News Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021
Rand Study Answers Some Questions about the Effects of drug therapy are much affected hy receiving a PPI. Most PPis respondents elected to take the drug once they had pur chased it; only a few seem to have chrmged their decision as Patient package inserts (PPIs) fared well in an FDA-spon a result of the information they received. sored study of alternative designs by the Rand Corporation. The 5. The costs of returned prescriptions are likely to be quite low. Previous estimates of the annual cost of returned pre study showed that patients read and understand PPIs, do not scriptions that will result from FDA's proposed labeling report more side effects as a result of reading PPIs, and can ' program have been as high as $87.75 million—a figure based handle fairly lengthy and complex PPIs. on the assumption that for every 60 new prescriptions, PPIs will cause one additional prescription to he returned. These The Rand study was conducted from autumn 1979 through results indicate that this estimate is several orders of mag spring 1980 at 69 pharmacies in Los Angeles County, CA. Al nitude too high. During the course of the study, only three ternative PPIs were studied for three drugs: erythromycin, prescriptions were returned to pharmacies for cash refunds, conjugated estrogens, and flurazepam. Six variables of PPIs out of more than 2000 prescriptions dispensed with PPIs. Even if pharmacies were to pass on the full costsof returned were included: specificity of instructions, amount of explanation, pr^riptions to the consiuner, the resulting increases in drug writing style, risk emphasis, format, and reduced content prices would he extremely small. (length). Patients having prescriptions for one of the study drugs 6. PPIs do not, in general, lead patients to report more side effects. PPI critics have contended that warning patients at the 69 pharmacies were informed of the study by the phar about side effects will cause them to experience those effects macist, and 1821 patients participated. Each subject was as through suggestion. However, the researchers found no signed randomly to receive one of several versions of a PPI or difference in the number of side effects reported hy re spondents who received leaflets and those who did not, in to a control group (no PPI for erythromycin and flurazepam, dicating that the provision of side effect information does the manufacturer's PPI for estrogens). Outcomes were assessed not, by itself, cause patients to "imagine every symptom in by means of a telephone survey conducted an average of two to the leaflet." Some evidence indicated increased side effect reporting for certain kinds of leaflets, however. three weeks after the prescription was filled, and by means of 7. PPIs are unlikely to change the frequency with which pa a subsequent mail questionnaire. tients contact their physicians. Some critics have claimed Principal findings of the study, as summarized by the inves that.PPIs will substantially increase the number of times tigators, were: patients call physicians to seek further information or re assurance, thereby increasing the costsof health care. Others have .claimed that PPIs will encourage patients to bypass 1. PPIs are likely to be widely read. In this study, about 70% their physicians in favor of self-diagnosis, self-monitoring, of those who received PPIs reported having read them. and self-care. The researchers found no evidence that PPIs Among those using the drug for the first time, readership had any effect whatsoever on the number of times patients was still higher. For two of the three drugs, older people were contacted their physicians. For one of the threestudy drugs more likely than younger people to report having read the (ei^hromycin) PPIs may have altered the content of phy PPI. No evidence was found that PPIs are read only hy an sician-patient interactions. Patients who received PPIs were information-seeking elite; the less educated were just as more likely to report having discussed drug safety and side likely to read them as anyone else. effects with their physicians. 2. Many patients use PPIs as reference documents. Between 8. Patients find written drug information helpful. For all three ^ and 56% of those who received a PPI reported having kept study drugs, most respondents who received PPIs reported it, and between 22 and 32% reported having read it more that they found PPIs helpful in understanding the drug and than once. The fact that PPIs receive such use suggests a its effects. In addition, most respondents who were t^ing potential advantage over other methods of providing drug flura^pam or erythromycin also said that the PPI contained information that do not place the information in the hands new information, helped them to follow their doctor's orders, of the patient. and helped them to know when to take thedrug. For all three 3. PPIs lead to reliable gains indrug knowledge. Piyiiaomycin drugs, evaluations tended to be most favorable among the • patients who received PPIs were better able to answer groups that are ordinarily least responsive to consumer- questions about how the drug works and how to use it, and oriented information (e.g., less educated respondents and more likely to know that the drug is contraindicated for minorities). These results indicate that the appeal of PPIs patients with a history of liver problems. Flurazepam pa is not limited to the more sophisticated patients who make tients who received PPIs were more aware of possible drug up the "carriage trade." interactions and of the potential dangers of taking the drug 9. The amount of explanation provided in a PPI makes very durmg pregnancy or lactation. PPIs appear to he an effective little difference in how much information patients under- vehicle for getting more information to more people. 4. PPIs seem to haoe little effect on how patients use a drug. The researchers found no evidence that patients who re ceived a PPI were any more or less likely to comply with the prescribed regimen or (if the amount to he taken was left up to them) to alter their patterns of drug use. The results also provide no evidence that patients' initial decisions regarding Continued on page 1642
Vol 38 Nov 1981 American Journal of Hospital Pharmacy 1835 AccudorAdministration Sets
Recision Gontrol with s; Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021
Accudot is an extraordinary I.V. administration set." You can establish a precise drop rate by simply adjusting the flow metering knob. Once set, you will be amazed how. seldom you have to readjust flow. In fact, control provided by the Accudot administration set is so precise that you can often use it in place of an electronic controller.. We have eliminated roller clamps from the Accudot control mechanism. Gone are your problems associated with roller clamp/I.V. tubing creep and cold flow. - When enhanced precision of an electronic controller is needed, you can easily insert the Accudot set into IMED's 350 Controller. The result is precision electronic monitor ing and maintenance of an established drop rate. Accudot I.V. administration sets are available in a. variety of configurations and are key components of the IMED Infusion Management™ System. Ask your Infusion Management Specialist for tech nical information and a demonstration.
IMP/ACC-lOSl Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 IMED 350 Controller
MicroprDcessor technoloi^^ Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Recision Gontiol of drop rate, safety andease-of-use.
For ultimate precision in gravity flow fluid delivery, simply insert the Accudot set' into IMED's 350 Controller. The IMED 350 Controller continuously monitors your prescribed drop rate. Simply set desired rate and the 350 Controller will automatically adjust the Accudot set to reliably maintain flow. IMED's 350 Controller also senses most infiltrations, low flows, empty solution containers, and t ' 1 other factors that can affect flow conditions. , . When your patient needs to be moved without the 350 Controller, simply remove the Accudot set from the controller. The amazing Accudot administration set allows a pre-established drop rate to continue. n' • Piggybacking is simple. That's because the sanie microprocessor technology which ensures drop rate accu racy also allows two IMED 350 Controllers to work to gether. This gives you electronic Precision Control of both primary and secondary solutions. In addition to monitoring drop rates, the micro processor in IMED's 350 Controller monitors itself and diagnoses its own intemal problems should they occur. The IMED 350 Controller is a key component of th IMED Infusion Management"' System. Ask your Infusion Management Specialist for.teclw^/^ nical information and a demonstration. ^ '
IMP/350-1081 Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 IMED" \blumetric Runps
Accusefcassette piuvidesVblun Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Delivery and safety.
