P H A R M A G R A M    

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

December, 2004

Formulary Additions and Denials:

• Rivastigmine (Exelon®) used in the treatment of Alzheimer ’s disease was added to provide a therapeutic alternative to patients not responding adequately to other therapies. Common side effects of this medication have included nausea, vomiting, diarrhea, anorexia, dyspepsia, abdominal pain, weight loss, headache, asthenia, dizziness, fatigue, and malaise.
• Ciprofloxacin ophthalmic solution 0.3% (Ciloxan®) added since the generic version is less costly. The most common adverse effects observed with this preparation are conjunctival irritation, increased lacrimation, keratitis, and papillary conjunctivitis.
• Terbinafine (Lamisil®) an antifungal was denied addition due to low frequency of in-patient use, other drugs available on Formulary (ex. itraconazole (Sporonox®), and out-patient Formulary considerations.

Concentrated Electrolyte Administration Policy Changes:

There have been some changes made for administering intravenous concentrated electrolytes (i.e. Potassium Phosphate and Chloride, Calcium Gluconate and Chloride, Sodium Phosphate, and Magnesium Sulfate). Two procedural changes specific to General Care Units are the following:

Peripheral administration of potassium chloride bolus infusions will be limited to a rate of 10meq/hr if the patient is not on telemetry and 20meq/hr (1meq/kg/hr for pediatrics) if on telemetry.

Peripheral administration of calcium gluconate boluses will be prepared by Pharmacy at a concentration of either 1-3gm in 100ml or 3-5gm in 250ml (for pediatrics use a 1:2 dilution with 5% dextrose) and a maximum infusion rate of 3gm per hour (240mg/kg/hr for pediatrics). Calcium chloride will be reserved for central line administration only and emergency use on the General Care Units.

The Nursing Drug Matrix contains these and other IV guidelines. Refer to the Nursing Protocols and Procedures under Hospital Standards on the SFMC Intranet site or use the URL address:

http://hospital-standards.sfmc.intranet.osfnet.org/pdf/procedures/drugmatrix.pdf

Darbepoetin (Aranesp®) Autosubstitution for Epoetin (Procrit®, Epogen®):

Darbepoetin is an epoetin analogue used for erythropoiesis stimulation and was formulated to have a longer half-life than epoetin alpha. The P&T Committee approved pharmacists’ autosubstituting orders for 20,000 units or greater of epoetin to darbepoetin based on significant cost savings and equal therapeutic efficacy. Listed below is a suggested autosubstitution for epoetin doses less than 20,000 units that physicians may consider:

                  Epoetin (Procrit®, Epogen®)              Darbepoetin (Aranesp®)

                        Less than 2,500  units/week               6.25 mcg/week

                        2,500 – 4,999       units/week            12.5   mcg/week

                        5,000 – 10,999    units/week               25     mcg/week

                        11,000 – 17,000 units/week                40     mcg/week

                        18,000 – 33,999 units/week                60     mcg/week

Consolidation of Intravenous Theophylline Products:

With decreased utilization of IV theophylline, the Pharmacy will now stock only the 800mg in 250ml solutions.

Hyaluronidase (Amphadase®) is Now Commercially Available:

Hyaluronidase 150 units/ml is now available as Amphadase® for treating certain types of extravasations and ophthamologic procedures.

Reminder: Please Use Your 5-digit IDX User Number and Signature for Orders

ADE (Adverse Drug Event) Hotline: 655-6805

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