PharmaFacts Pharmacy Newsletter
Saint Peter’s University Hospital
Volume 2009, 1st Edition
Newsletter Date
Department of Pharmacy Services
January 14, 2009
Randa Abdelal, Pharm.D., editor & Pharmacy Clinical Coordinator
Joaquim Noronha, M.D., Chairman, P&T Committee
Joseph Dicubellis, M.P.H., Director of Pharmacy
Safety Alerts
Inside this issue:
Safety Alerts 1 warfarin products together. pharmacy and asked for
1. Patient Weight &
Lovenox Dose Go Hand When branded generics are “tPA” (tissue plasminogen
Warfarin Pilot Program a Success 1 dispensed to patients, it is activator), a common but error-
in Hand
important that the generic name prone synonym for alteplase.
Recently, a Lovenox order was
FDA warning against Topical Products be listed on the prescription Because the call came from the
1 ordered on an inpatient. The
containing papain container label, along with the interventional radiology
order read “Lovenox 0.5mg SC
brand name, as necessary, department, and the prescribed
q12h”. The pharmacist
whether Jantoven or dose and intended use were not
Formulary Additions 1 contacted the physician to
Coumadin. Soon New Jersey communicated, the pharmacy
question the dose. The
Pharmacy Interventions 2 State law will require that both staff thought the medication was
physician stated he meant to
names appear on the patient indicated for another use in the
write 0.5mg/kg. Despite the
Why Are Antibiotics Still Being prescription label. Presently, interventional radiology
patient’s weight being on the
Prescribed for Uncomplicated Upper 3 many community pharmacies department, restoration of
patient profile screen, the
Respiratory Infection? simply list the brand name for central venous catheter function.
pharmacist still called the floor
branded products, but that Thus, the pharmacy dispensed a
for an updated weight since the
Common risks associated with heparin, might not help the patient 2mg/2mL syringe of
weight noted on the screen was
low- molecular weight heparin, & 3 identify duplicate medications. CATHFLO ACTIVASE
from the time of admission
This type of error can also be (alteplase; available in 2 mg
warfarin which was a week ago.
caused by a failure with lyophilized powder vials)
Lovenox is a weight based
discharge counseling, which instead of the 100 mg dose. The
anticoagulant that is longer
4
Therapeutic Interchange Update should be an integral physician running the code,
acting than heparin so getting
component of discharge along with a myriad of
an accurate weight is crucial to
Formulary Additions: reconciliation, no matter which physician residents in the room,
assures that the dose the patient
health professional provides assumed the dispensed syringe
will get is not over or under the
contained the correct dose to
the service.
dose required.
Bendamustine (Treanda)
treat a pulmonary embolism and
3. Two Types of Alteplase administered it. (The correct
2. Warfarin Brand Name
Temisirolimus (Torisel )
dose is 100 mg IV over 2
Confusion A patient who was undergoing
Ixabepilone (Ixempra) hours).
a procedure in an interventional
The potential for confusion
radiology department suffered
between a branded warfarin
• All three additions are new respiratory arrest attributed to
product, JANTOVEN,
chemotherapy agents an acute pulmonary embolism.
JANUVIA (sitaGLIPtin), and
The physician in charge of the
JANUMET (sitaGLIPtin and
procedure called a code and
metFORMIN) has been
requested ACTIVASE
recognized. Just as dangerous,
(alteplase) 100 mg IV. One of
if not more so, is that some
FDA issues warnings against Topical the pharmacists who attended
health professionals and
patients may not recognize the code called the
drug products containing papain
that Jantoven is a brand of
warfarin, and patients could
Companies marketing any unapproved easily end up taking two
topical drug products containing papain
Warfarin Pilot Program A Success
must stop manufacturing them on or
before November 24, 2008. Companies
or others engaged in shipping these
The Joint Commission therapy, a baseline INR dispensed. In the event a
products must stop shipping these
(TJC) requires ALL must be available before patient does not have an
products on or before Jan. 21,
hospital organizations to pharmacy can authorize INR result for review by
2009. After these dates, all topical meet the National Patient warfarin to be give. pharmacy within the past
products containing papain must have Safety Goal 3E, \"Reduce Furthermore, the INR 48 hours, the pharmacist
FDA approval to be manufactured or the likelihood of harm must also be within the has the authority to order
shipped in interstate commerce. associated with past 48 hours. The an INR to be drawn for
In response to this is discontinuation, anticoagulation therapy,\" concept is followed for that patient. There has been
SPUH has launched a patients being great success in this pilot
Saint Peter’s University Hospital is
warfarin pilot program maintained on warfarin. warfarin program that it
currently automatically substituting all
in which it is mandatory A current INR within the will be implemented
products containing papain (such as
for all warfarin orders to past 48 hours must be hospital wide come
Accuzyme (papain, urea) ) with
be written on pre-printed available for review by January, 2009.
Santyl (Collagenase) . order forms. For patients pharmacy before a
initiating warfarin warfarin dose is to be

