A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

GENERIC NAME  
Pain Management Opioid Equivalance Chart
PALONOSETRON INJECTION Non formulary, OUT PATIENT USE ONLY
Pantoprazole Pantoprazole will be automatically substituted for other proton pump inhibitors. When administering PPIs  via feeding tubes auto substitute Lansoprazole Solutabs.

·        Pantoprazole (Protonix), injection and oral, is the proton pump inhibitor of choice, with automatic substitution for omeprazole (Prilosecâ), rabeprazole (Aciphexâ),  Lansoprazole (Prevacidâ), and other oral proton pump inhibitors unless the physician has checked the dispense as written block.

Dosing Equivalence (mg)

Lansoprazole

(Prevacid)

Esomeprazole

(Nexium)

Omeprazole

(Prilosec)

Rabeprazole

(Aciphex)

Pantoprazole

(Protonix)

30 qd

20 qd

20 qd

20 qd

20 qd

30 qd

40 qd

40 qd

20 qd

40 qd

30 bid

20-40 bid

20-40 bid

20 bid

40 bid

 

Lanoprazole Solutabs, 15 mg or 30 mg, may be mixed with water and placed down a very small bore pediatric feeding tube. The granules do not clump or adhere to the tube.

Lanoprazole

Omeprazole

1-11 years

<= 30 kg

15 mg qd

>= 2 years

< 20 kg

10 mg qd

 

> 30 kg

30 mg qd

 

>=20 kg

20 mg qd

12-17 years

Non erosive GERD

15 mg qd

 

 

 

 

Erosive GERD

30 mg qd

 

 

 

Pantoprazole IV Criteria for use

·        Criteria for use of IV Proton Pump Inhibitors (PPIs) are list below.  If a patient does not meet criteria the pharmacist will call the physician and/or leave a chart note recommending conversion to oral therapy.

  • Initial treatment of patients with active upper GI tract bleeding, until they can tolerate oral therapy, usually after three days of therapy.
  • Initial treatment of patients with Zollinger-Ellison syndrome, until they can tolerate oral therapy
  • Stress-ulcer prophylaxis for critical care patients
  • Patients who require PPI therapy who can not tolerate oral or NG PPI therapy

·        Patients on IV proton pump inhibitors will have an order entered for the oral route allowing the nurse to use the oral route when the patient is tolerating oral therapy. Proton pump inhibitors may be given by the oral route if the patient does not have active gastrointestinal bleeding, malabsorption syndrome, short bowel syndrome, severe diarrhea, uncontrolled nausea and vomiting, continuous nasogastric suctioning, and is not at risk for aspiration. 

 

Papain / Urea Ointment

Papain / Urea / Chlorophllin Ointment

Papain / Urea, Papain / Urea / Chlorophyllin Ointment
  • Accuzyme and Ethezyme 830 are equivalent products containing identical amounts of active ingredients. Pharmacy will stock and autosubstitute the most cost effective product.
  • Panafil and Ziox Ointment are equivalent products containing identical amounts of active ingredients. Pharmacy will stock and autosubstitute the most cost effective product.

 

Accuzyme Ointment

Ethezyme 830 Ointment

Panafil Ointment

Ziox Ointment

Santyl Ointment

Xenaderm

Indications

Debridement of necrotic tissue and liquefaction of slough in acute and chronic lesions such as pressure ulcers, varicose and diabetic ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles and miscellaneous traumatic or infected wounds.

Acute and chronic lesions such as varicose, diabetic and decubitus ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles and miscellaneous traumatic of infected wounds.

Debriding chronic dermal ulcers.

Promote healing and the treatment of decubitus ulcers, varicose ulcers and dehiscent wounds.

Dosing Frequency

Once or twice daily

Once or twice daily

One daily

> Twice daily

Ingredients

Papain 8.3 x 105 units/gram

100 mg Urea/ gram

Hydrophilic ointment base

Papain 8.3 x 105 units/gram

100 mg Urea/ gram

Hydrophilic ointment base

Papain 5.2 x 105 /gram,

100 mg/gram Urea,

0.5% Chlorophyllin Copper Complex

in a hydrophilic base

Collagenase 250 units/gram

White petrolatum USP

Trypsin 90 units/gram,

Balsam Peru 87 mg/gram,

Castor Oil 788 mg/gram

Action

Papain digest nonviable protein.

