The pharmacies of rural communities often include veterinary products; however, many pharmacists have little knowledge about animal diseases and the pharmacokinetics of drugs in animals. The Colorado ...State University at Fort Collins has developed an elective one-week rotation for pharmacy students through the University Veterinary Teaching Hospital. The four objectives of the program are: (1) to observe the various aspects of veterinary medicine and its use in different animal species; (2) to work with the student of veterinary medicine to plan and evaluate a drug therapy course; (3) to understand species variance in absorption, metabolism, and elimination of drugs; and (4) to plan and evaluate a course of therapy for an assigned animal, using the Problem Oriented Medical Record (POMR) format.
Acetylcysteine treatment of acetaminophen overdose (24--30 g) in a 31-year-old female is reported. Acetylcysteine was used to prevent acetaminophen-induced hepatotoxicity. An oral loading dose of 7 g ...of acetylcysteine was followed with oral administraton of 3.6 g every four hours for 17 doses. Liver enzymes were elevated on the fourth day after overdose. Phytonadione was administered on days four through six for elevated prothrombin time ratios. Only mild elevations of liver enzymes still were present on day seven. Previous case reports and studies of acetaminophen-induced hepatotoxicity and acetylcysteine therapy are reviewed. The use of acetylcysteine in this case appeared to be beneficial.
An educational program on warafarin counseling for inpatients of a 200--bed community hospital which uses both pharmacy and nursing personnel is described. Following a physician's request for the ...educational service, a registered nurse arranged for the patient to view a slide presentation of anticoagultants and provided a booklet designed to reinforce the learning objectives for the warfarin education program. After the patient viewed the film and read the booklet, a pharmacist or nurse made a follow-up visit to answer questions and reinforce the objectives. The checklist of learning objectives was completed by the pharmacist or nurse and remained in the patient's chart as a permanent record of medication counseling. Forty-five request for warfarin patient education were received during the program's first six months of operation. The pharmacist spent an average of 30 minutes with each patient; the nurse spent an average of 15 to 20 minutes with each patient. The average time required of nursing and pharmacy service to provide the program was one and two hours per week, respectively. The warfarin education program provides an important patient service with a reasonable expenditure of time by pharmacy and nursing personnel.
The use of ketorolac was studied in patients undergoing lumbar laminectomy and those receiving lumbar fusion with or without instrumentation. Laminectomy patients in the ketorolac group used ...significantly less narcotic analgesic than did those in the narcotic treatment group. Ketorolac patients in both surgical categories experienced better pain control than narcotic group patients did. Laminectomy ketorolac patients experienced less sedation than did those in the narcotic group, and a similar trend was noted for fusion patients. A significant improvement in postoperative ambulation was demonstrated in the fusion ketorolac group. Postoperative total drug costs were significantly greater in both ketorolac treatment groups. A one-half day decrease in hospitalization was noted for laminectomy ketorolac patients. The overall annual financial impact of the use of ketorolac in lumbar spine patients is a net savings of $211,095.
An interdisciplinary diabetic team which provides inpatient and outpatient diabetic instructional services in a 200-bed community hospital is discussed. The team consists of a pharmacist, a ...dietitian, and a registered nurse, each of whom is assigned to a specific area of diabetic education. Instructional objectives include coordination of teaching efforts by hospital personnel, standardization of education, and development of evaluation procedures. Upon notification of a physician request for diabetic team services, a form which contains competency-based instructional objectives and patient referral questions is placed in the patient's chart. Diabetic instruction may then be initiated by ward personnel or a member of the diabetic team. Outpatient classes are offered for those who desire or require additional or indepth instruction.
Recent reports of cimetidine toxicity are summarized. Summaries of specific cases and categorized according to cardiovascular, central nervous system, dermatologic, endocrine, gastrointestinal, ...hematologic, or renal toxicity, or overdosage. Adverse reactions reported secondary to cimetidine during its investigational period and shortly after marketing were minimal. In several studies in which over 1200 patients were treated with cimetidine, the incidences of adverse clinical symptoms was no higher than in the nearly 500 placebo-treated patients. However, subsequent reports indicate that elderly patients, patients with impaired renal function, and patients with liver disease appear quite susceptible to mental confusion. Potentially serious hematologic depression, cardiac depression, and hypersensitivity-type hepatitis have also been reported. As a result of the reports of impotence and oligospermia, controlled trials evaluating the effect of cimetidine on fertility in young men are needed.
