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Journal of Health Care For the Poor and... Aug 2006We surveyed English-speaking parents attending an inner-city health center. Subjects read the label on a bottle of liquid medicine and 1) demonstrated how much medicine...
We surveyed English-speaking parents attending an inner-city health center. Subjects read the label on a bottle of liquid medicine and 1) demonstrated how much medicine they should give, 2) stated how many times a day they should give the medicine, and 3) stated when they should give the next dose. We calculated adjusted odds ratios to test for the likelihood of incorrect medication dosing for subjects with and without demographic risk factors. Three hundred twenty six subjects participated. Overall, 252 (77%) demonstrated incorrect medication dosing. Medication dosing was more likely to be incorrect among young parents (AOR 2.45; CI 1.14, 5.26), immigrants (AOR 2.27; CI 1.04, 4.96), subjects without a high school degree (AOR 2.05; CI 1.04,4.05), and those who did not recall ever having been shown how to use a medicine dropper (AOR 1.79; CI 1.01,3.19). Implications for practice are discussed.
Topics: Adult; Black or African American; Age Factors; Comprehension; Drug Labeling; Educational Status; Emigration and Immigration; Female; Health Knowledge, Attitudes, Practice; Hispanic or Latino; Humans; Insurance Coverage; Insurance, Health; Language; Male; Parents; Poverty Areas; Urban Population
PubMed: 16960318
DOI: 10.1353/hpu.2006.0109 -
Drug Development and Industrial Pharmacy Feb 2006The application of eye drops from flexible dropper bottles fitted with different types of dropper tips is associated with the high variability of eye drop weights. The... (Comparative Study)
Comparative Study
The application of eye drops from flexible dropper bottles fitted with different types of dropper tips is associated with the high variability of eye drop weights. The aim of this report was to investigate the simultaneous effect of three factors influencing the mean weight of drops dispensing from two plastic dropper tips. Using a designed experiment (Box-Behnken), the effect of the concentration of benzalkonium chloride solutions (BAC) in the range of 0-0.02%, the dispensing angle from 90 degrees to 30 degrees from horizontal, and the residual volume of liquid in the dropper bottle from 4 to 10 mL on the mean drop weights were examined. The significant effect of the increase in BAC concentration resulted in a linear decrease in drop weights for both of the dropper tips investigated. The significant effect of the dispensing angle was influenced by the dropper tip design. For the dropper tip A, the effect of the dropper tip tilt was described by the quadratic equation with a minimum, which corresponded to the dispensing angle equal to that of 48 degrees from horizontal. Below this angle, the increase in drop weights occurred due to the drop formation from the wetted external surface of the tip orifice. The linear decrease in drop weights in response to the decrease in dispensing angle was detected for the dropper tip B. The regression equations and the contour line plots obtained allowed the drop weights to be estimated for the actual combinations of both the BAC concentration and the dispensing angle. The effect of the residual volume was found to be non-significant. Based on the formula of Tate's law, the direct proportion between surface tension of a solution and the radius of the effective perimeter of a dropper tip can be used to estimate the theoretical maximal weight of drops at the dispensing angle of 90 degrees . Using the stalagmometric values of surface tension of the BAC solutions, the maximal drop weights were estimated for both of the dropper tips investigated. A comparison between the theoretical and the experimentally measured drop weights enabled the dropper tips behavior to be discussed by using Harkins and Brown correction factor F. The F-value of 0.74 noted for the dropper tip A differed from that of stalagmometer F-value (0.61) indicating a deviation from the simple drop formation process in answer to more complicated design of the dropper tip A. On the other hand, the F-value of 0.6 observed for the dropper tip B demonstrated the better consistency with stalagmometry. As a result, the dropper tip B with the linear decrease of drop weights in response to the increased concentration of BAC and the decreased dispensing angle without the adverse external drop formation could be recommended in real drop dispensing.
Topics: Administration, Topical; Anti-Infective Agents, Local; Benzalkonium Compounds; Chemistry, Pharmaceutical; Dose-Response Relationship, Drug; Equipment Design; Ophthalmic Solutions
PubMed: 16537200
DOI: 10.1080/03639040500466130 -
Die Pharmazie Dec 2005The application of eye drops is known to be problematic due to the high variability of eye drop volume, the low capacity of the precorneal area resulting in an optimal...
