Possible Oseltamivir-Induced Angioedema in a Patient with Chronic Renal Failure

Objective

To report a case of angioedema possibly associated with oseltamivir administration in a patient with chronic renal failure.

Case Summary

A 46-year-old female with an extensive allergy history and multiple co-morbidities, including chronic renal failure, was diagnosed with H1N1 influenza and given prescriptions for oseltamivir and methylprednisolone at an outside emergency department. She was sent home and took the first dose of both medications. The following day, the patient developed tongue swelling and left-sided edema. She discontinued methylprednisolone but continued oseltamivir. Her symptoms continued to worsen with the development of hivelike lesions and significant shortness of breath leading to hospitalization. Upon admission, oseltamivir was discontinued and the patient was started on dialysis. The patient's symptoms gradually improved, and she was discharged on hospital day 8.

Discussion

Oseltamivir was thought to be the causative agent due to the abrupt onset and resolution of symptoms associated with the administration and discontinuation of the medication. Application of the Naranjo probability scale found that oseltamivir was a possible cause of the patient's angioedema.

Conclusion

Health care providers should be aware of the rare but potentially life-threatening angioedema that may be associated with oseltamivir use.

Mycobacterium fortuitum infections associated with laparoscopic gastric banding

Mycobacterium fortuitum, a rapidly growing atypical mycobacteria, is commonly found in soil and water. This organism is most often known to cause skin, bone, and soft tissue infections associated with local trauma, surgical procedures, and in patients with immunodeficiency. Nosocomial infections associated with a variety of contaminated devices and equipment have also been widely documented. This report presents the first cases of M. fortuitum infection following laparoscopic gastric banding procedures. Both patients had complicated clinical courses necessitating removal of their banding devices and long-term antibiotic therapy.

Myxedema coma associated with combination aripiprazole and sertraline therapy

OBJECTIVE

To describe a case of myxedema coma (MC) associated with combination aripiprazole and sertraline therapy.

CASE SUMMARY

A 41-year-old male presented to the emergency department with confusion, right-sided numbness and tingling, slurred speech, dizziness, and facial edema. His blood pressure was 160/113 mm Hg, with a pulse of 56 beats/min and temperature of 35.4 degrees C. Initial abnormal laboratory values included creatine kinase (CK) 439 U/L; serum creatinine 1.6 mg/dL; aspartate aminotransferase 85 U/L; and alanine aminotransferase 35 U/L. Repeat cardiac markers revealed an elevated CK level of 3573 U/L with a CK-MB of 24 ng/mL. Thyroid function tests showed thyroid-stimulating hormone 126.4 microIU/mL and free thyroxine 0.29 ng/dL. Home medications of unknown duration were sertraline 200 mg and aripiprazole 20 mg daily. He was admitted to the intensive care unit and initially treated with intravenous levothyroxine and dexamethasone. By hospital day 4, the patient was clinically stable and discharged to home.

DISCUSSION

Myxedema coma, the most significant form of hypothyroidism (HT), is a rare but potentially fatal condition. The known precipitating causes of MC were ruled out in this patient, which left his home medications as the likely cause. Cases of HT caused by certain atypical antipsychotics and antidepressants are found in the literature, but none was reported with aripiprazole therapy. There are also no reported cases of sertraline or aripiprazole inducing MC. Use of the Naranjo probability scale indicates that the combination of aripiprazole and sertraline was a probable inducer of MC in this patient.

CONCLUSIONS

Due to the widespread use of psychotropic medications, clinicians should be reminded of the rare, yet life-threatening, occurrence of MC when treating patients, especially with combination therapies such as sertraline and aripiprazole.

New indices in scholarship assessment

Faculty members' contributions to research and scholarship are measured by a variety of indices. Assessment also has become an integral part of the Accreditation Council for Pharmacy Education's accreditation process for professional programs. This review describes some of the newer indices available for faculty scholarship assessment. Recently described metrics include the h-index, m-quotient, g-index, h(2) index, a-index, m-index, r-index, ar index, and the creativity index. Of the newer scholarship metrics available, the h-index and m-quotient will likely have the most widespread application in the near future. However, there is no substitute for thoughtful peer review by experienced academicians as the primary method of research and scholarship assessment.