IMED's entire line of pumps gives you volumetric delivery using a piston and valve mechanism in the Accuset cassette. Only this unique IMED valvirtg system is designed to prevent uncontrolled flow frorp container to patient, thus providing an extra margin of safety — even if Accuset cassettes are removed from IMED pumips. IMED volumetric pumps are easy, very easy, to use. Just purge cassette, set rate, set volume to be infused and start! Once the volume has been delivered, IMED vol- ' umetric pumps automatically switch to a keep open rate. IMED volumetric pumps detect air-in-line and occlusions. Long battery operating time adds to versatility of use. IMED's Model 927 Volumetric Infusion Pump deliv ers clear or opaque solutions at rates up to 299 ml/hr in 1 ml increments. A high volume version, IMED's Model 928 Volumetric Infusion Pump, is available for rates up to 799 ml/hr. Each model has status lights on the front panel which work in conjunction with an audible alarm to notify you if problems occur. IMED's Model 929 Volumetric Infusion Pump, "The, Computer Pump", is designed for regulation of mean arterial pressure with controlled infusion of vasodilating drugs. Linked to an external computer which monitors your pa tient, the Model 929 is capable of receiving and transmitting information to monitor or control pump functions. The Model 929 can be used in either computer rriode or manual mode of operation for precise infusion of other prescribed solutions. IMED's Model 960 Volumetric Infusion Pump fs microprocessor controlled and provides precision infusion at rates up to 999 ml/hr in 1 ml/hr increments. It displays instructions to assist you with setup and operation. IMED's Model 965 Micro-Volumetric Infusion Pump is similar to the Model 960 yet provides even greater preci sion delivery at low infusion rates. Flow can be set in 0.1 ml/hr increments up to a maximum of 99.9 ml/hr. ' IMED's variety of Volumetric Infusion Pumps are key components of the IMED Infusion Managerrient™ System. Ask your Infusion Management Specialist for tech nical information and a demonstration.
IMPA'P-1081 IMED Corporation IMED S.A. IMED GmbH IMED Canada Inc. 9925 Carroll Canyon Road Geneva Switzerland Eschbom/Ts Germany Mississauga Ontario Canada San Diego CA 92131 Tel; (022) 32 69 38 Tel: (06196) 48718 Tei: (416) 8212212 Tel: 800-854-1934 California: 714-566-9000 IMED Limited TMED Scandinavia IMED Australia, Pty., Ltd. Telex: 910 335 2004 IMED SDG Abingdon England Stockhbim Sweden Rydalmere N.S.W. Australia 249038 IMED UR Tel: (0235) 832111 Tel: 60 31 20 Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 News
Continued from page 1635 systematic attempts to simplify them—to be "fairly easy" to read. The leaflets' complexity had no effect on how much respondents learned from them and very little effect on other outcomes. Within this range of complexity; these results stand or remember. Some of our results suggest, however, imply that heroic efforts to simplify the language in a PPI the PPIs that run heavily toward explanation may convey are probably unnecessary. The researchers suspected that a slightly different impression about the drug. Allin all, there patients expect a certain amount of complexity in medical seems to be no advantage in writing PPIs that contain large information and are willing to put some effort into meeting amounts of explanation. the message halfway. 10. PPIs that contain numerous specific.instructions can lead 13. PPIs in outline format may reach a larger audience but with to increased reporting of side effects and other adverse a different message. For two of the three study drugs, PPIs outcomes. Although no one is certain why these effects having an outline format were more widely read than those occur, the researchers suspected that many patients find a in a text format. PPIs in outline format did not, however, barrage of specific behavioral recommendations unsettling convey any more (or less) information, arid results indicate and begin to monitor their physical states more closely, that patients found them more alarming. For both estrogen which may lead them to notice (or imagine) more side effects and erythromycin, significantly fewer patients who received and to feel that they have experienced less improvement in outline PPIs expressed willingness to take the drug again. their symptoms. Because all of the leaflets we studied in Erythromycin users who received these PPIs also reported cluded at least some behavioral recommendations, these significaiitly more side effects and other health problems. results did not lead the researchers to conclude that all such Thus, the outline versions appeared to induce some of the Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 recommendations will have deleterious effects. Such effects negative outcomes often predicted for PPIs in general— seem to occur only when the PPI contains a large numBer outcomes not found for most other PPIs that studied. of fairly detailed instructions. 14. Shorter leaflets convey less information than longer leaf 11. There is little advantage to be gained by highlighting in lets, but do so no better. Some of the leaflets studied were formation about a drug's risks. Patients who received leaf-" shortened quite drastically by reducing their informational lets in which risk information was emphasized through order content. As one would expect, patients who received these of presentation and typographical devices displayed no shorter leaflets demoiistrated less knowledge of the facts greater knowledge of risks than other patients. Risk em that were omitted in them, but included in full-length ver phasis sometimes affected patients' attitudes. The most sions.- They did not, however, display any greater knowl striking effects were on estrogen users, who became more edge of the facts covered in all versions. There is apparently positive in their beliefs about estrogen's effectiveness, pos little advantage in the hope that the reduced message will sibly to justify the risks they were assuming by their con- c reach more people who will understand it better. Most pa tinned use of the drug. tients can readily handle PPIs of 1000 words or more without 12. The simplicity with which a PPI is written has surprisingly •suffering information overload. little effect. Some of the leaflets studied would be considered fairly difficult by most objective yardsticks, yet patients OTA Releases Report on Patent-Term Extension for judged these leaflets—like other lesdlets that had undergone Pharmaceuticals Additional incentives for pharmaceutical research and de velopment would be provided by patent-term extension for drugs, but it is not certain that those incentives alone would appreciably increase pharmaceutical innovation. That was the POCKET GUIDE TO INJECTABLE DRUGS conclusion reached by the Congressional Office of Technology A handy new pocket size reference. Assessment (OTA) in a study of the effects of patent-term ex The POCKET GUIDE provides you: tension for products subject to federal regulations before rbar- • instant access to important information on injectable drugs keting (e.g., drugs, medical devices). • detailed information on dosage (including pediatrics), administration, reconstitution, stability and compatibility O'TA conducted the study for the House Judiciary Subcom • a convenient tabular description of compatibility with base solutions mittee on Courts, Civil Liberties, and the Administration of and drugs Justice, which is considering a bill that would extend the life of • complete cross-indexing of generic and proprietary names • indexing to the Handbook on Injectable Drugs and American Hospital patents for these products by the amount of time (up to seven Formulary Service. years) that the federal government takes to approve marketing. The