bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Growth Hormone (Recombinant): Lipodystrophy (HIV-Related)
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
A Guide to Drug Therapy in Patients with Enteral Feeding Tubes: Dosage Form Selection and Administration Methods
Authors: Beckwith M. Christina , Feddema Sarah S. , Barton Richard G. , Graves Caran
Published: January 2018

Drug therapy may be complicated in hospitalized patients receiving nutrition via enteral feeding tubes. Dosage form selection and appropriate administration methods are crucial in patients with feeding tubes. Although hospitalized patients receive nutritional support through various routes, oral nutrition is preferred. Enteral or parenteral nutrition may be used if oral intake is inadequate or inadvisable. Patients with functional gastrointestinal tracts usually receive enteral nutrition. Administering oral medications through the enteral feeding tube can lead to complications like tube clogging or decreased drug activity. However, drug therapy need not be compromised in patients receiving enteral nutrition. Careful selection and preparation of dosage forms reduces the complications of medication administration. Flushing the feeding tube and screening for drug incompatibilities decreases the incidence of tube clogging and replacement.
Evaluation of Once Daily Aminoglycoside Use in the Elderly
Authors: Barlows Theodore G. , Luque Carla A. , Bernstein-Solomon Bridget J. , Menendez Lourdes B.
Published: January 2018

Purpose

This study evaluated the incidence of nephrotoxicity due to once daily aminoglycoside (ODA) use in elderly patients at two South Florida institutions.

Methods

A retrospective review of all patients who received 7 mg/kg/day of either gentamicin or tobramycin was conducted.

Results

Eighty-one (49%) males and 84 (51%) females with a mean age of 73 (range, 60 to 95) years were included. Nephrotoxicity was evident in 16 patients (9.7%). Of these, eight (4.8%) experienced nephrotoxicity possibly associated with aminoglycoside administration. A subgroup analysis of nonnephrotoxic patients compared with nephrotoxic patients revealed no significant differences in mean initial serum creatinine (1 mg/dL vs 0.95 mg/dL, P = 0.861) or dosing interval (31.4 vs 31.5 hours, P = 0.983). The mean duration of aminoglycoside treatment was less in the nonnephrotoxic group compared with the nephrotoxic group (5.2 vs 9.9 days, P < 0.05).

Conclusion

The results of this retrospective evaluation suggest that ODA dosing in the elderly is safe; however, patients should be monitored closely, especially when they require more than 5 days of aminoglycoside therapy, or are receiving concomitant nephrotoxic agents.
Treatment of Pulmonary Arterial Hypertension with Sildenafil
Authors: Fung Stacey M. , Ferrill Mary J.
Published: January 2018

Purpose

The study aimed to evaluate data on the treatment of sildenafil for pulmonary arterial hypertension (PAH).

Selection Process

Clinical literature from 1966 to May 2003 was accessed through MEDLINE, EMBASE, IPA, and the Cochrane System. Key search terms included sildenafil, Viagra, and pulmonary hypertension.

Methods

Current treatment of PAH includes anticoagulation, vasodilation, and transplantation. Available oral agents include calcium channel blockers and endothelin receptor antagonists. An evaluation of studies of sildenafil for PAH was conducted.

Results

Sildenafil for PAH was reported to be effective in 21 of 23 patients summarized in 14 case reports; 6 short-term (n = 83) and four long-term (n = 68) clinical trials described sildenafil administered with standard treatments for PAH.

