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Öğe Acyclovir-induced nephrotoxicity and neurotoxicity in a case of viral encephalitis: a case report(Bmj Publishing Group, 2025) Dertli, Bulent; Guzel Karahan, Sena; Koseoglu, Kadir; Cakir, Ahmet; Salduz, EkremViral encephalitis is a hazardous central nervous system disorder requiring immediate antiviral intervention. Acyclovir is the standard treatment for herpes simplex virus (HSV) encephalitis; nevertheless, improper dosing or administration can lead to nephrotoxicity and neurotoxicity. This case describes a 54-year-old male patient admitted for an allergic reaction, who thereafter had incoherent speech, instability and involuntary motions suggestive of HSV encephalitis. Intravenous acyclovir treatment was initiated empirically following cerebrospinal fluid examination. On the third day of therapy, the patient exhibited acute renal impairment, accompanied by hallucinations and significant psychomotor agitation. Following the clinical pharmacist's recommendations, the dosage was adjusted and the infusion period was prolonged to at least 1 hour, predicated on an estimated glomerular filtration rate of 20 mL/min/1,73 m(2). Subsequent to these surgeries, renal function and neurological status steadily enhanced, enabling a successful resolution of treatment. This example highlights the crucial role of clinical pharmacists in reducing acyclovir-related toxicities via personalised dosage and infusion management.Öğe EVALUATION OF DRUG-DRUG INTERACTIONS IN A LIVER TRANSPLANTATION UNIT(Springer, 2025) Guzel Karahan, Sena; Durmus, Mefkure; Gun, Zeynep Ulku[No abstract available]Öğe Prospective evaluation of medication-related problems and pharmacist interventions in liver transplant recipients(Frontiers Media Sa, 2026) Guzel Karahan, Sena; Durmus, Mefkure; Cakir, Ahmet; Gun, Zeynep Ulku; Yilmaz, SezaiBackground: Medication-related problems (MRPs) are a common patient safety issue among hospitalized individuals, often associated with reduced quality of life, increased healthcare costs, and higher mortality. Due to the chronic and complex nature of post-transplant care, liver transplant recipients are particularly vulnerable to MRPs. Clinical pharmacists play a critical role in identifying and resolving MRPs, thereby promoting the rational use of medications. The objective of this study was to characterize MRPs among liver transplant recipients and assess the clinical determinants associated with their occurrence. Method: This prospective study was conducted between 5 October 2023 to 31 April 2024 at the Liver Transplantation Institute. A total of 373 hospitalized liver transplant recipients in inpatient wards and intensive care units who were receiving at least one medication were included. Donors and patients not receiving any medication were excluded. The Pharmaceutical Care Network Europe (PCNE) classification system version 9.1 was used to categorize MRPs. Clinical and demographic characteristics of patients with and without MRPs were compared statistically and risk factors were analyzed through logistic regression. Results: Among the 373 patients included in this study, at least one MRP was identified in 311 patients, yielding 620 MRPs in total. A total of 620 interventions were proposed, of which 547 (88.2%) were accepted, while 73 (11.8%) were rejected. The leading causes of MRPs was dose selection (C3) was the most common cause (44.2%), followed by drug selection (C1) at 26.1%. The presence of at least one comorbidity and acute kidney injury were significant risk factors for the occurrence of MRPs (p < 0.05). Conclusion: To our knowledge, this is the first and most comprehensive study applying the PCNE v.9.1 method to liver transplant recipients hospitalized in both ward and intensive care unit settings. The most prevalent MRPs were related to treatment effectiveness, primarily caused by dose selection and drug selection. Clinical pharmacists and physicians should particularly focus on these aspects when reviewing transplant patients' medication regimens. The results achieved in this study suggest that clinicians should exercise caution when prescribing new medications to transplant recipients with at least one comorbidity and a history of acute kidney injury.Öğe The safety profile of trimethoprim-sulfamethoxazole regarding concomitant other drugs: a comparative analysis of adverse effects in a tertiary level adult intensive care unit(Bmc, 2025) Durmus, Mefkure; Aydin, Davut; Ustaomer, Sena; Guzel Karahan, Sena; Kucuk, Ahmet Oguzhan; Pehlivanlar Kucuk, MehtapBackground Trimethoprim-sulfamethoxazole (TMP-SMX) has been used clinically against many gram-positive and gram-negative bacteria, Pneumocystis, and certain protozoa. Beside its beneficial effects, it has many adverse reactions such as hyperkalemia, aplastic anemia, fulminant hepatic necrosis, hematological and neurological toxicity. Evaluation of TMP-SMX-related adverse reactions in intensive care unit (ICU) patients who generally with polipharmacy is lacking. We aimed to identify TMP-SMX-related adverse effects associated with mortality, and to determine independent predictors of this outcome, and factors associated with adverse reactions in critically ill patients who generally with polypharmacy undergoing TMP-SMX therapy. Methods This retrospective observational cohort study was conducted in a 16-bed adult medical ICU in T & uuml;rkiye. To assess the impact of various factors on TMP-SMX-related adverse reactions, patients were categorized into two independent groups based on the presence or absence of adverse effects. Additionally, to analyze changes in laboratory parameters associated with TMP-SMX therapy, paired comparisons were made between pre-therapy and post-therapy values within the same patients. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 23.0. Results Serum creatinin (sCr) elevation, AST elevation, hyperbilirubinemia, thrombocytopenia, and metabolic acidosis were significantly associated with mortality, also sCr elevation was found to be an independent risk factor for mortality. Any of drugs or diseases were increased the risk of hyperkalemia concomitant TMP-SMX. ALT elevation were significantly associated with concomitantly teicoplanin. Endocrinologic disease or respiratory causes of ICU admission were found independent risk factors for AST elevation or acidosis respectively. Thrombocytopenia was associated with concomitantly colistin-echinocandin combination. Cardiovascular diseases concomitant TMP-SMX were found to be an independent risk factor for serum creatinin (sCr) elevation. There was no relationship between sCr elevation and TMP-SMX concomitantly colistimethate. Conclusions Physicians should pay attention when prescribing TMP-SMX to patients with cardiovascular diseases. Teicoplanin, colistin-echinocandin, piperacillin tazobactam and acyclovir should be administered carefully concomitantly TMP-SMX regarding liver enzyme elevation, thrombocytopenia and hyponatremia respectively.
