P H A R M A G R A M

Parenteral to Oral Substitution List Updated:

Several new drugs with excellent oral bioavailability have been added to the approved list that pharmacists may convert from intravenous to oral administration. Besides assessing the feasibility of oral administration, the pharmacist will also consult with the Patient Care Facilitators and others for appropriateness of the conversion. The complete policy, which covers only adults on non-ICUs, can be accessed under the ‘Pharmacy Service Protocols’ on the Pharmacy Portal http://myosf.osfhealthcare.org/sites/SFMC/pharm/default.aspx

New OSF Order Sets Approved:

OSF has started posting a number of new order sets that will be standardized throughout the OSF system. Evidence-based prescribing provided by Zynx® serves as a template for the OSF reviewers. These new OSF System orders and the institution-specific pre-printed orders can be easily accessed on the IDX Homepage by clicking OSF Order Sets on the Menu list.

Frequency Substitution for Respiratory Nebulization Orders:

To enable a more accurate charting of nebulized medications and to be consistent with actual practice, the P&T Committee approved the Respiratory Therapists to convert ‘every four hours while awake’ and ‘every six hours while awake’ orders to the following:

Every 4 hrs while awake: 7-11-15-19 and PRN at night Every 6 hrs while awake: 6-14-22 and PRN at night

Formulary Changes and Autosubstitutions;

Atenolol (Tenormin®) IV deleted due to discontinuation by the manufacturer.

Azelastine (Astelin®) nasal spray denied approval due to other available products (ex. Ipratropium (Atrovent®) and phenylephrine (Neosynephrine®) nasal sprays) and cost.

Iron polysaccharide (Niferex) 60mg capsule deleted and approved ferrous sulfate 325mg x 2 as an autosubstitution.

Iron/folate/B-12 (Iberet- 500®) deleted and approved

Iron polysaccharide (Niferex-150) as an autosubstitution.

IV Phenytoin (Dilantin) Conversion to IV Fosphenytoin (Cerebyx®):

To reduce adverse drug events and consolidate the Formulary, starting July 1^st all intravenous phenytoin orders will be substituted to fosphenytoin. Doses must be ordered as ‘phenytoin equivalents or PE.’ In addition, for adult patients, doses of 400mg PE and greater will be administered as 100ml piggybacks. The usual loading dose rate is 50mg per minute. Refer to the ‘Intravenous Drug Administration Reference (aka Drug Matrix)’ in the Guide to Medication Use for SFMC Clinicians which is located on the SFMC homepage for more information.