Kelly K. Nystrom

Patient satisfaction and costs associated with insulin administered by pen device or syringe during hospitalization.

PURPOSEnPatient satisfaction, safety and efficacy outcomes, and cost savings with insulin pens versus conventional insulin delivery via vials and syringes in hospitalized patients with diabetes were compared.nnnMETHODSnPatients were recruited from two general medical-surgical units from July 2005 to May 2006. Patients completed a survey regarding satisfaction with the method in which insulin was administered before discharge. Patients completed a telephone survey approximately four weeks after discharge to determine home insulin use. Cost savings were determined using the average wholesale price of insulin vials and syringes, pens, and pen needles.nnnRESULTSnA total of 94 patients were randomized to receive insulin administered via pen devices (n = 49) or using conventional vials and syringes (n = 45). Significantly more subjects in the pen group prepared or self-injected at least one dose of insulin during hospitalization, wanted to continue taking insulin at home using the method used during hospitalization, and would recommend their method of insulin administration used during hospitalization to other patients with diabetes compared with the vial and syringe group (p < 0.05). A cost saving of

Pazopanib for the treatment of metastatic renal cell carcinoma.

36 per patient was projected if only insulin pens were dispensed during the entire hospital stay compared to insulin vials and syringes (p < 0.05).nnnCONCLUSIONnIncreased patient satisfaction and continuation of the method of insulin administration used in the hospital at home were reported by patients who received insulin pens compared with patients who received conventional vials and syringes during hospitalization. A substantial cost saving was projected for patients in the insulin pen group if insulin pens had been dispensed during their entire hospital stay.

Oxycodone accumulation in a hemodialysis patient.

BACKGROUNDnRenal cell carcinoma (RCC) is the most common cancer in the kidneys. Until 2005, treatment options were limited to immunotherapy. Since that time, there have been numerous targeted therapy agents approved with improved efficacy toward RCC. Pazopanib is a multi-tyrosine kinase inhibitor that was approved by the US Food and Drug Administration in October 2009 and by the European Medicines Agency in June 2010 for the treatment of metastatic RCC.nnnOBJECTIVEnThe objective of this report was to review pazopanibs mechanism of action; pharmacologic, pharmacokinetic, and dynamic properties; potential drug interactions; and the results of clinical trials evaluating efficacy and tolerability associated with pazopanib for the treatment of RCC.nnnMETHODSnMEDLINE, International Pharmaceutical Abstracts, and Web of Science were searched for English-only clinical trials and therapeutic reviews (publication dates: 2000-January 1, 2012). Abstracts from the 2000 to 2011 meetings of the American Society of Clinical Oncology were searched for an updated safety profile and tolerability data of pazopanib in RCC. References from relevant articles were reviewed. Key search terms included pazopanib, Votrient, GW786034, renal cell carcinoma, adverse events, pharmacology, pharmacokinetic, and clinical trial.nnnRESULTSnTwo clinical trials met the inclusion criteria for the use of pazopanib in RCC (a Phase II and a Phase III trial). Pazopanib is an inhibitor of numerous tyrosine kinases, including vascular endothelial growth factor receptor and platelet-derived growth factor receptors. It is involved in inhibiting signaling pathways, angiogenesis, and cell proliferation. Pazopanib was approved by the US Food and Drug Administration and the European Medicines Agency at the dose of 800 mg daily. Peak concentrations are achieved within 2 to 4 hours of this dose with a mean t(½) of 35 hours. The pharmacokinetic properties of pazopanib are affected by food as well as by crushing the tablet. A 2-fold increase in AUC was seen when pazopanib was administered with a high-fat meal as well as when crushing the tablet. Thus, pazopanib should be administered on an empty stomach at least 1 hour before or 2 hours after a meal. Pazopanib is primarily metabolized by cytochrome P-450 3A4, and caution should be used with concomitant administration of cytochrome P-450 inducers and/or inhibitors. In a Phase III trial of pazopanib in metastatic RCC, pazopanib reportedly improved progression-free survival from a median of 4.2 to 9.2 months compared with placebo (P < 0.0001). The most common adverse effects of pazopanib were hypertension, hair depigmentation, diarrhea, nausea, anorexia, and vomiting. Many of the grade 3/4 toxicities were hepatic in nature, with elevations occurring in aspartate aminotransferase, alanine aminotransferase, and bilirubin.nnnCONCLUSIONSnPazopanib is reportedly effective in the treatment of metastatic RCC. Although there are currently no direct comparisons between pazopanib and other tyrosine kinase inhibitors, the data suggest that pazopanib may be a first-line option in the treatment of RCC. The only Phase III trial of pazopanib suggests improvement of progression-free survival in RCC as well as tolerability in the selected population.

