bluuebunny/crossref_metadata_2025 huggingface dataset:
A Pharmacy-Managed Intravenous to Enteral Proton-Pump Inhibitor Conversion Program
Authors: Turco Thomas F.
Published: January 2018

This article describes a pharmacy-managed, intravenous (IV) to enteral proton-pump inhibitor (PPI) program at a 377-bed tertiary care, teaching community hospital. IV pantoprazole was not restricted by indication, service, or patient location. Pharmacy converted any eligible patient prescribed an IV PPI to either pantoprazole tablets or lansoprazole capsules, packets, or enteral suspension according to protocol. Over a four-month evaluation period, 113 patients (mean age of 66 years) were prescribed IV PPIs for primarily suspected or documented GI bleeding. Gastroenterology specialists initiated 85% of IV PPI therapy. The most common dosage of IV PPI was 40 mg, once or twice daily with a median duration of 3 to 4 days. Continuous infusion IV PPI therapy was used for only two patients, both with GI bleeding. IV pantoprazole was converted to an enteral PPI in 73 of 113 patients in dosages of pantoprazole 40 mg or lansoprazole 30 or 60 mg administered once (32%) or twice (68%) daily. Pharmacists initiated 34% of the conversions. The total PPI expenditure was $6200 during the evaluation period. Daily acquisition cost savings, based on nominal pricing, ranged from approximately $5 to $25. Initial evaluation of the conversion program resulted in protocol revision and education of the medical staff, in an effort to minimize days of IV PPI use and encourage transition to enteral therapy. The protocol conversion dosage of lansoprazole 60 mg twice daily was changed to 30 mg twice daily and enteral pantoprazole tablets were deleted from the protocol (all IV PPI is converted to lansoprazole, 30 mg twice daily). Although IV pantoprazole remained on the hospital formulary, the medical staff were educated about the relative effectiveness of IV and enteral PPI therapy and the use of histamine-2 receptor antagonists for various indications. Prescribers of IV pantoprazole are now required to document the rationale for use. The Pharmacy and Therapeutics Committee will continue to explore the role IV PPI therapy, based on efficacy, safety, and cost.
Data Mining for the Health System Pharmacist
Authors: Felkey Bill G. , Liang Huigang , Krueger Kem P.
Published: January 2018

Data mining is an application of computer technology that allows pharmacists to analyze the large amounts of clinical and administrative data related to patient care that health care organizations accumulate. Data mining is the process of taking the raw material (data) from the data warehouse and converting it to information that can be used by decision makers. Online analytical processing (OLAP) is the tool that accomplishes the data mining process.

This article introduces the concept of data mining and related technologies, including the data warehouse, data mart, and OLAP — concepts that are closely related to one another. The benefits of applying data mining to pharmacy practice, with a focus on the point of care, are discussed.

Successful data mining often requires an enterprise-wide information system as a prerequisite. Data can then be collected electronically at all points in the health care supply chain. A strategic view of the information flow in an acute care setting is provided. To further illustrate the application of data mining, several examples of OLAP integration are given. In addition, some unique data sources and a pharmacy specific reporting technology are described.
More on the Requirements of the Medication-Related National Patient Safety Goals for 2003–2004
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.
Weight Variability of Scored and Unscored Split Psychotropic Drug Tablets
Authors: Rashed Sahar M. , Nolly Robert J. , Robinson Lawrence , Thoma Laura
Published: January 2018

The authors investigated the weight variation of split scored and unscored tablets of several dosages of three costly psychotropic drugs, using weight variation criteria based on the United States Pharmacopoeia 26 (USP) Content Uniformity of Dosage Units. Whole tablets of Paxil 20 and 40 mg, Risperdal 2 and 4 mg, and Zoloft 100 mg that had been split with a widely available device by pharmacy technicians in a managed care pharmacy were evaluated. Each half tablet weight was recorded using a digital electronic balance. Weight variability was determined by comparing actual half tablet weight to the theoretical half tablet weight and calculating the relative standard deviation. Results showed that weight variability occurred in half tablets of unscored tablets of Paxil 40 mg, Risperdal 2 and 4 mg, and scored tablets of Zoloft 100 mg. Half tablets of scored Paxil 20 mg tablets did not show weight variability, resulting in uniform half tablet dosages. The authors concluded that tablet splitting does not generally produce uniform and equal half tablet doses, and that split tablets should be evaluated using weight variation criteria before tablet splitting programs are initiated.
Cisplatin and Ifosfamide with Either Vinblastine or Etoposide (VIP) Regimen for Testicular Cancer
Authors: Sydnor Brian K. , Sano Harold 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.
The Pharmacists Role in CPOE: A Pediatric Perspective
Authors: Grisso Alison G. , Wright Lorianne , Hargrove Fred R.
Published: January 2018

