bluuebunny/crossref_metadata_2025 huggingface dataset:
Support Considerations (Part 1)
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) 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 CPOE at the Medical Center.
Pharmacists or Sinners? A Choice
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.
Gastroesophageal Reflux in Children
Authors: Shaffer Stephen E. , Levine Stuart
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.
Privacy, Confidentiality, and Security for PDAs
Authors: Felkey Bill G. , Fox Brent I.
Published: January 2018

The American Heritage Dictionary of the English Language defines the terms that are the subjects of this article. Privacy is defined as the quality or condition of being secluded from the presence or view of others. Confidentiality involves preventing the unauthorized disclosure of private information to others. Security seeks freedom from risk or danger, in a word, safety. In this article, we discuss these terms in relation to PDA technology.
Management of Community-Acquired Pneumonia in One Hospital Compared with a National Benchmark Database
Authors: Hampton Naomi , Romie Alice , Clewell Lynelle , Hadzima Stephen , Gerdes John M.
Published: January 2018

A hospital implemented a clinical pathway and medication orderset to improve the management of community-acquired pneumonia (CAP), then participated in a national outcomes program to measure the results. Comparison with a benchmark database, CAP-Compare (EPI-Q, Inc.), confirmed the program's success. Average length of stay after implementation was 4.5 days — 0.5 days less than for benchmark institutions and published Medicare data. More than 95% of patients received an antibiotic in the emergency department and 72.8% received an antibiotic within 4 hours of admission. Patients were switched to oral therapy within 2 days. Antibiotic use was consistent throughout the continuum of care and included ceftriaxone and clarithromycin as first-line agents. The hospital demonstrated excellent clinical outcomes as measured by the national benchmark project.
A New Patient Safety Initiative
Authors: May Sondra K.
Published: January 2018

Learning from the experiences of others is one of our most effective tools for improving patient safety. This column will describe how some health care organizations have effectively implemented the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO's) National Patient Safety Goals (NPSGs). The articles will focus on practical strategies for meeting the NPSGs and on JCAHO surveys related to the NPSGs. Updates on new goals and recommendations established by JCAHO will also be provided.
Pharmacy-Administered IV to Oral Therapeutic Interchange Program: Development, Implementation, and Cost-Assessment
Authors: Fox Erin R. , Beckwith M. Christina , Tyler Linda S.
Published: January 2018

This study describes the development, implementation, and estimated vs. actual cost benefits of an IV to oral therapeutic interchange program. Secondary objectives were determining patient eligibility criteria and selecting medications for future inclusion in the program. Medical charts were reviewed to determine which patients were appropriate candidates for the interchange. Targeted medications were selected by reviewing the literature and the institution's drug expenditures. Five medications — famotidine, ciprofloxacin, levofloxacin, fluconazole, and azithromycin — were selected for the initial stages of the program. Preimplementation cost analysis suggested that the interchange would yield cost savings of more than $30,000 per year in medication costs alone. The interchange was piloted on a single nursing unit to determine best procedures and possible barriers to implementation. Data collected in the first 6 months after implementation indicated greater potential cost benefits than originally estimated. Including more medications in the interchange would further reduce drug acquisition costs.
PVDA Regimen for Remission Induction of Acute Lymphoblastic Leukemia (ALL)
Authors: Adesuyi Olubunmi A. , 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.
Adalimumab
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. 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, 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 June 2003 monograph topics are aprepitant, gemifloxacin, desirudin for injection, gatifloxacin ophthalmic solution, and pegvisomant. The DUE is on aprepitant.
Management of Hyperglycemia in Patients Receiving Specialized Nutritional Support
Authors: Dickerson Roland N.
Published: January 2018

Nutritional Support Consultant features issues pertinent to the practice of clinical pharmacy in the area of nutritional support. The column is edited by Dr. Roland Dickerson, Associate Professor of Pharmacy, University of Tennessee Health Science Center; Memphis, TN.
Sildenafil: Pulmonary Hypertension (Pediatric, Neonatal)
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 .
Pharmacologic and Liability Considerations of Therapeutic Interchange with Low-Molecular-Weight Heparins
Authors: Gainor Carl , Vanscoy Gordon J , Niccolai Cynthia S , Rihn Thomas L
Published: January 2018

