Linguistic Analysis of Generic-Generic Drug Name Pairs Prone to Wrong-Drug Errors for which Tall-Man Lettering is Recommended.

OBJECTIVE: The Institute for Safe Medication Practices (ISMP) and the United States Food and Drug Administration (FDA) disseminated widely used lists of drug name pairs involved in wrong-drug errors, for which they recommended tall-man lettering (TML). Linguistic similarity is believed responsible for confusion of these drugs. This study aims to quantify linguistic similarity and other linguistic properties of these generic-generic name pairs. METHODS: The FDA's Phonetic and Orthographic Computer Analysis (POCA) software was used to generate numerical similarity scores for the generic-generic name pairs on these lists and to identify conflicts between these names and the names of other marketed products. Within each pair, differences in name length and the number of identical prefix (initial) letters and suffix (final) letters were determined. RESULTS: The selected pairs shared a mean of 2.5 (± 1.8) identical prefix letters and 3.2 (± 2.9) identical suffix letters. The mean POCA score 69.5 (± 9.7), indicated moderate-to-high similarity. POCA scores for individual pairs ranged from 90 (most similar) to 46 (least similar). Individual names averaged 11.2 (± 9.1) high-similarity conflicts with names of other marketed drugs. CONCLUSIONS: POCA analysis could be a valuable tool in determining whether linguistic similarity contributes to specific wrong-drug errors. The finding of 11.2 (± 9.1) high-similarity conflicts with names of other marketed drugs is more than for candidate names USAN accepts and suggests the names on the FDA and ISMP lists are linguistically problematic.

How Do Drugs Get Named?

Since the 1960s, the United States Adopted Names Program has been assigning generic (nonproprietary) names to all active drug ingredients sold in the United States. Pharmaceutical names are assigned according to a scheme in which specific syllables in the drug name (called stems) convey information about the chemical structure, action, or indication of the drug. The name also includes a prefix that is distinct from other drug names and that is euphonious, memorable, and acceptable to the sponsoring pharmaceutical firm. Drug names are the product of complex, multiparty negotiations in which the needs and desires of various stakeholders (patients, pharmaceutical firms, physicians, pharmacists, other health care professionals, and US and international regulators) must be balanced.

Tetranuclear and Pentanuclear Vanadium(IV/V) Carboxylate Complexes: [V(4)O(8)(NO(3))(O(2)CR)(4)](2-) and [V(5)O(9)X(O(2)CR)(4)](2-) (X = Cl(-), Br(-)) Salts.

The syntheses and properties of tetra- and pentanuclear vanadium(IV,V) carboxylate complexes are reported. Reaction of (NBzEt(3))(2)[VOCl(4)] (1a) with NaO(2)CPh and atmospheric H(2)O/O(2) in MeCN leads to formation of (NBzEt(3))(2)[V(5)O(9)Cl(O(2)CPh)(4)] 4a; a similar reaction employing (NEt(4))(2)[VOCl(4)] (1b) gives (NEt(4))(2)[V(5)O(9)Cl(O(2)CPh)(4)] (4b). Complex 4a.MeCN crystallizes in space group P2(1)2(1)2(1) with the following unit cell dimensions at -148 degrees C: a = 13.863(13) Å, b = 34.009(43) Å, c = 12.773(11) Å, and Z = 4. The reaction between (NEt(4))(2)[VOBr(4)] (2a) and NaO(2)CPh under similar conditions gives (NEt(4))(2)[V(5)O(9)Br(O(2)CPh)(4)] (6a), and the use of (PPh(4))(2)[VOBr(4)] (2b) likewise gives (PPh(4))(2)[V(5)O(9)Br(O(2)CPh)(4)] (6b). Complex 6b crystallizes in space group P2(1)2(1)2(1) with the following unit cell dimensions at -139 degrees C: a = 18.638(3) Å, b = 23.557(4) Å, c = 12.731(2) Å, and Z = 4. The anions of 4a and 6b consist of a V(5) square pyramid with each vertical face bridged by a &mgr;(3)-O(2)(-) ion, the basal face bridged by a &mgr;(4)-X(-) (X = Cl, Br) ion, and a terminal, multiply-bonded O(2)(-) ion on each metal. The RCO(2)(-) groups bridge each basal edge to give C(4)(v)() virtual symmetry. The apical and basal metals are V(V) and V(IV), respectively (i.e., the anions are trapped-valence). The reaction of 1b with AgNO(3) and Na(tca) (tca = thiophene-2-carboxylate) in MeCN under anaerobic conditions gives (NEt(4))(2)[V(4)O(8)(NO(3))(tca)(4)] (7). Complex 7.H(2)O crystallizes in space group C2/c with the following unit cell dimensions at -170 degrees C: a = 23.606(4) Å, b = 15.211(3) Å, c = 23.999(5) Å, and Z = 4. The anion of 7 is similar to those of 4a and 6b except that the apical [VO] unit is absent, leaving a V(4) square unit, and the &mgr;(4)-X(-) ion is replaced with a &mgr;(4),eta(1)-NO(3)(-) ion. The four metal centers are now at the V(IV), 3V(V) oxidation level, but the structure indicates four equivalent V centers, suggesting an electronically delocalized system. Variable-temperature magnetic susceptibility data were collected on powdered samples of 4b, 6a, and 7 in the 2.00-300 K range in a 10 kG applied field. 4b and 6a both show a slow increase in effective magnetic moment (&mgr;(eff)) from approximately 3.6-3.7 &mgr;(B) at 320 K to approximately 4.5-4.6 &mgr;(B) at 11.0 K and then a slight decrease to approximately 4.2 &mgr;(B) at 2.00 K. The data were fit to the theoretical expression for a V(IV)(4) square with two exchange parameters J = J(cis)() and J' = J(trans)() (H = -2JS(i)()S(j)()): fitting of the data gave, in the format 4b/6a, J= +39.7/+46.4 cm(-)(1), J' = -11.1/-18.2 cm(-)(1) and g = 1.83/1.90, with the complexes possessing S(T) = 2 ground states. The latter were confirmed by magnetization vs field studies in the 2.00-30.0 K and 0.500-50.0 kG ranges: fitting of the data gave S(T) = 2 and D = 0.00 cm(-)(1) for both complexes, where D is the axial zero-field splitting parameter. Complex 7 shows a nearly temperature-independent &mgr;(eff) (1.6-2.0 &mgr;(B)) consistent with a single d electron per V(4) unit. The (1)H NMR spectra of 4b and 6a in CD(3)CN are consistent with retention of their pentanuclear structure on dissolution. The EPR spectrum of 7 in a toluene/MeCN (1:2) solution at approximately 25 degrees C yields an isotropic signal with a 29-line hyperfine pattern assignable to hyperfine interactions with four equivalent I = (7)/(2) (51)V nuclei.