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Am J Hosp Palliat Care. 2002 Sep-Oct;19(5):351-5.
Gastrointestinal symptoms among inpatients with advanced cancer.

Komurcu S, Nelson KA, Walsh D, Ford RB, Rybicki LA.

The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Ohio, USA.

Nearly one-half of the most frequently reported and most distressing symptoms in patients with advanced cancer are gastrointestinal in nature. This prospective study was designed to assess the frequency of gastrointestinal symptoms among inpatients admitted to a palliative medicine program with advanced cancer. Twenty-nine men and 2l women, with a median age of 64 years (range, 35-84), were interviewed about 17 gastrointestinal symptoms. Age, gender, diagnosis, and medication use were also recorded The most common diagnoses were cancers of the lung (n = 14), breast (n = 6), and prostate (n = 4). Dry mouth (84 percent), weight loss (76 percent), early satiety (71 percent), taste change (60 percent), constipation (58 percent), anorexia (56 percent), bloating (50 percent), nausea (48 percent), abdominal pain (42 percent), and vomiting (34 percent) were the 10 most common gastrointestinal symptoms. Women had more gastrointestinal symptoms than men (median 8 vs. 6, p = 0.018), although this finding was not statistically significant (p = 0.11) after excluding gender-specific cancers. Women had more taste change and diarrhea than men after excluding gender-specific cancers (p = 0.036 and p = 0.046, respectively). Those with primary gastrointestinal cancers (n = 8) had more indigestion and hiccups than those with nongastrointestinal cancers (n = 39). There was no age difference in symptomatology. The drugs prescribed most commonly were opioids (n = 40), laxatives (n = 38), H2 blockers (n = 29), appetite stimulants (n = 29), and antiemetics (n = 29). Findings support that gastrointestinal symptoms are very common in hospitalized patients with advanced cancer and that the frequency and type of symptoms differ with gender and gastrointestinal vs. nongastrointestinal primary site.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12269782&dopt=Abstract

Pharmacoepidemiol Drug Saf. 2002 Jul-Aug;11(5):409-14.
Self-medication in a Portuguese urban population: a prevalence study.

Martins AP, Miranda Ada C, Mendes Z, Soares MA, Ferreira P, Nogueira A.

Centro de Estudos de Farmacoepidemiologia da Associacao Nacional das Farmacias, Lisboa, Portugal. paula.martinnf.pt

PURPOSE: To determine the prevalence of self-medication in a Portuguese urban population. To assess the feasibility of performing these studies in community pharmacies. METHODS: A cross-sectional study was chosen to collect information about demography, use of health services and drug utilization in a sample of pharmacy user-purchasers in a pre-determined period of time. RESULTS: The proportion of pharmacies which participated in the study was 18.3% (11 from 60 invited) in Lisbon and 37.5% (15 of 40 invited) in Porto. Among the 3312 selected patients, only 2.6% (n = 114) refused to participate. The prevalence of self-medication was found to be 26.2%. The distribution of self-medication by gender was 28.4% for males and 25.2% for females. Use of self-medication was statistically significantly higher (p < 0.001) among individuals aged between 10 and 49 years. The main therapeutic groups used for self-medication, according to the ATC classification, were throat preparations, cough and cold preparations, stomatological preparations (antiinfectives and corticosteroides for local oral treatment), laxatives, analgesics, dermatological preparations, vitamins, mineral supplements and other alimentary tract and metabolism products. CONCLUSIONS: In the urban areas under study the overall prevalence of self-medication was 26.2%. Predictive factors for self-medication seem to be, a high level of education, professional status and length of waiting times for a medical consultation in cases of a severe health problem. Further research on this subject is needed to confirm the reproducibility of these results, since potential selection bias could have been introduced due to the method used for patient selection. Pharmacoepidemiologic research is feasible in Portuguese community pharmacies.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12271884&dopt=Abstract

Perinat Care. 1978 Sep;2(8):19-25.
Drugs in breast milk.

Hervada AR, Feit E, Sagraves R.

PIP: The amount of drug excreted into breast milk is dependent upon the lipid solubility of the medication, the mechanism of transport, the degree of ionization, and change in plasma pH. The higher the lipid solubility, the greater the concentration in human milk. The majority of drugs are transported into mammary blood capillaries by passive diffusion. The rest are transported by reverse pinocytosis. Once the drug has entered the epithelial cells of breast tissue, the drug molecules are excreted into the human milk by active transport, passive diffusion, or apocrine secretion. The amount of free (active) drug available for transport depends on the degree of protein binding the plasma pH. Another factor affecting excretion of drugs is the time when breast feeding occurs. In the 1st few days of life, when colostrum is present, water-soluble drugs pass through the breast more easily than afterwards when milk is produced. Then lipid-soluble drugs cross in higher concentrations. The effect on nursing infants is dependent on the amount excreted into the milk, the total amount absorbed by the infant, and the toxicity of the drug. The use of the following drugs in breast feeding mothers is reviewed: anticoagulants, antihypertensives and diuretics, antimicrobials, drugs affecting the central nervous system (alcohol, chloral hydrate, meprobamate, lithium, and aspirin), marijuana, other drugs (antihistamines, atropine, ergot alkaloids, laxatives, nicotine, iodides, propylthiouracil, theophylline), hormones (insulin, thyroxine, and oral contraceptives), and radiopharmaceuticals.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12311408&dopt=Abstract

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