D&t jul 06.pub

DRUG AND
THERAPEUTICS
NEWSLETTER
A publication of the CSU Pharmaceutical Sciences Vancouver General Hospital, UBC Hospital, GF Strong 4. Fomepizole 1500mg/1.5mL vial (Antizol®)
•
Antidote to methanol and ethylene glycol • Restricted to approval from the Drug and 2 5. Ondansetron 4mg, 8mg tablets, 2mg/mL
2 injection
(Zofran®)
• To replace dolasetron for the management of post-operative nausea and vomiting, and other causes of nausea and vomiting that are All formulary changes and policy/procedure updates have been approved by the Drugs and Therapeutics (D&T) Committee and Medical Advisory Council (MAC). • See page 2 for therapeutic interchange This and other Drug and Therapeutics Newsletters are on the Web at www.vhpharmsci.com

Deletions

1. Salmeterol 25mcg Metered Dose Inhaler
(Serevent®)
Additions
• Alternative: Salmeterol 50mcg Diskus 1. Ifosfamide 1g, 3g vials (Ifex®)
• Note: 2 puffs salmeterol 25mcg MDI = 1 puff • Used for treatment of cervical and testicular cancer, soft tissue sarcoma, leukemia, non- • Structural analogue of cyclophosphamide 1. PARENTERAL DRUG THERAPY MANUAL
2. Gemcitabine 200mg, 1g vials (Gemzar®)
(PDTM) 2006 UPDATE
• Used for treatment of pancreatic, lung (non- updated with the June 2006 version. For any small cell), bladder cancer, lymphoma and questions regarding the PDTM, please contact EDITORIAL STAFF:
3. Alemtuzumab 30mg/3mL vial (Campath®)
• Monoclonal antibody indicated in B-cell Eric Lun, Pharm.D. Barbara Jewesson, B.Sc. (Pharm), Pharmacy Director chronic lymphocytic leukemia and as part of the conditioning regimen prior to stem Any comments, questions or concerns with the content of the newsletter should be directed to the editors. Write to CSU Pharmaceutical Sciences Vancouver General Hospital, 855 W12th Ave, Vancouver BC V5Z 1M9, send a FAX to 604-875-5267 or email karen.shalansky@vch.ca Drug and Therapeutics Newsletter
Volume 13, Number 2
6. LINEZOLID DRUG INTERACTION
Linezolid is an antibiotic that is also a weak The PDTM is also available ONLINE by clicking on reversible monoamine oxidase (MAO) inhibitor. the PDTM link under regional Web sites on the VCH Drugs that are contraindicated with linezolid because of its MAO inhibitor properties include: meperidine (Demerol®), levodopa/carbidopa 2. Y-SITE COMPATIBILITY CHART 2006
(Sinemet®), tryptophan, sumatriptan, selective All nursing units have been updated with the 2006 serotonin reuptake inhibitors (SSRIs e.g. Y-site compatibility chart. Contact Dr. Karen nefazodone, venlafaxine, citalopram, paroxetine), Shalansky if your unit requires an extra copy. tricyclic antidepressants (e.g. amitriptyline), heterocyclic antidepressants (e.g. mirtazapine, 3. METHADONE
REORDERING
trazodone) and bupropion. As well, consumption If the methadone dose remains the same, any of foods high in tyramine (aged cheeses, physician may reorder methadone. Changes in fermented meats, sauerkraut, soy sauce, draught dosage, however, need to be approved by beers, red wines) should be avoided. authorized prescribers. 4. DOLASETRON INTERCHANGE TO
serotonin. When given in combination with a ONDANSETRON
MAO inhibitor, accumulation of serotonin may A contraindication for dolasetron was recently occur leading to severe cardiovascular and/or issued by Health Canada for its use in post- neurological adverse reactions. Meperidine operative nausea and vomiting (PONV) due to the should be avoided in patients who have received risk of potentially life-threatening arrythmias. As a MAO-inhibitor therapy in the preceding 14 days. result, effective July 31/06, all dolasetron orders for Morphine is considered the preferred opiate in non-chemotherapy, non-radiation induced nausea and vomiting will be automatically interchanged to ondansetron as per Table 1. The ondansetron dose 7. PDTM CHANGES
for prophylaxis of PONV is 4mg IV x 1 (to be given intraoperatively); the dose for treatment of PONV is • Propofol may be administered in the ICU for
1mg IV q8h prn x 24 hours. This conversion is the treatment of refractory agitation in
i n t u b a t e d m e c h a n i c a l l y- v e n t i l a t e d
patients. Usage requires prior approval by a
Table 1. Dolasetron Conversion to Ondansetron for
non-chemotherapy, non-radiation induced nausea
and vomiting
• The smallest vial size for hydromorphone is Dolasetron Ondansetron
Hydromorphone should be
diluted to an appropriate concentration as
listed in the PDTM in order to accurately
measure small doses less than 1mg.

• A link to the Parenteral Chemotherapy/
Interval
Immunotherapy pre-printed order form has
been created on the on-line PDTM for each
*pharmacist to call physician for regularly scheduled doses > 24 hours cytotoxic drug. The link can be found under
the VH&HSC Administration Policy section.
5. SALMETEROL MDI INTERCHANGE TO
DISKUS
• The maximum dose of iron sucrose
Salmeterol (Serevent®) metered dose inhaler (MDI) (Venofer®) has been reduced to 300mg due
has been discontinued by the manufacturer. Once to an increase in serious adverse events that Pharmacy supplies of the MDI are used up, all orders for salmeterol MDI 25mcg 2 puffs twice daily will be automatically interchanged to salmeterol diskus 50mcg 1 puff twice daily. Physicians will be contacted for MDI doses less than 50mcg.

Source: http://vhpharmsci.com/Newsletters/2006-NEWS/Jul06_news.pdf