Surface contamination of counting tools after mock dispensing of cyclophosphamide in a simulated outpatient pharmacy.

PURPOSE: The primary aim was to determine if dispensing of cyclophosphamide tablets resulted in accumulated residue on pharmacy counting tools during a simulated outpatient dispensing process. Secondary objectives included determining if cyclophosphamide contamination exceeded a defined threshold level of 1 ng/cm2 and if a larger number of prescriptions dispensed resulted in increased contamination. METHODS: Mock prescriptions of 40 cyclophosphamide 50 mg tablets were counted on clean trays in three scenarios using a simulated outpatient pharmacy after assaying five cleaned trays as controls. The three scenarios consisted of five simulated dispensings of one, three, or six prescriptions dispensed per scenario. Wipe samples of trays and spatulas were collected and assayed for all trays, including the five clean trays used as controls. Contamination was defined as an assayed cyclophosphamide level at or above 0.001 ng/cm2 and levels above 1 ng/cm2 were considered sufficient to cause risk of human uptake. Mean contamination for each scenario was calculated and compared using one-way analysis of variance. P-values of < 0.05 implied significance. RESULTS: Mean cyclophosphamide contamination on trays used to count one, three, and six cyclophosphamide prescriptions was 0.51 ± 0.10 (p=0.0003), 1.02 ± 0.10 (p < 0.0001), and 1.82 ± 0.10 ng/cm2 (p < 0.0001), respectively. Control trays did not show detectable cyclophosphamide contamination. Increasing the number of prescriptions dispensed from 1 to 3, 1 to 6, and 3 to 6 counts increased contamination by 0.51 ± 0.15 (p = 0.0140), 1.31 + 0.15 (p < 0.0001), and 0.80 ± 0.15 ng/cm2 (p = 0.0004), respectively. CONCLUSION: Dispensing one or more prescriptions of 40 cyclophosphamide 50 mg tablets contaminates pharmacy counting tools, and an increased number of prescriptions dispensed correlates with increased level of contamination. Counting out three or more prescriptions leads to trays having contamination that surpasses the threshold at which worker exposure may be increased. Pharmacies should consider devoting a separate tray to cyclophosphamide tablets, as cross-contamination could occur with other drugs and the efficacy of decontamination methods is unclear. Employee exposure could be minimized with the use of personal protective equipment, environmental controls, and cleaning trays between uses. Future investigation should assess the extent of drug powder dispersion, the effects of various cleaning methods, and the potential extent of contamination with different oral cytotoxic drugs.

Single-dose dexamethasone for the prevention of pemetrexed associated cutaneous adverse reactions.

Pemetrexed (Alimta®) is a novel anti-folate antimetabolite agent that is used in combination with cisplatin for the treatment of patients with unresectable malignant pleural mesothelioma and as a single agent or in combination with cisplatin for patients with locally advanced or metastatic non-small-cell-lung-cancer. Cutaneous adverse reactions are common side effects of pemetrexed for which the manufacturer recommends 3-day premedication with dexamethasone 4 mg by mouth twice daily-(the day before, the day of, and the day after treatment). Patients' adherence to this premedication regimen is of concern. We report 14 cases of metastatic non-small-cell-lung-cancer patients who were premedicated with a single dose of dexamethasone 20 mg prior to pemetrexed or pemetrexed-based chemotherapy. None of these patients reported a grade 3 or above skin reactions over the course of their treatments. These findings suggest that a single dose of dexamethasone 20 mg may be an alternative premedication regimen in patients with metastatic non small cell lung cancer receiving pemetrexed or pemetrexed-based chemotherapy.

Preliminary evaluation of selected minerals in liver samples from springbok (Antidorcas marsupialis) from the National Zoological Gardens of South Africa.

Limited information is available on the mineral nutrition of captive antelope in South Africa. Zoo animals are usually offered a very limited array of feeds, which may result in nutritional imbalances. As a pilot study to investigate the presence of myopathy in antelope at the National Zoological Gardens of South Africa (NZG), stored liver samples from six springbok (Antidorcas marsupialis) and seven other antelopes from the NZG, as well as selected food items, were submitted for analysis of selenium, copper, manganese and zinc content by spectrophotometry. Springbok liver levels of copper were 23.07 mg/kg ± 0.72 mg/kg, whilst manganese, selenium and zinc levels were 6.73 mg/kg ± 0.22 mg/kg, 0.14 mg/kg ± 0.05 mg/kg and 135.02 mg/kg ± 1.26 mg/kg, respectively. Liver mineral levels in the other species were very variable. Food item copper levels ranged from 4.00 mg/kg (Eragrostis tef) to 17.38 mg/kg (antelope cubes), lucerne (Medicago sativa) and E. tef contained no detectable selenium. The highest zinc levels were in antelope cubes (147.00 mg/kg) and the lowest were in lucerne (20.80 mg/kg). Interpretation of these results was hampered by the small number of samples and a paucity of information on liver mineral levels in free-ranging and captive antelope; however, results suggested that, in the springbok, whilst copper and manganese intake are likely adequate, selenium nutrition is probably insufficient and may account for the myopathy diagnosed. Zinc liver levels are possibly within the toxic range, perhaps as a result of the high levels of zinc in the antelope cubes. This pilot study highlighted the need to establish baseline mineral nutrition data for captive and freeranging antelope under South African conditions.