Archived Message board responses
(Categorized by date)

Message:Dave, would you happen to recall the name of the nonsteroidal anti-inflammatory drug that was pulled off the market about 10 years ago? thanks, bob

Posted by John C. Batulis on November 13, 2001 at 20:51:30:

Here is a link to more information on Duract.
http://www.injury-lawyer-network.com/duract.htm

Message:Tamoxifen causes a lack of satiation (always hungry and not fully satisfied after eating). Has anyone been able to overcome this adverse effect, and if so, how? Please do not say "will power" because the drug effect apparently is stronger that psychological strategies

See if your Dr might not swich you over to Evista (Raloxifene). This drug is of the same class-a selective estrogen receptor modulator-the same as tamoxifen. The added benefits of evista over nolvadex is that it protects against estrogen positive breast AND uterine cancers while nolvadex has been shown to only protect against breast CA. Also, with Evista you have less chance of satiety, and there are a bizillion studies that show that Evista increases bone density to decrease risk of fracture in post-menopausal women who are at high risk for fracture due to lack of estrogen. The only draw-backs are a slightly increased risk of blood clots for the first few months of therapy and the cost-but that should be the same for tamoxifen. The other side effect is a "hot flash" type reaction that might be only if it is not tolerated.

Good luck
Nate

Message: i am writing a mystery book. i have read in other mystery books about a drug that causes death-like symptoms. For instance, very little breathing, faint heart beats. anyway, i cannot remember the drug's name or the book in which i read about it, but i do need my character to look like he's dead for about two days so i really need a drug that can do that. can anyone help?

Message:I have received several questions regarding how to switch a patient from an insulin drip to SQ "interval" /maintenance dosing. Has someone published an equation to estimate this??

If I find a good reference I will post it here.
By the way, what did you come up with as a recommendation?

Message: Looking for the most recent chart or list on the internet of dialyzable drugs. Can anyone help.   Thanks

Message: Does anyone have a good site or article that shows
a quantified dollar savings amount per type of
clinical intervention? Thanks.

I will provide you with a couple of links that should help you in this area. In the past 5 years, there has been tremendous growth in the area of pharmacoeconomics and "outcome" based research. The goal of all of this research is to improve the quality and efficiency of health care while reducing costs . This new area of study is much broader in scope compared to traditional drug utilization review strategies.

1) A Prospective, Randomized Trial to Assess the Cost Impact of Pharmacist-Initiated Interventions S. Troy McMullin, PharmD; Joel A. Hennenfent, PharmD; David J. Ritchie, PharmD; Way Y. Huey, PharmD; Thomas P. Lonergan, PharmD; Robyn A. Schaiff, PharmD; Michael E. Tonn, PharmD; Thomas C. Bailey, MD

2) Completed search results - Google    
3)Leading organization which focuses on this very subject      
4)Recommended links.....

Hope this helps....

Message:I work with a nurse who routinely gives single dose antibiotics via her primary IV solution. These are prophylatic prior to surgery nd should be administered in 30-60 minutes via IV push or piggyback. My boss finds nothing wrong with this administration of med. AM I CRAZY or is this not an inappropriate/incorrect technique?
Thanks

Sounds inappropriate to me. Is this a continous infusion were talking about or a rapid infusion (500-1000 ml/hr). Protracted infusions will lower the peak concentration obtained and may reduce efficacy. ;(

Message:IS ZOMAX CLASSIFIED AS A PROPIONIC ACID, ACETIC ACID, FENAMATE, NANACIDIC ACID, OXICAM OR OTHER??

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Zomax was classified as an acetic acid derivative. Its structure was very close to tolmentin.
Abstract excerpt (early 1980's):  Zomepirac: a review of its pharmacological properties and analgesic efficacy. Morley PA, Brogden RN, Carmine AA, Heel RC, Speight TM, Avery GS.

Zomepirac is an analgesic which is closely related chemically to the nonsteroidal anti-inflammatory agent, tolmetin. In short term studies mainly involving patients with acute pain of moderately severity, zomepirac was at least as effective as usual therapeutic doses of aspirin, codeine alone or with aspirin, phenacetin and caffeine, dextropropoxyphene with paracetamol, or orally administered pentazocine. Additionally, zomepirac may provide analgesia comparable to that with standard doses of intramuscular morphine in patients with acute pain of moderate intensity, but in severe pain states strong analgesics may be more appropriate.

