Drug Intelligence & Clinical Pharmacy

Online ISSN: 0012-6578
Publications
Article
The pharmacist is an active member of the cardiopulmonary resuscitation (CPR) team in many hospitals, dispensing medications, maintaining records, providing drug information, calculating doses, and mixing intravenous fluids. We surveyed 135 emergency department nursing directors across the country to assess the methods of and persons responsible for documentation during CPR. Ninety-five (70 percent) completed surveys were returned, showing that documentations was usually done by a nurse (81 percent), by a nurse and pharmacist (9 percent), by a pharmacist (7 percent), or by others (ward clerks, paramedics, or physicians) (3 percent). CPR flowsheets (83 percent), nurses' notes (7 percent), or other methods (10 percent) including notes on paper towels and blackboards are used to record such information in the emergency department. Most respondents were fairly confident (49 percent) or very confident (48 percent) that they could recreate the resuscitative sequence from the information recorded; 2 percent did not have confidence in the reproducibility of the data. Respondents felt that cardiac rhythms (83 percent), drugs and dosages administered (34 percent), and temporal sequence of events (33 percent) could be more accurately recorded during CPR. A majority of respondents (57 percent) felt that an automated recording system would be useful. We conclude that there appears to be considerable variability in the method of documentation of events during CPR in emergency departments throughout the country. Future efforts in emergency care should include the involvement of pharmacists in the development and implementation of a uniform database for use by field and hospital personnel during CPR.
 
Article
Metronidazole in high cumulative doses has been associated with convulsions. A case is presented in which this relationship is clear. In all reported cases of metronidazole-associated seizures, the cumulative dose of metronidazole has been high (greater than 40 g). The cumulative dose rather than the serum level is important in the pathogenesis of this complication.
 
Article
This article describes the number and types of psychotropic drugs on the market in Denmark, Finland, Norway, and Sweden from 1950-1977. The total number of drugs on the market in each country depended greatly on how psychotropic drugs were defined, but trends with time and differences between the countries were less affected by this definition. The number of drugs was highest in Finland and lowest in Norway. In all countries, the number of drugs increased from 1950 to the mid-1960s, most abruptly in Finland. They then quickly decreased in Finland and Sweden, but remained fairly constant in Denmark and Norway. The number of different active substances was much smaller than the number of drugs, and the differences between the countries were also smaller. The proportions of combination and hidden psychotropic drugs in relation to all psychotropics were considerable in Finland and Sweden, and the varying numbers of combination drugs contributed greatly to the wide differences in the number of drugs. From the medical point of view, far too many drugs were on the market in that period.
 
Article
In an attempt to determine the interrelationships of articles published regarding drug information services activity, a citation analysis was performed. The period chosen for study was 1961-1979. During this period, some 258 publications were identified as meeting the operational definition of drug information services activity. A subset of publications was selected for further study and showed that (1) less than 1/3 of the articles in the subset cited one another, (2) the "classic" article(s) are seldom cited, and (3) authors tend to cite themselves more frequently than others. A historiograph is presented which shows all of the citation interrelationships of the subset of publications.
 
Article
The author discusses the results of surveys conducted in Warsaw, concerning the extent of use of unprescribed medicine from 1970-1980. Drug use did not increase over the decade studied, and most respondents took the medication to treat particular complaints. No correlation was found between self-medication and social or occupational status. Respondents often began using unprescribed drugs on the recommendation of a doctor; self-medication, while widespread, does not imply a negative attitude toward health professionals or the existing system of medical care.
 
Article
In this paper the author recommends that American pharmaceutical education should move rapidly in the direction of a single terminal professional doctor of pharmacy degree for all of its graduates. An attempt is made to review for the reader: (1) some of the historical events of the twentieth century that influenced the direction of education in pharmaceutical, medical and related health professions,1,2,3,4 (2) the Pharmaceutical Survey of 1948 5,6 which was the last major introspective study prior to the present work underway by the Millis Commission, (3) the report of the Citizens Commission On Graduate Medical Education7 which appeared in 1966, (4) several tracts of the past few decades2,3,8,9,10 which have focused on the changing scene in American pharmaceutical education, (5) the development7,10 in medical education which have provided important precedents for pharmacy and (6) several recent papers11,12 which have espoused the professional doctor of pharmacy degree. The author particularly calls upon direct quotes and recommendations from the Findings And Recommendations of the Pharmaceutical Survey of 1948. Also, he draws upon and paraphrases remarks of The Report of the Citizens Commission and Graduate Medical Education, chaired by John S. Millis, and which appeared in 1966.
 
