International journal of pharmaceutical compounding
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Caring for the dying and their loved ones is challenging; most patients and their families find themselves overwhelmed by the many physical and emotional stages of dying. The caregiver team involved in a dying patient's care is extensive, and included in this team is the compounding pharmacist. This article provides definitions and features of the dying process. It discusses the role of hospice care and palliative care; the importance of including a compounding pharmacist in the patient's care; physical changes experienced by the dying patient; and some of the myths involved in the dying process.
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For former National Football League player Kerry Schmidt, BA,MBA, chronic pain is a part of everyday life. To repair sports-related trauma sustained during his 6-year career as a defensive back, Schmidt has undergone 24 major orthopedic surgeries over the past three decades and will undergo two or three additional procedures to repair his lower back. Now a sports reporter, a syndicated sports columnist, and a business owner, Schmidt says his pain at times has rated a 10-plus on a 10-point pain scale. ⋯ After he consulted with Jack P. McNulty, MD,FACP, a specialist in the management of chronic pain, who collaborated with George B. Muller, RPh, a compounding pharmacist, Schmidt found relief with no adverse effects from the seldom-prescribed drug levorphanol.
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This article introduces endotoxins and the application of the bacterial endotoxins (pyrogen) test to test for endotoxins in a manner compliant with the United States Pharmacopeia-National Formulary Chapter 797 Pharmaceutical Compounding-Sterile Preparations, the intent of which is to prevent harm and fatality to patients which could result from microbial contamination (nonsterility), excessive bacterial endotoxins, or compounding errors. Basic information about endotoxins is supplied in this article, along with information on testing methods. The purpose of this article is to assist compounding pharmacists to develop a documented system in which the quality of the components and the compounding procedure are well controlled and testing for endotoxins becomes a formality.
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The stability of ketamine hydrochloride (10mg/mL) in water for injection stored in polypropylene syringes has been studied at 25 deg C by means of a stability-indicating high-performance liquid chromatographic assay method. The concentrations of the drug were directly related to peak heights, and the percent relative standard deviation based on five injections was 1.9. ⋯ The injection did not lose potency after 30 days of storage at 25 deg C, and the pH value of 4.2 did not change. Ketamine hydrochloride appears to be a very stable drug.
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The objective of this study was to evaluate the physical and chemical stability of morphine sulfate 5 mg/mL with clonidine hydrochloride 0.25 mg/mL in 0.9% sodium chloride injection and morphine sulfate 50 mg/mL with clonidine hydrochloride 4 mg/mL in sterile water for injection when packaged in plastic syringes. Test samples of morphine sulfate 5-mg/mL with clonidine hydrochloride 0.25-mg/mL and morphine sulfate 50-mg/mL with clonidine hydrochloride 4-mg/mL solutions were packaged as 20 mL of drug solution in 30-mL plastic syringes, sealed with plastic tip caps, and stored at 4 deg C and 23 deg C for 60 days. Test samples were also stored at -20 deg C and 37 deg C (temperature extremes that might be encountered during shiping) for 2 days. ⋯ Morphine concentrations were found to be about 98% or greater, and clonidine hydrochloride concentrations were about 97% or greater throughout the study period under each storage condition. Morphine sulfate solutions at concentrations ranging from 5 to 50 mg/mL combined with clonidine hydrochloride ranging from 0.25 to 4 mg/mL can be packaged in plastic syringes, stored and shipped with little or no loss of drug. However, freezing should be avoided.