P H A R M A G R A M    

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

June, 2005

Formulary Changes: Drug Additions and Deletion:

v     Eplerenone (Inspra®), a newer aldosterone-inhibitor, was added to the Formulary and carries the indication to improve survival of patients with clinical evidence of congestive heart failure after an acute myocardial infarction. Spironolactone has not been evaluated for use in this patient population. Common side effects of eplerenone include hyperkalemia and increased serum creatinine. Because of potential drug interactions, eplerenone should be avoided in patients who are currently taking erythromycin, ketoconazole, fluconazole, verapamil and saquinavir.

v     PrismaSate 2K and 4K solutions were approved for use as dialysis solutions for use as continuous renal replacement therapy.

v     Dinoprost vaginal gel (Prepidil®) was deleted from the Formulary due to lack of use.

Nesiritide (Natrecor®) Restricted:

Based upon two recent reports of possible increased mortality and worsening renal function associated with the use of nesiritide (JAMA 2005; 293:1900-5 and Circulation 2005;111:1487-91), the Pharmacy and Therapeutics Committee voted to limit prescribing to and authorized approval for use to Cardiology service. Developing an informed consent for heart failure patients, outlining the potential therapeutic risks with nesiritide therapy, was included in the measure.

TALLman Lettering Helps Reduce Errors From Look-Alike Drug Names:

The Pharmacy at Saint Francis Medical Center has been incorporating TALLman lettering in the computer systems used to identify drug names. Such drug names as ceftazidime and cefuroxime or hydralazine and hydroxyzine or quinidine and quinine are easily confused with one another because their names look alike. By incorporating TALLman lettering into IDX patient information, Pyxis dispensing machines and AutoMed packaging and storage system, the Pharmacy calls attention to these drugs and reduces the possibility of a medication error. The drugs listed above now appear as: cefTAZIDIME, cefUROXIME, hydrOXYzine, hydrALAZine, quiniDINE, and quiNINE.

For a good reference of Look-Alike, Sound-Alike drugs and procedures for selected drug products, check the Pharmacy Website (see below) or the Library Website at http://library.osfhealthcare.org/ Abbreviations Policy:

The following list of abbreviations has been banned from use in the Medical Center and was approved by the Medical Executive Committee.

ü      Abbreviated drug name (ex. MS, MSO4, MgSO4) – Write out the complete name (ex. Morphine)

ü      “U” for units or “IU” for international units – Write out “units” or ‘international units”

ü      "µg” for micrograms – Use “mcg” or micrograms

ü      Q.D. – Use daily or q24hrs

ü      Q.O.D. – Write out every other day or use every 48 hrs

ü      .5 (no leading zero) – Should be 0.5

ü      5.0 (trailing zero) – Should be 5

ü      SC or SQ –Use “subq” or subcutaneous

ü      AU, AS, AD – Write out ‘both ears,’ ‘left ear,’ ‘right ear’

ADE (Adverse Drug Event) Hotline: 655-6805

Visit the Pharmacy Website for past issues of the PharmaGram: http://library.osfhealthcare.org/Pharmacists.asp