Patient-controlled analgesia with nalbuphine during labor.

The effectiveness and safety of nalbuphine administered via the patient-controlled analgesia system were investigated in 82 parturients during labor. Comparison of nalbuphine via the patient-controlled system versus 66 control patients receiving the same drug via intermittent intravenous bolus injections revealed it to be safe and effective in both cases. Patients receiving nalbuphine by the pump had less drowsiness and were more satisfied with their analgesia than those in the control group. There were no differences in the frequency of fetal distress or in Apgar scores.

Establishment and operation of an oncology satellite pharmacy.

The justification, establishment, and operation of an oncology satellite pharmacy in a 545-bed university teaching hospital are described. The oncology satellite pharmacy was established because of concerns expressed by nurses about the potential health hazards of handling cytotoxic drug products. The satellite pharmacy, which is located near the three floors that serve the majority of the adult and pediatric oncology inpatients, is responsible for preparing all injectable cytotoxic drug products used in the institution; this includes inpatient and outpatient use. The satellite is staffed by one full-time equivalent (FTE) supervisor, two FTE staff pharmacists, and 1.4 FTE technicians. It is open nine hours a day during the week and four hours a day on weekends. Pharmacists working in the satellite prepare all cytotoxic drug products in a laminar-flow biological safety cabinet. The pharmacists also provide clinical services for oncology patients, such as monitoring drug therapy and providing drug information to patients, nurses, and physicians. The implementation of an oncology satellite has allowed this pharmacy department to expand its services and decrease the potential risks to personnel involved in preparing and administering cytotoxic drug products.

Effect of cimetidine on phenytoin serum levels.

Cimetidine, 300 mg p.o. four times a day, was administered for 5 days to nine epileptics who were stabilized while receiving phenytoin. Five patients had statistically significant increases in phenytoin serum levels, including two who became clinically toxic. One patient had a statistically significant decrease in phenytoin serum concentration. A relationship was not found between cimetidine levels and change in phenytoin serum levels. Cimetidine can cause significant changes in phenytoin serum levels which may be manifested clinically.

Involvement of a state society of hospital pharmacists in third-party reimbursement for nondistributive services.

The investigation by a state society of hospital pharmacists of the possibilities for third-party reimbursement for nondistributive services is described. A questionnaire was sent to all hospitals in the state to determine what nondistributive services were being performed that might qualify for third-party reimbursement. A committee was established to investigate what nondistributive services were being reimbursed separately and which nondistributive services had reimbursement potential, and to establish guidelines that hospitals might use in seeking reimbursement for these services. Of 150 hospitals in the state, 71 returned the questionnaire and 44 (62%) of those hospitals indicated that they offered at least one nondistributive service, but only two reported that they were receiving reimbursement. The committee found that there are two reimbursement mechanisms available to cover cost of nondistributive services: (1) direct billing of the third parties for the individual service, or (2) inclusion of the cost of the service with patient charges for drugs. After meeting with Blue Cross & Blue Shield, the major third-party payer in its state, the committee determined that BC & BS would reimburse the institution for the costs incurred in patient-care services plus an additional 13% overhead fee. In general, the cost of providing the nondistributive service should be reflected in the cost of the pharmacy operating budget, and reimbursement is made to the hospital rather than to the direct provider of the service. A statewide effort can help establish reimbursement procedures for nondistributive services and prevent duplication of efforts by individual institutions investigating reimbursement.

Hepatitis and hemolytic anemia associated with methyldopa therapy.

The reported incidences of methyldopa-induced hepatitis and hemolytic anemia is notably small; however, practitioners should be aware of its association with these disorders. The mechanisms responsible for these adverse reactions have not been fully explained, but possible multisystem involvement is being recognized. Although the number of reported cases of hepatitis and AIHA seen concurrently in patients on methyldopa is few, one should recognize that the potential for such association does exist. The presence of a single system disorder should alert the practitioner to monitor for other disorders that may result from methyldopa therapy.

Pharmacokinetic principles in relation to serum drug sample collections.

Pharmacokinetics is a relatively new field in the health sciences. It is receiving more interest and utilization as patients' serum drug levels are being correlated with clinical response and drug side effects and toxicities. Many variable factors influence serum drug levels, consequently affecting the interpretation of these levels and possibly altering therapy. We discuss some of these variables in relation to proper timing for serum sampling, and suggest times for peak level serum sampling of some commonly monitored drugs.