Thyroid hormone replacement.

Various aspects concerning the practical application and forensic interpretation of data obtained by saliva drug testing and drug monitoring from the skin surface are discussed. Basic information on the composition of saliva and skin secretions and their particular transport mechanisms, as far as known, are given. For drugs of abuse secretion into saliva is suggested to be by passive diffusion and to depend on lipid solubility, pKa, plasma protein binding and on the pH of saliva. Drug molecules from blood are considered to reach the skin surface by various routes such as by sweat and sebum as well as by inter- and/or transcellular diffusion. The role of the stratum corneum as a temporary drug reservoir exceeding positive drug findings in urine is outlined. Current data on opioids, cocaine metabolites, cannabinoids and amphetamines detected in saliva and on the skin surface are reviewed. Aspects of collection, processing and analysis of the samples for implementation in roadside testing are addressed. The requirement of test sensitivity covering the broad concentration ranges and the importance of test specificity bearing in mind that the parent drug is the main analyte present in those specimens is stressed. Theoretical and practical findings on frequently abused drugs are discussed with regard to the possibilities and limitations of drug monitoring from saliva and perspiration to support a suspicion of actual or recent drug administration.

Drug Monitoring↗

PubMed1999

Perceived problems of pharmacotherapy: a problem detection study among physicians and nurses at a Swedish university hospital.

As a first step toward obtaining quality assurance regarding use and handling of drugs at Malmö University Hospital, a problem detection study (PDS) was performed, drug related problems being collected from nurses, physicians and pharmacists. Problem questionnaires relevant for physicians (67 items) and nurses (82 items) were prepared and sent to chief physicians and head nurses for distribution to colleagues. The problems identified covered all aspects of drug use and handling such as availability, prescription, dispensing, information and monitoring. Fifty-six per cent (79/141) of the physicians and 68 per cent (88/130) of the nurses responded. The main problems were related to information, chart order sheets and follow up. The item 'Uncertain whether patients take their medicine correctly after discharge' scored highest among physicians. The two main problems for the nurses were that 'newly licensed drugs and drugs used on a named-patient basis are not included in FASS' (the Swedish national formulary). The problem detection technique proved useful for the identification of drug-related problems, and the results will provide a basis for further improvement in quality assurance in pharmacotherapy at the hospital.

Drug Monitoring↗