OSF Saint Francis Medical Center, Peoria, Illinois

...an educational memo from your Pharmacy and Therapeutics Committee

September, 2001

To avoid errors with telephone orders, nurses, pharmacists and all others authorized to receive physician telephone orders are requested to repeat the orders back to the prescriber for verification.

Alendronate (Fosamax) must be taken with 6-8 ounces of water and the patient should remain in an upright position for at least 30 minutes after the dose. Because most hospitalized patients cannot comply with these requirements, there is an increased risk for esophagitis, esophageal erosion or ulcers. Due to potential and documented cases of significant adverse effects at OSF Saint Francis, and that missing doses of this medication during hospitalization is unlikely to cause long-term consequences, alendronate has not been added to the Formulary. Further, the P&T Committee voted to suspend all prescribing and dispensing of alendronate, including the use of the patient’s home medication, for hospitalized patients. Calcitonin (Miacalcin) may be considered as an alternative to alendronate if clinically necessary.

Since hyaluronidase has been in short supply, treatment of parenteral infiltrations has been restricted to drugs that can cause significant tissue damage. In addition to specific chemotherapeutic agents (etoposide, teniposide, paclitaxel, and vinca alkaloids), potassium boluses and calcium, phenytoin infiltrations should also be treated with hyaluronidase.

Irbesartan (Avapro) Irbesartan/Hydrochlorothiazide (Avalide)

Valsartan (Diovan) Valsartan/Hydrochlorothiazide (Diovan HCT)

Arsenic trioxide (Trisenox) Losartan/Hydrochlorothiazide (Hyzaar)

Vagisil ointment Reteplase (Retevase) (Restricted to Interventional Radiology)

Manufacturing problems has resulted in sincalide, a diagnostic agent used in cholecystography, to be backordered for one year. Our supply is restricted to what is currently in our inventory.

Administration of infliximab (Remicade), an antibody to tumor necrosing factor and approved for use in Crohn’s Disease, has been associated with the development of active tuberculosis infections in patients who had the latent form of the disease. Based on this information, the manufacturer now has a Black Box Warning in the product information recommending the administration of a tuberculin skin test before starting infliximab therapy.