bluuebunny/crossref_metadata_2025 huggingface dataset:
Paclitaxel and Carboplatin (PC) Regimen for Advanced Non-Small-Cell Lung Cancer
Authors: Waddell J. Aubrey , Wagner Keith A. , 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 reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Preventing Medication Errors with Antineoplastic Agents, Part 2
Authors: Beckwith M. Christina , Tyler Linda S.
Published: January 2018

Goal

The goal of this program is to present practical ways to prevent medication errors with antineoplastic agents, identify common types of medication errors, and describe a system for reducing and responding appropriately to antineoplastic medication errors.

Objectives

At the completion of this program the participant will be able to: 1. Describe the scope and impact of medication errors 2. Define common terms used in medication error literature. 3. List four common types of prescribing errors made with antineoplastic agents. 4. Identify steps where medication errors may occur in the drug ordering, preparation, and administration process. 5. Describe ways to prevent errors at each step of the medication use process. 6. Recommend a procedure for reporting and monitoring antineoplastic medication errors within the institution. 7. Describe a system for the nonpunitive management of antineoplastic medication errors in health care systems.
Pneumococcal 7-Valent Conjugate Vaccine
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched 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. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical 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 2000 Formulary monographs are linezolid, insulin glargine, rivastigmine, pemirolast, and tacrolimus ointment. The DUE is on linezolid.
Does Your Hospital have more Preventable Adverse Events than Other Hospitals?; Apparent Neuroleptic Malignant Syndrome in a Patient with Parkinson's Disease; Fluconazole and Amitriptyline Lead to Cardiac Toxicity; Manic Episode Caused by Chemotherapy; Anaphylactic Reactions to Proton-Pump Inhibitors
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Health Care Insurance is Changing from Defined Benefit to Defined Contribution Plans
Authors: Wilson C. Nick
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Prescriber Computer Order Entry: A Work in Progress
Authors: Miller Alicia S.
Published: January 2018

This monthly column will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center. Questions or suggestions should be addressed to Alicia S. Miller, Department of Pharmacy, The Ohio State University Medical Center, 368 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210.
A Survey of the Literature Evaluation Skills of Health-System Pharmacists
Authors: Ferrill Mary J. , Blalock Susan J. , Norton Linda L.
Published: January 2018

If pharmacists are to apply evolving medical information to patient care, they must have adequate literature evaluation skills. To assess pharmacists' literature evaluation skills, a survey that included a case study similar to an original research abstract and five multiple choice questions related to the case study were designed. Of the 2,500 surveys mailed to pharmacists, 545 usable responses were returned. The average score was 2.2 (SD = 1.1) out of 5. Overall, 42.6% of the multiple choice questions were answered incorrectly, and 13.0% were answered “I don't know.” Most pharmacists (93.4%) were able to identify the objective of the study and many recognized that the study had not enrolled enough subjects to obtain meaningful results (52.1%). Fewer pharmacists recognized that, according to the data given, none of the “study” medications normalized blood pressure (32.8%), that the confidence intervals reported were too wide to yield accurate estimates (25.7%), and that an incorrect statistical approach was used (18.3%).
Therapeutic-Interchange Programs: Potential Consequences of Automatic Conversion of Cimetidine to Another H2-Antagonist
Authors: Gray Thomas M.
Published: January 2018

The goal of this study was to determine—through an evaluation of the literature—if other H2-receptor antagonists work as well as cimetidine to improve the accuracy and precision of glomerular filtration rate (GFR) measurements following an automatic therapeutic interchange. A PubMed query was conducted for articles (published in the past 10 years) related to creatinine clearance, glomerular filtration rate (GFR), H2-receptor antagonists, and the H2-antagonist drugs. References from these articles were then reviewed to identify further sources. It was found that ranitidine and famotidine do not significantly inhibit tubular creatinine secretion and therefore have no effects on plasma creatinine or creatinine clearance. The literature search failed to provide information on nizatidine's effect on creatinine or creatinine clearance. Cimetidine appears to be the only H2-receptor antagonist with the ability to improve the accuracy and precision of GFR measurements. These conclusions imply that non-FDA approved uses must also be considered when designing and implementing therapeutic interchange programs.
New Drugs Approved by the FDA; New Dosage Forms and Indications; Agents Pending FDA Approval; Major Labeling Changes
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 .
Exemestane Thalidomide
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 reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
High Expectations: Standards and Guidelines for Immunization Delivery
Authors: Grabenstein John D.
Published: January 2018

Credit

This lesson if good for 0.2 CE units, with a passing grade of 70%.

