UNITYPOINT HEALTH - MARSHALLTOWN Marshalltown, Iowa PHARMACY POLICY AND PROCEDURE

Transcription

1 UNITYPOINT HEALTH - MARSHALLTOWN Marshalltown, Iowa PHARMACY POLICY AND PROCEDURE Subject: Dosage Form Changes and Therapeutic Interchanges Per Practice Protocol (Formerly Dosage Form Changes 3.18 AND Therapeutic Interchanges (TI) #?) UnityPoint Health Allen Hospital Inpatient Pharmacy Services (APPENDIX B) Policy #: IAC (3)A Purpose: To establish guidelines which authorize the exchange of one dosage form for another to meet the needs of the patient, without the need to contact the prescriber To establish guidelines which authorize the exchange of therapeutic alternatives when the pharmacy receives an order for a non-formulary or non-preferred medication, without the need to contact the prescriber Dosage Form Changes and Therapeutic Interchanges Per Practice Protocol (Marshalltown Hospital ONLY) Policy: 1. Dosage Form Changes a. Nurses/ pharmacists may change the dosage form of drugs to be administered from oral The medical staff has granted the authority for professional nurses and pharmacists to change the dosage form ordered from oral solid to liquid or from liquid to oral solid b. A nurse/ pharmacist must document the dosage form change citing nursing judgment as authority for the change c. Discontinue the previous order for the drug and place the new order with the new dosage form. d. No change to parenteral dosage forms or extended release dosage forms can be made prior to contacting the patient s physician 2. Therapeutic Interchanges (Appendix A) 3. Therapeutic Interchanges (Appendix B) Additional Information: 4. CMS Survey Procedure a. Standard: Delivery of Service. In order to provide patient safety, drugs and biologicals must be controlled and distributed in accordance with applicable standards of practice, consistent with Federal and State law. (CMS A (b)) i. Does the hospital pharmacy have a system of monitoring the effects of medication therapies for cases specified per hospital policy 5. Therapeutic Interchange (or therapeutic substitution) refers to the interchange or substitution by the dispenser of a drug product that is not chemically identical but is therapeutically equivalent to the product prescribed, pursuant to the guidelines established by the hospital Pharmacy and Therapeutics Committee and approved by the Medical Staff. Closing Banner: Originated by: Pharmacy Department Effective date: Authorized by: P&T Cmte/ Date: 1/88 Authorized by:

2 Jessica Rosenhamer, Pharmacy Director Revision date: 12/97, 07/16, 9/16, 6/17, 9/17, 11/17 Review date: 8/11, 4/04, 10/10 References: UpToDate Pharmacy and Therapeutics Committee Iowa Pharmacy Law CMS APPENDIX A (Marshalltown Hospital ONLY) ORDERED Oral bulk laxatives (non-psylium) Calcium/ Vit D Vit B12 Vit D Eye Vitamin Fish Oil Cranberry Estazolam (Prosom) 1mg tablet Eszopiclone (Lunesta) 1mg Eszopiclone (Lunesta) 2mg Oxazepam 10mg capsule (Allen Formulary) Oxazepam 15mg capsule (Allen Formulary) Triazolam 0.125mg tablet Triazolam 0.25mg tablet Zaleplon 5mg tablet Zaleplon 10mg tablet Zolpidem CR 6.25mg tablet Zolpidem CR 12.5mg tablet Desloratidine 5mg tablet Desloratidine 5mg redi-tab Bimatoprost 0.03% one drop in affected eye(s) once daily Travoprost (Travatan Z) 0.004% one drop in affected eye(s) once Enalapril 2.5mg tablet (Allen Formulary) Enalapril 5mg tablet (Allen Formulary) Enalapril 10mg tablet (Allen Formulary) Enalapril 20mg tablet (Allen Formulary) Aspart (novolog) 100units/mL 10mL vial Novolin 70/30 10mL vial (NPH) Protonix 20mg tablet DISPENSED Polycarbophil 1250mg tablet Calcium/ Vit D 500/200mg tablet Vit B meq tablet (cyanocobalamin) Vit D 1000 iu tablet Preservision or I-VITE Fish Oil 1000mg capsule AZO Cranberry Temazepam 15mg tablet Temazepam 30mg tablet Zolpidem 2.5mg Zolpidem 5mg Zolpidem 10mg Lorazepam 0.5mg tablet Lorazepam 1mg tablet Temazepam 7.5mg tablet Temazepam 15mg tablet Zolpidem 5mg tablet Zolpidem 10mg tablet Zolpidem 5mg tablet Zolpidem 10mg tablet Loratidine 10mg tablet Latanoprost 0.005% once drop in affected eye(s) once daily in the evening Latanoprost 0.005% once drop in affected eye(s) once daily in the evening Lisinopril 5mg tablet Lisinopril 10mg tablet Lisinopril 20mg tablet Lisinopril 40mg tablet Lispro (Humalog) 100units/mL 3mL vial Humulin 70/30 3mL vial (NPH) Protonix 40mg tablet APPENDIX B (Marshalltown and Allen Hospitals) ANALGESICS

