Trends in the use of selective serotonin reuptake inhibitors in nine Department of Veterans Affairs outpatient facilities.

The average daily dose and need for dose escalations for the drugs known as selective serotonin reuptake inhibitors (SSRIs) has frequently been a point of controversy. This study reports on the information gathered from nine Veterans Affairs hospitals over a two six-month periods. Average daily doses of fluoxetine, paroxetine, and sertraline started at 30.9 mg, 24.2 mg, and 87.8 mg and ended at 28.4 mg, 24.2 mg, and 89.8 mg, respectively. Cost, number of prescriptions, and dosage strength data is also presented.

Nefazodone: single versus twice daily dose.

This pilot study involved six men with major depression treated with nefazodone dosed either twice/day or once/day at bedtime. Depression was rated before nefazodone therapy and at 4 weeks by the self-report version of the Hamilton Depression Rating Scale. A simple 10-cm visual analog side effect scale for daytime drowsiness was completed at the latter time. Dosages of nefazodone were at least 400 mg/day. The results suggest that nefazodone given once/day at bedtime may be as effective as the currently accepted twice/day regimen, with less daytime drowsiness.

Money as a tool to extinguish conditioned responses to cocaine in addicts.

Classical conditioning principles offer a nondrug way to treat cocaine dependence. Eleven male subjects with the primary diagnosis of cocaine dependence were placed into one of two groups. The experimental group was asked to handle $500 cash in a mock budgetary task. The control group was asked to just imagine handling and budgeting the money. The subjects rated their craving-related feelings before and after each task. The experimental group showed significantly more craving after the money-handling task as compared to the control group, and the scores improved with time and as more tasks were completed. These data show that craving induced by handling cash is powerful and can be attenuated, at least on a short-term basis, using classical extinction procedures.

Neuroleptic malignant syndrome associated with carbamazepine.

We have described the case of a patient who had symptoms of the neuroleptic malignant syndrome after treatment with carbamazepine. The symptoms resolved after carbamazepine therapy was stopped, which suggests carbamazepine as their cause.

A postdischarge adverse drug reaction capture mechanism using medical record technicians.

This article describes a system of adverse drug reaction (ADR) reporting implemented at WJB Dorn Veterans Affairs (VA) Hospital, Columbia, South Carolina, which involves reviewing all inpatient charts by medical record technicians for possible ADRs and notifying the chief pharmacist for investigation. Cases are assigned to a clinical or staff pharmacist who completes an ADR data collection form. All ADR forms are presented to and reviewed by the pharmacy and therapeutic committee where a decision is made on whether to forward the ADR to the U.S. Food and Drug Administration via the VA Central Office for compilation. In the program's second quarter of 1990, ADR reporting increased approximately fivefold.

Development of Pseudomonas aeruginosa resistance to norfloxacin during therapy.

Two elderly patients diagnosed with Pseudomonas aeruginosa urinary tract infections were treated with oral norfloxacin in the recommended dose of 400 mg q12h. Initially, antimicrobial susceptibility data indicated the organisms were sensitive to norfloxacin. Six to eight days into therapy urine cultures became positive for P. aeruginosa once again; this time, however, susceptibility reports indicated the organisms were now resistant to norfloxacin. Since cross-resistance among norfloxacin, other quinolones, and cephalosporins can occur, we recommend repeated urine cultures during and after norfloxacin therapy in elderly patients with complicated P. aeruginosa urinary tract infections.

Tricyclic antidepressant education program and its evaluation.

The objectives of this study were (1) to develop an individualized tricyclic audiovisual education program and (2) to compare the program's effectiveness with that of traditional education. The program is designed to increase short-term and long-term knowledge about tricyclic antidepressants and depression. The patient's dose was stabilized, and then a pretest was given. If the patient was in the study group, he received the seven-minute slide-tape program and a posttest within 72 hours. The control group received the posttest within five days of the pretest. Both groups were given knowledge tests at approximately four weeks. Statistical analysis of the data from this small study group revealed significance at the 95% confidence level for the following statement: the study group showed a greater increase in factual short-term and long-term knowledge about its tricyclic therapy as shown by differences in pretest, posttest, and scores of tests at four weeks. This study demonstrates an effective standardized alternative to traditional education which can be used to educate the majority of patients about tricyclic antidepressants and depression with a minimum time investment.

Physician and pharmacy student expectations of pharmacy practice.

This study was initiated to examine the attitudes of some of the future health care providers, family practice residents, toward various ambulatory pharmacy services. Pharmacy students were then asked to predict what the resident attitudes would be and the results were compared. This project addressed the following questions: (i) What are the expectations of family practice residents of what today's pharmacists should be doing? and (ii) How accurately can pharmacy students judge what the responses of the residents will be? The survey results indicated that the family practice residents' perceptions of certain pharmacist behaviors rated significantly higher than how the pharmacy students thought they would respond. Such behaviors included: (i) maintain and review patient profiles; (ii) counsel patients; (iii) take medication/allergy histories; (iv) provide therapeutic information to physicians; and (v) stock a wide variety of generic drugs. Most of these behaviors reflect direct involvement of the pharmacist in disseminating information to the patient and/or physician. Other expanded roles of the pharmacist such as triage, refill determination, reimbursement for consultation services, and chronic care management were given low priority.