Bupropion-induced serum sickness-like reaction.

OBJECTIVE: To report three cases of serum sickness-like reaction (SSLR) associated with bupropion ingestion. CASE SUMMARY: A 27-year-old woman, a 46-year-old man, and a 43-year-old woman presented to our emergency department within a three-week period with symptoms consistent with SSLR. Symptoms consisted of pruritic skin rash, tongue swelling, and arthralgias. All three patients had initiated bupropion therapy within two to three weeks prior to arrival. DISCUSSION: This is the second published case describing SSLRs associated with bupropion. Reports of urticaria and rash with bupropion use are numerous and the incidence has been estimated at between 1% and 4%. Arthralgia and arthropathy with bupropion use are reported much less commonly. The onset of symptoms of SSLRs typically begins six to 21 days after administration of the causative agent. SSLRs are usually self-limiting, lasting four to 14 days. CONCLUSIONS: SSLRs following bupropion ingestion appear to be rare. However, the fact that this cluster of patients presented to our emergency department within a three-week period suggests that this reaction may be underreported.

Polyvinylchloride containers do not influence the hemodynamic response to intravenous nitroglycerin.

In-vitro evidence of sorption of nitroglycerin (NTG) to polyvinylchloride (PVC) containers suggests that these containers may deliver less nitroglycerin to the patient than glass containers. Sorption of NTG to the PVC container may result in hemodynamic changes in the patient when a fresh solution of NTG is prepared and administered from a PVC container. This study was designed as a prospective, randomized trial to measure the hemodynamic response in patients receiving NTG in glass or PVC containers, during the first hour after a container exchange. Patients admitted to the coronary care unit in a University hospital with chest pain considered to be due to unstable angina or acute myocardial infarction were eligible. Patients who received other vasoactive drugs within one hour of container exchanges were excluded. Systolic and diastolic blood pressures, and heart rate were measured at baseline and at intervals for one hour following a container exchange. Twenty patients completed the study. There were no significant changes with time in either group (ANOVA, p > 0.05) with respect to systolic, diastolic, or mean arterial blood pressure or heart rate. No chest pain occurred during the 60 minutes following the container exchange in either group. We conclude that NTG can be administered safely and effectively in PVC containers to patients with unstable angina or acute myocardial infarction. However, it remains possible that changes in hemodynamic status could occur in patients on NTG if a change in container type (i.e., from PVC to glass or vice versa) is made during the course of therapy.

Regional hospital pharmacy information index.

An index system was developed that provides participating hospitals with an up-to-date list of regionally available written materials used in hospital pharmacy practice. Eight acute-care hospitals agreed to participate in developing the index to avoid duplication of effort in producing original materials. A regional drug information center agreed to maintain the index and serve as the central repository for the materials. Newsletters and bulletins were given high priority for coverage by the system, followed by drug monographs and directed studies and residency projects. A three-year back-index period was set for most categories to ensure that the index was current. Only active entries were listed for investigational drug lists, i.v. drug administration monographs, and extemporaneously compounded drug products. Other categories were drug administration policies, unusual drug information requests, and patient-oriented drug information. The representatives provided the relevant materials from their institutions, and it was categorized and indexed. The index was entered on a word processor, which permits efficient updating. The index has been useful to the participating hospital pharmacy departments. As the system is tested through use, it will be evaluated formally and refined.