Message: Recently our hospital has started supplying NS 500ml bags to nursing units for nurses to withdraw syringefuls for use as "Heplock" flushes. These are being draw out of the bags via a needle adapter. Has anyone had experience with such a program pro or con. Thanks.

As long as each bag is dated and given a 24 hour expiration date, this is an acceptable practice.

Message: I should greatly appreciate any links to Oxidative Phosphorylation Disease. Diagnosis and Treatment. Thanks.

I have a few links for you. I did an extensive medline search and found very little studies... here are the links:
Completed medline search (clinical search)
Other links:

Mitochondrial diseases: pdf document

One more link

Message:Are there any alternatives for Regitine (Phentolamine)in the treatment of dermal necrosis after levophed infusion? What is the dosage?

: Here is a link for treating extravasation. Hope it helps.
http://www.extravasation.org.uk/Lett.htm

Message:
Does anybody there reduce the dose of enoxaparin in your hemodialysis patients? There are no guidelines that I can find other than use caution.

MEDLINE

Message:Can I take reglan in my 3rd trimester?

Lets see what others say!

"Typical drug guide response"
Metoclopramide is in the FDA pregnancy category B. This means that it is unlikely to harm an unborn baby. Do not take metoclopramide without first talking to your doctor if you are pregnant.
--------------------------
Noted Ob/Gyn Dr. Jonathan Scher answers your questions.

My friend has severe morning sickness with her pregnancy. Is Reglan safe?

There's no drug that is used for severe nausea and vomiting (hyperemesis gravidarum) that is absolutely 100 percent safe. Pregnancy risks and outcome are often contributed to any drugs a patient has taken, especially in the first trimester. However, if every other treatment has been tried, Reglan is regarded as the safest of the drugs for severe nausea and vomiting in early pregnancy. When you have morning sickness, usually in the first trimester, eating carbohydrates and starch, such as bread, pasta and cereal, which will help ease the discomfort.

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"Our data suggest that the administration of metoclopramide during the first trimester of pregnancy is probably not associated with an increased risk of fetal malformations, spontaneous abortions, or decreased birth weight of the infants," Dr. Matitiahu Berkovitch of Assaf Harofeh Medical Center in Zerifin, Israel, and colleagues explained in their letter.

Message:I like to know if it is an absolute contraindication to use a prophylasix dose of low molecular wt heparin such as lovenox 30mg sq bid in pt who is on epidural drip.Any hospitals are doing this? Thank you.

As with anything it is always based on a risk vs benefit analysis -- here is what the manufacturer says: When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis.

The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis such as non steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants. The risk also appears to be increased by traumatic or repeated epidural or spinal puncture.

Patients should be frequently monitored for signs and symptoms of neurological impairment. If neurologic compromise is noted, urgent treatment is necessary.

The physician should consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis

Message:What is the definition of nadir in cancer treatment?

This article addresses nadir as it relates to Prostate Cancer.
Nadir and Prostate Cancer

Message: Is it still advisable to filter reconstituted antiobiotics before adding it to an i.v. bag or sending it out in a syringe?

Actually, whenever in doubt - consult the package insert.

Message:I am trying to find out why the pediatric dosage for IV calcium chloride is greater than the adult dosage. I have seach far and wide and nobody seems to know why it is higher.

This is a simple matter of pharmacokinetic variation. Neonates have a much larger percentage of total body water (~80%). Furthermore, because of developmental factors e.g. rapid bone growth, increased requirements are necessary. Also, it is important to note that we are dealing with weight based calculations. The overall requirements will be lower in the pediatric population because of this fact, even though greater amounts/kg are needed in infants. Here is a web site that will provide you with additonal information:

http://www.baxter.com/doctors/iv_therapies/education/iv_therapy_CE/
neonate/neonate.html

pediatric factors

Message:Does anyone routinely add Regitine to the IV solution containing Levophed in order to prevent extravasation? Thanks.

Message:Can aspirin be given for stroke prophylaxis with a low
platelet count? Any concerns or precautions if yes?
Thanks, Paul-Eureka,CA

The package insert as well as most clinical studies recommend exercising caution in patients with concurrent thrombocytopenia. In other words, aspirin use in these patients is not contraindicated. [Side note: less than 1% of patients treated with aspirin develop thrombocytopenia].

Message:Does anyone have info on alternatives to kinevac?

One of our radiologists is considering using MCT oil po