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

February, 2003

Budesonide oral capsules (Entocort EC), which is indicated for the treatment of mild to moderate active Crohn’s Disease, was added to the Formulary. This extended-release product allows for once daily dosing as compared to 3 to 4 times a day dosing for other products used for this indication.

Perindopril (Aceon) was added to the Formulary based on the stroke prevention benefits reported from the PROGRESS trial (Lancet 2001;358:1033-41), when this agent is used in combination with a diuretic (indapamide). The words ‘for stroke prevention’ must accompany all orders for perindopril, otherwise an auto-substitution using 10mg lisinopril for a 4mg dose of perindopril will be made by the pharmacist.

Urokinase (Abbokinase), a thrombolytic agent that has been reformulated to eliminate the risk of viral contamination, was approved to the Formulary. Due to cost concerns and comparative efficacy with other thrombolytic agents, urokinase will be restricted to use in patients with venous or arterial thrombosis and who are at a high risk for bleeding.

Argatroban, a direct thrombin inhibitor, was added to the Formulary for use as an alternative parenteral anticoagulant in patients with heparin-induced thrombocytopenia and who are renally impaired..

The pre-printed physician orders for patient-controlled analgesia (PCA) also contain medication orders for treating nausea, vomiting, pruritis, constipation and oversedation. Physicians are reminded to discontinue each of these other drugs when the order to discontinue the PCA is written.

There is frequently misinformation and implications made that generic drug products are inferior to the trade name brand products. In an effort to assure the public that generic prescription drugs must meet the same strict government standards as the trade name product, the Food and Drug Administration has been advertising this information through various public media. Information about generic drugs is available at www.fda.gov/cder/ or by calling 1-888-INFO-FDA.

Adverse medical events are estimated to occur in 3.7% to 16.6% of hospitalized patients resulting in approximately 44,000 death in the U.S. A recent medical journal article (Circulation 2002;106:2623-9) examines this issue and promotes the following Principles for Quality Prescribing to reduce medication errors:

Prescribe medications only when appropriate and necessary.

Fully inform patients about their medications, including positive and negative outcomes.

Reporting errors and adverse events so others will not repeat them.

Withstanding pressures to prescribe in ways not in the patient’s best interest.

Knowing thoroughly the drugs being prescribed.

Anticipating and preventing drug interactions.

Establishing a partnership between physicians, pharmacists and nurses to monitor therapy for

interactions or errors and to counsel patients effectively.

Report Adverse Drug Events on the ADE Hotline – 655-6805