Occupational exposure to anti-cancer drugs: A review of effects of new technology.

Because anti-cancer drugs are non-selective, they affect both cancerous and non-cancerous cells. Being carcinogenic and mutagenic, many anticancer drugs therefore present a major health risk to healthcare staff working with them. This paper reviews the means by which exposure to anti-cancer drugs in the workplace may be monitored, assessed and reduced. Both biological monitoring, using non-selective methods or compound-selective methods, and environmental monitoring have provided information on the nature and degree of exposure in the workplace. Pharmaceutical isolators, used for the compounding of cytotoxic IV infusions and the preparation of injectable drugs, provide a physical barrier between pharmacists and cytotoxic drugs and reduce direct exposure. However, the interior of isolators and the contents thereof (e.g. infusion bags and syringes) are readily contaminated by aerosols and spillages and afford a secondary source of exposure to pharmacists, nurses and cleaning staff. Closed system transfer devices (CSTDs), designed to prohibit the transfer of contaminants into the working environment during drug transfer between the vial and syringe, have been successful in further reducing, but not eliminating surface contamination. Given that the number of patients requiring treatment with chemotherapeutic agents is predicted to increase, further efforts to reduce occupational exposure to anti-cancer drugs, including the refinement and wider use of CTSDs, are recommended.

Improved assay for R(-)-apomorphine with application to clinical pharmacokinetic studies in Parkinson's disease.

A high performance liquid chromatographic assay for the quantitative determination of apomorphine in human plasma is described. Sample clean-up and concentration was optimised using solid-phase extraction on C18 cartridges, enabling rapid and sensitive determination of apomorphine and potential metabolites. The limit of apomorphine quantification, using fluorescence detection, was 0.5 ng/mL. The assay was stability-indicating, and allowed the detection of analytes in the presence of commonly co-administered anti-Parkinsonian drugs. Apomorphine was stable in frozen plasma containing 0.14% (w/v) ascorbic acid for 98 days, and through four freeze-thaw cycles. The assay has been used in clinical pharmacokinetic studies of apomorphine in patients with Parkinson's disease, and in preliminary studies of novel apomorphine delivery devices in volunteers.

Supplementary prescribing by pharmacists in England.

PURPOSE: The implementation of supplementary prescribing by pharmacists within primary care trusts (PCTs) and secondary care trusts (SCTs) in England was studied. METHODS: A survey was developed and sent to pharmacists in PCTs and SCTs in England who would oversee the implementation of supplementary prescribing by pharmacists. RESULTS: The response rate was 68% for both surveys. The majority of SCTs and PCTs intended to implement supplementary prescribing by pharmacists by the end of 2005 (57% and 56%, respectively). The majority of SCT respondents did not believe that it would be more difficult to recruit designated medical practitioners to supervise supplementary prescribing training for pharmacists as opposed to nurses (67%, n = 43), whereas the largest group of PCT pharmacists believed it would be (47%, n = 86). Within secondary care, the clinical areas in which pharmacists were intending to work as supplementary prescribers were those where they already had established roles. Within primary care, the main clinical areas for pharmacists were influenced by those areas in the new General Medical Services contract Quality and Outcomes Framework for general practitioners. CONCLUSION: A survey investigating the implementation of supplementary prescribing by pharmacists in England found that there were significantly more barriers to its establishment within primary care than secondary care settings. Within primary care, supplementary prescribing is being implemented to develop new services. Within secondary care, the supplementary prescribing model is more often used to legitimize services already being provided.

Physical and chemical stability of paclitaxel infusions in different container types.

