P H A R M A G R A M

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

May, 2006

Auto-substitutions Approved:

The following autosubstitutions were approved by the Pharmacy and Therapeutics Committee:

Drug Ordered Substitution

►Diclofenac (Voltaren®)                                                   Ibuprofen (Motrin®)

►Sulindac (Clinoril®                                                         Ibuprofen (Motrin®)

►Lactobacillus (Bacid®)                                                    Lactobacillus (VSL#3®)

►Lactobacillus (Lactinex®)                                               Lactobacillus (VSL#3®)

►Leflunomide (Arava®)                                                    If patient’s supply is unavailable,

pharmacists may write ‘hold’ order

New Medication Safety Position Approved:

Ryan Taylor, PharmD., will assume the responsibilities of a newly approved position of Medication Safety Officer. Representing Pharmacy, Ryan will be working on drug-related issues such as adverse drug events and medication reconciliation and with Cassy Horack, the Patient Safety Officer. Cassy and Ryan have recently published an article on “Medication Reconciliation” in the March issue of Nursing 2006 Critical Care.

Formulary Additions:

Accuzyme ® ointment which is a combination of papain and urea, and Panafil® ointment, which combines papain and urea with chlorophyllin, have been approved to the Formulary. Adverse effects from these products tends to be limited to transient ‘burning’ sensation and irritation.

Standardized Concentrations of Drug Infusions:

In order to minimize multiple infusion concentrations, which can lead to confusion and potential dosing errors and increased costs, the following were approved as the standard drug concentrations.

Midazolam 100mg/100ml               Diltiazem 250mg/250ml D5W       Fentanyl 2500mcg/250ml

Oxytocin 10 units in 500ml NS or 500ml D5/LR                       

Oxytocin 10 units in 1000ml NS or 1000ml D5/LR

Bupivacaine 0.125% in 250ml NS                                  

Fentanyl 2mcg/ml with bupivacaine 0.125% in 100ml NS

Fentanyl 2mcg/ml with bupivacaine 0.0625% in 100ml NS

Fentanyl 4mcg/ml with bupivacaine 0.1% in 250ml NS

Medications Banned from the Hospital:

The following drugs are not approved for in-patient use:

Herbal or Nutritional Supplements – not regulated by the FDA, content not monitored, health claims

generally not substantiated

Alendronate (Fosamax®), risedronate (Actonel®) – associated with esophagitis and ulcers. Must

be taken in an upright position with 8oz of water.

Pramlinitide (Symlin®), exenatide (Byetta®) - risk of severe hypoglycemia in the acute care setting 

Use of Cephalosporins in Patients with Penicillin ‘Allergies’

Cephalosporin orders for patients with an ‘allergy’ to a penicillin that consists of GI irritation or other non-severe, non-IgE mediated reactions, may be processed and dispensed without consulting with the prescriber. The P&T Committee approved a protocol which outlines the required procedure.

ADE (Adverse Drug Event) Hotline: 655-6805

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