Archildrens.org

Pharmacy and Therapeutics Newsletter: The Dose Summer 2011
Additions & Changes to the Formulary:
Ceralyte 70 & 90 – a Rehydration solution has been added to the formulary, however, which department will
distribute this product has not been finalized.
Sodium Chloride Inhalation 3% and 7% - for use in the induction of sputum production to increase Mucociliary
clearance in Cystic Fibrosis. Note that the 7% is not covered by Medicaid.
Policy Change: CVL HEPARIN 100unit per ml flush solution – Implementation September 1st !!!
As part of our continuing safety initiatives we will eliminate Heparin 100 unit per ml from our standard Central
Venous Line Flush procedure starting September 1st. Previously patients ≥ 15kg received 100 unit per ml flush
starting September 1st all patients will receive the 10 unit/ml – unless another concentration is ordered by the
physician. Heparin 100 unit per ml concentration will be removed from all floor stock pyxis dispensing.
Restrictions
Acetaminophen (Ofirmev) Injection
Restrict to Anesthesia, Hem/Onc and Intensive Care Unit Staff physicians, All Orders will have a 72 hours autostop;
use w/ caution in premature infants or malnutrition due to possible glutathione depletion.
Dosing – per ACH clinical pharmacology: (FDA approval is ≥ 2 years of age)
15 mg/kg IV q 6 hours in children above 2, not to exceed 75 mg/kg/day. 10 mg/kg IV q 6 hours in children less than 2 years with gestational age > 36 weeks. 10 mg/kg IV q 8 hours (gestational age 31 to 36 weeks). 10 mg/kg IV q 12 hours (gestational age < 31 weeks). Adult dosing per mfg is 1 gram q4h iv or 650mg q4h not to exceed 4 gm/day - P&T suggests no more than
500mg/dose IV or PO for adults
Sildenafil – removed from restricted list

Simply Thick
The FDA is currently investigating a possible link between Simply Thick and Necrotizing Enterocolitis in premature
infants. P&T committee passed a restriction to not use this product in NICU or any patient ≤ 44 weeks post
conceptual age

Emergency Shortages
Severe include Cysteine (out), Atropine (small vial supply problem), Gentamicin, EMLA (may need to use LMX 4),
phentolamine(released in August), Arginine supplies received
Sigma Pump Recall –
Sigma initiated a voluntary recall select (in a specific serial number range) of spectrum pumps for a potential ball
bearing failure that can cause inaccurate delivery, including free flow. Our initial response to this recall is the use of
the back check valve sets. Pharmacy and Clinical engineering have been working on updating software and
exchanging pumps.
Deletions/Changes in the formulary:
Normocarb(small amount of supply still in stock), Domeboro, Captopril 50mg and 12.5mg tablets (25mg remains
formulary for inpatient, while Outpatient will continue to stock all 3 sizes of captopril), Acetaminophen 100mg per
ml oral liquid, Drotrecogin(Xigris), Avosil Scar care gel, Zolmitritpan(Zomig)
Product CHANGE!
The manufacturer is changing the concentration of Oseltamivir - Tamiflu suspension from 12 mg/ml to 6 mg/ml.
ACH has exchanged all existing stock with our wholesaler so that we now only stock the 6mg/ml concentration.
HOWEVER! Be aware that this was a voluntary exchange program so some retail pharmacies may still have the
12mg/ml in stock – prescribers should include the concentration on all prescriptions. Outpatient Charge on a 60 ml
bottle will be approximately $120.

Adverse Drug Reactions(ADR) Is your Patient having an ADR??????
The Adverse Drug Reaction Reporting form is on the INPT and OUTPT dashboard – please complete on any patient
you suspect of having an ADR – These forms also have the policy and procedure attached so when you print the
form you get the instructions! Recent reports? Piperacillin & Tazobactam decrease in WBC’s and Vancomycin
“RED MAN” syndrome – itching and redness. Vancomycin infusion related reactions are the most common
reported reaction – remember to infuse over 60 minutes!

Recent FDA WARNINGS: Black Box & Patient Safety Alerts!
• Reports of a rare cancer of white blood cells (known as Hepatosplenic T-Cell Lymphoma or HSTCL), primarily in adolescents and young adults being treated for Crohn’s disease and ulcerative colitis with medicines known as tumor necrosis factor blockers (The drugs in this class include Remicade (infliximab), Enbrel (etanercept), Humira (adalimumab), Cimzia (certolizumab pegol) and Simponi (golimumab), as well as with Azathioprine, and/or Mercaptopurine. Of note is that in a majority of cases reported patients were taking a combination of Remicade and Azathioprine or Mercaptorpurine. http://www.fda.gov/Drugs/DrugSafety/ucm250913.htm • Infants with a history of intussusception should not receive Rotarix. In post marketing experience, intussusception resulting in death following a second dose has been reported following a history of intussusception after the first dose. • Valproate and related products in pregnancy may lead to impaired cognitive development of children (in addition to birth defects). This conclusion is based on epidemiologic studies with other children born to mothers who took other anti-seizure medications during pregnancy.
Order Sets Coming!
We have several order sets under review which will be available in the Dashboard: Crotalidae(Crofab) for snake
bites, new Burn Center orders which include sedation & admission orders, Radiology orders for NON-IV contrast
and Nuclear Medicine. Oral contrast orders will be dispensed from the pharmacy for inpatients.

Floor Stock/Pack Changes: Transport Pack will have Levetiracetam(Keppra) injection added for seizures.
ISMP Patient Safety note
High Alert Medication Policy has been updated in the Policy Box – this policy reviews special safety measures for
High Alert and Sound Alike/Look Alike medications! Current High Alert medications include Chemotherapy,
Digoxin, Heparin, Insulin, Opiates, Concentrated Electrolytes, Sedatives and Neuromuscular blockers. The Hospital
has many safeguards in place to help reduce potential medication errors!!!!!
JCAHO reminder!!! Range Orders
Orders may use a range for the dose but not the interval; the dose range should not exceed 3 times the lowest dose,
and the 1st dose administered by the nurse should be at the lowest dose ordered to assess efficacy.
ACH Formulary Antihistamines

Source: http://www.archildrens.org/documents/Vital_SIgns_Weekly/Pharmacy-and-Therapeutics-Newsletter-summer-2011-(2).pdf