Clinical outcome and adverse effect profile associated with concurrent administration of alprazolam and imipramine.

Clinical outcome and adverse effects associated with concurrent alprazolam and imipramine administration were studied in 29 patients with major depressive disorder who completed a 6-week trial in which they served as their own controls. Alprazolam was added on Day 8 in gradually escalating, then gradually tapering dosages while imipramine dosages remained unchanged. Significant decreases were observed in scores on the Hamilton Rating Scales for Depression and Anxiety at all later evaluation days with Day 8 as baseline. The mean total Symptom and Side Effects score decreased significantly from Day 8 to Day 22 when alprazolam doses were 1 mg q.i.d. For most side effects, total number of reports remained constant or decreased from Day 1 to later evaluation days. Standing diastolic blood pressures were significantly lower on Day 22 than on Day 1. No significant relationship was found between any rating scale score and plasma concentration data.

Evaluating the impact of education by a clinical pharmacist on antibiotic prescribing and administration in an acute care state psychiatric hospital.

An antibiotic utilization review program was implemented by a clinical pharmacist in an acute care state psychiatric facility. Antibiotic utilization was concurrently audited in 61 antibiotic orders, written for 48 patients, in order to determine antibiotic prescribing and administration practices and problems. Interventions, consisting of educational presentations, problem-solving meetings, and distribution of written educational materials, were provided by a clinical pharmacist to improve antibiotic prescribing and administration practices. A second audit of 68 antibiotic orders written for 47 patients was concurrently audited after completion of the interventions. When prescribing problems were detected, the clinical pharmacist made recommendations to the prescribing physician. Statistically significant changes in the use of culture and sensitivity tests, appropriate dosage regimens, correct antibiotic administration, and selection of cost-effective therapy were found after all educational interventions were provided. A positive trend not resulting in statistical significance was noted for documentation of infectious disease and selection of appropriate antibiotic agents. This study demonstrates a drug utilization review role for clinical pharmacist's involvement in the acute care psychiatric facility, and illustrates one method by which clinical pharmacists can provide educational programs to improve nonpsychotropic drug prescribing and administration in this setting.

Level of pharmacy practice and job satisfaction of adult clinical and psychopharmacy pharmacists.

Two hundred fifty questionnaires were mailed to randomly selected members of the Psychopharmacy Special Interest Group (PS) and Adult Clinical Special Interest Group (ACS) of the American Society of Hospital Pharmacists. Questionnaires were designed to demographically characterize each group and compare levels of job satisfaction, job characteristics, sources of conflict, and levels of practice in pharmacy-based, clinical, educational, and administrative activities. Both groups were found to be slightly satisfied to satisfied with their jobs. PS members were significantly more satisfied than ACS members with the amount of visible impact their work had on their patients. Administrators and physicians were the greatest source of conflict for both groups. Individual job satisfaction items that correlated most strongly with overall job satisfaction were opportunity to do something meaningful, degree of job challenge, and opportunity to utilize skills. Careful attention to these aspects of practice by skilled administrators may enhance job satisfaction in the practice areas studied.

Elevated serum bromide in patients taking lithium carbonate.

Serum bromide levels were determined for 20 patients receiving lithium carbonate for manic depressive illness. Bromides averaged 17.06 +/- 8.15 mg/dl, which exceeded the control average of 3.22 +/- 3.2 mg/dl. Elevated serum bromide in patients taking lithium may reflect altered renal function.

Trazodone (Desyrel, Mead-Johnson Pharmaceutical Division).

Trazodone is the first triazolopyridine derivative to be used clinically for the treatment of depression. It has been shown to be equal in efficacy to the tricyclic antidepressants imipramine, desipramine, and amitriptyline in the treatment of major depressive episodes. Researchers have indicated that trazodone exceeds other antidepressants in relieving anxiety, but further study is needed to confirm this effect. Trazodone has been used successfully to relieve depression in schizophrenic patients without worsening their psychotic symptoms. Trazodone blocks serotonin reuptake into presynaptic neurons with little effect on norepinephrine or dopamine. It is rapidly absorbed orally and reaches peak serum levels within two hours. Trazodone is excreted primarily as metabolites by the kidneys and possesses a biphasic elimination half-life of 4.4 hours for the first 10 hours and 7.5 hours for the next 24 hours. Trazodone 200 mg is equal to imipramine 100 mg, and the therapeutic dosage range is 200-600 mg/d. Side effects are infrequent with trazodone; its anticholinergic activity is minimal. Trazodone appears to produce less cardiovascular toxicity than tricyclic antidepressants. To date, reports of fatal overdoses are rare. Trazodone equals available antidepressant drugs in clinical efficacy, and, because it has fewer cardiovascular and anticholinergic side effects, it should prove beneficial in the treatment of depression.