September 2007 Pharmagram

NAME CONFUSION: Phenylephrine (Neosynephrine®) and Norepinephrine (Levophed®)

Phenylephrine and norepinephrine infusions are commonly used vasopressors used in acute care areas and are sometimes confused with each other. The use of abbreviations such as ‘Neo’ or ‘Levo’ when ordering is not allowed and using both trade and generic names should be considered. Be sure to be specific about the infusion rate (i.e. mcg/min).

Bedside Medications:

The policy regarding ‘bedside’ medications has been revised and is now limited to sublingual nitroglycerin and albuterol inhalers. The Joint Commission will allow these drugs to be stored out of sight (bedside table or over-the-bed table). Patients are to notify the nurse as soon as possible when a dose is administered. The revised policy will be posted on the SFMC intranet on September 13^th.

Formulary Denials:

Brinzolamide (Azopt®) ophthalmic solution used in the treatment of open-angle glaucoma, was denied approval to the Formulary. The approved substitution will be dorzolamide (Trusopt®), which is therapeutically equivalent. In addition, an anticipated patent expiration will reduce the cost of the dorzolamide.

Sitagliptin (Januvia®), indicated for the treatment of type-II diabetes, was denied Formulary addition. Hemoglobin A1C improvement is similar or less than currently available drugs. The long term side effects are unknown. It is costly compared to other oral agents and, generally, is considered a ‘non-preferred’ drug by third-party insurers.

Calcium/Ceftriaxone (Rocephin®) Interaction:

The FDA has reported fatal reactions in term and premature neonates due to precipitates in the lungs and kidneys iwhen calcium and ceftriaxone are administered concurrently. Current ceftriaxone use in neonates is very rare, and with this alert, this antibiotic should now be avoided in this age group.

For all other patients, ceftriaxone should not be mixed or administered simultaneously with intravenous calcium, especially in high doses.

New High-Alert Medications:

The Institute for Safe Medications Practices (ISMP) has added the following to their list of drugs that bear a heightened risk of causing patient harm: parenteral epoprostenol, oxytocin (Pitocin®), and promethazine (Phenergan®), and 100ml or larger bags of sterile water for injection, inhalation or irrigation. Antithrombotic agents (ex. alteplase (Activase®) and IV antiarrhythmics are two new categories added to the list.