OSF Saint Francis Medical Center, Peoria, Illinois

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

August, 2002

A Patient Assistance Program is available for indigent patients who cannot pay for their medication and could otherwise be treated with the low molecular weight heparin, enoxaparin, as an outpatient. Patient qualification is based on family income being below twice the 2001 HHS Poverty guidelines. For example, a family of one or two members would qualify if their annual income is less than $17,180 or $23,220, respectively. For more information and a Patient Assistance form, contact the Vascular Case Manager or the Discharge Planning Office (655-2311).

The multivitamin product used in the parenteral nutrition solutions has recently been modified by the manufacturer and now contains 150 micrograms of vitamin K. Therefore, additional supplemental vitamin K (i.e. vitamin K 10mg IM weekly) is probably unnecessary given this change in formulation.

Sevelamer (Renagel®) is a nonabsorbable cationic polymer indicated for the reduction of serum phosphate in patients with end-stage renal disease. This product was added to the Formulary as an alternative or supplement to the calcium and aluminum containing phosphate binding agents. Although not specifically studied, the product information suggests coadministration with antiarrhythmics and seizure medication should be avoided within 1-2 hours of dosing with sevelamer to circumvent binding and reduced absorption.

During the shortage, supplies of diphtheria and tetanus vaccine decreased nationally by 40%. Currently stock levels of this vaccine have been restored. Persons who were deferred from routine vaccinations may now receive the booster dose.

Pantoprazole (Protonix®) is currently the only FDA approved proton pump inhibitor that can be administered intravenously. The undiluted drug must be refrigerated and, once it is reconstituted, is stable for up to 12 hours at room temperature. IV administration is over 15 minutes, or not to exceed

3 mg/min. Because of precipitates that form upon reconstitution, pantoprazole must be administered in a dedicated IV line with the inline filter provided with the product . A 0.22-micron inline filter, which is available on some IV administration sets, may be used as an alternative.

To avoid errors when prescribing ‘as needed’ or ‘PRN’ medications, be sure to include the allowable frequency and the indication as to when the medication should be given. For example, avoid promethazine 25mg IM PRN . Such orders are considered incomplete and will prompt a request for clarification. A more complete order is promethazine 25mg IM every 4 hours PRN nausea.