3 Acetaminophen IV (Ofirmev ) Butorphanol (Stadol ) 2mg Inj Naproxen Sodium (Aleve ) 220mg po Oxycodone/APAP (Tylox ) 5mg/500mg po Restricted to 1 dose to be used in ASU, PACU or intraop only (ALLEN ONLY) Buprenorphine (Buprenex ) 0.3mg Inj same Naproxen (Naprosyn ) 250mg po same Oxycodone/APAP (Percocet ) 5mg/325mg po same ANGIOTENSIN II RECEPTOR ANTAGONISTS Candesartan (Atacand ) 8mg po Losartan (Cozaar ) 50mg po same Candesartan (Atacand ) 16mg po Losartan (Cozaar ) 100mg po same Candesartan (Atacand ) 32mg po Losartan (Cozaar ) 100mg po same Eprosartan (Teveten ) 400mg po Losartan (Cozaar ) 50mg po same Eprosartan (Teveten ) 600mg po Losartan (Cozaar ) 100mg po same Eprosartan (Teveten ) 800mg po Losartan (Cozaar ) 100mg po same Irbesartan (Avapro ) Losartan (Cozaar ) 25mg po Losartan (Cozaar ) 50mg po Losartan (Cozaar ) 100mg po Olmesartan (Benicar ) 10mg po Losartan (Cozaar ) 25mg po same Olmesartan (Benicar ) 20mg po Losartan (Cozaar ) 50mg po same Olmesartan (Benicar ) 30mg po Losartan (Cozaar ) 75mg po same Olmesartan (Benicar ) 40mg po Losartan (Cozaar ) 100mg po same Olmesartan/Amlodipine (Azor ) 20/5 Losartan/Amlodipine 50/5 Olmesartan/Amlodipine (Azor ) 40/5 Losartan/Amlodipine 100/5 Olmesartan/Amlodipine (Azor ) 20/10 Losartan/Amlodipine 50/10 Olmesartan/Amlodipine (Azor ) 40/10 Losartan/Amlodipine 100/10 Olmesartan/HCTZ (Benicar HCT ) 20/12.5 po Losartan/HCTZ (Hyzaar ) 50/12.5 po same Olmesartan/HCTZ (Benicar HCT ) 40/12.5 po Losartan/HCTZ (Hyzaar ) 100/12.5 po same Olmesartan/HCTZ (Benicar HCT ) 40/25 po Losartan/HCTZ (Hyzaar ) 50/12.5 x2 tablets same