Pocket Guide to Injectable Drugs gives you the information you need The bill, introduced in the Senate by.Charles McC. Mathias to make decisions about therapy with injectable drugs. Its unique format (R-MD) and in the House by Robert W. Kastenmeier (D-WI), • provides quick answers to the.most commonly asked questions. The index aids in resolving more complex problems. has passed the Senate and was being considered by the House Pocket Guide to Injectable Drugs published by the Aiherican Society of at press time. Hospital Pharmacists, 159 pp.; softbound; $10.00 The OTA researchers found that pharmaceutical-jndustry © 1981 American Society of Hospital Phannacists profits have remained high, revenues have increased steadily, and that research and development expenditures have increased Please send. copies of the PockelGuide to Injectable Drugs at $10.00 each. rapidly enough to offset inflation in biomedical costs. This Enclosed is my eheck for $ contradicts claims by pharmaceutical manufacturers that re Enclosed is our purchase order; please issue an invoice and add postage search. has become less profitable because of shorter patent and handling.. terms, government encouragement of generic drugs, and higher Charge to: • Master Charge • VISA research costs. OTA did state that the full effects of government (Minimum charge, $25.00) Account # Expiration Date ^ regulation in these areas may not be apparent yet. Signature Other points OTA made in its report were: Checks must be drawn on a US bank. Name ^ • Patent-term extension would increase the attractiveness Institution ; • of research on drugs for large markets but not for small Street • . markets. City • • Increases in research activities would probably not begin State ZIP. until the 1990s when patent-term extension would first American Society of Hospital Pharmacists generate substantial additional revenues, of whiis^ 8-9% Publication and Membership Records would be spent on researchand development. 4630 Montgomery Avenue i Washington, D.C. 20014 Continued on page 1644
1642 American Journal of Hospital Pharmacy Vol 38 Nov 1981 ©te ¥i
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\ Continued from page 1642 INTRAVENOUS FAT EMULSION Liposyn^ 10% • Drug prices would be higher during the extension period DESCRIPTION Liposyn 10% (Intravenous Fat Emulsion) is a sterile, nonpyrogenic fat than they would have been without the extension, and el emulsion prepared for intravenous administration. Liposyn 10% contains 10% safflower derly and chronically ill patients would he affected more oil, 1.2% egg phosphatides and 2.5% glycerin in Water for Injection. Sodium hydroxide has been added to adjust the pH to approximately 8.0. than others. . The safflower oil is a mixture of neutral triglycerides of predominantly unsaturated • Patent-term extension,would prevent marketing of generic fatty acids. The fatty acids forming the major component of safflower oil are linoleic ' drugs in some cases. This would occur when the extension 177%), oleic 113%), palmitic (7%) and stearic acid (2.5%)^. Studies indicate that saf flower oil also contains approximately 0.1% linoienic acid. • reduced the market value of the drug remaining after the Liposyn 10% has an osmolarity of approximately 300 mOsmlliter and contains •patent had expired to a level too low to justify mar emulsified fat particles of approximately 0.4 micron in diameter, similar to naturally^ keting. occurring chylomicrons. The total caloric value of Liposyn 10% including fat, phospholipid and glycerol is 1.1 kcal/ml. Of this total, approx. 0.7 kcal/ml is supplied by linoleic acid. Hospital Pharmacy Now Regulated In Texas INDICATIONS Liposyn 10% is indicated as a source of calories for patients requiring parenteral nutrition. Where such nutrition is required for extended periods of time (more Texas hospital pharmacies are now regulated by that state's Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 than 5 days), Liposyn 10% is also indicated as a source of essential fatty acids to hpard of pharmacy as a result of the new Texas Pharmacy prevent biochemical changes in fatty acid composition of plasma lipids {elevated trieneltetraene ratio) and the clinical manifestations of EFAD. Practice Act, which became effective September 1. The Act CONTRAINDICATIONS The administration of Liposyn 10% is contraindicated in replaces the previous Texas Pharmacy Act, which expired under patients demonstrating disturbances in normal fat metabolism. such as pathologic the provisions of the state's "sunset" law. hyperlipemia, lipoid nephrosis or acute pancreatitis if accompanied by hyperlipemia. . The- new legislation recognizes four classes of pharmacy This stable emulsion should not be mixed with electrolytes, nutrients or other additive solutions. However, heparin has been shown to be stable when added to the emulsion at permits: community, nuclear, institutional, and clinical phar a concentration of 1 to 2 units per ml. Filters should not be used for administration of macy. The clinical'pharmacy permit is designed to allow closer the emulsion. .r interactions with clinics, such as ones for family planning, ve Liposyn L0% is supplied in single-dose containers. Partially used bottles must be discarded and should not be stored or resterilized for later use. Do not administer the nereal disease, or tuberculosis, and a committee of pharmacists contents of any container in which the emulsion appears to be oiling out. and nurses has been named to make recommendations to the WARNINGS hoard fpr this area of practice. Deaths in preterm infants after infusion of intravenous fat emulsions have been The Act gives the hoard authority to establish rules for using reported in thFmedical literature.''' Autopsy findings included intravascular supportive personnel in institutional pharmacies hut not to set fat accumulation in the lungs. Treatment of premature and low birth jyeight ratios. The law defines supportive personnel as "those indi infants with intravenous fet emulsion must be based upon careful benefit-risk viduals utilized in pharmacies whose responsibility it shall be assessment. Strict adherence to the recommended total daily -dose^is man datory; hourly infusion rate should be as slow as possible in each case and to provide nonjudgmental technical services concerned with the should not in any case exceed 1 glkg in four hours. Premature and small for preparation and distribution of drugs under the direct super gestational age infants have poor clearance of intravenous fat emulsion and vision of and .responsible to a pharmacist." increased free fatty acid plasma levels following fat emulsion infusion; therefore, serious consideration must be given to administration of less than Two consumer members and one pharmacist will-he added the maximum recommended doses in these patients in. order to decrease the to the state hoard, increasing the number of members from six likelihood of intravenous fat overload. The infant's ability to eliminate infused to nine. The executive director of the hoard is required to he a fat from the circulation must be carefully monitored (such as triglyceride.andfor plasma free fatty acid levels). The lipemia must clear between daily infusions. pharmacist. , The.Texas Society of Hospjtal Pharmacists was actively in Caution should be exercised in administering Liposyn 10% to patients with severe liver volved in representing institutional pharmacy's needs in the damage, pulmonary disease, anemia or blood coagulation disorders or when there is danger of fat embolism. Texas legislature, as reported in last month's ASH? Affiliates column. PRECAUTIONS Because free fatty acids displace bilirubin bound to albumin'the use of lipid infusions in jaundiced or premature infants should be undertaken with caution. During Liposyn 10% therapy, the