Linda S. Tyler

Prevention and Management of Antineoplastic Extravasation Injury

Goal The goal of this program is to inform the participant of practical ways to prevent, identify, and manage the extravasation of anti-neoplastic agents. Objectives At the completion of this program the participant will be able to: 1. List antineoplastic agents known to be vesicants or irritants. 2. Identify the signs and symptoms of extravasation injury. 3. Recommend a procedure for the safe administration of vesicant medications. 4. Describe the appropriate management of antineoplastic-induced extravasation injury.

Recent trends in drug shortages: an update from the 2003 report

In 2003, we reported our seven-years experience managing drug shortages.[1][1] This report explores the recent trends we have identified while managing drug shortages at our own health system and while providing shortage content for Novation and the ASHP Drug Shortage Resource Center, with emphasis

Preventing Medication Errors with Antineoplastic Agents, Part 1

Goal — The goal of this program is to present practical ways to prevent medication errors with antineoplastic agents, identify common types of medication errors, and describe a system for reducing the incidence of medication errors and responding appropriately to antineoplastic medication errors. Objectives — At the completion of this program, the participant will be able to: 1. Describe the scope and impact of medication errors 2. Define common terms used in medication error literature. 3. List four common types of prescribing errors made with anti-neoplastic agents. 4. Identify steps where medication errors may occur during the drug ordering, preparation, and administration process. 5. Describe ways to prevent errors at each step of the medication use process. 6. Recommend a procedure for reporting and monitoring antineoplastic medication errors within the institution. 7. Describe a system for the non-punitive management of antineoplastic medication errors in health care systems.

Potential Association between Drug Shortages and High-Cost Medications

Shortages and sudden price increases of certain drugs may both occur emergently, with little to no warning, and they can have a dramatic impact on patient care. Little data are available linking drug shortages and price increases. Many of the same characteristics that may make medications susceptible to shortages can also place them at risk for sudden price increases. These characteristics include unapproved drugs, off‐patent sole‐source medications, and infrequently used medications. We reviewed drug shortage data from the University of Utah Drug Information Service to demonstrate how frequently these characteristics occurred and resulted in higher drug prices. Clinicians can use drug shortage management principles to mitigate the impact of sudden price increases for patients and health care organizations.

Fatigue in Palliative Care Patients

SUMMARY Fatigue is the most common symptom reported by patients approaching death. There is no generally accepted definition of this symptom. Some authors consider asthenia to be the same as fatigue, others do not. This monograph treats them as the same symptom. Fatigue may have multiple causes involving physical, emotional, and psychological factors. Drugs may cause or exacerbate fatigue. Identification and management of underlying causes, supportive therapy and drug therapy are described. Evaluation instruments that have been used to assess fatigue are described. Some open research questions are listed. A treatment algorithm, evidence tables and drug therapy tables are presented.

Dyspnea in Palliative Care Patients

SUMMARY Dyspnea is perhaps the most distressing symptom experienced by palliative care patients. Potential underlying causes are listed. Supportive therapy is important. Oxygen and opioids are the most common therapies for dyspnea, but several other drugs and drug classes have been used to help manage the symptom. Evaluation instruments that have been used for the symptom are described. Some open research questions are listed. A treatment algorithm, evidence tables and drug therapy tables which include drug costs are presented.

The Future of Medication Information Practice: A Consensus

OBJECTIVE: To analyze the current practice of drug information and develop a strategic plan for a “valued” specialty of medication information practice. DATA SOURCES: The Consortium for the Advancement of Medication Information, Policy, and Research (CAMIPR) met in June 1994 to initiate a strategic plan for a future of medication information practice. A multidimensional situation analysis and strategic planning process was conducted and the results are discussed. RECOMMENDATIONS: Trends in health care (e.g., healthcare reform, managed care) will impact the future of medication information practice, and the medication information specialist must evolve with societys values. Medication information practice must transform and attention will likely focus on medication policy research/ development and information systems. However, new skills, resources, and relationships must be developed to facilitate this evolution. In addition, interest in the practice of drug information has declined. Strategies are presented to enhance the “value” and “image” of future medication information practice.

Nausea and Vomiting in Palliative Care

SUMMARY Nausea and vomiting occur commonly in palliative care patients and these symptoms are usually manageable. Identification of the cause(s) is important in planning therapy. Common causes, general treatment measures and drug therapy are summarized. Evaluation instruments that have been used to assess these symptoms are described. Some open research questions are listed. A treatment algorithm, evidence tables and drug therapy tables are which include drug costs are presented.

Visual compatibility of i.v. medications routinely used in bone marrow transplant recipients

PURPOSE The visual compatibility of i.v. medications routinely used in bone marrow transplant recipients was studied. METHODS A total of 17 drug combinations were tested using simulated Y-site administration. Medications were prepared to the standard concentrations used at University of Utah Health Care and infused at the appropriate rate. For each combination, the two drugs had 99 cm of shared tubing. At the end of the shared tubing was a 0.8-microm filter disk. All of the drug combinations were tested in triplicate. After the infusion was complete, each filter was bubble-point tested to ensure filter integrity and to remove residual solution. The tubing and dried filter were examined by eye as well as a magnification microscope. Drug combinations were considered incompatible if a precipitate or color change was visible to the naked eye during filtration or if the number of particles observed under the microscope exceeded 12 particles of > or =10 microm in diameter per milliliter of solution or if 2 or more particles of > or =25 microm in diameter per milliliter of solution were observed, per guidelines established by the United States Pharmacopeia for large-volume injections. RESULTS Of the 17 drug combinations tested, 5 combinations were observed to be visually incompatible. All of the incompatible combinations included acyclovir as the primary infusion. Acyclovir was incompatible with cyclosporine, diphenhydramine, gentamicin, granisetron, and metoclopramide. CONCLUSION Of the 17 drug combinations tested, 5 combinations were observed to be visually incompatible during simulated Y-site injection. The combinations found to be visually incompatible included acyclovir with cyclosporine, diphenhydramine, gentamicin, granisetron, or metoclopramide.

Visual compatibility of caspofungin acetate with commonly used drugs during simulated Y-site delivery.

PURPOSE The physical compatibility of i.v. caspofungin with other commonly used i.v. medications was tested. METHODS Two methods were used to combine caspofungin and the secondary drugs. For drugs administered by i.v. push, caspofungin was delivered through a poly-vinyl chloride (PVC) i.v. solution set with secondary drugs injected into the Y-site of the i.v. extension set. For drugs given by i.v. infusion (over 10 minutes), secondary drugs were infused into the Y-site of the i.v. solution set through microbore PVC tubing. The two drugs shared 39 in of tubing. Attached to each end of the i.v. extension set were 0.8-mum filter disks. All drug combinations were tested three times; after each infusion, the filters were bubble-point tested. Drug combinations were considered physically compatible if no visible precipitate was seen and no color change was noted by the unaided eye during the infusion, or if the number of particles found on the filter under a microscope did not exceed the number stated in United States Pharmacopeia guidelines for particulate levels of large-volume parenteral fluids. RESULTS A total of 8 of the 31 drugs tested (acyclovir, ceftriaxone, cefazolin, clindamycin, furosemide, heparin, pantoprazole, and piperacillin-tazobactam) were found to be physically incompatible with caspofungin. CONCLUSION Caspofungin acetate was physically compatible during Y-site injection with 23 of 31 medications tested.