4 Telmisartan (Micardis ) 20mg po Telmisartan (Micardis ) 40mg po Telmisartan (Micardis ) 80mg po Valsartan (Diovan TM ) Losartan (Cozaar ) 25mg po same Losartan (Cozaar ) 50mg po same Losartan (Cozaar ) 100mg po same ANGIOTENSIN-CONVERTING ENZYME INHIBITORS Benazepril (Lotensin ) tab po Lisinopril (Zestril, Prinivil ) tab po same dose & Captopril (Capoten ) tab po Fosinopril (Monopril ) tab po Lisinopril (Zestril, Prinivil ) tab po same dose & Lisinopril (Zestril, Prinivil ) Moexipril (Univasc ) tab po Lisinopril (Zestril, Prinivil ) 10mg po for each 7.5mg Moexipril, same Ramipril (Altace ) cap po Perindopril (Aceon ) tab po 2mg Lisinopril (Zestril, Prinivil ) tab po 5mg same Perindopril (Aceon ) tab po 4mg Lisinopril (Zestril, Prinivil ) tab po 10mg same Perindopril (Aceon ) tab po 8mg Lisinopril (Zestril, Prinivil ) tab po 20mg same dose and Quinapril (Accupril) Lisinopril (Zestril, Prinivil ) same dose and Trandolapril (Mavik ) tab po 1mg Trandolapril (Mavik ) tab po 2mg Trandolapril (Mavik ) tab po 4mg Lisinopril (Zestril, Prinivil ) tab po 10mg same Lisinopril (Zestril, Prinivil ) tab po 20mg same Lisinopril (Zestril, Prinivil ) tab po 40mg same ANTACIDS & LAXATIVES Docusate Calcium (Surfak ) 240mg po Maalox or Mylanta written as PRN (Metamucil or Citrucel ) po 0-15ml Psyllium (Metamucil or Citrucel ) po 16-30ml Docusate Sodium (Colace ) 100mg po same Maalox Plus Susp. po same vol. & Psyllium Husk, Sugar Free (Metamucil ) po 3.4Gm [One(1) single dose packet] same Psyllium Husk, Sugar Free (Metamucil ) po 6.8Gm [Two(2) single dose packets] same ANTIBIOTICS

5 Ampicillin (Omnipen ) cap po QID Alvimopan (Entereg ) Cefaclor (Ceclor ) po susp Cefaclor (Ceclor ) po cap BID or TID Cefadroxil (Duricef ) po BID Cefazolin (Ancef, Kefzol ) Inj q6h (exception is post-op CABG patients) Cefotaxime (Claforan ) Inj 1Gm any 2Gm any Cefotaxime (Claforan ) Inj (for neonates and pediatrics) Cefotetan (Cefotan ) Inj q12h or pre-op Cefprozil (Cefzil ) po tab Vancomycin patients with pneumonia with MRSA with MIC >2 and on SSRIs or any meds with serotonergic activity Amoxicillin (Amoxil ) same dose TID Restricted to patients undergoing partial large or small bowel resection surgery (ALLEN ONLY) Cefprozil (Cefzil ) po susp same dose BID Cefuroxime (Ceftin ) po tab same dose BID Cephalexin (Keflex ) po ½ the dose QID Cefazolin (Ancef, Kefzol ) Inj q8h (ALLEN ONLY) Ceftriaxone (Rocephin ) Inj 1Gm q24h 2Gm q24h Cefotaxime (Claforan ) Inj as written Cefoxitin (Mefoxin ) Inj q8h or pre-op Cefuroxime (Ceftin ) po tab same dose BID Ceftaroline (Telflaro ) 600mg q12hr Cefuroxime (Zinacef ) Inj Contact Physician Cefuroxime (Ceftin ) po susp Cefprozil (Cefzil ) po susp same dose & Cephalothin, Cephradine (Velosef ) Inj Cefazolin (Ancef, Kefzol ) Inj same dose & Ciprofloxacin (Cipro ) IV any dose/ Levofloxacin (Levaquin ) IV per indication and renal function Ciprofloxacin (Cipro ) PO any Levofloxacin (Levaquin ) PO per indication and dose/ renal function Erythromycin base 250mg oral susp Erythromycin ethyl succinate (EryPed ) 400mg oral susp same (ALLEN ONLY) Imipenem-cilastatin (Primaxin) Doripenem (Doribex) dose and based on renal function Levofloxacin (Levaquin) for pneumonia, skin and soft tissue infections, and sinusitis, diverticulitis, peritonitis, intraabdominal infections, complicated UTI Daptomycin (Cubicin ) Inj. Doripenem (Doribex) 250mg Doripenem (Doribex) 500mg Dose increased to 750mg then adjusted to renal function Calculate dose using adjusted body weight and round to nearest 250mgs Meropenem (Merrem) 500mg Frequency determined by renal function Meropenem (Merrem) 1gm Frequency determined by renal function