patient's hemogram, blood coagulation, liver USP Aiding. Pharmacists In Promoting Patient-Education function, platelet count and plasma lipid profile must be closely monitored. The lipemia Programs must clear between daily infusions. Liposyn 10% should be discontinued should a significant abnormality in any- one of' The U.S. Pharmacopeial Convention is following its national these parameters be attributed to the therapy. ADVERSE REACTIONS Sepsis due to contamination of administration equipment and . promotion of patient-education programs with emphasis on thrombophlebitis due to vein Irritation from concurrently administered hypertonic local promotion by individual pharmacists. Speech materials, solutions have been encountered. These are attributable 101.V. therapy in general or to handouts, posters, ad mats, and promotional guidelines have the type of infusion administered. - been prepared hy USP for use by pharmacists in promoting Adverse reactions directly related to fat emulsions are of two types': (1) immediate (acute) and (2) long-term (chronic). In studies of lipid products in general, the following consumer education about medicine on a local basis. immediate reactions have been noted: Allergic reactions, hyperlipemia, dyspnea, Each pharmacy purchaser of USP Dispensing Information cyanosis, flushing, dizziness, headache, sleepiness, nausea, vomiting, hyperthermia, or About Your Medicines, USP's drug-use information refer sweating, chest and back pain, thrombocytopenia (rarely in neonates), hypercoagulability and transient increases in liver enzymes. ences, receives a promotional packet. A speech series on patient The following reactions have been noted with long-term therapy with lipid infusions in education is appropriate for presentation to local schools, general: Hepatomegaly, jaundice due to central lobular cholestasis, splenomegaly, nursing homes, and community groups. Leaflets on the general thrombocytopenia, leucopenia, transient increases in liver function tests, overloading syndrome and the deposition of brown pigment ("fat pigment") in the reticuloendothelial use of medicines are available for-use in conjunction with tissue of the liver. The significance of this last occurrence and its cause are unknown. speeches. Sample press releases, merchandising suggestions, and HOW SUPPLIED Liposyn 10% (List No. 4335) is supplied in 500 ml, 200 ml, 100 ml ads fpr USP's publications complete the package. While most and 50 ml single-dose containers. of the promotional packet is tied in closely with promoting Protect from freezing. Do not store above 30° C (86° F). USP's products, the speech series is useful.for general PR ac , References . < ' 1. Levene M, Wigglesworth J, Desai R. Pulmonary fat accumulal'^n after Intralipidinfusion In the preterminfant. tivities. fa/7cer//.-81S-618,(Oct. 18)1980. 2. Dahms 6, Halpin T. Pulmonary arterial lipid deposit in newborn infants receiving intravenous lipid Infusion. For more information, contact USP Drug Information Divi- J. Pediatrics 97:800-805.(Nov.) 1980. sion,,12601 Twinhrook Parkway, Rockville, MD 20852. Caution: Federal (USA) law prohibits dispensing without prescription. C'AUioll 06-3065-R6-5I81 Printed in USA Continued on page 1647
1644 American Journal of Hospital Pharmacy' Vol 38 Nov 1981 Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021
[JCnCOelCOfiTAinS 400r.2llDOCAin£ . !rn)-CCHlOHlDE USP SSOEITSOSE HYOROliS disp /iFpitox pH5,o pH ADJUSTED nmi HYDHOXtOE ' :'-fTC:i::iaTt UllllOS^^OLS PER LITER 232 •i3 r:0TaDD SUFPIEUEHTARY tlEDlCATIOrj ^l^osflGE fls DIRECTED GY A PHYSICIATI J:KJW: .. this, critical eare product is arable premised ia -5"1-JISTER nTRAVlKOUSLY USIRS STERILE convement, spike-aird-liangVdiFLESC Plastic Containers. j^^TT SEC ACCOyPAHYIfiG DiRECTiO.'lS Choose from two ready-to-use concentrations offering these FEDERAL (USA) LAa PP0H121TS riiSf. ? PRESCRiPTiorj ugsinOT impcsriant advantages: , SERIES COnnECTlOJiS 00 ROT ^^-IRlSTEfl SlLlULTAr-iEOUSlT WITH CICCO • Save valuable time in emergency situations cccras ^ '"'fusion if aovESSE CAcnon u EHminate possibility of dosage eiror in compounding n Reduce potential contBirunation by eliminating entry into delivery system 3 Avoid risk of accidental bolus administration inherent with floor stocked 1-2 gram additive .syringes n Twp-year ejcpiration dating
Lidccaine Gat. No. HCl Size 2B0973 0.4% Lidocaine HQ and 596 Dextrose 2.0 g 500 ml 2B0974 0.4% Lidocaine HQ and 596 Dextrose 4.0 g 1000 ml 2B0993 0.296 Lidocaine HQ and 596 Dextrose 1.0 g 500 ml 2B0994 0.296 Ddocaine HQ and 596 Dextrose 2.0 g 1000 ml
] Di n Nonair-dependent administration system helps eliminate potential aiibome contamination • Lightweight, compact containeis are easy to work'with, easy to store • Shatterproof plastic protects patients and staff firom accidental brealcage Lidocaine Hydrochloride end 5% Dextrose injection in VIAFLEX'Plastic Container
Description. lidocaine hydrochloride in patients with severe liver or can be gtven at a rate of 15 to 60 ml/hr (0.25 to 1ml/min). Lidocaine Hydrochlorideand 5%Dextrose Injection is renal disease because accumulatiorl may occur and Precise dose is determined by patient response. a sterile, nonpyrogenic solution prepared from lidocaine lead to toxic phenomena, since lidocaine hydrochloride hydrochloride and dextrose in water for injection. is metabolized mainly inlheliver and excreted by the "Pharmacokinetic data fndicatereduced eliminationof lidocaine after prolonged infusion(24 hours) with Lidocaine hydrochloride is designated chemically as - ^ • kidneys. The drug should also be used withcaution in resultant prolopgation of the half-life to approximately 2-(Diethylamino)-2:6'-acetoxylidide monohydro- patients with hypovolemia and shock, andin all forms three times that seen following a single administration. chloride. The sfllution serves as a cardiac antiarrhyth of heart block (see Contraindications and Warnings). mic agent intended for intravenous use. The pH range Failure toadjust the rate of infusion in keeping with ttiis In patients with sinus bradycardia or incomplete heart is 3.5 to 6.0. The pH is adjusted with sodium hydroxide. altered ability tq eliminate lidocaine may result in toxic block, the administration of lidocaine hydrochloride accumulation of thedrug inthe patient's serum." intravenously for the'eiiminatidn of ventricular ectopic Intravenous infusions of lidocaine hydrochloride must ^CH. CHjOH beats without prior acceleration in heart rate (e.g., by be administeredunder constant ECG monitoring to isoproterenol or by electric pacing) may promote more NHCOCH,NlC,Hj),HCL lA—• avoid potential.overdosage andtoxicity. Intravenous frequent and serious ventricular arrhythmias or infusion Should be terminated as soon as the patient's '^CH. complete heart block (see Contraindications). • H OH basic cardiac rhythm appears to be stable or at the ' , Care should betaken in the administration of intra earliest signs of toxicity It should rarely be necessary UDOCAINEHCL venous fluids in patients with compromised myocardial to continue intravenous infusions beyond 24 hours. As function to avoid fluid overload or disturbances of • soon as possible and when indicated,patients should Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 The VIAFLEX Plastic Container is fabricated from a serum electrolyte concentrations which might interfere be changed to anoral antiarrhythmic agent for specially formulated polyvinyl chloride (PL146® plastic). with cardiac conduction or result in congestive heart maintenance therapy. , failure. Water can permeate from inside the container into the CAUTION: When administering lidocaine hydrochloride overwrap in amounts insufficient to affect the solution Clinical evaluation and periodic laboratory deter- '. by continuous infusion, it is advisable to closely