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B WI U N Y TE G e in E R se U R rt I D ’S af te E r pa
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The Pharmacist’s News Source
pharmacypracticenews.com
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Volume 38 • Number 12 • December 2011
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Stories of Success In Cutting Costs Yet Preserving Value
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s hospitals continue to pinch pennies, strategies that minimize waste and length of stay, while maximizing reimbursements and a pharmacist’s documented value, are crucial to the future of pharmacy practice. This was the message of several initiatives reported by health systems in 2011, each providing evidence that every dose, day and dollar can make a difference. The fact that hospitals are actively seeking ways to find more cost efficiencies in today’s practice model is not surprising to Robert T. Adamson, PharmD, corporate vice president of clinical pharmacy systems at Saint Barnabas Health Care System, in West Orange, N.J. “More than ever, pharmacy is under scrutiny,” Dr. Adamson said. “Since a hospital pharmacy
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see CUTTING COSTS, page 32
Serotonin Syndrome, Linezolid Alert Poses Challenge in MRSA
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he FDA is warning that linezolid use in patients receiving serotoninergic drugs may cause serotonin syndrome. An agency statement dated Oct. 20 noted that linezolid’s often forgotten monoamine oxidase inhibitor (MAOI) properties can raise serotonin levels and lead to the central nervous system complication. The restricted use of linezolid in some methicillin-resistant Staphylococcus aureus (MRSA)infected patients receiving serotoninergic drugs “poses a significant clinical conundrum and a limitation for providers,” said Romy George, PharmD, an infectious diseases clinical pharmacist at Cooper University Medical Center, in Camden, N.J. “While there are oral alternatives to linezolid for the treatment of community-acquired MRSA, alternatives for hospital-acquired MRSA need to be administered intravenously. Given that IV treatment with these agents, such as daptomycin and
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see LINEZOLID, page 14
in this issue Clinical
Practice Pearl VA strategies for meeting drug shortages head-on.
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Critical Care Two new studies of tight glucose control in the surgical ICU a mixed bag.
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Hem/Onc Pharmacy Aflibercept touted as breakthrough for colorectal cancer.
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Operations & Mgmt
Leadership in Action After 35 years, one constant: Leaders don’t succeed on their own.
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Medication Safety Practice-based research network shows its worth in drug-safety monitoring.
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Policy
Drug Costs Patient assistance programs for oncology medications.
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Drug Abuse Adolescents at high risk for prescription drug abuse.
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Continuing Medical Education
Opioid REMS in Practice: How To Measure Success See page 17.
Educational Review
Management of Warfarin Therapy Access at pharmacypracticenews.com
Is QT Prolongation a Valid Reason To Abandon Zofran? Hem/onc pharmacists caution against overreaction
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lthough the FDA is conducting a safety review of Zofran (ondansetron) because of its link to cardiac arrhythmias, some pharmacists say the drug is still useful in many patients, provided it is appropriately monitored. Ondansetron, used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy and surgery, is a serotonin type 3-receptor (5-HT3) antagonist. The FDA previously noted that ondansetron could prolong the QT interval of the electrocardiogram, which can lead to the potentially fatal heart rhythm known as torsades de pointes (TdP). In September, the agency announced it added a new warning that ondansetron should not be used in patients with congenital long QT syndrome because these patients are at particular risk for developing TdP. (Previous versions of the labels for ondansetron included a warning about QT interval prolongation.) The FDA also added recommendations for electrocardiogram monitoring in patients with electrolyte abnormalities, congestive heart failure and bradyarrhythmias, or in patients taking other medications that can
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see QT Prolongation, page 28
Breakpoints to MICs Help Hone Pseudomonas aeruginosa Therapy Pittsburgh—Selecting the most appropriate antibiotic therapy can be a challenge when it comes to empirical treatment for severe, multidrugresistant infections, such as those caused by Pseudomonas aeruginosa. At the University of Pittsburgh Medical Center, clinical pharmacists bolstered the odds of success against likely P. aeruginosa infec-
New Product
tions by devising a combination antibiogram that applied pharmacodynamic (PD) breakpoints to minimum inhibitory concentration (MIC) distributions for a range of commonly used antibiotics. Inclusion of PD breakpoints led to “substantial changes” in antibiotic treatment
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see BREAKPOINTS, page 14
The Book Page
AHP expands its line of unit-dose medications.
Pharmacotherapy Handbook, Eighth Edition
See page 40.
See page 41.
Barbara Wells, Joseph DiPiro, Terry Schwinghammer, Cecily DiPiro