AHFS Drug Information 2022 is available as a curated print edition. Some monographs have been omitted from this print edition due to space limitations. These are available on the ‘For Subscribers’ page of the AHFS DI website (www.ahfsdruginformation.com) in the ‘Electronic Only Monographs’ section.

The book comprises a collection of revised and expanded drug monographs, on single drug entities available in the USA. Drugs included in this edition are those that are frequently prescribed, those used as first-line therapy, or as the mainstay of important treatment regimens, those having a wider range of established indications, those with unique roles and those monographs which have been accessed frequently in the AFHS CDI data base. The monographs and references relate to current therapeutic guidelines including the latest information on Covid-19 vaccines and Covid-19 monoclonal antibodies, anticoagulant and neuromuscular blocking reversal strategies and expanded off-label uses, real world data and long-term clinical data. Fifty-one new molecular entities, approved since January 2021 are included.

Drug monographs are arranged by the AHFS Pharmacologic-Therapeutic Classification. Each monograph provides information that is critical at the point of care. It contains a concise overview of the drug’s uses (both labelled and off-label) and an easily navigated list of doses specific to each use, age group, route of administration and special population (e.g. patients with hepatic or renal impairment). Important cautionary information follows a structured outline with numerous subdivisions to help the reader in locating specific contraindications, warnings, sensitivity alerts, age and condition specific precautions, safety in pregnancy and in breast-feeding women, the most common and serious adverse effects and drug interactions. An overview of the drug’s pharmacological actions and effects, as well as key pharmacokinetic characteristics is also included.

Each monograph is organised so that the most clinically relevant and frequently sought information appears at the beginning.

AHFS Drug Information 2022 is soft backed with very flimsy pages. It is very easy to use and is an extremely valuable reference source.

The price includes access to the AHFS CDI app.

AHFS Drug Information 2022, Editor-in Chief Daniel J. Cobaugh.

Pp xxii + 3476. Price $440.  American Society of Health-System Pharmacists (Maryland), 2022. ISBN 978-1-58528-684-3

Paediatric drug dosing presents challenges because the weight and maturity of the patients vary considerably. 3D printing of doses on demand offers a potential solution to the problem. The technology has already been developed and is in use for the production of levetiracetam tablets (Spritam^®Aprecia Pharmaceuticals). However, in this case it is being used as an alternative to traditional compression tabletting in order to make a tablet that disintegrates rapidly (ZipDose^® technology).

The researchers used fused deposition modelling to produce oral 3D printlets (3Dp) of small doses of amiodarone, suitable for paediatric use, from a 20% (w/w) amiodarone filament supplied by a pharmaceutical laboratory. A 3D printer (Prusa® MK3S) was used to produce three batches each of three different strengths (25, 140 and 200 mg) of amiodarone.  Three operators each received one hour’s training on using the printer. When the tablets were tested the overall variation in mass was 4% and in content 6%.

The authors noted that the process itself was easy and that training time was short, particularly when compared with the training required to produce capsules.  Moreover, it could easily be undertaken in a hospital pharmacy in real conditions. The quality of the final product relies heavily on the uniformity of drug content in the filament. The printer that was used was not ideal for tablet printing and there is a need for printers that meet the requirements of Good Preparation or Manufacturing Practices.

In a separate experiment the researchers compared the ease of delivering three different doses of amiodarone in an oral syringe using amiodarone capsules (5, 20, 70 and 100 mg), amiodarone suspension 50mg/ml and the 3D printlets.  They concluded that the 3D printlets offered the advantages of solid oral dosage forms whilst ensuring the precision of the oral suspension. They also noted that faster disintegration of the 3D printlets would be helpful.

GERPAC – Groupe d’Évaluation et de Recherche sur la Protection en Atmosphère Contrôlée (Group for Evaluation and Research for Protection in Areas under Control).The 2020 virtual GERPAC Congress was held 23-24^th November 2020.

One of the problems with containing SARS-CoV2 infection is the number of people who turn out to have had the disease without exhibiting symptoms who could, unwittingly, have passed it to others. A quick, cheap, non-invasive screening test could be useful for identifying such people at an early stage. Apparently there are differences between the coughs of asymptomatic covid patients and those of healthy individuals but these differences are not discernible to the human ear.

Building on technology that had recently been developed for the diagnosis of Alzheimer’s disease the researchers developed an AI model that they ‘trained’ on thousands of forced cough recordings that people voluntarily submitted through web browsers and devices such as mobile phones and laptops. The model focuses on subtle changes in four biomarkers – vocal cord strength, sentiment, lung and respiratory performance and muscular degradation – and identifies a characteristic pattern of changes for covid-19.

The final model achieves 97.1% discrimination accuracy on subjects diagnosed with an official test.

The important implication of this is that the model could be built into a mobile device app for regular (e.g. daily) screening. A user could log in daily, cough into their phone, and instantly get information on whether they might be infected and therefore should confirm with a formal test.

“The effective implementation of this group diagnostic tool could diminish the spread of the pandemic if everyone uses it before going to a classroom, a factory, or a restaurant,” says co-author Brian Subirana, a research scientist in MIT’s Auto-ID Laboratory. This work was reported in the IEEE Open Journal of Engineering in Medicine and Biology (September 2020) . An audio description of the work is also available. This is helpful because it illustrates the different coughs and clearly shows how difficult it is for the human ear to distinguish between them.