Conclusions

Sildenafil may be a convenient option for PAH after traditional treatments have been attempted. It is administered orally and is longer-acting than other treatments for PAH. A dose of 50 to 100 mg three times daily was used in adults in four long-term studies, although doses from 25 to 500 mg/day in two to six divided doses have also been used in case reports. The only long-term study in children gave a median dose of 87.5 mg/day in children greater than 5 years of age weighing less than 30 kg. Side effects in the clinical trials were minimal, consisting primarily of mild headache, dizziness, flushing, and mild abdominal discomfort. Further studies to define the exact role and the dosing range of sildenafil in the management of PAH are needed.
Memantine
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The March 2004 monograph topics are cinacalcet hydrochloride, sertaconazole nitrate, etoricoxib, abetimus sodium, and rasagiline mesylate. The DUE is on atypical antipsychotics.
Modafinil: Multiple Sclerosis-Related Fatigue
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Alternative Strategies for Dispensing Exogenous Surfactant: Drug Cost Implications and in Vitro Feasibility Studies
Authors: Stevens Timothy P. , Sinkin Robert A. , Notter Robert H. , Wang Zhengdong , Delmonte Keith , Consenstein Larry , Maniscalco William M.
Published: January 2018

Surfactant replacement therapy is highly effective in treating Respiratory Distress Syndrome, but remains expensive despite market competition.

Objectives

(1) to model potential surfactant drug cost savings under alternative dispensing strategies compared with the current, FDA-approved, single-patient, single-dose vial dispensing strategy; and (2) to determine whether alternative dispensing strategies potentially would maintain efficacy and safety by measuring surfactant surface activity and sterility under conditions designed to simulate alternative dispensing conditions.

Design

Potential drug cost savings were modeled by comparing the current, FDA-approved single-patient, single-dose vial dispensing guidelines with alternative dispensing strategies including single patient, multidose vials; multipatient, multidose vials; and reduced volume surfactant vials (ie, “half-sized”) to decrease drug wastage. To assess whether surface activity or sterility of exogenous surfactant could be reduced under these alternative dispensing conditions, serial surface tension measurements and bacterial and fungal cultures were conducted with aliquots of exogenous surfactant under conditions designed to simulate each strategy.

Results

Potential savings of $49,000 to $61,000/year (28.5%), depending on drug usage and cost, were identified in a model comparing a single-patient, multidose vial dispensing protocol with the current FDA-approved dispensing strategy. The greatest cost savings, $57,000 to $72,000/year (33.3%), were for multipatient, multidose drug dispensing. Simulating alternative dispensing conditions, three cycles of warming, entering, and cooling surfactant vials over 1 to 2 days or 1 to 2 weeks did not cause a measurable decrement in in vitro surface activity or compromise in drug sterility.

Conclusion

Substantial cost savings could be realized through use of multidose surfactant dispensing strategies.
Clinical and Economic Impact of Pharmacy Services in a Low-Income Family Practice Clinic within a Community Hospital Setting
Authors: Figueroa Zoila , Harkins Lynn , Sloan Steve
Published: January 2018

Providing medical care to the underprivileged is a mission of the Sisters of St. Joseph at St. Joseph Hospital in Orange, California. An outpatient family medical clinic was established to serve this population, a majority of whom do not have health insurance or access to government-sponsored prescription assistance programs. To provide medications to patients and to help reduce medication costs, the pharmacy department opened a medication room in the clinic and staffed it with a pharmacist and a pharmacy technician. This effort involved maximizing the use of pharmaceutical companies’ patient assistance programs, which provide free medications to qualified indigent patients. The project also incorporated pharmacist-regulated involvement; the development of and compliance with a formulary; strict inventory controls on the purchase of medications; and identification of patients who qualify for government health service programs. A computer database program that simplified the tracking, reporting, and organizing of patient information and provided financial reports was implemented. Within three years of operation, medication costs decreased from $328,000 to $32,800. The presence of a pharmacist in this setting was advantageous in both the financial and clinical arenas. The pharmacist was intimately involved in medication provision by evaluating appropriate medication use in a cost-effective manner and providing education to health care providers and patients.
More Questions and Answers about the 2004 Medication Management Standards
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environments. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Extreme Caution Needed with Flammable Products; Drug Information Errata; Protonix and Protamine; Prohibited Abbreviations
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.
An Update on the Diagnosis, Complications, and Treatment of Heparin-Induced Thrombocytopenia
Authors: Howard Patricia A. , Barnes Brian J.
Published: January 2018

