Clinical twisters: Did therapy cause thrombosis?
July 24th 2006A 76-year-old woman, L.R., is seen in your hospital for a hot, painful, red, swollen leg injury. Deep vein thrombosis is ruled out by ultrasound. L.R. is diagnosed with superficial venous thrombosis and compression stockings are prescribed. L.R. maintains her varicose vein problem worsened significantly when she started nisoldipine (Sular, First Horizon Pharmaceutical) for blood pressure control. L.R.'s physician asks you about this possibility. He also asks you to recommend an alternative drug (to nisoldipine) for L.R.'s hard-to-control hypertension. She currently takes valsartan (Diovan, Novartis) 320 mg, hydrochlorothiazide (HCTZ) 50 mg, plus nisoldipine 20 mg/d. Her BP averages 145/90. Her only other medicine is prednisone 2 mg. What do you recommend?
Solid advances against cancer hailed at ASCO
July 24th 2006Since cancer is the No. 1 area for drug research, it's no coincidence that more than 400 targeted compounds are in development and scores were touted at the recent annual meeting of the American Society of Clinical Oncology (ASCO) in Atlanta. Below is a sampling of promising new or improved cancer fighters:
New analgesia device is needle-free
July 24th 2006The Food & Drug Administration recently approved the fentanyl iontophoretic transdermal system (IONSYS, Alza Corp.), the first needle-free, patient-activated transdermal analgesic (PATS) system. IONSYS is indicated for the short-term management of acute postoperative pain in adult patients requiring opioid analgesia during hospitalization. Alza said that it expects to start distributing IONSYS in 2007.
Generic approvals may set off statin storm
July 24th 2006The Food & Drug Administration recently approved three generic versions of simvastatin (Zocor, Merck), the largest-selling drug yet to be opened to generic competition. For the next 180 days, Teva will have exclusive rights to sell the 5-, 10-, 20-, and 40-mg dosages of simvastatin and Ranbaxy will have the rights to sell the 80-mg dosage. In addition, Dr. Reddy's Laboratories will sell all five dosages under an agreement with Merck to be the authorized generic manufacturer of the drug.
Clinical Twisters: Treating depressive episode
June 19th 2006A 28-year-old woman, S.A. (two months' pregnant), is brought to your ER by her husband, who believes she is suicidal. According to your health-system medical records, S.A. was diagnosed with bipolar II disorder several years ago. She was previously treated with lithium and lamotrigine (Lamictal, GlaxoSmithKline) separately but was noncompliant. Her psychiatrist is weighing a mood stabilizer and/or antidepressant therapy during pregnancy. He asks for your recommendation.
Breakthroughs reported in controlling colon cancer
June 19th 2006Of the thousands of drug studies presented at the recent meeting of the American Association for Cancer Research (AACR) in Washington, D.C., two took center stage as "genuine breakthroughs in colon cancer treatment and prevention." First, international scientists cited the biologic panitumumab (Amgen) for extending progression-free survival in advanced cancer patients. Then they hailed new research on celecoxib's (Celebrex, Pfizer) potential to prevent colon cancer-despite concern about heart-related side effects.
USP proposes new 797 standards
June 19th 2006While most people haven't had time to digest the intricate details of the United States Pharmacopeia's proposed changes to General Chapter 797 (Pharmaceutical Compounding-Sterile Preparations), response to the protracted document has been almost universally positive.
Software helps hospitals deal with narcotics theft
May 22nd 2006Pandora Data Systems recently released a multi-user, HealthInsurance Portability & Accountability Act (HIPAA)-compliantversion of its medication usage analysis software. Designed in 1989in partnership with a local pharmacist to be used in conjunctionwith his Pyxis 1000 automated dispensing system (ADS), the currentversion of Pandora is compatible with the Pyxis 3000 and theMcKesson AcuDose and Omnicell dispensing systems as well.