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (VUMC) — with an emphasis on pediatrics. The authors focus on the development and maintenance of decision support tools created specifically for use in the pediatric population.
Omalizumab
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 2003 monograph topics are daptomycin, cetuximab, anidulafungin, methyl aminolevulinate, and cilomilast. The DUE is on daptomycin.
Stop the Insulin Hazardous Abbreviation for “Intranasal” Cancer Patients Deserve the Safest Practices Regardless of Where They are Treated
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.
Pervasive Computing and the PDA
Authors: Felkey Bill G. , Fox Brent I.
Published: January 2018

This column takes a look at real-time computing technology, now in development, that promises to greatly enhance clinical decision making for the pharmacist.
Personality Disorders Pharmacy Technicians
Authors: Generali Joyce A.
Published: January 2018

To help readers monitor the most important developments in specialized areas of pharmacy practice in organized health systems, Hospital Pharmacy commissions Basic Bibliographies by guest editors, who have expertise in their respective fields. These guest editors survey the relevant literature and rank approximately 15 to 20 references that represent the most significant research and practice contributions in their areas. The more fundamental are listed first so that persons with limited time can select reading appropriate to their needs. A cumulative index to Basic Bibliography topics will be published semiannually in June and December.
CVP (Cyclophosphamide, Vincristine, and Prednisone) Regimen for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphomas
Authors: Kem Ravie , 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.
Emtricitabine
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 2003 monograph topics are daptomycin, cetuximab, anidulafungin, methyl aminolevulinate, and cilomilast. The DUE is on daptomycin.
Topiramate: Binge Eating Disorder
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 .
Pharmacist Intervention Documentation in US Health Care Systems
Authors: Kim Youngmee , Schepers Gregory
Published: January 2018

The methods, extent, and use of pharmacist intervention documentation (PID) were studied by surveying US health-systems pharmacy directors by mail. This survey focused on the qualities of a hospital's PID system, use of PID data, and demographics of responding hospital and pharmacy departments. The survey was sent to 1895 randomly selected hospital pharmacy directors from an American Society of Health-System Pharmacists (ASHP) mailing list. The response rate was 23% (433/1895). Commonly reported types of PID included changing or clarifying medication orders, eliminating therapeutic duplications, evaluating drug-drug interactions, avoiding adverse drug reactions, participating in formulary conversions, recommending medications, providing pharmacokinetic consults, making therapeutic substitutions, and reporting medication error and drug levels. The methods for documenting interventions varied widely and included paper, computer databases, medical records, personal digital assistants (PDAs), and combinations of the above. PID reports were frequently shared with hospital and pharmacy managers, Pharmacy and Therapeutics (P&T) committees, and process improvement groups. The majority of respondents reported dissatisfaction (lack of outcomes or cost savings data, labor intensive) with their current PID systems and hoped to implement comprehensive, user-friendly, labor-saving PID systems in the future.
Questions and Answers about the 2004 Medication Management Standards, Part 1
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.
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 .
Gabapentin: Nausea, Chemotherapy-Induced
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 .
Formulary Conversion from Doxazosin to Terazosin for the Treatment of Benign Prostatic Hyperplasia in a Small Veterans Hospital
Authors: Yamreudeewong Weeranuj , Mcpeak Dennis , Greenwood Mark C.
Published: January 2018

