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Volume 5 Number 1
October/November 2005
A Publication of the Pharmacy Department,
Western Memorial Regional Hospital.
Pharmacy Hours: Monday - Friday 0800-2100hrs
Saturday & Sunday 0830-1630hrs
Stat Holidays 0900-1300hrs
Esmolol injection (Brevibloc ®)is on backorderuntil the end of December 2005.
“Chocolate is heart healthy”. Well, there is Streptokinase Injection (Streptase ®) is on backorder indefinitely - there is no known exactly what you’d like to hear. Eating DARK
chocolate daily seems to lower blood pressure, reduce
LDL cholesterol, and improve insulin sensitivity.
Unfortunately you are NOT likely to get these benefits
II. REQUESTS AND REMINDERS
from most store bought chocolate goodies. The benefitsare only seen with pure cocoa and dark chocolate .
A. Shortcuts to avoid shorts
which taste very bitter due to their high content of flavanols. Thus, while the data with flavanols from cocoa looks promising: its very preliminary. Keep this in mind when tempted by those Christmas treats. items like TPN, with patients when
they are moved. Pharmacy does not
Other interesting items in this issue include: patients are often missing medications when they B. Diltiazem by any other name is NOT the
Diltiazem is the latest pharmacy chameleon: you never know what formulation your patients will present as Discontinued and Backorders
their “med from home”. Currently available on themarket are regular release tablets, sustained release Tetracaine (Pontocaine.®) ophthalmic solution capsules, controlled delivery capsules and extended in the 15ml size is discontinued. Individual release tablets! Unfortunately these formulations are not bioequivalent. For example, Tiazac XC ® has an
extended -release delivery system designed to deliver
All Hydrocortisone (Cortate ®) ointments in maximum antihypertensive effect in the morning if ALL strengths are discontinued. The creams
given at bedtime. Accordingly Tiazac XC ® should be
administered at bedtime and not chewed or crushed. Itmay be given with food or without but should be taken Erythromycin 333mg capsules (Eryc ®) are consistently. Given these specifics, Tiazac XC ®
unavailable possibly until the end of 2005.
cannot be substituted with another diltiazem
formulation.
2 Volume 5 Number 1- A Publication of the Pharmacy Department, October/November 2005
Western Memorial Regional Hospital.
It is extremely important to specify the diltiazem
of non-B-lactam therapy to treat the infection dosage form and strength when ordering, especially if (particularly in serious, life threatening infections).
it’s a patient’s medication from home. If possible, in
this situation, indicating the BRAND would be very
Serious reactions with cephalosporins can occur in any helpful to Pharmacy for order-entry. Please remember patient although the incidence of the same is considered that SR,CD, and XC are not all the same (Diltiazem SR rare relative to reactions occurring with penicillin.
is actually formulated for twice daily dosing!) The final word on diltiazem formulations: Reference: Information adapted from Principles and Practice of Infectious Disease (Mandel et al, 5th edition An extra minute is all it takes to ensure your patients B. Ampicillin oral is on the way out .
In the past, Western Regional Integrated Health III. DRUG INFORMATION
Authority pharmacy sites have stocked both oralampicillin and oral amoxicillin preparations. Ampicillin A. Penicillin Allergy and Cephalosporins
and amoxicillin are similar in activity, however, oral by Darrin Park & Wayne Hicks
amoxicillin is generally preferred over oral ampicillindue to the following advantages: The following is intended to guide in interpretation ofthe significance of penicillin allergy in a patient ordered a cephalosporin antibiotic. It is not intended to replace the judgement of the prescribing clinician. Penicillins and cephalosporins have demonstratedcross reactivity in vitro but the incidence of clinically Cost differences in these two medications are negligible
relevant cross-reactivity is much lower. Many issues – however, different sites have been required to stock exist as to the significance of this finding. both ampicillin and amoxicillin oral formulations Assessment of previous reactions to B-lactam (depending on preference of the local prescribers).
antibiotics is important in assessing any new orders forcephalosporins: Many areas such as ER stock a number of medications 1. Please assess the nature of the penicillin allergy in
as wardstock including both oral ampicillin and consultation with the patient and document amoxicillin formulations. With the increasing number 2. Ensure physician is aware of any significant
of new medications available, it is desirable to reduce unneeded stock in many areas to “make room” for The following information may be used as a guide: newer medications - particularly those needed on an ** For patients with non-severe or questionable Therefore, RMAC approved the deletion of oral
- cephalosporin may be used at the discretion of the ampicillin from the drug formulary upon the depletion
attending physician particularly where cephalosporin of inventory. To facilitate this, the following automatic therapy is more suitable than the alternative. Risk of severe reactions is considered to be rare andadministration of cephalosporins is not uncommon.
