The link

The Link
A publication from the Alton Memorial Hospital Infection/Pharmacy Committee
on Formulary and Drug Use Evaluation for physicians.
March 2012
Medication Shortage Update
There is currently a critical nationwide shortage of a number of commonly used injectables. One of these, potassium phosphate injection, is out of stock at Alton Memorial and there is no release date from the manufacturer. The pharmacists are evaluating every order for IV KPhos and are substituting whichever options [sodium phosphate or potassium chloride injection, or occasionally oral phosphate] are more appropriate for the patient condition and lab values. If none of these options would be beneficial for a particular patient, pharmacy has been able to procure a very limited supply of pre-mixed potassium phosphate 20mM IV solution which will be dispensed. Enoxaparin (LOVENOX) Pharmacy Protocol Revision
Although data is still limited, a rapidly growing body of literature suggests that anticoagulant dose adjustments in morbidly obese patients may reduce VTE risk. For this reason, the committee approved the following changes to the Enoxaparin (LOVENOX) Pharmacy Protocol: Patients with a BMI (body mass index) greater than 40 and an estimated CrCl 30mL/min or higher = increase Lovenox to 40 mg SQ Q12hrs. Patients with a BMI (body mass index) greater than 40 and an estimated CrCl less than 30mL/min = increase Lovenox to 40 mg daily. Formulary Changes

Prochlorperazine Injection Removed from Formulary

Prochlorperazine Injection has been unavailable for a couple years and there are no
current plans for this drug to be manufactured anytime soon. The committee removed the
injection from formulary and approved an automatic therapeutic substitution to
promethazine as follows:
Prochlorperazine 10 mg IM/IV will be substituted with promethazine 25 mg IM at the same frequency ordered Prochlorperazine 5 mg IM/IV will be substituted with promethazine 12.5 mg IM at the same frequency ordered
Trypsin-Balsam Peru Topical for Wound Healing

Using data from a six month trial at Barnes-Jewish Hospital, where the products were
found to be comparable in safety and efficacy, the committee approved an automatic
substitution of Vasolex for Xenaderm.
Triptorelin (Trelstar) and Leuprolide Agents (Eligard/Lupron)
The committee approved the following automatic therapeutic substitutions for LHRH
products (luteinizing hormone-releasing hormone agonists):
Trelstar 3.75 mg IM monthly will be substituted with Eligard 7.5 mg SQ monthly Trelstar 11.25 mg IM every 3 months will be substituted with Eligard 22.5 mg SQ every 3 months Trelstar 22.5 mg IM every 6 months will be substituted with Eligard 45 mg SQ every 6 months Lupron “X” mg every “Y” months will be substituted with Eligard “X” mg every “Y” months Topical Steroid Formulary Revisions
Will be therapeutically interchanged with
FORMULARY product on the left
Alclometasone 0.05% cream/oint (Aclovate) Desonide 0.05% cream/oint/lotion (Desowen) Fluocinolone 0.01% cream/soln/oil (Synalar) Hydrocortisone 0.5% cream/liquid, 1% oint/lotion Betamethasone valerate 0.1% cream/oint/lot/foam Desoximetasone 0.05% cream/oint/gel (Topicort) Fluocinolone 0.025% cream/oint. (Synalar) Flurandrenolide 0.05% cream/lotion (Cordran) Fluticasone 0.05% cream/lotion (Cutivate) Hydrocortisone butyrate 0.1% cream/oint/soln (Locoid) Hydrocortisone valerate 0.2% cream/oint. (Westcort) Mometasone 0.1% cream/oint/lot/soln (Elocon) Prednicarbate 0.1% cream/oint (Dermatop) Triamcinolone 0.025% oint, 0.1% ointment/lotion (Kenalog) Amcinonide 0.1% cream/oint/lotion (Cyclocort) Desoximetasone 0.25% cream/oint (Topicort) Diflorasone 0.05% cream/oint (Florone/Psorcon) Fluocinolone acetonide 0.25% cream/oint (Synalar HP) Fluocinonide 0.05% cream/oint/gel/soln (Lidex) Halcinonide 0.1% cream/oint (Halog) Triamcinolone 0.5% ointment (Kenalog) Betamethasone dipropionate-augmented 0.05% Halobetasol 0.05% cream/ointment (Ultravate)

Clotrimazole 1%/ Betamethasone 0.05% cream (Lotrisone) Nystatin/ Triamcinolone 0.1% ointment (Mycolog-II)


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