Gastrointestinal complications associated with intramuscular ketorolac tromethamine therapy in the elderly.

OBJECTIVE: To report 3 cases of gastrointestinal (GI) complications associated with the use of intramuscular ketorolac tromethamine therapy in elderly patients. CASE SUMMARIES: In case 1, an 88-year-old woman was taken to surgery for the management of an acute abdomen and repair of a 2+ cm perforated prepyloric gastric ulcer. The patient had received a total 16 doses of ketorolac 30 mg im. The patient died after surgery from complications associated with bacterial and candidal sepsis, as well as acute renal failure. In case 2, an 80-year-old woman with no known history of GI problems developed a prepyloric gastric ulcer, which perforated and penetrated into the pancreas after the patient received 13 doses of ketorolac 30 mg im. The patient died from complications associated with candidal sepsis, peritonitis, and cardiopulmonary collapse. In case 3, an 85-year-old man with a history of a gastric ulcer developed GI bleeding after receiving a total of 9 doses of ketorolac 30 mg im. The bleeding was stabilized and the patient was discharged 12 days later in stable condition. DISCUSSION: Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug with potent analgesic properties. We report 3 cases of GI complications associated with intramuscular ketorolac therapy in the elderly. A temporal relationship was established with the development of gastric ulceration in 2 patients and the recurrence of a gastric ulcer in the third patient. CONCLUSIONS: We recommend that the manufacturer's guidelines be followed when ketorolac is used in elderly patients, and the drug should not be used in patients with a history of gastric ulcer disease. The use of misoprostol may be warranted as prophylactic therapy in high-risk patients who are receiving ketorolac.

Acute pancreatitis associated with the use of lisinopril.

OBJECTIVE: To report a case of acute pancreatitis associated with lisinopril use. CASE SUMMARY: A 67-year-old man with no past history of pancreatitis or its associated risk factors developed acute pancreatitis after taking lisinopril for two years. To date, the use of angiotensin-converting enzyme (ACE) inhibitors and development of pancreatitis has been described in the literature with captopril, enalapril maleate, and one case temporally related to lisinopril use. CONCLUSIONS: The use of ACE inhibitors as first-line agents in controlling hypertension and congestive heart failure has increased. In addition to monitoring for efficacy and commonly reported adverse effects, clinicians need to be aware that acute pancreatitis may occur with all ACE inhibitors.

An update on ready-to-use intravenous delivery systems.

The advent of ready-to-use intravenous (IV) delivery systems, particularly small-volume parenterals less than 250 mL has contributed greatly to pharmacy and patient care. Since their introduction in the late 1970s, the availability and variety of systems have increased. The purpose of this article is to update practitioners on small-volume parenterals systems that have a large product availability requiring little manipulation to make the system patient-specific. Additional benefits such as extended stability, potential for decreasing waste of products, as well improved end-quality are also discussed. With the benefits described that these systems have over the traditional method of preparing small-volume parenterals, there is still hesitation to fully utilize these systems. The primary reason for this seems to be the issue of cost. With various rebate incentive programs offered by manufacturers as well as the benefits that the systems provide, ready-to-use IV delivery systems are comparable in price to the traditional method of preparing small-volume parenteral agents.

Evaluation of the Drug-O-Matic automated dispensing system.

OBJECTIVE: To compare the time savings and accuracy rates of a manual dispensing system with the Drug-O-Matic (DOM), an automated tablet and capsule counter. DESIGN: In part one, phase A of this two-part study, a time trial measured the time of the prescription-filling process using the manual method. In part one, phase B, a time trial measured the time of that process using the DOM system. Part two of the study measured the accuracy of the DOM. RESULTS: The DOM requires 9 hours 42 minutes less per day than does the manual system. However, its accuracy causes some concern because we found a 14 percent discrepancy rate in terms of over- and underfills. CONCLUSIONS: Our initial experience with the DOM suggests significant time-savings potential compared with the manual method of prescription filling, and our institutional goal is to translate the time saved into other activities that will allow us to function as a free-standing pharmacy. A concern is the DOM's 14 percent discrepancy rate. Further studies are needed to confirm or challenge our initial findings.

A description of a successful computerized adverse drug reaction tracking program.

The University of Illinois Hospital Drug Information Center recently began using a database software program (File Express, Version 4.0, Redmond, WA) for storing and retrieval of reported adverse drug reactions (ADRs). Important features of the software program include the capability of easily generating reports, rapid sorting of data, large storage capability, minimal startup cost, and a user friendly menu system. The number of reported ADRs increased from 24 in 1987 to 124 in 1988 due, in part, to increased educational efforts, revision of the ADR reporting form, and cooperation from the medical records department in identifying reported ADRs during chart review. Overall, pharmacists were found to report most of the ADRs. Retrospective analysis of the ADR reports may help identify trends in ADRs based on the drug and route of administration. A decrease in the incidence of some ADRs and, thus, improved patient care, may result as the information obtained from the computer-based ADR reporting system is shared among healthcare professionals.