Drug monitoring in IV tubing using Raman spectroscopy

chemistryworld: “Recent research, led by Brian Cunningham at the University of Illinois in the US, has produced biomedical tubing that uses surface enhanced Raman spectroscopy (SERS) to monitor the contents and concentrations of drugs within a patient’s IV line.  The plasmonic nanodome array surface enhances the Raman signals.  The tubing could detect 10 pharmaceutical compounds with reproducible signals for a period of up to five days. For four of the drugs, the signal magnitude was dependent upon the drug concentration and combinations of compounds could also be detected, giving a much more detailed picture of a patient’s medication.” – This is great work being done by the University of Illinois. I’ve contemplated something like this in the past.

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Time to accept pharmacy robotics as our friend and ally

As the word “robot” passes its 90th birthday1 – introduced by Karel Capek in his play R.U.R. (Tossums’s Universal Robots) in January 1921 – it’s become obvious that robotics has not only captured the imagination of geeks everywhere, but has become a point of interest in many industries including healthcare.

Late last year ASHP began pushing the idea of a new pharmacy practice model, PPMI. The movement was a hot topic for a while, but seems to have lost a lot of steam recently – “Hence the name: movement. It moves a certain distance, then it stops, you see? A revolution gets its name by always coming back around in your face” (Tommy Lee Jones in Under Siege 1992) – Anyway, when the PPMI movement was still going strong many important people in the pharmacy world struggled with the best way to approach a new pharmacy practice model. Many believe, and rightly so, that the best way for pharmacists to reinvent themselves is to become the cornerstone of a more robust patient care model. After careful consideration I believe the best hope for developing such as model will be to rely heavily on pharmacy robotics to handle much of the repetitive dispensing duties now handled by pharmacist on a day to day bases. You know, free up the pharmacists. It’s not a new concept, but one that seems to escape us.

Obviously it will take some time to develop robotics to the point where it will be effective in such a system, and it certainly won’t be cheap, and pharmacists will have to fight with state boards of  pharmacy to accept it, and pharmacy administrators will have to work closely with their hospitals to develop such a systems, and someone’s going to have to be brave enough to step up to the plate and get stated, and so on and so forth. In other words it’s going to be hard and it won’t happen overnight.

Who’s up for a little project? For now let’s just take a quick look at some of the things that lead me to believe robotics is worth another look as a potential solution.

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New device for delivering volatile anesthetics to patients in the ICU


“Volatile anesthetics like isofluorane or sevofluorane, usually used in the operating room, have a much quicker wake-up time, but the size and cost of an anesthesia machine make them impractical for use in the ICU.

Sedana Medical (Uppsala, Sweden) seems to have overcome this limitation with the introduction of the AnaConDa (Anesthetic Conserving Device). The device features a syringe pump that delivers Isofluorane or Sevofluorane to a small carbon-fiber device which goes in-line with a traditional ICU ventilator. In many ways, this can be considered a disposable anesthetic vaporizer.
This month’s Anesthesia & Analgesia features a study that validated this device in an ICU setting and found that it is quite accurate (end-tidal concentration was within 13% of target concentration). Advantages of this device, in addition to quick wake-ups, include lower cost of the equipment as compared to traditional vaporizers and an overall decreased consumption of anesthetic.”

When I worked in the pediatric ICU we would use volatile anesthetics like sevoflurane on rare occasion. It was always quite an ordeal as the equipment necessary to deliver the gas wasn’t exactly portable. Anyway, the AnaConDa is a pretty cool piece of hardware.

You can get more information on The AnaConDa at the product website.

It may be time to consider robotic IV preparation at the bedside

Hospitals make a lot of intravenous (IV) preparations. That makes sense when you consider that most people admitted to the hospital are there because their acute illness requires more care than can be administered at home; not always, but in most cases. This is especially true for patients in the intensive care unit, i.e. the ICU.

A fair number of the medications used in the ICU are prepared on demand for a host of reasons including stability, differences in concentration, difficulty in scheduling secondary to rate variability, etc. Any pharmacist or nurse reading this will understand what I’m talking about. Example medications that fall into this category include drips like norepinephrine, epinephrine, phenylephrine, amiodarone and nitroprusside.

Last year I mused about using devices on the nursing stations designed to package oral solids on demand at the point of care. I still like the idea for several reasons, all of which can be found in the original post.  Based on currently available technology the same concept could be applied to preparation of IV products at the bedside. Robotic IV preparation has come a long way and these devices could be used at the point of care to make a nurses, and patient’s, life a whole lot easier. The use of robotic IV preparation at the bedside could reduce wait times for nurses and lesson the workload on pharmacy.
Continue reading It may be time to consider robotic IV preparation at the bedside

Cool Technology for Pharmacy

One of the best pharmacy jobs I ever had was working for a small compounding pharmacy in the Bay Area of California. Many of the prescription items compounded in this particular pharmacy had to be flavored based on the needs of the patient; sometimes animal, sometimes human. Regardless, the art of flavoring was always a challenge but also a lot of fun. I learned quite a bit about how to mask bitterness, how to use various sweeteners to get the flavor just right and how to use various flavor combinations to create some pretty tasty medications; it’s an art. And don’t underestimate the amount of science that goes into creating flavors like these or the science behind using those flavors to mask unpleasant tastes. It takes time, energy and patience.

FLAVORx, a company in Columbia, MD has taken a lot of the experimentation out of the flavoring equation by creating a system for dealing with “yucky medicine”.

According to the FLAVORx website, their product is in use by over 35,000 pharmacies nationwide. The company website offers a handy Pharmacy Locator to assist you in finding a pharmacy nearby that can flavor your child’s, or your own, medication.

FLAVORx lets children and their parents customize the medicine to whatever they’d prefer it to taste like

Our scientifically tested FLAVORxâ„¢ Flavoring System is available at pharmacies nationwide and is designed to make any liquid medication easier for your child to take. Using our unique Bitterness Suppressor and Sweetness Enhancer, Pharmacists mask the unpleasant flavor associated with many prescription and over-the-counter liquid medications. And with our wide assortment of kid-approved flavors, your child (with the help of the Pharmacist) can customize their medicine to suit their individual tastes.

All FLAVORxâ„¢ flavors are sugar-free, gluten-free, dye-free, casein-free, inert, and non-allergenic. Our flavors are made from a blend of natural and artificial ingredients and we never use phosphates or other potentially harmful chemicals.

Available flavors include apple, banana, banana orange, bubblegum, chocolate, chocolate cherry, citrus punch, grape, grape bubblegum, grapeade, lemon, orange, raspberry, sour apple, strawberry, vanilla, watermelon and wild cherry.

Check out the FLAVORx Favorable Flavors tool (PDF)

Sperm-like nanopropeller is smallest swimmer ever

Newscientist.com: “REMOTE-CONTROLLED nano-devices that look like sperm but mimic the corkscrew motion of flagella may one day deliver drugs to where they are needed in the body.”  -The applications here are limitless. I had the opportunity to work on something along these lines when I was an undergrad (Chemistry). We used polyaniline to carry drugs to a specific location. Once at the location, a current was applied directly to the polyaniline, releasing the drug. Of course we had no remote control and our experiments were performed in a beaker, but it was still pretty darned cool. I still have my lab notebooks from back then. Thumbing through them brought back a lot of good memories. Being involved in any type of R&D is exciting and fun, I highly recommend it (if you get the chance).