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We have come across some conflicting results regarding drug incompatibilities with aminophylline IV. One pharmacist states both drugs in question (Meperidine & Promethazine) are incompatible yet another says it is ok. We are administering these two drugs via IVPush. Please give me the low-down on whether there is a incompatibility or not and if there is, is it to the extent that a totally different access should be used. (a 2nd iv/int site) (or) is it okay to stop the aminophylline pump, flush, push, flush and restart the pump. Please indicate the best way to do this and the acceptable way to do this if it is not the best way. Also, if a reaction is to occur will we see the crystallization in the tubing, cloudiness, or what? Lastly, am I right in thinking that aminophylline should be on its own pump versus piggybacking into a IV line in which the IV line is on a pump? Thanks for your help on this!!!!!

In Reply to: Aminophylline incompatibilities posted by Brenda Pangrazio on July 26, 2001 at 15:29:26:
From Gold Standard Multimedia
Aminophylline and Promethazine HCl ( PHENERGAN ) are incompatible when mixed in solution.
Crystals/haze/precipitate develops immediately in D5W and NS

Aminophylline and Meperidine HCl ( DEMEROL ) are incompatible when mixed in solution.
The products are Physically incompatible

Promethazine HCl ( PHENERGAN ) and Meperidine HCl ( DEMEROL ) are compatible when mixed in a syringe.
The products are Physically compatible for at least 15 to 30 minutes.

Note: There is conflicting reports with meperidine and aminophylline: Trissels states that they are compatible...

Anybody got any info about 12-hour interval schedule for metronidazole?

In Reply to: Metronidazole dosing interval posted by Kenneth on July 27, 2001 at 01:14:00:

Regimens approved by the FDA are either q8h or q6h. Patients who are in renal failure (crcl < 10 ml/min) should also receive the drug at a standard interval (every 6 or 8 hours), however the dose should be reduced by 50%. There have been some Non-FDA approved uses of metronidazole that utilized a q12h interval. An example would be for the treatment of alcoholism (metronidazole has a mild "antabuse-like" effect). Effectiveness: equivocal.

Posted by Kenneth on August 28, 2001 at 04:41:19:
In Reply to: Re: Metronidazole dosing interval posted by D. McAuley on July 27, 2001 at 22:18:00:

Bearing in mind the Pharmacokinetics of Metronidazole..biological t1/2 about 10-12 hours, wouldn't a 12 hour interval be good enough?

Any experience with running TPN through a dialysis catheter during dialysis

In Reply to: intra-dialytic TPN posted by N Carace on July 27, 2001 at 11:26:12:

The following website RenalWeb has a discussion board monitored by industry professionals. I saw one response concerning eating during dialysis which was a gray area.
http://www.renalweb.com
Hope this helps.

Any information on folic acid (IV) stability alone in D5W or NS or with MVI+Thiamine+folic acid in IVF?

In Reply to: stability posted by SHASHI SHANI on July 30, 2001 at 11:43:10:
A query of Medline using FOLIC ACID and STABILITY
brought 243 article abstracts. Several of them looked promising but I do not have access to the complete articles.

Which hypertensive medication has the least incident of impotence as a side effect?

In Reply to: hypertensive drugs and impotence posted by Anna Potter on July 30, 2001 at 14:46:52:

Incidence is usually < 1 percent with calcium channel blockers or ace-inhibitors. Avoid if possible the following medications (incidence of impotence or sexual dysfunction may approach 10 percent): Beta Blockers; Alpha Adrenergic Antagonists: e.g. doxazosin (Cardura), or terazosin (Hytrin); Diuretics: thiazides etc.;
: Centrally acting alpha adrenergic agonists: Methyldopa (Aldomet), Reserpine;
: Central adrenergic agonist -Clonidine (Catapres). Some studies have found that using lower doses and a combination of medications may reduce the incidence of impotence as a side effect. This is an important distinction because some combinations have been found to have a greater impact on mortality rates(decreased mortality rate): example: low dose beta-blocker + diuretic (risk of impotence is usually < 2 percent).

I was wondering if any other pharmacist ever come across the The Enneagram and have used it in their counseling with patients.

In Reply to: The Enneagram posted by Stephan Bajon on July 31, 2001 at 20:07:56:
In todays retail pharmacy environment, there is still a disproportionate amount of time spent in drug delivery/dispensing compared to the provision of couseling services. The impact of automation (e.g. computer generated drug info sheets etc) has also reduced the need for face-to-face counseling. I do not feel that there is adequate time in such a setting to develop counseling tools based on the concepts of the enneagram. Similar barriers also exist in the hospital setting..... What do you think?

Posted by John C. Batulis on August 04, 2001 at 09:43:30:

In Reply to: Re: The Enneagram posted by D. McAuley on August 01, 2001 at 08:27:12:

Maybe, this Senate Bill 974 will help.
Medicare Pharmacist Services Act of 2001 S.974
http://thomas.loc.gov/cgi-bin/query/z?c107:S.974:

How long the reconstituted solution of pamidronate can be stored (as per available ref. can be stored for 24hrs. under refrigerator)with out effecting its stability & activity. We stock 90mg vial, and when a pediatric dose of 0.5mg/kg/d is to be dispensed ONE vial of 90mg is wasted.

In Reply to: Stability of reconstituted inj. Pamidronate posted by naushadali on August 05, 2001 at 05:12:56:

There is also a 30mg vial available from
Novartis..Comes packed with 4 vials...The stablity
is 24 hours however by using the 30mg vial you
would not waste a 90mg vial..
NDC:0083-2601-04

Posted by John C. Batulis on August 07, 2001 at 21:47:54:

In Reply to: Stability of reconstituted inj. Pamidronate posted by naushadali on August 05, 2001 at 05:12:56:

I contacted Novartis Oncology through their internet site at http://aredia.net and basically received the same information that you already have. They apologized for having to waste the product for a pediatric dosage due instability. They did not mention whether or not there might be a pediatric dosage unit available in the future, but it probably would be a good idea to contact them in writing since other pharmacies may be having the same problem.

Posted by D. McAuley on August 05, 2001 at 09:14:16:

In Reply to: Stability of reconstituted inj. Pamidronate posted by naushadali on August 05, 2001 at 05:12:56:

I agree with the 24 hour stability.(Source: Micromedex and Package insert). By the way, did you find any additional info regarding the alteplase syringes? Also, I noticed your E-mail address is from Aramco. I was in Saudi Arabia in the early 80's. I lived in Al-khobar and worked in Dhaharan in support of the military. How long have you been there?

I am looking for patient education materials (specifically posters and videos) for educating hospitalized patients on pain management. Does anyone have any recommendations where the best place to look for these materials would be?

In Reply to: Pain Management posted by Dan Springfield, RPh on August 06, 2001 at 15:31:29:

http://www.virtual-anaesthesia-textbook.com/vat/narcotics.html

Posted by J. Adams, Pharm D. on August 07, 2001 at 04:41:09:

In Reply to: Pain Management posted by Dan Springfield, RPh on August 06, 2001 at 15:31:29:

Here is a site that should help you:

• Partners against pain..

Does anyone know what 0.45% Sodium Chloride's specific gravity?? Thank you for anyone who helped!

In Reply to: 1/2 Sodium chloride's Specific gravity? posted by Tracey Hang on August 07, 2001 at 13:14:17:

Should be very close to 1.00 eg: 1.008
Density = mass/volume.

Specific gravity = Density of substance divided by the density of h20 at specified temp. Units will cancel and since density of h20= 1.00 the specific gravity is equal to the density of a substance without units....
Density of 5% sodium chloride is 1.037