Article
The impact of a specially designed patient education program upon the diabetes-related knowledge and compliance of insulin dependent diabetic patients was investigated. The program consisted of an audiovisual presentation, illustrated handout material, and pharmacist-patient counseling. Based on statistical considerations, 65 eligible patients were assigned systematically to a control group (Group I) and a study group (Group II) and were evaluated for compliance following a standardized protocol. Immediately following the interview, Group II patients were instructed utilizing the patient education program. Scores for initial and final evaluations of knowledge and compliance were compared using appropriate statistical procedures. The program was successful in producing improvements in both knowledge and compliance but a need for individualization of patient education efforts was indicated. Significant improvements in compliance were not observed among patients older than the mean age for study patients and those with diabetes complicated by cardiovascular and hypertensive disease.
 
Article
During June and July 1982, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its second annual national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response of 80 percent to the questionnaire. Sixty-three fellowships are offered at 25 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.
 
Article
The author discusses the role of the pharmacist as a patient counselor, using as a background the history of the USP as a mirror to the changing roles of pharmacy practitioners. The controversy over patient package inserts is presented as a conflict between pharmacy's traditional functions and the Food and Drug Administration's perception of a need for higher standards in patient information and as an example of how pharmacists, through their own neglect, stand in danger of abrogating their function as patient counselors. The author advocates that pharmacy expand its activities through increased attention to and more judicious use of the USP Dispensing Information and the other services that the USPC offers.
 
Article
During June and July 1983, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its third annual national survey by mail questionnaire regarding postgraduate pharmacy fellowships. There was a total response of 76 percent to the questionnaire. Eighty-three fellowships are offered at 31 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is reported.
 
Article
During July and August 1984, the Pharmacy Services Department of the Brigham and Women's Hospital conducted its fourth annual national mail questionnaire survey of postgraduate pharmacy fellowships. It was found that 91 fellowships are offered at 36 fellowship sites. Information regarding type of specialty fellowship, fellowship characteristics, fellowship location and contact person, and qualifications of applicants is presented.
 
Article
During August and September 1985, the Brigham & Women's Hospital Pharmacy Services Department conducted its fifth annual nationwide survey of postgraduate pharmacy fellowships. There are 115 fellowships offered with 89 fellows at 33 sites.
 
Article
Cyclosporine is an important immunosuppressive agent in organ and bone marrow transplantation. The pharmacokinetics of cyclosporine are quite complex and are complicated by the availability of two assay systems that yield differing results. This article summarizes the views from two major solid organ transplant centers and one bone marrow transplant center on important cyclosporine monitoring questions. A general consensus exists in the four areas discussed that: cyclosporine concentrations must be monitored due in part to the extreme variability in kinetics, either blood or plasma can be used in monitoring programs, the radioimmunoassay or high pressure liquid chromatography can be used in routine monitoring, and the interpretation of cyclosporine concentrations must be performed in relation to patient variables that affect drug response and toxicity.
 
Article
During September and October 1986, the Brigham and Women's Hospital Pharmacy Services Department conducted its sixth annual nationwide survey of postgraduate pharmacy fellowships. There are 170 fellowships offered with 146 fellows at 44 sites.
 
Article
During August and September 1987, the Brigham and Women's Hospital Pharmacy Services Department conducted its seventh annual nationwide survey of postgraduate pharmacy fellowships. There are 185 fellowships offered with 150 fellows at 53 sites.
 
Article
This comprehensive bibliography is intended to enhance the education of the practitioner, student, and academician in the area of parenteral nutrition. This bibliography is not all-inclusive but serves as an update from the original published in 1983. Of particular note in this work is the addition of topics that reflect a growing interest in medical specialties with regard to patient nutritional status and support.
 
Article
The nonsteroidal antiinflammatory drug (NSAID) indomethacin has been shown to increase blood pressure in normotensive individuals. The effect of other NSAID on blood pressure has not been as well studied. We evaluated the effects of ibuprofen, an NSAID currently available without a prescription, on 24-hour ambulatory blood pressure in ten young, healthy, normotensive women. Using a randomized, crossover, double-blind design, subjects received ibuprofen 800 mg and a placebo identical in appearance to ibuprofen three times a day for eight days with a washout period between regimens. Subjects were instructed to follow a no-added salt diet during the study. Twenty-four-hour blood pressure monitoring and 24-hour urine collection for prostaglandin E2, creatinine, and sodium were performed on days 1 and 8 of each study week. Tablet counts and a 40 percent reduction in urinary prostaglandin E2 documented compliance with ibuprofen. Ibuprofen had no significant effect on systolic or diastolic blood pressure at any hour during the 24-hour period. Mean blood pressure for the 24-hour period was 112/73 and 111/73 mm Hg on day 1 and 111/73 and 112/73 mm Hg on day 8 for placebo and ibuprofen, respectively. We conclude that ibuprofen at doses as high as 2400 mg/d for up to seven days has no effect on blood pressure in normotensive women. Further studies are needed in hypertensive subjects.
 
