The Link A publication from the Alton Memorial Hospital Infection/Pharmacy Committee on Formulary and Drug Use Evaluation for physicians. August 2011 PCA changes in preparation for CPOE
The BJC Community Hospitals have completed the physician order form for PCA (patient controlled analgesia) and have standardized to specific concentrations and ordering parameters. AMH plans to make these changes September 1 in preparation. Here are the new ordering parameters and the new concentration for fentanyl (previously 25mcg/ml):
Fentanyl 10mcg/ml Suggest: 10mcg Suggest: 10 min Suggest: max 75 mcg/hour Suggest: 0-20 mcg/hour Hydromorphone (DILAUDID) 0.2 mg/ml Suggest: 0.2 mg Suggest: 10 min Suggest: max 1.5 mg/hour Suggest: 0-0.5 mg/hour Erythropoetin Stimulating Agents (ESA) - Protocol Revision June, 2011: In collaboration with the FDA, Amgen and Janssen updated ESA product
labeling, including the boxed warning and Warnings and Precautions. No trial has
identified a Hgb target level, ESA dose, or dosing strategy that does not increase the
risk of death, serious adverse cardiovascular reactions and stroke when ESAs are
administered to target a Hgb level of >11g/dL.
Pharmacy will automatically HOLD ESA therapy (Procrit, Epogen, Aranesp) for all
patients with a Hgb > 11, and for patients with CKD (chronic kidney disease) who are not on dialysis with a Hgb > 10, according to the latest patient safety recommendations.
Formulary Changes
Lovastatin Fluvastatin Simvastatin Atorvastatin Rosuvastatin Formulary HMG-CoA Reductase Inhibitors (Statins):
Due to a superior safety and efficacy profile, AMH will streamline to a single statin, rosuvastatin (Crestor), and will automatically substitute Crestor, in therapeutically equivalent doses, for all other statin orders, beginning September 1, 2011.
Opthalmic Prostaglandins:
Due to comparable safety and efficacy, Lumigan and Travatan opthalmic solutions have been removed from formulary and latanoprost (Xalatan) will be automatically substituted (1 drop in affected eye once daily) when these prostaglandins are ordered.
Injectable Iron:
Due to comparable safety and efficacy, iron sucrose (Venofer) has been removed from formulary and Na ferric gluconate complex (Ferrlecit) will be automatically substituted, in equivalent doses, when Venofer is ordered:
Additions to the Renal Dosing Protocol
The pharmacist will automatically adjust doses in renally impaired patients, according to manufacturer recommend doses, for the following medications:
1. Cefdinir (Omnicef): CrCl < 30 = decrease to 300 mg daily
2. Ceftaroline (Teflaro): CrCl < 51 requires decreased dosing
3. Levofloxacin (Levaquin): CrCl < 50 requires decreased dosing
4. Televancin (Vibativ): CrCl < 50 requires decreased dosing
Tetracycline Plate Kit (for Honey) INTENDED USE The Abraxis Tetracycline Plate Kit is a competitive ELISA for the quantitative analysis of Tetracycline in Honey. ASSAY PRINCIPLES The Abraxis Tetracycline plate kit is a competitive enzyme-labeled immunoassay. Tetracycline is extracted from honey by shaking with extraction solution. The Tetracycline sample extract and calibrators
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