September 2005 Vol. 24




Results of the Unapproved Abbreviations Audit



During the week of August 1 through August 7 both hospital pharmacies reviewed orders written by the physician for the use of unapproved abbreviations. The physicians who wrote orders and did not use an unapproved abbreviation, even once, received a letter of commendation and a gift certificate good to the “coffee shop” at either hospital. Please join us in congratulating them!!



Tikosyn® Physician Enrollment by Physicians



To prescribe Tikosyn® a physician must register at the Tikosyn® website, www.tikosyn.com. The P&T Committee continues to urge all cardiologists to register to be able to prescribe and monitor patients receiving this medication. Even if you never will prescribe Tikosyn® you need to register for when you are covering for the prescribing physician.


Iron Sucrose Added to Formulary in Place of Iron Dextran



Iron dextran poses the risk of anaphylactoid reactions at a level of from 0.6 to 1.8%. In comparison, the risk from iron sucrose appears to be 0.028%. In addition, an anaphylactoid reaction can occur with the first dose or the fifth dose, in other words, at any time during the treatment cycle. When initiating iron dextran treatment a test dose must first be given in the presence of the physician and the patient observed for at least one hour before starting the infusion. Iron sucrose requires no test dose or physician presence.
Iron sucrose will be therapeutically interchanged for all iron dextran orders on a mg per mg basis. For the first three months of this transition the ordering physician will be notified via phone call of the interchange.

Decision: Remove Iron Dextran (Dexferrum/Infed) from the formulary
Add Iron Sucrose (Venofer) to the formulary and interchange with iron dextran mg per mg.



Oral Cephalosporin Therapeutic Interchange



After extensive review and input from various medical specialties the oral cephalosporin therapeutic interchange has been approved. The only exception to the chart below is for pediatrics patients, Omnicef® (cefdinir) oral suspension will remain on formulary.

MEDICATION ORDERED CONVERTED TO
Vantin® (cefpodoxime) 200 mg or 400 mg orally every 12 hours Ceftin® (cefuroxime) 250 mg or 500 mg orally every 12 hours
Ceclor® (cefaclor) 250 mg or 500 mg regular release orally every 8 hours Ceftin® (cefuroxime) 250 mg or 500 mg orally every 12 hours
Cefzil® (cefprozil) 250 mg or 500 mg orally every 12 hours Ceftin® (cefuroxime) 250 mg or 500 mg orally every 12 hours
LoraBid® (loracarbef) 200 mg orally every 12 hours Ceftin® (cefuroxime) 250 mg orally every 12 hours
Omnicef® (cefdinir) 300 mg orally every 12 hours Ceftin® (cefuroxime) 500 mg orally every 12 hours
Omnicef® (cefdinir) suspension for pediatrics Not interchanged (on formulary)
Duricef®/ Ultracef® (cefadroxil) 1 gram orally once a day or divided twice a day Keflex® (cephalexin) 500 mg orally every 12 hours


Decision: Cefuroxime and cephalexin will be the oral cephalosporins on formulary.



Nicotine Replacement Products

Both Cedar Rapids hospitals are going “smoke free” on January 1, 2006. To assist physicians in ordering nicotine replacement products for inpatients an order form has been developed. The order form explains who should not receive nicotine replacement products and then allows the physician to choose the gum, oral inhaler, or transdermal patch for use in hospital.

Antibiotic Control/Resistance Reduction Task Force


The P&T Committee has formed a subcommittee charged with finding solutions to rising antibiotic resistance and aiding in antibiotic control. The subcommittee will include pharmacists, laboratory personnel, and the infection control nurse from both hospitals. Dr. McGrail has agreed to participate in the committee and other physicians will be recruited to serve when physician expertise is needed. The results from a committee of this type take several months to years to develop, but can help preserve the usefulness of the antibiotics available while improving patient care.