Objectives

After completing this continuing education article, the pharmacist will be able to: 1. Name sources of professional standards for immunization delivery. 2. Describe specific standards related to vaccine administration, record-keeping, and public education. 3. Describe how vaccination standards can be applied to a clinical practice site.
Meloxicam
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched 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. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical 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 2000 Formulary monographs are linezolid, insulin glargine, rivastigmine, pemirolast, and tacrolimus ointment. The DUE is on linezolid.
Avoid Errors with Look-Alike Products Patients Still at Risk of Accidental Intrathecal Vincristine Injection
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 of 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 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
ADR Monitoring in Children; Pancytopenia and Valproic Acid: A Dose-Related Phenomenon; Asterixis with Lithium Therapy?; Splenic Rupture Due to Subcutaneous Heparin; EPS on Clozapine?
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Security of Crash Carts with Plastic Locks; Expiration Dating of Chemicals and Unit-Dose Medications; Intensive Analysis of Medication Error Data; Verification of Pharmacists' Licenses; Medication Storage in Refrigerators; Pharmacist Review of Emergency Department Drug Orders; Security of Radiology Contrast Media; Security of Syringes and Bedside Medications; Security of Premixed IVs
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 environment. 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.
Gabapentin for Leg Cramps: Muscling in on Quinine
Authors: Burnakis Thomas G.
Published: January 2018

Practicing clinicians come across uses of pharmacologic agents that may not always be listed in the usual references. For example, glycerin injection for nerve block, H2 antagonists in colorectal cancer, or colchicine for systemic sclerosis may represent novel, hard-to-find clinical applications. If you have encountered a new and/or unusual use of a drug, submit the information to this Hospital Pharmacy feature. Send three copies, double-spaced, 1,000 words or less, to: Thomas G. Burnakis, PharmD, Baptist Medical Center, 800 Prudential Drive, Jacksonville, FL 32207.
Chemoprevention of Colorectal Cancer
Authors: Mays-Holland Theresa
Published: January 2018

Goal

After completing this CE program, the participant will understand the basic concepts of chemoprevention and will be able to discuss the currently existing clinical data for the chemoprevention of colorectal cancer.

Objectives

At the completion of this program the participant will be able to: 1. Discuss the complicating factors in performing chemoprevention trials. 2. Describe the dietary modifications to prevent colorectal cancer. 3. Describe the proposed mechanisms of action of agents used in the chemoprevention of colorectal cancer. 4. Discuss, and where appropriate recommend, appropriate agents for use in the chemoprevention of colorectal cancer. 5. Describe the differences between familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), and spontaneous adenoma formation.
Design Flaw Predisposes Abbott Lifecare PCA plus II Pump to Dangerous Medication Errors; Folinic Acid: More than a Vitamin; Oral Liquid Medications: More Vulnerable to Errors than Previously Recognized?
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 of 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 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Adverse Reaction without Drug Absorption; Allergic Reaction to Spinal Cord Stimulator; Interferon Beta-1b and Hypothyroidism; Priapism with Sildenafil Citrate; Chest and Back Pain Associated with Liposomal Daunorubicin; Interaction between Warfarin and Trazodone
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Health Information Privacy: On the Top of the Political Agenda (Part 2 of 2)
Authors: Bogen Jonathan D. , Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Cost Analysis of Pharmacy-Based Aminoglycoside Regimens: Once-Daily vs. Multiple Daily Dosing
Authors: Chen Jack J. , Yokoyama Glenn Y.
Published: January 2018

A retrospective, case-controlled cost analysis was performed to compare the aminoglycoside-related costs of pharmacy-managed once-daily (ODA) and multiple-daily (MDA) gentamicin dosing in 274 patients. Outcome measures included the amount of drug and infusion-related supplies consumed, length of therapy, number of drug levels performed, and occurrence of nephrotoxicity. Costs were calculated based on outcome measures. Characteristics related to demographics, renal function, and site of infection were similar for both groups. The mean cumulative gentamicin dose per patient was greater in the ODA group (2223 mg) as compared with the MDA group (1169 mg), but median duration of therapy was similar in both groups (4 days). The ODA group required significantly fewer drug assays per patient than the MDA group (0.39 ± 0.63 and 1.1 ± 1.2, respectively; p < 0.01). Nephrotoxicity occurred in 1.4% of ODA patients and in 3% of MDA patients (p > 0.05). The mean costs per patient for the ODA and MDA groups were $85.66 and $140.61, respectively. Once-daily dosing of gentamicin was associated with a 65% reduction in therapeutic drug monitoring, a 53% reduction in rate of nephrotoxicity, and an overall reduction of 39% in total aminoglycoside-related costs (excluding cost of labor).]
Low-Molecular-Weight Heparin Therapy in Acute Coronary Syndromes
Authors: Lee Craig R. , Pieper John A.
Published: January 2018

