Propranolol-induced dyspnea in a nonasthmatic male.

The authors report the onset of wheezing and dyspnea in a 32-year-old, nonasthmatic male who was receiving propranolol for chronic migraine headaches of 20 years' duration. The symptoms first appeared during the "cold season"; the diagnosis was bronchitis. After three months without propranolol, the patient, prompted by continuing migraine headaches, again took the drug (40 mg bid). Within 48 hours he complained of rhinitis that rapidly progressed to wheezing, resembling bronchitis. Other reports in the literature are discussed.

Female preponderance in diuretic-associated hypokalemia: a retrospective study in seven long-term care facilities.

A retrospective review of the medical records of 161 geriatric nursing-home patients receiving diuretics alone or in combination with potassium supplements or potassium sparing-diuretics revealed a 13.7 per cent overall prevalence of hypokalemia. The prevalence of hypokalemia in patients receiving diuretics alone, diuretics with potassium supplements, and potassium-sparing diuretics with kaliuretic diuretics were similar. However, there was a significantly higher prevalence of hypokalemia in women (16.4 per cent) compared with men (3.0 per cent), P less than 0.05. In patients taking non-chloride salts of potassium, there was a significantly higher prevalence of hypokalemia than in those taking the chloride salt (3.6 per cent vs. 8 per cent, P less than 0.025). Seven per cent of patients taking diuretics with potassium supplements and 11.5 per cent of patients taking potassium-sparing diuretics had hyperkalemia. Thus, although many elderly women taking diuretics may have hypokalemia routine potassium supplementation for all non-digitalized geriatric patients receiving diuretics does not seem to be indicated.

Pharmaceutical services for skilled nursing facilities in compliance with federal regulations.

A program of providing dispensing, clinical and administrative pharmaceutical services to three skilled nursing facilities is described. Medications are provided to patients from a community pharmacy through a centralized unit dose drug distribution system. Features of the system include pharmacy review of the physician's original order, medication histories obtained by a pharmacist, patient medication profiles, and a 24-hour exchange of drug cabinets containing individual patient drawers. The time requirements for administrative and clinical functions, and the calculation of a fee for these services, are described. Over a four-year period, the average number of medications per patient was reduced from 7.7 to 6.1. Two factors believed to be related to this reduction are an effective automatic stop order policy and careful review of patient medication profiles by the pharmacist.