water, and body cell mass were measured on day 1 of enteral nutrition and then at day 7, day 10, and study exit. Patients …

Sequential Group Trial To Determine Gastrointestinal Site Of Absorption And Systemic Exposure Of Azathioprine, Jane M. Gervasio, Rex O. Brown, John Lima, M. G. Tabbaa, Thomas Abell, Robert Werkman, Lynda J. Haberer, Lawrence J. Hak

Scholarship and Professional Work – COPHS

Azathioprine (AZA) is used in the treatment of patients with refractory inflammatory bowel disease; however, its use is limited because of systemic toxicity associated with long-term use. Ileocecal delivery of AZA might be advantageous if local intestinal therapeutic effects could be provided with decreased systemic side effects. Decreased cecal systemic absorption would allow higher dosages of AZA to be administered. A two-phase study was performed to compare the systemic exposure of AZA and 6-mercaptopurine (6-MP) following administration of AZA into the stomach, jejunum, and cecum and to compare the systemic exposure to AZA and 6-MP following administration of three different …

Sequential Single Doses Of Cisapride, Erythromycin, And Metoclopramide In Critically Ill Patients Intolerant To Enteral Nutrition: A Randomized, Placebo-Controlled, Crossover Study, Robert Maclaren, David A. Kuhl, Jane M. Gervasio, Rex O. Brown, Roland N. Dickerson, Teresa N. Livingston, Kyle Swift, Stacey Headley, Kenneth A. Kudsk, John J. Lima

Scholarship and Professional Work – COPHS

Objective: To evaluate the comparative efficacy of enteral cisapride, metoclopramide, erythromycin, and placebo for promoting gastric emptying in critically ill patients with intolerance to gastric enteral nutrition (EN).

Design: A randomized, crossover study.

Setting: Adult medical intensive care unit at a university-affiliated private hospital and trauma intensive care unit at a university teaching hospital.

Patients: Ten adult, critically ill, mechanically ventilated patients not tolerating a fiber-containing EN product defined as a single aspirated gastric residual volume >150 mL or two aspirated gastric residual volumes >120 mL during a 12-hr period.

Interventions: Patients received 10 mg …

The Skn7 Response Regulator Of Saccharomyces Cerevisiae Interacts With Hsf1 In Vivo And Is Required For The Induction Of Heat Shock Genes By Oxidative Stress, Desmond C. Raitt, Anthony L. Johnson, Alexander M. Erkine, Kozo Makino, Brian Morgan, David S. Gross, Leland H. Johnston

Scholarship and Professional Work – COPHS

The Skn7 response regulator has previously been shown to play a role in the induction of stress-responsive genes in yeast, e.g., in the induction of the thioredoxin gene in response to hydrogen peroxide. The yeast Heat Shock Factor, Hsf1, is central to the induction of another set of stress-inducible genes, namely the heat shock genes. These two regulatory trans-activators, Hsf1 and Skn7, share certain structural homologies, particularly in their DNA-binding domains and the presence of adjacent regions of coiled-coil structure, which are known to mediate protein–protein interactions. Here, we provide evidence that Hsf1 and Skn7 interact in vitro and …

Cell Cycle-Dependent Binding Of Yeast Heat Shock Factor To Nucleosomes, Christina Bourgeois Venturi, Alexander M. Erkine, David S. Gross

Scholarship and Professional Work – COPHS

In the nucleus, transcription factors must contend with the presence of chromatin in order to gain access to their cognate regulatory sequences. As most nuclear DNA is assembled into nucleosomes, activators must either invade a stable, preassembled nucleosome or preempt the formation of nucleosomes on newly replicated DNA, which is transiently free of histones. We have investigated the mechanism by which heat shock factor (HSF) binds to target nucleosomal heat shock elements (HSEs), using as our model a dinucleosomal heat shock promoter (hsp82-ΔHSE1). We find that activated HSF cannot bind a stable, sequence-positioned nucleosome in G₁-arrested …

Measured Energy Expenditure Of Tube-Fed Patients With Severe Neurodevelopment Disabilities, Roland N. Dickerson, Rex O. Brown, Jane M. Gervasio, Emily B. Hak, Lawrence J. Hak, John E. Williams

Scholarship and Professional Work – COPHS

Objective: To determine measured resting energy expenditure (REE) of nonambulatory tube-fed patients with severe neurological neurodevelopmental disabilities.

Methods: Twenty patients were prospectively studied. Only steady state indirect calorimetry measurements were taken. All measurements were conducted using a canopy system. Nutritional needs were met entirely by enteral feedings via a permanent ostomy.

Results: REE was widely distributed from 16 kcals/kg/day to 39 kcals/kg/day. The mean REE (888 ±176 kcals/day) of the patients was significantly (p < 0.01) lower than predicted as estimated by the Harris-Benedict equations (1081 ± 155 kcals/day) and World Health Organization equations (1194 ± 167 kcals/day). Fat-free mass (FFM) was the best parameter for predicting REE. Two predictive equations were developed that are not significantly biased and more precise (≤ 15% error) than conventional predictive formulas.

