P H A R M A G R A M    

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

April, 2004

 

Warfarin (Coumadin®) Dosing Time Change:

Starting Monday, April 26th, the universal in-patient warfarin dosing time will be 1800. The 6-Sigma Coumadin® ADE Reduction Committee based this change on a review of clinical studies, a nursing survey showing dissatisfaction with the current dosing time of 1500, and a benchmarking survey of other facilities.  If a physician wants to override the1800 dosing time, he/she must write an order stating his/her preferred time.

Formulary Deletions, Autosubstitutions, and Denials:

Ø      Nifedipine (Procardia®, Adalat®) regular-release capsules were deleted from the Formulary due to low usage and potential harm associated with their use.

Ø      Cetacaine® spray (benzocaine/tetracaine) was deleted from the Formulary and benzocaine spray (Hurricaine®) was approved as the autosubstitution. Significant cost savings and potential inappropriate reuse of a contaminated applicator tube were the reasons for this change.  

Ø     Human milk fortifier Similac® product will be switched to an equivalent Enfamil® product which contains iron resulting in reduced need for separate iron supplementation.

Ø     Two alternatives to using the non-formulary one-quarter normal saline (NS) with sodium bicarbonate (i.e. Dextrose 5% with 150meq sodium bicarbonate or one-half NS with 70meq sodium bicarbonate) were approved. These alternative IV solutions are isotonic, use a base solution that are commercially available and reduce the potential for using hypotonic IV infusions.

Ø     Paroxetine (Paxil®) autosubstitution for paroxetine controlled-release (Paxil CR®) was approved.

Ø     Eplerenone (Inspra®) was denied Formulary status based on the presence of another aldosterone antagonist already on Formulary (i.e. spironolactone (Aldactone®), significant cost difference, non-preferred status by outpatient insurers, and drug interaction warnings.

Drug Discontinuations:

The following drug products have been discontinued by their manufacturers and will no longer be available: chlorpromazine suppositories (25 and 100mg), aminophylline liquid and tablets, theophylline liquid and theophylline 450mg sustained-release tablets.

Mercaptopurine (Purinethol®) and Azathioprine (Imuran®) Metabolism Inhibition – Screening for a Genetic Deficiency:

There are individuals with an inherited deficiency of the enzyme thiopurine methyltransferase (TPMT) who may be unusually sensitive to the myelosuppressive effects of mercaptopurine or azathioprine and prone to developing rapid bone marrow suppression following the initiation of treatment. Substantial dose reductions may be required to avoid the development of life-threatening bone marrow suppression. Identification of these individuals is encouraged and is available through a blood test which can be ordered as ‘TPMT-RBC’ or Test Code ‘XC36.”

Only the Patient May Activate Patient-Controlled Analgesia (PCA):

The Pharmacy and Therapeutics Committee wishes to emphasize that caregivers, family members, or anyone other than the patient may not activate or administer analgesic doses using the PCA system. Only a patient, who has received proper instructions and judged capable, may activate the on-demand doses from a PCA.

Is There a Documented Reason for Each Medication Ordered?:

The Joint Commission Standard MM.3.10 states: Only medications needed to treat the patient’s condition are ordered.  Be sure there is a documented diagnosis, condition, or indication-for-use for each medication ordered.

 

ADE (Adverse Drug Event) Hotline: 655-6805

 

Drug Information Service – 655-2382 (Mon-Fri; 8am – 4pm)