A. Thomas Taylor

Acute Management of Cancer-Related Hypercalcemia

OBJECTIVE: TO review the pathogenesis and pharmacologic treatment of acute hypercalcemia associated with malignancy. DATA SOURCES: A MEDLINE search (1966 to 1995) of the English-language literature pertaining to acute hypercalcemia was performed. Additional literature was obtained from reference lists of articles identified through the search. STUDY SELECTION AND DATA EXTRACTION: All articles discussing the etiology and medical management of cancer-related acute hypercalcemia were considered in the review. Clinical trials reporting efficacy and safety of antihypercalcemic agents were also included. Information selected in the review was based on the discretion of the authors. DATA SYNTHESIS: Hypercalcemia is a life-threatening disorder associated with malignancy. It occurs in approximately 10–20% of patients with cancer. A variety of medications have been used in the management of hypercalcemia including bisphosphonates, calcitonin, furosemide, gallium nitrate, glucocorticoids, NaCl 0.9%, and plicamycin. Each of these agents has been reviewed with consideration of pharmacologic mechanism of action, evaluation of clinical trials, recommended dosages, efficacy, safety, cost, and role in treating cancer-related acute hypercalcemia. CONCLUSIONS: Immediate management of cancer-related acute hypercalcemia to prevent death and provide symptomatic relief is warranted. Severity determined by symptoms, calcium concentrations, and the overall status of the patient are important considerations in selecting appropriate therapy. Although the specific role of individual agents may vary, hydration remains the cornerstone of therapy. NaCl 0.9%, calcitonin, and Pamidronate disodium have established roles as dominant first-line agents for the management of acute hypercalcemia associated with malignancy.

The Expanding Role of Pharmacy and Therapeutics Committees

SummaryTraditionally, pharmacy and therapeutics (P&T) committees have been responsible for overseeing the drug use process, using formulary systems to control drug costs. Primarily, these committees act in an advisory capacity as policy-recommending bodies within healthcare systems, for the specific purpose of promoting rational drug therapy. Methodologies utilised by these committees include drug use evaluation, medical staff education, continuous quality improvement, formulary restriction and therapeutic interchange. Future roles of P&T committees will include the evaluation of clinical outcomes information, including quality-of-life issues, to establish policies governing the use of drugs at all levels and in all types of healthcare.

An Evaluation of a Medication History Method

The purpose of this study was to evaluate a drug history method. The method consisted of a review of systems (ROS) history format, which utilized common symptoms/diseases per organ system matched with corresponding drug treatments. Findings of this method were compared with drug histories documented in the medical record. The study was conducted over an eight-week period on general medicine inpatients and ICU patients. All data retrieved were categorized into total number of drugs found and then analyzed as to legend, non-legend, and unidentifiable content. Findings were statistically analyzed using chi–square. During the study, 207 patients were admitted. Of these patients, 186 drug histories were obtained; 21 patients could not be interviewed. The ROS method documented 406 drugs as compared with 60 drugs by the medical record (p < 0.001). Performance time was comparable to similar studies (14 ± 5.85 min). Using a concise, logically organized technique, more drugs were identified than reported by the medical record. We conclude that the experimental method is a productive method for obtaining a drug history.

Physician Acceptance of Clinical Pharmacy Service in a Skilled Nursing Home

A study was made of physician acceptance of pharmacist‐recommended changes in the drug therapy of elderly institutionalized patients. The records of 92 such patients were reviewed by the pharmacist. In 33 instances the pharmacist recommended changes in drug therapy. In 75.8 percent (25 of these 33 patients) the recommendations were judged appropriate and were accepted by the physician concerned.

A difficult monitoring situation: theophylline toxicity.

The author discusses the mishandling of drugs as one of the difficulties of monitoring serum theophylline levels, citing the case of a 68-year-old woman with long-standing chronic obstructive pulmonary disease, in whom the first three days of aminophylline therapy were prescribed and administered in a manner inconsistent with policy and procedure. The need for pharmacists to participate actively in clinical practice and patient care is stressed.

The Thorax and the Lungs

This article discusses physical examination of the thorax and lungs. Basic anatomy and physiology are described, as well as the principles of assessment techniques. To illustrate application of these principles, a case of asthma is described and discussed with emphasis on physical findings.

Physical Assessment of the Neck and its Related Structures

This article reviews the anatomy and physiology necessary to perform a physical assessment of the neck. Illustrations, a case report and a discussion of drug therapy for treatment of hyperthyroidism demonstrate the clinical pharmacy application of the material.