 

Urea denatures nonviable protein making is susceptible to enzymatic digestion and exposes sulfhydryl groups which active papain.

Papain digest nonviable protein.

 

Urea denatures nonviable protein making is susceptible to enzymatic digestion and exposes sulfhydryl groups which active papain.

 

Chlorophyllin copper complex inhibits the hemagglutinating and inflammatory properties of protein degradation products in the wound.

 

Collagenase digest collagen in necrotic tissue

Balsam Peru is a capillary bed stimulant used to increase circulation in the wound site area. Castor oil is used to improve epithelialization by preventing drying and cornification and is a protective covering.  Trypsin is a debriding agent.

Active pH range

3-7

3-12

3-7

3-12

6-8

 

Inactivate by

Heavy metals, hydrogen peroxide

Heavy metals, hydrogen peroxide

Heavy metals

 

Cost per gram

$1.27

$0.43

$2.17

$0.98

$1.60

$0.65

 

Paricalcitol Autosubstitution with Doxercalciferol (Hectoral)

Pharmacy will autosubstitute oral Hectorol for injectable Hectorol, injectable Zemplar, and oral Zemplar at an equivalent dose in patients who can take oral medications. If the patient is unable to take oral use injectable Hectorol.

Dosage Equivalence (mcg)

Calcijex (calcitriol) Injection

Zemplar (paricalcitol) Injection

Zemplar (paricalcitol)

Oral

Hectorol (doxercalciferol) Injection

Hectorol Oral

(doxercalciferol)

0.2

0.7

1

0.3

0.5

0.4

1.4

2

0.6

1.5

0.75

2.5

4

1

2.5

1.5

5

8

2

5

2.25

7.5

10

3

7.5

3

10

14

4

10

3.75

12.5

18

5

12.5

4.5

15

20

6

15

5.25

17.5

24

7

17.5

6

20

28

8

20

Reference: K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease

1 mcg of doxercalciferol inj. is approximately equivalent to 2.5 mcg of paricalcitol inj. or 0.75 mcg calcitriol inj.

Paricalcitol oral 72% bioavailable, doxercalciferol oral 42% bioavailable

 

 

Patient Education Materials
 
Vaccine Information for the Patient
Warfarin Booklet
Paxil CR Autosubstitution with Paroxetine
  • Paxil CR and paroxetine immediate release are equally effective and tolerable; generic paroxetine will be autosubstituted for Paxil CR at the equivalent dose (80% of the Paxil CR Dose).
 

Dosage Equivalence Table

Ordered

mg

 Substitute

mg

Paxil CR

12.5

Paroxetine

10

Paxil CR

25

Paroxetine

20

Paxil CR

37.5

Paroxetine

30

Paxil CR

50

Paroxetine

40

Paxil CR

62.5

Paroxetine

50

Paxil CR

75

Paroxetine

60

 

Pegfilgrastimn Pegfilgrastim is Non formulary, filgrastim is autosubstituted for inpatients

·        Pegfilgrastim (NeulastaTM)  is non formulary.  It lacks adequate additional benefit for the hospitalized individual as compared to filgrastim (Neupogenâ) and is much more expensive.

·        Automatically substitute with filgrastim (Neupogenâ) 5mcg/kg/day, rounded to the closest vial size (300 mcg or 480 mcg) when pegfilgrastim (NeulastaTM) is ordered for inpatients.

Pegfilgrastim OPIC Monitoring Form 6/06

Pergolide Peroglide (Permax) withdrawn from market (3/07)
Pharmacokinetic Drug Dosing Page  
Pharmacokinetic Patient Monitoring Form  
Phenylephrine Standard Concentrations

Phenylephrine 50 mg / 250 ml

Phenylephrine 100 mg / 250 ml, Standard Concentration for Severe Hypotension

PICU IV Compatibility Chart  
Posaconazole Posaconazole P&T Review

·        Posaconazole (Noxafil®) suspension is recommended for formulary addition for the following FDA approved indications:

o       Posaconazole oral suspension, 105 ml with 40 mg/ml, is indicated for prophylaxis of invasive Aspergillus and Candida infections in patients 13 years of age and older who are at high risk of developing these infections due to being severely immunocompromised, such as hematopoietic stem cell transplant (HSCT) recipients with Graft versus Host Disease (GVHD) or those with hematologic malignancies with prolonged neutropenia from chemotherapy

§        Hematopoietic stem cell transplant (HSCT) recipients with Graft versus Host Disease (GVHD): Posaconazole was not shown to be statistically superior to fluconazole

§        Hematologic malignancies with prolonged neutropenia from chemotherapy:  Posaconazole was shown to be statistically superior to fluconazole

o       Treatment of oropharnygeal candidiasis refractory to fluconazole or itraconazole. 

