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Abstract Drugs ordered on a chronic basis for patients of a 72-bed skilled nursing facility were reviewed by a consultant pharmacist for efficacy as part of drug regimen reviews, over a two-year period. Drugs classified as "less than effective" or "probably ineffective" by NAS/DRC, or established clinical practice literature, were questioned in 47 episodes: papaverine in dementia (25); multiple vitamin/tonic without iron in iron deficiency or anemia (8); methenamine complexes in chronic urinary tract infections (CUTI) where the patient was catheterized, had a urine pH greater than 7 and/or had consistent urinalyses indicating 4 + bacteria while on the drug (6); ...