Contemporary management of patients with the acute coronary syndromes (ACS), unstable angina and non-Q-wave myocardial infarction, includes nitrates, beta blockers and/or calcium channel blockers, aspirin, anticoagulation (heparin or low-molecular-weight heparin), and antiplatelet therapy (glycoprotein IIb-IIIa inhibitor). Low-molecular-weight heparins have several pharmacological advantages over unfractionated heparin, including a more predictable anticoagulant response, subcutaneous administration, greater activity against factor Xa, and no aPTT monitoring requirement. Several large clinical trials have demonstrated that low-molecular-weight heparins, in particular enoxaparin, are superior to unfractionated heparin for the in-hospital management of ACS. In addition, the total patient care costs at 30 days appear to be lower. Existing data do not support the use of low-molecular-weight heparins after hospital discharge. Low-molecular-weight heparin efficacy has not been adequately studied in ACS patients undergoing interventions, but should be strongly considered as a replacement for unfractionated heparin in all other treatment strategies.
Development and Implementation of a Multidisciplinary Anticoagulation Educational Program
Authors: Bradford Gregory S. , Byrd Debbie C. , Taylor Charles T.
Published: January 2018

Staff development programs have been developed by national pharmacy organizations to improve clinical skills and expand the services offered by pharmacists. Most of these programs do not involve the training of other health care professionals. This article describes an anticoagulation training program designed not only for pharmacists, but for physicians and nurses as well. For pharmacists, the effectiveness of educational interventions was assessed by pretest/post-test/surveys with an average increase of 38% from baseline (p < 0.01). The knowledge gained by physicians and nurses is an ongoing process evaluated by follow-up warfarin medication use evaluations and prospective weight-based heparin protocol evaluations. The goal of staff development should be to equip each member of the health care team with the knowledge needed to improve patient outcomes.
New Drugs Approved by the FDA New Dosage Forms and Indications Agents Pending FDA Approval Major Labeling Changes
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 .
Lopinavir/Ritonavir
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched 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. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical 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 January 2001 Formulary monographs are nateglinide, mitoxantrone, alemtuzumab/campath-1H, galantamine, and levofloxacin. The DUE is on nateglinide.
How to Evaluate a Randomized Controlled Trial: What Every Pharmacist Should Know
Authors: Tsourounis Candy
Published: January 2018

The primary literature is replete with drug-related-information. The pharmacist is often faced with interpreting and applying this information to clinical practice. Although there are many forms of primary literature, the randomized controlled trial (RCT) is the most commonly used for assessing drug efficacy. This article is designed to review the components of a RCT, including the title, abstract, introduction, methods, results, conclusions, and references. Bias may be introduced into any of these components, either intentionally or unintentionally. Knowing how to evaluate these components will provide pharmacists a framework for interpreting RCT quality. In addition, examples of bias will be provided for each RCT component.

Goals

(1) to familiarize pharmacists with the components of an RCT; (2) to review sources of RCT bias; and (3) to help pharmacists apply RCT findings to clinical practice.

Objectives

This article should enable pharmacists to (1) list the components of an RCT; (2) describe five ways bias may be introduced in an RCT; and (3) discuss the limitations and constraints of using an RCT to make clinical decisions.
Verifying Antineoplastic Dosages Calculated According to Body Surface Area (BSA)
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 reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
The Biologics Industry: How Federal Regulation Enhances Quality of Vaccine and Antibody Manufacture
Authors: Grabenstein John D.
Published: January 2018

Credit — This lesson is good for 0.2 CE units, with a passing grade of 70%.