Personal Digital Assistant (PDA) Clinical Intervention Documentation System: Development, Implementation, and Comparison to a Previous Paper-Based System

Oxycodone and oxycodone-containing analgesics are often used for the relief of pain. In the presence of renal dysfunction, the half-life of oxycodone and metabolites can be prolonged. We describe the case of a 41-year-old chronic hemodialysis patient who received multiple doses of oxycodone/acetaminophen resulting in accumulation of the medication and consequent lethargy, hypotension and respiratory depression. These adverse effects were reversed with multiple bolus doses of naloxone, followed by a continuous infusion administered for 45 hours. Utilizing the Naranjo probability scale, the patient had a “probable” adverse drug reaction to the oxycodone. Oxycodone should be used with caution in patients with chronic renal failure.

Nonchemotherapy drug-induced neutropenia and agranulocytosis: could medications be the culprit?

Purpose In preparation for the complete decentralization of pharmacists at our institution, we were asked to create a user-friendly intervention program the pharmacists could use on the patient floors. Summary The current system was cumbersome; the paper-based system made it hard to retrieve meaningful data and many interventions were not being captured. We felt that personal digital assistants (PDAs), with a tailored intervention program developed with Pendragon forms, would best meet our needs. A form was developed and modified based on the feedback of specific staff. After staff training, the program was implemented in June 2002. In an attempt to simplify the program, more forms were added and current forms were streamlined also based on staff feedback. The program is bridged with a Microsoft Access database and reports generated from this database provide essential information for administration to justify current positions, as well as, new positions. A literature search was performed and evaluated to determine our cost avoidance data (based on published cost avoidance associated with clinical pharmacy interventions). Institution-specific ingredient costs were used for cost savings data. Based on pre-PDA data, the number of interventions increased from an average of 112/mo to 361/mo (322% increase). An increase in the number of accepted interventions was also noted. The total cost savings and avoidance by pharmacists for the 21-month period assessed was

A Review of Clinical Pharmacy Interventions Prior to Implementation of a Personal Digital Assistant Intervention Program in a Community Hospital

1,827,286: intervention total cost savings and avoidance of

Gastrointestinal Bleeds Associated with Rofecoxib

1,580,593 and drug information cost avoidance of

An Oncology Pharmacy Practice Elective Course for Third-Year Pharmacy Students

246,693. Conclusion This program has increased the documentation of clinical pharmacy services at our institution, while reaping the additional benefit of transferring our total cost avoidance and savings into additional full-time equivalent positions.

Temozolomide-Induced Desquamative Skin Rash in a Patient with Metastatic Melanoma

Drug-induced agranulocytosis is a severe complication that has been implicated with most classes of medications. Medications such as clozapine, trimethoprim-sulfamethoxazole and methimazole have been more commonly associated with agranulocytosis than other agents. Although the pathogenesis isnt fully elucidated, it appears to be two-fold with a direct toxicity to the myeloid cell line and immune-mediated destruction. Patients may be asymptomatic at the time neutropenia is discovered or may present with more severe complications such as sepsis. In approximately 5% of cases drug-induced agranulocytosis may be fatal. Management of drug-induced agranulocytosis includes the immediate discontinuation of the offending medication, initiation of broad-spectrum antibiotics and consideration of the use of granulocyte colony-stimulating factors in high-risk patients.

Fatal hepatic and renal toxicity as a complication of trabectedin therapy for radiation-induced sarcoma

Purpose To evaluate pharmacist interventions and identify areas of improvement prior to decentralization and implementation of a personal digital assistant (PDA) program for documenting interventions. Methods Intervention data were collected from April 1999 to June 2001 using standardized intervention and activity forms. Following collection, data were analyzed to determine the most common medications requiring intervention, acceptance rates, total and estimated cost savings, interventions performed per care unit, and pharmacist time. Results A total of 3030 interventions were captured from April 1999 through June 2001. The most common interventions were dosage or frequency changes (80.6%). The total cost savings for the medication ingredients during the period reviewed was