6 Methicillin (Staphcillin ) Inj Ofloxacin (Floxin ) 400mg Inj BID Ofloxacin (Floxin ) 400mg po BID Ofloxacin (Floxin ) 300mg po BID Ofloxacin (Floxin ) 200mg po BID Oxacillin (Prostaphlin ), Nafcillin (Nafcil TM, Unipen ), Cloxacillin (Tegopen ) po Piperacillin-tazobactam (Zosyn ) Ticarcillin (Ticar ), Azlocillin, Mezlocillin (Mezlin ) Inj Ticarcillin/Clavulanate (Timentin ) Inj 3.1Gm Oxacillin (Prostaphlin ) Inj same dose & Levofloxacin (Levaquin ) 500mg Inj q24h Levofloxacin (Levaquin ) 500mg po q24h Levofloxacin (Levaquin ) 500mg po q24h Levofloxacin (Levaquin ) 250mg po q24h Dicloxacillin (Dynapen ) po ½ the dose & same Piperacillin-tazobactam (Zosyn ) 4.5gm loading dose over 30min then 3.375gm q8hr 4hr infusion or 3.375gm q12hr 4hr infusion 6hr after loading dose depending on renal function (ED, Peds, preop doses exempt). ED will only give 4.5gm doses over 30min.(ALLEN ONLY) ANTIHISTAMINES Any non-sedating antihistamine po Any combination non-sedating antihistamine/decongestant po Cetirizine (Zyrtec ) 10mg po QD Fexofenadine (Allegra ) 60mg po BID Fexofenadine/Pseudoephedrine (Allegra-D ) 60mg/120mg po BID Loratadine/Pseudoephedrine (Claritin-D 24Hour ) 10mg/240mg po QD BLADDER AGENTS (ANTICHOLINERGICS) Darifenacin (Enablex ) 7.5mg po QD Darifenacin (Enablex ) 15mg po QD Fesoterodine (Toviaz ) 4mg po QD Fesoterodine (Toviaz ) 8mg po QD Trospium (Santura ) 20mg po QD Trospium (Santura ) 20mg po BID Trospium XR (Santura XR ) 60mg po QD Claritin po Claritin-D po Loratadine (Claritin ) 10mg po QD Loratadine (Claritin ) 10mg po QD Loratadine/Pseudoephedrine (Claritin-D ) 5mg/120mg po BID Loratadine/Pseudoephedrine (Claritin-D ) 5mg/120mg po BID Tolterodine (Detrol LA ) 2mg po QD Tolterodine (Detrol LA ) 4mg po QD Tolterodine (Detrol LA ) 4mg po QD Tolterodine (Detrol LA ) 4mg po QD Tolterodine (Detrol LA ) 2mg po QD Tolterodine (Detrol LA ) 4mg po QD Tolterodine (Detrol LA ) 4mg po QD COUGH AND COLD PREPARATIONS Orders for non-formulary products shall be automatically filled with the formulary product closest in composition to the product originally ordered. The product shall be dispensed in an equivalent dose with an equivalent. (See attached APPENDIX C for a list of formulary products) DIURETICS

