A survey of plasma and urinary concentrations of phenylbutazone and its metabolites in thoroughbred horses racing in Kentucky was carried out. Post-race blood samples from more than 200 horses running at Latonia Racetrack and Keeneland in the Spring of 1983 were analysed. The modal plasma concentration of phenylbutazone was between 1 and 2 micrograms/ml, the mean concentration was 3.5 micrograms/ml and the range was up to 15 micrograms/ml. Oxyphenbutazone had a modal plasma concentration between 1 and 2 micrograms/ml, a mean concentration of 2.07 micrograms/ml and a range of up to 13 micrograms/ml. gamma OH-phenylbutazone had a modal plasma concentration of less than 1 microgram/ml, a mean level of 1.39 micrograms/ml and a range of up to 7.32 micrograms/ml. All plasma concentration frequency distributions were well fitted by log normal distributions. Urinary concentrations of phenylbutazone yielded modal concentrations of less than 1 microgram/ml, a mean urinary concentration of 2.9 micrograms/ml, with a range of up to 30.5 micrograms/ml. This population fitted a log-normal distribution. For oxyphenbutazone the modal concentration was less than 3 micrograms/ml, the mean concentration was 15.26 micrograms/ml, with a range to 81.5 micrograms/ml. The frequency distribution of these samples was apparently bimodal. For gamma OH-phenylbutazone, the modal concentration was less than 4 micrograms/ml, the mean concentration 21.23 micrograms/ml, with a range of up to 122 micrograms/ml. The population frequency distribution for gamma OH-phenylbutazone was indeterminate. Analysis of the pH of these post-race urine samples showed a bimodal frequency distribution. The pH values observed ranged from 4.9 to 8.7, with peaks at about pH 5.25 and 7.25. This bimodal pattern of urinary pH values is consistent with observations made in England and Japan. Urinary pH influenced the concentrations of phenylbutazone, oxyphenbutazone and gamma OH-phenylbutazone found in the urine samples. The concentration of these metabolites found in alkaline urines were from 32 to 225 times greater than those found in acidic urines. Plasma concentrations of phenylbutazone and its metabolites, however, were unaffected by urinary pH. In interlaboratory experiments, horses running at Hollywood Park were dosed with phenylbutazone at about 2 g/1000 lbs 24 and 48 h before racing, and a mean dose of 0.6 g/1000 lbs at 72 h prior to racing. Post-race plasma samples from these horses showed phenylbutazone concentrations ranging from 0.44 to 9.97 micrograms/ml, with a mean concentration of 4.09 micrograms/ml.(ABSTRACT TRUNCATED AT 400 WORDS)
Experiments to determine the residual plasma concentrations of phenylbutazone and its metabolites found in horses racing on a 'no-race day medication' or 24-h rule were carried out. One dosing schedule (oral-i.v.) consisted of 8.8 mg/kg (4 g/1000 lbs) orally for 3 days, followed by 4.4 mg/kg (2 g/1000 lbs) intravenously on day 4. A second schedule consisted of 4.4 mg/kg i.v. for 4 days. The experiments were carried out in Thoroughbred and Standardbred horses at pasture, half-bred horses at pasture, and in Thoroughbred horses in training. After administering the i.v. schedule for 4 days to Thoroughbred and Standardbred horses at pasture, the mean plasma concentrations of phenylbutazone increased from 0.77 microgram/ml on day 2 to 2.5 micrograms/ml on day 5. The shape of the frequency distribution of these populations was log-normal. These data are consistent with one horse in 1,000 yielding a plasma level of 8.07 micrograms/ml on day 5. After administration of the oral-i.v. schedule to Thoroughbred and Standardbred horses at pasture, the mean plasma concentrations of phenylbutazone were 3.4 micrograms/ml on day 2 and 3.5 micrograms/ml on day 5. The range on day 5 was from 1.4 to 8.98 micrograms/ml and the frequency distribution was log-normal. These data are consistent with one horse in 1000 having a plasma level of 15.8 micrograms/ml on day 5. In a final experiment, the oral dosing schedule was administered to 62 Thoroughbred horses in training. Plasma concentrations on day 5 in these horses averaged 5.3 micrograms/ml. The range was from 1.3 to 13.6 micrograms/ml and the frequency distribution was log-normal. Statistical projection of these values suggests that following this oral dosing schedule in racing horses about one horse in 1000 will yield a plasma level of 23.5 micrograms/ml of phenylbutazone 24 h after the last dose.
Interference or 'masking' in thin layer chromatography occurs when the presence of one drug on a thin layer plate physically obscures or interferes with the detection of another drug. We investigated the ability of phenylbutazone and oxyphenbutazone to mask or interfere with the detection by high performance thin layer chromatography (HPTLC) of basic drugs used illegally in horse racing. Of fifty-five basic drugs called 'positive' since 1981 by laboratories affiliated with the Association of Official Racing Chemists (AORC), forty did not comigrate with phenylbutazone or oxyphenbutazone and could not, therefore, be masked. When 75 micrograms/ml of oxyphenbutazone was spiked into urine samples, subjected to an extraction procedure for basic drugs, and then run in our routine HPTLC systems, no 'spots' due to oxyphenbutazone appeared. 'Masking' by oxyphenbutazone, therefore, did not and could not occur in our test systems. When phenylbutazone at a concentration of 30 micrograms/ml was spiked into urine samples and run in the routine HPTLC system, phenylbutazone spots were visible under ultraviolet light and after certain specific oversprays were used to visualize basic drugs. These spots, however, did not interfere with routine thin layer testing for basic drugs. It was concluded that phenylbutazone and oxyphenbutazone had no significant ability to interfere with detection of the parent forms of these basic drugs under the conditions described in these experiments.
1529 Background: Tobacco assessment and cessation is advocated by ASCO and national clinical oncology guidelines, but there is little information on large scale clinically efficient models to assess tobacco use and provide cessation in a structured evidence based manner. Automation through the electronic medical record (EMR) could reduce subjective interpretation by clinicians and assist in increasing data tracking accuracy to enhance meaningful use initiatives. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an annotated fixed-variable response system in the EMR delivered by nursing at initial consult and at follow-up. A logic based EMR referral system was developed to determine patient eligibility for mandatory automated referral to a dedicated tobacco cessation service. An evidence based institutional clinical cessation program was developed to provide cessation support to referred patients. The evidence based screening and referral algorithms will be presented. Results: Over 13 months, 677 patients were referred and 529 patients were successfully contacted to date for cessation support. In the 529 patients, 21 (3.9%) were inappropriate referrals (never smokers or long term former smokers), 48 patients (9.1%) did not want to enroll, but wanted to discuss cessation at a later date. Notably, only 18 patients (3.4%) refused any intervention. In a total of 415 patients enrolled in the cessation program, 104 patients (25.1%) were thinking about quitting (contemplation), 134 patients (32.3%) were preparing to quit, 169 patients (40.7%) were quitting (action phase), and 8 patients (1.9%) have relapsed. Tobacco assessments and automated referrals through the EMR took a median of 4 minutes to complete. Conclusions: A large volume of patients were screened and referred to a dedicated cessation program with low patient refusal for intervention without impeding physician workflow. These data suggest that this nursing driven EMR based assessment is a highly efficient clinical model for tobacco assessment and cessation.
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