| New Business |
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| 2004 Medication
Safety Initiative-Allergy Considerations |
Discussion
The Committee was presented with the 2004 Medication Safety Initiative-Allergy
Considerations. Of primary concern is the lack of standardization of antibiotic
and chemotherapy desensitization protocols, as well as the medication issues
surrounding latex-allergic patients. At present there is one established
committee to review the chemotherapy desensitization protocols and the pharmacy
will establish two separate committees to review the current latex allergy
and antibiotic desensitization protocols. The Committee recognizes and
supports the Allergy Considerations 2004 Medication Safety Initiative and
the establishment of the review committees. |
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Formulary
Line Extension
Risperidone (Risperdal M-Tabs)Approved with Restrictions |
Discussion
The clinical benefits of risperidone orally disintegrating tablets (Risperdal
M-Tabs) with respect to tolerability and efficacy as compared to olanzapine
orally disintegrating tablets (Zyprexa Zydis) are very comparable for select
patients in acute psychiatric situations. The Committee approved the addition
of risperidone orally disintegrating tablets (Risperdal M-Tabs) to Formulary
with the following restrictions: Acute Psychiatric Service and Blake 11
patients only. |
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Formulary
Drug Shortage
Flu Shot Availability |
|
Discussion
The following process will be followed for the approving, dispensing and
administration for all adult and pediatric flu vaccine: For all inpatient
adult and pediatric vaccine orders, a pharmacist will need to review the
order to validate that the patient meets the following inclusion/ exclusion
criteria for the use of the inactive trivalent influenza vaccine. The
live attenuated inhalation vaccine will not be used for inpatients.
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Adult Criteria for Use:
-
Adults aged > 65 years
-
Pregnant women in their
second or third trimester during influenza season
-
Persons aged > 18 years
with underlying chronic conditions
-
Residents of nursing homes
and other long-term care facilities that house persons of any age
who have long-term illnesses
-
Persons aged > 18 years
who have chronic heart or lung conditions, including asthma
-
Adults who need regular
medical care or had to be in a hospital because of metabolic diseases
(such as diabetes), chronic kidney disease or weakened immune system
(including immune system problems caused by medicine or by infection
with human immunodeficiency virus [HIV])
Pediatric Criteria for Use:
-
All children aged 6-23
months
-
Persons aged > 2 years
with underlying chronic conditions
-
Residents of nursing homes
and other long-term care facilities that house persons of any age
who have long-term illnesses
-
Children > 6 months
of age who have chronic heart or lung conditions, including asthma
-
Children > 6 months
of age who need regular medical care or had to be in a hospital because
of metabolic diseases (like diabetes), chronic kidney disease, or
weakened immune system (including immune system problems caused by
medicine or by infection with human immunodeficiency virus [HIV])
-
Children and teenagers
(aged 6 months to 18 years) who are on long-term aspirin therapy and
therefore could develop Reyes syndrome after the flu.
Exclusion criteria:
-
People who are have a
severe allergy (i.e. anaphylactic allergic to hens' eggs)
-
It is prudent to avoid
vaccination in people who previously developed Guillain-Barré syndrome
(GBS) in the 6 weeks after getting a flu shot (an extraordinarily
rare occurrence at around 1 in 1 million doses)
- A pharmacy documentation form
must be filed including the criteria for use
-If approved, the vaccine is to be dispensed and administered on the day
of discharge.
-There are two different commercially available inactive trivalent influenza
vaccines, Fluvirin and Fluzone. The major difference between the two products
is that Fluzone carries FDA-approved package labeling for children between
the ages of 6 months and 4 years. Fluvirin can be used in any patient above
the age of 4. Outpatient and clinic dispensing has been allocated based
on a needs assessment by the medical directors of the various on- and off-campus
practices. The Pharmacy Department has been able to provide all patients
with the vaccine and to date we have not been out of stock for either the
adult or pediatric vaccines. |
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| Cefotetan Alternative-Cefoxitin (ID Recommended) |
|
Discussion
Cefotetan is indefinitely unavailable due to manufacturing issues at AstraZeneca.
Consensus opinion was reached with discussions between the Infectious
Disease Unit and Pharmacy. Cefotetan therapy will be replaced with cefoxitin
1 gm IV every 4 hours for adult patients. Pediatric doses are listed
in LexiDrugs.
|
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| DTC Old Business |
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| Free Care Formulary Items Requiring
Prior Authorization (PA) |
|
Discussion
Changes and updates to the Partners Free Care formulary were reviewed
and approved.
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Drug
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Recommendation
|
Revision
|
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Augmentin
|
PA for
animal bites
|
PA
|
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Advair
|
PA recommended
per Dr. Atkins
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PA
|
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Zetia
|
PA for
lipid goal not reached on statin
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PA for
lipid goal not reached on statin or not tolerating statin
|
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Plan
B
|
PA
|
Remove
once available OTC
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