...an educational memo from your Therapeutics Committee

May, 2000

The Pharmacy and Therapeutics Committee has voted to keep these three ACE inhibitors on the OSF SFMC inpatient formulary. Orders received for the other six ACE inhibitors will be automatically substituted with lisinopril, using a therapeutic substitution policy. This automatic substitution chart for ACE inhibitors and many other drugs can be found in the Drug Formulary notebook on each nursing unit.

Whenever a pharmacist makes an approved substitution, he/she sends a Therapeutic Equivalent Substitutions form to be placed on the patient’s medical record. This lists the drug discontinued and the drug substituted.

The oral biphosphonate drug approved for the treatment of Paget’s disease and osteoporosis, and for prevention of osteoporosis remains a non-formulary drug. Alendronate has caused esophagitis, esophageal ulcers, and esophageal erosions. The manufacturer recommends that patients take each dose with at least 6 to 8 ounces of water and remain in a sitting or standing position for at least 30 minutes after the dose (Prod Info Fosamax(R), 1996). Because inpatients are often unable to successfully adhere to this rigorous positioning, the Pharmacy and Therapeutics Committee has voted to keep alendronate off the inpatient formulary. Use of the patient’s home supply is still permitted, but not encouraged, due to this risk of erosive esophagitis.

At the request of the Committee Members from the Departments of Surgery and

Anesthesiology, and in order to increase participation from these Departments in the Pharmacy and Therapeutics Committee, the time of the meeting has been changed to 07:00 on the second Friday of each month. It is the sincere hope of all of the members of the committee that this change will be successful.

and pediatric pulmonary hypertension. Dispensed by Respiratory Therapy, it is approved only for use in neonatal and pediatric cases, and only to be used in the Operating Room for neonatal and pediatric cases, the Neonatal ICU and the Pediatric ICU. Provisionally approved in February, the Committee added the above restrictions. 100% of all cases in which this drug was used will be reviewed.

(April) Nutren Jr. and Nutren Jr. w/ Fiber – oral and tube feeding for ages 1 – 10 y.o.

This will be substituted for Pediasure and Pediasure w/ Fiber.

of invasive pneumococcal disease in children below 5 years old.

 

gastrointestinal motility, diabetic gastroparesis, gastroesophageal reflux, constipation and nocturnal (GERD) heartburn. Cisapride is contraindicated with drugs that inhibit the cytochrome P450 3A4 enzyme or with drugs that prolong the QT interval. Avoid cisapride therapy in-patients who are at increased risk for cardiac arrhythmias. The drug is slated to be removed by the manufacturer from the U.S. market in July 2000. An additional action taken by the Pharmacy and Therapeutics Committee was to disallow the use of cisapride brought into the hospital from home.

(April) Pediasure and Pediasure w/ Fiber - oral and tube feeding for ages 1 – 10 y.o.

(April) Thirty other drugs, all approved by the FDA in 1999, were reviewed

This completes the review of 1999 drugs by the Pharmacy and Therapeutics Committee.