RxList: The Internet Drug Index, which bills itself as a "complete, comprehensive resource for answering drug questions," has added "RxListID," a search capability that allows Web visitors to scan a directory of more than 4,000 prescription and over-the-counter medicines organized by numeric code, color, or keywords. RxList can be found at www.rxlist.com.
Mosby, a health sciences publishing subsidiary of the Times Mirror Company, announced last month it has launched Physicians GenRx, a Web site for health care professionals, support staff, and consumers. The site is a resource for drug information-including full prescribing information for more than 2,000 FDA-approved drugs-cost comparisons, and information about the pharmaceutical industry.
Users can enter a drug name to call up a complete or selected portion of a drug monograph. Drugs also can be accessed by pharmacologic and therapeutic class and indications for use. Physicians GenRx includes generic, brand, and international brand names, off-label uses, major formulary coverage, cost of therapy, extensive cost comparison data, and generic equivalency ratings.
Physicians GenRx is available by subscription. It can be found on the Mosby Web site: www.mosby.com/Mosby/PhyGenRx. For more information, call 800-325-4177.
A caveat: Because Physicians GenRx lists international product names, at least one case of pharmaceutical "mistaken identity" has occurred. A physician checking dosage information on Relafen called up methocarbamol, a generic name listed under Relafen, then followed dosing information contained in the methocarbamol monograph. Although Relafen is a brand name for methocarbamol in some countries, in the United States methocarbamol is called Robaxin.
The editors of Physicians GenRx have agreed to run a computer search to determine if any other brand names represent more than a single generic name.
Patients with sudden or recurring conjunctivitis that takes several weeks to clear up may be overusing nonprescription decongestant eyedrops, according to researchers at Baylor College of Medicine.
A recent article in Archives of Ophthalmology (1997; 115:34-8) points out that overuse of over-the-counter products containing vasoconstrictors such as naphazoline, tetrahydrozoline, or phenylephrine may produce acute or chronic conjunctivitis marked by eye inflammation, redness, discomfort, and discharge. If other causes of conjunctivitis have been ruled out, ask patients about their use of these products.
Poor nutrition increases the risk of health problems, especially among the elderly. The Nutrition Screening Initiative, a nonprofit organization sponsored by the American Academy of Family Physicians, the American Dietetic Association, and the National Council on Aging, has published a brochure that explains conditions that put elderly people at risk for poor nutrition and gives simple tips for improving nutritional health.
"Strong and Healthy: Your Guide for Better Nutritional Health" is designed to accompany NSI's "Determine" checklist, which measures a person's risk of poor nutrition. For a copy of the checklist and the "Strong and Healthy" brochure, write to the Nutrition Screening Initiative at 1010 Wisconsin Ave. NW, Suite 800, Washington, DC 20007.
The U.S. Food and Drug Administration has granted market clearance for miglitol (Glyset), a treatment for non insulin-dependent diabetes mellitus developed by Bayer. Last year FDA gave clearance for acarbose (Precose), which was first launched in Germany in 1990.
Miglitol was first registered in the Netherlands in July of last year. The parallel clearance of miglitol and acarbose in the United States and Europe opens the way for further international registration.
Both paregoric (camphorated opium tincture) and opium tincture can be used for diarrhea control. However, having both items on an institutional formulary poses dangerous risks for residents, warns the Institute for Safe Medication Practices (ISMP Medication Alert!, Volume 1, issue 12).
ISMP cautions that accurately measuring doses of opium tincture is difficult, and adds that it is too easily confused with paregoric, risking as much as a 25-fold overdose.
Paregoric contains just 0.4 mg of morphine per mL, while opium tincture contains 10 mg per mL of morphine. ISMP points out that the differences in these products are not always made clear, and in some references, information about paregoric, including dosing information, is listed together with information about opium tincture.
Citing the risk of confusing these products, especially on busy nursing units, ISMP concludes that the risks of having opium tincture on a modern institutional formulary far outweigh the benefits, especially given the fact that there are many other products available to control diarrhea and treat pain.
The U.S. Food and Drug Administration has approved amlexanox oral paste, 5%, (Aphthasol) as a treatment for painful, severe oral canker sores, called aphthous ulcers, in people with normal immune systems.
The agency based its approval on placebo-controlled clinical trials demonstrating that amlexanox relieved pain and reduced the time needed for ulcers to heal.
The safety and effectiveness of amlexanox have not yet been evaluated in immunocompromised individuals.