Objectives

1. Describe the historical development of federal regulations that affect manufacture of vaccines and antibodies. 2. Describe the procedures used by the Food and Drug Administration (FDA) to enhance manufacturing quality. 3. List examples of actions FDA may take to deal with substandard products or procedures.
Questions and Answers from the F.I.X.
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X.
Misuse of Liquid Phosphate Laxatives Used as Bowel Preps
Authors: Pamer Carol A.
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 of 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 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Medication Bezoar with Extended-Release Nifedipine/Biliary Cirrhosis Caused by Erythromycin/Four Cases of Lactic Acidosis and Hepatic Steatosis Associated with Stavudine Therapy/Acute Myelopathy following Heroin Insufflation/Increased Lithium Concentrations with a “Safe” NSAID/Drug-Induced Stroke and Complications of Intravesical Bacillus Calmette-Guerin
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
The Positive Effects of Managed Care
Authors: Wilson C. Nick
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Antibiotics in Coronary Heart Disease: A Review of the Literature
Authors: Paik Hannah , Hasson Noelle K.
Published: January 2018

Hospital Pharmacy welcomes contributions to this column. Articles originally published in pharmacy department newsletters are reprinted here. Material is selected because of its educational value to pharmacists or because it demonstrates the type of information of interest to newsletter readers. If you wish to have your newsletter material considered for publication in this column, mail a copy—along with a computer disk containing the document—to Neil M. Davis, Editor-in-Chief, Hospital Pharmacy, 1143 Wright Drive, Huntingdon Valley, PA 19006-2721.
Prescriber Computer Order Entry: Hardware Configuration and Pharmacy Issues
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center.
Stability of Cefepime Hydrochloride Injection and Metronidazole in Polyvinyl Chloride Bags at 4° and 22°–24° C
Authors: Stewart James T. , Maddox Frances C. , Warren Flynn W.
Published: January 2018

Cefepime hydrochloride injection 2 g (Maxipime) was mixed with metronidazole injection USP (Flagyl IV ready-to-use, 500 mg/100 mL) and metronidazole hydrochloride IV (Flagyl HCI IV, 500 mg) reconstituted with 0.9% sodium chloride injection USP and/or 5% dextrose injection USP to yield cefepime concentrations of 2, 1, 0.5, and 0.25 g and 500 mg metronidazole per 100 mL of solution. The mixtures were stored in polyvinyl chloride bags up to 168 hours at 4°C and at 22°–24°C. Cefepime and metronidazole mixtures in metronidazole injection USP were stable up to 168 hours and 96–168 hours, respectively, stored in PVC bags at 4°C. The 2.5 mg/mL cefepime and 5.0 mg/mL metronidazole mixtures were stable up to 8 and 72 hours, respectively. Identical mixtures stored at 22°–24°C were stable up to 8–48 and 12–24 hours for cefepime and metronidazole, respectively. Cefepime and metronidazole mixtures in metronidazole HCl IV reconstituted with 0.9% sodium chloride injection USP were stable for 24–168 hours, respectively, stored in PVC bags at 4°C. Identical mixtures of cefepime and metronidazole stored at 22°–24°C were stable for 8–24 and 24–168 hours, respectively. Cefepime and metronidazole mixtures in metronidazole HCl IV reconstituted with 5% dextrose injection USP were stable for 8–48 and 81–68 hours, respectively, stored in PVC bags at 4°C. Identical mixtures of cefepime and metronidazole at 22°–24°C were stable for 8–12 and 168 hours, respectively. In general, cefepime and metronidazole controls were more stable than the mixtures.
Put a Stop to Problem-Prone Automatic Stop Order Policies/Pharmacists Should Review All Nonurgent Drug Orders before Administration/Be on Guard for Name Confusion with Two New Medications
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 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Insulin Aspart
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched 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. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical 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 2000 Formulary monographs are lopinavir/ritonavir, cetrorelix, fluticasone propionate/salmeterol inhalation powder, atovaquone/proguanil hydrochloride, and exisulind. The DUE is onlopinavir/ritonavir.
The Effects of the Balanced Budget Act on Health Care Professionals
Authors: Wilson C. Nick
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Gemcitabine and Cisplatin (GC) Regimen for Advanced Non–Small Cell Lung Cancer
Authors: 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 reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Parenteral Nutrition Collaborative Drug Therapy Management Service
Authors: Adams Glenn W.
Published: January 2018

Collaborative drug therapy management (CDTM) is a method for developing a patient-centered practice in which the pharmacist's activities are integrated with those of other health care providers. The goals of this continuing feature are to refine the concept of CDTM and provide patient-care applications from the authors' experience in Washington state. Questions or suggestions should be addressed to Timothy S. Fuller, FASHP, Fuller and Associates, 1948 Boyer Avenue East, Seattle, WA 98112-2924 (tel.206-860-8308). E-mail: timfuller@kendra.com
Significant Drug–Drug Interactions with Antineoplastics
Authors: May Sondra K.
Published: January 2018

Goal

The goal of this program is to inform the participant about the clinical and economic significance of drug interactions, review their potential mechanisms, present significant interactions related to antineoplastics, and provide resources for managing them.

