Recombinant hemopoietic growth factors: comparative hemopoietic response in younger and older subjects.

OBJECTIVE: To study the effectiveness of hemopoietic growth factors in older patients. DESIGN: Literature review. All articles published in English language between 1987 and 1990 were reviewed. Those reporting studies without age limits as entry criteria and describing the effects of growth factors in individual patients were suitable for analysis. Bone marrow transplantation related articles were excluded. MAIN OUTCOME MEASURES: The meanfold increase of granulocytes for Granulocyte-Colony Stimulating Factor, Granulocyte Macrophage-Colony Stimulating Factor, and Interleukin 3 and of hemoglobin for erythropoietin were compared in subjects younger and older than 65, by Mann-Whitney U test. RESULTS: Of 68 studies, 23 were suitable for analysis. These included patients with myelodysplastic syndromes, aplastic anemia, chemotherapy-induced myelosuppression, chronic granulocytopenia, anemia, and myelosuppression of malignancies and of chronic disease. Of 204 patients, 67 were 65 years of age or older and 42 were over 70. No difference was seen in meanfold increase of granulocyte and hemoglobin in time of response to growth factors or in response in presence of an absolute neutrophil count lower than 1000/microliters between younger and older patients. CONCLUSION: Early response to hemopoietic growth factors appears well maintained with advanced age. Prospective studies of the prolonged effects of these factors in older and younger patients are needed.

A standardized parenteral nutrition solution: prescribing, use, processing, and material cost implications.

The influence of a standardized parenteral nutrition solution (TPN) on prescribing patterns, use, preparation time, and material costs was studied. The percentage of patients receiving the standardized TPN was derived from a 5-month utilization study. A retrospective chart review evaluated 50 patients receiving nonstandardized TPN (Group I) and 48 patients receiving standardized TPN (Group II). A stopwatch motion study of the IV admixture service evaluated processing and compounding time. Material cost savings resulting from standardized TPN use was evaluated. Order changes in Group I patients occurred on the average of once every 3.4 days. Alterations in electrolyte composition accounted for 73% of order changes. Prescribing error frequency was 9.3% in Group I patients. After implementation of the standardized TPN solution, 73% of patients receiving TPN during the study period were prescribed the standardized solution. Prescribing error frequency was 0% in Group II patients. The standardized TPN solution decreased processing and compounding time by 55% (p less than 0.01) and decreased material cost by 19%. Although some patients require individualized solution formulae, a majority of adult patients tolerate standardized TPN without adverse metabolic complications. A standardized TPN solution can decrease processing and compounding time, favorably affect prescribing patterns, and lower solution costs without adversely affecting patient safety.

Oral sulfonylureas for the treatment of type II diabetes: an update.

Oral hypoglycemic agents have been in clinical use since 1956 in the United States. Two new second-generation sulfonylureas, glipizide and glyburide, have been marketed recently. This article reviews the pharmacology of the oral sulfonylureas, compares the drugs from a safety and efficacy standpoint, and provides updated information regarding their use in the management of type II non-insulin-dependent diabetes mellitus.

Clinical evaluation of the Abbott TDx fluorescence polarization immunoassay analyzer.

The Abbott TDx fluorescence polarization immunoassay (FPIA) system was evaluated and compared with well-established enzyme multiplied immunoassay technique (EMIT) and radioimmunoassay (RIA) methods utilizing five high-volume drug assays including theophylline, gentamicin, phenytoin, phenobarbital, and digoxin. These drug assays were evaluated for precision, calibration stability, specificity, and accuracy. Within-run precision studies utilizing control samples (n = 20) in the subtherapeutic, therapeutic, and toxic ranges resulted in coefficients of variation (CV) of less than 4.0% for the theophylline, gentamicin, phenytoin, and phenobarbital assays and of less than 9.5% for the digoxin assay. Between-run precision studies based on an initial TDx calibration curve over a 2-3 week period yielded CVs of less than 8% for all five drug assays. Cross-reactivity of the FPIA gentamicin assay with concurrently used aminoglycosides such as tobramycin and amikacin was less than 0.1%, and interference due to hemolysis and lipemia was negligible. Highly icteric specimens resulted in clinically significant decreases in theophylline and phenytoin concentrations, but this problem can be corrected by subtraction of blank intensity values. Comparison of the FPIA method with the EMIT and RIA methods indicated an extremely good analytical correlation (r greater than 0.97) for all five comparisons. The Abbott TDx FPIA system offers significant advantages in calibration and reagent stability, and greater sensitivity in the low drug concentration ranges while maintaining accuracy and precision comparable with those of established EMIT and RIA procedures.

Penicillin skin test kits prepared by pharmacy service.

Penicillin skin tests are of value in detecting patients at risk of experiencing an immediate or accelerated hypersensitivity reaction. This paper briefly reviews the immunologic aspects of penicillin hypersensitivity, the indications and procedure for using penicillin skin tests, and the interpretation of skin test results. A pharmacy-prepared skin test kit is also described. The penicillin skin test kit can facilitate the proper use of penicillin test reagents.

Evaluation of gentamicin pharmacokinetics during peritoneal dialysis.

The pharmacokinetics of gentamicin were examined in two functionally anephric patients undergoing peritoneal dialysis (PD). Peritoneal dialysis effectively decreased the gentamicin half-life (t1/2 beta) by 73 and 78% while increasing total body clearance [QB(ml/min/kg] of gentamicin 4.3- and 3.4-fold. The appreciable variability in gentamicin pharmacokinetics among renal failure patients being peritoneally dialyzed may necessitate dosage adjustments based on rapid and accurate measurement of serum gentamicin concentrations.