Journal of Pharmacy Technology

To report a case of probable nafcillin—warfarin interaction and to discuss the occurrence of this event.

A 74-year-old white woman with stage IV ovarian cancer was given warfarin and nafcillin concurrently for a subclavian venous thrombus and an infected subclavian mediport. After 10 days of therapy, the patient's prothrombin time remained within the range of 11.6–13.8 seconds (control range 10.4–12.8). Her international normalized ratio (INR) ranged from 1.0 to 1.45 and her activated partial thromboplastin time ranged from 49 to 80 seconds (22–34). Nafcillin was discontinued. Continuous intravenous heparin was continued, and the patient was given warfarin 10 mg po for four days. A maintenance regimen of warfarin 5 mg po daily was then initiated. Within seven days of discontinuing nafcillin, the INR increased from 1.08 to 2.10.

Several cases of nafcillin—warfarin interaction have been reported in the literature. The case reported here is similar to a previously reported one in which a lower dose of nafcillin (6 g/d) was used for a short time (10 d). Therapeutic warfarin doses were started simultaneously with nafcillin. The interaction usually occurs within three to 10 days and abates within one to eight weeks. The postulated mechanism of interaction is induction of hepatic microsomal enzymes by nafcillin, leading to warfarin resistance.

When nafcillin is prescribed concomitantly with warfarin, high doses of warfarin are usually required and close monitoring is necessary to keep the patient's INR within a designated range. Clinicians should be aware of a potential nafcillin—warfarin interaction because warfarin has a narrow therapeutic window that may readily lead to therapeutic failure or toxicity. Frequent review of clinical signs and symptoms of bleeding or thromboembolism and warfarin dosage adjustment are necessary if both drugs are used concurrently, and also when nafcillin is discontinued.

To conduct field testing of the ExACT CM compliance monitoring device and provide results to the manufacturer.

Questionnaires, interviews, and patient diaries were used to collect data on targeted product attributes of interest.

The Veterans Affairs Medical Center outpatient anticoagulation clinic in Tucson, AZ.

A convenience sample of 31 ambulatory male patients (average 68 ± 0.5 y) who had been stabilized on warfarin therapy for at least one month.

Scaled attitudinal scores and open-ended comments on device attributes.

Data were collected for 28 days per patient. The device was determined to be both functional and acceptable to patients.

Results suggest that it is feasible to market ExACT CM for use by the pharmaceutical industry in clinical research.

To determine the stability of low-dose vancomycin hydrochloride 25 μg/mL and preservative-free heparin sodium 100 IU/mL stored at room temperature versus refrigerated temperature for 100 days.

A prospective, controlled pharmacologic study.

The test article (V-H) was prepared by mixing vancomycin hydrochloride 25 μg/mL in heparin sodium 100 IU/mL. The antibiotic control (V) was the same dose of vancomycin in NaCl 0.9% only The heparin control (H) was commercially available 100 IU/mL vials of this agent.

Half of the test and control solutions were stored at room temperature (28 °C) and half were kept in a refrigerator (4 °C). On study days 0, 1, 14, 30, 63, and 100, the concentration of vancomycin was measured by Emit. The functional activity of heparin was determined on identical days by the activated partial thromboplastin time (aPTT) assay.

Sixty-three days after preparation, the refrigerated V-H solution maintained over 90% of its original vancomycin concentration; in contrast, the V-H solution kept at room temperature had a 21% reduction in its antibiotic concentration. All V-H and V solutions had a significant (p = 0.01) drop in their vancomycin concentrations after 100 days of storage. There was no significant change in the measured aPTT of the V-H and H solutions stored in the refrigerator versus room temperature for 0 versus 100 days (p = 0.35 and p = 0.41, respectively).

An admixture of vancomycin hydrochloride 25 μg/mL and heparin sodium 100 IU/mL is stable for up to 63 days when stored at 4 °C.

To collect demographic information from pharmacy technicians working in Ohio hospitals and to determine their attitudes toward national voluntary pharmacy technician certification.

A survey was developed and sent to directors at 58 hospitals in Ohio for distribution to an exploratory sample of 735 technicians.

The response rate was 19.9%. Men comprised the majority of certified technicians and had been in their current job fewer years than the women surveyed. Technicians' attitudes toward certification differed depending on certification status. More certified technicians than uncertified technicians agreed with the beneficial aspects of certification. All technicians agreed that certification is not a substitute for on-the-job training and that certified technicians will not replace pharmacists. Technicians unsure of certification questioned its impact on improving qualifications, skills, likelihood of being hired, and opportunities for promotion.

The use of technical personnel in pharmacies likely will increase because of pressures from the healthcare system to control costs. Future research should continue to document the characteristics of technicians and the benefits and costs of certification to technicians, employers, and pharmacists.