Drug-induced agranulocytosis is a severe complication that has been implicated with most classes of medications. Medications such as clozapine, trimethoprim-sulfamethoxazole and methimazole have been more commonly associated with agranulocytosis than other agents. Although the pathogenesis isn't fully elucidated, it appears to be two-fold with a direct toxicity to the myeloid cell line and immune-mediated destruction. Patients may be asymptomatic at the time neutropenia is discovered or may present with more severe complications such as sepsis. In approximately 5% of cases drug-induced agranulocytosis may be fatal. Management of drug-induced agranulocytosis includes the immediate discontinuation of the offending medication, initiation of broad-spectrum antibiotics and consideration of the use of granulocyte colony-stimulating factors in high-risk patients.

Increased patient satisfaction and continuation of the method of insulin administration used in the hospital at home were reported by patients who received insulin pens compared with patients who received conventional vials and syringes during hospitalization. A substantial cost saving was projected for patients in the insulin pen group if insulin pens had been dispensed during their entire hospital stay.

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Objective. To develop and implement a 1-credit-hour oncology pharmacy practice elective course for third-year pharmacy students and assess its impact on examination scores in a required pharmacotherapeutics course. Design. Major topics were identified to focus on therapeutic management and supportive care of the oncology patient. Psychosocial topics were incorporated to help pharmacy students better relate to oncology patients. Assessment. Learning was assessed by means of 2 computer-based examinations, weekly reflection posts, and a completed oncology service-learning project and reflection paper. Students enrolled in the course achieved higher pharmacotherapeutics oncology section examination scores than students who had not taken the course. Also, this course increased students' interest in oncology pharmacy. Conclusion. The oncology pharmacy elective course has received overwhelmingly positive feedback from students and student enrollment continues to grow. We will continue to offer this course to future practitioners.

Oxycodone and oxycodone-containing analgesics are often used for the relief of pain. In the presence of renal dysfunction, the half-life of oxycodone and metabolites can be prolonged. We describe the case of a 41-year-old chronic hemodialysis patient who received multiple doses of oxycodone/acetaminophen resulting in accumulation of the medication and consequent lethargy, hypotension and respiratory depression. These adverse effects were reversed with multiple bolus doses of naloxone, followed by a continuous infusion administered for 45 hours. Utilizing the Naranjo probability scale, the patient had a "probable" adverse drug reaction to the oxycodone. Oxycodone should be used with caution in patients with chronic renal failure.