The application of eye drops is known to be problematic due to the high variability of eye drop volume, the low capacity of the precorneal area resulting in an optimal drop volume of about 20 microl, and the risk of adverse systemic effects of drugs due to systemic absorption via the nasal mucosa. While dropper tip design and the surface activity of the antimicrobial preservative strongly influence the volume of an aqueous ophthalmic solution dispensed as eye drops, the handling of the preparation (dispensing angle, dispensing rate, and the residual volume of liquid in the dropper bottle) is generally believed to produce a minimal effect. In this study, properties of two dropper tips (rubber and plastic) frequently used in the Czech Republic were systematically investigated in a fractional factorial experiment. Of seven determinants potentially influencing the size of eye drops, the dropper tip design, the dispensing angle and the dispensing rate have been found to have a significant effect on the eye drop volume. Wetting of the rubber dropper tip resulted in a dramatic increase in drop volume which could hardly be foreseen in real drop dispensing. As a result, therefore, rubber dropper tips could scarcely be recommended, as opposed to plastic dropper tips which produced drops of comparable volume when used in upright position with approximately the same dispensing rate. Under those defined dispensing conditions, the variability of the drop volume could be expressed by a variability coefficient of 3.3%. Using a dispensing angle of 45 degrees from horizontal led to a decrease in drop volume and, in addition, to greater volume variability due to the formation of air bubbles inside the dropper tip chamber.
Topics: Algorithms; Benzalkonium Compounds; Data Interpretation, Statistical; Drug Packaging; Ophthalmic Solutions; Preservatives, Pharmaceutical; Reproducibility of Results; Surface-Active Agents; Thimerosal
PubMed: 16398268
DOI: No ID Found -
Survey of Ophthalmology 2004Ophthalmic solutions are available for multidose or single-dose administration in a wide variety of glass and plastic dropper bottles which deliver drops with a volume... (Review)
Review
Ophthalmic solutions are available for multidose or single-dose administration in a wide variety of glass and plastic dropper bottles which deliver drops with a volume between 25 and 70 microl. From a biopharmaceutical and economic point of view, however, smaller volumes of 5 to 15 microl should be instilled. In this review, the technical, pharmaceutical, and therapeutic aspects of eye drop formation and delivery are presented. The different types of containers are described and the determinants of eye drop size are discussed, such as the design and physical characteristics of the dropper tip and bottle, the physico-chemical properties of the solution, and the manner in which the patient dispenses the drops. Preferred and alternative instillation techniques and aids to facilitate the administration of eye drops by elderly patients are described.
Topics: Chemistry, Pharmaceutical; Drug Packaging; Equipment Design; Humans; Ophthalmic Solutions
PubMed: 14998692
DOI: 10.1016/j.survophthal.2003.12.009 -
Contact Dermatitis Aug 2002This study examines reproducibility of water and ethanol drop volumes from plastic squeeze dropper bottles, examines the difference in drop volumes between commonly used... (Comparative Study)
Comparative Study
This study examines reproducibility of water and ethanol drop volumes from plastic squeeze dropper bottles, examines the difference in drop volumes between commonly used liquid patch test solutions, and evaluates the volumes of water and ethanol needed to saturate Finn and IQ Chamber filter papers. 2 plastic squeeze dropper bottles recommended for use in patch testing have poor reproducibility compared to other bottles tested. 3 aqueous allergens tested (formaldehyde 1%, methylchloroisothiazolinone/methylisothiazolinone 0.01%, and dimethylol dihydroxyethyleneurea 4.5%) have drop volumes equivalent to water. Smaller drop volumes are produced by ethanol, hydrocortisone butyrate 1% in ethanol, cocamidopropyl betaine 1% a.q., and propylene glycol 30% a.q. Filter paper saturation volumes using distilled water are 16-19 micro L in standard Finn Chambers and 29-35 micro L in IQ Chambers. Ethanol saturation volumes are slightly lower. Previously recommended volumes of application for aqueous allergens of 15 micro L for standard Finn Chambers and 25 micro L for IQ Chambers (slightly below the filter paper saturation points) are appropriate. Selection of dropper bottles should consider drop volume reproducibility, differing drop volumes for different allergens, and the patch test chamber system being used.
Topics: Allergens; Dermatitis, Allergic Contact; Diffusion Chambers, Culture; Dose-Response Relationship, Drug; Ethanol; Humans; Patch Tests; Reproducibility of Results; Sensitivity and Specificity; Water
PubMed: 12423405
DOI: 10.1034/j.1600-0536.2002.470205.x -
European Journal of Pediatrics Mar 2001Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the Czech...
Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the Czech Republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis.
