• persons >= 50 years of age
  
• children < 2 years of age
  
• persons of any age with chronic medical conditions
  

The licensed flu vaccine used in the United States, which is made from inactivated or killed influenza viruses, cannot cause influenza infection and does not cause influenza illness. The most important means to prevent influenza illness from spreading in a health care facility is influenza vaccination of both patients and healthcare personnel.
Pneumococcal disease (which includes pneumonia, bacteremia and meningitis) kills more people in the United States every year - 40,000 or more - than all other vaccine preventable diseases combined.
Pneumococcal Pneumonia is estimated to cause 150,000 - 570,000 cases annually, causes up to 36% of adult community-acquired pneumonia and 50% of hospital-acquired pneumonia, is the common bacterial complication of influenza and, has a case-fatility rate of 5-7%, higher in the elderly.

Newly Restricted Access

New warning and limited access to Propulsid, issued January 2000, Janssen Pharmaceutica, Inc. (www.us.janssen.com) will stop marketing Propulsid (cisapride) for nighttime heartburn from gastroesophegal reflux disease in July 2000. This is due to continued reports of cardiac arrhythmias (80 of which were fatal), despite five updates to the drug’s label warnings.
Propulsid will still be available through a limited access program for patients who have certain serious gastrointestinal problems or certain life-
threatening pediatric conditions. To obtain the drug through the limited access program, physicians will need to meet certain conditions and demonstrate need by the patient.
Because of inappropriate use of cisapride in the United States, Jansen and the Federal Drug Administration have decided to limit its access starting July 14, 2000 and health care professionals with questions can contact the company at (800) JANSSEN.

New Warnings

New warning for St. John’s wort, issued February 10, 2000, the Center for Drug Evaluation and Research of the Food and Drug Administration has issued a warning that significant drug reactions may occur with St. John’s wart, an herbal product sold as a dietary supplement and indinavir. If you have patients on indinavir, check with a physician or pharmacist with regard to this interaction.


Removed From The Market

Rezulin removed, Warner-Lambert/Parke-Davis has voluntarily removed troglitazone (Rezulin) from the U.S. market in response to a request from the Food and Drug Administration (FDA). It was approved for type two diabetics whose disease wasn’t adequately controlled by other antidiabetics drugs. Since 1997, when issues of severe liver toxicity surfaced, Parke-Davis strengthened the drug’s label instructions several times. It was pulled from the British market in 1997 and by the Japanese market in 1999. Patients can call Warner-Lambert at 877-798-7398 to inquire about reimbursement for unused troglitazone.


Clinical Reminders

Heatstroke and Cholinergic Blockers

The risk of heatstroke increases with geriatric patients who take cholinergic blockers (Cogentin, atropine, and many parkinsonian medications) and live in a warm climate or an area with hot summers. The risk is even greater in those patients with cardiovascular disease. These patients should limit outdoor activity during hot weather, have adequate ventilation and cooling inside and drink plenty of cool liquids.


Cultural Response to Antihypertensives

Antihypertensives and other cardiac drugs often effect black, white and Asian patients differently. For example, black patients respond better to thiazide diuretics (i.e., HCTZ, etc.), white patients respond better to angiotensin-converting enzyme inhibitors (i.e., captropril, etc.) and Asian patients are twice as responsive to propranolol’s effects on blood pressure and heart rate than white patients.


Helpful Tips

Cardiac Pacemakers and Cellular Telephones
Persons with cardiac pacemaker implants can experience negative effects or malfunction of the pacemaker while using a cellular telephone. Implantable pacemakers are designed to sense and pace the heart when the patient’s own conduction system fails. But the electrical signals from some cellular telephones may interfere if they’re used within 6 inches of the pacemaker.
Persons with implanted cardiac pacemakers using a cellular telephones should take the following precautions:

• Hold the phone to the ear on the opposite side of the pacemaker
  
• Store the phone on the side opposite the pacemaker - at least 6 inches away
  
• Have the pacemaker checked if you feel dizzy or faint
  
• Check http://www.fda.gov/cdrh for more information
  

Education Reminders

Persons working in the adult care homes when Arizona’s new laws for assisted living facilities went into effect November 1998 have their continuing education credits counted from November to November.
Persons trained and who began working in assisted living facilities after November 1998 have their continuing education credits counted from their anniversary dates.



Arizona Department of Health Services Continuing Education Requirements

Effective November 1998 annual continuing education requirements for managers and caregivers for all levels of care must include six (6) hours in the following five (5) subjects:

• Promoting resident dignity, independence, self-determination, privacy, choice and resident rights;
  
• Fire, safety, and emergency procedures;
  
• Infection control;
  
• Assistance in self-administration of medication, and
  
• Abuse, neglect, and exploitation prevention and reporting requirements