Therapeutic interchange (TI), a formulary management process, is used by health care systems to help contain medication costs. A scientifically defensible and pharmacoeconomically beneficial TI program adheres to rigorous criteria enforced by an institution's Pharmacy and Therapeutics Committee. In situations where adherence to essential criteria is not mandated, TI may not produce the intended clinical and economic outcomes, and in practice may have legal implications. Appropriate application of TI has been described within the position statements of certain health care organizations and associations. Due to the high cost and frequent use of low-molecular-weight heparins (LMWHs), health care institutions have identified this pharmacologic class as a potential target for TI. Currently, the application of the TI process to LMWHs is questionable. This paper reviews the TI process and explores its controversial role in the formulary management of LMWHs.
Hospital Pharmacy–Based, Computer-Generated Tikosyn (Dofetilide) Physician Order Protocol
Authors: Zolnierz Michael
Published: January 2018

Tikosyn (dofetilide) is a Class III antiarrhythmic agent used for the conversion or maintenance of patients with either atrial fibrillation or atrial flutter. Tikosyn is excreted predominantly by the renal system. Proper dosing, which involves the estimation of creatinine clearance rates, is critical in preventing the cardiac arrhythmia torsades de pointes. The pharmacy department of Charlton Memorial Hospital developed a Tikosyn physician order form — using the Excel computer spreadsheet program — that prints estimated creatinine clearance rates and proper dofetilide dosages. Using the same spreadsheet concept, other institutions can develop physician order forms in an efficient manner.
Drug Shortages: An Approach to Managing the Latest Crisis
Authors: Leady Michelle A. , Adams Ann L. , Stumpf Janice L. , Sweet Burgunda V.
Published: January 2018

In recent years, many drug shortages have compromised patient care. Drug shortages can lead to altered therapeutic outcomes, increased risk of medication errors, and increased medical costs. This article presents one hospital's successful algorithm for managing medication shortages. Methods included drafting a shortage policy and procedure; identifying a primary contact person to assess the impact of the shortage; identifying appropriate clinicians to perform research; establishing references for identification of alternative agents; and promptly communicating with and disseminating shortage information to appropriate individuals.
More on Range Orders and PRN Orders What is Concentrated KCl? Expiration Dating of Investigational Drugs Sliding Scale on MAR Two Identifiers on Label Unacceptable Abbreviations Configurable Alarms New Standards
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environments. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Gemifloxacin Mesylate
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 September 2003 monograph topics are tositumomab, omalizumab, emtricitabine, testosterone buccal system mucoadhesive, and alfuzosin. The DUE is on omalizumab.
Patient Data Monitoring: Watchdog Technology that Detects Impending Adverse Events Lean Body Weight or Actual Body Weight?
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.
Vancomycin Concentrations in Necrotic Pancreatic Tissue: A Pilot Study
Authors: Green David L. , Cook Janet B. , Triemer Helen L. , Galloway John R.
Published: January 2018

Purpose:

To determine vancomycin concentrations in necrotic pancreatic tissue of intensive care unit (ICU) patients with acute necrotizing pancreatitis.

Methods:

The prospective, observational pilot study was conducted at a university-based tertiary hospital. The patient population consisted of 11 patients with necrotizing pancreatitis receiving vancomycin and undergoing necrosectomy. Tissue samples taken during surgical debridement were assayed for vancomycin by immunoassay. Patients were divided into steady state and nonsteady-state groups. Two patients were excluded because necrosectomy was not performed, and one tissue sample could not be assayed because of contamination.

Results:

The mean tissue concentration was 5.84 mcg/mL (ranging from 3.1 mcg/mL to 8.94 mcg/mL). Four patients in the nonsteady-state group, who each received a single dose of vancomycin, had a mean tissue concentration of 4.5 ± 1.68 mcg/mL, compared with 7.76 ± 1.05 mcg/mL for the four steady-state patients.

Conclusion:

