Drug therapy may be complicated in hospitalized patients receiving nutrition via enteral feeding tubes. Dosage form selection and appropriate administration methods are crucial in patients with feeding tubes. Although hospitalized patients receive nutritional support through various routes, oral nutrition is preferred. Enteral or parenteral nutrition may be used if oral intake is inadequate or inadvisable. Patients with functional gastrointestinal tracts usually receive enteral nutrition. Administering oral medications through the enteral feeding tube can lead to complications like tube clogging or decreased drug activity. However, drug therapy need not be compromised in patients receiving enteral nutrition. Careful selection and preparation of dosage forms reduces the complications of medication administration. Flushing the feeding tube and screening for drug incompatibilities decreases the incidence of tube clogging and replacement.

Goal The goal of this program is to inform the participant of practical ways to prevent, identify, and manage the extravasation of anti-neoplastic agents. Objectives At the completion of this program the participant will be able to: List antineoplastic agents known to be vesicants or irritants. Identify the signs and symptoms of extravasation injury. Recommend a procedure for the safe administration of vesicant medications. Describe the appropriate management of antineoplastic-induced extravasation injury.

This study describes the development, implementation, and estimated vs. actual cost benefits of an IV to oral therapeutic interchange program. Secondary objectives were determining patient eligibility criteria and selecting medications for future inclusion in the program. Medical charts were reviewed to determine which patients were appropriate candidates for the interchange. Targeted medications were selected by reviewing the literature and the institution's drug expenditures. Five medications — famotidine, ciprofloxacin, levofloxacin, fluconazole, and azithromycin — were selected for the initial stages of the program. Preimplementation cost analysis suggested that the interchange would yield cost savings of more than $30,000 per year in medication costs alone. The interchange was piloted on a single nursing unit to determine best procedures and possible barriers to implementation. Data collected in the first 6 months after implementation indicated greater potential cost benefits than originally estimated. Including more medications in the interchange would further reduce drug acquisition costs.

Meperidine is FDA-approved for relieving moderate to severe pain and has been widely used since its introduction in the 1930s. However, the drug is no longer considered a first-line analgesic. Many clinicians recommend that meperidine be removed from health-systems or that its use be restricted, due to concerns about adverse reactions, drug interactions, and normeperidine neurotoxicity. In addition, clinical evidence shows that meperidine has no advantage over other opioids for biliary colic or pancreatitis. The formulary status of meperidine has been extensively discussed at University of Utah Hospitals and Clinics. The Pharmacy and Therapeutics Committee has been working with hospital staff to assess the impact of either removing meperidine from the formulary, or limiting its use. The Drug Information Service developed this document to help pharmacists respond to prescribers' questions and to alleviate the prescribers' concerns about these changes. Information is provided comparing meperidine with other opioids, including dosage equivalency, pharmacodynamics, pharmacokinetics, cost, adverse effects, and drug interactions. Where available, alternatives to meperidine are suggested for various indications.