Carl Gandola: Pharmacology

Safer warfarin?
How can we use warfarin (Coumadin) more safely and effectively? What is the best algorithm? Toronto's experience refining pharmacist-assisted warfarin protocols can shed some light.

Magnesium Sulfate and Pulmonary Edema?
A hospital in Kansas City found a 3% incidence of pulmonary edema in women given MgSO4 for preeclampsia. Women with premature labor with the same Mg serum levels during MgSO4 therapy, had no pulmonary edema. Many factors may predispose in this setting (preeclampsia as well as MgSO4 itself).

To reduce the pulmonary edema risk, they speculate that monitoring colloid oncotic pressures may signal an early need to cut back on parenteral fluids.
...A helpful study for hospitals reviewing their incidence of pulmonary edema after MgSO4.

Yeast JD, Halberstadt C, Meyer BA, Cohen GR, Thorp JA. The risk of pulmonary edema and colloid osmotic pressure changes during magnesium sulfate infusion. Am J Obstet Gynecol 1993 Dec;169(6):1566-71 (St. Luke's Perinatal Center, St. Luke's Hospital, Kansas City, Missouri)

Wireless
Still hanging in there.

Group Purchasing Organizations (GPO)

GPO's
Group Purchasing Organizations stir strong sentiments. Do they save money for the consumer and hospital? Do they restrain trade? Government oversight continues. Big GPOs and little GPOs are making their case.

Since the last posting, an even broader understanding of these issues has been created by Mercy Resource Management Incorporated links to government, media, and corporate findings.

Bar codes

Bar codes sooner or later?
More on bar codes in the news.

Drug Shortages

Drug Shortages
"No lasix?"
Next week: "Where's the solumedrol?"
...Medication shortages happen. To keep up on which and why, the FDA helps.

GPOs, GAO and NYT

GPOs, GAO and NYT
The General Accounting Office (GAO) did a pilot study of Group Purchasing Organizations (GPO's) to see if consumers benefitted--sometimes they did not. Group purchasing among hospitals can lead to efficiences that benefit the consumer. But without regulation and oversight, the consumer can be harmed by market domination and restraint of competition.

Here is the GAO report, an abstract of the New York Times coverage, and Premier's response (Premier is a GPO). The GAO report is worth reading. It reviews the history of GPOs and their special exemptions in a regulated market.

The NYT has gone on to raise questions about Premier's excess spending and potential conflicts of interest.

Activated Protein C (drotrecogin)
Also await mortality data from use of activated protein C (drotrecogin) in sepsis. Will broader use loosen criteria of sepsis diagnosis? Could alter the balance of risk/benefit.

Nesiritide
Do patients with congestive heart failure (CHF) live longer after nesiritide? Waiting for data. JAMA article showed some physiologic parameters improved compared to nitroglycerin. Dr. Mickelson has found an article claiming reduced mortality in nesiritide versus dobutamine, after six months. More to come on this.