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Microsoft word - newsletter p&t 1st quarter 2010


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VOLUME 14.1 March 2010 EDITORS: Alina Lopo, M.D., Ph. D Susan Wee, Pharm.D.
http://www.tarzanameded.com/pharmacy/pharmacy.html
PHARMACY AND THERAPEUTICS
Vancomycin Trough Value Revision
COMMITTEE ACTIONS
nearly 50 years and has been a treatment of FORMULARY:
choice for MRSA. Due to gradual development of resistant strains and limited Additions: Micafungin (Micamine)
Deletions: Caspofungin (Cancidas)
tissues, current guidelines published by the POLICY UPDATE:
(IDSA), and the American Society of Health Therapeutic Substitution Policy
When Ordered
Substituted With
targeting higher trough values for specific Micamine
A target trough value of 15-20 mcg/ml is
Metamucil
recommended for indications such as: (1) pneumonia, (2) meningitis, (3) endocarditis, Novolin (insulin regular)
(4) osteomyelitis, and (5) bacteremia. Trough Phenergan
values of 10-15 mcg/ml may be sufficient for (promethazine) IM
other indications. These higher trough values for these indications have been shown to have a better clinical outcome and less
emergence of resistance2, 3.
Heparin IV Protocol Medication
Utilization Evaluation (MUE):
vancomycin monotherapy is rare (<1%) but The MUE found that the revised protocol of that risk is approximately 3 – 4 times higher 60 units/kg bolus and 12 unit/kg/hr initial infusion achieved the target goal aPTT in 24 correlation between higher trough values (of revision) with less patients exceeding facility 15-20 mcg/ml) and nephrotoxicity, however, it upper therapeutic aPTT value of greater than insufficiency since vancomycin is eliminated Fewer patients were prescribed warfarin on the first day of heparin IV protocol (33% compared to 60% of pre-revision) for those REFERENCES
1. Rybak M, Lomaestro B, et al. AJHP 2009. 66;82-
who could take oral medications. Physicians are recommended to initiate warfarin on the 2. Howden BP, et al. Clin Infect Dis. 2004; 38:521-8. first day of heparin or enoxaparin (Lovenox) 3. Sakoulas G J Clin Microbiol. 2004; 42:2398-402. 4. Zimmermann et al Pharmacotherapy.1995;15:85- Antimicrobial Stewardship Report
ADVERSE DRUG REACTIONS
76 year old female was started on Sotalol changes of antibiotic based on culture and 80mg bid for a-fib and rapid ventricular rate. sensitivity results and de-escalation of (Baseline Scr = 1.41; CrCl = 36). The patient diaphoresis, and renal insufficiency (Scr = 2.71; CrCl = 17). Sotalol was put on hold and the patient was admitted inpatient for three (metronidazole). Pip/tazo and metronidazole both have an excellent anaerobic coverage The manufacturer recommends that in order and the prescribing both of the antibiotics
to minimize the risk of induced arrhythmia, is unnecessary unless the patient is NPO
patients initiated or re-initiated sotalol should be placed for a minimum of three days in a INSTITUTE for SAFE MEDICATION
PRACTICES (ISMP) UPDATE:
4th Quarter 2009 ADR Report:
Is the figure below Provera, Prozac, or
Proscar?
Analgesics and antibiotics continue to be the medication classes most frequently associated with ADR. (medroxyPROGESTERone) 10 mg po daily.
L2 enoxaparin and warfarin - severe epistaxis
L2 linezolid IV – thrombocytopenia
PROZAC (FLUoxetine) 10 mg po daily. The
L2 enalapril – bronchospasm & swelling nurse did not detect the error when verifying in the medication administration record. MEDICATION UPDATE
The patient received one dose of Prozac. Morphine Epidural in Cesarean Delivery:
The physician discovered the error the next Observation studies report that the frequency day while he was reviewing the patient’s of respiratory depression ranges from 0.08% to 3% when single-injection epidural morphine are administered. 1 The studies also report detected many errors). The handwritten order that doses larger of 3.75mg did not further was shown to several nurses, pharmacists, increase analgesia.2 For cesarean delivery, and physicians and some interpreted the intrathecal doses of morphine greater than order as Prozac, Provera or PROSCAR.
100 – 200 mcg and epidural doses greater Poor handwriting was a contributing factor, as was the fact that Provera is infrequently It is recommended that initial dose of
epidural morphine be less than 4 mg for
prescribed drug, perhaps biasing the reader’s interpretation as “Prozac” on the handwritten 1. Horlocker TT et al. Anesthe 2009;110:218-230 2. Palmer CM et al. Anesth Analg 2000;90:887-91 3. Carvalho B. anesth Analg 2008; 107-956-61 DIRECTOR,
PHARMACY SERVICES

Source: http://www.tarzanacme.com/pdf/Newsletter_PT_1st_Quarter_2010.pdf

Curriculum vitae

CURRICULUM VITAE ROBERTO OGGERO , nato a Torino il 18/7/1947. Diploma di maturità classica presso il Liceo Classico "Cavour" di Torino nel Luglio Diploma di Laurea in Medicina e Chirurgia conseguito presso l'Università degli Studi di Torino il 13/7/1973 a pieni voti legali (100/110), con tesi di Laurea in Clinica Pediatrica dal titolo: "Le Mucopolisaccaridosi nel ' infanzia.&#

Microsoft word - hp11_levine_pdf_260510.doc

Philippa Levine, « Gendering Decolonisation », Histoire@Politique . Politique, culture, société , N°11, mai-août 2010, www.histoire-politique.fr Gendering Decolonisation Philippa Levine In the past twenty years or so, something of a revolution has occurred in the writing of British Empire history. Once the exclusive province of economic and of diplomatic and political history,

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