OBJECTIVE: To identify the classes of drugs that most commonly cause adverse drug reactions (ADRs) and the characteristics of these ADRs and to determine the economic impact of ADRs on patients' length of stay and hospitalization costs. METHODS: Data on ADRs from patients admitted to a hospital in New Jersey were collected, studied, and analyzed over a five-month period. To determine the economic impact of ADRs, patients who experienced ADRs during hospitalization were matched to controls. Each ADR was rated with regard to its severity, the patients' outcomes were determined, and specific classes of medications were identified as particularly causative of ADRs. RESULTS: A total of 196 patients experienced ADRs; 131 of these individuals were matched with 1338 patients who did not experience an ADR, based on their diagnosis-related group code. The leading causal drugs according to therapeutic class were antiinfective (17%), cardiovascular (17%), antineoplastic (15%), and analgesics/antiinflammatory agents (15%). The organ systems most often affected were gastrointestinal (24%), dermatologic (19%), and immune systems (15%). The mean length of stay per patient differed significantly between the ADR case group and matched control group (10.6 vs. 6.8 d; p = 0.003), as did the total hospitalization cost ($22 775 vs. $17 292; p = 0.025). CONCLUSIONS: Length of hospital stay and total hospitalization costs were significantly higher for patients experiencing ADRs than those who did not experience ADRs. ADR reporting systems in hospitals need to be changed and strengthened to decrease the incidence of avoidable reactions.

Purpose. The treatment of pulmonary arterial hypertension (PAH) in pregnancy is reviewed. Summary. PAH is a disease characterized by narrowing of the pulmonary arteries and increased vascular resistance. Women with PAH should avoid becoming pregnant, as the physiological, cardiovascular, and pulmonary changes that occur during pregnancy can exacerbate the condition. However, several viable treatment options are available to improve the outcomes in this patient population, including inhaled nitric oxide, calcium-channel blockers, targeted pulmonary vasodilators, and sildenafil. Epoprostenol, a naturally occurring prostaglandin and vasodilator, is a pregnancy category B drug. Reproductive studies in rats and rabbits have found no impaired fertility or fetal harm at 2.5–4.8 times the recommended human dosage of epoprostenol. Most of the published case reports describe initiating epoprostenol 2–4 ng/kg/min i.v. several weeks before or near the time of delivery. Iloprost is a pregnancy category C drug but has demonstrated benefit in pregnant patients with PAH, with no congenital abnormalities and no postpartum maternal or infant mortality reported. Sildenafil causes vasodilation of the pulmonary vascular bed and vasodilation in the systemic circulation. Two case reports have described the successful treatment with sildenafil, a pregnancy category B drug, of pregnant patients with PAH. Patients with idiopathic PAH or chronic thromboembolic PAH should receive full-dose subcutaneous low-molecular-weight heparin therapy instead of warfarin for bleeding prophylaxis during pregnancy. Conclusion. Targeted pulmonary vasodilators are viable treatment options for pregnant patients with PAH. Early recognition and management of worsening symptoms are essential to improve outcomes for both the mother and infant.

Biological disasters can be natural, accidental, or intentional. Biological threats have made a lasting impact on civilization. This review focuses on agents of clinical significance, bioterrorism, and national security, specifically Category A agents (anthrax, botulism, plague, tularemia, and smallpox), as well as briefly discusses other naturally emerging infections of public health significance, Ebola virus (also a Category A agent) and Zika virus. The role of pharmacists in disaster preparedness and disaster response is multifaceted and important. Their expertise includes clinical knowledge, which can aid in drug information consultation, patient‐specific treatment decision making, and development of local treatment plans. To fulfill this role, pharmacists must have a comprehensive understanding of medical countermeasures for these significant biological threats across all health care settings. New and reemerging infectious disease threats will continue to challenge the world. Pharmacists will be at the forefront of preparedness and response, sharing knowledge and clinical expertise with responders, official decision makers, and the general public.

Purpose. The role of colistin in the treatment of infections caused by multidrug-resistant gram-negative microorganisms is discussed.

Purpose. The diagnosis and treatment of congenital tuberculosis are discussed.