7 Chlorothiazide (Diuril ) po Methyclothiazide (Enduron ) po H2 ANTAGONISTS Cimetidine (Tagamet ) mg po BID, TID, or QID Cimetidine (Tagamet ) 800mg po QD Cimetidine (Tagamet ) 300mg IVPB q12h, q8h, or q6h Cimetidine (Tagamet ) 900mg-1200mg IV continuous QD Cimetidine (Tagamet ) 900mg-1200mg in TPN QD Famotidine (Pepcid ) 20mg IVPB q12h Famotidine (Pepcid ) susp. 20mg po BID Nizatidine (Axid ) 150mg po BID or TID Ranitidine (Zantac ) syrup po Ranitidine (Zantac ) 150mg po BID or TID Ranitidine (Zantac ) 300mg po QD Ranitidine (Zantac ) 50mg IVPB q8h or q12h Ranitidine (Zantac ) mg IV continuous QD Ranitidine (Zantac ) 150mg in TPN QD Hydrochlorothiazide (HydroDIURIL ) po 0.1 x dose of ordered med, same Hydrochlorothiazide (HydroDIURIL ) po 10 x dose of ordered med, same Famotidine (Pepcid ) 20mg po BID Famotidine (Pepcid ) 40mg po QD Famotidine (Pepcid ) 20mg IV push BID Famotidine (Pepcid ) 40mg IV continuous QD Famotidine (Pepcid ) 40mg in TPN QD Famotidine (Pepcid ) 20mg IV push q12h Ranitidine (Zantac ) syrup 150mg po BID Famotidine (Pepcid ) 20mg po BID Famotidine (Pepcid ) 20mg po BID Famotidine (Pepcid ) 40mg po QD Famotidine (Pepcid ) 20mg IV push q12h Famotidine (Pepcid ) 40mg IV continuous QD Famotidine (Pepcid ) 40mg in TPN QD HMG-COA REDUCTASE INHIBITORS Fluvastatin (Lescol ) 20mg po QHS Fluvastatin (Lescol ) 40mg po QHS Fluvastatin (Lescol ) 80mg po QHS Lovastatin (Mevacor ) 10mg po QHS Lovastatin (Mevacor ) 20mg po QHS Lovastatin (Mevacor ) 20mg po BID Lovastatin (Mevacor ) 40mg po QHS Lovastatin (Mevacor ) 40mg po BID Rosuvastatin (Crestor ) 5mg po QD Rosuvastatin (Crestor ) 10mg po QD Rosuvastatin (Crestor ) 20mg po QD Atorvastatin (Lipitor ) 20mg po QHS Atorvastatin (Lipitor ) 10mg po QD Atorvastatin (Lipitor ) 20mg po QD Atorvastatin (Lipitor ) 40mg po QD INHALED CORTICOSTEROID EQUIVALANCY TABLE

8 Drug Low Daily Dose Medium Daily Dose High Daily Dose Max Daily Dose Per Manufacturer Beclomethasone Dipropionate HFA (QVAR) mcg mcg >480mcg 640mcg 40mcg/puff 2-6 puffs/day 7-16 puffs/day >16 puffs/day 640mcg 80mcg/puf 1-3 puffs/day 3-18 puffs/day >8 puffs/day 640mcg Budesonide (PULMICORT TURBUHALER) mcg mcg >1200mcg 1600mcg 90mcg/inhalation 180mcg/inhalation >22 >6 1600mcg 1600mcg Ciclesonide (ALVESCO) mcg mcg >640mcg 80mcg/inhalation >8 160mcg/inhalation >4 640mcg 640mcg Flunisolide (AEROBID) mcg mcg >2000mcg 2000mcg 250mcg/puff 2-4 puffs/day 5-8 puffs/day >8 puffs/day 2000mcg Fluticasone (FLOVENT) mcg mcg >660mcg 1760mcg 44mcg/puff 2-6 puffs/day 1760mcg 110mcg/puff 2 puffs/day 3-6 puffs/day >6 puffs/day 1760mcg 220mcg/puff >3 puffs/day 1760mcg Triamcinolone Acetonide (AZMACORT) mcg mcg >2000mcg 1600mcg 100mcg/puff 4-10 puffs/day puffs/day >20 puffs/day 1600mcg Mometasone (ASMANEX TWISTHALER) ~220mcg ~440mcg ~>440mcg 880mcg 220mcg/inhalation 1 inhalation/day mcg