Article
The effects of chronic phenytoin therapy on serum calcium, phosphorus, folate, and various hematological indices were assessed. One hundred and fifty-one patients, ages 18 months to 81 years, received phenytoin in a previously-conducted, double-blind, placebo-controlled study. Of the patients receiving phenytoin, initially 127 were evaluable while for control patients receiving placebo, 116 were evaluable. All patients had various laboratory parameters monitored at one day post-loading dose, one week, 1,3,6,9,12,15,18,21, and 24 months. Laboratory values examined were serum calcium, phosphorus, folate, white blood cell count with differential, hemoglobin, hematocrit, and red blood cell and platelet counts. A statistical analysis using the t-test method was employed to evaluate data. Data are reported as mean values ± standard deviation. Patients suffering early hypersensitivity, manifested by a morbilliform skin rash, were removed from the drug by day 30 and were not included in the chronic therapy review. Results indicate that the various laboratory values examined were not significantly affected by phenytoin administration in the patient population. Therefore, chronic phenytoin therapy following the initial hypersensitivity period does not cause abnormal laboratory values as followed in this study.
 
Article
A model-independent program for pharmacokinetic analyses based on statistical moment theory is presented and demonstrated. The program uses an inexpensive and portable TI-59; a PC-100A printer adds convenience but is optional. The program may be used in analysis of blood, serum, or plasma concentration vs. time curves originating from iv, im, po, sl, or sc administration. Drug input can be zero or first order; both single-dose and multiple-dose steady-state conditions can be evaluated. A comparison between results generated using moment analysis and traditional two-compartment nonlinear regression showed excellent agreement.
 
Article
This article describes the normal anatomy and physiology of the abdomen. Physical examination techniques illustrate the evaluation of the abdominal structures. The text describes physical presentation of selected diseases and discusses their pathophysiology. The text material is applied through a case study.
 
Article
A 50-year-old male developed an Enterobacter cloacae abdominal infection as the result of gangrene of a gastric remnant after gastrectomy. Aggressive antibiotic treatment with tobramycin and clindamycin was instituted, but despite documented in vitro bacterial sensitivity and high serum tobramycin levels, the patient's clinical condition worsened. Enterobacter cloacae continued to grow in the abdominal drainage cultures. As a last resort, moxalactam therapy was started. Within 36 hours, dramatic clinical improvement was seen and Enterobacter disappeared from the abdominal fluid cultures. Antibiotic assays showed that abdominal fluid contained approximately 50 percent of the simultaneous serum moxalactam concentration, while tobramycin was present in abdominal fluid at less than 15 percent of the serum concentration. In spite of bacterial sensitivity to both drugs, it is likely that moxalactam produced better results than did tobramycin, because of better tissue penetration characteristics.
 
Article
Antibiotic prophylaxis and treatment regimens ideally are selected on the basis of efficacy, safety, and cost. This review evaluates current, selected literature on antibiotic prophylaxis for colorectal surgery, presumptive antibiotic administration following penetrating abdominal trauma, and treatment of intraabdominal infections. Single-drug regimens with the newer, broad-spectrum agents are assessed and compared with combination regimens; specific regimens are recommended. Colorectal procedures require an antimicrobial agent with activity against both aerobes and anaerobes. Patients undergoing elective colorectal procedures can be adequately protected with an orally administered three-dose regimen of neomycin/erythromycin. Parenteral antibiotic administration is generally not necessary, but, cefoxitin is recommended for nonelective colorectal surgery. The risk of potential infectious complications following penetrating abdominal trauma without colonic perforation is less than with colonic perforation; however, antibiotic therapy that includes activity against aerobes and anaerobes is recommended for all types of penetrating abdominal trauma. Although cephalothin, cefamandole, or cefoxitin alone may be used in abdominal trauma without perforation of the colon, only cefoxitin is recommended as a single-drug alternative to the standard clindamycin/gentamicin regimen in trauma with colonic perforation. Single-drug therapy with cefoxitin or moxalactam can be used successfully as alternatives to the standard regimens of clindamycin/gentamicin or metronidazole/gentamicin in many patients with intraabdominal sepsis. Single-drug regimens reduce the risk of developing adverse effects and are cost-effective. However, if resistant organisms are suspected, or if the patient has been hospitalized for a prolonged period or has multiple organ failure, it may be necessary to supplement cefoxitin therapy with an antibiotic that will enhance coverage against gram-negative aerobes.
 