monitor significantly. Solutions in contact with the plastic minations are necessary to monitor changes in fluid the infusion rate. container can leach out certain of its chemical balance, electrol^e concentrations; and acid-base components in very small amounts within ttie expiration isalance duringprolonged parenteral therapy or • USAGE IN CHILDREN: Dosagerequirements for patients period, e.g., di 2-ethyihexyl phthalate (DEHP),up to 5 whenever the condition of the patient warrants such 12 years of age and under have not been established. parts per million. However, the safety of the plastic has evaluation. Lidocaine hydrochloride should.not be added to blood been confirmed in tests in animals according to LISP transfusion assemblies: biological standards for plastic containers as well as by Pregnancy: Teratogenic Effects. tissue culture toxicity studies. Pregnancy Category C. Animal reproduclion studies All injections in VIAFLEX Plastic Containers are intended for intravenous administration using sterile equipment Clinical Pharmacology have not been conductedwith Liddcaine Hydrochloride and 5% Dextrose Injection, it is also not known whether It is recommended that the intravenous administration Lidocaine hydrochloride exerts an antiarrhythmic effect apparatus be replaced at least once every 24 hours. by increasingthe electric stimulation threshold of the Lidocaine Hydrochloride antJ 5% Dextrose Injection can ventricle during diastole. In usual therapeutic doses, cause fetal harm when administered to a pregnant (Ret. LeLorier, et at.Pharmacokinetics of lidocaine after lidocaihe hydrochloride produces no change in woman or can affect reproduction capacity. Lidocaine prolonged Intravenous infusions in uncomplicated, myocardial contractility, in systemic arterial pressure, Hydrochloride and 5% Dextrose Injection should be myocardial infarction, Ann. Int. Med. 87:700-702.) or in absolute refractory period. given toa pregnant woman only if clearly needed. How Supplied About 90% of an administered dose of the drug is Adverse Reactrons Lidocaine Hydrochloride and 5% Dextrose Injection is metabolized in the liver.The remaining10% is excreted , Systemic reactions of the following types have been supplied inVIAFLEX Plastic Containers, 12 units per unchanged via the kidneys. reported: carton, in the followirig sizes and concentrations: This solution provides approximately 170 calories 1. Central Nervous System:Light-headedness; . 500 ml units 1000 ml units per liter. drowsiness; dizziness; apprehension; euphoria; 0.1% Lidocaine ' 2B0983 2B0984 tinnitus; blurred or double vision; vomiting; sensation . Hydrochloride and Indications and Usage of heat, cold or humbness; twitching; tremors; 5% Dextrose Lidocaine hydrochloride administered intravenouslyIs •convulsions; unconsciousness; respiratory Injection • NDC 0338-0405-03 0338-0405-04 specifically indicatedin the acute management of depression and arrest. (1) ventricular arrhythmias occuring during cardiac 0.2%i;idocaine ' 2B0993 - 2B0994 manipulations, such as cardiac surgery and (2) life- 2. Cardiovascular System;Hypotension; cardiovascular Hydrochloride and threatening arrhythmias which are ventricular in origin, arrest; and bradycardia which may lead to cardiac 5% Dextrose such as occur during acute myocardial infarction. . arrest. . Injection NDC 0338-0407-03 0338-0407-04 USAGE IN CHILDREN: 3. Allergic reactions may occur but are infrequent. There 0.4% Lidocaihe 2B0973 2B0974 Dosage requirements for patients 12 years of age and have been no reports of cross-sensitivity between Hydrochloride and under have not been established. lidocaine hydrochloride and procainamide or 5% Dextrose between lidocaine hydrochlorirJe and quinidine. Injection NDC 0338-0409-03 0338-0409-04 Contraindications Lidocaine hydrochloride is contraindicated in patients Ivlanagement of Adverse Reactions 0.1% LidocaineHydrochloride solution provides 1mg with a khowh history of hypersensitivity to local 1. In the case of severe reaction, discontinuethe use lidocaine hydrochloride per ml. of the drug. anesthetics of the amide type. Lidocaine should not 0.2% Lidocaine Hydrochloride solution provides 2 mg be used in patients with Stokes-Adams syndrome, 2. Institute emergency resuscitative procedures and of lidocaine hydrochloride per ml. Wolff-Parkinson-White syndrome, or with severe administer the emergency drugs necessary to , degrees of sinoatrial, atrioventricular, or intraventricular 0.4% LidocaineHydrochloride soliitidnprovides 4 mg manage the severe reaction. For severe convulsions, of lidocaine hydrochloride per ml. block. Do not administer unless the solution is clear small increments of diazepam or an ultrashort-acting. and the seal is intact. barbiturate (thiopental or thiamyial) or if those are Do not remove unit from overwrap until ready for use. Warnings hot available, a short-acting barbiturate (pentobar The overwrap is a moisture barrier. The inner bag Constant monitoring with an electrocardiograph is bital or secobarbital); or if the patient is under maintains the sterility of the product.After removihg essential to the proper administration of lidocaine anesthesia, a short-actihg muscle relaxant (succinyi- overwrap, check for mihute leaks by squeezing inner hydrochloride ihtravenously. Signs of excessive depres choline) may be given intravenously. Muscle relaxants bag firmly. If leaks are found, discard solution as sterility sion of cardiac conductivity, such as prolohgatioh and intravenous medications should only be used may be impaired. Do not store above 40° C (104°F). of the PR interval, widening of the QRS.ihtervai and by those familiar withtheir use. Patency of the Directions for Use of VIAFLEX Rasfic Container the appearance or aggravation of arrhythmias, should • airway and adequacy of ventilation must beassured. WARNING: Do not use plastic containers in series be followed by prompt cessation of the intravenous 3. Should circulatory depression occur, vasopressors connections. Such use could result in air embolism due infusion of this agent.It is mandatory to have emergency may be used. to residual air (approximately 15 ml) being drawn from resuscitative equipment and drugs immediately Dosage and Administration the pripiary container before administration of the fluid available to manage adverse reactions involving from the secondary containeris completed. cardiovascular, respiratory, or central nervous systems. Therapy of ventricular arrhythmias is often initiated with a single iV bolus of 50-100 mg of lidocaine hydro To Open Occasional acceleration of ventricular rate may occur chloride injection.Following acute treatment by bolus Tear overwrap down side at slit and remove solution when lidocaine hydrochloride is administered to in patients in whom arrhythmias tend to recur and who container. DO NOT ADD SUPPLEMENTARY patients with atrial fibrillation. Evidence for proper are incapable of receiving oral antiarrhythmic agents, ' MEDICATION. usage inchildren is limited. intravenous infusion of Lidocaine Hydrochloride and Preparation of Administration Because dosages of this drugare titrated to response 5% Dextrose Injection is administered cohtinuously at 1, Suspend contalnerfrom eyelet support. (see Dosage and Administration), NO ADDITIVES the rate of 1 to 4 mg/min (20to 50 mcg/kg/min inthe SHOULD BE IVIADE TO LIDOCAINE HYDROCHLORIDE .average 70 kg adult). The 0.1% solution (1mg/ml) can be 2. Remove plastic protector from outlet port at bottom AND 5% DEXTROSE INJECTIONS. given at a rate of 60 to 240 mi/hr (1 to 4 ml/min). The of container. 0.2% solution (2 mg/mi) can be given at a rate of 30to 3, Attach administration set Refer to complete Precautions 120 ml/hr (0.5 to 2 ml/min). The 0.4% solution (4 mg/mi) Caution shouldbe employed in the repeated use of • directions accompanying set.
