PHARMACY AND THERAPEUTICS NEWSLETTER




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VOLUME 5.1
June 2000
Susan Wee, Pharm.D.,EDITOR
PHARMACY AND THERAPEUTICS COMMITTEE ACTIONS

Formulary Additions:
Trade Generic Indication
Miralax Polyethylene glycol Constipation
Renagel Selvelamer Phosphate binder
Viracept Nelfinavir Antiviral
Valtrex Valacyclovir Antiviral
Crixivan Indinavir Antiviral

Formulary Deletion:
Nalidixic acid (Negram®), minocycline (Minocin®), erythromycin gluceptate IV, flucytosine (Ancobon®), griseofulvin(Fulvicin®), mefloquine (Lariam®), paromomycin (Humatin®), zalcitavine (Hivid®) atovaquone (Mepron®), methyl cellulose (Citrucel®) were deleted from the formulary based on low usage. Troglitazone (Rezulin®) was deleted due to the manufacturer's discontinuation of the medication.

Therapeutic Equivalence of Betapace AF:
Betapace Betapace AF Sotalol Sotalol Sotalol
Manufacturer Berlex EON PAR TEVA
AUC generic AUCBetapace 100%* 97.18% 98% - 105% 102.2%
Strength tested 80, 120, 160, 240mg 80, 120, 160, 240 mg 240 mg 160 mg
Cost 80mg/tab $ 1.96 $ 0.24 $ 0.46 $ 1.79
Cost 80mg/month $ 117.60 $ 14.40 $ 27.6 $ 107.4

*Potency quality control for Betapace AF: 95 - 105%
*The only difference between Betapace and Betapace AF is the blue dye for Betapace.
The P&T committee has reviewed the data and concluded that the generic sotalol may be used as a therapeutic equivalent for all indications for Betapace and Betapace AF (sotalol) manufactured by Berlex Company. The indications include atrial fibrillation, atrial flutter, and ventricular arrhythmias.

POLICY AND PROCEDURES
Revised PCA Infusion Order form: has been approved. The changes include a reference table of doses and a simplification of the form. The new form will be available when current supply is exhausted.

Therapeutic interchange:
Dolasetron (Anzemet®) for ondansetron (Zofran®) in Post-op nausea and vomiting(PONV)
The following algorhithm will be utilized.

When (Zofran) ondansetron is ordered Use (Anzemet) dolasetron as noted
Adult PONV iv 4 mg iv before end of case or PONV. 12.5 mg iv
15 min. before end of cases or PONV
Adult PONV Oral 16 mg tab 1hr pre induction. 100 mg tab
2 hr pre-op
Pediatric PONV iv 0.1 mg/kg iv <40kg 4mg iv >40 kg (Age 2-12) 0.35mg/kg with max. 12.5mg iv
15 min before end of case (Age 2-16)
Pediatric PONV Oral (Age 2-16)
-
 1.2 mg/kg up to 100mg 2hr pre-op

Vicoprofen (7.5/200 hydrocodone/ ibuprofen) will be substituted with Lortab 7.5/500 instead of Vicodin ES (7.5/750 hydrocodone /acetaminophen). This is an attempt to avoid excessive acetaminophen administration to a patient.


URGENT DRUG NEWS!
Flumazenil (Romazicon®) is unavailable from the manufacturer, Roche until further notice.


Quality Improvement Tips from the JCAHO Survey
During May 9 to May 12, 2000, Encino-Tarzana was surveyed by the JCAHO. The hospital went through an intense survey from JCAHO surveyors as well as the

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