Conclusion: Conventional formulas for estimating energy expenditure are inaccurate and generally overestimate measured energy expenditure of nonambulatory patients with severe developmental …

Cooperative Binding Of Heat Shock Factor To The Yeast Hsp82 Promoter In Vivo And In Vitro, Alexander M. Erkine, Serena F. Magrogan, Edward A. Sekinger, David S. Gross

Scholarship and Professional Work – COPHS

revious work has shown that heat shock factor (HSF) plays a central role in remodeling the chromatin structure of the yeastHSP82 promoter via constitutive interactions with its high-affinity binding site, heat shock element 1 (HSE1). The HSF-HSE1 interaction is also critical for stimulating both basal (noninduced) and induced transcription. By contrast, the function of the adjacent, inducibly occupied HSE2 and -3 is unknown. In this study, we examined the consequences of mutations in HSE1, HSE2, and HSE3 on HSF binding and transactivation. We provide evidence that in vivo, HSF binds to these three sites cooperatively. This cooperativity is seen …

Comparison Of Arterial Plasma Amino Acid Concentrations In Rats Fed Ad Lib Oral Chow Or Parenteral Nutrition Via Intravenous Or Gastric Infusion, Jane M. Gervasio, Emily B. Hak, Michael C. Storm, M. E. Croft, Lawrence J. Hak

Scholarship and Professional Work – COPHS

Abstract from the 22nd Clinical Congress of the American Society for Parenteral and Enteral Nutrition, Orlando, FL, January 18-21, 1998.

Renal Phosphorus Regulation In Thermally-Injured And Multiple Trauma Patients Receiving Enteral Nutrition, Jane M. Gervasio, Rex O. Brown, Justin J. Sherman, William L. Hickerson, Kenneth A. Kudsk, Roland N. Dickerson

Scholarship and Professional Work – COPHS

Abstract from the 22nd Clinical Congress of the American Society for Parenteral and Enteral Nutrition, Orlando, FL, January 18-21, 1998.

Interaction Of Gaba And Excitatory Amino Acids In The Basolateral Amygdala: Role In Cardiovascular Regulation, Robert P. Soltis, Jennifer C. Cook, Adam E. Gregg, Brian J. Sanders

Scholarship and Professional Work – COPHS

Activation of the amygdala in rats produces cardiovascular changes that include increases in heart rate and arterial pressure as well as behavioral changes characteristic of emotional arousal. The objective of the present study was to examine the interaction of GABA and excitatory amino acid (EAA) receptors in the basolateral amygdala (BLA) in regulating cardiovascular function. Microinjection of the GABA_A receptor antagonist bicuculline methiodide (BMI) or the E A A receptor agonists NMDA or AMPA into the same region of the BLA of conscious rats produced dose-related increases in heart rate and arterial pressure. Injection of the nonselective EAA receptor …

Chronic Hypothermia And Energy Expenditure In A Neurodevelopmentally Disabled Patient: A Case Study, Jane M. Gervasio, Roland N. Dickerson, Rex O. Brown, J. Barret Matthews

Scholarship and Professional Work – COPHS

Hypothermia is defined as a core body temperature of <35°C and results in a decrease in measured resting energy expenditure. A 51-year-old mentally disabled patient experienced chronic hypothermia from neurologic sequelae. Because of her continued weight gain and increased body fat in the presence of presumed hypocaloric nutrition, indirect calorimetry measurements were performed twice in a 3-month period. The resting energy expenditure measurements prompted a reduction of her daily caloric intake to prevent further overfeeding. Hypothermia reduces oxygen consumption and, as a consequence, decreases resting energy expenditure. In patients for whom chronic hypothermia is a problem, nutritional intake must be adjusted to prevent overfeeding, excessive weight gain, and the long-term complications of an excess of total calories.

Enteral Cisapride, Erythromycin, And Metoclopramide In Critically Ill Patients Intolerant To Enteral Nutrition: A Randomized, Placebocontrolled, Cross-Over Study, Robert Maclaren, Jane M. Gervasio, David A. Kuhl, Teresa N. Livingston, Kyle Swift, Roland N. Dickerson, Rex O. Brown, Stacey Headley, Kenneth A. Kudsk, John J. Lima

Scholarship and Professional Work – COPHS

Abstract from American College of Clinical Pharmacy 1997 Annual Meeting, Phoenix, AZ, November 9-12, 1997.

Measured Energy Expenditure Of Nonambulatory Patients With Severe Neurodevelopmental Disabilities, Roland N. Dickerson, Rex O. Brown, Jane M. Gervasio, Emily B. Hak, John E. Williams, Lawrence J. Hak

Scholarship and Professional Work – COPHS

Abstract from American College of Clinical Pharmacy 1997 Annual Meeting, Phoenix, AZ, November 9-12, 1997.

