Brian L Erstad
Work Summary
Brian Erstad’s research interests pertain to critical care medicine with an emphasis on patient safety and related outcomes research.
Brian Erstad’s research interests pertain to critical care medicine with an emphasis on patient safety and related outcomes research.
Abstract:
Several classes of drugs can be used in the management of acute pain: acetaminophen, salicylates, miscellaneous mild analgesics, nonsteroidal anti- inflammatory drugs (NSAIDs), and opioids. In part one of this two-part series, agents used to treat mild pain states will be explored. For this condition, acetaminophen and aspirin remain the standards of comparison. These agents are inexpensive and their adverse effect profiles are well described. For patients unable to take acetaminophen or aspirin, a variety of NSAIDs are available. This article reviews the advantages and disadvantages of the various agents and their role within the analgesic armamentarium for management of mild, acute pain states. Next month, in part two of this two- part series, the use of opioids will be explored.
PMID: 16670359;Abstract:
BACKGROUND: Estimation of renal function in patients with end-stage liver disease (ESLD) is complicated by several factors. OBJECTIVE: To develop a practical and relatively inexpensive method for estimating creatinine production and clearance in patients with ESLD. METHODS: Serum creatinine concentrations and urinary excretion of creatinine were measured in 27 patients with moderate-to-severe liver disease with the goal of developing equations to predict creatinine clearance from serum creatinine. Subjects were studied during an initial evaluation for a liver transplant program. Two 24 hour urine specimens were collected along with 3 serum samples over a 2 day evaluation period. Serum and urine creatinine concentrations were determined using both a modified Jaff́ (autoanalyzer) method and an HPLC method. The data were analyzed using nonlinear mixed-effects modeling. RESULTS: Considering both statistical criteria and physiological conventions through allometric scaling theory, creatinine clearance (mL/min) in males can be estimated as (80/serum creatinine) × (actual body weight/70)0.75. For females, the same equation is valid, but the result is multiplied by 0.661. A simplified equation without the exponent is presented, along with equations that are appropriate when an HPLC assay is used for greater specificity. CONCLUSIONS: These equations offer potential for improved estimation of creatinine clearance in patients with liver impairment; however, they need further validation using an independent group of subjects.
PMID: 16179559;Abstract:
A workshop was conducted on November 18-19, 2004, to address the issue of improving predictive models for drug delivery to developing humans. Although considerable progress has been made for adult humans, large gaps remain for predicting pharmacokinetic/pharmacodynamic (PK/PD) outcome in children because most adult models have not been tested during development. The goals of the meeting included a description of when, during development, infants/children become adultlike in handling drugs. The issue of incorporating the most recent advances into the predictive models was also addressed: both the use of imaging approaches and genomic information were considered. Disease state, as exemplified by obesity, was addressed as a modifier of drug pharmacokinetics and pharmacodynamics during development. Issues addressed in this workshop should be considered in the development of new predictive and mechanistic models of drug kinetics and dynamics in the developing human. © 2005 New York Academy of Sciences.