trations de gentamicine suivant une dialyse apres I'administration d'une dose (2 mg/kg en 30 min) chez des patients non-infectes presentant une insuffisance renale chronique. Chez les six patients evalues, les auteurs ont observe une augmentation moyenne de 3.6070 a 0.5 h, 12.6070 iI I h (p < 0.05) et 6.6070 a 2 h. Le changement maximal des concentrations seriques observe chez ces patients variait de 7.3 iI RESEARCH/PRACTICE 55.9 070. Malgre que l'effet rebond des concentrations de gentamicine observe dans cetle etude soit statistiquement significatif, la grande variabilite interpatient et la faible etendue absolue de cette variation rendent ce rebond non significatif cliniquement.ABSTRACT: During the past 15 years, the pharmacy profession has experienced much change. Certain pharmacy roles are being challenged and others are coming into existence. Today, healthcare practitioners and health-care providers are seeking services not sought before from pharmacists in the area of rational therapeutics. This need for information extends to all pharmacy practice settings: institutional, independent pharmacies, chain stores, governmental agencies, and the pharmaceutical industry. In order to meet this demand for drug and toxicology information, however, the pharmacist must use resources outside the immediate area of his practice. The Drug Information Center (DIC) can be used as such a resource by pharmacists in their daily practice to provide the best possible care with regard to the rational use of drugs for their patients/clients. Specifically, our data indicate that in Tennessee, (I) there is a need for providing drug and toxicology information; (2) pharmacists perceive their role to be providers of drug information as well as drugs; (3) the DIC plays an integral and necessary role as a back-up information resource and in teaching, service, research, and continuing education programs; and (4) the programs provided by the DIC are cost effective and cost justifiable. Drug In/ell Clin Pharm 1987;2/:49-56. KEY WORDS: Drug Information Center, rational therapeutics, cost effectiveness.IN THE LAST FEW DECADES, some roles in pharmacy have been challenged and others have come into existence. 1.2 One of these challenging areas involves pharmacists functioning as drug and toxicology information consultants or providers of drug and toxicology information.!" Today, health-care practitioners, health-care providers, patients, and the general public demand information services that were not required before from pharmacists on the rational use of drugs.":" With the growing emphasis on clinical pharmacy practice and the advances in the medical profession and pharmaceutical industry, drug information centers (DIC) throughout the U.S. have been asked to provide more drug information services. In addition, DIC continue to par-

Leuprolide is the first member of the class of gonadotropin-releasing hormone (GnRH) agonist analog to be released in the U.S. The pharmacology of leuprolide is complex and not yet completely defined. This agonist analog is more potent than natural GnRH and appears to be capable of occupying pituitary GnRH receptors. This results in a "down regulation" of the receptors' activity and gonadotropin release, ultimately decreasing serum testosterone levels to those seen following castration. Leuprolide has been found effective in the palliative treatment of advanced cases of prostatic cancer and is not associated with the cardiovascular and thromboembolic toxicity seen with conventional diethylstilbestrol therapy. Leuprolide is administered by daily subcutaneous injections and has been generally well tolerated. The most common adverse effects are hot flashes and a possible flare-up of prostatic carcinoma symptoms on initial dosing. As clinical experience grows in the use of GnRH agonist analog, GnRH will assume a greater role in the treatment of metastatic prostatic cancer.

Terfenadine is an antihistamine recently approved for use in the U.S. Terfenadine possesses a unique chemical structure when compared with other antihistamines. It is a selective inhibitor of H1-receptors with little or no anticholinergic, antiserotoninergic, or antiadrenergic effects. Comparative studies have shown that terfenadine is as effective as other antihistamines in the treatment of allergic rhinitis and other hypersensitivity conditions. This drug produces a minimal amount of central nervous system (CNS) depression, which is documented by studies demonstrating that terfenadine and its metabolites do not readily pass into the CNS and have little affinity for central H1-receptors. The lack of CNS depression and anticholinergic effects, and the long duration of action that allows twice-a-day dosing make terfenadine an attractive alternative to other antihistamines.

Indomethacin, a nonsteroidal antiinflammatory drug, has been shown to be effective for the treatment of pericarditis in chronic hemodialysis patients. Data regarding the dialyzability of indomethacin in these patients, however, is lacking. The aim of this study, therefore, was to evaluate (1) the dialyzability, and (2) the absorption and elimination kinetics of indomethacin, using six stable anephric adult patients who were maintained on chronic hemodialysis and were receiving indomethacin for the management of their uremic pericarditis. The results from this study demonstrate that indomethacin is dialyzable, but not to an appreciable extent. The mean predialysis and postdialysis indomethacin plasma levels were 3.4 and 1.6 micrograms/ml, respectively. The mean total amount of indomethacin removed by five hours of hemodialysis was 19.6 percent of the single dose of indomethacin 100 mg po. However, mean Cpmax, tmax, t1/2, and AUC0-infinity during and in the absence of hemodialysis were 5.4 and 5.4 micrograms/ml (not statistically significant [NS]), 1.9 and 2.0 h (NS), 6.1 and 5.3 h (NS), and 30.9 and 35.7 micrograms h ml-1 (NS), respectively. Based on these findings, it can be concluded that although indomethacin is dialyzable, no dosage adjustment is required in patients receiving indomethacin for the management of their uremic pericarditis when undergoing maintenance hemodialysis.

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