Doxazosin and terazosin are alpha1-adrenergic blockers that are commonly used for the treatment of benign prostatic hyperplasia (BPH). Doxazosin or terazosin can both be given once daily because of their relatively long elimination half-lives (approximately 22 hours for doxazosin, and 9 to 12 hours for terazosin). Common adverse effects of these two drugs include orthostatic hypotension and syncope, especially with the first dose or initial therapy. Based on cost and equivalent efficacy between the two alpha1 blockers, terazosin was selected as the formulary agent for a long-acting alpha1-adrenergic blocker in the Cheyenne Veterans Administrative Medical Center (Cheyenne VAMC). The study was conducted with 12 patients with symptomatic BPH to evaluate the appropriate doses of terazosin when patients taking doxazosin are switched for the treatment of BPH. The results indicated that the two alpha1 blockers provided similar control of BPH symptoms. The mean differences of symptom scores obtained after the two treatment regimens (doxazosin vs terazosin) were not significant (mean ± S.D. 11.17 ± 7.93 vs 9.67 ± 7.48, 95% confidence interval [CI] of the mean difference −1.18 ± 4.18; P = 0.243). No dosage titration was needed at the time of initial switching from doxazosin to terazosin. Additionally, it appears that terazosin doses of 1, 2, 5, 7, and 10 mg can be used initially when doxazosin (at corresponding doses of 1, 2, 4, 6, and 8 mg, respectively) is converted to terazosin for the management of BPH.
Paroxetine: Hot Flashes
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 .
Experience with Vancomycin in Patients Receiving Slow Low-Efficiency Dialysis
Authors: Ahern John W. , Lai Cecilia , Rebuck Jill A. , Possidente Carl J. , Weidner Mark
Published: January 2018

Background

Slow low-efficiency dialysis (SLED) is an emerging dialytic strategy for managing acute renal failure. There is no published data describing how SLED effects the pharmacokinetics of vancomycin.

Methods

A prospective pharmacokinetic evaluation of vancomycin was performed in critically ill medical and surgical patients with acute renal failure who required IV vancomycin and concurrent SLED therapy. Patients received vancomycin 15 mg/kg by actual body weight. Serum drug concentrations were evaluated at 6, 12, and 24 hours postinfusion. Patient-specific vancomycin pharmacokinetic parameters were determined from serum concentrations to calculate a maintenance dosage regimen.

Results

Mean ± SD half-life, volume of distribution, and systemic clearance, were 43.1 hours ± 21.6 hours, 0.84 L/kg ± 0.17 L/kg, and 24.3 mL/min ± 8.39 mL/min, respectively. Vancomycin dosing intervals ranged from 24 to 72 hours.

Conclusion

The elimination half-life of vancomycin was variable and prolonged in patients receiving SLED therapy. An initial vancomycin dose of 15 mg/kg is recommended for patients receiving SLED. Given the variability of the vancomycin half-life during SLED, a vancomycin serum concentration should be obtained 24 hours following the initial dose.
Evaluation of Herbal–Drug Interaction Data in Tertiary Resources
Authors: Meyer Jenny R. , Generali Joyce A. , Karpinski Julie L.
Published: January 2018

Purpose

To objectively evaluate various tertiary resources using a set of predetermined criteria to assess which provide the most complete, current, and accurate herbal–drug interaction information.

Methods

A search of the primary literature was conducted to gather evidence related to herbal–drug interactions. Based on the information found, six specific interactions were selected for review: St. John's wort–cyclosporine, St. John's wort–sertraline, coenzyme Q10–warfarin, ginseng–digoxin, danshen–warfarin, and kava kava–alprazolam. Thirteen resources commonly used in our drug information center were selected for evaluation: three drug interaction texts, three computer databases, and seven herbal texts. Criteria were developed to objectively evaluate the accuracy, completeness, and currentness of interaction information provided by each resource. Resources were ranked using an interaction content score, a referencing score, and an overall resource score (a sum of the interaction score and referencing scores).

Results

Interaction content scores and overall resource scores were highest for drug interaction texts and databases, whereas herbal texts generally earned lower scores. Interaction data found within the three Micromedex databases sometimes varied. Only three of the evaluated resources contained all six interactions.

