This two-phase retrospective study was designed to evaluate the impact of the clinical pharmacist on prescribing practice of physicians in an internal medicine service. Streptococcal (pneumococcal) pneumonia was chosen as the model disease state. The drug of choice was used more frequently and there was a statistically significant difference in raw cost of antibiotic, total cost for antibiotic administration, daily raw cost for antibiotics; total raw cost for antibiotic administration, and patient charges when physicians were exposed to the clinical pharmacists' influence.

The clinical pharmacist is an integral member of the Docent team at the University of Missouri--Kansas City School of Medicine with duties in both teaching and patient care. These doctoral-level clinical pharmacists have sole responsibility for providing instruction in basic pharmacology and pharmacokinetics and for teaching pharmacotherapeutics to medical students and house officers at the Truman Medical Center. The pharmacology programs have been well received and are successful. Student evaluations have been positive, and acquisition of knowledge as measured by the computer-generated objective exam referred to as the Quarterly Profile Examination indicate progressive acquisition of basic pharmacologic information during periods of exposure to the clinical pharmacist. Analysis of part I of the National Boards of Medical Examiners Test shows that medical students with this instruction achieved higher scores in pharmacology than their mean performance on part I. House officers working with these clinical pharmacists also show progressive acquisition of basic pharmacologic knowledge as measured by the Quarterly Profile Exam. Preliminary evaluation of this nontraditional method of providing pharmacologic instruction indicates that the program is effective.

Esmolol is an ultrashort-acting, cardioselective, intravenous beta-blocker with an elimination half-life of about nine minutes. After administration of a loading dose, its full therapeutic effect is evident within five minutes. Its efficacy in treating supraventricular arrhythmias is equal to that of propranolol, but unlike propranolol, the action of esmolol is titratable and is largely reversed within 10 to 30 minutes after stopping its administration. Esmolol is also effective in attenuating life-threatening perioperative tachycardia and hypertension caused by adrenergic stimulation in high-risk patients.