***Not Applied to patients <18 years of age***
Proton Pump Inhibitors Formulary Medication Ordered Medication
Ordered when any other PPI is ordered for GT, PEG, NG
Esomeprazole (Nexium) Oral Suspension, Lansoprazole (Prevacid) Solutabs
Lansoprazole (Prevacid) 15 mg PO Omeprazole (Prilosec) 10 mg PO
Dexlansoprazole (Dexilant/Kapidex) 30-60 mg PO Esomeprazole (Nexium) 20-40 mg PO Lansoprazole (Prevacid) 30 mg PO Omeprazole (Prilosec) 20-40 mg PO Omeprazole-Sodium Bicarbonate (Zegerid) 20-40 mg PO Rabeprazole (Aciphex) 20 mg PO
Esomeprazole (Nexium) 40 mg IV Lansoprazole (Prevacid) 30 mg IV
Patients on Plavix and PPIs may be suggested to switch to Pepcid at either 20 mg BID or 20 mg daily based on renal function. In this case, the pharmacist will write an order in the chart. Simplified lansoprazole solution (SLS) will be substituted at an equivalent dose if a liquid is necessary. H-2 Antagonists Formulary Medication Ordered Medication
Cimetidine (Tagamet) 300-400 mg PO Nizatidine (Axid) 150 mg PO Ranitidine (Zantac) 150 mg PO
Nizatidine (Axid) 300 mg PO Ranitidine (Zantac) 300 mg PO
Ranitidine (Zantac) 50 mg IV q8-12h Cimetidine (Tagamet) 300 mg IV q6h
Antacid Formulations Formulary Medication Ordered Medication
Any antacid or antacid with simethicone ordered.
Prevpac Substitution Formulary Medication Ordered Medication Hmg Co-A Reductase Inhibitors Formulary Medication { ͌ % LDL Lowering} Ordered Medication { ͌ % LDL Lowering} Simvastatin (Zocor) 5 mg { ̴ 26%}
Lovastatin (Mevacor) 10 mg { ̴ 21%} Pravastatin (Pravachol) 10 mg { ̴ 22%}
Atorvastatin (Lipitor) 5 mg Fluvastatin (Lescol) 20 mg { ̴ 17%} Lovastatin (Mevacor) 20 mg { ̴ 29%} Pravastatin (Pravachol) 20 mg { ̴ 24%} Pitavastatin (Livalo) 1 mg
Atorvastatin (Lipitor) 10 mg { ̴ 37%} Fluvastatin (Lescol) 40 mg { ̴ 23%} Lovastatin (Mevacor) 40 mg { ̴ 31%} Pravastatin (Pravachol) 40 mg { ̴ 34%} Rosuvastatin (Crestor) 5 mg { ̴ 43%} Pitavastatin (Livalo) 2 mg
Atorvastatin (Lipitor) 20 mg { ̴ 43%} Fluvastatin (Lescol) 80 mg { ̴ 33%} Fluvastatin XR (Lescol XR) 40 mg { ̴ 33%} Lovastatin (Mevacor) 80 mg { ̴ 40%} Pravastatin (Pravachol) 80 mg { ̴ 35%} Rosuvastatin (Crestor) 10 mg { ̴ 50%} Pitavastatin (Livalo) 3 mg
Fluvastatin XR (Lescol XR) 80 mg { ̴ 38%} Rosuvastatin (Crestor) 20 mg { ̴ 53%} Pitavastatin (Livalo) 4 mg { ̴ 41%}
Atorvastatin (Lipitor) 80 mg { ̴ 60%} Rosuvastatin (Crestor) 40 mg { ̴ 62%}
We will not institute our regular therapeutic substitution to Zocor when a patient is on a protease inhibitor due to increased risk for myopathy/rhabdomyolysis. Amprenavir (Agenerase) Atazanavir (Reyataz), Darunavir (Prezista), Fosamprenavir (Lexiva), Indinavir (Crixivan), Lopinavir/Ritonavir (Kaletra), Nelfinavir (Viracept), Ritonavir (Norvir), Saquinavir (Invirase), or Tipranavir (Aptivus) Insulins Formulary Medication Ordered Medication
Insulin Aspart (Novolog) Insulin Glulisine (Apidra)
Pancreatic Enzymes Formulary Medication Ordered Medication
Any pancreatic enzyme ordered at closest similar
Electrolyte Supplement Formulary Medication Ordered Medication
K-Phos Original 2 tablets (dissolved in 6-8 oz water)
Multivitamin Formulations Formulary Medication Ordered Medication Oral Calcium Products Formulary Medication Ordered Medication
Calcium with Vitamin D (same dose) 500 mg
Fiber Laxatives Formulary Medication Ordered Medication Fluoroquinolone Antibiotics Dx: Respiratory/Skin/Sinus/Gram Positive/Non Urinary Tract Infections Formulary Medication Ordered Medication
Levofloxacin (Levaquin) 500 mg IV daily Levofloxacin (Levaquin) 750 mg IV daily
Ophthalmic Quinolone Eye Drops Formulary Medication Ordered Medication
Levofloxacin (Quixin) 0.5% Ophthalmic Solution
Moxifloxacin (Vigamox) 0.5% Ophthalmic Solution
Norfloxacin (Chibroxin) Ophthalmic Solution Ofloxacin (Floxin) 0.3% Ophthalmic Solution
