PHARMACY AND THERAPEUTICS NEWSLETTER

VOLUME 5.4

November 2000

Susan Wee, Pharm.D.,EDITOR

PHARMACY AND THERAPEUTICS COMMITTEE ACTIONS

Formulary Additions:

Trade	Generic	Indication
Cafcit	Caffeine	Neonatal apnea
Tikosyn	Dofetilide	Arrhythmia
Lamictal	Lamotrigine	Seizure
Mirapex	Pramipexole	Antihypertensive

Formulary Deletion:
Ketoprofen (Orudis), nabumetone (Relafen), piroxicam (Feldene), thiethylperazine (Torecan), cyclizine (Marezine), clorazepate (Tranxene), meprobamate (Equanil), amoxapine (Asendin), trimipramine (Surmontil), maprotiline (Ludiomil), Phenelzine (Nardil), tranylcypromine (Parnate), promazine (Sparine), trifluoperazine (Stelazine), pimozide (Orap), chlordiazepoxide & amitriptyline (Limbitrol), perphenazine & amitriptyline (Triavil), tacrine (Cognex), ergoloid (Hydergine), enflurane (Ethrane), chloroprocaine (Nesacaine), ethosuximide (Zarontin), chlorzoxazone (Parafon Forte), orphenadrine (Norflex), enflurane (Ethrane), alfentanil (Alfenta).

POLICY AND PROCEDURES

Automatic Stop Date Ketorolac(Toradol):
The stop date was changed to 5 days.

Topical medicinal agents compounded by another pharmacy, the pharmacist will verify the identity of the product from the labeling and that the expiration date has not elapsed.

ADVERSE DRUG REACTIONS:
45 ADRs were reported in the 3rd quarter (0.85%). This is the third consecutive quarter that the ADR reporting has decreased. All of the healthcare team members are encouraged to report ADRs.

There were 4 severe reactions reported during the 3rd quarter. The first reaction was a severe digoxin toxicity treated with Digibind. The second reaction was respiratory distress due to Adenosine. The third reaction was severe hypotension due to verapamil and atenolol. The last reaction was severe GI bleed due to Coumadin, heparin , and Lovenox. All of the severe ADRs from 1998 to present were reviewed and the following are the conclusions.
Majority of severe ADRs were preventable and associated with prescribing by physicians.
Anticoagulants and cardiovascular class medications were the most frequent groups reported. The recommendations were to revise the heparin policy and the flow sheet for anticoagulants. Additionally, recommendation was made to use cefazolin in place of cefotetan for surgical prophylaxis associated with cesarean section.

3rd quarter ADR of 2000:
ANTIBIOTIC: Levaquin-3, Ancef-2, Cefotan-2,Zosyn, Cefotaxime, Unasyn, Vancomycin
NARCOTIC/SEDATIVES: ANTIPSYCHOTIC: Dilaudid X4, Demerol X 3, MS EpiX3, Dilaudid PCA, 0xycontin, Percocet , Morphine, Xanax
CARDIOVASCULAR: digoxinx2, Adenosine, Verapamil, atenolol, NTG paste,Zanaflex, ANTICOAGULANTS: Coumadin-6,
OTHER: Hydroxyurea, Comtan, Prednisone, Toradol

Adverse Drug Reaction Winners:

Tarzana: Rachael Kamin R.N. (Post Partum)
Encino: Jean-Luc Noiray, Pharm. D. (Pharmacy)
The winners received $50.00 each.

DRUG UTILIZATION REVIEW (DUE)
ZOSYN IV:

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