9 INHALED LONG ACTING BETA AGONISTS/STEROID INHALERS Advair Inhalers (Fluticasone/Salmeterol) Dulera Inhalers (Mometasone/Formoterol) Advair HFA* 45/21 2 puffs BID Dulera 100/5 1 puff BID Advair HFA 115/21 2 puffs BID Dulera 100/5 2 puffs BID Advair HFA 230/21 2 puffs BID Dulera 200/5 2 puffs BID Advair Diskus* 100/50 BID Dulera 100/5 1 puff BID (ALLEN ONLY) Advair Diskus 250/50 BID Dulera 100/5 2 puffs BID (ALLEN ONLY) Advair Diskus 500/50 BID Dulera 200/5 2 puffs BID Breo Ellipta (Fluticasone/ Vilanterol) Breo Ellipta mcg/INH 1 puff QD Dulera 100/5 2 puffs BID Breo Ellipta mcg/INH 1 puff QD Dulera 200/5 2 puffs BID Symbicort Inhalers (Budesonide/Formoterol Symbicort 80/4.5 2 puffs BID Dulera 100/5 2 puffs BID (ALLEN ONLY) Symbicort 160/4.5 2 puffs BID Dulera 200/5 2 puffs BID (ALLEN ONLY) * Orders for pediatric patients < 12 years old will not be substituted TOPICAL ANTIVIRALS Acyclovir (Zovirax ) 5% cream/ointment Acyclovir and Hydrocortisone (Xerese ) 5%/1% cream Penciclovir (Denavir ) 1% cream LEUKOTRIENE RECEPTOR ANTOGONISTS Zafirlukast (Accolate ) 20mg po QD Zafirlukast (Accolate ) 20mg po BID Docosanol (Abreva ) 10% cream Apply 5 times per day to affected area on face or lips and continue until healed. Montelukast (Singulair ) 5mg po QPM Montelukast (Singulair ) 10mg po QPM ERYTHROPOIETICS Oncology Epoetin Alfa Total weekly Dose Darbepoetin alfa (Aranesp ) 0-59,999 Units weekly 100mcg Sub-q weekly 60,000-79,999 Units weekly 150mcg Sub-q weekly 80,000 Units weekly 200mcg Sub-q weekly Anemia from Chronic Renal Disease Epoetin Alfa Total weekly Dose Darbepoetin alfa (Aranesp ) < 5,000 Units weekly Use Epogen 5,000-10,999 Units weekly 25mcg Sub-q/IV weekly 11,000-17,999 Units weekly 40mcg Sub-q/IV weekly 18,000-33,999 Units weekly 60mcg Sub-q/IV weekly 34,000-89,999 Units weekly 100mcg Sub-q/IV weekly 90,000 Units weekly 200mcg Sub-q/IV weekly MISCELLANEOUS MEDICATIONS

10 Phenytoin IV Albuterol sulfate SR (Volmax ) po Glyburide, micronized (Glynase PresTab ) po Colchicine 0.5mg po Flurazepam (Dalmane ) po Haloperidol (Haldol ) IV Immune Globulin (IVIG) InFLIXimab (Remicade) Kcentra (prothrombin complex concentrate) Fosphenytoin (Cerebyx ) IV equivalent dose Albuterol sulfate SR (Proventil Repetabs ) po same dose and (ALLEN ONLY) Glyburide (Micronase, DiaBeta ) 5mg for every 3mg micronized po same Colchicine 0.6mg po same Temazepam (Restoril ) po same dose & All orders will be switched to IM except for Comfort Care patients. Dose using IBW. If actual body weight is less than IBW, use actual. Round to nearest available whole vial. If no premeds are ordered to prevent reactions, order acetaminophen 650mg PO and diphenhydramine (Benadryl) 50mg PO 30min prior to infusion. Dose rounded to nearest full vial. 50mg rounded up. (ALLEN ONLY) All vials will be rounded to 500units. Doses will be rounded to the nearest full vial (500units). Metformin (Glucophage XR ) Extended release po QD Paroxetine (Paxil CR ) 12.5mg po Paroxetine (Paxil CR ) 25mg po Metformin (Glucophage ) ½ dose po BID Paroxetine (Paxil ) 10mg po same Paroxetine (Paxil ) 20mg po same Buprenorphine (Buprenex ) 0.3mg Inj q6h Pentazocine (Talwin ) 30mg Inj q3-6h Diltiazem (Cardizem LA ) po Diltiazem (Cardizem CD ) same dose and 7 day and 1 day Vaginal treatments 3 day Vaginal treatment Bupropion (Wellbutrin XL ) 150mg QD Bupropion (Wellbutrin SR ) 100mg po BID Bupropion (Wellbutrin XL ) 300mg QD Bupropion (Wellbutrin XL ) 450mg QD Ciprofloxacin and hydrocortisone (Cipro HC ) otic Bupropion (Wellbutrin SR ) 150mg po BID Bupropion (Wellbutrin SR ) 200mg po BID Ciprofloxacin and dexamethasone (Ciprodex ) otic same number of drops and 5-HT1 Agents Sumatriptan (Imitrex) Orders for Probiotics Saccharomyces boulardii (Florastor ) 250mg BID Sevelamer (Renagel ) Sevelamer (Renvelal ) same dose and schedule (ALLEN ONLY) NUTRITIONAL SUPPLEMENTS at same

