...an educational memo from your Therapeutics Committee

March, 2000

Also mentioned are pre-existing conditions including various kinds of heart disease, respiratory failure and renal failure. The Therapeutics Committee recommends that, before administration of cisapride, the prescriber should order and interpret a 12-lead ECG. If the QTc exceeds 450 milliseconds, do not give cisapride. In addition, the patient’s serum potassium should be monitored, as hypokalemia is a predisposing factor for developing torsades de pointes. The recommended doses of cisapride should not be exceeded. If the patient develops syncope, rapid or irregular heartbeat, the patient should stop taking the drug and seek the attention of a physician. Report Adverse Drug Events using the ADE hotline (655-6805) and the FDA Medwatch program. MedWatch forms are available from the pharmacy.

OSF Saint Francis Medical Center has amended its Vendor Representative Policy to add a section regarding "inservice presentations". These are invited presentations by a vendor representative in a specific department to provide information about a drug or device. The amendment requires the vendor to submit the materials to be used during the inservice to the appropriate department (e.g. all drugs, OTC drugs and Dietary Supplements to Pharmacy) at least one week in advance. If approved by the department, the materials may be used during the inservice. Other provisions of the policy are not changed.

You may receive a call from a pharmacist, informing you that an order has been written that may result in a significant "drug-drug interaction". The pharmacist will ask you to: 1) discontinue one of the drugs, 2) change to a similar (non-interacting) drug or 3) proceed with the orders as written. The Therapeutics Committee approves this program in order to reduce the risk of Adverse Drug Events. Recently, 27 new drug-drug interactions were approved for incorporation into this computer-based program. Of particular interest are the numbers of drug-drug interactions involving the "cytochrome P-450 metabolism" in the liver, and drug interactions that result in "torsades de pointes" ventricular arrhythmias.

The use of ibutilide is restricted to telemetry units and administered by a physician.

Ibutilide is used for rapid conversion of atrial fibrillation and atrial flutter. The dose is 1mg/50ml NS or D5W infused over 10 minutes and may be repeated in 10 minutes. It may cause hypotension, headache and nausea. Like many antiarrhythmics, ibutilide may be pro-arrhythmic in some patients. Hypokalemia or hypomagnesemia predisposes the patient receiving ibutilide to arrhythmias, including torsades de pointes. There are reports of drug-drug interactions between ibutilide and 40 other drugs, especially those that prolong the QT interval (for example: atropine, other antiarrhythmics, diuretics, vasodilators, psychotropics, antidepressants, some antibiotics [erythromycin, sulfamethoxazole-trimethoprim], corticosteroids, chloroquine, isoproterenol, amantadine, chloral hydrate, vasopressin, cisapride and tacrolimus). Ibutilide also interacts with digoxin.

pulmonary hypertension (vote to add/not add will be taken at the 4/14/2000 meeting)

The use of nitric oxide gas is restricted to the Neonatal ICU and the Pediatric ICU.

of Type 2 diabetes

The pharmacy will stock two dosage strengths, the 15mg and 30mg doses. Prescribers should monitor liver function in patients placed on this medication.

invasive pneumoccal disease in children below 5 years old, especially below 2 years old.

of Type 2 diabetes

The pharmacy will stock one dosage strength, the 4mg dose. Prescribers should monitor liver function in patients placed on this medication.

prevention of acute and chronic solid organ (kidney) transplant rejection

of Type 2 diabetes - due to reports of hepatic toxicity. See additions to the formulary.