The major finding of this study is that, in DA neurons, current conducted through L-type Ca2 channels makes up the bulk of whole cell Ca2 channel current evoked by small depolarizations near the activation threshold. These data support previous studies showing that SOPs and spontaneous firing are abolished by L-channel blockers Mercuri et al. 1994; Nedergaard et al. 1993 ; . SOPs and the PLSD, which underlie regular spontaneous firing, generally involve fluctuations of the membrane potential between around 50 and 40 mV, where L-channel current may comprise the bulk of the whole cell Ca2 current in DA neurons. Conversely, N-channel current appears to account for a much smaller fraction of whole cell Ca2 current over this same voltage range, which could explain why the N-channel antagonist Ctx did not abolish SOPs or spontaneous firing in DA neurons in two studies Fujimura and Matsuda 1989; Nedergaard et al. 1993 ; . Our estimates of current block by Nim, Ctx, and Atx are probably not highly accurate representations of the contribution of L-, P-, and N-channels to whole cell Ca2 channel current at different membrane potentials under physiological conditions. The permeability of the different channels to Ba2 is different from that for Ca2 . Also, the presence of rundown likely generates error in the quantification of the block. Finally, 2 mM Ba2 externally and the N-methyl-D-glucamine based internal solution both produce negative shifts in the voltagedependency of Ca2 channels Bargas et al. 1994; Hille 1992; Malecot et al. 1988 ; . Although, regarding this last point, a previous study using Ca2 imaging suggests that the threshold for Ca2 entry in DA neurons is around 50 mV Wilson and and cefadroxil.
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To Err is Human", the report from the Institute of Medicine, has triggered a nation wide look at improving the safety of medical practices. Sadly nearly 100, 000 people a year die as a result of medical errors and 75% of these are drug related.1 The Harvard Medical Practice Study reported that in 1984, 3.7% of hospitalized patients experienced some type of Adverse Drug Event ADE ; . When it comes to pediatric patients they are at even greater risk as medication errors have been found to occur in over 10% of medication orders written for children.2 Pediatricians know that from birth through most of childhood a child's ability to absorb, distribute, metabolize, or excrete medications may change, making prescribing a bit more challenging. A study of medication errors among pediatric inpatients found 616 5.7% ; medication errors, 115 1.1% ; potential ADEs and 26 actual ADEs, among 10, 778 total medication orders. 3 If you look at errors occurring in emergency departments, you will find the rates to be even higher.4 On a more positive note, possibly 30% or more medication errors could be prevented and that fact alone should motivate us to examine the process of drug therapy to identify opportunities to prevent errors from reaching the patient. At the manufacturing level, medications need to be made with children in mind. Solutions and suspensions that are stable and palatable are badly needed. This would negate the need for pharmacists to extemporaneously compound medications. Obviously there are risks for errors when compounding. These range from calculation errors, dilutional errors, errors from mixing incompatibilities, possibly adverse effects on the bioavailability of the active ingredients, to name a few. Even when there are professionally manufactured pediatric products, someone has to be able to determine how much is to be given. No matter who does the calculation, an error could occur. That most pediatric drug doses have to be calculated based on the patient's weight is well known. An accurate weight is of paramount importance yet when studied, weights were missing, inaccurate or reported using pounds in a busy pediatric emergency department.5 If a calculation used to determine the drug dose depends on the weight being in kilograms, as most do, then reporting the weight in pounds could result in a 2 fold error in the amount of drug ordered. Even when this type of error is detected, converting from pounds to kilograms provides another chance for a math error to occur. It has been shown that interns and residents, especially early in their training, are not well prepared to do the math involved in prescribing. 6 There is clearly a need to improve the education and training of providers in the skills needed to accurately order and prescribe medication. Prescribing errors are also more likely to occur when the provider is sleep deprived, working weekends or faced with seriously ill patients.2, 3, 4 Fortunately, computerized order entry CPOE ; systems are being developed that could help prevent prescribing errors.7 Of course nothing is perfect and CPOE systems also have to be monitored and checked to prevent errors from being perpetuated.8 An alternative to having to perform calculations to determine drug dosages is the new Broselow-Luten system being test marketed now. Broselow and Luten began by assigning an approximate weight to children based on the child's length, after developing and validating a length-weight nomogram. Then they selected a range of weights that could be averaged into one grouping without risking over dosing or under dosing the children. Each weight grouping was assigned a unique color, and on the tape they printed the recommended endotracheal tube sizes, nasogastric tube sizes, and various drugs and dosages that should have been appropriate to a child of that size. Hence the Broselow Tape was developed and is now a staple in emergency departments and among EMS providers nationwide. Taking a lesson from the early success with this approach, Broselow and Luten have developed a book of most of the drugs commonly prescribed for children, including drugs given as drips. In it the drug doses appear within colored bands, similar to the bands on the Broselow tape. Each color section has the dose of the drug already calculated, even when the medication is a suspension or solution. One assigns the color band by weighing the child first and if the child can't be weighed on a scale, then the length based tape is used to estimate the weight and assign a color. Once a color band is assigned, simply turn to the mediation desired and select the dose. Since the drips are calculated using standard premixed drips currently on the market, any calculation of drip dose, rate of infusion or mixing errors are eliminated. This system has the potential to eliminate errors of calculations for medications being ordered for children Broselowprivate communication ; . Many other types of errors can lead to an adverse drug event. Drugs may have sound alike names, that could lead to an error in drug selection or dispensing, whether the order was given verbally, handwritten, by facsimile, or computer generated. Drug packaging may lead to confusion if the appearance of different medications is too similar. Use of a "brand" to identify several different products has caused confusion Robitussin vs Robitussin PE for example ; . Nurses or pharmacists could misinterpret verbal orders, or handwritten orders if illegible. Unclear orders, orders that use abbreviations, orders that fail to use a leading zero as a place holder for drug dosages that are 1 can result in significant errors. Ten fold errors are common because prescribers frequently use a trailing zero, which may make the order appear 10 times larger. Other sources of a ten fold error include miscontinued on page 3 and biaxin.

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