Article
The expansion of service levels in traditional community pharmacies in the face of structural and process impediments as well as the lack of reinforcement that would be provided by demand and reimbursement for such services requires a highly dedicated professional. As a result, this research had the goals of investigating the relationship between service provision and pharmacist willingness and competency, and characterizing pharmacists who presently do or do not provide expanded levels of service. A census of South Carolina community pharmacists was carried out using a self-administered, mail questionnaire. Analysis of the 890 responses representing 63.4 percent of the sample revealed that there is a significant relationship between pharmacists' willingness and ability and the extent to which they provide expanded levels of service. Pharmacists providing services were not only more willing and able to do so, but worked longer hours, tended to work in apothecary or independent pharmacies, held advanced degrees, and were more involved in continuing education. The results generally support the hypothesis that both willingness and competency may serve as barriers to the extension of clinical services into traditional community pharmacy settings.
 
Article
A report of hematologic abnormalities associated with administration of vidarabine in a neonate is presented. High doses of vidarabine (30 mg/kg/d) for the treatment of herpes simplex infection may have caused a decrease in hematocrit and platelet count. This case demonstrates the need to monitor hematologic indices during administration of vidarabine. The use of doses greater than 15 mg/kg/d is questioned.
 
Article
Assessment in young children of the bioavailability of slow-release theophylline formulations is hampered by the requirement for frequent blood sampling. Calculations of bioavailability from serial serum and passively absorbed saliva samples were therefore compared in six 9- to 12-year-old asthmatic children receiving multiple doses of Theo-Dur Sprinkle every 12 hours, using Theo-Dur tablets, a previously characterized formulation, as a reference. Results indicated 85 +/- 5 percent and 82 +/- 8 percent (mean +/- SEM) relative bioavailability based on serum and salivary measurements, respectively. Correlation coefficient for serum and passively absorbed saliva bioavailabilities was 0.90. Passively absorbed saliva provides an acceptably accurate, noninvasive method for theophylline bioavailability assessment and may be a useful alternative for bioavailability studies in young children.
 
Article
Digoxin is a commonly prescribed medication for a variety of cardiovascular abnormalities. The therapeutic index of digoxin is considered narrow and drug is absorbed predominantly from the duodenum and upper jejunum. When the small intestine is intact, the absorption can vary; therefore, in the case of a small bowel resection or bypass, this erratic absorption may be accentuated. There is some controversy concerning the effect of small bowel resection or bypass on the absorption of digoxin. Some investigators have shown that small bowel resection or bypass decreases the absorption of oral digoxin, whereas others report no change in absorption. When the study methodologies were evaluated, certain common factors that support each view were found. In most studies reporting malabsorption, a solid dosage form of digoxin was used. Studies reporting no change in absorption investigated a solution dosage form.
 
Article
Oral cefaclor is rapidly absorbed in patients with a shortened gastrointestinal tract (23 cm). A case is reported of a 27-month-old female child who had received oral cefaclor for five days in treatment of otitis media. The child had had a bowel resection at birth. She did not respond to oral therapy with cefaclor and was admitted to the hospital, where she received cefamandole intramuscularly. The patient recovered in five days. Further investigation using cefaclor with this patient demonstrated serum concentrations below the minimum inhibitory concentration of Hemophilus influenzae, pneumococcus, and many other organisms. When oral antibiotics are prescribed, it is necessary to monitor serum concentrations to ensure absorption.
 
Article
The influence of enteral feedings (with Ensure) on the absorption of phenytoin sodium from capsules was studied. Six healthy adult volunteers were given a single dose of phenytoin capsules 400 mg po on two occasions. Blood specimens were collected for 48 hours after each dose. In a randomized, crossover fashion, each subject completed the following two phases: (1) phenytoin without enteral feedings, and (2) concomitant enteral feedings before phenytoin and continued at 100 ml/h for ten hours. The areas under the concentration versus time curves from 0-48 hours (AUC0-48) were not significantly different between the two phases (p greater than 0.5). The percent relative bioavailability of phenytoin with enteral feedings was 101.7 percent. This study suggests that enteral feedings do not affect the serum concentrations of phenytoin after a single dose given in capsule form.
 
Top-cited authors
Hind Tellawi Hatoum
  • University of Illinois at Chicago
David W Newton
  • Shenandoah University
Vincent Gotz
  • Adigica Health
Thomas Ray Einarson
  • University of Toronto
Steven L Barriere