Current strategies in the diagnosis and treatment of childhood attention-deficit/hyperactivity disorder

Symptoms of childhood attention-deficit/hyperactivity disorder affect cognitive, academic, behavioral, emotional, social, and developmental functioning. Attention-deficit/hyperactivity disorder is the most commonly diagnosed neurodevelopmental disorder in children and adolescents. An estimated 2 to 16 percent of school-aged children have been diagnosed with the disorder. The prevalence of attention-deficit/hyperactivity disorder in the primary care setting is similar to that in the general community, depending on the diagnostic criteria and population studied. The causality of attention-deficit/hyperactivity disorder is relatively unknown. Most recent studies focus on the role of dopamine; norepinephrine; and, most recently, serotonin neurotransmitters. The disorder is classified into three general subtypes: predominantly hyperactive-impulsive, predominantly inattentive, and combined. Screening tools and rating scales have been devised to assist with the diagnosis. Appropriate treatment can dramatically improve the function and quality of life of the patient and family. Pharmacologic treatment includes stimulants, such as methylphenidate and mixed amphetamine salts, or nonstimulants, such as atomoxetine. Behavioral approaches, particularly those that reward desirable behavior, are also effective. A combination of pharmacologic and behavioral therapies is recommended.

Publication metrics and record of pharmacy practice chairs

BACKGROUND

Scholarship is an essential component of academic pharmacy. Department chairs are considered role models and mentors to junior faculty, but their publication record has not been documented.

OBJECTIVE

To quantify publication patterns of pharmacy practice chairs in general and, specifically, at health sciences center (HSC)-based versus non-HSC-based and public versus private colleges of pharmacy.

METHODS

Pharmacy practice chairs were identified using the 2006-2007 roster of faculty from the American Association of Colleges of Pharmacy. Of the 89 colleges of pharmacy in the roster, 11 listed no pharmacy practice chair and 5 listed more than one. Data were collected on the remaining 73 schools by searching each chair's name on PubMed and Web of Science (WoS). Data on total publications, publications per year, total citations, citations per article, h-index, and m quotient were collected.

RESULTS

A total of 2394 papers published by 73 pharmacy practice chairs were found in a search of PubMed. The mean number of total publications per chair was 33 (95% CI 21 to 44). The mean number of publications per year was 1.4 using PubMed and 1.6 using WoS. Mean h-index was 8.0 (95% CI 6.3 to 9.6). Mean number of total citations was 410 (95% CI 252 to 568). Thirty-three percent (n = 24) had less than 10 lifetime publications and 18% had more than 50 lifetime publications. HSC-based chairs averaged 51.3 papers while non-HSC-based chairs averaged 19.1 (p < 0.01). Similar data were found for total citations (HSC = 673 vs non-HSC = 216; p < 0.001). Public school chairs had an average of 41.5 articles cited on PubMed, versus 15 for private school chairs (p < 0.01). Public school chairs had an average h-index of 9.7 versus 4.4 for private school chairs (p < 0.001), and an average of 9.2 citations per article compared with 5.2 for private school chairs (p < 0.001).

CONCLUSIONS

These data provide a normative pattern of publication metrics and record for pharmacy practice chairs and demonstrate marked variability in scholarly productivity.

Aseptic meningitis associated with chronic sulindac use for osteoarthritis: a case report

We report a case of aseptic meningitis thought to be associated with chronic sulindac use in a patient with osteoarthritis. The patient was hospitalized with an acute onset of headache, nuchal rigidity, nausea, and blurred vision. Brain imaging was unremarkable and a lumbar puncture revealed a lymphocytic pleocytosis. No infectious source was identified. The patient reported taking sulindac over the past year, it was discontinued, and symptoms promptly resolved. This case underscores the importance of obtaining a thorough drug history in conjunction with the knowledge of causative medications associated with aseptic meningitis. Given the widespread use of nonsteroidal anti-inflammatory drugs, clinicians must recognize that aseptic meningitis is a possible adverse effect of these medications.

Stevens-Johnson syndrome associated with oral minoxidil: a case report

Minoxidil is frequently used in patients with advanced renal disease who have been unresponsive to other antihypertensive agents. We describe a case of a 50-year-old man with chronic renal failure who was hospitalized complaining of a 2-week history of sore throat that had progressed to severe oral lesions and multiple pustular blisters on many sites of his body. The patient had been placed on oral minoxidil for uncontrolled hypertension one week prior to the onset of symptoms. The diagnosis of minoxidil-induced Stevens-Johnson syndrome (SJS) was established, minoxidil was discontinued and the patient subsequently improved. Although minoxidil-induced SJS is extremely rare, clinicians should be aware of this potentially severe adverse effect. This report emphasizes the importance of monitoring patients who are taking oral minoxidil for any signs or symptoms associated with SJS.

Plasmodium falciparum malaria associated with mefloquine failure in Gambia

A 25-year-old Caucasian man developed Plasmodium falciparum malaria after traveling to Gambia, despite having received chemoprophylaxis with mefloquine. The patient was hospitalized after returning to the United States. He received a 3-day course of atovaquone-proguanil and made a complete recovery. This case illustrates the potential role of pharmacists in the pharmaceutical care of travelers and underscores the importance of using current recommendations for preventing and treating malaria.