Norland gp 05-11.pub

N O R L A N D A V E N U E P H A R M A C Y . C O M P R E S C R I P T I O N C O M P O U N D I N G P R E S C R I P T I O N C O M P O U N D I N G F O R N O R L A N D A V E N U E P H A R M A C Y C H E M O T H E R A P Y - I N D U C E D N A U S E A A N D V O M I T I N G This study concluded that topical use of ABH gel appears to be a promising and safe rescue therapy for breakthrough CINV that occurs despite prophylactic antiemetic therapy - “Lorazepam, diphenhydramine, and haloperidol transdermal gel for rescue from chemotherapy-induced nausea/vomiting: results of two pilot trials” (J Support Oncol. 2008 Jan;6(1):27-32). ABSTRACT: “Despite their use of prophylactic antiemetic thera- The results were collected during two trials: Trial I began in April pies, cancer patients continue to consider chemotherapy-induced 2003, and Trial II began in March 2006. During Trial I, 23 patients nausea and vomiting (CINV) to be a significant problem. Patients were evaluated; 17 patients (74%) reported that use of the gel frequently use various "breakthrough" medications for these symp- decreased their CINV, with 15 (70%) reporting relief within 30 min- toms. Unfortunately, there is a paucity of trials regarding treatment utes of its application. Three patients believed that the gel caused sedation; no troubles with skin irritation or muscle spasms were reported. In Trial II, all 10 patients believed that the treatment was effective. When the severity of CINV was quantified on a scale of 0- This study investigated the efficacy of "ABH," a topical gel contain- 10, the mean CINV score decreased significantly from a 6.1 before ing lorazepam (Ativan), diphenhydramine (Benadryl), and haloperi- gel application to a 1.7 as evaluated 30 minutes following gel ap- dol (Haldol), in reducing breakthrough CINV. Adults receiving stan- dard recommended prophylactic antiemetics as outpatients were instructed to use 0.5 mL of the gel topically when they experi-enced significant CINV. Patients then were contacted retrospec- Topical use of ABH gel appears to be a promising and safe rescue tively to respond to a questionnaire rating their nausea and/or therapy for breakthrough CINV that occurs despite prophylactic vomiting and their response to ABH-gel treatment. antiemetic therapy. These results warrant further confirmation in a large, randomized, placebo-controlled trial.” PMID: 18257398 With our state of the art compounding lab and pharmaceutical knowledge and experience, we can compound lorazepam, diphenhydramine, and haloperidol into one transdermal gel. An example of how you might prescribe follows: Lorazepam 1mg/ml + Diphenhydramine12.5mg/ml + N O R L A N D A V E N U E P H A R M A C Y The following review investigates the efficacy and safety of naltrex- The following case report discusses the successful use of naltrex- one in pediatric patients with autistic disorder -“Efficacy and safety one for treating a child with severe autistic disorder - “Treatment of naltrexone use in pediatric patients with autistic disorder” (Ann of a serious autistic disorder in a child with Naltrexone in an oral suspension form” (Encephale. 2009 Apr;35(2):168-72). OBJECTIVE: To review the efficacy and safety of naltrexone in ABSTRACT: “.The onset of treatment, at a dose of 1mg/kg/ pediatric patients with autistic disorder (AD). day, led to a transitory increase in negative behavior. However, a dose of 0.75mg/kg per day subsequently led to significant im- DATA SOURCES: Using the terms pediatric, child, naltrexone, provements, as shown by outcome measurements. Self-mutilating autism, and autistic disorder, a literature search was performed behavior disappeared completely. Certain side effects were ob- using MEDLINE (1966-May 18, 2006) and the International Phar- served, namely transitory sedation at the beginning of treatment maceutical Abstracts (1971-May 18, 2006) database. The refer- ences of these articles were scanned for additional relevant litera-ture. CONCLUSION: This clinical case confirms that treatment of a serious autistic disorder in children using Naltrexone in oral sus- STUDY SELECTION AND DATA EXTRACTION: All arti- pension form is a potentially interesting therapeutic alternative for cles describing or evaluating the efficacy and/or safety of naltrex- treating behavioral symptoms resistant to classical drug therapy. one in pediatric patients with AD were included in this review. Three case reports, 8 case series, and 14 clinical studies were identified as pertinent. DATA SYNTHESIS: Naltrexone has been used most com-monly at doses ranging from 0.5 to 2mg/kg/day and found to be predominantly effective in decreasing self-injurious behavior. Naltrexone may also attenuate hyperactivity, agitation, irritability, temper tantrums, social withdrawal, and stereotyped behaviors. Patients may also exhibit improved attention and eye contact. With our state of the art compounding lab and Transient sedation was the most commonly reported adverse event. Small sample size, short duration, and inconsistent