Patrick M. Malone

Educational Technology Use Among US Colleges and Schools of Pharmacy

Objective. To develop a searchable database of educational technologies used at schools and colleges of pharmacy. Methods. A cross-sectional survey design was used to determine what educational technologies were being used and to identify an individual at each institution who could serve as an information resource for peer-to-peer questions. Results. Eighty-nine survey instruments were returned for a response rate of 75.4%. The resulting data illustrated the almost ubiquitous presence of educational technology. The most frequently used technology was course management systems and the least frequently used technology was microblogging. Conclusions. Educational technology use is trending toward fee-based products for enterprise-level applications and free, open-source products for collaboration and presentation. Educational technology is allowing educators to restructure classroom time for something other than simple transmission of factual information and to adopt an evidence-based approach to instructional innovation and reform.

Eosinophilia Associated with Bupropion

Objective: To describe the first incidence of eosinophilia following administration of bupropion. Case Summary: The patient was a 72-year-old woman admitted for evaluation of chest pain. During hospitalization, the eosinophil count reached 0.60 fraction of 1.00, with absolute eosinophil count of 6693 × 109/L and a white blood cell count of 18.5 × 109/L. She had been receiving bupropion therapy for 5 days prior to this admission. Discussion: Potential causes of the eosinophilia, including disease states and medications, were reviewed comprehensively and ruled out. A review of the literature (MEDLINE 1966—1994) did not identify previous cases of eosinophilia associated with bupropion therapy. Causes of eosinophilia include parasitic infections, allergic diseases, and medication use. A proposed mechanism for the occurrence of eosinophilia in this patient is unknown. Conclusions: Considering the temporal sequence of events, drugs administered prior to the development of eosinophilia, and the rapid decline of the eosinophil count following discontinuation of the medication, bupropion appears to be the precipitating agent.

Subcutaneous Administration of Nifedipine

Contents of a 10 mg nifedipine capsule (0.33 ml) were withdrawn by syringe and administered subcutaneously to a patient with hypertensive urgency due to misinterpretation of a physicians order. The drug apparently had its desired hypotensive effect and no adverse effects were noted. The literature on use of nifedipine in hypertensive urgency is reviewed. Subcutaneous administration is not recommended because of a lack of suitable controlled studies and the potential for adverse effects.

Elevated International Normalized Ratio associated with concurrent use of ophthalmic erythromycin and warfarin

PURPOSE The case of a patient whose International Normalized Ratio (INR) increased with concurrent use of ophthalmic erythromycin and warfarin is reported. SUMMARY A 77-year-old Caucasian woman began therapy with warfarin for thromboembolism prophylaxis secondary to atrial fibrillation (target INR, 2-3). Warfarin was prescribed by her cardiologist, and care was established with clinical pharmacists in an anticoagulation clinic. She was receiving a weekly maintenance dosage of 14 mg. She had a history of atrial fibrillation, hyperlipidemia, osteoarthritis, hypothyroidism, coronary artery disease, myocardial infarction, congestive heart failure, and breast cancer. In addition to warfarin, the patient had been receiving alprazolam, carvedilol, furosemide, levothyroxine sodium, lisinopril, nitroglycerin, potassium chloride, propoxyphene hydrochloride-acetaminophen, simvastatin, and trazodone. After receiving warfarin at the same weekly dosage for over four months, the patients ophthalmologist prescribed erythromycin ophthalmic ointment for chronic bacterial conjunctivitis. Three weeks later, her INR was found to be 8.5. A total of four warfarin doses were withheld, and her weekly maintenance dosage of warfarin was subsequently decreased to 12 mg. Five weeks later, her INR was 1.5, and it was determined that the erythromycin ophthalmic ointment had been discontinued five days prior. Her weekly maintenance dosage of warfarin was increased to 16 mg. Rechallenge with erythromycin five days before her next INR measurement resulted in an INR of 4.2. A new weekly maintenance dosage of 13 mg was established, and her subsequent INRs were within normal range. CONCLUSION An increase in INR values was reported after initiation of ophthalmic erythromycin in a patient receiving warfarin and recurred upon rechallenge with ophthalmic erythromycin.

Drug Information Technology and Internet Resources

The Internet poses many challenges and opportunities for pharmacists. This article discusses what is needed to access the Internet, including hardware and software. Afterwards, a discussion of the various capabilities that pharmacists can take advantage of and integrate into their practice philosophy is presented. Specific items covered include web searching, web site establishment, electronic mail, USENET News, collaboration software, listservers, and push technology. Furthermore, some likely future areas for pharmacists to evaluate are discussed.

Applying principles of formulary management to blood banking.

The pharmacy and therapeutics (P&T) committee or its equivalent has been a long‐standing committee of the medical staff in almost every institution. The P&T committee is typically defined as the body that recommends policy to the medical staff and the administration of the organization on matters related to the safe and therapeutic use of medications as well as other matters relating to medication use. The Food and Drug Administration definition of a drug includes blood and blood components, and the American Society of Health‐System Pharmacists guidelines suggest including blood derivatives in their definition of a drug. Clinicians and other health care providers have needed to become more familiar with blood and blood component therapy as more prescription blood products have become available. As such, the P&T committee could work collaboratively with blood bank personnel, who are experts in this area, to help ensure that blood derivative products undergo the same evidence‐based formulary review process as other medications.