Topics: Brain Edema; Child; Child, Preschool; Consumer Product Safety; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Male; Renal Agents; Water Intoxication
PubMed: 11277376
DOI: 10.1007/s004310000686 -
South African Medical Journal =... Jul 2000Low-birth-weight (LBW) infants (< 2,500 g) are at increased risk of respiratory infection in the first few months of life and have low liver stores of vitamin A. As... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Low-birth-weight (LBW) infants (< 2,500 g) are at increased risk of respiratory infection in the first few months of life and have low liver stores of vitamin A. As retinol is essential for respiratory epithelial cell differentiation, deficiency could result in pathological changes in the respiratory epithelium, with respiratory problems.
OBJECTIVE
A randomised, double-blind, placebo-controlled trial to investigate the effect of vitamin A supplementation on the incidence and severity of respiratory infections in LBW infants during their first year of life.
METHOD
One hundred and thirty LBW infants (gestational age < 36 weeks and birth weight 950-1,700 g) were enrolled in the study. The infants were randomly allocated to a vitamin A or placebo group. Infants in the vitamin A group received 25,000 IU of vitamin A (retinyl palmitate, Arovit drops, Roche, Basle, Switzerland) on study days 1, 4 and 8. Study day 1 was between 36 and 60 hours after delivery. Infants in the placebo group received a placebo (formulated by Roche) with a similar appearance and packed in the same dropper bottles as the vitamin A drops.
RESULTS
Vitamin A supplementation markedly improved serum retinol levels. After the last vitamin A dose, the vitamin A group had higher mean serum retinol concentrations than the placebo group (45.77 +/- 17.07 micrograms/dl v. 12.88 +/- 6.48 micrograms/dl, P = 0.0001). There was no evidence of improvement in neonatal or post-neonatal respiratory problems associated with vitamin A supplementation. Vitamin A and placebo groups did not differ in the occurrence or duration of respiratory distress or the need for head-box oxygen. There were also no significant differences in the cumulative probability of developing lower or upper respiratory tract infection through the first year of life. There was a slight suggestion of an increase in the risk of hospitalisation with pneumonia associated with vitamin A supplementation. The cumulative probability of being hospitalised with pneumonia by 6 months of age was 24.6% (7 hospitalisations) in the vitamin A group compared with 7.4% (2 hospitalisations) in the placebo group (log rank test P = 0.04). After adjusting for risk factors this difference was no longer significant.
CONCLUSION
Vitamin A supplementation in LBW neonates may not reduce incidence or severity of respiratory infections. These results do not negate the importance of improving vitamin A status in children as an important public health measure to reduce morbidity and mortality from other childhood infections.
Topics: Chi-Square Distribution; Double-Blind Method; Female; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Logistic Models; Male; Proportional Hazards Models; Respiratory Tract Infections; Vitamin A
PubMed: 10985138
DOI: No ID Found -
The Journal of Allergy and Clinical... Aug 1999Nebulized bronchodilator solutions are available in the United States as both nonsterile and sterile-filled products. Sulfites, benzalkonium chloride (BAC), or... (Review)
Review
Nebulized bronchodilator solutions are available in the United States as both nonsterile and sterile-filled products. Sulfites, benzalkonium chloride (BAC), or chlorobutanol are added to nonsterile products to prevent bacterial growth, but there have been reports of contaminated solutions containing preservatives. Ethylenediamine tetraacetic acid (EDTA) is added to some products to prevent discoloration of the solution. With the exception of chlorobutanol, all of these additives are capable of inducing bronchospasm in a concentration-dependent manner. However, it is rarely apparent to the patient or health care provider that the additive diminishes the bronchodilator effects. Older products (eg, isoproterenol and isoetharine) contain enough sulfites to produce bronchospasm in most patients with asthma, even in those without a prior history of sulfite sensitivity. Bronchoconstriction from inhaled BAC is cumulative, prolonged, and correlates directly with basal airway responsiveness. The multidose dropper bottle of albuterol contains 50 microg BAC/dose, which is below the threshold for bronchoconstriction whereas the screwcap unit-dose vial contains 300 microg/dose, which is above the threshold for many patients. If the screwcap product is used in the emergency department, a patient could receive as much as 1800 microg of BAC in the first hour. Three sterile-filled unit dose albuterol products contain no additives, whereas a fourth, (manufactured by Dey Laboratories) contains 300 microg of EDTA, which is also below the threshold dose for bronchoconstriction. Only additive-free sterile solutions should be used for hourly or continuous nebulization of albuterol. The multidose dropper bottle or the Dey product can be used when the interval between doses is longer, whereas the screwcap product should not be used for acute therapy. Ipratropium is available only as a sterile, additive-free unit-dose vial, as is levalbuterol.
