P & T : a peer-reviewed journal for formulary management
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We sought to evaluate the pharmacokinetics, efficacy, safety, stability, pharmacoeconomics, and quality-of-life effects of continuous-infusion antipseudomonal beta-lactam therapy in patients with cystic fibrosis (CF). ⋯ Efficacy and safety studies suggest that ceftazidime, administered as a continuous infusion for the treatment of CF pulmonary exacerbations, is safe and effective; has the potential to reduce the costs of treatment; and is preferred to intermittent infusion among patients treated at home. Continuous-infusion ceftazidime may therefore be an alternative to traditional dosing on a case-by-case basis, such as for patients with multidrug-resistant isolates of P. aeruginosa. Treatment with continuous-infusion ceftazidime at home may be considered in such a case, assuming resources and support equivalent to the hospital setting can be ensured. Additional studies assessing the safety and efficacy of other antipseudomonal beta-lactams, when administered as a continuous infusion, during CF pulmonary exacerbations are needed.
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Methadone HCl is used for the management of opioid addiction and chronic pain. Published reports indicate that methadone can be associated with a prolonged corrected QT (QTc) interval, especially at daily doses greater than 100 mg. The risk of this adverse effect is not always considered by health care pain specialists, who sometimes use lower doses. The objectives of this case series were to evaluate the effects of methadone on the QTc interval in patients being treated for chronic pain and to determine whether there was a correlation between dosing and the degree of QTc prolongation. ⋯ Our case series suggested that QTc intervals should be routinely monitored in patients receiving methadone and that patients should be screened before therapy is initiated. Ideally, the QTc interval should be monitored before treatment begins and during repeated intervals thereafter. On the basis of the analysis, a protocol was developed at our facility for monitoring ECGs in patients being treated with methadone for chronic pain.
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This article presents the third in a series of three interviews that P&T conducted with several members of the American Society of Health-System Pharmacists (ASHP) Expert Panel on Formulary Management. In 2008, ASHP convened this panel of experts to develop revised guidelines for P&T committee and formulary management to replace the previous guidance issued in 1991.1 These revised guidelines include recommendations concerning the review and evaluation of drugs for formulary inclusion, pharmacoeconomic assessments, therapeutic interchange, medication-use evaluations (MUEs), management of drug shortages, and many other important topics. In this series, ASHP experts discuss P&T committee and formulary management guidelines in their respective institutions as well as other observations and insights. In Part 3, the author interviews Sabrina Cole, PharmD, Clinical Specialist, Drug Information, at the Grady Health System in Atlanta, Georgia.