PharmaFacts Pharmacy Newsletter
Page 2
Pharmacy Interventions and Trending for Total Doses Dispensed
Unacceptable
Abbreviations:
• QD, QOD, U, IU
• MS, MSO4, MgsO4
• No zero before
a decimal point
• Must have a
zero after a
decimal point
Total Pharmacy Savings From Interventions
Total
# Accepted # Rejected %Accepted Saving
Interventions
$76380
1365 1364 1 99.93%

Volume 2009, 1st Edition Page 3
Why Are Antibiotics Still Being Prescribed for Anything else with Yes…give
Uncomplicated Upper Respiratory Infection? me one
that madam?…
STRONG
antibiotic,
The myriad causes of
Emergency physicians are should no longer be please
overprescribing include accepted due to this
five times more likely to
perceived patient and other studies. What
prescribe antibiotics when
demand, pressure for patients want is a clear
they think patients expect
increased patient explanation of what is
them, but patients are
throughput, and wrong with them, what
equally satisfied whether
physician error, & most to expect, and how to
they receive antibiotics or
recently the advertising feel better
not.
of free antibiotics being (symptomatic relief).
Although most
offered by retail & chain The reason that
emergency department
stores, nationally. antibiotics are available
patients with
Overuse of antibiotics is by prescription only is,
uncomplicated
a serious public health supposedly, to ensure
respiratory infection
problem, and there is responsible use.
have viral infections,
no longer any excuse
antibiotics often are
for prescribing them for
prescribed.
conditions for which
Overprescribing of
they are known not to
antibiotics has been
have any benefit. The
linked to increased drug
old excuse that \"the
resistance and drug-
patient wanted them\"
related complications.
Common risks associated with heparin, low-molecular weight heparin, &
warfarin
• Duplicate or concurrent therapy
• Accidental stoppage of therapy
• Look-alike bags, vials, or syringes
H = Heparin
• Look-alike names
• Dosing/infusion errors O = Opioids
• Calculation errors
T = Total Parenteral Nutrition
• Drug and food interactions
• Adverse reactions
The use of standardized practices (that include patient involvement) can reduce I = Insulin
the risk of adverse drug events associated with the use of heparin, low-molecular
heparin, warfarin, and other anticoagulants. Offering continuous educational
C = Chemotherapy
opportunities to medical providers, nurses, pharmacists, laboratory staff, and
others associated with anticoagulation therapy will go a long way in helping
E = Electrolytes
prevent errors associated with anticoagulation therapy.. Medical staff must
remain up-to-date on prescribing, dispensing, and monitoring anticoagulants – a
requirement of the NPSG 3 implementation standard. In addition, identify &
develop a HIGH RISK medication list that includes anticoagulants. Here at
SPUH, we developed a “HOT ICE” list which identifies heparin as one of the
HIGH RISK medication agents that is reviewed yearly by the pharmacy
department for possible revisions or modifications.

PharmaFacts Pharmacy Newsletter
Therapeutic Interchange Update
The Following drug interchanges were approved at the January 2009 P&T meeting
Non-Formulary Formulary
Clotrimazole 1% (Lotrimin®) Cream Miconazole 2% (Monistat®) Cream
EMLA (lidocaine 2.5%, prilocaine 2.5%) cream LMX-4 (lidocaine 4%) cream
Accuzyme or Panafil Ointment Santyl (Collagenase) Ointment
(Papain, Urea)
Lumigan (Bimatoprost 0.03%) Xalatan (Latanoprost 0.05%)
XOPENEX AUTOMATIC SWITCH APPLY TO ADULTS ONLY
Xopenex (Levalbuterol) nebulizer solution Albuterol nebulizer solution
Coreg CR Carvedilol ( Generic Coreg)
Losartan + Hydrochlorthiazide
Avalide (losartan, hydrochlorthiazide)
254 EASTON AVENUE, P.O. BOX 591, NEW
Look For Us Soon On BRUNSWICK, NEW JERSEY 08903-0591
The
Department of Pharmaceutical Services
SPUH Homepage!
Saint Peter's University Hospital
254 Easton Avenue, New Brunswick, NJ
08901
Randa Abdelal, Pharm D
Pharmacy Clinical Coordinator
Ph: 732-745-8600 (Ext.8732) Pager: 732-
651-4604