Top 10 Drugs Involved in Medication Errors: Albuterol

#4 Albuterol

Basic Characteristics

Albuterol is a drug used to treat the symptoms of asthma, an inflammatory lung disease that causes difficulty in breathing. Asthma is a chronic condition in which the airways react when stimulated by an allergen or other triggers in the environment. Symptoms of an asthma attack include wheezing, shortness of breath, coughing, chest pain or tightness, rapid heart rate and sweating.

Albuterol is classified as a quick relief or rescue medication. As a bronchodilator, it opens the airways and rapidly relieves moderate to severe asthma attacks. Albuterol is generally administered through an inhaler and is effective for 3 to 6 hours.

Short vs. Long-term Asthma Treatment

Bronchodilators like Albuterol relieve the symptoms of asthma attacks but do not treat the underlying inflammation. Thus, they do not help to control the disease itself. Some health professionals recommend long-term control therapy by use of corticosteroids. These are man-made drugs that resemble a hormone that occurs naturally in the body. Corticosteroids work by reducing inflammation and the activity of the immune system.

Albuterol Misuse

When taken over time, short-acting asthma drugs like Albuterol may become less effective. Patients may develop a tolerance for them and overuse them. One of Albuterol’s possible side-effects is fast or irregular heartbeat, making overuse especially risky for people with heart conditions.

Legal Action Involving Albuterol

In 1995 a class action lawsuit against Copley Pharmaceutical, the manufacturer of Albuterol, resulted in a $150 million settlement for the plaintiffs. Due to a bacterial contaminant found in Albuterol solution, numerous users suffered bronchial infections, pneumonia, respiratory distress and, in some cases, death. In 2011 a number of asthma patients died due to problems with inhalers containing Albuterol. The inhalers, manufactured by Schering-Plough, had not been properly filled with Albuterol. Patients using the inhalers were receiving little or no relief because the inhalers contained insufficient amounts of Albuterol, or none at all. Pressure by a public consumer group resulted in an FDA investigation and the recall of millions of inhalers by the manufacturer.

Medication Error and Albuterol

Asthma patients who develop a tolerance for Albuterol may believe that larger and more frequent doses will bring them more relief. In order to avoid overuse of Albuterol, patients should be monitored and assessed for long-term drug therapy. Another serious risk of overdoes occurs when Albuterol prescriptions are filled in the wrong dosage. In one case, a patient received a 3 day dosage in an inhaler meant to contain a daily dose. Recently, the FDA issued a warning concerning mislabeled dose vials of Albuterol. Vials containing 2.5 mg/3 mL were mislabeled as 0.5 mg/3 mL and were 5 times more powerful than the dosage indicated on the label. Overdose can cause Albuterol toxicity and may result in tremors, dizziness, anxiety, headache, angina, high blood pressure, seizures, low potassium, heart rates of up to 200 beats per minute, and death.

Albuterol packaged in plastic ampules has also been problematic. Plastic packaging is used because it reduces contaminants. In addition, the labels are embossed rather than printed because dyes used in ink can be inhaled along with the medication. Plastic ampules are available in multiple dose solutions and the embossed labels can be small and difficult to read. Furthermore, due to similarity in appearance, plastic ampules of Albuterol can be mixed up with other look-alike products stored in cabinets, refrigerators, or even the health provider’s coat pocket. One nurse in a long-term care facility mistakenly picked up an ampule of Albuterol when she was about to administer eye drops to a patient. Fortunately, she realized her error in time. The package of Albuterol had been placed in the resident’s medication drawer by mistake.

Albuterol is a valuable drug that can cause grave consequences if improperly dispensed and overused. If you or a loved one has been harmed by a pharmacist’s error concerning Albuterol, The Orlow firm can offer a thorough and professional evaluation of your case.

Contact The Orlow Firm Today

If you or a loved one has suffered harm due to negligence in the dispensing of Albuterol, contact New York prescription error attorneys at The Orlow Firm for a caring and knowledgeable legal consultation.

