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
November, 2003
Remember to Indicate the Whole Drug Name – Including Suffixes:
The list of drug names with suffixes, such as LA, CR, SR, XT seems to continue to grow. Potential life-threatening reactions can occur when drug orders do not include the suffix. One example is when an immediate-release product is dispensed in place of a sustained-released drug. Listed below is a partial list of products with suffixes as part of their names.
Adalat CC Aspirin EC Cardizem SR Cardizem CD Depakote ER
Catapres-TTS-1 Beconase AQ Betoptic S Bicillin LA Detrol LA
Creon-5 Darvocet N-100 Effexor XR Niacin SR Glucophage XR
Norpace CR Percocet-5 Procardia XL Prostin VR Glucotrol XL
Sinemet CR Ritalin SR Tegretol XR Toprol XL Bicillin LA
Formulary Additions:
Escitalopram (Lexapro ®) is a selective serotonin reuptake inhibitor indicated in the treatment of depression. Escitalopram is an enantiomer of citalopram (Celexa ®), has been increasingly prescribed and is less expensive than citalopram.
Gatifloxacin ophthalmic solution 0.3% (Zymar ®) was added to the Formulary. As a fluoroquinolone, it shares a very similar spectrum of activity as the other fluoroquinolone ophthalmic products. The P&T Committee agreed to allow an autosubstitution of these other fluoroquinolone ophthalmic solutions to gatifloxacin.
Enoxaparin Drug Orders Using Milligram per Body Weight:
When ordering enoxaparin (Lovenox), prescribers are encouraged to write out the total dose rather than a milligram/Kilogram amount, unless the patient’s weight appears on the Physician Order Sheet along with the order. Occasionally, inaccurate current patient weights appear in the computer data base which may result in an incorrect enoxaparin dose being calculated. Writing out the actual desired dose provides a better system for double-checking an order and a more accurate medical record of the dose prescribed.
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Caspofungin (Cancidas®) Added to the Formulary:
Caspofungin (Cancidas®) is a systemic antifungal agent indicated in the management of aspergillus infections refractory to conventional amphotericin B. In vitro, it also covers many candida spp. Its mechanism of action differs from amphotericin B and the “azole” antifungals. Caspofungin inhibits beta-(1,3)-glucan synthesis and disrupts the cell-wall integrity resulting in osmotic instability and eventual cell lysis. Caspofungin use is associated with fever, thrombophlebitis, flushing, and headache. It does not interact with the cytochrome P450 system as a substrate, inducer or inhibitor. Voriconazole (Vfend ®), and now the newest Formulary addition caspofungin, offer two less costly alternatives to amphotericin B lipid complex (Abelcet ®). These two antifungal agents may also be considered as potential alternatives in patients who are intolerant to amphotericin B therapy.