A review of the National Formulary, Ninth Edition 1950.
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The preliminary experience of the drug information service of the Department of Veterans Affairs (VA) central office is described. The drug information service assists the drug and pharmaceutical product management section of the pharmacy service for the VA central office. The purpose of the drug information service is to promote efficacious drug therapy while meeting cost containment goals for pharmaceutical products. The pharmacist coordinator of this service has experience in both patient care and drug information service. The drug information service is involved in the following activities: (1) making recommendations for contract bidding on therapeutically equivalent products, (2) identifying prescription duplication within the system, (3) reporting product defects, (4) planning drug procurement in unique situations, such as during war, (5) developing gender-specific therapy, (6) evaluating the appropriateness of brand-name-only purchasing of certain products, (7) evaluating new drug products, (8) compiling national drug-use data, and (9) projecting drug price increases. The VA drug information service has diverse responsibilities meant to optimize drug therapy and reduce pharmacy costs in the VA health-care system.
Formulary recently conducted a survey of 2,000 of its readers to uncover what forces are at play in their formulary decision-making processes. Topics included general philosophies toward formulary decision making, philosophies toward adding and deleting products, influences on the process, trends related to product reviews, formulary management strategies, drug information educational strategies, and new approaches to the formulary decision-making process. Some 295 surveys (14.75%) were returned. Highlights and analyses of the survey findings are presented for your review and comparison with your practice setting's approaches.
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The clinical use of clozapine and risperidone is reviewed. Traditional antipsychotic drugs are effective for treating the positive symptoms of schizophrenia but have little or no effect on the negative symptoms of this disease. Newer antipsychotic agents, such as clozapine and risperidone, are effective for treating both positive and negative symptoms in acutely ill and treatment-resistant patients. Clozapine and risperidone also have a lower incidence of extrapyramidal symptoms (EPS) than traditional antipsychotic drugs. Three hypotheses have been proposed to account for the newer agents' ability to relieve negative symptoms: (1) Improvement in negative symptoms may be linked to improvement in positive symptoms. (2) Negative symptoms may improve in the absence of the EPS often caused by traditional agents. (3) The newer antipsychotic agents may directly affect the neural circuits that trigger negative symptoms.
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Terfenadine is an antihistamine recently approved for use in the U.S. Terfenadine possesses a unique chemical structure when compared with other antihistamines. It is a selective inhibitor of H1-receptors with little or no anticholinergic, antiserotoninergic, or antiadrenergic effects. Comparative studies have shown that terfenadine is as effective as other antihistamines in the treatment of allergic rhinitis and other hypersensitivity conditions. This drug produces a minimal amount of central nervous system (CNS) depression, which is documented by studies demonstrating that terfenadine and its metabolites do not readily pass into the CNS and have little affinity for central H1-receptors. The lack of CNS depression and anticholinergic effects, and the long duration of action that allows twice-a-day dosing make terfenadine an attractive alternative to other antihistamines.
OBJECTIVE: To describe the pharmacology, pharmacokinetics, efficacy, and safety of tenecteplase in reducing mortality associated with acute myocardial infarction (AMI). DATA SOURCES: Published articles were identified from MEDLINE (from 1966 to December 2000) and Current Contents (all sections) searches. STUDY SELECTION AND DATA EXTRACTION: Dose-ranging and pivotal studies were included for analysis in the clinical trials section. DATA SYNTHESIS: Tenecteplase is a third-generation thrombolytic indicated for the reduction of mortality associated with AMI. Tenecteplase has a longer half-life that allows for single-dose, intravenous bolus administration. Data from clinical trials support that tenecteplase is similar to alteplase in reducing 30-day mortality rates in patients who have had an AMI. In the ASSENT-2 (Assessment of the Safety and Efficacy of a New Thrombolytic) trial, patients treated with tenecteplase required fewer blood transfusions and experienced fewer episodes of noncerebral bleeding compared with those treated with alteplase. CONCLUSIONS: Tenecteplase is an effective thrombolytic agent for the treatment of AMI. It can be given as a single weight-based dose; however, it appears to offer no significant advantage over other agents in terms of its efficacy or rate of intracranial hemorrhage.
Americans sometimes pay a premium price for brand name drugs when lower - priced products that are "therapeutically equivalent" are available. Two lanmark projects recently unveiled by the Department of Health, Education, and Welfare and the Federal Trade Commission may help consumers save money on the prescription drugs they buy.
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