P H A R M A G R A M    

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

May, 2005

Auto-substitutions Approved:

Due to lack of drug availability(*), inventory consolidation or evidence-based prescribing, the following drugs will be substituted to the drug and/or dose specified below:

Drug Ordered                                                                          Substitution

►Cefotetan (Cefotan*) 1-2gm every 12 hours                    Cefazolin (Ancef) 1gm every 8 hrs, plus

    Metronidazole (Flagyl) 500mg every 12 hrs

►Triethanolamine (Cerumenex*)                                         Carbamide Peroxide (Debrox)

►Anusol* hemorrhoidal ointment                                         Tucks Hemorrhoidal Ointment

►Nystatin (Mycostatin), Clotrimazole (Gyne-Lotrimin),      Miconazole (Monistat) 3-day vaginal cream

    Teraconazole (Terazole), 7-day Miconazole                       or suppositories

   (Monistat) vaginal creams and suppositories

►Ondansetron (Zofran) 4-8mg every 1-6 hrs/PRN           Ondansetron 4mg every 8 hours/PRN x 48 hrs

     (exception: chemo- or radiation therapy)                          (For Peds: use same dose as ordered)  

Formulary Changes: Drug Addition and Deletions:

v     Duloxetine (Cymbalta®), which is indicated for treating major depression by blocking the re-uptake of norepinephrine and serotonin, was approved to the Formulary. Common side effects include insomnia, headache, somnolence, nausea, dry mouth, tremor, asthenia, constipation, diarrhea, anorexia, dizziness, sexual dysfunction, sweating, flu, rhinitis, and agitation.

v     Carbidopa (Lodosyn®) and Cardia (salt substitute) were deleted from the Formulary due to low use.

Corrections to the Guide to Choice of Antibiotic-2005 Therapy (Antibiogram):

Doses for two antibiotics were incorrectly listed in the Guide to Choice of Antibiotic Therapy.  Levofloxacin (Levaquin®) dose should be 500mg daily, instead of 400mg and the daily dose for piperacillin/tazobactam (Zosyn® ) should be 4.5gm every 8 hours, instead of 3.375gm.

Hyaluronidase Commercially Available Again:

Vitrase® 200 units/ml is the hyaluronidase product available at Saint Francis Medical Center to treat selected extravasations. Although similar to the former Wydase® product, Vitrase® does not contain the preservative thimerosol, which will make it safer for use in children.  Please consult the Adult or Pediatric Extravasation Protocol for specific procedures on using this product.

Look-Alike, Sound-Alike Drug Listing and Procedures:

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/ .

‘PRN’ For What or When?

Be sure to include a reason when ordering ‘PRN’ or as needed medications. Also consider situations when more than one drug is ordered for the same indication (ex. analgesics, laxatives). Provide information to the care giver to help in choosing which drug to choose to meet the needs of the patient.

ADE (Adverse Drug Event) Hotline: 655-6805

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