The role of the suspicious renal pharmacist in identifying unusual adverse drug reactions-why this is not a small problem.

Renal patients have a high incidence of adverse drug reactions due to both pharmacokinetic and pharmacodynamic changes and detecting these adverse drug reactions relies heavily on having a high index of suspicion-which seems to be invoked through experience, whether our own or that of our colleagues. Pharmacists must be vigilant about adverse drug reactions and it is vital that pharmacists continue to teach their colleagues about their experiences identifying less common adverse drug reactions and adverse drug reactions with unusual presentations in addition to simply reporting these adverse drug reactions.

Drug related problems identified by community pharmacists on hospital discharge prescriptions in New Zealand.

Background: There can be a lack of transfer of information between hospitals and community pharmacies following patient discharge, which puts patients at a high risk of suffering drug related problems (DRPs). Community pharmacy plays a vital role in identifying and solving these discharge DRPs and taking action before these DRPs can lead to patient harm.

Objective: To identify the types and quantities of DRPs that community pharmacies detect within a single district health board (DHB) in New Zealand.

Determination of methylphenidate in Calliphorid larvae by liquid-liquid extraction and liquid chromatography mass spectrometry--forensic entomotoxicology using an in vivo rat brain model.

The aim of this study was to examine the potential forensic utilisation of blowfly larvae (Diptera: Calliphoridae) as an alternative toxicological specimen for the detection of the psychotropic model drug methylphenidate (MPH). MPH was extracted from biological matrices (rat brain, serum and Calliphorid larvae) by liquid-liquid extraction with recovery of >80%, and quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The LC-MS/MS assay was validated for entomotoxicological use and initially applied to male Sprague-Dawley rats (n=6) that were dosed with MPH (20mg/kg) ante-mortem.

Design of pharmacokinetic studies for latent covariates.

Latent covariates are covariates that are known to exist but are either observable but unavailable or unobservable at the time of the clinical study. Designs to account for latent covariates must incorporate both uncertainty in the prevalence of the covariate and the data-type of the covariate. The informativeness of the covariate will then depend on whether the covariate data is continuous, ordinal or nominal.

Methanol and ethylene glycol acute poisonings - predictors of mortality.

Context: Methanol and ethylene glycol cause significant mortality post-ingestion. Predicting prognosis based on the biomarkers osmolal gap, anion gap and pH is beneficial.

Objective: To evaluate the relationship between biomarkers, measured post-methanol and ethylene glycol exposure, and clinical outcomes.

Modeling red blood cell survival data.

Anaemia of chronic kidney disease (CKD) is a common complication in patients with renal impairment, especially in end-stage renal failure. As well as erythropoietin deficiency, decreased red blood cell survival is a contributing factor. However, it remains unclear which mechanism underlies the altered survival of red blood cells (RBCs).

Evaluation of red blood cell labelling methods based on a statistical model for red blood cell survival.

The aim of this work is to compare different labelling methods that are commonly used to estimate the lifespan of red blood cells (RBCs), e.g. in anaemia of renal failure, where the effect of treatment with erythropoietin depends on the lifespan of RBCs.

Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring.

Aim: Due to altered red blood cell survival and erythropoietin therapy glycated haemoglobin (HbA1c) may not accurately reflect long-term glycaemic control in patients with diabetes and chronic kidney disease (CKD). Glycated albumin (GA) and fructosamine are alternative markers of glycaemia. The aim of this study was to investigate the accuracy of HbA1c, GA and fructosamine as indicators of glycaemic control using continuous glucose monitoring.

A dosing regimen for immediate N-acetylcysteine treatment for acute paracetamol overdose.

Context: Current treatment of paracetamol (acetaminophen) poisoning involves initiating a 3-phase N-acetylcysteine (NAC) infusion after comparing a plasma concentration, taken ≥ 4 h post-overdose, to a nomogram. This may result in dosing errors, a delay in treatment, or possibly more adverse effects - due to the use of a high dose rate for the first infusion when treatment is initiated.

Objective: Our aim was to investigate a novel dosing regimen for the immediate administration of NAC on admission at a lower infusion rate.

Red blood cell survival in long-term dialysis patients.

Background: Shortening of red blood cell (RBC) survival contributes to the anemia of chronic kidney disease. The toxic uremic environment accounts for the decreased RBC life span. The contribution of mechanical damage caused by hemodialysis to the shortened life span is unclear.

The pharmacokinetics of methanol in the presence of ethanol: a case study.

Background And Objective: Methanol is a toxic alcohol that can cause significant morbidity and mortality in overdose, while ethanol is a readily available and effective antidote. Little is known about the pharmacokinetics of methanol in the presence of ethanol and vice versa. This paper explores the influence of methanol and ethanol on the pharmacokinetics of each other along with the effect of continuous venovenous haemodiafiltration (CVVHD) on alcohol removal.

A statistical model for red blood cell survival.

A statistical model for the survival time of red blood cells (RBCs) with a continuous distribution of cell lifespans is presented. The underlying distribution of RBC lifespans is derived from a probability density function with a bathtub-shaped hazard curve, and accounts for death of RBCs due to senescence (age-dependent increasing hazard rate) and random destruction (constant hazard), as well as for death due to initial or delayed failures and neocytolysis (equivalent to early red cell mortality). The model yields survival times similar to those of previously published studies of RBC survival and is easily amenable to inclusion of drug effects and haemolytic disorders.