The system with options 8-19-12-262 iy\RENTERAL PRODUCTS DMSION TRAVErvO. LABORATORIES.INC. TRAVENOL DEERFeiDiLrKJors MXJS Continued from page 1644 macy, University of Colorado, Denver. Lenox Hill Hospital, New York, NY, has made the following New Edition of USAN Avaiiable appointments to its staff: Bruce J. Kimelblatt, PhamtD., has been appointed Assistant Director, Pharmacy Services; Janis A new, fully cumulative edition of USAN and the USP Dic^ M. Kucich has been appointed Senior Clinical Pharmacist; and tionary of Drug Names is now available from the U.S. Phar- Debra A. Wible, Pharm.D., has been appointed Clinical macopeial Convention. The edition includes all U.S. Adopted Pharmacist. Names (USAN) released from June 15,1961, when the USAN Michael G. Carvalho, Pharm.D., has been appointed As program began, until June 15,1981. sistant Professor of Clinical Pharmacy, Massachusetts College Molecular weights for most compounds were added to the of Pharmacy and Allied Health Sciences, Hampden Campus, 1982 edition. Also, more international nonproprietary names Springfield, and Clinical Coordinator, Holyoke Hospital, Hol- are included than in previous editions. yoke, MA. Orders for the 1982 USAN, which is $25 per copy, should he George P. Provost has been named Manager, Information sent to USAN Division, USP Convention, Inc., 12601 Twinhrook Systems, and Senior Pharmacist, Editorial Services, United Parkway, Rockville, MB 20852. States Pharmacopeial Convention, Inc., Rockville, MD. Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021
Appointments and Promotions Meetings and Continuing Education Programs Terry Trudeau, M.B.A., has been appointed Associate Clinical Aspects of Drug Development Workshop ... Professor, Department of Pharmacy Practice, College of sponsored by Drug Information Association... Williamsburg, Pharmacy, Howard University, Washington, DC. Previously, VA... December 6 to 9... contact DIA, P.O. Box 113, Maple Trudeau was Director of Pharmacy Services, Brokaw Hospital, Glen, PA 19002. Normal, IL. He continues as editor of Topics in Hospital American Society of Nutritional Support Services ... Pharmacy Management. First Annual Meeting ... San Francisco ... February 1 ... Henry J. Derewicz has been appointed Vice-President contact: Annette Whitney, R.N., ASNSS, 340 Boulevard, N.E.', Professional Services, Good Samaritan Medical Center, Mil Suite 102, Atlanta, GA 30312; 404-525-8299. waukee, WI.. • 17th Annual San Francisco Cancer Symposium ... Thomas C. Hardin, Pharm.D., has been appointed Clinical sponsored by West Coast Cancer Foundation... San Francisco Coordinator, Pharmacy Services, Audie Murphy VA Hospital, ... February 27 and 28 ... contact: West Coast Cancer Foun- and Cliriical Assistant Professor, College of Pharmacy, Uni versity of Texas Health Scien9es Center, San Antonio, TX. Previously, Hardin was Assistant Professor, College of Phar Continued on page 1650
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Vol 38 • Nov 1981 American Journal of Hospital Pharmacy 1847 An important, emerging medical concept in the control of chronic physical pain, never
PRN Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021
Increasing cocaine in.tfie mixture. Subsequent evalua COMMON SIDE EFFECTS OF attention Is tion, however, demonstratecTthat narcotics NARCOTIC ANALGESICS focusing on alone are the effective analgesics in Brompton • Constipation is a common side effect of the quality of life in type narcotic/cocaine cocldaiis and produce narcotic analgesics and measures should patients with terminal fewer side effects than the combination.'' ^' be taken to prevent the problem from illnesses. As a result, a new philosophy of As a result, the cocaine component has been occurring. Ample intake of water or other treating chronic pain is emerging. One dropped from their formulations. liquids should be encouraged. of its basic concepts is Regular Scheduling Effectiveness of Oral Concommitant administration of a stool of Analgesics...never administering softener and a peristaltic stimulant with analgesics PRN.' Administration the narcotic analgesic can be an effective ACETAMINOPHEN TO And, yet another myth... "Narcotics' preventive measure for those patients in require parenteral administration" need of therapeutics, if elimination does not MORPHINE OR METHADONE- ... "Morphine is commonly believed to be occur for two days, an enema sliouid be BCT NEVER PRN a poor drug for oral use. This is untrue. administered to prevent impaction. The key to relief of chronic agonizing Although Morphine is only about tw/o- in the event diarrhea occurs, seepage pain in terminally ill patients is prevention thirds absorbed following oral adminis- ' around a fecal impaction is a possible cause of onset. tration, this effect may be obviated by to consider before antidiarrheai measures Chronic pain in the terminally i|l patient adjusting the dose. are employed. should be controlled with scheduled admin ... "Oral doses are as effective as parenteral Nausea and vomiting are common istration of the mildest analgesic that will doses in maintaining drug levels in the among patients with advanced terminal maintain a tolerable pain level. body. Furthermore, parenteral administra disease and as a side effect of heavy doses "The right dose of any analgesic is that tion creates a feeling of patient dependence of narcotic analgesics. Phenothiazines and which gives adequate relief for at least on others for administration of the drugs. antihistamines can be effective treatments three and preferably four or more hours." ^ Parenteral administration may also for nausea of the medullary-and vestibular intimate that heroic measures are being in many patients, aspirin or sources respectively. However, these drugs undert&ken."® acetaminophen, alone or in corhbination may potentiate the side effects of the with codeine or oxycodone, will suffice.Most .