The data shows that vancomycin is detectable in necrotic pancreas tissue but possibly not in concentrations sufficient to prevent or treat bacterial contamination in patients with pancreatic necrosis.
Pharmacy Work Plan
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) at the Ohio State University Medical Center. (By “pre-scribers,” 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 CPOE at the Medical Center.
Unit-Dose Capsules for Inhalation An Example of how Color-Coding Can Contribute to Medication Errors is an Antithyroid or Antimetabolite Needed? Preventing Confusion between Propylthiouracil and Purinethol
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.
Lansoprazole: Alternate Day Dosing
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 .
Alteplase: Pleural Effusion (Parapneumonic)
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Antibiograms: Hospitals, Part 1 Pharmaceutical Care in Japan Practice Guideline Implementation
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.
Rosuvastatin Calcium
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 January 2004 monograph topics are risperidone long-acting injection; efalizumab; epinastine HCL ophthalmic solution; prussian blue; and bevacizumab. The DUE is on polonosetron.
Acute Delirium after Hepatitis a Vaccine Ocular Side Effects with Topiramate Omeprazole-Induced Intractable Cough Levetiracetam Behavioral Side Effects: Another Large Review Atorvastatin-Induced Polyneuropathy Prolonged Thrombocytopenia in a Patient Using Isotretinoin
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.
Corticosteroids in the Critically Ill
Authors: Fraser Gilles L. , Yahwak Jason A. , Riker Richard R.
Published: January 2018

This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. Recent advances in drug therapy for adult ICU patients (including evolving and controversial data) will be reviewed and assessed in terms of clinical, humanistic, and economic outcomes. Direct questions or comments to Gil Fraser, PharmD, at fraseg@mmc.org .
Can Selective Beta-Blockers be Prescribed Safely for Hemodialysis Patients? A Retrospective Review
Authors: Faulkner Michele , Mears A. J. , Adams Pat M. , Frock James T. , Dunlay Robert W.
Published: January 2018

Purpose

Cardiovascular disease is the leading cause of death in hemodialysis patients. Beta-blockers (ß-blockers) have been shown to reduce cardiovascular morbidity and mortality in patients with coronary artery disease and heart failure. Available data demonstrate that end-stage renal disease patients are prescribed ß-blockers much less often than are those with normal kidney function. The concern that these agents may lead to critical elevations in serum potassium (K) has led some nephrologists to avoid their use. This study evaluates the possible association between hyperkalemia and ß-blocker use in stable hemodialysis patients.

Methods

The records of 121 patients in an inner-city dialysis unit treated over a 3-month period were evaluated retrospectively. Patients taking ß-blockers were compared to those who were not. Differences in age, incidence of diabetes mellitus, mean serum K level, use of ß1-selective agents, dialysate concentration, and number and severity of hyperkalemic episodes were assessed. The highest K value recorded during the study period was used for each patient. Serum K levels greater than 6.5 mEq/L were defined as serious. Levels of this magnitude or greater were included in the analysis.

Results

Only three patients were taking nonselective ß-blockers. Twenty percent of patients in the ß-blocker group had serum K levels greater than or equal to 6.5 mEq/L compared with 13.9% of those not taking ß-blockers. A comparison of the two groups revealed no statistically significant difference in any of the parameters evaluated.

Conclusion

The use of ß1-selective agents does not appear to be associated with an increased incidence of serious hyperkalemia in hemodialysis patients. ß-blockers should not be selectively withheld from hemodialysis patients for this reason.
Questions and Answers about the 2004 Medication Management Standards, Part 2
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.
Expansion of Pharmacokinetic Services through the Electronic Health Record Using CPOE and Computerized Note Capture Tools
Authors: Grisso Alison G. , Wright Lorianne , Rosenbloom S. Trent
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.
Justification-Based Pharmacy Benefits
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.
Questions and Answers about the 2004 Medication Management Standards, Part 3
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.
How to Write an Abstract Suitable for Publication
Authors: Kane-Gill Sandy , Olsen Keith M.
Published: January 2018

Writing an abstract suitable for publication is often challenging. The authors of this article propose simple techniques for initiating the writing process, such as using a structured abstract model. They also describe several essential elements to include within the abstract, so that the outcome is a clear, concise document. Following the advice and steps outlined in this article should make writing abstracts easier. In addition, learning the “do's and don'ts” of abstract writing will improve quality and increase the likelihood of acceptance for publication.
Should Lidocaine be Added to IV Potassium Infusions to Prevent Burning Sensation?; Poor Readability of Low-Density Polyethylene Plastic Ampul Labels; Roxanol Involved in Another Serious Error
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.
Melphalan and Prednisone (MP) Regimen for Multiple Myeloma
Authors: Sano Harold S. , 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.
Taste Disturbance and Hospital Admission Due to Terbinafine
Authors: Noviasky John A , Sulaiman Jasmine
Published: January 2018