Conclusion

Pharmacists should be familiar with the content and limitations of available resources for herbal–drug interactions. Based on the variability noted, it is recommended that providers use more than one of the more comprehensive resources described in this review. An evaluation of resources for herbal–drug interactions should be performed periodically as they are updated.
Exploring Infrared Beaming as a Clinical Practice Tool
Authors: Fox Brent I. , Felkey Bill G.
Published: January 2018

In this installment, we focus on the PDA's infrared beaming function as a means of sharing clinical resources. We also explore some of the questions frequently asked about beaming.
Incidence, Cause, and Severity of Anaphylaxis; Quinine and Quinidine Thrombocytopenia; Ephedra-Associated Cardiomyopathy; Seizures Caused by Hydrocortisone; Paroxetine-Induced Hyponatremia; Heparin-Induced Hyponatremia
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 (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
The Development of an Antimicrobial Stewardship Program at a Pediatric Hospital
Authors: Chan S. , Levine S. , Di Pentima C.
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 .
Conversion of Chronic Hemodialysis Patients from Erythropoietin Alfa to Darbepoetin Alfa
Authors: Martin-Holohan Amy , Curtis Kelley A. , Masterson Patricia , Goldfarb David S.
Published: January 2018

Fourteen hemodialysis patients were selected to receive once every other week darbepoetin alfa in substitution for weekly subcutaneously administered epoetin alfa. All patients included in the analysis were male veterans over the age of 18 on established and unchanging doses of subcutaneous erythropoietin alfa and on hemodialysis for at least 3 months. All patients had sufficient iron stores, defined as serum ferritin concentrations of greater than 100 mcg/L. Patients were converted to darbepoetin alfa using the manufacturer's conversion chart. Doses of darbepoetin alfa were adjusted to maintain a hemoglobin concentration greater than 11 to 12 g/dL and a hematocrit greater than 33% to 36%. Patients were followed for 4 months and evaluated for efficacy. Hemoglobin, hematocrit, and serum ferritin levels were measured at baseline and repeated every month. Among the 12 patients completing the study 12 dose increases of darbepoetin alfa were needed. Switching these 12 patients from erythropoietin alfa to darbepoetin alfa was projected to increase acquisition cost by more than $36,000, assuming that these patients remained on their current doses of darbepoetin alfa for 1 year. The authors concluded that darbepoetin alfa should not be used in patients with anemia caused by chronic renal failure who require hemodialysis until further studies support this use.
Effect of Smart Infusion Pumps on Medication Errors Related to Infusion Device Programming
Authors: Malashock Colleen M. , Shull Sara Smith , Gould D. Allen
Published: January 2018

Errors related to the administration of medication delivery are less common than those that occur during the ordering phase.2 However, traditional medication delivery systems have fewer safeguards to intercept administration errors, and serious consequences may result.

In a study by Leape et al,3 5% of medication errors identified were related to parenteral drug delivery. To address the problem of infusion errors, preprogrammed, customizable, computerized systems are being developed. ALARIS Guardrails software is designed to apply user-defined maximum/minimum infusion rate limits for selected medications (eg, those that are frequently used or have a narrow therapeutic index).

To gain a better understanding of this new technology, a observational, prospective study was conducted. The study's goals were to document how often smart infusiondevices alerted users to potential errors, to quantify specific alert types, to specify the medications involved in alerts, and to detect trends associated the devices. User satisfaction with the devices was also measured. This information was used to assess the value of smart-infusion software in the prevention of infusion-device programming errors. Data representing all device alerts that occurred on three special care units over an 8-month period (May 20, 2002 to January 13, 2003) was downloaded from the infusion devices. Seven categories were used to describe each alert. One-hundred fifty-seven alerts resulted in the discontinuation of the initial entry and subsequent reprogramming of the device to a different rate of infusion. A model was developed to assess the rate at which errors occurred and to assess the possible harm potential of events that may have been avoided by the alerts. A potentially life-threatening dose was initially programmed in 17 different events analyzed. The number of reprogramming events was small compared with the total number of doses administered. However, the outcome from any one of those errors could have been significant. Therefore, the device may prove valuable even in settings that have achieved a low rate of infusion-related errors.
Botulism Immune Globulin Intravenous
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 April 2004 monograph topics are cinacalcet hydrochloride, bevacizumab, mycophenolic acid delayed-release tablets, oblimersen sodium, and ciclesonide. The DUE is on cinacalcet hydrochloride.
Montelukast-Induced Hepatitis; Dobutamine-Induced Eosinophilia; Ezetimibe and Statin-Associated Myopathy; Valproic Acid and Hypersensitivity Syndrome; Ribavirin-Induced Hemoglobinuria; Fingernail Clubbing and Discoloration Associated with Angiotensin II Receptor Blockers
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 (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Intravenous N-Acetylcysteine
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 May 2004 monograph topics are cinacalcet hydrochloride, bevacizumab, mycophenolic acid delayed-release tablets, oblimersen sodium, and ciclesonide. The DUE is on cinacalcet hydrochloride.
Vancomycin: Aerosolization
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 .
Retrospective, Observational Comparison of Eptifibatide vs Abciximab in Patients Undergoing Percutaneous Coronary Intervention
Authors: Ottinger Joseph G.
Published: January 2018

