A means of compounding dextran 70 injection labeled with technetium Tc 99m by using readily available pharmaceutical components is described, and the compound's biological distribution is evaluated. The radiopharmaceutic...A means of compounding dextran 70 injection labeled with technetium Tc 99m by using readily available pharmaceutical components is described, and the compound's biological distribution is evaluated. The radiopharmaceutical was prepared by mixing 10 mg (0.17 mL) of dextran 70 in sodium chloride with 0.33 mL of 0.9% sodium chloride injection in a 1-mL syringe. This solution was added to a sterile, pyrogen-free vial containing stannous chloride, and the steps were repeated until five vials had been prepared. The contents of each vial were mixed by swirling until the solids were dissolved. The mixture was incubated for five minutes at 22 degrees C, then 1.48 gigabecquerels of sodium pertechnetate Tc 99m injection in a volume of 0.5 mL was added to each vial. The final mixture was incubated for 15 minutes at 22 degrees C and then stored at room temperature. Thin-layer chromatography was performed after zero, three, and six hours of storage to assess radiochemical purity. Five more vials were prepared as above, and five male volunteers were given 185 megabecquerels of the radiopharmaceutical by i.v. push, and scintigraphic images of the anterior chest were taken immediately and 1, 2, and 24 hours after injection. Immediately after preparation, a mean +/- S.D. of 99.0 +/- 1.0% of the 99mTc was bound to dextran 70. Mean +/- S.D. binding was 98.1 +/- 3.7% and 95.8 +/- 7.5% at three and six hours, respectively. Scintigraphy in the five volunteers yielded high-contrast images of the cardiac blood pool with little uptake of the radionuclide by the lungs. (ABSTRACT TRUNCATED AT 250 WORDS)
The stability of esmolol hydrochloride in a variety of i.v. solutions was studied. Solutions of esmolol hydrochloride 10 mg/mL were prepared separately in 0.45% sodium chloride injection, 0.9% sodium chloride injection,...The stability of esmolol hydrochloride in a variety of i.v. solutions was studied. Solutions of esmolol hydrochloride 10 mg/mL were prepared separately in 0.45% sodium chloride injection, 0.9% sodium chloride injection, 5% dextrose injection, 5% dextrose and 0.45% sodium chloride injection, 5% dextrose and 0.9% sodium chloride injection, 5% dextrose with lactated Ringer's injection, lactated Ringer's injection, 5% sodium bicarbonate injection, and 5% dextrose injection with potassium chloride 40 meq/L. One glass and one polyvinyl chloride container of each solution (except glass only in the case of the solution in 5% sodium bicarbonate injection) were stored in the dark at 5 degrees C, under ambient room light at 23-27 degrees C, in the dark at 40 degrees C, and under intense light at 25-30 degrees C. At storage intervals up to 168 hours, samples were tested for esmolol hydrochloride concentration by high-performance liquid chromatography. Optical density and pH were also measured. Esmolol hydrochloride was stable in the various i.v. fluids for at least 168 hours when stored at 5 degrees C or 23-27 degrees C, for at least 24 hours when stored under intense light, and, with one exception, for at least 48 hours when stored at 40 degrees C. When mixed with 5% sodium bicarbonate injection, the drug was stable for only about 24 hours at 40 degrees C. There were no substantial changes in optical density or pH. The type of container had no effect on stability. With one exception, esmolol hydrochloride was stable in all the i.v. solutions under all the conditions tested.
Barr JT, Schumacher GE, Luks DB
… +1 more, Karpel J
Am J Hosp Pharm
· 1994 Nov · PMID 7856581
The relationship between theophylline-associated adverse drug reactions (ADRs) and serum theophylline concentration (STC) was studied. Patients with obstructive airway disease who received theophylline on the pulmonary w...The relationship between theophylline-associated adverse drug reactions (ADRs) and serum theophylline concentration (STC) was studied. Patients with obstructive airway disease who received theophylline on the pulmonary ward of a large urban hospital over a 10-month period were included in the study. Each patient was interviewed within two hours after collection of a sample for determining STC and, without knowing the STC, the interviewer classified each patient into one of the following categories: ADR, no ADR, or indeterminant (symptoms similar to a theophylline-associated ADR but possibly caused by concomitant drugs or comorbidities). ADRs were also classified as to their severity. The interviewer identified 340 ADRs during 201 interviews of 126 patients. All but four of the ADRs were mild. In half of the interviews, patients reported at least two concurrent ADRs. Not including the indeterminant group, ADRs occurred in 69% of the patients, a much higher frequency than previously reported. The mean +/- S.D. STCs for the ADR and no-ADR groups were 6.5 +/- 1.7 and 7.7 +/- 2.0 micrograms/mL, respectively. When the indeterminant ADRs were added to the theophylline-associated ADRs, the resulting group had a mean +/- S.D. STC of 11.5 +/- 3.3 micrograms/mL. No significant association was found between STC and occurrence of ADRs. Theophylline-associated ADRs occurred more frequently than expected at STCs within and below the usually accepted therapeutic range.
Effects of converting a free drug information service at a university medical center to a 900 telephone number are described. Calls to a university medical center drug information service had increased beyond the capacit...Effects of converting a free drug information service at a university medical center to a 900 telephone number are described. Calls to a university medical center drug information service had increased beyond the capacity of staff. A telephone survey to recent users of the service indicated that callers outside the institution would be willing to pay a fee for the service, so a 900 number was instituted for outside calls in January 1993. Staff recorded data on all questions they answered; data for 1993 were compared with those from 1992. Question volume decreased by 48% after the 900 number was instituted, with questions from outside the institution dropping by 55%, questions from outside health care professionals dropping by 72%, and questions from the lay public increasing slightly. One severe impediment to callers from local hospitals was that many hospitals block access to 900 numbers from their telephone systems. The average length of a call was three minutes and the average cost per call was $6. Net income during the first year of operation was $6698. The 900 number provided some income, but it did not completely offset operating costs. A 900 telephone number is a workable, but imperfect, method of providing drug information to outside callers. Early notification of users before implementing a 900 number is essential to allow time for them to arrange telephone access.
The extent to which clinical pharmacy services are provided in National Health Service (NHS) hospitals in the United Kingdom was studied by means of a questionnaire. Questionnaires inquiring whether and to what extent ce...The extent to which clinical pharmacy services are provided in National Health Service (NHS) hospitals in the United Kingdom was studied by means of a questionnaire. Questionnaires inquiring whether and to what extent certain clinical pharmacy services were provided were mailed to all NHS hospital pharmacies in 1992. The questionnaires also requested information about the hospital and the number and qualifications of pharmacists employed. The results were compared with those of a survey of pharmaceutical services in the United States. Of 508 questionnaires mailed, 416 usable responses were returned. Services commonly provided were inpatient drug therapy monitoring (96%), clinical trials support (92%), formulary management (89%), participation in drug and therapeutic committees (97%), and an on-site drug information center (60%). Services infrequently provided were therapeutic drug monitoring (21%), medication history-taking (16%), and a 24-hour on-site pharmacist (10%). Several services were associated with pharmacies that employed many pharmacists, pharmacists with advanced education, or specialist clinical pharmacists and pharmacies located in medical school teaching hospitals. U.K. hospital pharmacies provided fewer patient-oriented services and more drug information, therapy monitoring, and pharmacist education services than U.S. hospital pharmacies. Provision of clinical pharmacy services in the United Kingdom was associated with employment of many pharmacists, pharmacy clinical specialists, and pharmacists with advanced education.