Terbinafine is a synthetic allylamine antifungal that can infrequently cause taste disturbance. The onset of taste disturbance usually occurs within 4 to 6 weeks after initiation of therapy and lasts for an average of 6 weeks after therapy is discontinued. The presentation of this adverse effect varies widely, from mild to more dramatic cases. Here, the authors report a dramatic example that resulted in extreme weight loss, dehydration, and hospitalization of the affected individual.
Risperidone Long-Acting Injection
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 tiotropium bromide inhalation powder, IV n-acetylcysteine, pemetrexed for injection, cetuximab, and alvimopan. The DUE is on tiotropium bromide.
Implementation of Pediatric-Specific Decision Support in a CPOE System
Authors: Wright Lorianne , Waitman Lemuel Russell , Grisso Alison
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.
PDAs, Patient Safety, and Science Fiction
Authors: Felkey Bill G. , Fox Brent I.
Published: January 2018

We cover several PDA-related topics in this installment about the roles that PDAs can play in promoting patient safety. The discussion refers to both existing and future technologies.
Myopathy Due to Inhaled Corticosteroid TIA Associated with SSRI Tenofovir Nephrotoxicity Linezolid-Induced Neuropathy Adverse Events Related to Transferring between Acute Care and Long-Term Care Facilities ADRs with Anthelmintics
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.
Thalidomide and Dexamethasone (TD) Regimen for Advanced Multiple Myeloma
Authors: Waddell J. Aubrey , Moussavian Parvaneh 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 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.
Sustaining Treatment of Coccidioidal Meningitis by Extending the Stability of Amphotericin B
Authors: Burger David E. , Caldwell John W.
Published: January 2018

Coccidioides immitis is an endemic fungus in California's San Joaquin Valley. The most debilitating and life-threatening manifestation is meningitis. The administration of intrathecal amphotericin B is an effective treatment, without which mortality is almost certain within 1 year. Kern Medical Center currently prepares 600 intrathecal doses annually for patients who have failed treatment with high-dose oral fluconazole. The recent national amphotericin B shortage severely compromised this life-saving therapeutic modality.

Although a vial of amphotericin B reconstituted with sterile water for injection is stable in the refrigerator for 7 days, this extended period of use could subject a single vial to as many as 15 entries. To prevent contamination, our practice has been to discard the remaining amphotericin B after 24 hours. However, if the stability of admixed amphotericin B could be extended and its sterility ensured, our institution would be able to provide care during drug shortages. After reconstitution of a 50 mg amphotericin B vial with 10 mL of sterile water, a 1 mL aliquot was added to each of seven 50 mL bags of 5% dextrose in water, resulting in a concentration of 100 mcg/mL. Five 2 mL samples were obtained from each bag on days 0 and 15. Visual stability, concentration, pH, and sterility were measured. Our results indicate that an amphotericin B concentration of 100 mcg/mL is stable in 5% dextrose for 15 days when stored at 4° Celsius and protected from light.
The Role of Activated Protein C in Sepsis
Authors: Dib Jean G , Zarikian Karen
Published: January 2018

Sepsis is an uncontrolled, unregulated and self-sustaining intravascular inflammation that results from an imbalance between proinflammatory reaction and excessive anti-inflammatory response. It is associated with increased mortality and morbidity. The major cause of death is multiple end-organ failure that occurs secondary to disseminated intravascular coagulation. Activated protein C has anti-inflammatory, anticoagulant, and fibrinolytic activity and demonstrated a beneficial effect in reducing mortality in patients with severe sepsis. In this review, the authors evaluated the role of Activated Protein C in sepsis.
Computerized Total Parenteral Nutrition (TPN) Order Entry in the Neonatal Setting
Authors: Grisso Alison G. , Webb Ty A.
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.
Clarifying Adverse Drug Event Terminology; Thiazolidinedione-Induced Congestive Heart Failure; Riluzole-Induced Neutropenia; Possible Pancreatitis Linked to Quetiapine Use; Clopidogrel-Induced Thrombotic, Thrombocytopenic Purpura
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.
PDA Data Integrity and Security
Authors: Fox Brent I. , Felkey Bill G.
Published: January 2018

Many of the articles in this series have been devoted to how the PDA can fit into the professional and personal lives of the pharmacist. We are convinced that the PDA is, and will continue to be, an invaluable resource for pharmacists and other health care professionals. However, as with any tool, you'll get the most out of your PDA if you know when and how to use it. This month, we discuss applications that can help you maximize the utility of your PDA.
Error-Prone Unit-Dose Packages; Concentration Confusion; Apply the JCAHO “Two-Identifier” Rule in the Pharmacy
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.
Essential Tremor Treated with Topiramate: A Case Series
Authors: Daugherty Kimberly K. , Ryan Melody , Slevin John T.
Published: January 2018

Objective

The authors evaluated a series of essential tremor (ET) patients treated with topiramate in a university-based movement disorders clinic.

