Kathryn Tortorice

U.S. Department of Veterans Affairs | VA · Pharmacy Benefits Services

The following recommendations are based on current medical evidence and expert opinion from clinicians. The content of the document is dynamic and will be revised as new clinical data becomes available. The purpose of this document is to assist practitioners in clinical decision-making, to standardize and improve the quality of patient care, and to...

Studies of the retreatment with consensus interferon (CIFN) and ribavirin (RBV) of hepatitis C virus (HCV)-infected patients who failed prior pegylated interferon alfa/ribavirin (PEG-IFN/RBV) have found quite variable efficacy and tolerability of this therapy. As such, CIFN/RBV use and efficacy in clinical practice were evaluated within the Departm...

The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. We analyzed all-cause...

The ex vivo effect of aspirin (ASA) on platelet aggregation, the platelet component of thrombosis, was studied at repeated intervals in a cohort of patients taking aspirin for recurrent ischemic stroke prevention to define the maintenance of efficacy over time. We administered increasing doses of aspirin (from 325 to 1300 mg/d) to patients with pre...

Whether the risks of acute rejection after elective cyclosporine (CsA) withdrawal in renal transplantation outweigh the potential benefits is unclear. We examined results for 236 patients who underwent transplantation between January 1986 and June 1991. Patients were treated with prophylactic CsA, prednisone, and azathioprine, and had grafts that f...

Parkinson's disease is a progressive neurological disorder with a usual age of onset between 40 and 70 years. It is characterized by a tetrad of symptoms: resting tremor, bradykinesia, rigidity, and postural abnormalities. In addition, patients may display varying degrees of autonomic dysfunction. The clinical course of the disease is unpredictable...

To review trials involving risk factor management and pharmacologic therapy for the prevention of stroke. English-language literature published between 1966 and 1992 was analyzed; pertinent literature is reviewed. Studies that evaluated the impact of risk factor management on prevention of vascular events were selected. In addition, trials assessin...

The purpose of this study was to assess the biological effect of aspirin as measured by the inhibition of platelet aggregation in patients taking aspirin for stroke prevention and in patients with acute stroke. We administered increasing doses of aspirin (325, 650, 975, and 1,300 mg daily) to 113 patients for stroke prevention and measured the inhi...

The extent to which cyclosporine (CsA) directly, or indirectly, influences serum lipid levels in renal transplant patients treated with multiple-drug immunosuppression protocols is unclear. Indeed, patients treated with CsA have reduced corticosteroid requirements, fewer acute rejection episodes, and other differences from patients receiving conven...

Despite having important implications for the design of therapeutic trials, the clinical setting, time of onset, and rate of progression for chronic declines in renal allograft function have not been well characterized. In the present investigation, monthly estimates of glomerular filtration rate (E-GFR) were made using creatinine clearance and int...

Although calcium channel blockers have been reported to increase trough cyclosporine (CsA) blood levels, few studies have systematically examined the effects of calcium channel blockers on CsA pharmacokinetics. In the present investigation, complete pharmacokinetic profiles of CsA and its major metabolites (M1, M17, and M21) were determined in 11 v...

The treatment of hypercholesterolemia in renal transplant recipients has been problematic. In the present double-blind study, 11 patients were treated with diet for at least 4 weeks. They were then randomized to placebo or the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, lovastatin (20 mg/day) for 6 weeks, followed by crosso...

To determine whether polyvalent, immune globulin (IgG) prevents cytomegalovirus (CMV) infection after cadaver renal transplantation, 28 patients were randomly allocated to receive 12 weekly infusions of 500 mg/kg of IgG (n = 15) or no treatment (n = 13). Both groups were similar with respect to age, sex, antigen mismatches, number of diabetics, and...

Lyme disease is caused by the spirochete Borrelia burgdorferi, which is carried by infected ticks. This disorder has a variable clinical course with multisystem manifestations, including dermatologic, neurologic, cardiac, and rheumatologic abnormalities. Although Lyme disease has been commonly associated with stages, the utility of staging may be l...