Emergency department medication and drug interaction evaluation.

The emergency department evaluation had two primary objectives: 1) to determine the accuracy of the oral medication history given at arrival at the emergency department and 2) to determine how often the emergency department physician may prescribe medications which when taken with current medications, may cause a potential drug interaction. Data were collected from 228 emergency department visits of clinic patients 65 years old and older. The average number of medications reported by the patients' medication history was 3.0 +/- 2.3 (range 0-13). The number of medications the patient "forgot" was 1.3 +/- 1.8 (range 0-9). A complete medication history was given by 50.4% of patients. There was an upward trend that correlated with an increased chance for an incomplete medication history as the total number of current medications increased. The rate of a potentially significant drug interaction between a newly prescribed medication in the emergency department and current medications was 3.4% for patients receiving a new medication.

Pharmacy participation in pharmaceutical representative displays in a large teaching hospital.

The Department of Pharmacy in a 1200-bed private teaching hospital was seeking additional ways to inform the medical staff of pharmaceutical services and decided to participate as an exhibitor in an established pharmaceutical representative display. The format for the display consisted of three different exhibitors twice weekly in a centrally located area with catering provided. Topics presented by the Pharmacy Department, bi-monthly, included patient medication teaching sheets, drug information services, drug use evaluation results, Additive Room services, formulary content and use, as well as kinetics.

Hepatic and renal contributions to valproic acid-induced hyperammonemia.

Valproic acid (VPA) consistently and reproducibly elevates arterial ammonia in rats injected with an amino acid load. The extent of the hyperammonemia is dependent on the dose of VPA injected or VPA plasma concentration and the amino acid dose. Bilaterally nephrectomized rats injected with VPA and an amino acid load also develop hyperammonemia, which overall approximates 75% of that achieved in non-nephrectomized animals. In non-nephrectomized animals injected with an amino acid load, valproic acid produces a marked reduction in baseline and activated hepatic mitochondrial carbamyl phosphate synthetase I activity. Our results suggest that VPA-induced hyperammonemia after an amino acid load results from inhibition of hepatic intramitochondrial citrullinogenesis with only a limited contribution from the kidneys.

Heparin-induced thrombocytopenia. What is its real frequency?

A prospective study of 104 patients was undertaken to determine the frequency of severe heparin-induced thrombocytopenia in patients receiving either bovine lung or porcine mucosal heparin. One of 54 patients randomized to receive bovine heparin and two of 50 patients randomized to receive porcine heparin developed heparin-induced thrombocytopenia (platelet count less than 100,000/microliters). Although three previous studies suggest a remarkably high frequency of bovine heparin-induced thrombocytopenia, or a high frequency compared to porcine heparin, our study supports other evidence that clinically important, severe heparin-induced thrombocytopenia (platelet count less than 100,000/microliters) occurs in 10 percent of patients or less receiving heparin, and that there is no significant difference of occurrence between bovine and porcine heparin.

Sodium valproate-induced hyperammonemia without clinical hepatic dysfunction.

Three adults on unrestricted protein diets receiving valproic aci (VPA) developed gastrointestinal symptoms with encephalopathy and/or deteriorating seizure control associated with arterial hyperammonemia and normal liver function tests. The signs and symptoms did not directly correlate with VPA dosage and the arterial ammonium levels did not correlate with serum VPA concentrations. Two of the three patients had phenobarbital concentrations above the therapeutic range, but remission of neurologic or gastrointestinal symptoms was dependent on a reduction of the VPA concentration. In one case, rechallenge with VPA reproduced hyperammonemia.