American journal of hospital pharmacy
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Systemic hemostatic agents are reviewed. Among the agents discussed are vitamin K preparations (phytonadione, menadione, menadione sodium bisulfite, menadiol sodium diphosphate); and blood products (whole blood, plasma, cryoprecipitate, factor VIII concentrates, factor IX concentrates and fibrinogen concentrates). Normal and abnormal hemostasis and fibrinolysis are discussed, as is the general management of systemic hemostatic defects. Specific disorders covered are clotting factor deficiencies, hemophilia A, factor VIII inhibitors, von Willebrand disease, hemophilia B (Christmas disease), other congenital coagulation disorders, acquired deficiency of factors II, VII, IX and X, and defibrination syndrome.
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Methotrexate sodium, cytarabine and hydrocortisone sodium succinate were evaluated in three vehicles, Sodium Chloride Injection, USP, Lactated Ringer's Injection, USP, and Elliott's B solution, an artificial cerebrospinal fluid (CSF). Osmolarity values of all drug solutions studied were within 10% of normal human. No vehicle-related alterations in the stability of methotrexate or cytarabine were detected under simulated use conditions. ⋯ Principal differences among the vehicles involved electrolyte content, pH and buffer capacity. Elliott's B solution is similar to CSF in electrolyte composition and buffer capacity, and was the only vehicle to maintain the pH of dilute methotrexate and cytarabine solutions between 7.2 and 7.8. The significance of these in vitro data await a careful clinical study.
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A study was conducted to determine the manner in which semisynthetic fiber-free liquid diets and complete oral liquid diets were being used in a large teaching hospital, and to determine the influence of the establishment of a dietary formulary and guidelines on prescribing. A use review of the dietary formulations was conducted both prior and subsequent to the publication of the formulary and guidelines. ⋯ There was a significant decrease (p less than 0.005) in orders for semisynthetic fiber-free diets, from 34 to 4, after publication of the formulary and guidelines. The guidelines and formulary appeared to have caused the decreased use of the diet formulations and to have aided in eliminating less than optimal prescribing of the products.
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Federal regulations governing the introduction of new drugs in the United States are reviewed. The discussion includes the legislative background, what constitutes a "new drug," drug development, investigational new drugs, new drug applications, pharmacist involvement in clinical trials, the approval process and postmarketing surveillance.
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Comparative Study
Effect of inline filtration of intravenous infusions on the incidence of thrombophlebitis.
The effect of inline filtration on the incidence of infusion phlebitis was examined in a community hospital. Two general surgical units, comparable in their patient populations, were studied during a one-month period. On one unit, an extension set with a 45 micrometer filter was attached to every i.v. catheter; no inline filtration was instituted on the second unit. ⋯ None of these differences was significant (p = 0.05). There was also no significant difference between the two groups in the severity of phlebitis and the incidence of phlebitis following the administration of irritating solutions containing cephalothin sodium or potassium chloride. Based on this study, the value of inline filtration in routine clinical conditions appears to be questionable.