As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions.Electrolyte IV Potassium Pharmacy Other Modification for Administration Ordered Medication
Central Line maximum rate: 20mEq per hr - MUST USE INFUSION PUMP
Peripheral Line maximum rate: 10 mEq per hr - MUST USE INFUSION PUMP
**Pharmacy will use Pre-mixed bags unless written by the physician “Do not substitute”**
Echinocandin Antifungals Formulary Medication Ordered Medication
Caspofungin (Cancidas) 70 mg or 50 mg IVPB Andulafungin (Eraxis) 50 to 200 mg IVPB
As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions.Venlafaxine Formulary Medication Ordered Medication
daily Venlafaxine XR (Effexor XR) 75 mg PO
daily As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions.Carvedilol Substitution Formulary Medication Ordered Medication Sedative Agents Formulary Medication Ordered Medication
Zaleplon (Sonata) 5-10 mg Eszopiclone (Lunesta) 1 or 2 mg Zolpidem CR (Ambien CR) 6.25 mg Any patient over age 65 for all sedatives
Eszopiclone (Lunesta) 3 mg Zaleplon (Sonata) 20 mg Zolpidem CR (Ambien CR) 12.5 mg
Flurazepam (Dalmane) 15 mg Estazolam (Prosom) 1 mg Triazolam (Halcion) 0.125 mg
Flurazepam (Dalmane) 30 mg Estazolam (Prosom) 2 mg Triazolam (Halcion) 0.25 mg
Hydrocodone/Acetaminophen Combinations Formulary Medication Ordered Medication
Hydrocodone/Acetaminophen (Lortab) 5/500
Hydrocodone/Acetaminophen (Vicodin) 5/500 Hydrocodone/Acetaminophen (Zydone) 5/400 Hydrocodone/Acetaminophen (Lorcet) 5/500
Hydrocodone/Acetaminophen (Lortab) 7.5/500
Hydrocodone/Acetaminophen (Vicodin ES) 7.5/750 Hydrocodone/Acetaminophen (Lorcet Plus) 7.5/650
Hydrocodone/Acetaminophen (Lortab) 10/500
Hydrocodone/Acetaminophen (Lorcet) 10/650 Hydrocodone/Acetaminophen (Vicodin HP) 10/660 Hydrocodone/Acetaminophen (Maxidone) 10/750
Extended Spectrum Penicillins/Carbapenems Formulary Medication Ordered Medication
Piperacillin/Tazobactam (Zosyn) 3.375 gm IV Ticarcillin/Clavulanic Acid (Timentin) 3.1 gm IV Piperacillin/Tazobactam (Zosyn) 2.25 gm IV
Ticarcillin/Clavulanic Acid (Timentin) 2 gm IV
Imipenem-Cilastatin (Primaxin) 500 mg IV q6h Meropenem (Merrem) 1 gm IV q8h
Imipenem-Cilastatin (Primaxin) 500 mg IV q8h to q12h Meropenem (Merrem) 500 mg IV q6h to q8h
Dose adjustment for Creatinine Clearance: Pain Medications Formulary Medication Ordered Medication
Oxycodone/Aspirin (Percodan) 5/325 Oxycodone/APAP (Tylox) 5/500
Acetaminophen with Codeine #4 60/300 1 tab
2 tabs Butalbital/APAP/Caffeine (Fioricet/Esgic)
Butalbital/ASA/Caffeine (Fiorinal) 50/200/40
Butalbital/APAP/Caffeine (Esgic Plus) 50/500/40
Inhaled Bronchodilators Formulary Medication Ordered Medication
Levalbuterol (Xopenex) metered dose inhaler
Orders for pediatric patients will not be changed. As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions.Inhaled Steroid Formulary Medication Ordered Medication
Budesonide (Pulmicort) 1-2 puffs daily Flunisolide (Aerobid) 2-4 puffs daily Triamcinolone (Azmacort) 4-10 puffs daily
Budesonide (Pulmicort) 3 puffs daily Flunisolide (Aerobid) 5-8 puffs daily Triamcinolone (Azmacort) 11-20 puffs daily
Budesonide (Pulmicort) > 3 puffs daily Flunisolide (Aerobid) >8 puffs daily Triamcinolone (Azmacort) >20 puffs daily
As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions.Inhaled Steroids/Long Acting Beta Agonists Formulary Medication Ordered Medication
Budesonide-Formoterol (Symbicort) 80/4.5
Budesonide-Formoterol (Symbicort) 160/4.5 Fluticasone-Salmeterol (Advair) 250/50 and 500/50 2 puffs BID
As a courtesy to prescribers and nursing, pharmacy will continue to write clarifications for the above substitutions.Inhaled Nasal Steroids Formulary Medication Ordered Medication
Fluticasone (Veramyst) Triamcinolone (Nasacort AQ) Mometasone (Nasonex) Budesonide (Rhinocort AQ) Beclomethasone (Beconase AQ) Ciclosenide (Omnaris)
