Transcript Lesson 9 Special Prescription Filling Situations

Medications that require special
handling
 Drugs that require IV infusion sets that don’t have PVC
or DHEP plasticizer (soft Plastic)
 Nitroglycerin
 Nitroprusside
 Paclitaxel,
 Fat Emulsions (should also use an IV filter of 1.2
microns)
 Amiodarone
 Should use Glass or non PVC bags (stiff plastic)
 IV Drugs that are light sensitive and should be covered
during infusions with aluminum or amber colored sleeves
(>90 UV light filter out)
 Nitroprusside (VERY light sensitive)
 Norepinephrine (Levophed®)(blue discoloration )
 Levofloxacin (Levaquin®)
 Linezolid (Zyvox®)
 Phytondione (Vitamin K) Injections
 If a drug is light sensitive they will be made in brown
amber vials. Reconstituted solutions should be covered. If
the drug will be used immediately protect from light may
not be necessary>> consult with pharmacist
 IV Drugs with specific dilution requirements
 Phenytoin Injection (Dilantin ®)
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Must use NS or give undiluted slowly
Dilution with D5W can cause precipitation of crystals “salting out”
Use at least a 5 micron filter during IV infusion
 Sulfamethoxazole/Trimethoprim Injection(Bactrim®)
 Use D5W, not NS
 Infusion over 60-90 minutes
 Levothyroxine Injection (Synthroid®)
 Mix with NS
 Administer immediately
 Most IV administration sets contain in line filters of 5
microns or less to filter out precipitates during infusions
Medication that cause
photosensitivity in Patients
 It’s the responsibility of the pharmacist to advise patients using these drugs to
wear protect clothing when in the day sunlight and using these drugs
 This reaction does not always happen but when it does may cause a severe sun
burn type reaction
Generic
Brand
Doxycycline and other
Tetracycline drugs
Various
Sulfonamide drugs
Various
Retinoids
Accutane and others
Sulfonylureas (Glipizide)
Glucotrol
Diuretics (Furosemide and
HCTZ)
Lasix and Hydrodiuril
Dapsone
Various
Outdated Medication Warning
 Remember that expired tetracycline products are
unsafe.
 Expired tetracycline products can cause Fanconi’s
syndrome, a disorder of the kidney that can produce
dangerous electrolyte abnormalities in patients
 When in doubt, discard these medications
 US FDA publishes the Orange Book
 Orange Book publishes ratings data on drug therapeutic
equivalence between drugs and lists all drugs approved in the US
 Orange Book is officially called, FDA: Approved Drug Products with
Therapeutic Equivalence Evaluations
 Most States define an acceptable generic substitution as one where
the drugs are therapeutically equivalent
 For drugs to be consider therapeutically equivalent to each other,
they must have a rate of AB or AA
 Drugs that have B ratings are not therapeutically equivalent and
substitution between them is not permitted
 Pharmacists are to determine substitutability
 revised yearly with month updates
 Can be accessed at: www.fda.gov/cder/ob/default.htm
FDA restricted drugs
 Some drugs have strong side effects such that the FDA
mandate special rules in the marketing of these drugs
 Prior to 2007,FDA restricted drug program was called
RiskMAP, risk mitigation action plans
 After 2007 the new standards are called REMS, risk
mitigation evaluation and mitigation strategies
 For some drugs the REMS involves distributing PPI
with each script (Oral Contraceptives, Hormone
products (Estradiol), Accutane, and Inhaler products);
others involve drug manufacturer to set up registries of
patients, prescribers and pharmacies
REMS Special programs
Drug
REMS
Special requirements
Fentanyl Transmucosal Systems
(Actiq)
Transmucosal Immediate Release
Fentanyl (TIRF) REMS
Registration of wholesalers and
pharmacies to dispense products
Accutane (Isotrenoin)
I Pledge REMS
Patient and Prescribers must be
enrolled, Female patients must
have a negative pregnancy test
and use two forms of birth
control, Pharmacies must
enrolled to order
Avandia products
Rosiglitazone Medicines Access
Program
Prescibers/patients must enroll
and only specialty pharmacies
stock it
Clozapine
Clozaril National Registry
Prescribers and patients must be
enrolled; must provide ANC and
WBC count to pharmacy,
pharmacy must enroll to order
Procrit and Epogen and Aranesp
APPRISE REMS
Prescribers must enrolled in
program, patient must sign form
to understand the risks
Commercially Prepared dehydrated
powder medications for oral use
 Products: Amoxicillin, Augmentin, Clindamycin,
Zithromycin, and may other antibiotics
 Once mixing these antibiotics with water: a 14 day
expiration is used under refrigeration
 Exceptions: Augmentin (amoxicillin/clavulunate
potassium) and Biaxin (clarithromycin) are both 10 days
 Remember these, very common
Medications that should be
dispensed in Original Container
 Some medications should, according to package insert
information, be dispensed in the original
manufacturer’s container
 Label will contain a disclaimer: “Pharmacist: Dispense
in bulk container provided by manufacturer”
 Often container will contain a silicone pellet bag in the
container called a “dessicant” to absorb excessive
moisture
 Drugs that require original container dispensing
 Pradaxa®capsules: (Dabigatran)
 Tekturna ®: Aliskiren Tablets
 Augmentin XR® Tablets: (amoxicillin/Clavulanate)
 Sandimmune®, Gengraf ® Capsules and oral solution:
Cyclosporine
 Nitroglycerin SL tablets: all brands
 Pancrelipase capsules: Creon®, Viokase ®
 Most HIV meds: Truvada ®, Atripla ®, Norvir ®