This continuing feature will update readers on recent developments in cardiovascular pharmacotherapy. Cardiovascular disease remains the number one killer in the US, and more clinical outcome trials have been conducted in cardiology than in any other field of medicine. Given this rapidly expanding knowledge base, pharmacists can have a significant impact on prevention and treatment — if they keep current with developments in drug therapy.
Vincristine, Doxorubicin and Dexamethasone (VAD) Regimen for Multiple Myeloma
Authors: Doulaveris Paula , Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Prior Authorization in Prescription Drug Benefit Management: An Apologia
Authors: Teagarden J. Russell
Published: January 2018

Managed care pharmacists are involved formally with the interface between the delivery and financing of health care; their work thus entails an accountability for both elements. Interpreted broadly managed care pharmacists are pharmacists working within the sphere of a health care system, health care purchaser, health insurer, managed care organization, or benefit administration agency. Patients, the pharmacy profession, and society are best served by this broad interpretation, because the interdependency of financing and delivery is inextricably linked to the achievement of good health outcomes. This continuing feature will explore contemporary issues facing managed care pharmacists.
Fatal Potassium Errors Linked to Pharmacy Processes Neumega, Neulasta and Neupogen
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

The reports described in this column were received through the USP–ISMP Medication Errors Reporting Program (MERP). Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) web sites or communicated directly to ISMP by calling 1-800-FAIL SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.

In 2004, ISMP is celebrating the 10th anniversary of its incorporation as a nonprofit organization. The Institute represents more than 20 years of experience in helping health care practitioners keep patients safe and continues to lead efforts to improve the medication use process.
Epoetin: Once-Weekly Administration (Cancer Patients)
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Antibiograms: New NCCLS Guidelines, Development, and Clinical Application
Authors: Lacy Melinda K. , Klutman Neil E. , Horvat Rebecca T. , Zapantis Antonia
Published: January 2018

Antibiograms are an important resource for health care providers. All clinicians involved in antibiotic selection and monitoring should become familiar with the NCCLS M39-A document “Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data: Approved Guideline.” Providers who interpret and apply antibiogram data in clinical practice should know about susceptibility testing methods, the susceptibility breakpoint determination process, and problems associated with antibiogram data analysis. The M39-A guidelines contain more than 40 recommendations, including the following: antibiogram data should be analyzed at least annually, an attempt should be made to remove duplicate isolates, and only organisms with 10 isolates or more should be presented. Accurate antibiograms facilitate improved empiric antibiotic selection and more precise monitoring of bacterial resistance in the hospital. This article reviews common antimicrobial susceptibility testing methods and relevant issues, highlights the major NCCLS M39-A recommendations, discusses the antibiogram preparation process and challenges in data interpretation, and provides a general overview of how antibiogram data may be applied to clinical practice.
New Drugs Approved by the FDA; New Dosage Forms and Indications; Agents Pending FDA Approval; Significant Labeling Changes Related to Safety
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com .
“Thin Client” PDA Computing
Authors: Fox Brent I. , Felkey Bill G.
Published: January 2018

PDAs are commonly used as portable reference and data collection tools. This month, we focus on a related yet different feature that enhances this point of care device – the PDA as a “thin client” in a wireless client/server environment.
FDA Committee Tackles Poor Labeling on Plastic Containers; Tracking Kayexalate; Orally Disintegrating Tablets Not Absorbed in the Mouth; Supply All Units with Oral Syringes
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

The reports described in this column were received through the USP-ISMP Medication Errors Reporting Program (MERP). Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) web sites or communicated directly to ISMP by calling 1-800-FAIL SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.