Antitussives Formulary Medication Ordered Medication For Tube Patients Guaifenesin Oral Solution 200 - 400mg q4h Oral Antihistamines Formulary Medication Ordered Medication
Cetirizine (Zyrtec) 5 mg PO daily Fexofenadine (Allegra) 30 mg PO BID
Cetirizine (Zyrtec) 10 mg PO daily Desloratadine (Clarinex) 5 mg PO daily Fexofenadine (Allegra) 60 mg PO BID Fexofenadine (Allegra) 180 mg PO daily Levocetirizine (Xyzal) 5 mg PO daily
Fexofenadine-Pseudoephedrine (Allegra-D) Claritin D (12) – Ordered daily
Fexofenadine-Pseudoephedrine (Allegra-D) Claritin D (12) Ordered BID or Claritin D (24) ordered daily
Fibric Acid Derivatives Formulary Medication Ordered Medication
Antara 43 mg Fenoglide 40 mg Fenofibrate (generic) 50 mg, 54 mg, or 67 mg Fenofibric acid (TriLipix) 45 mg Lofibra 54 mg or 67 mg Lipofen 50 mg Triglide 50 mg
Antara 130 mg Fenoglide 120 mg Fenofibrate (generic) 120 mg, 134 mg, 150 mg, 160 mg, or 200 mg Fenofibric acid (TriLipix) 135 mg Lofibra 134 mg, 160 mg, or 200 mg Lipofen 150 mg
Phosphate Binders Formulary Medication Ordered Medication Promethazine Substitution Formulary Medication Ordered Medication
Promethazine (Phenergan) 12.5 mg IV q4h, q6h, q12h
Promethazine (Phenergan) 25 mg IV q4h, q6h, q12h
Promethazine (Phenergan) 50 mg IV q4h, q6h, q12h
Orders for IV promethazine on L&D and chemotherapy floors (A400 & A200 respectively) will not be autosubstituted. Physicians who choose to prescribe IV promethazine on other floors shall write "Do Not Substitute." In those cases, IV promethazine will be diluted in 50 cc of normal saline. If an order for ondansetron already exists, then autosubstitution will not be made and previous order will remain active. 5-HT3 Antiemetics Formulary Medication Ordered Medication
Dolasetron (Anzemet) 12.5 mg IV Granisetron (Granisol) 0.1 mg IV
Granisetron (Granisol) 1 mg IV q12h Dolasetron (Anzemet) 100 mg IV q24h Palonosetron (Aloxi) 0.25 mg IV q24h
Dolasetron (Anzemet) 100 mg PO q24h Granisetron (Granisol) 2 mg PO q24h
** Excludes Chemotherapy Patients** Bladder Antispasmodics / Incontinence Formulary Medication Ordered Medication
Solifenacin (Vesicare) 5 mg PO daily Trospium (Sanctura) 20 mg PO daily Tolterodine (Detrol) 1 mg PO BID Fesoterodine (Toviaz) 4 mg PO daily
Solifenacin (Vesicare) 10 mg PO daily Trospium (Sanctura) 20 mg PO BID Tolterodine (Detrol) 2 mg PO BID Fesoterodine (Toviaz) 8 mg PO daily
Antiepileptics Formulary Medication Ordered Medication
Levetiracetam (Keppra XR) 1000-3000 mg PO daily
Phenytoin Equivalents (PE) doses – 1:1 conversion
Renal Vitamins Formulary Medication Ordered Medication
Renal Caps NephroCaps (contains folic acid, B vitamins, biotin,
(contains folic acid, B vitamins, biotin,
Hemocyte Plus Iberet Folic 500 Nephron –FA
Niferex Chromagen (iron polysaccharides)
FolBee Foltx (contains folic acid, B12, and B6)
Angiotensin II Receptor Blockers Formulary Medication Ordered Medication
Note: Combination Products excluding generic Hyzaar (hctz/irbesartan) - such as Micardis HCT, Avalide, etc will be converted to the equivalent components.
CHAPTER 2 LITERATURE REVIEWS 2.1 Risperidone (Risperdal®) is a psychotropic agent belonging to the chemical class of benzisoxazole derivatives. The chemical designation is 3-[2-[4-(6-fluoro-1, 2-benzisoxazol- 3-yl)-1-piperidinyl] ethyl]-6,7,8,9-tetrahydro- 2-methyl-4H-pyrido [1,2-a]pyrimidin- 4-one. Its molecular formula is C23H27FN4O2 (Figure 1) and its molecular weight is 410.49
Detoxification • Dependence• Model of Change• Motivation The Seven Markers of Dependence Salience of drug-seeking behaviour (Simply obtaining the drug becomes increasingly important at the expense of other aspects of the drug users life)Relief or avoidance of withdrawal symptomsNarrowing of the repertoire of drug taking behaviour (Drug use becomes a daily activity, an increasin