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The Pharmacist’s News Source
pharmacypracticenews.com
in this issue Time To Progression Front Longer in Myeloma Pts Up Capsules Taking Lenalidomide Compounding pharmacy linked to multistate ocular infections.
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Operations & Mgmt
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enalidomide maintenance therapy after initial treatment significantly prolonged progression-free survival (PFS) among patients with newly diagnosed multiple myeloma during three new randomized Phase III clinical trials. But that benefit came at the price of an increased rate of secondary cancers. Experts consider the findings a significant advance in melanoma treatment, but they acknowledge that many questions remain about what represents optimal therapy. The three studies, which were published in the May 10, 2012 online edition of The New England Journal of Medicine, are “setting the stage
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see LENALIDOMIDE, page 10
Highlighting the Good, The Bad and the Ugly Of Rx Drug Misuse Progress cited, but poor medication disposal, ‘pill mills’ still causing harm
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ith one brief anecdote about a toddler dying after exposure to a discarded fentanyl patch while visiting his grandmother in a nursing home, FDA Commissioner Margaret Hamburg, MD, crystallized the sometimes tragic consequences that can occur when safe drug disposal methods fall short. “Nobody noticed that he had stuck the patch on himself; he suffered an overdose and passed away two days later,” related Dr. Hamburg during an April press telebriefing with representatives from the Centers for Disease Control and Prevention (CDC), Drug Enforcement Administration (DEA) and Office of National Drug Control Policy (ONDCP). “As a physician, stories like this have both a professional and personal impact on me. Fentanyl patches have
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see DRUG MISUSE, page 40
40th ANNIVERSARY YEAR 1972–2012
Printer-friendly versions available online
Three trials show benefit, but secondary cancer risk triggers concern
Volu ume 39 • Number 7 • July 2012
ASHP Late-Breaker Antibiotic stewardship program emphasizes care, not cost.
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Clinical
Practice Pearls Pisa Syndrome triggered by psychoactive drugs.
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Managing cardiotoxicity from metoclopramide.
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Hem/Onc Pharmacy Same-day pegfilgrastim and cabazitaxel urged. Metronomic chemotherapy scores in breast cancer.
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Critical Care Keeping an eye on colistin at both ends of the dosing spectrum.
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Infectious Disease Switch to extended piperacillin/tazobactam infusion cuts cost.
ixty years ago, Henry Knowles Beecher, MD, and Donald Todd, MD, published a provocative study in the Annals of Surgery. The study showed that patients given neuromuscular blocking agents were six times as likely to die in recovery as those who did not receive the drugs. Most of that excess mortality resulted from respiratory events. Six decades later, shockingly little has changed. As many as 100,000 patients suffer respiratory complications and other adverse events after surgery each year in the United States because they experience residual paralysis from neuromuscular blocking agents (NMBAs), experts warn. The lack of clinical standards for monitoring post-surgery weakness means the situation is unlikely to improve anytime soon, according to Sorin Brull, MD, a professor of anesthesiology at Mayo Clinic in Jacksonville, Fla. Pharmacists who specialize in critical care and anesthesiology share Dr. Brull’s concern that the guidance gap may place patients at risk.
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Journal Scan Pharmacists’ impact on diabetes, plus a call for more autism education.
Post-Op Paralysis and NMBAs Still a Threat to Patient Safety S
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Educational Review
Emerging Therapies in the Systemic Treatment of Metastatic Melanoma See page 16
see NEUROMUSCULAR, page 31
Adding Boceprevir to Hepatitis C Therapy Deemed Practice-Changer
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oceprevir, used in combination with peginterferon and ribavirin, achieved high rates of sustained virologic response in patients with hepatitis C who failed prior treatment with peginterferon and ribavirin alone, a new study has found. The results, documented in both partial and null responders, are potentially practice-changing, according to Janet Nguyen, PharmD, BCPS, vice president
Continuing Education The unSUMMIT for Bedside Barcoding introduces online CE for BPOC. See page 44.
of network strategy, at A-Med Health Care, Huntington Beach, Calif., who was not associated with the study. “This is the first time boceprevir has shown efficacy in null responders,” Dr. Nguyen said. Such patients, she noted, “are usually unlikely to respond to retreatment with an interferon-based therapy.” The results were based on an interim analysis from PROVIDE, an ongoing,
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see HEPATITIS C, page 34
New Product Pfizer Injectables introduces cytarabine injection. See page 44.
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