Ampicillin mg po q6h ÷ Amoxicillin
** For patients with previous SEVERE reactions to mg po q8h in the same dosage form
penicillin (ie. anaphylaxis, urticarial reactions-particularly those mediated by IgE): Please note that this interchange applies to oral
- alternate therapy with non-B-lactam agents should dosage forms only (liquid and capsules). Ampicillin is
the only product available for iv or im use and thus the Note that the selection of cephalosporin therapy in a 500 mg and 1g ampicillin vials will remain on the penicillin allergic patient should be guided by the history of the previous reaction as well as the suitability 3 Volume 5 Number 1- A Publication of the Pharmacy Department, October/November 2005
Western Memorial Regional Hospital.
reactions you can try one of these literature Latex Allergy
by Angie Park - Pharmacy Student
1) remove the vial stopper- Useful only if the benefits outweigh the risks for potential dosing errors, dilution problems, Working in a healthcare field, it’s important to know the basic facts regarding latex allergies. The incidence of latex allergy in individuals with increased exposure is 5- only puncture the vial once and change the needle 17%. Thus, the chance that healthcare workers may before administration to the patient.
experience an allergy is significant. While the most These procedures do not eliminate the possibility that prominent source of latex allergy is latex gloves, latex latex proteins may leach from rubber vial stoppers into can also be found in tourniquets, syringes, catheters, the drug solution during storage. It is best to use latex- injection ports, rubber tops of multi-dose vials and free products whenever possible for patients with latex masks. Contact with any one of these items may result in one of 3 different possible reactions.
i) Non-allergic irritant contact dermatitis: The lilac pages of the CPS contain a list of selected
This is the most common reaction and is not an
parenteral products that do not contain natural rubber actual allergy. It’s characterized by redness, scaling, latex. The list is not exhaustive and should only serve dryness and itching which is primarily on the back of as an initial screening tool. For information on specific drug products, call the Pharmacy Department, orcontact the Manufacturer. ii) Allergic contact dermatitis:This is localized type IV or cell-mediated delayed hypersensitivity reaction. This reaction is caused by the D. PANTO IV - BLUE IS NEW!!!
chemical antigens added during processing natural latex and not due to the actual latex itself. Products labeled Please be advised that pantoprazole sodium (Panto® IV) “hypoallergenic” are low in these chemicals.
for injection has been reformulated. The new vials can Manifestation includes redness, itching and vesicle be identified by the blue cap on the vial. (old product
formation and these symptoms begin several hours after exposure with maximum effects at 24-48 hours. As a result of the reformulation, intravenous infusionsfor continuous Panto® IV orders can now be prepared by diluting 80mg of pantoprazole in 100ml of D5W or This allergy is a Type I hypersensitivity reaction (IgE 0.9% NS and infusing at 10ml/hr (8mg/hr) for a 10-hr mediated) and can begin within minutes of exposure.
infusion time. Formerly, the recommended stability for Individuals show symptoms of rashes, hives, flushing, Panto® IV was 6 hours regardless of means of itching, sneezing, sore throat, bronchospasm, chest administration. This 6 hour stability limit still applies to tightness and wheezing to name a few. All symptoms are any old (grey cap) vials still in circulation.
Please note: the new and old formulations of Panto® IV
should not be mixed.
Although we, as health care providers, are at risk of a Any questions, please contact the Pharmacy latex allergy, it is important to remember patients may experience this allergy as well. Any patient havingundergone multiple surgeries or having a great amount DRUG INTERACTIONS
of contact with latex is at risk. Knowledge of both your by Angie Park - Pharmacy Student
own as well as your patient’s latex allergy status is veryimportant. Pantoprazole and Warfarin
In managing a latex allergy, ideally latex products Sometimes drug interactions are not unveiled until should be completely avoided. Be aware of syringes, tip the post marketing research stage. At this point, it is caps, containers, mini-bags, transfer sets and infusion sets. Although there is limited information on vialstoppers, reactions have been reported. To avoid these 4 Volume 5 Number 1- A Publication of the Pharmacy Department, October/November 2005
Western Memorial Regional Hospital.
important to investigate the severity and cause of anyinteractions. Pantoprazole (Pantoloc ®) is a proton-pump inhibitor V. LAST LAUGH
used frequently at WMRH due to our auto-sub policy. Ithas been shown recently that pantoprazole and warfarinwhen used concurrently may result in an increased international normalized ratio (INR) and prothrombin know, walked barefoot most of the time, which time. Manufacturer recommendations are that INR and produced an impressive set of calluses on his feet.
prothrombin time be monitored after initiation, He also ate very little, which made him rather termination, or irregular use of pantoprazole. Warfarin frail, and with his odd diet, he suffered from bad dosage adjustments may be needed to maintain thedesired level of anticoagulation. Although no bleeding events have been reported in a clinical or research setting, it is important to be aware of A super calloused fragile mystic hexed by this interaction when patients present with this drugcombination. So, be on the lookout and ensure INR CONDOLENCES
Pharmacy wishes to express our deepest sympathy tothe family and friends of Dr. Barry May. Dr May wasa great asset to the region and was a dedicated andrespected physician. He was a great supporter of the Pharmacy Department and he will be sadly missed.
Alison Alexander B.Sc.Pharm
Pharmacy Department
***********
Ph. (709) 637-5263
Fax (709) 634-0421
E-mail: aalexa@healthwest.nf.ca
GOOD BYE & GOOD LUCK (
Best of luck to our pharmacy student, Angie Park,
who has returned to her studies after a full summer
working with us. Enjoy your last year in school
***********
WELCOME ABOARD (
“Welcome Aboard” to Bob Pitcher, our newest
staff member who has accepted the position of full-
time pharmacist. Congratulations, Bob!
5 Volume 5 Number 1- A Publication of the Pharmacy Department, October/November 2005
Western Memorial Regional Hospital.

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