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Disposing of hazardous pharmaceutical waste is nothing new for hospitals. However, the task has become more challenging in recent years due in part to a greater variety of toxic drugs that are being discarded.

As propofol utilization increases, so do the safety risks of fast-acting anesthesia. Readily adaptable oversight procedures for propofol management by clinical pharmacists have led to the awarding of medication safety awards to two hospitals by the Delaware Valley Healthcare Council in Philadelphia (DVHC).

Recognizing that health systems are failing to success-fully manage inpatient diabetes, the Joint Commission on Accreditation of Healthcare Organizations and the American Diabetes Association (ADA) joined forces recently to implement the inpatient diabetes certification of distinction program.

The American Association for Respiratory Care (AARC) recently launched a free Web-based tutorial to educate those with asthma and chronic obstructive pulmonary disease (COPD) about the proper use of their inhaled medications.

Ortho-McNeil Neurologics (OMN) has launched a campaign to warn pharmacists about prescribing and dispensing errors. The campaign centers around two OMN drugs, topiramate (Topamax) and galantamine (Razadyne and Razadyne ER).

A 59-year-old Caucasian woman, D.P., is seen regularly in your hospital's diabetes clinic. Daily medications include glipizide ER (Glucotrol XL, Pfizer) 10 mg, pioglitazone (Actos, Takeda) 45 mg, metformin ER (Glucophage XR, Bristol-Myers Squibb) 500 mg, citalopram 40 mg, ezetimibe/simvastatin (Vytorin 10/80, Merck/Schering-Plough), aspirin 81 mg, lisinopril 40 mg. Glycemic control appears good (A1c=7.0), but she has gained >40 lb. in four years (BMI=33). Despite a Jenny Craig diet (1,200 calorie/day) for six months, plus three weekly sessions with a personal trainer, she has lost only 2 lb. D.P. saw a blog claiming pioglitazone causes weight gain-she believes that is her problem. Her physician asks your opinion. What do you say?

Recent news reports linking methadone with a number of casualties, including that of the actress Anna Nicole Smith's son, have fostered the idea that the substance is a "killer" or dangerous drug of abuse. This is a bit paradoxical since methadone has been successfully used in heroin detoxification programs for decades.

The 2007 pipeline promises novel therapeutic classes for some diseases but no new drugs in others

The recent news that CVS and pharmacy benefit manager Caremark Rx are hooking up (Drug Topics, Nov. 20) didn't come as a surprise to pharmacy insiders. What does the industry think of the $21 billion agreement?

Rising gasoline prices have drained consumers' wallets this year. The housing market is losing steam. The war in Iraq is dragging on. Still, chains and independents are optimistic that consumers will fill Santa's sleigh with gifts plucked from their shelves. The National Retail Federation's (NRF) annual Holiday Consumer Intentions and Actions Survey offers plenty of reasons for retailers to celebrate.

Are you liable for technician mistakes?

Pharmacists hope a new Congress will roll back reimbursement cutbacks that were originally slated

Medicare Part D is still not for wimps, be they health professionals or consumers, any more than it was in early 2006, according to a Kaiser Family Foundation (KFF) analyst. Indeed, there is high risk that many beneficiaries are getting into plans, both for 2006 and 2007, that are not good for covering their medications and there could be health consequences, said Patricia Neuman, Sc.D., director of the foundation's Medicare Policy Project.

Q: Medicare Part D patients are often unprepared for the realities of the new drug plan. If a dual-eligible patient can't cover his co-pay, should the pharmacist send the patient home without the drug?

Previous columns examined the Medicare decisions that plans faced for 2007 and the choices available to enrollees. Pharmacists, too, will be facing some plan adjustments as the new year begins. In some cases pharmacy providers must sign and return a contract to continue their participation in pharmacy networks associated with the plans. Many pharmacies work with a third-party contracting organization that will sign the agreement on their behalf. Although many existing contracts expire on Dec. 31, 2006, CMS is encouraging plans to adopt automatic renewals, or evergreen contracts, for subsequent years.