In 2004, ISMP is celebrating the 10th anniversary of its incorporation as a nonprofit organization. The Institute represents more than 20 years of experience in helping health care practitioners keep patients safe and continues to lead efforts to improve the medication use process.
Abarelix Pemetrexed
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
The $181,000 Adverse Drug Reaction
Authors: Mcdonnell Patrick J.
Published: January 2018

This article reports the case of a 52-year-old male, status post-heart transplant, who was admitted to the hospital with profound pancytopenia. The cause was an adverse drug reaction, specifically the well-established drug interaction between allopurinol and azathioprine. This reaction was severe and costly, with total charges of $181,000 incurred during the patient's 31-day hospital stay.

The annual cost of drug-related morbidity and mortality exceeds $136 billion. Adverse drug events can be classified variously; two common categories are adverse drug reactions and medication errors. If an adverse drug reaction is determined to be preventable, it can be classified as a medication error. Factors that determine preventability include whether a known drug-drug interaction was involved in the event and whether health care providers made efforts to avoid this interaction through increased monitoring or dose adjustments. Pharmacist intervention and increased vigilance can decrease the occurrence of such events. Furthermore, pharmacists who are aware of preventability factors involved in adverse drug events can become proactive leaders in the area of medication safety.
Implementation of Safety-Focused Pharmacy and Therapeutics Monographs: A New University HealthSystem Consortium Template Designed to Minimize Medication Misadventures
Authors: Murri Nelda A. , Somani Shabir
Published: January 2018

The University HealthSystem Consortium (UHC) Pharmacy Council Medication Management/Quality Improvement Committee has revised their template for drugs being researched for formulary inclusion. The new template incorporates controls aimed at reducing preventable patient injuries by assessing the safety risks of medications before they are added to an institution's drug formulary. Implementing this proactive strategy will improve the ability of Pharmacy and Therapeutics Committees to balance the benefits and risks of adding new drugs to the formulary. Key elements for the successful implementation of the UHC safety-focused strategy are discussed.
Cinacalcet Hydrochloride
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The July 2004 monograph topics are insulin glulisine; azacitidine; morphine sulfate extended-release liposome injection; rifaximin; and lidocaine hydrochloride/epiniphrine inontophoretic patch. The DUE is on insulin glulisine.
C-Reactive Protein as a Marker for Cardiovascular Disease
Authors: Backes James M. , Howard Patricia A.
Published: January 2018

This continuing feature will update readers on recent developments in cardiovascular pharmacotherapy. Cardiovascular disease remains the number one killer in the US, and more clinical outcome trials have been conducted in cardiology than in any other field of medicine. Given this rapidly expanding knowledge base, pharmacists can have a significant impact on prevention and treatment — if they keep current with developments in drug therapy.
Using a Data Warehouse to Monitor Clinical Outcomes Associated with Simvastatin Tablet Splitting
Authors: Coblio Nicholas A. , Mowrey Kim Allen , Ford Vonda , Loos Dana , Mccormick Michael T.
Published: January 2018

A data warehouse was used to monitor therapeutic outcomes for a simvastatin tablet-splitting initiative. The data included prescription and laboratory information for all patients taking simvastatin between October 1, 1998 and February 28, 2003. Among 44,038 patients receiving simvastatin, the low-density lipoprotein (LDL) levels of 194,213 patients were reported. The tablet-splitting initiative was started in April 1999 and 5,683 patients were converted from whole to half tablets. The average LDL for these patients decreased by 15 mg/dL. A subset of patients (464 or 8.1%) had an increase in LDL greater than 10% and were above levels established in therapeutic guidelines. Based on the findings, concern about tablet splitting is most warranted during the initial period, when patients are switched from whole to split tablets. The economic benefit was more than $300,000 per year at our facility. Simvastatin tablet splitting appears to be an effective cost savings measure with little associated risk.
Sodium Polystyrene Sulfonate Dosing Guidelines for the Treatment of Adult Hyperkalemia
Authors: Mikrut Michael , Brockmiller-Sell Heather
Published: January 2018

Standard treatment of hyperkalemia has consisted of the administration of a number of medications including sodium polystyrene sulfonate (SPS) suspension orally or as an enema. Dosage ranges of 15 to 60 g are described in the literature, but specific dosing recommendations based on a patient's serum potassium are lacking. The purpose of this study was to develop a dosing guideline for the oral administration of SPS in the treatment of adult hyperkalemia at our institution.