Purpose

To provide outcome data to health care practitioners involved in the care of patients undergoing percutaneous coronary intervention (PCI). Adjunctive treatment with eptifibatide can be used in a wide range of patients requiring glycoprotein IIb/IIIa inhibitors to attenuate platelet response secondary to coronary artery interventions requiring a stent. The use of eptifibatide will provide comparable revascularization protection and may be safer than using abciximab.

Methods

Preselected outcome measures were collected for consecutive patients receiving a glycoprotein IIb/IIIa inhibitor and the deployment of at least one coronary arterial stent for a 2-year period. The results were reported on a quarterly basis to the institution's cardiac interventionalists.

Results

No clinical or statistical differences in the event rate of a revascularization procedure for a “same target vessel” lesion at either the 6-month or 12-month evaluation periods were identified. The revascularization rate for “any vessel” interventions favored the use of abciximab at 6 months, but this advantage deteriorated at 12 months. Finally patients receiving eptifibatide were less likely to experience any bleeding event.

Conclusions

These outcome data can facilitate the use of eptifibatide in a wide range of patients undergoing PCI. An expectation of comparable clinical outcomes is merited. Based on these observations, the use of eptifibatide can at least provide a reduction in cost per procedural case.
Risk of Morphine-Hydromorphone Mix-ups; Actonel Dispensed Instead of Actos; Mucomyst and Mucinex Confused; Current Nonproprietary Drug Names under Consideration by United States Adopted Names Council
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.
Doxycycline and Intracranial Hypertension; Anorgasmia with a “Good”Antidepressant; Fluoroquinolones Should be Avoided in Myasthenia Gravis; Antipsychotics and Risk of Sudden Cardiac Death; Sotalol-Induced Depression; Methemoglobinemia Associated with Benzocaine Products; Allergic to Generics?; Call for ADR Reports
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 (800-FDA-1088). If you have reported an interesting preventable ADR to MEDWATCH, please consider sharing the account with our readers.

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.
Sodium Bicarbonate: Prevention of Contrast-Agent-Induced Nephrotoxicity
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 .
Superselective Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Experience with a New Emulsion
Authors: Gammon David C. , Rao Sekhar , Kim Ducksoo , Bhargava Pankaj , Bartlett Timothy R.
Published: January 2018

The authors provide background information on chemoembolization and describe their experience with a new emulsion formulation that may be useful for transcatheter arterial chemoembolization (TACE) procedures in patients with hepatocellular carcinoma. Patients were selected using standardized criteria and underwent TACE using a chemotherapeutic emulsion consisting of doxorubicin, carboplatin, Renografin-60, and Ethiodol. A detailed description of the reconstitution methods for the chemotherapeutic emulsion is provided. The combination of agents used in this emulsion did not separate into water/oil components for up to 5 minutes, a relatively long period for such compounds. In addition, the radiographic contrast agents used in the emulsion made the procedure easier to perform because they showed up more clearly in fluoroscopic imaging, according to the radiologists. Further controlled studies are needed to confirm the superior results of this emulsion compared with previously used emulsions.
Misprogram a PCA Pump? It's Easier than you Think: Ratio Expression for Epinephrine Injection Again Leads to Error: Tetanus Toxoid Vaccines Used for PPD: Current Nonproprietary Drug Names under Consideration by United States Adopted Names Council
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.
Reports of (the PDA's) Death Have Been Greatly Exaggerated
Authors: Felkey Bill G. , Fox Brent I.
Published: January 2018

Recent actions by PDA manufacturers have led to speculation that the device is about to follow the path of the dodo bird. These business events provide important information about the PDA market; this column discusses their implications.
Update on Resistance among Respiratory Tract Pathogens: Results of the Antimicrobial Resistance Management Program
Authors: Gums John G. , Epstein Benjamin J.
Published: January 2018

Purpose

This update from the Antimicrobial Resistance Management (ARM) Program reports surveillance data for Streptrococcus pneumoniae and Haemophilus influenzae isolates from 1994 to 2002.

