NAME	GEN. NAME	CLASS	INDICATION	DOSAGE	SIDE EFFECTS
Amaryl 1 mg, 2 mg, & 4 mg tablets	Glimepiride	Anti-diabetic	Type 2 diabetes mellitus	1 to 4 mg once daily	Hypoglycemia, disulfiram-like reaction, SIADH
Actos 15 mg, 30 mg, & 45 mg	Pioglitazone	Anti-diabetic	Type 2 diabetes mellitus	15 - 45 mg once daily	Headache, Upper resp. infection, myalgia, pharyngitis
Accuzyme Ointment	Papain-Urea	Topical debriding agent	Pressure ulcers, diabetic ulcers, post-op wounds, burns.	Once or twice daily	Burning sensation

For patients who have been stabilized on Rezulin prior to a hospital admission, it will be available for
administration after the pharmacist determines if the patient was taking Rezulin at home.

All other patients who are starting the thiazolidinedione class for the first time, the medical staff are encouraged to prescribe Actos or Avandia
.

Policy and Procedures:

Potassium Sliding Scale Policy

The sliding scale policy was brought to the committee for discussion regarding the areas where this policy could be executed. The "monitored area" of the protocol was defined as following:

Tarzana -ICU, DOU, CVU; Encino ICU, CCU.

Non-Formulary Drug Request Policy

Whenever a non-formulary agent is dispensed, a Non-Formulary Drug Request Form must be generated. A pharmacist will assess the order for the non-formulary medication which will eliminate the need to call the prescriber. The pharmacist will then complete the Non-Formulary Drug Request form for the physician.

Automatic Renal Dose/Interval Adjustment Policy

The pharmacist will adjust the dose and interval of target medications for patients with compromised renal function. The pharmacist will monitor all creatinine values greater than 1.5 mg/dl, calculate the creatinine clearance for the patient, and adjust the drug dose or the interval on the "physician order" form.

For a one-month period, the pharmacist will fax a copy of the dose adjustment communication form to the physician. After the one-month period, the adjustment will be done automatically without notice.

Penicillins, cephalosporins, quinolones, and H-2 antagonists are subject to adjustment based on the patient's renal function. For a copy of the adjustment protocol, please call the pharmacy department.

Encino: 995-5181; Tarzana: 708-5360

Adverse Drug Reaction Winner:

Tarzana: John Steigleder, Pharm .D. (Pharmacy)

Encino: Martha Jorgensen, R.N. (GI LAB)

The winners received $50.00 each.

* ADVERSE DRUG REACTIONS

The ADR reports for the 3rd quarter 1999 were 78 compared to 68 reports for the 2nd quarter of 1999.

There were 6 severe reactions of which 2 were from inpatients. Both reactions were unexpected reactions. One was an anaphylactic reaction due to clarithromycin and the other was hemolytic anemia due to Cefotan.

The following are medications associated with adverse reactions during the 2nd quarter of 1999:

DRUG	Reaction	Severity
Claforan iv	itching	B/Mod
Claforan	Thrombocytopenia	B/Mod
Flagyl	Rash	B/Mod
Ancef IV x 5	Rash, itching,	B/Mod
Keflex, Ancef	Thrombocytopenia	B/Mod
Cefotan 2gm iv	Hemolytic anemia	B/Sev
Clarithromycin	Itching	B/Min
Clarithromycin	Red face, diff. Breath	B/Sev
Zithromax po	Nausea	B/Mod
Vancomycin	Rash	B/Mod
Zosyn	Drug fever	B/Mod
Flagyl 250 po	Nausea	A/Minor
Levaquin IV	Itch, rash	B/Mod
Augmentin	Severe diarrhea	A/Mod
Morphine iv	Rash	B/Min
Demerol IV x3	Sedation	A/Mod
Dilaudid PCA	Nausea, vomiting	A/Mod
Dilaudid PCA	Itching	B/Mod
Dilaudid IM x 2	Lost consciousness	A/Mod
MS Epidu x 4	Itching, nausea	A/Mod
Vicodin x 2	Confusion, sedation	A/Mod
Percocet	Itching	B/Min
Digoxin	Bracycardia	A/Mod
Digoxin	Elevated level	A/Mod
Vasotec	Hypotension	A/Mod
Betapace x 2	Bradycardia, hypoten	A/Min
Betapace	Arrhythmia	A/Mod
Tenormin	Bradycardia	A/Min
Lopressor	Bradycardia	A/Min
NTG sl	Hypotension	A/Mod
Digoxin	Level>2	A/Mod
Quinidex	Diarrhea	A/mod
Coumadin x2	CVA,GI Bleed (C)	A/Sev
Coumadin x 2	INR>4	A/Mod
Lovenox	Hematoma	A/Mod
Integrilin	Itching	B/Mod
Contrast dye	Hives, nausea	B/Mod
Effexor	Nausea, vomiting	B/minor
Diph/Tet Vac	Redness	B/Minor
Insulin	Hypoglycemia BS=37	A/Mod
Compazine x 2	Dystonic reaction	A/Minor
Infed	Hypotension	B/Mod

*A = Expected ADR, B = Unexpected ADR

C = Community

DRUG UTILIZATION REVIEW (DUE)

Study of the usage of Lovenox during the 2nd quarter found that the area of greatest difficulty was in dosing of the drug:

Prevention of DVT:

Hip or Knee: 30 mg SC q12hr (7-14 days)

Hip or abdominal surg:40mg SC q24hr (3 weeks)

Treatment of DVT and PE:

1 mg/kg SC q12hr or

1.5mg/kgk SC q 24hr.

Unstable Angina & Non-Q-Wave MI:

1 mg/kg SC q12 hr with ASA (100 325 mg)

Mitral Valve Disease and Atrial Fibrillation;

1 mg/kg SC q12hr

DRUG NEWS: Linazolid

by Asher Kashanchi, Pharm. D. candidate

Linezolid is a member of new class of synthetic antimicrobial agent, oxazolidinones. It is an investigational agent undergoing phase III clinical trias and has not received FDA approval. The manufacturer of this antibiotic is Pharmacia & Upjohn.

The mechanism of action of linazolid is interference with protein synthesis by binding to the 50S ribosomal subunit.

The oxaolidinones possess activity against gram-positive bacteria including Methicillin resistant Staphylococcus aureus (MRSA), MRSE, vancomycin intermediate/resistant staphylococcus aureus or Stapylococcus epidermidis, and vancomycin-resistant enterococci.

In regards to indications, linezolid has demonstrated activity in the treatment of skin and soft tissue infections as well as pneumonia and bacteremia.

Linezolid is formulated for intravenous and oral administration. The bioavailability of the oral formulation is excellent.

Linezolid is a mild, Monoamine Oxidase Inhibitor (MAOI) similar to the antidepressant of this class. Caution should be exercised when administering concurrently with food containing tyramine such as aged cheese, fermented sausage , tap beers, or amphetamines, tricyclics (amitriptyine, doxepin), or SSRI (fluoxetine).

The adverse reactions of this medication include brown or yellow tongue discoloration, superficial fungal infections, and headache.

In conclusion, linezolid is a promising clinical agent from a new class of antimicrobials. Its unique mechanism of action and the lack of cross-resistance with current antibiotic classes will make linezolid an essential alternative agent in the treatment of gram-positive infections.