This tool helps you standardize infusions
May 22nd 2006For many years, doses and rates of administration for continuousinfusions in pediatric patients have been based upon the "rule ofsix." This weight-based method relies on the following formula: sixtimes body weight is the amount of drug to be added to 100 ml ofcarrier fluid.
Cerner launches smarter med dispensing system
May 22nd 2006Cerner Corp.'s CareAware RxStation characterizes the nextgeneration of automated medication dispensing systems. Itintegrates electronic medical records with dispensing cabinets. "Itis a closed-loop system," said Dawn Iddings, director of resourceplanning for the company's device innovation group. "It's anend-to-end solution, fully integrating ordering, dispensing, andadministration at bedside, through a completely sealed device."
USP Drug Safety Review: Medication errors involving NMBAs
May 22nd 2006Medication errors involving neuromuscular blocking agents (NMBAs)are potentially serious and life-threatening because these agentsparalyze respiratory muscle and, if misused, can adversely affectrespiratory function. NMBAs should be administered only by staffwith experience in maintaining an adequate airway and respiratorysupport in facilities where intubation can readily be performed,oxygen can be administered, and respiratory support can beprovided.
Bedside bar-coding still lagging in hospitals
May 22nd 2006Despite a new Food & Drug Administration mandate, which wentinto effect April 26 requiring all drugs supplied to hospitals tobe bar-coded, less than 10% of U.S. hospitals have a bedsidebar-coding system in place. Many hospital pharmacy executives saythe main reason they are not on board yet is the high cost ofimplementing it.
Clinical twisters: Resolving HF 'revolving door'
May 22nd 2006A 68-year-old man is hospitalized with shortness of breath,fatigue, and 2+ edema-his third hospitalization in 12 months.He has heart failure (HF) (currently New York Heart Associationclass IV, ejection fraction 20%), LVH, and MI history. Heart rhythmis normal; lungs clear; lab tests within normal limits excepthemoglobin510.5 gm/dl, SrCr52.3 mg/dl; BP5160/90, pulse 85,respiratory rate522. Admitting medications: furosemide 80 mg,potassium (K), benazepril 20 mg, aspirin 81 mg, carvedilol (Coreg,GlaxoSmithKline) 6.25 mg twice daily. The resident continues allmedications, increasing furosemide to 80 mg twice daily. He askswhether adding digoxin might reduce future hospitalizations.
Personalized medicine is new watchword
May 22nd 2006The National Comprehensive Cancer Network (NCCN) recently sponsoreda roundtable discussion called Cancer Care in the 21stCentury-Reality and Promise. The panelists discussed a widerange of topics, including the most important advances in cancercare since the war on cancer was declared during the NixonAdministration in 1972 and how pharmacogenomics is revolutionizingcancer treatment. The roundtable meeting, at which the group ofoncology leaders assembled for the first time, took place duringthe NCCN 11th Annual Conference, held recently in Hollywood, Fla.
MTM takes center stage at AMCP meeting
May 22nd 2006Medication therapy management (MTM) was the recurring theme at thisyear's Academy of Managed Care Pharmacy (AMCP) meeting, heldrecently in Seattle. The American Pharmacists Association led aworking group of 11 pharmacy organizations to define MTM servicesin 2004. This year, a similar working group led by AMCP defined MTMprograms. The resulting consensus document was presented at theAMCP meeting.
Advances in treatment of MI reported at ACC show
April 17th 2006The low molecular weight heparin enoxaparin (Lovenox, Sanofi-Aventis) is superior to unfractionated heparin as an adjunct to thrombolytic therapy in patients with ST elevation myocardial infarction (MI), researchers reported at the 55th Annual Scientific Session of the American College of Cardiology (ACC). The meeting was held in Atlanta last month.
How urban hospitals can help rural pharmacies
April 17th 2006Virtually none of the more than 1,000 rural critical access hospitals (CAHs) in rural America can afford a round-the-clock R.Ph. on staff. And this lack of coverage can adversely affect quality by slowing the prescription review process, said Tim Stratton, R.Ph., Ph.D., an associate professor at the University of Minnesota College of Pharmacy in Duluth.