Research Essay

DRUG NEWS

CHEMOTHERAPY DRUGS

Skin exposure reduces nurses' fertility Female nurses exposed to chemo- therapy drugs on tbe job may ex- perience reduced fertility and poor neonatal outcomes, a new study suggests. Self-administered ques- tionnaires were completed by 4,393 Dutch nurses ages 22 to 37, Be- tween 1990 and 1997, the nurses worked for at least 2 months in a hospital as oncology nurses or as nurses in certain other settings wbere chemotherapy exposure is unlikely. (The latter served as the reference group.) Tbe question- naire was designed to assess preg- nancy outcomes, work-related ex- posures, and lifestyle factors. Over 1,500 nurses in the study met the requirements for one of tbe study categories while pregnant or trying to become pregnant.

On average, nurses with the high- est level of exposure to chemothera- py dmgs took 1 month longer to con- ceive and were twice as likely to deliver a child with low birth weight, compared with nurses who weren't exposed to chemotherapy drugs. Skin exposure to tbese drugs also sligbtly raised the risk of premature deliver}'.

Even minimal skin exposure to chemotherapy drugs while wearing gloves can affect fertility and birtb weigbis, researchers report. They didn't find any significant increase in risk of stillbirth, miscarriage, or birth defects. Sourtc: hransmaii W, c! al.. Nurses with deimal exposure to antincoplastlc drugs: Reproductive outcomes. Epidemiology. January 2007.

INTRACEREBRAL BLEEDING

Dramatic increase linked to warfarin Tbe rate of anticoagulant-associated intracerebral hemorrhage (AAICH)

r PANCREATIC CANCER

Drug offers one small step forward A common cancer drug may help some patients with pancreatic cancer stay in remission longer, a new study suggests. A notorious killer, pancreatic cancer usually recurs after surgery. Fewer than ] in 10 patients live for 5 years after surgery, which offers the best hope for cure.

The study involved 368 patients who had complete resection of pancreatic can- cer and no prior radiation therapy. Patients treated with gemcitabine (Gemzar) after surgery lived disease-free for 13.4 months, compared with 6.9 months for patients who didn't take the drug.

Researchers followed patients for an average of 4.5 years. Cancer returned in 74% of patients who took gemcitabine, compared with 92% ot those in the control group. Overall survival rates were similar in both groups.

Source: Oettle H, et al.. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing cutative- intent resection of pancreatic cancer. JAMA, January 17, 2007.

increased fivefold in greater Cincinnati (Ohio) during the 1990s, researchers have found. In people age 80 and older, the rate increased more than tenfold. As defined, AAICH is intracerebral hemorrhage in patients receiving warfarin or heparin.

Researchers collected data on patients in the greater Cincinnati area who were hospitalized with first-time intracerebral hemor- rhage during 1988, 1993 through 1994, and 1999. In 1988, the rate of intracerebral bemorrbage asso- ciated witb warfarin was 0.8 cases per 100,000 people. In 1Q99, the rate was 4.4 cases per 100,000 people. The rate among people age 80 and older increased from 2.5 in 1988 to 45.9 in 1999.

Researchers say most of the changes are explained by tbe increasing use of warfarin. They say their findings shouldn't dis- courage the appropriate use of warfarin, but they call for more researcb into safer alternatives, improved risk stratification for older adults, and better treatments for bleeding complications. Sourtt. Flaherty ML. el al.. The increasing intLdencc of aniicoagulani-mssociaied iniraterebral hemorrhage, Nrurolugv, Januarj' 4, 2007.

HIV NEUROPATHY

Medical marijuana: Good medicine? In a small study, smoking marijuana effectively reduced pain from periph- eral neuropathy related to HIV infec- tion. In ihe randt)mized, placebo- controlled study, 25 patients smoked marijuana tbree times daily for 5 days. Another 25 patients smoked placebo cigarettes lacking cannabi- noids. The patients' pain was mea- sured with daily pain diaries; in 30 patients, pain was also assessed us- ing a cutaneous beat stinuilaiion procedure.

On average, those in the marijuana group reported neuropathic pain reduction of 34%, compared with 17% in the placebo group. A pain reduction greater than 30% is cotisid- ered a clinically significant level of improvement. Marijuana use bad lit- tle effect on the painfulncss of heat stitnulation.

Although small, this study is significant as the first placebo- controlled published research on the effectiveness of medical mari- juana. Critics argue even if marijua- na has therapeutic value, inhaling the smoke is inherently hazardous

2 8 Hursing2007. Volume 37. Number 4 www.nijrsing2007.com

to someone wilh a compromised immune system. Siiurtf Alsrams 111. et al., Inniwhisin painliil HlV-assofiiiied •.rnaory neurupalh)', N«(rolu){v. February 13. 2007.

ADVERSE DRUG EVENTS

More are dying from accidental overdoses Deaths from unintentional poison- ing, mostly associated with pre- scription drugs, have increased dra- matically and are now second only to motor vehicle crashes as a cause of accidental death, report re- searchers from the Centers for Dis- ease Control and Prevention (CDC). Between 1999 and 2004. the rate of unintentional deaths due to drug poisoning was 7.1 deaths per 100,000 people. The largest increases were found among

non-Hispanic white women and people between ages 15 and 24, which is "consistent with substan- tial recent increases in recreational prescription drug and cocaine use among adolescents and young adults." The drugs most commonly involved in accidental poisonings were categorized as psychothera- peutic drugs (including sedatives) and narcotic/hallucinogens.

Recommendations for reducing accidental deaths include better reg- ulation of unsafe drugs; increased prescriher awareness about appro- priate treatment for pain, psychi- atric prohlems, and drug depen- dence; and possihly the modifica- tion of certain drugs to reduce their potential forahuse. Sourer. CtiKtrs lur Disciist Conlml and Ptevcnlion. i;iiinicnlliinal jiiiiMining iliaths—Dm Its Si ales. I'^'W-IOIM, Morblililv anil Moflalitv Werfelv Kqiari, February 9. 2007.

DRUG SAFETY

FDA steps up postmarketing scrutiny The Food and Drug Administration (FDA) has launched a set of initia- tives aimed at improving che safety of dmgs and other medical products, in- cluding a program to hetter track the safety of dmgs after they're marketed. The initiatives also include develop- ing new approaches to detecting and preventing adverse drug events.

Under fire for approving certain dmgs that later proved hazardous, the FDA is adapting many recom- mendations proposed hy the Institute of Medicine in its 200b report llif Future ofDing Safety: Promoting and Protecting the Hcakh of the Public. For more information, visii hllp:// wTvw.fda.gov. < >

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