OBJECTIVES: To determine the physicochemical stability of generic (Teva Pharmaceuticals) paclitaxel infusions (0.3 and 1.2 mg/mL) in 0.9% sodium chloride or 5% glucose in polyolefin (Viaflo), low-density polyethylene (Ecoflac), and glass containers at 2-8 and 25 degrees C. METHODS: Paclitaxel infusions of various concentration/diluent/container combinations were prepared. Containers were light-protected and incubated at test temperatures with further analysis at predetermined intervals of 1-3 days for up to 30 days. Infusions were monitored for pH, weight loss, precipitation, colour change, and subvisual particulates as indicators of physical stability, and assayed for drug concentration to determine chemical stability. RESULTS: Precipitation was the limiting factor. Infusions of paclitaxel (0.3 mg/mL) in 0.9% sodium chloride remained stable for 13, 16 and 13 days at 2-8 degrees C in polyolefin, low-density polyethylene and glass containers, respectively; in 5% glucose for 13, 18, and 20 days, respectively. At 25 degrees C, paclitaxel infusions (0.3 mg/mL) remained stable for 3 days in all diluent/container combinations with the exception of 5% glucose in glass, where stability reached 7 days. Paclitaxel infusions (1.2 mg/mL) in 0.9% sodium chloride remained stable for 9, 12, and 8 days at 2-8 degrees C in polyolefin, low-density polyethylene and glass containers, respectively; in 5% glucose for 10, 12, and 10 days, respectively. At 25 degrees C, paclitaxel 1.2 mg/mL remained stable for 3 days in all diluent/container combinations with the exception of glass, where stability reached 5 days in 0.9% sodium chloride diluent, and 7 days in 5% glucose. CONCLUSION: Paclitaxel stability was influenced by storage temperature, with longer shelf-life at 2-8 degrees C, and also by drug concentration, where 0.3 mg/mL infusions were more stable than 1.2 mg/mL for all diluent/container combinations. Physical stability (precipitation) was the limiting parameter in each case.

Risks and concerns about supplementary prescribing: survey of primary and secondary care pharmacists.

UNLABELLED: OBJECTIVE (OF THE STUDY): To provide data on the views of chief pharmacists (CPs) and primary care trust pharmacists (PCTPs) on the risks and concerns surrounding supplementary prescribing. SETTING: Secondary and primary care within England. METHOD: Postal questionnaire surveys of chief pharmacists and primary care trust pharmacists. MAIN OUTCOME MEASURE: Significance of the association between the extracted factors. RESULTS: The response rate was 68% for both the primary care (183/271) and secondary care surveys (97/143). The survey tool was subjected to factor analysis and reliability testing. For both sectors, the three factors that were extracted described concerns over the training model for supplementary prescribing, concerns about the professional competency/responsibility of the supplementary prescribers once trained, and positivity about the implementation of supplementary prescribing. For both sectors, as trusts have more experience of supplementary prescribing by nurses, the respondents had less concerns about the supplementary prescribing training model. For secondary care, as the total number of pharmacists employed within the trust increases, the respondents had less concerns over the limitations of the supplementary prescribing training model. CONCLUSION: Although both sectors have concerns over the training model for supplementary prescribing and also professional competence and responsibility once trainees qualify, there is overall a positive attitude towards supplementary prescribing and there is a belief that pharmacists wish to take this role on.

Studies on the decontamination of surfaces exposed to cytotoxic drugs in chemotherapy workstations.

OBJECTIVE: The aim of this study was to examine the removal and deactivation of cytotoxic contamination from surfaces of a pharmaceutical isolator workstation. METHODS: Three marker cytotoxic drugs were evaluated in three phases using decontamination technologies currently available in the pharmaceutical and healthcare environments. Phase I investigated the physical removal of contamination by detergents. Phase II and III investigated the effectiveness of detergents and Vaporised Hydrogen Peroxide (VHP) in degrading cytotoxic drugs, respectively. RESULTS: 5-Flurouracil, doxorubicin and cyclophosphamide were removed from a surface by wiping with detergents. VHP and alkaline detergents caused degradation of doxorubicin. The observed effect with detergent cleaning was pH dependent, but neither of the technologies applied had any effect on the chemical stability of 5-flurouracil and cyclophosphamide under the conditions tested.