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
September, 2003
New Antiemetic Pre-printed Orders for Adults Coming Soon:
With antiemetic therapy over the past few years parenteral prochlorperazine (Compazine®) has become unavailable, FDA warnings about ECG changes with droperidol (Inapsine®) has resulted in removal of this product from the Formulary and inappropriate prescribing of ondansetron (Zofran®) has increased the projected cost to about $800,000 for fiscal year 2003. In order to simplify product selection, provide some guidance to the treatment of nausea and vomiting and to promote rational prescribing, an Antiemetic Pre-printed Order form will be made available on all units excluding pediatrics and ante-partum. For non-chemotherapy related nausea and vomiting, the recommended ondansetron dose is 4mg IV for one dose, which may be repeated for one dose within 8 hours after the initial dose. Higher doses are not supported by the literature or product information.
Formulary Additions:
The following two drugs were added to the Formulary:
Bimatoprost (Lumigan®) ophthalmic solution is a synthetic prostamide analog indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension who are intolerant or unresponsive to other intraocular pressure lowering medications.
Pegasparaginase (Oncaspar®) is L-asparaginase modified through a linkage with polyethylene glycol which extends the half-life and allows for lower doses and less frequent administration. Pegasparaginase is indicated for the treatment of lymphoblastic leukemia. Stocking of this item will be limited to specific patient requirements.
Warfarin (Coumadin®) Administration to Patients Receiving Enteral Tube Feedings Reviewed:
A literature search and benchmarking with other hospitals has shown no evidence supporting holding tube feedings prior to or after administering warfarin. New guidelines for administering warfarin specify crushing the warfarin tablet, adding tap water, flushing the nasogastric/nasoduodenal/gastric tube with 10 mls tap water, administering the crushed warfarin tablet, flushing again with 10 mls of tap water, and resuming the tube feeding.
.Autosubstitutions Approved:
The following therapeutic substitutions were approved by the Pharmacy and Therapeutics Committee.
Clarithromycin XL (Biaxin XL®), a macrolide antibiotic, can be substituted to regular-release clarithromycin
Desloratadine (Clarinex®) a non-sedating antihistamine can be switched to loratadine (Claritin®)
Heme iron polypeptide (Proferrin ES®) can be changed to Ferrous gluconate (Fergon®)
Diatx, a multivitamin used in nephrology, will be substituted to Nephron FA
Enteral Protein Supplement Changed to Casec®:
Casec® was approved by the P&T Committee as the enteral protein supplement replacing Promod®. Casec® contains an extra gram of protein per tablespoonful and costs less than the Promod® product.
Parenteral to Oral Fluoroquinolone Substitution Approved:
The P&T Committee has approved guidelines which will allow pharmacists to change parenterally administered fluoroquinolones (ex. gatifloxacin (Tequin®) to an equivalent oral dosage form in adult patients on general care units. Special autosubstitution order forms containing the approved guidelines will be used whenever this change in dosage form is made.
Remember to Use Dictation Numbers when Writing Orders:
Dictation numbers are more easily read, help identify prescribers and assist in quickly resolving questions about written orders.