evalua- pharmaceutical knowledge and experience, we can tive methods characterize the available research. compound naltrexone as flavored oral solution that CONCLUSIONS: A child affected by AD may benefit from a trial of naltrexone therapy, particularly if the child exhibits self-injurious behavior and other attempted therapies have failed. Seri-ous adverse effects have not been reported in short-term studies. PMID: 16735648 An example of how you might prescribe follows: N O R L A N D A V E N U E P H A R M A C Y The following study found that topical immunotherapy with The following study found that SADBE topical immunotherapy is a SADBE (squaric acid dibutylester) is a relatively safe and effective safe, effective option for home therapy of warts in children- alternative treatment in the management of multiple and resis- “Squaric acid immunotherapy for warts in children” (J Am Acad tant cutaneous warts in children -“Use of squaric acid dibutylester (SADBE) for cutaneous warts in children” (Pediatr Dermatol. 2000 Jul-Aug;17(4):315-8). BACKGROUND: Warts are a common pediatric skin infection caused by human papillomavirus (HPV). Spontaneous clearance of warts involves anti-HPV immunity, which may be enhanced by con-tact sensitizers. Squaric acid dibutylester (SADBE) is a non- “We evaluated the efficacy of squaric acid dibutylester (SADBE) mutagenic sensitizing agent useful for immunotherapy of alopecia contact immunotherapy for the treatment of warts on a series of 188 children. Included in the study were those children who satis-fied at least two of the following criteria: single or multiple sites OBJECTIVE: We hypothesized that SADBE home application with several warts, warts resistant to repeated medical and/or surgical treatments, recurrent multiple warts, and patient or par-ent refusal to undergo destructive or surgical treatment. Excluded METHODS: An open-label, retrospective study of 61 children from the study were children with single warts or with flat warts with warts was performed. Sensitization with 2% SADBE on the located exclusively on the face and children less than 2 years of forearm was followed with home application of 0.2% SADBE to age. Treatment consisted of twice weekly applications of serial warts 3 to 7 nights per week for at least 3 months. dilutions of SADBE (0.03-3%) for no more than 10 weeks. Of the RESULTS: Complete clearing occurred in 34 patients (58%), 148 children who completed the study, 124 (84%) showed com- with a mean duration of therapy of 7 weeks. Partial clearing oc- plete clinical resolution with no significant side effects. Of those curred in 11 (18%), and no response in 14 (24%). Clearance corre- with total clinical resolution, 101 completed a 24-month follow-up lated with plantar distribution, wart duration under 2 years (P with no relapses. Twenty-four (16%) children were nonrespondent. <.05), and first-line therapy with SADBE. Mild side effects occurred No apparent correlation between treatment response and age, in one third of patients, were limited most commonly to mild ery- gender, anatomic site, lesion type, or atopy was found. Contact thema at the site of sensitization, and necessitated discontinua- immunotherapy with SADBE is a relatively safe and effective alter- native treatment in the management of multiple and resistant cutaneous warts in children.” PMID: 10990585 CONCLUSION: SADBE topical immunotherapy is a safe, effec-tive option for home therapy of warts in children. PMID: 10775858 With our state of the art compounding lab and pharmaceutical knowledge and experience, we can compound squaric acid dibutylester into a topical An example of how you might prescribe follows: Prescriber Name___________________________________________________________________________________ Prescriber Address________________________________________________________________________________ City _________________________________________________ State_______________ Zip____________________ Phone____________________________________________ Fax__________________________________________ Date _________________ Patient Name____________________________________________ DOB_____________ Address________________________________ City/State/Zip__________________________ Phone______________ □ Patient will pick up at pharmacy □ Please ship to patient □ Bill Insurance Plan:____________________________________ID#_____________________________________ All topical compound %s are per 1 ml or 1 gm unless otherwise noted Chemotherapy Induced Nausea & Vomiting [ ] Lorazepam 1mg/ml + Diphenhydramine 12.5mg/ml + Haloperidol 1mg/ml Transdermal Gel Quantity 60ml Directions: Apply sparingly to inner wrist TID PRN Autistic Disorder [ ] Naltrexone 25mg/ml Quantity 30ml Directions: Give 1ml PO in the evening QD Quantity 15ml Directions: Apply to wart(s) twice a week _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Prescriber’s Signature____________________________________ Refills: 1 2 3 4 5 6 7 8 9 10 11 12 NR

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