Call (646) 647-3398 or contact us online.

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Top Ten Drugs Involved in Medication Errors: Potassium Chloride

#3 Potassium Chloride

Basic Characteristics

Potassium is a mineral found in many foods, including tomatoes, beans, peas, lentils, bananas and sweet potatoes. The body requires a certain level of potassium in order to keep the heart beating. Potassium chloride is a compound created by combining potassium and chlorine. This compound dissolves more quickly in the body than food-based potassium and can more easily be absorbed when potassium levels are low.

Importance of Adequate Potassium Levels

A New York cardiologist has described potassium as “part of the heart’s battery acid.” A person with low potassium levels, a condition known as hypokalemia, may experience symptoms such as irregular heartbeat and muscle weakness. This deficiency can be caused by certain drugs, such as high blood pressure medications, by certain diseases, or by illnesses involving prolonged vomiting and diarrhea. The deficiency can be treated by dietary supplements in pill form but should not be taken by people with kidney disease. When the kidneys cannot properly process potassium, it causes a condition called hyperkalemia. Too much potassium in the body can be as dangerous as too little. While potassium deficiency can cause uneven heartbeat, an excess of the mineral can stop the heart outright.

A Powerful Drug

In concentrated doses, potassium chloride is nearly always deadly. In fact, it is one of several drugs used in lethal injections for executions and euthanasia. When used in treatment, it is crucial that potassium chloride be administered in proper doses. An equivalent number of patient deaths are caused by not giving it, or by giving too little, as by giving too much.

Medication Errors Involving Potassium Chloride

As is true of many medication errors, mistakes involving potassium chloride often result from poor handwriting on prescriptions, unclear verbal orders, memory lapses, and the enormous number and variety of drugs currently in use. Look-alike labels and packaging are common sources of confusion. In one case, a patient with an acid imbalance was prescribed sodium bicarbonate. Instead, he was transfused with potassium chloride and required cardiac resuscitation. Both packages were from the same pharmaceutical company, contained red labels and were of the same strength. They were also stored side-by-side on the same rack. In another case, a mother of four died after being given 10 times the amount of the drug she was supposed to receive. To correct her low potassium levels, the patient was prescribed 10 ml. potassium chloride per hour to be administered by infusion pump. The hospital nurse instead pushed the button on the pump to deliver 100 ml. per hour. The nurse, who was supposed to be supervised in signing out and administering the drug, was found directly responsible for the patient’s death.

Potassium chloride helps save lives but, improperly used, it can be extremely dangerous. The pharmacists that dispense it and the medical staff that administers it should be carefully trained and supervised.

Contact The Orlow Firm Today

If you or a loved one has suffered harm due to negligence in the dispensing of potassium chloride, contact New York prescription error attorneys at The Orlow Firm for a caring and knowledgeable legal consultation.

Call (646) 647-3398 or contact us online.

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Top Ten Drugs Involved in Medication Errors: Morphine

#2 Morphine

Basic Characteristics

Morphine is an opioid pain medication made from the opium poppy. It is used to treat moderate to severe pain and is one of the world’s oldest known analgesics (pain relievers). Morphine is also classified as a narcotic drug and works by changing the way the body senses pain. Morphine can be taken orally by pill or by capsule, or by methods other than through the mouth, such as by injection.

Common Medication Errors Involving Morphine

According to a recent study, wrong dosages account for more than half of all morphine incidents, many of which result in serious harm. Misinterpreting a written order is a common cause of error. The pharmacists may read 7.5 mg. (milligrams) instead of 1.5 mg. and dispense a 7-fold overdose. Or, he or she may mistake 0.5 mg. for 5 mg. and dispense a dose ten times stronger than what was ordered. In one case, a 9 month-old baby recovering from surgery was mistakenly given 5 mg. of morphine instead of 0.5 mg. She suffered cardiac arrest and died. Medication errors in general are all too common on children’s hospital wards. Mistakes involving the wrong drug, wrong dosage and wrong frequency occur in one out of every 18 prescriptions for children.