A retrospective review was conducted for adult patients receiving only SPS to treat hyperkalemia during a 3-month period. Serum levels of potassium were recorded prior to and following SPS administration. The retrospective review demonstrated that a 30 g SPS dose resulted in an average decrease in serum potassium of 0.99 mEq/L with a standard deviation (SD) of 0.64. Based on these results, an SPS dose of 30 g was recommended for a serum potassium level greater than 5 mEq/L but less than 6.0 mEq/L in the guidelines. A SPS dose of 60 g was recommended for a serum potassium level of 6 mEq/L or greater. After an internal review in the pharmacy and physician approval, the guidelines were instituted. Clinical outcomes were monitored for 1 month following implementation of the guideline. The prospective analysis resulted in an average decrease of 1.01 mEq/L (SD = 0.67) in serum potassium with a 30 g SPS dose, supporting the guideline.
Expanding Data Input Options
Authors: Felkey Bill G. , Fox Brent I.
Published: January 2018

One of our main objectives for this series is to identify methods to increase the efficiency of PDA use. As such, we support the PDA's current role as a tool for disseminating and gathering data. This month, we describe several ways to incease the ease and efficiency of entering data into a PDA.
Phosphodiesterase Inhibitors and Persistent Pulmonary Hypertension of the Newborn
Authors: Ten Eick Andrew P. , Gormley Andrew
Published: January 2018

This continuing feature will focus on recent advancements in the areas of pediatrics and neonatal pharmacology and on methods for reducing medication error risk in this patient population. Most pharmacological agents are designed with the adult in mind, and there is little literature-based data from which to derive dosing schedules and proper drug administration techniques for the pediatric and neonatal patient. Moreover, pharmacological response in this group is not well understood. We hope that this feature will help you provide pharmaceutical care to this high-risk population. Direct questions or comments to hospitalpharmacy@drugfacts.com .
Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (MVAC) Regimen for Urothelial Tract Tumors
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Nonpunitive, Voice-Mail-Based Medication Error Reporting System
Authors: Peshek Stephanie C. , Cubera Kathleen
Published: January 2018

By eliminating paperwork, Summa Health System has increased health care providers’ compliance in reporting medication errors, potential errors, and near misses. Nurses, pharmacists, pharmacy technicians, physicians, and respiratory therapists call errors or potential errors into a voice mail system. The voice mails are screened by a Medication Safety Coordinator (a pharmacist), who enters the data into the MEDMARx database and provides reports and feedback to the various departments. The system has resulted in a significant increase in reporting and several process improvements that can be tied directly back to the reports. Although the number of significant medication errors reaching the patient has not increased, the number of reported near misses or potential errors has gone up significantly. The Medication Safety Coordinator has been able to identify process issues and corroborate the existence of perceived problems that were previously unquantified. The new information is being used to educate personnel, improve computer shortcuts, change the appearance of medication administration records and labels, and facilitate formulary decisions. The data will also be used as input in decision making for the computerized physician order entry system in development at Summa Health System.
Controlled-Substance Diversion Detection: Go the Extra Mile
Authors: O'neal Brian C.
Published: January 2018

The capabilities of controlled substance diversion detection systems have evolved significantly along with decentralized automated dispensing machines. However, these systems have certain limitations. This article describes several scenarios in which commonly used systems may fail to detect diversion. These situations include diversion through the creation of discrepancies, large-volume removals over short periods of time, substitution with noncontrolled pain medications, and tampering and other unauthorized removals. The objective of this article is to increase awareness of these scenarios and suggest ways for pharmacy managers to improve their detection systems.
Intravesical BCG Live for Superficial Bladder Cancer
Authors: Fields Laurel S. , Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Use of Acid Suppression Agents following Acute, Nonvariceal, Upper Gastrointestinal Bleeding
Authors: Nguyen Cindy M. , Barletta Jeffrey F. , Devlin John W.
Published: January 2018

Purpose

This study evaluated the utilization of acid suppression agents following upper gastrointestinal (GI) bleeding in the state of Michigan.

