A publication from the Alton Memorial Hospital Infection/Pharmacy Committee
on Formulary and Drug Use Evaluation for physicians.
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):
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
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.
Lovastatin Fluvastatin Simvastatin Atorvastatin Rosuvastatin
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.
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.
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
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