P H A R M A G R A M
OSF Saint Francis Medical Center, Peoria, Illinois
...an educational memo from your Pharmacy and Therapeutics Committee
May, 2003
Sodium and Potassium Content of Oral Phosphorous Replacement:
Oral phosphorous replacement products have varying amounts of sodium and potassium, which may present problems in particular patient populations. Listed below are the Formulary phosphorous replacement products with their sodium and potassium contents.
Product Potassium Sodium Phosphorus
(meq) (meq) (mmols)
Fleets Phosphosoda®
(per ml) 0 4.8 4.1
K-Phos Neutral®
(per tablet) 1.1 13 8
Neutra-Phos®
(powder* or capsule*) 7.13 7.13 8
Neutra-Phos K®
(powder* or capsule*) 14.25 0 8
* Capsules or packets should be opened to dissolve powder in 75 mls of water.
Points to Consider when Prescribing Meperidine (Demerol®):
Meperidine has a duration of action that lasts about 2-3 hours, which may necessitate frequent drug administration times. Individual doses for adults with moderate to severe pain require at least 75-100mg, with 150 – 200mg sometimes being needed. Normeperidine is an active metabolite of meperidine, that can accumulate with higher doses, long term use, or in patients with impaired renal function. Normeperidine has been associated with causing seizures, tremors, twitches and other neurological toxicities. Because of these issues, morphine, hydromorphone (Dilaudid®) and fentanyl are considered better and safer alternatives. Patient-Controlled Analgesia (PCA) using meperidine is discouraged and is not allowed for in-patient use.
Availability of Dexmedetomidine (Precedex®) Expanded with Restrictions:
Dexmedetomidine is an alpha-2 CNS agonist with analgesic and sedation properties. This drug, which until recently, was restricted to use during the immediate postoperative phase for cardiovascular surgical patients, can now be used in all of the adult ICUs. Use in the Pediatric ICU is pending. Other commonly used agents, such as midazolam (Versed®), propofol (Diprivan ®), and fentanyl are still considered first line agents over dexmedetomidine, unless intolerance or lack of therapeutic effect are encountered. Dexmedetomidine is unlikely to cause respiratory depression and does not cause amnesia. It has been associated with hypotension, bradycardia, A-V block, dry mouth, and is synergistic with other analgesics and anesthetics. Costs associated with dexmedetomidine are significantly greater than with any of the other more commonly used agents.
Secobarbital (Seconal®) Discontinued; Continued Use Restrictions for Parenteral Corticosteroids and Pantoprazole:
Due to low usage, discontinuation of the parenteral dosage form and the difficulty to obtain oral dosage form, secobarbital has been removed from the Formulary.
Parenteral methylprednisolone (Solu Medrol®), hydrocortisone (Solu Cortef ®), betamethasone (Celestone®) and pantoprazole (Protonix®) availability from the manufacturers continues to be limited. Previously published policies regarding autosubstitution and specifying the indication with the drug order if no substitution is desired, will remain in effect for at least the next month or two until adequate supplies of these drugs are available.