Methods

A focus group was used to develop a one-page survey that consisted of questions pertaining to acid suppression agents following acute, upper GI bleeding. Survey consistency and validity were established through review by several experienced pharmacists practicing in either critical care or drug information. Surveys were mailed twice (at 30-day intervals) to the director of pharmacy at all hospitals (n = 267) in the state of Michigan.

Results

Completed surveys were received from 76/267 (28.5%) institutions. Sixty-five percent of institutions stated that they had one preferred intravenous (IV) acid suppressive agent for acute GI bleeding, with 59% using a histamine-2 receptor antagonist (H2RA) and 41% using a proton pump inhibitor (PPI). When an IV PPI was prescribed, only 36% used a continuous infusion dosing regimen. For IV to oral step-down therapy, PPIs were chosen more often than H2RAs (81% vs 19%). Oral PPI therapy was usually initiated using a capsule/tablet (82%) as opposed to a PPI suspension (18%). Institutional guidelines for acid suppression were in place at only 23% of institutions, although 67% had restrictions for IV PPI use.

Conclusion

Wide variation exists in the use of acid suppressive agents following upper GI bleeding in the state of Michigan.
Tinidazole
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The October 2004 monograph topics are duloxetine, acamprosate calcium, methyl aminolevulinate cream, poly-l-lactic acid, and pentetate calcium trisodium. The DUE is on duloxetine.
New Drugs Approved by the FDA: New Dosage Forms and Indications: Agents Pending FDA Approval: Significant Labeling Changes Related to Safety
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com .
Intravesical Mitomycin for Superficial Bladder Carcinoma
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases and reviews issues related to the preparation, dispensing, and administration of cancer chemotherapy.
Ezetimibe/Simvastatin
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The November 2004 monograph topics are erlotinib hydrochloride, clodronate, oxypurinol sodium, pegaptanib sodium injection, and ramelteon. The DUE is on ezetimibe/simvastatin.
Treating Veterans for Helicobacter Pylori Infection: Retrospective Evaluation of Long-term Outcomes
Authors: Segarra-Newnham Marisel
Published: January 2018

Purpose

This study documented the long-term outcomes of patients treated in a pharmacist-managed Helicobacter pylori (HP) clinic.

Background

An HP clinic was created in 1996 at a Veterans Affairs (VA) hospital. Patients received clarithromycin/amoxicillin-based therapy according to the clinic protocol. Clarithromycin use was restricted to treatment of HP infection. Metronidazole was used instead of amoxicillin in penicillin allergic patients. Results at 1 year showed that 53% of the patients were able to discontinue chronic heartburn therapy. Outcomes beyond 1 year were not established.

Methods

The electronic records of patients treated at the HP clinic from June 1996 to March 2001 were evaluated. Patients with at least 2 years of follow-up information were included. Baseline demographic and long-term outcome data were collected. Discontinuation rate, failure rate, and need for retreatment were evaluated.

Results

Of 229 patients treated during the period studied, at least 2 years of data was available for 198 individuals. Of these, 177 were men and 21 were women. Three of the 198 patients (1.5%) were unable to complete antibiotic therapy. Five patients (2.5%), two of them women, failed an initial course to eradicate HP. After treatment with bismuth-based therapy, four of these five patients showed documented eradication of infection. Forty-four percent of patients were off chronic therapy at the time of last review.