Objectives

At the completion of this program, the participant will be able to: 1. Describe the scope and economic impact of preventable drug interactions. 2. Explain why oncology patients are at increased risk for drug interactions. 3. Define the pharmacokinetic, pharmacodynamic, and pharmaceutic principles underlying antineoplastic related drug–drug interactions. 4. List specific classes of antineoplastics involved in significant drug–drug interactions. 5. Identify multiple resources for obtaining drug interaction information.
New Drugs Approved by the FDA/New Dosage Forms and Indications/Agents Pending FDA Approval/Major Labeling Changes
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@drug-facts.com .
Anticholinergic Side Effects Mimic Diseases of Old Age/Anaphylactoid Reactions to Acetaminophen/Olanzapine-Induced Urinary Incontinence/Withdrawal with Quetiapine?/Kidney Stones Associated with Ceftriaxone/Amiodarone-Induced Blue-Gray Syndrome
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Incompatibility of Erythromycin Lactobionate and Sulfamethoxazole/Trimethoprim with Linezolid Injection
Authors: Trissel Lawrence A. , Zhang Yanping , Xu Quanyun A.
Published: January 2018

The objective of this study was to evaluate the physical compatibility and chemical stability of linezolid 200 mg/100 mL admixed with erythromycin lactobionate 500 mg and separately with sulfamethoxazole 400 mg/trimethoprim 80 mg for up to 7 days at 4° C and 23° C. The test samples were prepared by adding the required amount of erythromycin lactobionate and sulfamethoxazole/trimethoprim to separate bags of linezolid injection. Evaluations were made at the initial time point and at 1, 3, 5, and 7 days of storage at temperatures of 4° C and 23° C for physical and chemical stability. Physical stability was assessed using visual observation in normal light and a high-intensity monodirectional light beam (Tyndall beam). In addition, turbidity and particle content were measured electronically. Chemical stability was evaluated by using stability-indicating high-performance liquid chromatographic (HPLC) analytical techniques. The linezolid admixtures with erythromycin lactobionate were clear and colorless when viewed in normal fluorescent room light and using a Tyndall beam. Measured turbidity and particulate content were low and exhibited little change. HPLC analysis found no loss of linezolid in any sample stored at either temperature throughout the study. However, erythromycin lactobionate underwent rapid and extensive losses. Under refrigeration, erythromycin losses were about 45% in 24 hours; at room temperature, losses of over 80% occurred during the first day. The linezolid admixtures with sulfamethoxazole/trimethoprim resulted in gross precipitation nearly immediately upon preparation of all samples. The precipitate consisted of white needle-like crystals. HPLC analysis found that both sulfamethoxazole and trimethoprim had precipitated. Consequently, no further analysis was performed on these samples.
Proton Pump Inhibitor Therapeutic Interchange: Patient Expectations and Satisfaction Ratings
Authors: Galt Kimberly A. , Galt Michael A. , Sodorff Michelle M. , Turner Paul D. , Lambrecht Jason
Published: January 2018

The purpose of this prospective study was to determine patients' expectations and satisfaction levels related to the therapeutic interchange of proton pump inhibitors. Hospitalized patients were assigned to one of two groups: Group 1 (n = 21) comprised patients initially on omeprazole who were changed to lansoprazole, and Group 2 (n = 19) included patients initially on lansoprazole who were continued on lansoprazole. Data collection methods included personal interviews, chart reviews, and postdischarge telephone interviews. No differences in expectations or degree of satisfaction with therapy were observed pre- and posthospitalization for either group or between groups (p >.05). Forty-three percent of Group 1 patients were unaware that interchange had occurred and reported a high degree of satisfaction with their hospitalizations (97.1%), their doctors (97%), and their health plans (94.2%). Preliminary trends suggest that in-hospital therapeutic interchange does not affect patient expectations or satisfaction with proton pump inhibitor therapy.
Evaluating and Interpreting Epidemiological Risk
Authors: Chandramouli Jane C , Tyler Linda S
Published: January 2018

