No abstract

This randomized, single-blind, crossover study compared three formulations of propranolol, each given once daily for hypertension. After an initial titration phase, subjects randomly received regular-release, long-acting, or a generic propranolol formulation. Each drug was given for 4 weeks and each active treatment was separated by a washout phase to allow blood pressure to return to baseline. Twelve subjects received all three active treatments. Systolic and diastolic blood pressures and pulses were significantly reduced from baseline by all formulations. There was no significant difference among drugs. Examination of diastolic blood pressures suggested some loss of antihypertensive control at the end of the dosing interval. These results indicate that it may be possible to administer propranolol once daily for hypertension and that there is no advantage for using the long-acting form.

Adverse drug events affect approximately 10% of patients in hospitals and result in increased rates of morbidity and mortality. These adverse events extend hospital stays an estimated 1.7 to 2.2 days and increase costs by approximately $3,200 for patients who are affected. Nurses play a key role in reducing risks of adverse drug events. Through purposeful, planned actions, nurses can help to curtail unexpected costs and can further promote safe patient care. Specific problem areas of the drug delivery system resulting in high numbers of significant (lethal or severe) drug events can be targeted for precautionary actions. An interdisciplinary "safety net" can be developed and maintained to reduce these events. Guidelines are recommended for system-wide approaches to prevention and continuous quality improvement activities.

Antibiotics were approved for use as animal feed additives in 1950 after it was discovered that their use increased growth rate, improved feed utilization, and reduced mortality and morbidity from clinical and subclinical infections in animals. Subtherapeutic use of antibiotics in animal feed grew extensively and concern has arisen that this "indiscriminate" use of antibiotics could lead to increased numbers of antimicrobial-resistant bacteria and ultimately compromise treatment of human bacterial infections. Three recently published studies seem to indicate that animal-to-man transmission of antimicrobial-resistant bacteria is possible. Increased debate on the continuing allowance of antibiotic feed additives has ensued. The National Resources Defense Council has recently petitioned the FDA to disallow penicillin and tetracycline use in animal feed, and legislation has been introduced in the U.S. House of Representatives that would limit the subtherapeutic use of antibiotics in animal feed. Experts have predicted that meat prices would increase and meat quality would decrease if antibiotics are disallowed as a feed additive. It is the opinion of the authors that there is no conclusive evidence at this time to support the premise that subtherapeutic use of antibiotics in animal feed poses a greater threat to human health than if antibiotic feed additives were banned.