·        Pharmacy Monitoring

o       Pharmacy will ensure that orders are entered to be given with food to increase the bioavailability.

§        The package insert recommends each dose to be given with a full meal or liquid nutritional supplement such as Boost Plus.

§        Posaconazole’s prophylaxis should start 24 hours after the last anthracycline dose in patients receiving chemotherapy

o       Pharmacy will monitor for interacting drugs and notify the physician as needed.

§        Posaconazole should not be administered with rifabutin, phenytoin, and cimetidine due to a 50% decrease in posaconazole serum levels. (Note: other H2 antagonist and PPIs do not interact)

§        Contraindicated with ergot alkaloids as ergotism may result; cisapride, pimozide (Orap), halofantrine (antimalarial), and quinidine due to increase serum levels of these drugs which may lead to increased QTc interval and torsades de pointes.

§        Cyclosporin and tacrolimus require dosage reductions as their levels are increased.

o       Patients allergic to itraconazole will probably react to posaconazole. Physicians will be contacted if patients are allergic to itraconazole.

o       Doses above 800 mg per day are not recommended as higher serum levels and AUC are not achieved.

o       A serum level is recommended 5-8 days after starting therapy to verify absorption. If levels are lower than 500 ng/ml a dosage increase, change in time of administration, or increased frequency of administration is needed.

 

Cost Comparison of Oral Antifungals used for prevention of invasive fungal infections

Indication

Posaconazole

Itraconazole

Fluconazole

Prophylaxis of Invasive Fungal Infections

200 mg PO TID

$66.62 per day

Not FDA Approved

 

400 mg/day

Cost/day = $5.72/day

Oropharyngeal Candidiasis Refractory to Itraconzole or fluconazole

400 mg BID

$88.82 per day

 

 

Oropharyngeal Candidiasis

100 mg BID, then 100 mg daily for 13 days

$11.21 per day

200 mg/day

$14.14

200 mg x1; 100 mg/day

Cost/day = $0.4/day

Treatment of Invasive Fungal Infection (not FDA approved)

200 mg QID until improvement, then 400 mg BID

$88.82 per day

200-400 mg/day

$14-28

400-800 mg/day

$5.72-$11.44

Note: Voriconazole (Vfend)  200 mg q12 hours cost $60 per day for oral and  $199 per day for IV.

 

Drug

Dose

Conc. average ng/ml

AUC ng*h/ml

Posaconazole Suspension

200 mg TID

583

15,900 (0-24 hour)

Posaconazole Suspension

400 mg BID

723

9,093 (0-12 hour)

Itraconazole Capsule

200 mg BID

2068

22,569 (0-12 hour)

Potassium Chloride Injection

·        Orders for small volume potassium chloride infusions will be converted to the closest available premix concentration to give the ordered amount of potassium chloride using the table below. 

o       Example: 50 meq/500 ml over 5 hours peripheral will be converted to 10 meq/100 ml premix for 5 doses.

·        The base fluid for small volume potassium chloride infusions will be sterile water as the premixed bags contain sterile water for injection and have an osmolarity of 200-799 mOsmol/l depending on the concentration (10meq/100 to 20 meq/50 ml). Orders for other base fluids will be changed to the premixed bags. 

 

Small Volume Infusion

 

Peripheral Line

Central Line

Recommended Infusion Rate

10 meq/hour

10 meq/hour

Maximum Infusion Rate

Cardiac Monitoring Required

20 meq/hour

 

20 meq/hour

40 meq/hour*

Recommended Concentration

0.1 meq/ml

10 meq/100 ml

0.2 meq/ml

10 meq/50 ml

Maximum concentration

0.2 meq/ml

10 meq /50 ml

20 meq /100 ml

0.4 meq/ml

20 meq/50 ml

*If potassium < 2.5 meq/liter and the patient is symptomatic 40 meq/hour may be administered to intensive care patients.  Hourly serum potassium determinations should be drawn to avoid severe hyperkalemia and/or cardiac arrest.