-.."Methadone is well absorbed after oral narcotics or the antinauseant ' patients not adequately relieved of pain with administration." Sedation is another common side effect these drugs can achieve tolerable pain levels Successful results with oral morphine , of narcotic analgesics. Once pain control or a pain free state with morphine or and methadone have been well documented • is achieved, undesirable sedation can be rhethadone. by thpse working in hospice care. Mahy minimized by titrating-the dosage to a level patienfe can be adequately controlled on that just maintains a tolerable pain or pain NARCOTICS MYTHS an oral morphine regimen of 20mg or less free state. - Addiction every four to six hours or oral methadone The stigma of morphine and methadone of 15mg or less every six to eight hours. FOOTNOTES as addictive drugs is unfortunate since it However, in some instances, larger doses 1. Report to the White House, TheInteragency prevents the proper, ethical treatment of are required. Committee on New therapies for Pain and pain in many terminally ill patients. The DOSAGE REDUCTION Discomfort, May 1979, U.S. DepL of Health, chance of drug dependence is substantially Education and Welfare, Public Heaith Service, reduced when the patient is placed on During the first two or three.days of National Institutes of Health.' effective pain relief, the patient may sleep scheduled narcotic programs instead of a 2. Twycross RQ, Relief of Pain In: Saunders CM, ed. "pain to reiief-of-pain" cycle typical of a PRN for many hours. This can.be misinterpreted as the effect of excessive analgesic dosing The Management of Terminal Disease,Volume regimen. Although drug dependence can 1. London: Edward AmoldLtd; 1978. occur in some patients, the benefit of paih rather than the first sign of relief in a pain relief probably outweighs the risk. exhausted patient. The dose, therefore, 3. Report to the White House, The Interagency should be maintained for at least three days Committee on New Therapies for Pain and "Addiction to narcotics is not a problem Discomfort, May 1979, U.S. DepL of Health, in the terminally iii."^ before reduction, if,respiratory activity and other vital signs are adequate. Education andWelfare, Public Health Service, Effectiveness and Tolerance Following successful relief of severe pain, National Institutes of Health. Without Cocaine periodic attempts to reduce the narcotic dose 4. Melzack R,Mount BM, Gordon JM, The Another myth is that morphine or " should be made. Smaller doses or complete Brompton Mixture VersusMorphine Solution methadone with cocaine (associated with discpntinuation of the narcotic analgesic Given Orally: Effects onPain. CMAJoumal. the Brompton Cocktail) is more effective may become feasible due to a physiologic 1979; 120 (Feb. 17): 435-8. than the narcotic alone. True, the pioneering change or the improved mental state of 5. Twycross RG, Relief of Rain In:Saunders CM, ed. hospice work with narcotics didinclude the patient The Management of Terminal Disease, Volume 1. London: Edward AmoldLtd; 1978. 6. Lipman AG, Drug Therapy in Cancer Pain. Cancer Nursing. 1980; Volume 2 (Feb.): 39-46. 7. Morgan JP, Penovich P, Methadone: Still an Analgesic. Drug Therapy (Hosp) Jan. 1977. To control chronic agonizing pain in the terminally ill... Morphine Sulfate Oral Solution 20mg/5ml and 10mg/5ml Methadone Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Oral Solution Analgesic Potency Oral Solutiom.. Img/lml INDtCAllOM AND USAGE The Preferred Eforrn Methadone Hydrochloride Ora!Solution is indicated for the relief of severe pain. • for better titration to the patient's needs CONTKA INDICATIONS liypersensilivity to methadone. • for ease with which the medication can be taken VMRNINOS The dosage required to achieve adequate analgesia is a Metha
• \ 919 Continued from page 1647 Salivarf dation, 50 Francisco Street, Suite 200, San Francisco, CA 94133; SYNTHETIC SALIVA 415-,981-4590. ASHP National Institute... Las Vegas.. . March 21 to 27 The first truly .., contact: ASHP, 4630 Montgomery Avenue, Bethesda, MD 20814; 301-657-3000. effective synthetic New England Council of Hospital Pharmacists ... 1982 Spring Symposium ... Hartford, CT ... May 25 and 26 ... saliva for the contact: Gregory Gousse, Department of Pharmacy Services, Hartford Hospital, Hartford, CT; 203-524-3011. treatment of 39th ASHP Annual Meeting ... Baltimore, MD ... June 6 to 10,.. contact: ASHP, 4600 Montgomery Avenue, Bethesda,. xerostomia and MD 20814; 301-657-3000. Drug Information Association .*.. 18th Annual Meeting Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 hyposaiivation. ... Kansas City, MO... June 13 to 16... Call for papers... for Clinically proven information on how to submit a paper, contact: Paul E. Groth, Studies show that SALIVART relieves Program Chairman, Micromedex, Inc., 2750 South Shoshone dry mouth quickly, regardless of the Street, Englewobd, CO 80110; 800-525-9083. cause, because SALIVART has vir- , ASHP National Institute... Cleveland, OH... August 15 tually all the physical and chemical • to 21... contact: ASHP, 4630 Montgomery Avenue, Bethesda, properties of natural saliva. MD 20814; 301-657-3000. Highly effective 13th International Cancer Congress ... Seattle, WA... An average 1-seccnd spray applica September 8 to 15... contact: Congress Operations Office, 13th tion will help keep the mouth moist and International Cancer Congress, Fourth and Blanchard Building, refreshed. SALIVART Is distributed Suite 1800, Seattle, WA 98121. rapidly and evenly throughout the oral 17th Annual ASHP Midyear Clinical Meeting ... Los cavity. Angeles ... December 5 to 9, 1982 ... contact: ASHP, 4630 Montgomery Avenue, Bethesda, MD 20814; 301-657-3000. Salwart...the "natural", way to relieve dry mouth. News Briefs • The National Association.of Boards of Pharmacy has named the following to its Committee on Institutional Phar macy: Marjorie Fleming (AZ), Chairman, Thomas Campbell (DL), Carl Lyons (OK), Joseph Elmes (KY), Carolyn Wilson (TN), and Arthur Zoloth (WA). • The Drug Information Association's new officers Were installed at its annual meeting in Boston recently. The new slate is: Judith K. Jones of the Food and Drug Administration, president; Robert V. Cuddihy of Sandoz, president-elect; Howard S. Corey, Jr., of Lederle Labo.ratpries, past president; R. Michael Crocco of American Hoechst, vice president; Barbara C. Shappy of E. R. Squibb & Sons, secretary; and Amy M. Levine of USV Pharmaceuticals, treasurer. • B. Jane Gillespie of Toronto has been named editor of the • Canadian Journal of Hospital Pharmacy, effective January 1, 198,2. Gillespie is director of pharmacy at the Hospital for Sick Children in Toronto. Named