This special feature sets forth the basic skills pharmacists need to evaluate the primary literature with regard to epidemiological risk. The author discusses (1) the three key types of observational study designs used in epidemiological literature; (2) common measures of association and and their utility; (3) calculation of attributable risk, relative risk, and odds ratio; (4) the limitations of using relative risk and odds ratio; and (5) inappropriate use of risk in the primary literature.
Irinotecan, Fluorouracil, and Leucovorin for Metastatic Colorectal Cancer
Authors: Mayer Michael I. , 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 reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Side Effects of Vaccination: A Consumer's Guide to Cause and Effect
Authors: Grabenstein John D.
Published: January 2018

Credit

This lesson is good for 0.2 CE units, with a passing grade of 70%.

Objectives

1. To describe historical examples of adverse events truly and spuriously associated with vaccination. 2. To describe a rational basis for deciding whether adverse events are causally or coincidentally linked to a medication. 3. To demonstrate how to apply this rational basis to a variety of exposure—outcome associations.
Nebulized Lidocaine Solution for Control of Intractable Cough in a Patient with Metastatic Malignant Melanoma
Authors: Burns Kevin E.
Published: January 2018

Clinical Pearls

Each of these special features conveys an idea, concept, or fact that may be useful in your pharmaceutical practice, but may not be widely known, published, or taught. A 76-year-old male with a diagnosis of metastatic malignant melanoma was experiencing problems with a chronic cough. The cough had initially been managed with guaifenesin with codeine syrup and later with benzonatate capsules, but had become intractable. The patient's paroxysmal coughing resulted in dyspnea, gagging, vomiting, and fatigue—and had a significant impact on the patient's quality of life. The patient was evaluated, and no significant comorbid conditions or drug therapies that might have been aggravating his condition were noted. The patient was evaluated for pharmacologic treatment options. After discussing the pros and cons of each modality, it was decided that nebulized lidocaine would be used as a palliative measure for controlling the patient's intractable cough. A follow-up review of the patient's clinical course revealed that lidocaine was effective in controlling the cough with no adverse consequences.
Questions and Answers from the F.I.X.; • New Guidelines; •Prochlorperazine/Diphenhydramine Compatibility; • Heparin-Induced Thrombocytopenia in Dialysis Patients; •Subcutaneous Administration of Asparaginase; •Antimicrobial Dosing in Obesity
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service or you may log on through drugfacts.com .. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X., please call 800-322-4349.
Methylphenidate Extended-Release Tablets
Authors: Cada Dennis J. , Baker Danial E. , Levien Terri
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched 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. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical 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 December 2000 Formulary monographs are budesonide inhalation suspension, arsenic trioxide, sodium phosphate, ziprasidone, and unoprostone. The DUE is on budesonide inhalation suspension.
Anaphylaxis Seen with a Special Dye; •Cholestasis Caused by Cetirizine; •Acarbose and Lymphocytic Colitis; •Seizures Caused by Intravenous Alatrofloxacin; •Pedal Edema Caused by Olanzapine; •Disturbances in Electrolyte Homeostasis as an Adverse Effect of Gentamicin Therapy
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Complementary and Alternative Medicine: Regulatory Issues and Perspectives
Authors: Budlong Lynn , Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Pharmacy Issues: Drug Routes, Dosage Forms, and Drug Frequencies
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center.
Contracted Drug Information Services: Comparison of Utilization with Local Hospital Pharmacists
Authors: Chyka Peter A.
Published: January 2018

In recent years, pharmacy management companies have begun to contract with drug information centers to provide centralized services for participating institutions. This study compared the utilization of drug information services by contracting pharmacists with local hospital pharmacists. All drug information questions from contract pharmacists during 1993 to 1995 were compared with those from local hospital pharmacists utilizing the drug information center. A total of 997 and 1,835 questions were received from contract and local pharmacists, respectively, with the types of information requests being similar for pharmacotherapeutic questions and differing (p < 0.001) for requests for product information and a reference or monograph. Complex responses were required more frequently (p < 0.05) for contracting pharmacists (13%) than for local pharmacists (10%) and took longer to complete. Contract pharmacists more frequently received a response by fax or mail than local pharmacists. Provision of drug information services for a contracting group of pharmacists may present different demands for the types of drug information responses than those from local hospital pharmacists.