Antiviral drugs in the immunocompetent host: part II. Treatment of influenza and respiratory syncytial virus infections.

Family physicians should be familiar with the various drugs available for treating and preventing viral infections. Part II of this two-part article focuses on agents used to manage influenza and respiratory syncytial virus. Rimantadine and amantadine traditionally have been used to prevent and treat influenza type A infections.

Antiviral drugs in the immunocompetent host: part I. Treatment of hepatitis, cytomegalovirus, and herpes infections.

Since the release of amantadine in 1966, other agents designed to fight a diverse range of viral infections have been released. Part I of this two-part article focuses on agents used to manage hepatitis, cytomegalovirus, and herpes infections. In patients with chronic hepatitis B, interferon alfa-2b or lamivudine is the treatment of choice.

Clinical and regulatory concerns in Alzheimer's disease management: role of the pharmacist.

The role of the pharmacist in managing Alzheimer's disease (AD) is discussed. Health-system pharmacists can play a critical role in the management of AD, provided they remain up-to-date on new drug therapies, recent clinical findings, and educational resources for caregivers and families. Pharmacists in a long-term-care setting must know and apply the federal regulations set forth in the Omnibus Budget Reconciliation Act of 1987.

Establishing a pharmaceutical care database.

This article has presented basic tools for collecting, using, storing, and retrieving patient information needed for the delivery of pharmaceutical care in the community pharmacy, using case studies that illustrate the practical application of this material. The documentation of collected information is a vital component in providing comprehensive pharmaceutical care. Whether a pharmacist uses handwritten forms or automated computer programs for documentation, an ongoing, updated pharmaceutical care database remains an essential tool.

Family medicine residents' knowledge and attitudes about drug-nutrient interactions.

Objective: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that health professionals recognize the importance of drug-nutrient interactions and educate patients to prevent adverse effects. Drug-nutrient interactions are an important issue in medical practice, but it is not clear how or if physicians are trained in this issue.

Methods: This investigation was a needs assessment that examined attitudes and knowledge about drug-nutrient interactions that was examined in a national sample of 834 family medicine residents in 56 residency programs.

An evaluation of antihypertensive prescribing practices.

We evaluated the management of patients with hypertension (including drug prescribing) by US physicians, compared their prescribing to National Institutes of Health (NIH) guidelines, and compared the pharmacoeconomics of the prescribed antihypertensive drugs. A 1991 national US database, using physician-patient encounter forms, was our data source. Results showed that physicians generally met the NIH guidelines regarding diagnostic/screening services, patient counselling/education, antihypertensive drug prescribing and follow-up.

Drug prescribing for the elderly.

Both the geriatric population of the United States and the use of prescription drugs by this age group continue to increase. Cardiovascular medicines, analgesics, anti-inflammatories, and psychotropic medications are used most commonly. Polypharmacy, defined as a condition in which a patient receives too many drugs, drugs for too long, or drugs in exceedingly high doses, often results.

The clinical use of histamine-2 receptor antagonists.

Histamine-2 receptor antagonists have been available for fifteen years for the treatment of peptic ulcer disease and related disorders. While very safe, clinicians need to know correct dosing guidelines, drug interactions, and side effect profiles. Long-term therapy should be reserved for patients at high risk of recurrence.

Evaluating drug prescribing in a large, ambulatory population: application of an embedded expert system.

DUR is a process of problem detection and intervention designed to improve the quality and economy of drug prescribing. Retrospective DUR attempts to detect and address patterns of prescribing that might be indicative of inappropriate therapy. When the process is extended to a largely ambulatory population such as Medicaid beneficiaries, a number of complications are introduced due to the large numbers of patients and sparsity of data.

Alternate drugs.

It is important to consider a number of factors when deciding on drug therapy for elderly patients. The principles of efficacy, side effect profile, ease of administration, interaction with other drugs or concomitant illness, cost, and constant reevaluation of the need for continued treatment should be remembered for any treatment. In many cases the ideal drug may be initially no drug at all.

Medication management.

The elderly receive more drugs than any other patient group, and those in nursing homes receive the most. However, little is known about drug action, particularly in the very old. A host of factors can alter drug action.

A flexible module for teaching quality assurance and drug prescribing review concepts.

A case-approach, educational module is described that was designed with the necessary flexibility for teaching a variable number of quality assurance and drug prescribing review concepts to different types of students in different types of teaching situations. Module evaluation showed effectiveness as well as areas needing improvement.

Evaluation of routine screening physicals by emergency room personnel for an alcohol rehabilitation program.

A study of the University of Maryland Hospital emergency room's medical screening program for alcohol rehabilitation revealed that the screening exam works well, but that it may not be necessary in a resource-intensive ER. Cost-effective, rational approaches for supplying appropriate services are suggested.

Audit of digoxin prescribing in ambulatory patients.

Digoxin prescribing for ambulatory patients with uncomplicated congestive heart failure in normal sinus rhythm (UCHF) was evaluated. The audit was conducted at a hospital primary care clinic and was performed retrospectively over a recent 2-year period. The audit focused on the discontinuance of digoxin prescribing and the attendant monitoring necessary.