American journal of hospital pharmacy
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The stability of six antibiotics in intravenous fluids in polyvinyl chloride containers after freezing and microwave-thawing is reported. Tobramycin sulfate 160 mg, amikacin sulfate 1 g, ticarcillin disodium 3 g, clindamycin phosphate 300 mg, nafcillin sodium 1 g, and ampicillin sodium was also diluted in plastic bags of 0.9% sodium chloride injection 50 ml. For each antibiotic except ampicillin sodium, three bags were prepared and assayed immediately for antibiotic content. ⋯ All antibiotics except ampicillin retained 90% or more potency when microwave-thawed after storage at -20 degrees C for 30 days, and after subsequent storage at room temperature for 24 hours. Ampicillin sodium was stable in 0.9% sodium chloride when stored at -30 or -70 degrees C, microwave-thawed, and stored up to eight hours at room temperature. Ampicillin sodium was stable in 5% dextrose when stored at -70 degrees C and microwaved-thawed, but its potency declined to 70.5% after eight hours storage at room temperature.
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The ability of total parenteral nutrition (TPN) solutions containing albumin to support bacterial and fungal growth was studied. The following solutions were tested for microbial growth: (A) thioglycolate broth, (B) solution A with preservatives, (C) albumin 6.25 g in 500 ml 0.9% sodium chloride injections, (D) solution C with preservatives, (E) amino acid and dextrose TPN solution with magnesium sulfate and folic acid, (F) solution E with albumin 6.25 g in 500 ml, (G) amino acid and dextrose TPN solution with calcium gluconate and multivitamins, and (H) solution G with albumin 6.25 g in 500 ml. Each solution was inoculated with 1 X 10(5) bacteria/ml or 1 X 10(3) yeast/ml in 12 serial dilutions using minimum inhibitory concentration (MIC) plates. ⋯ The presence of albumin had no effect on the growth of S. faecalis or Ps. aeruginosa. The addition of albumin to crystalline amino acid TPN solutions increases the potential of these solutions to support the growth of fungi and bacteria. Hence, it is recommended that albumin be administered separate from amino acid TPN solutions.
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A case of diabetic ketoacidosis in a 64-year-old black woman with maturity-onset diabetes receiving phenytoin for a seizure disorder is reported. The woman was admitted to the hospital with a one-day history of polyuria and polydipsia. For the 10 months before admission, her diabetes was controlled with isophane insulin suspension 27 units daily. ⋯ Phenytoin was discontinued because the seizure disorder was considered secondary to the previous episode of hyperosmolar coma. A literature review of phenytoin-induced hyperglycemia is presented, including previous case reports, possible mechanisms of action, monitoring guidelines, and potential therapeutic uses. If hyperglycemia occurs in a patient taking phenytoin, especially after starting phenytoin therapy or increasing the dose, drug-induced hyperglycemia should be considered in the differential diagnosis.
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The chemistry, pharmacokinetics, pharmacology, clinical efficacy, adverse effects, physical dependence and tolerance, drug interactions, dosing, and cost of zomepirac sodium (Zomax, McNeil) are reviewed. Zomepirac is a new nonsteroidal anti-inflammatory agent (NSAIA) approved for the treatment of mild to moderately severe pain. The drug is well absorbed when given orally. ⋯ The drug has not demonstrated any potential for physical dependence, withdrawal, or tolerance. Zomepirac may provide a suitable alternative to aspirin, narcotic/NSAIA combinations, and narcotics in the treatment of mild to moderately severe pain. It is unlikely that zomepirac will replace narcotics in more severe types of pain.
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A competency-based advancement program for practicing pharmacists is presented. The criteria for selecting this method of providing incentives for pharmacists are outlined. Procedures for developing and implementing this competency-based program are described. ⋯ Criteria for pharmacist placement and promotion from one completely level to another are outlined. The administration of the program is described, including budget considerations and methods for evaluating its effectiveness. This system recognizes and rewards accomplishments of staff pharmacists without removing them from patient care roles.