Pharmacy & Therapeutics - September 2008 - (Page 516)

NEW DRUGS study from Baleares, Spain. Of 99 patients who had undergone surgery for a fractured hip, 49 received patient-controlled femoral nerve analgesia (PCAF) and 50 received IV analgesia. Patients in the PCAF group were dramatically less likely to have postoperative delirium (8%), compared with those receiving conventional analgesia (42%). The PCAF patients also did not receive any morphine rescue medication; by contrast, 28% in the traditional group did. Thanks to the earlier, more effective pain relief, patients receiving PCAF were also able to sit up in bed much sooner. (Source: Acute Pain 2008;10:59–64.) DRUG NEWS more than 3,000% during the previous 20 years. Many patients are coping with shorter hospital stays, less clinical oversight, and more powerful medications. In the past, patients stayed in the hospital much longer. More procedures are now performed on an outpatient basis, more drugs are prescribed with less follow-up, many drugs are now available over the counter, and analgesics and antidepressants can be bought on the street. All of these trends increase the risk of mistakes and misuse. A study sought to quantify deaths from medication errors that occur at home, where professional oversight is least likely. The increase in deaths was more than fivefold in situations least likely to be supervised. There was a 564% jump in deaths from prescription drugs taken alone at home and a 555% rise in deaths away from home. Increases in deaths from medication errors occurred among all races and ages of people except children younger than 10 years of age. Middle-aged white men were most likely to die. The authors call for better screening of patients for drug and alcohol use and for advising patients about the potential dangers of mixing medications and other substances. (Source: Arch Intern Med 2008;168: 1561– 566.) Rosiglitazone (Avandia) And Broken Bones Long-term treatment with rosiglitazone maleate (Avandia, GlaxoSmith Kline) appears to almost double the risk of bone fractures in women with type-2 diabetes, compared with patients taking metformin (Glucophage, Bristol-Myers Squibb) or glyburide (DiaBeta, SanofiAventis; Micronase, Pfizer). The findings, say researchers for the ADOPT study (A Diabetes Outcome Progression Trial), are notable, especially for patients who already have a high risk of fracture. Of 2,511 men, 89 reported a fracture; fracture rates did not vary among treatment groups. By contrast, 111 of 1,840 women had fractures, and 60 (9%) of those were taking rosiglitazone, compared with 30 (5%) taking metformin and 21 (3.5%) taking glyburide. Both premenopausal and postmenopausal women taking rosiglitazone experienced fractures, but most of the fractures, predominantly of the lower and upper limbs, occurred in the postmenopausal women. The risk did not seem related to increased falls or accidental limb injuries. Among women with a fracture, 12% in the rosiglitazone, 17% in the metformin, and 24% in the glyburide groups reported an accidental limb injury or fall within 30 days before the fracture. Among women who reported a fracture, 18% of those taking rosiglitazone had more than one fracture, as did 17% of those taking metformin and 14% of those taking glyburide. The differences between the drugs’ effects did not appear until after a year of therapy, a fact that highlights the value of large, long-term clinical trials, the researchers say. Their median follow-up period was three to four years. Most clinical studies involving thiazolidinediones, they note, are small and last only three to 12 months. (Source: Diabetes Care 2008;31:845– 851.) Vaccine Fears May Be Leading to More Measles Measles cases in the U.S. are at their highest level in more than 10 years. Almost 50% of these cases involve children whose parents declined vaccinations for them. Parents’ unfounded fears about the vaccines causing autism may be fueling this trend. Some measles cases have involved home-schooled children, who are not required to get the vaccines. Childhood measles vaccination rates have stayed above 92%, according to 2006 data. However, the recent outbreaks suggest that pockets of unvaccinated children are forming. Health officials worry that vaccination rates have begun to fall. Please see the Health Care and Law column on page 542 for a discussion of the effects of vaccine declinations. (Source: Associated Press, August 22, 2008.) NIH WATCH Diabetes Vaccine On the Horizon? A vaccine to prevent diabetes might be closer than we know. A study suppor ted by the National Institutes of Health (NIH) and Baxter Health Care describes a microsphere-based nucleic acid vaccine that not only prevents but also reverses new-onset autoimmune diabetes in animals. The microspheres carr y antisense oligonucleotides to CD40, CD80, and CD86. The vaccine confers an immunoregulatory phenotype continued on page 521 Lethal Overdoses at Home The number of Americans who have died at home after ingesting toxic combinations of prescription medications, alcohol, and street drugs has grown by 516 P&T® • September 2008 • Vol. 33 No. 9

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - September 2008

Pharmacy & Therapeutics - September 2008 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Effect of Prescription Copays on Adherence and Treatment Failure with Oral Antidiabetic Medications Vaccine Declinations Present New Challenges for Public Health Universal Health Care in America Digestive Disease Week and American Diabetes Association Pharmaceutical Approval Update

Pharmacy & Therapeutics - September 2008

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