as assistant editors were Sister Frances Sauve, a consultant pharmacist at Toronto's St. Jo seph's Health Centre, and Isabel Stauffer, archivist-historian : " Available In 50 ml pocket-size pres- sure cans. For product Information, of the Canadian Society of Hospital Pharmacists. The changes J t fill out and return the form below. were necessitated by a move in Journal operations from Sas iSaliyan'' katoon, where Professor Jack L. Summers is editor currently, to CSHP headquarters in Toronto. Name (please print) • The second edition of FDA's Approved Prescription Address Drug Products with Therapeutic Equivalence Evaluations is available from the Superintendent of Documents, U.S. Gov City State Zip ernment Printing Office, Washington, DC 20402. The cost is $45 per year, which includes monthly cumulative supplements. Type of practice .Westport Pharmaceuticals Inc. • The American Hospital Association Guide to the RO. Box 816 Health Care Field, 1981 edition, is now available from AHA, Westport, CT 06881 Continued on page 1653
1650 American Journal of Hospital Pharmacy Vol 38 Nov 1981 From Bristo Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021
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m n Mexatf i B'3ooS 100 mg convenitint size A/EXATE Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Continued from page 1650 of Medicine and Howard University College of Pharmacy and Pharmacal Sciences, under a contract from the Health Re sources Administration. 840 North Lake Shore Drive, Chicago, EL, 60611. The cost is $44 for AHA institutional and personal memhers and $55 prepaid • Ronnie Chandler of Roxboro, NC, is the first person in for nonmembers. 20 years to pass that state's pharmacy-licensure examination withqut having attended pharmacy school. North Carolina • Results of a "Survey of Disposal of Low-Level Radio permits nongraduates who have at least two years of college and active Waste from Major Medical Product Manufactur 15 years experience in a pharmacy under direct supervision of ers—1979" is available at no cost from Jaii Donelson, Phar a registered pharmacist to become licensed upon passing the maceutical Manufacturers Association, 1155 15th Street, N.W., board examinations. Washington, DC 20005. • Sister M. Gonzales Duffy, director of pharmacy at • Up to three copies of a booklet entitled, "Coping with Pittsburgh's Mercy Hospital from 1948 until 1980, and past Cancer—A Resource for the Health Professional," are ASHP president, was honored at a luncheon held at Mercy on Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 available at no cost from the Office of Cancer Communications, August 7. The administration, medical staff, and hoard of National Cancer Institute, Building 31, Room 10A18, Bethesda, trustees of Mercy presented Gonzales with a plaque recognizing MD, 20205. When requesting copies, ask for NIH publication her achievements and contributions to the hospital. The plaque number 80-2080, and describe how the booklet(s) will be will be hung in the pharmacy area. used. • • Leonard Scara, director of pharmacy at Riverside General • The National Hospice Organization has received a Hospital in Secaucus, has been appointed to the New Jersey three-year, $611,700 grant from the W. H. Kellogg Foundation. State Board of Pharmacy. The grant will be used to educate, inform, and encourage idea- sharing among persons developing and operating hospices and • Kenneth T. Chang and Linda Hogan, M.S., of the Uni among a variety of health professionals. versity of Kansas Medical Center, received the Donald E. Francke Award from the Drug Information Association for their •. A series of papers on "Pharmacist Roles in Disease article, "Analysis of Drug Information Needs in a 550-Bed Prevention and Health Promotion" will be compiled by University Hospital." The article was published in the Drug Patricia J. Bush, Ph.D., of the Georgetown University School Information Journal in October/December 1980.
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Vol 38 Nov 1981 American Journal of Hospital Pharmacy 1653 OMEQREOT COIXECnOTi Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021
rrom the collrciion of Nr. and Mrs. Lester BanwU-nnc of the larq Parke-Davis generic and brand name Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Abdec® Fen-ous Sulfate pharmaceuticais for almost every C ID Acetaminophen msQor therapeutic category. The line with Codeine Phosphate Hydrochlorothiazide includes parenterals, liquid orals, TabletsMos.2&3 Mandelamine® and, as follows,' a broad selection of Amcill® (ampicillin (methenamine mandelate) solid oral products. This tremendous capsules, USP) as the variety makes Ulil/USE a rnajor trihydrate Myadec® source for your unit dose needs. Amoxicillin Pavabid® (papaverine HCI), Aspirin Marion Laboratories Aspirin, Phenacetin, Penicillin V Potassium UMCOMPROMISIMG QUALITY. Caffeine Compound Peritrate® Parke-Davis quality distinguishes (A-P-C) (pentaerythritol both products and packaging in the C ID Aspirin Compound with tetranitrate) Um/USE line. Ourfoil-on-piastic Codeine Phosphate Mo. 5 . CIV Phenobarbital blister packs are moisture resistant. Tablets Pyridium® The aluminum dispensing containers Benadryl® (diphenhy (phenazopyridine HCI) that we use for liquid oral products dramine HCI) Quinidine Sulfate are easy to open yet leak resistant. CIV Chlordiazepoxide HCI And the advanced Steri-Dose ® Chlorprbmazine HCI Tabron® Syringe is used for many of our Tedral® Dilantin® (phenytoin parenteral products. The F^rke-Davis sodium capsules, USP) TedralSA name on all Ulil/USE packages is Dilantin Infatabs® ypur assurance of product quality Dilantin with Phenobarbi- tal PERSOMAL SERVICE.Ulil/USE D-S-S (dioctyl sodium products come With the continuing sulfosuccinate, USP) personal service of the Parke-Davis D-S-S Plus (dioctyl representative, who can help you sodium sulfosucci with your unit dose needs, tie or she nate with casan- can explain our reasonable pricing thranol capsules) policies and see that your questions are promptly answered. It's this kind. of concerned service thatsetsthe Parke-Davis Ulil/USE Une apart from those of other unit dose suppliers. UMTTDOa; PHARMACEUTICALS FIOl B\RKE-DAVIS UMI/USE PARKE-DAVIS DIv of Wamer-Lambert Co PD-JA-2724-l-P(r-80) Morris Plains, HI 07950 USA