Symptoms of hypokalemia include: fatigue, malaise, generalized muscle weakness, respiratory failure, paralysis; EKG changes include T wave flattening or inversion, U waves, or ST segment depression, and arrhythmias.

 Small volume infusions of Potassium chloride are available from the pharmacy in premixed bags of:

10 meq/100 ml (Preferred peripheral concentration)

10 meq/50 ml (Preferred central concentration)

20 meq/100 ml (Cardiac monitoring required, peripheral or central use)

20 meq/50 ml (Cardiac monitoring required, central line only)

  

Large Volume Infusion

 

Peripheral Line

Central Line

Maximum concentration

0.04 meq/ml

40 meq/L

0.08 meq/ml

80 meq/L

TPN Maximum Concentration

40 meq/l

80 meq/l

 

Recommended maximum dose should not usually exceed

  • 10 meq/hour or 200 meq for a 24 hour period if the serum potassium level is greater than 2.5 meq/liter per product package insert
  • 40 meq/hour or 400 meq for a 24 hour period if the serum potassium level is less than 2.5 meq/liter.
Potassium Phosphate Injection

Protocol below approved by P&T/MEC approved 2001 at MRMC,

·        IV phosphate repletion should be limited to treatment of moderate to severe hypophosphatemia.

·        Mild to moderate serum phosphate levels may be treated with oral products.

·        When serum phosphate is > 1.5-2 mg/dl IV treatment may be switched to the oral route.

·        If serum potassium is > 3.5 meq/L sodium phosphate is recommended for IV treatment.

·        The use of lean body weight is recommended when calculating the dose.

·        Monitor serum phosphorus, calcium, magnesium, and potassium every six hours, along with blood pressure.

 

Pressor Agents In ICU, Chart of Dosage & Action  
Propoxyphene Propoxyphene and combination products containing propoxyphene are not recommended for use in pain management due to limited potency and accumulation of toxic metabolites (norpropoxyphene T1/2 39 hours, seizures, cardiac toxicity). Propoxyphene and norpropoxyphene have potent local anesthetic properties. Propoxyphene has a low therapeutic index and deaths have been reported with its use. Propoxyphene appears to display non-linear kinetics; steady state serum levels are 5-7 higher than those obtained after the first dose. Propoxyphene and norpropoxyphene are not removed by dialysis and naloxone is ineffective in treating cardiac toxicity. Alkalinization of the urine decreases propoxyphene excretion by 95%.
Propoxyphene/ Acetaminophen Tablet Autosubstitute propoxyphene 65 mg with acetaminophen 650 mg for propoxyphene napsalate 100 mg with acetaminophen 650 mg
Prophylaxis and Treatment of Postoperative and Opioid Induced Nausea And Vomiting: P&T Review

Emend P&T Review

·      Aprepitant (Emend™)  is not recommended for formulary inclusion for prevention of postoperative nausea and vomiting (PONV), MEC APPROVED. The multiple center study conducted in the U.S. failed to demonstrate a statistically significant difference between aprepitant 40 mg oral and a single dose of ondansetron 4 mg injection.

o       Zofran administration was not timed appropriately in the studies

o       Agents from multiple classes may be combined for patients at high risk of PONV (dexamethasone, 5HT3 receptor antagonists, droperidol, prochlorperazine) to reduce the risk of PONV at a lower cost with a high efficacy rate.

o       Coadministration of aprepitant with warfarin may significantly decrease INR for those patients on chronic warfarin therapy.  Monitor closely in the two week period (particularly at 7-10 days) following both the 3 day chemotherapy regimen and the one time 40 mg dose of aprepitant.

o       Patients using oral contraceptives require an alternative method for one month following aprepitant.

o       The Antiemetic Prophylaxis For Patients At Risk For PONV card will be made available to the anesthesia groups to help promote a more systematic approac

 

Protocols for Bon Secours Richmond
 

 

Acetaminophen Toxicity
Argatroban for Heparin Induced Thrombocytopenia
Use of Calcium in Treatment of Hypocalemia or Hyperkalemia in Adults
Hypocalcemia

Hyponatremia
Digoxin Immune Fab
Hypophosphatemia
Tru Blue for Coloring Tube Feeding

 

   
   


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