Morphine Oral Solution

The use of morphine oral solution has caused numerous adverse drug events and deaths. The solution is available in three strengths: 10 mg/5 ml (10 milligrams per 5 milliliters of fluid), 20 mg. /5 ml. and 100 mg. /5 ml. (20 mg/1 ml.) The last and highest concentration is intended for relief of moderate to severe pain and only in patients who can tolerate opioids. A number of unintentional overdoses have occurred due to mistakes in reading milliliters for milligrams. An error of this type regarding the high concentration solution causes a 20-fold overdose.

In response to these dangers, the manufacturer of morphine oral solutions has changed the color and design of the packaging; using bright labels to differentiate the strength and type of the solution and highlighting patient warnings.

Morphine vs. Hydromorphone

Some patients cannot tolerate morphine or may have a kidney or liver condition that affects the use of the drug. A common alternative for treating pain is hydromorphone (Dilaudid). Oral hydromorphone is 4 times more potent than oral morphine. Non-oral hydromorphone is 20 times more powerful than non-oral morphine. The similarities in the names of the two drugs have led to inadvertent mix-ups. In addition, pharmacists may substitute hydromorphone for morphine in the mistaken belief that it is a generic replacement for morphine. Mix-ups between these two drugs outnumber those for all other drug pairs. Recently, a 69 year-old patient was mistakenly given 10 mg. of non-oral solution instead of 10 mg. of non-oral morphine and was then sent home from the hospital. The dosage was 6 to 7 times higher than what was appropriate. By the time the hospital discovered its mistake, the patient had experienced cardiac arrest and could not be revived.

Preventing Morphine/Hydromorphone Errors

It is extremely important that morphine and hydromorphone be clearly marked and stored separately in medical facilities. In particular, pre-filled syringes of each drug should never be stocked together in the same strength. Pharmacy and hospital staff must be carefully instructed as to the difference between the two drugs. Before administering any narcotic, medical staff should speak to the patient and say the name of the drug out loud. This helps to ensure that the drug being administered is the one that was ordered.

Contact The Orlow Firm Today

If you or a loved one has suffered harm due to a medication error involving morphine or other opioid pain relievers, The Orlow Firm can guide you as to the proper legal action. Contact the New York prescription error attorneys at The Orlow Firm for a caring and knowledgeable legal consultation.

Call (646) 647-3398 or contact us online.

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Medication Error and the Role of Compounding Pharmacies

Beginning in the 1990s, people with severe back and neck pain began to rely on spinal steroid injections to relieve their discomfort and help them avoid surgery. The injections, which combine a steroid with a numbing medication, seemed to quiet irritated and inflamed nerves. By 2011, 2.5 million Medicare patients, along with an equal number of younger adults, sought relief with the injections and fueled a growing demand for steroids. In September 2012 an alarming number of steroid injection recipients developed meningitis, an inflammation of the membranes covering the brain and spinal cord. By December 2012, 39 people had died, and the numbers are still rising. The outbreak was caused by a drug that had been contaminated with a fungus. An estimated 14,000 people had been injected with the adulterated steroid.

Who Made the Drug?

The New England Compounding Center in Framingham, Mass. had manufactured the tainted drug, selling 17,676 vials to 75 pain clinics in 23 states. Patients who developed meningitis from the drug were later struck with a second illness caused by epidural abscess. Fungal infections arose at the site of the injections but, because they were internal, they could only be detected by MRI. Left untreated, the abscesses can cause meningitis and severe pain. The condition occurred in patients with or without meningitis and even in those who were taking powerful anti-fungal medications.

An FDA inspection of the New England Compounding Center revealed greenish-yellow residue on sterilization equipment and work surfaces layered with mold and bacteria. The company, now closed, supplied some of the most prestigious hospitals in the country, including those affiliated with Harvard, Yale and the Mayo Clinic. New York City’s Beth Israel Medical Center and St. Luke’s Roosevelt Hospital were also former clients.

