[Changes in plasma proteins and drug distribution in kidney and liver diseases]. / Promjene plazmatskih proteina u bolestima bubrega i jetre i distribucija lijekova.

Kidney and liver diseases induce alterations in drug binding to plasma proteins. These alterations are caused by qualitative and quantitative changes of plasma proteins and the presence of endogenous substances which act as competitive inhibitors of drug binding to plasma proteins. These changes are the most prominent in nephrotic syndrome and uremia among kidney diseases and in cirrhosis among liver diseases. The more important drugs in which the free fraction is changed in these entities are listed in the tables. The changes in drug distribution caused by plasma protein alterations may induce significant changes in entire drug pharmacokinetics. Discussed are theoretically expected and experimentally proven changes in plasma proteins in kidney and liver diseases and their influence to drug action and dosing regimen.

Qualitative analysis of drug prescription in a geriatric population sample.

The rationality of specialist drug prescription in 154 patients older than 64 in 3 Zagreb homes for the aged was analyzed over an 11-month period. Categories analyzed were: number of prescribed drugs, justification of prescription, adequacy of the dose, route, form and therapy duration of the prescribed drugs, adequacy of the type of the prescribed drugs in the advanced age and the presence of contraindications of drugs used. The criterion of the rational drug use was the WHO's modified definition of rational drug therapy: "Application of an appropriate drug by a correct route in an adequate dose over a sufficiently long period of time". This basic criterion was further elaborated in relation to the analyzed categories. There were 2.66 (+/- 1.65) prescribed drugs per visit in which drugs were prescribed. In all analyzed categories, distinctive aberrations from the principles of rational drug prescription were found. One hundred and sixty-four (41.4%) of all drugs were unjustifiably prescribed and 103 (26.4%) were not dosed correctly. The duration of the therapy was inadequate for 60 (15.4%), route for 41 (10.5%), form for 32 (8.2%) of drugs prescribed. Seventy-five (19.3%) were not adequate because of patients' age and 15 (3.9%) were prescribed in spite of existing contraindications.

[Analysis of the use of digitalis in a sample of the geriatric population]. / Analiza primjene digitalisa u uzorku gerijatrijske populacije.

Rationality of digitalis use in 20 elderly patients in long term-care institution was analysed using the method of correlation of the past medical history, clinical examination and basic laboratory findings. After consultation of clinical pharmacologist, general practitioner and medical biochemist it was possible to stop the digoxin therapy in 6 (30%) of the patients. Four (20%) patients were hypersaturated with digoxin. Lack of indication was the reason for stopping the digitalis in one of them. Therapy was modified in 3 patients. Use of digitalis was rational in 10 (50%) of the patients. The results suggest that digitalis was prescribed too often in this sample of the elderly patients.

[Hypersensitivity vasculitis caused by ethyl biscoumacetate]. / Hipersenzitivni vaskulitis izazvan etilbiskumacetatom.

A case report of a 61-year-old patient with hypersensitive vasculitis caused by ethylbiscumacetate is presented. After the implantation of the artificial aortic valve the patient was treated with medigoxine, furosemide, dipiridamole, disopiramide, potassium chloride and ethylbiscumacetate. Among these drugs furosemide and ethylbiscumacetate are reported to cause hypersensitive vasculitis. On the basis of the past medical history, clinical and histological findings furosemide was ruled out as a causative agent. The diagnosis was confirmed by the skin biopsy and finding of a normal biologic activity of protein C. The discontinuance of all previous drugs and administration of methylprednisolone led to improvement in the skin lesions of the patient. The need for continuous anticoagulant therapy was the reason for fepromarone to be given, achieving good anticoagulant effect, without any side effects. According to the criteria of Karch and Lasagna the degree of connection between drug use and side effects in this case belongs to the category "probable".