P H A R M A G R A M    

July, 2008                                                         ..an educational memo from your Pharmacy and Therapeutics Committee

 

Improved Accountability with Midazolam (Versed®) and Fentanyl Infusions:

 

Reduced midazolam and fentanyl infusion bag sizes for adult patients has been instituted in order to increase documentation accountability and safety. The new bag sizes, 50mg in 50ml for midazolam and 1500mcg/150ml for fentanyl, will maintain the same concentration as the previous preparations, but will limit the duration of each individual bag to 12-24 hours.

 

 

Better Tracking of Patient’s Home Medication Infusions:

 

Continuous home infusion pumps of insulin, baclofen and morphine are becoming more common and are likely to be continued during hospitalization. IDX Carecast has now been updated to allow for documentation of these home infusions on the Medication Reconciliation forms and the inpatient medication list.

 

 

Warfarin (Coumadin®) ‘Reminder’ Entry in IDX Carecast:

 

A separate ‘reminder’ entry will be placed onto the medication list in IDX Carecast for warfarin therapy whenever warfarin is ordered.  Since warfarin is often ordered as single doses (based on that day’s INR value), this ‘warfarin reminder’ entry will serve as a cue that the anticoagulation therapy is ongoing; unless specifically discontinued. This reminder will reduce missed doses and missed orders on transfer.

 

 

Interaction: Carbamazepine (Tegretol®) and MAO Inhibitors:

 

Serotonin syndrome has been associated with the concomitant administration of carbamazepine and MAO inhibitors.  Oxcarbazepine (Trileptal®), which is metabolized to carbamazepine, and linezolid (Zyvox®), which has MAO inhibitor properties, should be included in this warning. A 14 day washout period is suggested prior to the initiation of the potential interacting drug.

 

 

Formulary Changes and Autosubstitutions;

 

Aprotinin (Trasylol®) was recently recalled by the FDA after being associated with increased morbidity and mortality. Tranexamic acid and aminocaproic acid are possible alternatives for hemostasis during cardiovascular surgery.

Chloral hydrate suppositories have been removed from the Formulary since they are no longer commercially available.

Irbesartan (Avapro®) and the combinations with hydrochlorothiazide were removed from the Formulary because of low prescribing and to provide formulary consistency with the other OSF hospitals. An autosubstitution of irbesartan to valsartan (Diovan®) was approved.

Candesartan (Atacand®) and the combinations with hydrochlorothiazide were added to the Formulary. This angiotensin receptor blocker is approved for treating heart failure and the formulary addition provides consistency with the other OSF hospitals.

Opium and belladonna suppositories, which are used for ureteral spasms, have a new manufacturer and are once again available on the Formulary

 

 

 

Drug Information Service – 655-2382 (Mon-Fri; 7 am – 3 pm)