PHARMACY AND THERAPEUTICS NEWSLETTER

VOLUME 5.3

August 2000

Susan Wee, Pharm.D.,EDITOR

PHARMACY AND THERAPEUTICS COMMITTEE ACTIONS

Formulary Additions:

Trade	Generic	Indication
Aggrenox	Aspirin & dipyridamole	Stroke
TNKase	Tenecteplase	Thrombolytic
Zyvox	Linezolid	Antiinfective
Atacand	Candesartan	Antihypertensive
Detrol	Tolterodine	Overactive bladder
Calmoseptine	-	Dermal Ulcer

Formulary Deletion:
Pemoline (Cylert®), phentermine (Ionamin®), phenylpropanolamine (Dexatrim®), oxymorphone (Numorphan®), Darvocet-N-50®, Wygesic®, buprenorphine (Buprenex®), pentazocine inj (Talwin®).

Oxcarbazepine (Trileptal®) was not added. This medication is available to patients (who were stabilized at home) provided that a Non-Formulary Drug request form is completed by the prescriber and forwarded to the Department of Pharmacy.

POLICY AND PROCEDURES
Droperidol (Inapsine®) and prochlorperazine (Compazine®) are the antiemetic agents of choice at ETRMC for post-op nausea and vomiting (PONV). For high-risk patients such as those with a history of motion sickness or head & neck surgery, dolasetron (Anzemet®) will be substituted for ondansetron (Zofran®).
Upon review of clinical studies that compare the efficacy and the cost of above agents to ondansetron (Zofran®), the P&T Committee recommended droperidol and prochlorperazine as the agents of choice. Zofran is 35 times more expensive than these two medications. Droperidol has a lower incidence of extrapyramidal events when compared to prochlorperazine.

ADVERSE DRUG REACTIONS:
45 ADRs were reported in the 2nd quarter (0.93%). This is the second consecutive quarter that our ADR reporting has decreased. The 1st quarter rate was 1.95%. All of the healthcare team members are encouraged to report ADR.
There were 5 severe reactions. The first reaction was a severe respiratory depression due to excessive Dilaudid IV administration. The second reaction was severe bradycardia due to Betapace. The third reaction was a gastrointestinal bleed due to heparin and Coumadin. The last two reactions were a severe GI bleeds due to an excessive dose of Integrilin.
The appropriate Medial Staff Committees were notified and the FDA was notified as required.

1st quarter ADR of 2000:

ANTIBIOTIC: Levaquin-2, Flagyl-2, Ancef, Cefotan, Claforan, Zithromax, Zosyn, Rocephin
NARCOTIC/SEDATIVES: Dilaudid IV-3, Ambien-3, Demerol-2, Darvocet-N-100-2, Dilaudid PCA, Fentanyl IV, Fentanyl patch
ANTIPSYCHOTIC: Zyprexa, Compazine
CARDIOVASCULAR: Betapace-2, Diamox, Lasix, Capoten, Norvasc, Cardizem CD, Lopressor, Dopamine IV
ANTICOAGULANTS: Coumadin-7, Integrilin-2
OTHER: Hexabrix-2, Infed, Dilantin

Adverse Drug Reaction Winners:

Tarzana: Jeanne Ann Micale R.N. (L&D)
Encino: Dave Forman, Pharm. D. (Pharmacy)
The winners received $50.00 each.

DRUG UTILIZATION REVIEW (DUE)

HEPARIN IV:
A study of the usage of heparin IV during the 2nd quarter showed that 100% of the patients met the criteria for indication. 87% of the patients received heparin per the hospital protocol.

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