Topics: Administration, Inhalation; Animals; Benzalkonium Compounds; Bronchoconstriction; Bronchoconstrictor Agents; Bronchodilator Agents; Chlorobutanol; Drug Contamination; Edetic Acid; Humans; Nebulizers and Vaporizers; Preservatives, Pharmaceutical; Sulfites; United States
PubMed: 10452789
DOI: 10.1016/s0091-6749(99)70274-5 -
International Journal of Pharmaceutical... 1999The stability of amphotericin B 5 mg/mL in 5% dextrose ophthalmic solution prepared by the Hospital Pharmacy Service was studied in different conditions of storage and...
The stability of amphotericin B 5 mg/mL in 5% dextrose ophthalmic solution prepared by the Hospital Pharmacy Service was studied in different conditions of storage and use. Admixtures of amphotericin B were aseptically prepared in low-density polyethylene dropper bottles. The stability of amphotericin B was evaluated in ophthalmic dropper bottles stored in a refrigerator, at room temperature, protected from, or exposed to, light. To simulate the effect of exposure to air, some ophthalmic dropper bottles were opened twice daily and two drops were removed. Immediately after preparation, samples were collected to determine the initial drug concentration by high-performance liquid chromatography and to assess pH, osmolality and sterility. The same tests were conducted after four, eight and 15 days of storage in ophthalmic containers opened daily and unopened after eight, 15, 30, 60, 75 and 120 days of storage. Samples were visually inspected daily for signs of physical incompatibility. An additional study was conducted in four ophthalmic containers collected in the ophthalmology unit after eight or 15 days of current patient use testing the same parameters. Ophthamlic containers stored in the refrigerator (the closed and the opened daily set) showed no loss or deterioration of amphotericin B during the corresponding period of storage (120 and 15 days, respectively). We observed precipitation and degradation after 13 days of storage in ophthalmic containers exposed to normal lighting conditions at room temperature, and after 16 days in ophthalmic containers protected from light. There was no appreciable change in pH or osmolality in any of the samples. Microbiological invesigation disclosed negative culture results for all samples. This study shows that aseptically prepared amphotericin B ophthalmic solution packaged in low-density polyethylene bottles can be stored safely for up to 120 days when unopened and stored at 4 deg C and protected from light, for 16 days when stored at 22 deg C and protected from light and for 13 days when stored at 22 deg C and exposed to light.
PubMed: 23985715
DOI: No ID Found -
American Journal of Health-system... Mar 1999The stability of fumagillin 70 microg/mL (as the bicyclohexylammonium crystal) in an extemporaneously prepared ophthalmic solution was studied. An ophthalmic solution of...
The stability of fumagillin 70 microg/mL (as the bicyclohexylammonium crystal) in an extemporaneously prepared ophthalmic solution was studied. An ophthalmic solution of fumagillin 70 microg/mL was prepared by combining 120 mg of fumagillin bicyclohexylammonium crystals with 20 mL of 0.9% Sodium Chloride Injection, USP, and 20 mL of an ophthalmic irrigating solution. The solution was stored in 12 sterile semi-opaque dropper bottles; 4 bottles were stored at 25 degrees C exposed to light, 4 were stored at 25 degrees C in the dark, and 4 were stored at 4 degrees C in the dark. Samples were taken on days 0, 7, 14, 21, and 28 and analyzed by high-performance liquid chromatography. Sterility was tested as well. In the solutions stored at 25 degrees C, 17-30% of the initial drug concentration was lost during the first week. The solution protected from light and stored at 4 degrees C lost about 12% of active drug by week 4. There was no change in color or odor in any of the solutions and only a minor change in pH over the study period. There was no evidence of microbial growth in any of the solutions tested. Fumagillin 70 microg/mL (as the bicyclohexylammonium crystal) in 0.9% sodium chloride injection and an ophthalmic irrigating solution containing benzalkonium chloride was stable in the dark for 14 days at 4 degrees C.
Topics: Antiprotozoal Agents; Cyclohexanes; Drug Compounding; Drug Stability; Eye Infections, Parasitic; Fatty Acids, Unsaturated; Humans; Ophthalmic Solutions; Sesquiterpenes; Time Factors
PubMed: 10192690
DOI: No ID Found