P H A R M A G R A M

...an educational memo from your Therapeutics Committee

July, 1999

Pharmacists offer Clinical Services to 4SUR, 1700 and 2700 Patient Care Units

Pharmacists are now assigned to three Patient Care Units to provide traditional pharmacy services and additional clinical pharmacy services. With the assistance of Stewardship Support Services, we will measure the impact of Pharmaceutical Care on these pilot units. Several areas of focus will be reduced adverse drug events, reduced time to process physician drug orders and improved decision support. Pharmaceutical Care Services will continue to offer Pharmacokinetic Drug Monitoring on a consultation basis throughout the Medical Center. We will also continue to welcome your calls to the Drug Information Center (655-3047) and the Adverse Drug Event Hotline (655-6805)

 

 

Drugs Added to the OSF Saint Francis Medical Center Inpatient Drug Formulary

(April) hydroxyamphetamine (a.k.a. Paredrinẻ ) eye drops - A drug used to diagnose Horner’s syndrome. Note: this drug is not commercially available and must be obtained by the physician or (by prescription) by the patient from Leiter’s Park Avenue Pharmacy, San Jose, CA (800) 292-6773. This drug will not be stocked by the inpatient Pharmacy.

(June) human albumin microspheres and octafluoropropane (Optison̉ ) – A three ml injectable suspension for use in patients with suboptimal echocardiograms to opacify the left ventricle and its endocardial borders.

(June) rofecoxib (Vioxx̉ ) – an oral non-steroidal anti-inflammatory (NSAID) (inhibiting prostaglandin synthetase through selective inhibition of COX-2) It is FDA approved to relieve the signs and symptoms of osteoarthritis, manage acute pain in adults and treat primary dysmenorrhea.

To minimize the potential risk for an adverse GI event, the lowest effective dose should be used for the shortest possible duration. It is available in 12.5mg and 25mg tablets, 12.5mg/5ml, and 25mg/5ml strawberry flavored oral suspensions. Initial dosing for osteoarthritis is 12.5mg daily; whereas for the management of acute pain or treatment of primary dysmenorrhea, the initial dose is 50mg daily for up to five days. Rofecoxib has not been evaluated in patients below the age of 18 years.

Physicians prescribing rofecoxib for inpatients at OSF Saint Francis Medical Center will be asked to complete a concurrent Drug Usage Evaluation. This form will be sent to the prescriber at the time that the first dose is dispensed. It should be completed and returned to the Pharmacy by the prescriber.

Long-term studies comparing the incidence of serious, clinically significant upper GI adverse events in patients taking rofecoxib compared to other NSAIDS have not been performed. The acquisition cost of a 12.5mg rofecoxib tablet is $2.02 and for a 50mg tablet, $4.04. In comparison, the acquisition cost of a 325mg aspirin tablet is less than $0.01; for an 800mg ibuprofen tablet, $0.06 and for a 500mg naproxen tablet, $0.09.

Drugs Removed from or NOT Added to the

OSF Saint Francis Medical Center Inpatient Drug Formulary

celecoxib (Celebrex̉ ) - an oral non-steroidal anti-inflammatory (NSAID) (inhibiting prostaglandin synthetase through selective inhibition of COX-2) See discussion on rofecoxib.

CMI anergy skin test panel – This product is no longer manufactured. It is suggested that you order two approved skin test antigens when testing for anergy. They are Candida (Candin̉ ) and mumps (MSTẢ ). The test dose of 0.1-mL intradermally is intended to elicit 48 hours (48 – 72 hrs for MSTẢ ) after injection an induration response in excess of 5mm, in immunologically competent persons with cellular hypersensitivity to the antigen. If an order is received for CMI, an automatic substitution of one Candida and one mumps skin test is sent to the floor.

orlistat (Xenical̉ ) – a non-systemic inhibitor of gastrointestinal lipases used in the treatment of obesity

tamsuloson (Flomax̉ ) - a selective alpha-1A adrenoceptor antagonist with claimed selectivity for the genitourinary tract used for the treatment of benign prostatic hyperplasia

trovafloxacin and alatrofloxacin (Trovan̉ and Trovan IV̉ ) - a fluoroquinolone antimicrobial agent used for the treatment of various respiratory, abdominal, gynecologic, and urinary infections

 

 

Drugs to be Automatically Substituted

alprazolam oral (Xanax̉ ) – for lorazepam oral (Ativan̉ ) except in children under 16 y.o. (This is a change in the autosubstitution policy to exclude pediatric patients.)

fexofenadine (Allegrả ) - for cetirizine (Zyrtec̉ ) except in children under 16 y.o. (This is a change in the autosubstitution policy to exclude pediatric patients.)

Candida skin test (Candin̉ ) – see earlier discussion of CMỈ skin test panel

mumps skin test (MSTẢ ) – see earlier discussion of CMỈ skin test panel

cefoxitin (Mefoxin̉ ) every six hours - for cefotetan (Cefotan) every 12 hours – (This is the reverse of the current autosubstitution policy, necessitated by the current shortage of cefotetan.)

rofecoxib (Vioxx̉ ) – for celocoxib (Celebrex̉ ) as follows:

Drug Ordered (Brand) dose/freq. Drug Substituted(Brand) dose freq.

celecoxib (Celebrex) 100mg/daily or BID rofecoxib (Vioxx) 12.5mg/day

celecoxib (Celebrex) 200mg/day rofecoxib (Vioxx) 12.5mg/day

celecoxib (Celebrex) 200mg/BID rofecoxib (Vioxx) 25mg/day

 

trimethobenzamide orally (Tigan̉ ) – for trimethobenzamide orally (Tigan̉ ) as follows:

Drug Ordered (Brand) dose/freq. Drug Substituted(Brand) dose freq.

trimethobenzamide (Tigan) 200mg/any freq. trimethobenzamide (Tigan) 250mg/any freq.

This autosubstitution is being done because of many orders received to switch from Tigan IM to Tigan PO. The normal dose of Tigan IM is 200mg, while the usual dose of Tigan PO is 250mg. The Therapeutics Committee considers the slight increase in the oral dose to be acceptable, reducing the frequency of telephone calls to clarify this discrepancy in doses when the route of administration changes.