Design

A retrospective clinical review of patient cases in a naturalistic setting was employed.

Subjects and Setting

Patients who were prescribed topiramate for ET were identified from clinic records. Patients were contacted by telephone to determine subjective improvement of tremor. Patients reporting improvement were invited to return for clinical evaluation.

Outcome Measures

Patients drew the Archimedes Spiral and were asked about performance of activities of daily living at each office visit. These activities were evaluated using a 5-point Essential Tremor Scale (ETS).

Results

Fourteen ET patients had been prescribed topiramate. The average age was 58 years and the average tremor duration was 17 years. The mean final topiramate dose was 105 mg/day (range: 25 to 400 mg/day). Eight of the 14 patients reported subjective tremor improvement with a mean dose of 128 mg/day (50 to 400 mg/day). Five of the patients were available for further evaluation. The average topiramate dose for the five patients was 175 mg/day (50 to 400 mg/day). The mean initial ETS score was 3.02 (2.5 to 3.5) for the patients; the final mean ETS score was 2.3 (1.75 to 3). The mean dose for the six patients who stated they did not respond to topiramate treatment was 75 mg/day (25 to 100 mg/day). One patient discontinued topiramate due to increased nervousness.

Conclusions

Based on the 57% subjective response rate seen in our case series, topiramate may be a useful treatment for some patients with ET in a clinical practice.
Morphine Sulfate Extended-Release Liposome Injection
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 September 2004 monograph topics are ezetimibe, iloprost solution for inhalation, posaconzole oral suspension, palifermin, and cilansetron The DUE is on tindazole.
Tenofovir-Associated Renal Problems: Hyperphosphatemia from OTC Bowel Preparations: Beta-Blocker Induced Quadriparesis: Two Adverse Reactions in the Same (Unlucky) Patient: Warfarin-Associated Hemorrhage: Benzodiazepines and Hip Fractures
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. Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices in cooperation with the FDA's medWatch Program and Temple University School of Pharmacy. ISMP is an FDA medWatch partner.

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.
Folic Acid to Prevent Neural Tube Defects: A Potential Pharmacy Initiative with Public Health Implications
Authors: Ryan Melody
Published: January 2018

Purpose

This study (1) reviewed available data and recommendations regarding the prevention of neural tube defects (NTDs) through folic acid supplementation for the general population, women with previous NTD pregnancies, and women with epilepsy and (2) examined the potential role of pharmacy in the prevention of NTDs.

Methods

Published clinical literature was identified through a review of articles abstracted from MEDLINE and International Pharmaceutical Abstracts. Search terms were folic acid, neural tube defect, spina bifida, myelomeningocele, anencephaly, epilepsy, clinical guidelines, and pregnancy. Clinically relevant information consistent with current guidelines was extracted.

Results

Administration of 0.4 mg/day of folic acid to women of childbearing age decreases rates of NTDs. In the general population, two types of NTD-reduction strategies have been employed: educational campaigns and food supply supplementation. Continued surveillance of NTD rates is needed to fully assess the effect of food supply supplementation in the US. Women with previous NTD pregnancies should consume 4 mg/day of folic acid during the month before and the month after conception. Public health interventions, including targeted educational materials and a national database to track subsequent pregnancies in women with previous NTD pregnancies, are needed. No evidence-based information about the effectiveness or dosing of folic acid supplements in women with epilepsy is available.

Conclusions

Pharmacists have an important role to play in the education of other health care professionals and patients about periconceptual folic acid supplementation. However, pharmacists must first be prepared to fulfill this role. Significant research in special populations — to determine the best folic acid dose and the most effective educational strategies — should be undertaken in the future.
Computerized Decision Support for Intravenous Fluid Management in Pediatric Patients
Authors: Wright Lorianne , Hargrove Fred R. , Waitman Lemuel Russell , Webb Ty A.
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.
Hyperammonemia with Valproic Acid: Colonic Ischemia Associated with “Triptan” Use Visual Side Effects with Pegylated Interferon: Alopecia Areata with Infliximab: Adverse Effects Seen with Medications Used for Irritable Bowel 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 (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.