Criteria-based DUE aids in selection of preferred agent.

The combination of a criteria-based drug utilization evaluation and a comprehensive drug literature review can be effectively used to reach therapeutically sound, cost-efficient formulary decisions. This report describes the approach to evaluating the available H2-receptor antagonists used by the Pharmacy & Therapeutics Committee of Memorial Medical Center, a 550-bed, community-based teaching hospital affiliated with the Southern Illinois University School of Medicine in Springfield.

Clinical strategies in drug therapy selection: an application of "counter-detailing".

These projects have realized significant control of drug costs while also serving as a basis for future project implementation. In general, communication through the P&T, medical department heads, and senior hospital administrators has positively impacted on the ability to achieve these cost savings. The forms of communication have incorporated written and posted information along with oral presentations for the purposes of enhancing positive and progressive service in the cost-efficient delivery of pharmacotherapy.

Cimetidine-associated adverse reaction.

Cimetidine, a histamine2-receptor antagonist, is used in the treatment and prophylaxis of peptic ulcer disease. Its use is relatively free of serious adverse reactions and only a few accounts of hypersensitivity exist. We report a case of intravenous cimetidine-associated adverse reaction characterized by junctional rhythm, bradycardia, and hypotension apparently not secondary to rapid intravenous cimetidine infusion. The adverse reaction was reproduced upon rechallenge. No previous accounts of this reaction appear clearly defined in the literature nor have such reactions been confirmed by rechallenge.

Dopamine versus dobutamine: are all the facts there?

During the last 5 years we believe that the prescribing of dobutamine has increased over that of the older agent dopamine. The literature reports advantages such as less tachycardia, less peripheral vasoconstriction, and fewer increases in intracardiac pressures with dobutamine as opposed to dopamine. After a thorough review of the literature, we were unable to find conclusive evidence of these initial findings, and present several studies to show potential flaws in their interpretation that may help explain the increased use of dobutamine over dopamine. The overuse of dobutamine, if it does exist, must be dealt with by pharmacy departments in an informed, yet unbiased fashion, to aid in preventing the continued escalation of health care costs.