Pharmacology Of Antiparkinsonian Agents, Robert P. Soltis

Scholarship and Professional Work – COPHS

The following is a summary of a two hour class on the basic pharmacology of antiparkinsonian agents. It is presented to fourth-year pharmacy students in pharmacotherapeutics III, a course structured using team-taught modules. Faculty from the Department of Pharmacy Sciences provide instruction on the basic pharmacology of therapeutic agents and faculty from the Department of Pharmacy Practice follow up with a discussion of the therapeutic applications of these agents. This course is lecture-based with opportunities for in-class discussion. One week prior to the lecture sequence on the basic pharmacology of antiparkinsonian drugs, students are provided a handout that includes the …

Enhancing Compliance With Allergic Rhinitis Therapy, Beth Wofford, Deborah S. Zeitlin

Scholarship and Professional Work – COPHS

Allergic rhinitis is one of the most common chronic conditions in the US, surpassing even heart disease. Over $1 billion is spent annually for over-the-counter (OTC) and prescription medications. In addition, allergic rhinitis causes an estimated annual loss of $639 million related to lost work days and diminished work performance.

If not effectively treated, allergic rhinitis may lead to potential complications such as otitis media, sinusitis, facial and dental abnormalities, hearing loss, poor speech development, and recurrent upper respiratory tract infections. Ineffective treatment often the result of intentional or unintentional noncompliance and inadequate patient education. Therefore, it is imperative that …

Heat Shock Factor Gains Access To The Yeast Hsc82 Promoter Independently Of Other Sequence-Specific Factors And Antagonizes Nucleosomal Repression Of Basal And Induced Transcription, Alexander M. Erkine, C. C. Adams, T. Diken, D. S. Gross

Scholarship and Professional Work – COPHS

Transcription in eukaryotic cells occurs in the context of chromatin. Binding of sequence-specific regulatory factors must contend with the presence of nucleosomes for establishment of a committed preinitiation complex. Here we demonstrate that the high-affinity binding site for heat shock transcription factor (HSF) is occupied independently of other cis-regulatory elements and is critically required for preventing nucleosomal assembly over the yeast HSC82 core promoter under both noninducing (basal) and inducing conditions. Chromosomal mutation of this sequence, termed HSE1, erases the HSF footprint and abolishes both transcription and in vivo occupancy of the TATA box. Moreover, it dramatically reduces promoter chromatin …

Comment On Small Bowel Necrosis, Jane Gervasio

Scholarship and Professional Work – COPHS

Comment on the Article Small bowel necrosis associated with postoperative jejunal tube feeding.

Hypothalamic Excitatory Amino Acid Receptors Mediate Stress-Induced Tachycardia In Rats, Robert P. Soltis, Joseph A. Dimicco

Scholarship and Professional Work – COPHS

The role of hypothalamic excitatory amino acid (EAA) receptors in mediating the cardiovascular response to stress was examined using conscious chronically instrumented rats. Microinjection of the EAA agonists N-methyl-D-aspartic acid (NMDA; 1-10 pmol), alpha-amino-3-hydroxy-5-methyl-4-isooxazolepropionic acid (AMPA; 0.3-3.0 pmol), or kainic acid (0.1-1.0 pmol) into the dorsomedial hypothalamus (DMH) elicited dose-related increases in heart rate and modest elevations in arterial pressure. Local microinjection of the NMDA antagonist 2-amino-5-phosphonopentanoic acid (AP5; 100 pmol) selectively blocked NMDA-induced cardiovascular changes, whereas the non-NMDA EAA antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX; 50 pmol) selectively blocked the responses to AMPA and kainic acid. In the stress trials, microinjection of …

Interaction Of Hypothalamic GabaA And Excitatory Amino Acid Receptors Controlling Heart Rate In Rats, Robert P. Soltis, Joseph A. Dimicco

Scholarship and Professional Work – COPHS

We have previously shown that microinjection of drugs that impair gamma-aminobutyric acid (GABA)-mediated synaptic inhibition into the dorsomedial hypothalamus (DMH) of rats generates cardiovascular and behavioral changes that mimic the response to stress. The purpose of this study was to examine the role of excitatory amino acid (EAA) receptors in the DMH in generating the cardiovascular changes caused by withdrawal of local GABAergic inhibition in urethan-anesthetized rats. Local treatment of the DMH with the nonselective EAA antagonist kynurenic acid blocked or reversed the increases in heart rate and blood pressure caused by microinjection of the GABAA antagonists bicuculline methiodide (BMI) …

GabaA And Excitatory Amino Acid Receptors In Dorsomedial Hypothalamus And Heart Rate In Rats, Robert P. Soltis, Joseph A. Dimicco

Scholarship and Professional Work – COPHS

We have previously shown that microinjection of drugs that interfere with the function of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) into the hypothalamus produces cardiorespiratory and behavioral changes resembling those seen in emotional stress. The purpose of this study was to determine whether excitatory amino acids (EAAs) can produce a cardiovascular response similar to that caused by the GABAA receptor antagonist bicuculline methiodide (BMI) when microinjected at the same hypothalamic site in urethan-anesthetized rats and to clarify the precise locus of action of these agents. N-methyl-D-aspartic acid (NMDA, 0.68-6.8 pmol/50 nl) and kainic acid (KA, 0.47-4.7 pmol/50 nl) produced dose-related …