Conclusions

A pharmacist-managed HP treatment clinic can facilitate discontinuation of chronic acid suppressive therapy in more than a third of patients. A low treatment failure rate — below the national average for clarithromycin-based regimens — was found in our population.
Acamprosate Calcium Delayed-Release Tablets
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The November 2004 monograph topics are erlotinib hydrochloride, clodronate, oxypurinol sodium, pegaptanib sodium injection, and ramelteon. The DUE is on ezetimibe/simvastatin.
Article
Authors: Nielsen Per , Røjskjær Steffen
Published: January 2018

Per Nielsen & Steffen R⊘jskjær: Dual disorder among alcohol addicted inpatient clients

This study examines the prevalence and subtypes of personality disorders among alcohol-addicted inpatients, and the impact on drop out during treatment. The study is the first phase of a prospective study of dual disorder clients (alcohol addiction and personality disorder). Subjects were 104 clients with severe alcohol problems consecutively admitted to a Danish addiction treatment center (Ring-gaarden) applying a cognitive frame of reference.

Each client was tested during the first two weeks using the Millon Clinical Multiaxial Inventory (MCMI II-I). According to the psychological testing seven out of eight subjects manifested at least one personality disorder – and 65% of the clients had two or more personality disorders. Anti-social and/or passive-aggressive personality disorder was present in more than 50% of the subjects. Borderline personality disorder was found in about 30%. More than half of the subjects had elevated scores of anxiety and/or dysthymia. Cluster analysis revealed four distinct subtypes of clients: a. no/slight personality disorder, b. “avoidant/dependent”, c. “antisocial/narcissistic” and d. “borderline”. The drop-out rate was significantly higher for the “borderline” group than for the other three. The implications for treatment are discussed.
Risk factors in dropping out from in-patient treatment of substance abuse
Authors: Saarnio Pekka , Knuuttila Vesa
Published: January 2018

The purpose of the study was to identify risk factors in dropping out from in-patient treatment of substance abuse. Such information is needed in order to target interventions aimed at improving the continuity of treatment. The subjects (N=114) were clients of a Finnish treatment institution. The results indicated that significant risk factors for dropping out included the age of the subject, contemplation of change and attitude toward AA/NA. Continuity of treatment improved with age, and also with improved contemplation. Subjects with an extremely positive attitude toward AA/NA dropped out infrequently. Younger clients were more positively disposed to AA/NA than were older clients. The findings suggest that interventions to prevent dropping out should be aimed on the one hand at younger clients who are not positively disposed to AA/NA and on the other at older clients with an inadequate contemplation of change.
Therapeutic ‘öffentlichkeit’ as a complex hybrid. Why do (some) immigrants drop out of treatment?
Authors: Berg Elin
Published: January 2018

This paper focuses on the interaction between clients and clinicians in the context of drug treatment in Norway. The 23 clients were adults with different non-Norwegian ethnic backgrounds, and the 61 clinicians were mainly professional social workers and trained nurses. The interaction took place in institutions such as treatment and detoxification centres, special institutions and social security offices. In order to study this interaction I was involved in a six month period of fieldwork in 1998 as an observing participant. After the fieldwork I regularly had interviews with four clients over a period of one year. The clinicians' working days were characterised by a culture of meeting and talking in which they expected the clients to take part. The dominant treatment method aiming at enabling clients to quit drug abuse was participation in the ‘Talking Cure’. Many of the clients evidently thought that such treatment would merely tend to confirm their identity as drug abusers. Instead, they asked for help in obtaining a job and consigning their problems to the Ocean of Oblivion. The clients and the clinicians tried to co-operate without possessing a common definition of the situation, which was not very successful. The nature of their relationship changed from intense to more tense when the staff's therapeutic model of treatment became the prevailing one. For the clients, this meant entering a ‘Therapeutic ‘öffentlichkeit’, which they rejected because they did not have sufficient trust in the expert system or faith in the Talking Cure. This resulted in a break in the interaction, and many of the clients dropped out of treatment. The problems involved in entering the Therapeutic “öffentlichkeit” were not confined to these ethnic clients: Norwegian clients also showed mistrust towards the clinicians and a lack of faith in the Talking Cure. Since positive interaction is a very important aspect of treatment, there should be an intensified focus on this theme so that it can be improved.