Journal of Pharmacy Technology

An approach to drug counseling that helps organize and standardize the documentation of a patient's specific drug-taking problem is presented.

Patient counseling on the proper use of prescribed medications should be treated as a problem-solving session. The patient's underlying drug-taking problems may be complicated and deep-seated and may not be apparent unless specifically sought. This article introduces an approach that is intended to provide a systematic process for drug counseling: (1) establish a comprehensive, patient-specific database; (2) list patient-specific drug-taking problems; (3) provide counseling information and promote compliance; and (4) assess and monitor compliance. An important attribute of this approach is that it facilitates the dynamic nature of the counseling process.

This approach to drug counseling serves as a guideline for patient counseling. Additional experience with this system is necessary to determine its effectiveness at achieving the desired counseling outcomes.

To determine how formulary changes, based on the recommendations of a clinical pharmacy specialist, affected outpatient nonsteroidal antiinflammatory drug (NSAID) prescribing patterns and drug costs in a Department of Veterans Affairs (VA) teaching hospital.

Cost-benefit analysis.

VA teaching hospital.

Outpatient veterans.

Sulindac, piroxicam, and diflunisal were removed from the formulary and made available only on a case-by-case review process. Buffered aspirin and phenylbutazone also were removed from the formulary; these drugs were made unavailable altogether. Ibuprofen, indomethacin, salsalate, enteric-coated aspirin, and plain aspirin retained their formulary status and were available for routine prescribing.

Changes in the number of prescriptions dispensed and in prescription costs for each NSAID were measured 3 months before and 5 and 21 months after implementation of formulary changes.

No prescriptions were dispensed for diflunisal, buffered aspirin, and phenylbutazone 21 months after implementation of the formulary changes. During this same period, prescriptions for sulindac and piroxicam declined 95.7 and 97.1 percent, respectively. The average cost per outpatient NSAID prescription declined from $14.78 to $4.75 (67.9 percent) after 21 months. An extrapolated yearly savings of $137,704 was calculated.

Formulary changes based on recommendations of a clinical pharmacy specialist resulted in altered physician prescribing patterns and reduced outpatient drug costs for NSAIDs in a VA teaching hospital.

To determine the pharmacokinetic parameters of aminoglycosides in patients with AIDS and to compare these parameters with those of a control group of patients not infected with HIV.

Retrospective, chart-review study.

Nineteen AIDS patients and 19 non-HIV-infected patients (control) were identified through a review of pharmacokinetic monitoring cards.

Patients’ charts were reviewed for demographic data, aminoglycoside (gentamicin, tobramycin, and amikacin) dosing schedule, and steady-state peak and trough concentrations. Pharmacokinetic parameters were calculated using a one-compartment open model.

Significant differences were found in the elimination rate constant (K_e) between the two groups (mean ± SD, 0.20 ± 0.084/h in the AIDS group and 0.26 ± 0.095/h in the control group). Half-life was significantly longer in the AIDS group versus controls (4.3 ± 2.5 and 2.99 ± 1.15/h, respectively). The volume of distribution (V_d), expressed in terms of liters and liters per kilogram total body weight (TBW), was significantly larger in the AIDS group than in the control group (28.3 ± 14 L [0.43 ± 0.21 L/kg TBW] and 19.2 ± 4.95 L [0.28 ± 0.07 L/kg TBW], respectively). Clearance in terms of liters per hour and V_d in terms of L/kg ideal body weight were not significantly different between the two groups. Albumin was similar in both groups (34 ± 7 g/L, control group; 28 ± 7 g/L, AIDS group).

Aminoglycoside pharmacokinetics were found to be altered in the patients with AIDS. When calculating an initial dose of an aminoglycoside in AIDS patients, use of estimated normal population parameters may result in lower peaks in these individuals. Pharmacokinetic parameters may need to be adjusted in AIDS patients because of their large V_d and slower K_e.

To provide an overview of the development, chemistry, adverse-effect profile, and economic impact of radiographic contrast media (CM).

Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles pertaining to the use of CM. References cited in published review articles and manufacturer's product information also were used.

Studies, review articles, and editorials were selected for review if they addressed the synthesis, clinical use, or economic impact of CM. Comparative studies conducted in humans were used to address the adverse-effect profile of CM.

Data were extracted from reviews and editorials when the information from multiple sources was consistent and pertained to the purpose of this review. Comparative reviews addressing adverse reactions were reviewed by the author for appropriate methodology and reporting of results.

Radiographic CM are iodine-containing compounds that can be injected intravascularly or intrathecally for multiple diagnostic tests. CM are differentiated according to water solubility, viscosity, radiopacity, and osmolality. In the past decade, low-osmolality CM (LOCM) have been developed that may impart fewer adverse effects, such as flushing, nausea, vomiting, allergic reactions, cardiovascular effects, and nephrotoxicity. The use of LOCM has steadily increased since their introduction in 1985. The cost of LOCM is approximately 10- to 20-fold higher than previously available CM. This represents a growing financial burden to the healthcare system.

CM are an integral tool in diagnostic medicine. LOCM appear to be safer than previous agents; however, they are also more expensive. Balancing safety and financial concerns will be a recurring issue facing both the medical society and third-party payers when selecting appropriate CM to administer to patients.