The Rise of Compounding Pharmacies

Under the law compounding companies like New England Compounding were intended as local services producing tailor-made prescriptions for patients with special needs. Brigham and Women’s Hospital in Boston, for example, depended on New England Compounding for drugs that were in short supply, unavailable from major manufacturers, or which the hospital pharmacy could not readily produce. Over time, as drug shortages increased and brand-name products became too expensive, pharmacies turned to compounding companies for more cheaply made drugs. New England Compounding charged $25 per vial of the steroid injection drug while the brand-name product available from Pfizer sold for $40 to $46 per dose. Eventually, due to high demand for less costly drugs, compounding companies came to resemble smaller scale drug manufacturers, even sending out sales representatives to solicit business from doctors.

Are the Cost Savings Worth It?

Although there are clear financial incentives to utilize compounding companies, they seem to operate in the shadows, away from government oversight. The FDA regulates drug manufacturers but compounding companies register as pharmacies. As such, they are subject to non-uniform state rules. Many hospitals that relied on compounding companies believed these pharmacies were monitored by state and federal regulators and that their products were safe. It took a dangerous, multi-state outbreak of meningitis to prove how mistaken they were.

Contact The Orlow Firm Today

If you have been harmed by a drug that was negligently manufactured by a compounding company, the New York prescription error attorneys at The Orlow Firm can help you determine whether legal action is warranted.

Contact our New York City law office today by calling (646) 647-3398.

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Prescription Error: Wrong Label, Wrong Dosage, Wrong Advice

Medication errors can be costly and are often caused by the hectic, multi-tasking work environments of many drug retailers. In one scenario, a busy pharmacist receives a telephone call from a doctor’s office with a prescription order for digoxin, a heart drug. The pharmacist counts out the correct mediation, pours it into a bottle, prepares a label and places it alongside the bottle. The phone rings again, this time with a request for warfarin, a drug used to prevent blood clots. The pharmacist prepares the correct medication but switches the labels, dispensing the wrong drug to each of the two patients.

Wrong Label

For a distracted, overworked pharmacist, labeling mistakes can also occur while preparing medications for a single patient. For example, the patient might have two prescriptions, one for a medication to be taken twice a day, and another to be taken once a day. If the bottles are wrongly labeled, the patient may suffer an overdose of one drug and a serious risk of undertreatment by the other.

Wrong Dosage

Dispensing medications in the wrong dosage, or strength, is another common prescription error. The pharmacist may receive a prescription for a drug a drug at 0.125 mg. but fill it at strength of 0.25 mg. A misplaced decimal point, substituting 5 mg. for 0.5 mg., can result in serious injury, even death. Even a familiar, oft-prescribed drug such as the anti-psychotic Haldol, can give rise to errors in calculating strength. A dosage of 5 mg of Haldol may be entirely appropriate for one patient but highly improper for an ambulatory elderly person with senile dementia. Further, the drug manufacturers themselves may fail to label products clearly, resulting in confusion as to proper dosage and use.

Wrong Advice

Wrong advice, or wrong directions, constitutes another significant source of medication error. A pharmacist may advise a patient incorrectly out of ignorance or unfamiliarity with a new type of drug. Or, the pharmacist may enter incorrect information into the pharmacy’s computer, resulting in erroneous instructions for use of the drug. Computers are immensely helpful in the pharmacy trade and, although they have become essential, their users are not infallible. Pharmacists should always make sure that the information contained in the hard copy of the prescription is identical to the data entered into the pharmacy’s computer.

Contact The Orlow Firm Today

If you or a loved one has been harmed by medication error caused by a pharmacist’s improper labeling, dosage or directions for use of a drug, contact experienced New York prescription error attorneys at The Orlow Firm for a competent legal consultation.

Call (646) 647-3398 or contact us online.

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