July 2005 Vol 22
"What's in your wallet?"
No, this is not a CitiCorp commercial though physicians have an exciting opportunity to say that they have a gift certificate for a coffee and muffin at Java World at St. Luke's or Lundy Common Grounds at Mercy in theirs!!
We are recognizing physicians for their GREAT efforts in reducing or eliminating the use of unapproved abbreviations in their written medication orders. Inclusion in this elite group will be determined by a thorough review of all orders written during a random week in July or August at both St. Luke's Hospital and Mercy Medical Center. Those physicians that use NO unapproved abbreviations during that week will be rewarded with a gift certificate for a coffee and muffin at Java World at St. Luke's or Lundy Common Grounds at Mercy. The most frequently seen unapproved abbreviations were:
#1 : QD (for daily)
#2 : MS (for morphine sulfate)
#3 : U (for units)
The use of these three abbreviations accounted for over 80% of the variances!!
Nicotrol(r) Inhaler is Added to the Formulary
The Nicotrol(r) Inhaler consists of a nicotine cartridge which releases vapor and is absorbed buccally rather than through the lungs. It is FDA approved for smoking cessation. When one cartridge is used by frequent continuous puffing (20 minutes) the patient sees the best results. The maximum daily dose is 16 cartridges, equivalent to 16 cigarettes. Common adverse effects include nicotine withdrawal (dizziness, headache, insomnia) and oral/airway irritation. Serious, but rare, adverse effects include fast or irregular heartbeat, hypersensitivity, and hypertension.
Decision: Approve Nicotrol(r) Inhaler for formulary inclusion.
Gelclair(r) Concentrated Oral Gel is Added to the Formulary
Gelclair(r) is a bio-adherent oral gel indicated for the management/relief of pain associated with oral mucositis. Gelclair(r) contains three main ingredients to help lubricate the mouth while soothing pain: PVP (a bioadherent, fill-forming agent), hyaluronic acid (for hydration and lubrication), and licorice root extract (flavoring agent). One packet is diluted with 15-30 ml of water then used at once to rinse the mouth for at least 1 minute. After gargling and spitting out the Gelclair(r) the patient should not eat or drink for at least one hour.
Decision: Approve Gelclair(r) Concentrated Oral Gel for formulary inclusion
Relpax(r) (eletriptan) is Added to the Formulary
Relpax(r) is a serotonin-1B/1D (5HT1B/1D) receptor agonist indicated for the treatment of acute migraine headaches. The initial dose is 20-40 mg orally and may repeat after 2 hours if headache returns. The maximum daily dose is 80mg. In geriatric patients reduce the dose to 20mg with a daily maximum dose of 40 mg. Contraindications and precautions are the same as for other meds of this drug class.
The most common adverse effects include: asthenia, dizziness, nausea, and somnolence. Serious adverse effects include: acute hypertension, angina, MI, arrhythmia, heart block, cerebrovascular ischemia, and neuropathy. Drug-drug interactions include (but are not limited to): ergot-type medications, CYP3A4 inhibitors, MAOI's and SSRI's.
Decision: Approve Relpax(r) for formulary inclusion.
Pneumonia Pathway - Antibiotic Changes
The current pneumonia pathway alternates every month between ceftriaxone and azithromycin in even months to levofloxacin in odd months. The original intent was to attempt to delay resistance to levofloxacin in this area. However levofloxacin has become such a popular antibiotic both in and out of the hospital that the number of doses prescribed in hospital is small in comparison to community use.
Beginning August 1st the pneumonia pathway will have levofloxacin 500mg IV daily as the standard selection unless one of the other options is checked. If there is a strong suspicion of aspiration then clindamycin 900mg IV every 8 hours can be added. Three alternative intravenous regimens listed on the order sheet are: levofloxacin 750mg daily, ceftriaxone 1 gram daily, and azithromycin 500mg daily.
Decision: Revisions to the pneumonia pathway antibiotics were approved.
Invanz(r) (Ertapenem) Quick Review
Invanz(r) is indicated for the treatment of adult patients with the following moderate to severe infections caused by susceptible strains of the designated microorganisms: Complicated intra-abdominal infections, complicated skin/skin structure infections, community-acquired pneumonia, complicated urinary tract infections, including pyelonephritis, acute pelvic infections, including postpartum endomyometritis, septic abortion, and post-surgical gynecologic infections.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Invanz(r) and other antibacterial drugs, Invanz(r) should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
The usual dose of Invanz(r) in adults is 1 gram given once a day. Patients with advanced renal insufficiency (creatinine clearance ²30 mL/min/1.73 m2) require half the regular dose, or 500 mg daily.