Our current system is not working and needs reform was the take-away message from a three-hour workshop examining both Medicare Part D and the future of drug pricing. Held at the American Public Health Association's 134th Annual Meeting, which convened in Boston in November, the workshop included speakers discussing the various issues surrounding the drug benefit and potential methods for reform.

As reimbursements for drugs keep falling, chains must fill more prescriptions-and apply even more pressure on their pharmacists to dispense quickly-to make up for their loss. But pharmacists claim this is leading to more drug errors.

If there is a lesson from the last election, it may be this: Beware of seniors bearing donuts. Pennsylvania Representative Melissa Hart, a Republican from the southwestern part of the state, certainly should have. Instead, just two weeks before the mid-term elections, Hart called the police to handle a group of 40 Association of Retired Americans (ARA) activists who brought donuts as a demonstration against the donut-hole gap in coverage in the Medicare Part D benefit. Hart, who was leading in polls at the time, went on to lose the election.

This past April, methylphenidate (Daytrana, Shire) was approved as a transdermal drug delivery system (TD-DDS) for the treatment of attention deficit hyperactivity disorder. And many more patches are on the horizon. Novartis is seeking Food & Drug Administration approval for its rivastigmine (Exelon) patch to aid in the treatment of Alzheimer's disease. Researchers in the United Kingdom are working on a TD-DDS to deliver synthetic cannabinoids for use as antiemetics and appetite stimulants in patients with AIDS and cancer.

Despite better tools, decreased time to Food & Drug Administration approval, and an unbelievable figure for 2006 projected pharmaceutical sales-$321.1 billion-the payoff for drug innovation in the United States has been lagging. Over the past 10 years, there has been an annual average of only 10 to 15 new molecular entities (NMEs) to receive a nod from the FDA through fast-track approval, and only five through the regular approval process. This was the news coming from the 2006 Annual Meeting of the American College of Clinical Pharmacy (ACCP), held in St. Louis in October.

Peak and trough serum levels should be measured for patients on vancomycin, right? Well, sort of. According to Sharon See, Pharm.D., BCPS, associate clinical professor at St. John's University College of Pharmacy in New York, only trough levels are necessary. And in most cases, no levels are needed at all. That was one medical myth that was exploded at the recent American College of Clinical Pharmacy (ACCP) annual meeting in St. Louis in October.

New molecular entities on the horizon for the treatment of osteoporosis face a tough row to hoe in their quest for approval from the Food & Drug Administration. That was the subject of a presentation at the 2006 Annual Meeting of the American College of Clinical Pharmacy (ACCP), held in October in St. Louis.

An expert panel convened by the Alzheimer?s Drug Discovery Foundation recently released consensus recommendations on the treatment of Alzheimer?s disease and related dementias (ADRD) in managed care. The guidelines were published as a supplement to the American Journal of Geriatric Pharmacotherapy.

The Centers for Disease Control & Prevention (CDC) estimates that 1.25 million Americans are chronically infected with hepatitis B virus (HBV). Now a new, oral, once-daily treatment has been approved by the Food & Drug Administration and is indicated for the treatment of the illness in adult patients with both evidence of viral replication and either persistent elevations in serum aminotransferases or histologically active disease.

The long-delayed drug pedigree regulations announced by the Food & Drug Administration in mid-November have evoked a storm of criticism and lawsuits. No one is objecting to the FDA's stated goal of reducing drug diversion and counterfeits, but the cure may be worse than the disease.

CMS has issued a final rule on four conditions hospitals must satisfy to participate in Medicare and Medicaid. Three of them are drug related. They involve authenticating verbal orders, securing medications, and completing postanesthesia evaluations. The new requirements call for verbal orders to be authenticated promptly by the prescriber or another practitioner responsible for the patient's care, Schedule II through V drugs to be kept locked within a secure area with access by authorized personnel only, and a postanesthesia evaluation to be documented within 48 hours after patient surgery. Published in the Nov. 27 Federal Register, the new rules go into effect on Jan. 26.

A new software version for managing orders and calculations for total parenteral nutrition (TPN) compounding was released by Baxa Corp. in August. The company supplies about 70% of the nation's hospitals with automated TPN compounding products.