P H A R M A G R A M    

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

May, 2004

Community Acquired Pneumonia: Antibiotics Within 4 hours!

Evidence based medicine tells us that rapid antibiotic initiation and appropriate antibiotic selection for community acquired pneumonia will result in a significant decrease in length of stay and improved outcomes for our patients. Based on a study of more than 13,000 patients, the 2004 update from the Infectious Disease Society of America reported that timeliness may be MORE important than antibiotic selection. Community acquired pneumonia is one of the quality indicators that will be monitored by the Joint Commission and the results of their findings will be shared publicly on a ‘Report Card’ of U.S. hospitals.  Within 4 hours from hospital admission to antibiotic administration has been determined to be an acceptable target time.

Things to Consider When Prescribing Enoxaparin (Lovenox®):

o       DVT prophylactic doses of 40mg once a day is the preferred dose for medical, general surgery, and stroke patients. Patients at high risk or undergoing total knee surgery may require enoxaparin 30mg every 12 hours.

o       Minimal dosing information for obese patients weighing greater than150 KG. Consider using unfractionated heparin, which can be monitored with PTTs.

o       For patients with severe renal impairment (creatinine clearance <30 mL/min) the recommended dosages are 30mg daily for prophylaxis or 1mg/kg daily for treatment.  

o       DVT therapy: see www.tagpeoria.org for orders.

o       Do not write 1 mg/kg by itself; include the total dose or provide the patient’s weight.

o       Round doses to the nearest 10mg (pre-filled syringes are 30, 40, 60, 80, 100, 120, 150mg)

Darbepoetin (Aranesp®)Autosubstitution for Epoetin (Procrit®, Epogen®): Darbepoetin and epoetin are two erythropoietin products that are currently on the Formulary and are approved for use in treating anemia.  Since darbepoetin has a longer half-life and is significantly less expensive than epoetin, the P&T Committee approved a pharmacist autosubstitution of weekly injections of these products equivalent to 40,000 units of epoetin to 100mcg darbeopoetin.

FDA Defends Generic Equivalency:

The Food and Drug Administration has made available a website (www.fda.gov/cder/) and a phone number (1-888-INFO-FDA) for people who want to know more about generic drugs and their equivalency to the trade name products.

Safe Writing Habits: Avoid Unsafe Abbreviations:

Do not use U (for units), IU (for international units), Q.D. (for daily), Q.O.D. (for every other day), drug abbreviations, trailing zeros (i.e. 5.0) or missing leading zeros (i.e. .5).

ADE (Adverse Drug Event) Hotline: 655-6805

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