The drug is contained in a paste that is applied to the ulcers four times a day, following oral hygiene after meals and before bedtime. Some participants in clinical trials reported stinging or burning where the medicine was applied, and, less frequently, nausea and diarrhea.
The American Psychiatric Association's Practice Guidelines for the Treatment of Patients with Alzheimer's Disease and Other Dementias of Late Life is now available from APA for $22.50. The guidelines were contained in a supplement to last month's issue of The American Journal of Psychiatry.
The document contains sections on definitions, natural history, and epidemiology of dementia; treatment principles and alternatives; treatment plans; site-specific issues; and demographic and social factors. For ordering information, contact the American Psychiatric Press at 800-368-5777.
The first double-blind international study of two antischizophrenia drugs found olanzapine (Zyprexa) to be more effective than risperidone (Risperdal) in improving several key aspects of schizophrenia, including negative symptoms (social withdrawal, inappropriate emotional response), incidences of relapse, and interpersonal relations. Study findings were reported at a May 20 meeting of the American Psychiatric Association.
The 28-week study, which was conducted in nine countries, included 339 patients randomized to either olanzapine or risperidone. Patients met the DSM-IV criteria for schizophrenia, schizophreniform disorder, or schizoaffective disorder and were required to have a minimum score of 24 on the Brief Psychiatric Rating Scale. Dosing ranges were 10 mg to 20 mg a day for olanzapine and 4 mg to 12 mg a day for risperidone.
The study was conducted by Eli Lilly and Company. For further information, contact Joan Griffin at 416-699-7349.
Pharmacy Corporation of America has published a new reference book geared toward helping long-term care providers choose the most cost-effective and clinically appropriate medications for their patients.
The Guide to Preferred Drugs in Long-Term Care: A Comparative Formulary for Geriatric Specialists features an alphabetic listing of branded and generic drugs, including comparative cost information. Also included are disease references with information on appropriate medications and dosages, potential drug interactions, essential lab work, and other key facts.
For information, contact PCA at 800-237-7676.
Health care quality report cards are in the news lately, part of an effort by managed care organizations and federal administrators to get a better handle on monitoring quality and accountability in health plans. However, many questions remain to be answered about the art and science of measuring quality in health care.
In an editorial in the Winter/Spring 1997 issue of the HCQA Quality Forum, James T. Ziegenfuss, Jr., PhD, talks about some of the issues that still must be addressed:
Researchers studying heart attack patients in a New Jersey Medicare population concluded that beta-blocker therapy is underused in elderly survivors of acute myocardial infarction, leading to measurable adverse outcomes. Study results were published in the January 8, 1997, issue of JAMA.
Researchers identified 3,737 patients in the study as eligible for beta-blocker therapy; however, only 21% actually received beta-blockers during the 90-day period following their discharge from the hospital for a heart attack.
The mortality rate among the beta-blocker recipients was 43% less than for those who did not receive the medication, and beta-blocker recipients in the study were rehospitalized 22% less often than nonrecipients.
The study's authors concluded that barriers to beta-blocker therapy "may include mistaken beliefs that these agents are harmful or less beneficial for patients with left ventricular dysfunction or with diabetes (a relative contraindication), and exaggerated concerns regarding adverse effects on quality of life."
They further commented that the findings of the study suggest that "substantial opportunities exist for increased use of this inexpensive preventive therapy for reducing morbidity and mortality among elderly acute myocardial infarction patients."
Assuming there are no significant changes in public policy, nursing
home and home care costs are expected to grow at an average of
nearly 10% annually over the next eight years, according to a
report issued by the Georgetown University Institute for Health
Care Research and Policy. This compares to an average growth of
less than 8% per year for other personal health care expenditures.
Overall, nursing home and home health costs are projected to increase
from 13% of personal health expenditures in 1996 to 15% in 2004.
Home care spending, which is expected to grow more rapidly than nursing home spending, will grow from $36 billion in 1996 to $95 billion in 2004. Spending for nursing home care is projected to grow from $88 billion to $169 billion over the same period.
Although most residents of long-term care facilities need help
from another person to perform activities of daily living, specific
ADL needs vary widely in prevalence. For instance, in 1992, bathing
was the most prevalent ADL limitation among nursing home residents
(91%), while only 42% needed help with eating.
Statistics were compiled by the Georgetown University Institute
for Health Care Research and Policy from information gathered
in the 1992 Medicare Current Beneficiary Survey.