Methods

Antibiograms and sensitivity reports submitted to the ARM program database were reviewed for resistance to commonly prescribed antibiotics

Results

Nationally S. pneumoniae resistance to penicillin was 37.4% (n = 37,688); to erythromycin, 29.6% (n = 18,774); and to clindamycin, 9.9% (n = 5510). Resistance to cefotaxime was 25.5% (n = 10,527) and 16.8% to ceftriaxone (26,594). For H. influenzae, resistance to cefotaxime was 4.3% (n = 4,927) and to ceftriaxone 1% (n = 10,353), a difference seen largely in the Northeast.

Conclusions

Resistance to penicillin appears to have reached a plateau above 40%; however, sparing of beta-lactam antibiotics may occur at the expense of other agents (ie, macrolides). Clindamycin remains active against penicillin-resistant S. pneumoniae (PRSP), but use of agents with antianaerobic properties is discouraged. The ARM program suggests important differences between cefotaxime and ceftriaxone.
Perspectives on Prescription Drug Benefit Formularies
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.
Improving Communication and Safety with CPOE Decision Support Tools
Authors: Wright Lorianne , Hargrove Fred R. , Grisso Alison G.
Published: January 2018

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (VUMC) — with an emphasis on pediatrics. The authors focus on the development and maintenance of decision support tools created specifically for use in the pediatric population.
New Antifungal as a Potential Cause of Severe Thrombocytopenia: Pancreatitis Due to ACE Inhibitor: Recurrent Hepatitis Due to Cetirizine: Long-Term Cardiovascular Risks Associated with Protease Inhibitors: Pure Red Cell Aplasia and Epoetin Therapy: Pure Red Cell Aplasia Redux: Interferon Therapy: Excellent Drug Reaction Reviews
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 (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.

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.
The Impact of Hospital Pharmacist and Technician Teams on Medication-Process Quality and Nurse Satisfaction
Authors: Weber Robert J. , Skledar Susan J. , Sirianni Carol R. , Frank Susan , Yourich Bryan , Martinelli Barbara
Published: January 2018

Purpose

This project deployed pharmacist and technician teams on patient care units to improve (1) the quality of the medication process and (2) nurse satisfaction with pharmacy services.

Methods

An interdisciplinary team developed a decentralized pharmacy model, establishing complimentary roles for pharmacists and technicians based on their current roles, expected roles, and published evidence. A trained nurse or pharmacist observed the medication process before and after implementing the service model; nurses were surveyed for satisfaction with pharmacy services. Statistical analysis of changes in order-processing times and nurse satisfaction were determined using an independent samples t-test (CI = 0.95, P < 0.05).

Results

Two processes were significantly improved before after implementing the decentralized model (PRE vs POST): (1) order entry time, PRE 24.4 ± 18.1 min (Mean ± SD) vs POST 12.1 ± 10.5 min, P = 0.001; (2) order delivery time, PRE 50.5 ± 18.9 min vs POST 27.5 ± 15.2 min, P = 0.048. Nursing satisfaction significantly improved after implementation of the decentralized model, specifically in perception of quality, PRE (Median score = 3) vs POST (Median score = 4), P = 0.04, timely delivery of STAT and routine medications PRE (Median score = 2) vs POST (Median Score = 4, P = 0.00, pharmacy as an asset to patient care PRE (Median score = 3) vs POST (Median Score = 5), P = 0.04, and effective pharmacy and nursing communication PRE (Median score = 2) vs POST (Median Score = 4), P = 0.04. Pharmacists increased their medication safety interventions and documentation almost five-fold.

Conclusions

Pharmacist-technician teams on the patient care units improved service and nurse satisfaction and may be a useful method for decentralizing pharmacy services in hospitals that do not have satellites.
Multifunction PDAs: Digital Imaging
Authors: Fox Brent I. , Felkey Bill G.
Published: January 2018

In this installment, we focus on the integrated digital camera, a feature found in many of today's PDAs.