11 Calcium tab po Calcium Carbonate 600mg po Folic acid 400mcg po Potassium Chloride 8mEq po Chewable Vitamin po Liquid Vitamin po Pediatric Vitamin or Vitamin with Drops specified po Prenatal Vitamin po MVI po Vitamin or Therapeutic Vitamin po Vitamin with Minerals po Vitamin with Iron po Vitamin with Zinc po Misc. Multivitamin po Vitamin C po Vitamin E po Vitamin K IM for warfarin reversal Zinc po PROTON PUMP INHIBITORS Dexlansprazole (Dexilant ) 30mg po Dexlansprazole (Dexilant ) 60mg po Esomeprazole (Nexium ) 20mg po daily Esomeprazole (Nexium ) 40mg po daily Esomeprazole (Nexium ) 40mg IV daily* Esomeprazole (Nexium 80mg IV bolus and continuous infusion Lansoprazole (Prevacid ) 15mg po Lansoprazole (Prevacid ) 30mg po Lansoprazole (Prevacid ) 60mg po Lansoprazole (Prevacid ) 30mg IV intermittent infusion Omeprazole (Prilosec ) 10mg po Omeprazole (Prilosec ) 20mg po Calcium Carbonate 500mg tab po Calcium Carbonate 500mg po same Folic acid 1mg po same Potassium Chloride 10mEq po Poly-Vi-Sol with Iron and Zinc po or equivalent chewable tab Theragran Liquid po or equivalent Poly-Vi-Sol with Iron Drops po or equivalent, Pharmacist will determine equivalent amount StuartNatal 1+1 or equivalent po Therapeutic Multivitamin with Minerals po Therapeutic Multivitamin with Minerals po Therapeutic Multivitamin with Minerals po Therapeutic Multivitamin with Minerals po Therapeutic Multivitamin with Minerals po Therapeutic Multivitamin with Minerals po Ascorbic Acid 500mg po Vitamin E 400IU po Vitamin K same dose/ Sub-Q Zinc 50mg po Omeprazole (Prilosec ) 20mg po same Omeprazole (Prilosec ) 40mg po same Pantoprazole (Protonix ) 20mg po daily (ALLEN ONLY) Pantoprazole (Protonix ) 40mg po daily Pantoprazole (Protonix ) 40mg IV daily* Pantoprazole (Protonix ) 80mg IV bolus over 15min then 80mg continuous infusion 8mg/hr** Omeprazole (Prilosec ) 20mg po same Omeprazole (Prilosec ) 40mg po same Omeprazole (Prilosec ) 40mg po same Pantoprazole (Protonix ) 40mg IV daily *

12 Omeprazole (Prilosec ) 40mg po Pantoprazole (Protonix ) 20mg po Pantoprazole (Protonix ) 40mg po Pantoprazole (Protonix ) 40mg IV intermittent infusion Pantoprazole (Protonix ) 80mg IV bolus and continuous infusion Rabeprazole (Aciphex ) 20mg po Omeprazole (Prilosec ) 40mg po same *All orders for IV PPI s written by gastroenterology will be dispensed as written (substituted to Pantoprazole (Protonix ) IV if other product ordered). All other orders for intermittent IV PPI s will be screened for presence of GI bleed. If GI bleed is present, Pantoprazole (Protonix ) 80mg IV bolus over 15min then 80mg continuous infusion 8mg/hr will be substituted. If no GI bleed present, orders for intermittent IV PPI s will be substituted to Pantoprazole (Protonix ) 40mg IV daily if other product and/or is ordered. **Orders for continuous IV PPI s may be dispensed without evidence of GI bleed since an order for continuous IV PPI implies suspicion of GI bleed. THEOPHYLLINE Aminophylline oral tab Theophylline oral, same dose & (ALLEN ONLY) TOPICAL STEROIDS Dexamethasone top Methylprednisolone top Cordran SP 0.025% Cordran, Cordran SP 0.05% Synalar 0.01% Synalar 0.025% Cyclocort 0.1% Synalar-HP 0.2% Hydrocortisone 1% same base Hydrocortisone 1% same base Triamcinolone 0.025% cream Triamcinolone 0.1% same base Triamcinolone 0.025% same base Triamcinolone 0.1% same base Triamcinolone 0.5% same base (ALLEN ONLY) Triamcinolone 0.5% same base (ALLEN ONLY)