P H A R M A G R A M

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

August, 2006

Formulary Changes: Auto-Substitutions, Deletions and Additions:

Auto-Substitutions: Insulin aspart (NovoLOG®) may be substituted for Insulin lispro (HumaLOG®).

Calcitonin (recombinant) (Fortical®) may be substituted for Miacalcin Nasal®

Deletions: Insulin Lispro (HumaLOG®)

Additions: The following was added to the Formulary.

Rasburicase (Elitek®), is indicated for the initial management of plasma uric acid levels in pediatric patients with leukemia, lymphoma, and solid tumor malignancies who are receiving anti-cancer therapy. The most frequently adverse reactions are vomiting, fever, nausea, headache, abdominal pain, constipation, diarrhea, mucositis, and rash.

Hydroxyprogesterone caproate is used for the prevention of premature delivery and recurrent miscarriage. Side effects include injection site pain, rash, nausea and vomiting. This product is not commercially available and continuation of the home medication when available is preferred.

Protocols Approved:

The Pharmacy Vancomycin Dosing protocol has recently been revised and approved. Changes include targeting higher trough levels for MRSA hospital or ventilator acquired pneumonias, dose calculation based on actual weight and a revised dose adjustment nomogram.

Argatroban dosing protocol in hepatically impaired patients was approved and will be made available as a pre-printed order.

Nationwide Piperacillin/Tazobactam (Zosyn®) Drug Shortage:

Due a shortage of Zosyn®, Wyeth Pharmaceuticals has allocated drug supply for the past few months and future allocations will not meet our current utilization. The duration of this shortage is expected to last for 9 months. We are asking physicians to be prudent in prescribing piperacillin/tazobactam and reserve its use to patients in which there exists no alternative. Substitutes for piperacillin/tazobactam (Zosyn) on the formulary are dependent on the infection treated. Pharmacists will fill all piperacillin/tazobactam (Zosyn) orders as written during the first half of the month. From the 15^th until the end of month, pharmacists will automatically substitute meropenem (Merrem) for all piperacillin/tazobactam (Zosyn) orders.

Medications that Should Not Be Crushed:

Web access to a listing of drugs that should not be crushed is located on the Drug Information webpage: http://library.osfhealthcare.org/Pharmacists.asp . Reasons for not crushing medications are: 1) extended release medications, 2) enteric or protective coated medications, 3) medications formulated for sublingual or buccal absorption or those designed to exert a local effect in the mouth (eg, lozenges), 4) medications that are offensive-tasting to the patient, irritate the oral mucosa, or contain dyes or substances which may stain teeth or the oral mucosa; and 5) medications that are potentially carcinogenic and/or teratogenic and require special handling to limit exposure to health risks.

ADE (Adverse Drug Event) Hotline: 655-6805

Drug Information Service (Monday – Friday) 655-7448