OSF Saint Francis Medical Center, Peoria, Illinois

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

April, 2002

Imatinib and atorvastatin were added to the Formulary. Imatinib, which is FDA approved for the treatment of chronic myeloid leukemia, is an oral agent with mild to moderate side effects.

Atorvastatin was added since it is on a number of outpatient health plan formularies and is one of the most prescribed cholesterol lowering agents. Pravastatin (Pravachol®) will remain on the Formulary and serve as the substitute for all other ‘statin’ drugs.

Orders for fexofenadine XR 180 mg will be autosubstituted by the pharmacist with three 60 mg regular fexofenadine capsules. The half-life of fexofenadine is 14-18 hours and the kinetic data is identical between the two products, when equal once daily doses are used.

Heparin 25,000 unit in 500ml infusion bags will no longer be available to nursing through the SureMed® machines without prior pharmacist approval. Pharmacists can detect duplicate drug therapy or check for patient drug allergies prior to dispensing without causing significant delays in therapy. Bolus doses of heparin will still be available for emergencies prior to pharmacist review.

Glacial acetic acid, flexible collodian and intravenous colchicine were removed from the Formulary due to potential or actual risks or adverse drug events that have been reported.

A significantly lower acquisition cost compared to enoxaparin (Lovenox®) and once daily dosing for most indications were two reasons dalteparin was added to the Formulary. Although enoxaparin is still on the Formulary, it is hoped that physicians will consider switching to dalteparin whenever clinically appropriate. A comparison list of enoxaparin with dalteparin with usual doses is given below.

DVT prophylaxis 30mg subcut BID 5000 units subcut daily

or 40mg subcut daily

DVT prophylaxis post hip 30mg subcut BID 2500 units subcut 6hrs postop

replacement or 40mg subcut daily then 5000 units subcut daily

DVT/PE treatment 1 mg/KG subcut BID 200 units/KG subcut daily

or 1.5 mg/KG subcut daily maximum of 18,000 units daily

Look for pre-printed physician order forms for the following drugs. They are complete, contain useful information and help speed the ordering process.

Heparin-Cardiology Iron Dextran (InFed) tPA – Ischemic Stroke

Heparin-Medicine (High Bolus) Potassium Replacement (SICU) Nesiritide (Natrecor)

Heparin-Neurology (Low Bolus) RSV IG (Respigam) Infusion Dofetilide (Tikosyn)

Insulin Sliding Scale (Nephrology) Enoxaparin Acute Coronary Synd Morphine PCA

Insulin Sliding Scale (Medicine) Propofol (Diprivan) Infusion Infliximab (Remicade)

Reteplase for Dialysis Graft Thromb Abciximab (ReoPro) Ziprasidone (Geodon)

Warfarin Ortho INR Protocol Eptifibatide (Integrilin) Rocuronium (Zemuron)

Drotrecogin (Xigris) Thymoglobulin/Muromonab (OKT3)

Fentanyl Adult Postop Analgesia Hydromorphone (Dilaudid) PCA

Morphine, Fentanyl, Midazolam Weaning (CHOI)