Extemporaneous compounding activities and the associated informational needs of pharmacists.

The results of an ASHP survey of extemporaneous compounding activities and the associated informational needs of selected pharmacists are reported. A questionnaire on extemporaneous drug formulations was mailed in September 1989 to 517 pharmacists with presumed interest in or knowledge of extemporaneous compounding activities. There were 235 questionnaires returned by recipients, for a net response rate of 45.6%. Of these 235 questionnaires, 210 were usable for the analyses. Eighty percent of the respondents practiced in hospitals. The respondents listed 314 single-entity and combination drug formulations that are frequently compounded in their institutions but for which adequate information on stability was judged not to be available. Oral suspensions were the most commonly listed dosage forms for which stability information was deemed to be needed. Other frequently reported informational needs pertained to the preparation of topical and ophthalmic drug formulations and pediatric dilutions. Data on the patient age groups involved, the usual routes of administration, and the approximate total volume and dose (volume) per patient were also reported for each drug formulation. Pharmacists perform a broad range of extemporaneous compounding activities, and further efforts are needed to supply practitioners with pertinent information on extemporaneous drug formulations.

National audit of drug information centers.

A comprehensive audit of drug information centers (DICs) was conducted to obtain information on sources of funding, staffing, information resources, computerization, workload, and scope of services and activities and to examine the role of DICs in education, patient care, and research. Responses were obtained from 98 of the 121 DICs surveyed. The scope of activities and services varied considerably between centers and depended on such factors as source of funding, size of institution, academic affiliation, staffing, and workload. Many DICs are involved in writing newsletters, preparing information for pharmacy and therapeutics committee meetings, developing and updating formularies, and providing contract services to other organizations. The patient-care activities of DICs include providing consultations, performing drug-use reviews, monitoring adverse drug reactions, and coordinating investigational drug studies; DICs are also involved in training undergraduate and graduate pharmacy students and residents and conducting research projects. Large workloads and lack of time were cited most often as factors limiting DIC participation in patient-care, educational, and research activities. Because DICs are involved in a wide variety of educational, research, and patient-care activities, more emphasis should be placed on documenting the costs of these services in relation to their benefits to the institution.

Drug therapy and nutritional management of patients with gastrointestinal fistulas.

The drug therapy and nutritional management of patients with gastrointestinal fistulas are reviewed. The goal of therapy is to compensate for loss of electrolytes, nutrients, and water in the fistula drainage and to monitor the acid-base status of the patient. Positive nitrogen balance is essential for anabolism and closure of the fistula. Usually it is not feasible to analyze the fistula drainage for nitrogen content, and nitrogen requirements must be estimated. To prevent folic acid deficiencies, patients should receive daily doses of folic acid 1 mg orally or 0.5 mg in parenteral nutrient solutions. Positive zinc balance usually can be established with the addition to parenteral nutrient solutions of zinc 3-12 mg/day. It is not clear whether the parenteral or enteral route of nutrient administration is preferable. Drug therapy may be needed to treat diarrhea, infection, and any underlying disease. Reductions in the acidity and the volume of fluid lost may allow spontaneous closure and healing; antacids and anticholinergic drugs are not recommended for these purposes. The use of cimetidine has been effective in decreasing the acid content and volume of output from fistulas in the upper gastrointestinal tract and has allowed spontaneous healing to occur. Drainage of any intra-abdominal abscesses is essential; this should be combined with systemic antibiotic therapy. The management of patients with gastrointestinal fistulas is complex because of disturbances in fluid, electrolyte, and acid-base balance and because of difficulties in determining nutritional requirements.