M. Christina Beckwith

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.

A guide to drug therapy in patients with enteral feeding tubes: Dosage form selection and administration methods

Drug therapy may be complicated in hospitalized patients receiving nutrition via enteral feeding tubes. Dosage form selection and appropriate administration methods are crucial in patients with feeding tubes. Although hospitalized patients receive nutritional support through various routes, oral nutrition is preferred. Enteral or parenteral nutrition may be used if oral intake is inadequate or inadvisable. Patients with functional gastrointestinal tracts usually receive enteral nutrition. Administering oral medications through the enteral feeding tube can lead to complications like tube clogging or decreased drug activity. However, drug therapy need not be compromised in patients receiving enteral nutrition. Careful selection and preparation of dosage forms reduces the complications of medication administration. Flushing the feeding tube and screening for drug incompatibilities decreases the incidence of tube clogging and replacement.

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.

Prevention and Management of Chemotherapy-Induced Nausea and Vomiting, Part 2

Credit This lesson is good for 0.3 CE units, with a passing grade of 70%. Goal The goal of this program is to inform the participant about cost-effective ways to prevent, identify, and manage nausea and vomiting induced by antineoplastic agents. Objectives At the completion of this program the participant will be able to: 1. List antineoplastic agents associated with a high incidence of nausea and vomiting. 2. Identify patient-specific risk factors for developing chemotherapy-induced nausea and vomiting (CINV) and how these factors may influence treatment of this syndrome. 3. Compare the three major types of CINV, including the pathophysiologic mechanism, time of onset, and symptom duration of each type. 4. Explain the mechanism of action and appropriate place in therapy for each type of antiemetic agent. 5. Differentiate between pharmacologic regimens for the prevention and treatment of CINV in adults. 6. Identify drug-specific factors that must be considered when developing a formulary management strategy for the antiemetic agents. 7. Describe specific information that the pharmacist can share with patients to help them understand and manage CINV.

Acetaminophen Injection: A Review of Clinical Information Including Forms Not Available in the United States

ABSTRACT Acetaminophen injection is an antipyretic and analgesic agent recently marketed in the United States as Ofirmev. A recent review published in the Journal of Pain & Palliative Care Pharmacotherapy focused on the labeled uses of acetaminophen injection in the United States. A variety of studies were excluded that may be of interest to clinicians. This addendum provides these citations and further insight into the strategy used to develop the review. Acetaminophen injection represents another agent for multimodal pain management.

This CE is published through an unrestricted educational grant from Bristol-Myers Squibb: Prevention and Management of Chemotherapy-Induced Nausea and Vomiting, Part 1

Credit This lesson is good for 0.2 CE units, with a passing grade of 70%. Goal The goal of this program is to inform the participant of costeffective ways to prevent, identify, and manage nausea and vomiting induced by antineoplastic agents. Objectives At the completion of this program the participant will be able to: 1. List antineoplastic agents associated with a high incidence of nausea and vomiting. 2. Identify patient-specific risk factors for developing chemotherapyinduced nausea and vomiting (CINV) and how these factors may influence treatment of this syndrome. 3. Compare the three major types of CINV, including the pathophysiologic mechanism, time of onset, and symptom duration of each type. 4. Explain the mechanism of action and appropriate place in therapy for each type of antiemetic agent. 5. Differentiate between pharmacologic regimens for the prevention and treatment of CINV in adults. 6. Identify drug-specific factors that must be considered in developing a formulary management strategy for the antiemetic agents. 7. Describe specific information that the pharmacist can share with patients to help them understand and manage CINV.

Constipation in Palliative Care Patients

SUMMARY Constipation is a common result of advanced disease and drug therapy. It occurs in as many as 50% of advanced cancer patients and 85% of patients taking high dose opioids. Potential causes are described. Prevention and early reversal are important. Nondrug and pharmacological methods of preventing and treating constipation are described. Evaluation instruments that have been used for this symptom are described. Some open research questions are listed. A management algorithm, evidence tables, and drug therapy tables which include drug costs are presented.

Drug Interactions Reported with Grapefruit Juice

Grapefruit juice ingested concurrently with several classes of drugs can profoundly influence drug effects and toxicity. Fatal interactions have been reported. Grapefruit juice inhibits cytochrome P450 3A (CYP3A) enzymes and may inhibit cytochrome P450 1A2 (CYP1A2) enzymes.2,5 This can inhibit metabolism of drugs whose metabolic fate relies upon those enzymes. Only orally administered drugs are effected. First-pass metabolism mediated by the CYP3A subfamily of enzymes is a common property shared by drugs that interact with grapefruit juice.2 Also, drugs that undergo a significant first-pass metabolism with a lower bioavailability ranging from 5% to 30% may be affected to a greater degree by grapefruit juice.2 Drugs that interact with grapefruit juice include antiepileptic agents, antimicrobial agents, benzodiazepines, calcium channel blockers, HMG-CoA reductase inhibitors, hormones, immunosuppressant agents, and others. Reported interactions are summarized.