DICP : the annals of pharmacotherapy
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Comparative Study
Medical versus pharmaceutical continuing education: are both appropriate for the pharmacist?
Continuing education (CE) courses in pharmacy and medicine often overlap with regard to their informational content. At the present time, however, it is feasible that two pharmacists could attend the same national meeting that has continuing medical education (CME) approval status and only one of them would receive CE credit from his state board of pharmacy. Therefore, a survey of 51 state board of pharmacy policies regarding acceptance of CME was conducted. ⋯ Twenty percent of state boards requiring CE accept CME credit without review, 24 percent do not accept CME credit, and the remaining 56 percent review submitted requests for CME credit. A general lack of uniformity exists among state boards regarding policies pertaining to CE credit. If CME credit was universally accepted, pharmacists would benefit from the increased availability of CE, the building of collegial relationships with other healthcare professionals, and the cost savings of combining courses that mutually benefit both pharmacists and physicians.
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Because of a significant increase in the number of patients receiving patient-controlled analgesia (PCA) therapy at our institution, we conducted a review of PCA use. Our objectives were to determine if a PCA recording document (monitoring form) could be used to identify potential problems associated with PCA therapy and to identify measures that could be taken to improve analgesic therapy with this method of administration. The PCA recording document for each patient was reviewed retrospectively to identify patients suspected of having problems with the therapy. ⋯ Nausea and vomiting were the most prevalent adverse reactions. Our results indicate that PCA therapy is discontinued in many patients because of inadequate pain relief and suspected narcotic-induced nausea and vomiting. To improve analgesic therapy, clinicians should be reeducated regarding ways to optimize analgesic therapy, and a prospective PCA monitoring service should be considered.
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We report a life-threatening case of phenytoin hypersensitivity syndrome, a rare reaction primarily characterized by fever, skin eruptions, lymphadenopathy, eosinophilia, and hepatotoxicity. The reaction developed in a 27-year-old black man with surgically corrected tetralogy of Fallot who was treated with phenytoin for one month for exercise-induced sustained ventricular tachycardia. ⋯ This adverse reaction usually develops within six weeks of starting phenytoin therapy and may be fatal in up to 40 percent of the patients who develop hepatotoxicity. Early recognition of this relatively rare reaction is essential to prevent serious and potentially fatal complications.
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This article addresses some therapeutic controversies concerning medications that may be needed during advanced pediatric life support (APLS) and the routes of administration that may be selected. The controversies that are discussed include the appropriateness and selection of various routes for drug administration during APLS; the determination of whether epinephrine hydrochloride is the adrenergic agent of choice for APLS and its appropriate dose; treatment of acidosis associated with a cardiopulmonary arrest; recommendations for atropine sulfate doses; and the role, if any, of calcium in APLS. Background information differentiating pediatric from adult cardiopulmonary arrest is presented to enable the reader to have a better understanding of the specific needs of children during this life-threatening emergency. The article also presents an overview of various drugs used for APLS and a table of their typically recommended doses and routes of administration.
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The legal history and current developments in the right to refuse antipsychotic medication are reviewed. In Washington v. ⋯ A narrow issue was clarified but substantial uncertainty remains. As a result, law and policy problems at both state and institutional levels have become evident and may need to be addressed by drug policy decision makers.