PHARMA-MEDIC SERVICES INC. POLICY MANUAL

Transcription

1 PHARMA-MEDIC SERVICES INC. POLICY MANUAL SUBJECT: INDEX: P.5.a.iii Automatic-Therapeutic Substitution DATE: June 1/2011 REVISED: March 2, 2015., Feb PROCEDURE: 1. Long term care homes use the Manitoba Drug Benefits and Interchangeability Formulary for ordering drugs. 2. The Long Term Care Pharmacy and Therapeutics Committee selects those categories of drugs where automatic therapeutic substitution will be advantageous and consistent with resident safety considerations. 3. Therapeutic substitutes are accepted and may include some or all of the following: Category of Drugs: -Antacids -Laxatives -Vitamins -Cough and Cold Preparations -Potassium Supplements -Iron Salts -Proton pump inhibitors -Nitro tabs/nitroglycerin Spray -Acetaminophen 650 mg LA (Tylenol Arthritis)- Sept. 10/08 -Mupirocin Ointment/gm (Bactroban) Sept. 1/08 -Refresh Tears (Ocular lubricant) March 24, Sennosides 8.6 and Docusate 100mg (Senokot-S)- Jan. 20/10 -Macrobid 100 (Nitrofurantoin 100mg. b.i.d) Jan.20/10 -Azithromycin 250 (Clarithromycin 500mg) (Dec. 2004) Jan.20/10 - Latanoprost 0.005% Eye Drops (Bimatoprost 0.01% Eye Drops) Feb, The list of selected drug products will be circulated for comments and clinical review at the LTC Pharmacy and Therapeutics Committee meeting. Page 1 of 2

2 PHARMA-MEDIC SERVICES INC. POLICY MANUAL SUBJECT: INDEX: P.5.a.iii Automatic Therapeutic Drug DATE: June 1/2011 Substitution (con t) REVISED: March 2, Upon receipt of a drug order that is governed by the automatic therapeutic substitution, Pharmacy will dispense a substitution product in accordance with the existing approved list. 6. A Medication Change Notice, noting the automatic therapeutic substitution, will be completed by a Pharmacist and forwarded for inclusion in the order Sheet in the health record. 7. The LTC Pharmacy and Therapeutics Committee regularly reviews and revises the automatic therapeutic substitution list. A complete review will be completed at minimum every 2 years. Please see attached LTC Automatic Substitution List Page 2 of 2

3 Long Term Care (LTC) Automatic Substitution List General Statements: 1. Cream will be supplied when topical formulation unspecified 2. : the contracted pharmacy provides the their best economical option TABLE OF CONTENTS: Medication Classification Page Analgesics... 2 Analgesics (Opioids)... 2 Benzodiazepines... 2 Cardiac Calcium Channel Blockers... 2 Cardiac Beta Blockers... 2 Gastrointestinal Antacids/Antiflatulents... 2 Gastrointestinal H2 Receptor Antagonists... 2 Gastrointestinal Proton Pump Inhibitors... 2 Gastrointestinal Laxatives... 2 Gastrointestinal Pancreatic Enzymes... 2 & 3 Nasal Anti- Inflammatory... 3 Nasal Lubricant... 3 Ophthalmic Artificial Tears... 3 Supplements Electrolytes... 3 Supplements Vitamins/Minerals... 3 Topicals NSAIDs... 3 Topicals Antibacterials/Antifungals... 3 Topicals Vaginal Antifungals... 3 Topicals Rectal... 3 Topicals Oral Miscellaneous... 4 Topicals Anti- Inflammatory (Levels 1-7)... 4 Miscellaneous... 4 & 5 Second Generation Antihistamines... 5 Incomplete s or Clarifications... 5 Original Effective Date: Page 1 of 5

4 Analgesics Acetaminophen 650 mg Acetaminophen 500 mg Opioids Morphine sulfate SR or ER (any brand) Benzodiazepines flurazepam temazepam same dose and directions lorazepam oral or sublingual lorazepam oral Can be administered sublingually triazolam mg lorazepam 0.5 mg same directions triazolam 0.25 mg lorazepam 1 mg same directions Cardiac Calcium channel blockers diltiazem long-acting Lowest Cost Alternative Cardiac Beta-blockers metoprolol SR metoprolol same daily dose divided bid Gastrointestinal antacids/antiflatulent Antacid plain or with antiflatulent Pink lady lidocaine viscous 2% /antacid plus 1:1 Gastrointestinal H2 receptor antagonists H2 antagonist Ranitidine contact pharmacy for dosing Gastrointestinal proton pump inhibitors If dosing is not included in this chart consultation with the physician is required to determine substitution. Dosing frequency other than once daily is only officially indicated in Hyper- Secretory conditions and H-Pylori eradication. Proton Pump Inhibitors Equivalent Doses Proton Pump Inhibitor Standard dose dexlansoprazole 30 mg esomeprazole 20 mg lansoprazole 30 mg omeprazole 20 mg (contracted item) pantoprazole Contact Pharmacy for dosing rabeprazole Contract Pharmacy for dosing Gastrointestinal - laxatives sennosides or sennosides with docusate sennosides 8.6 mg sodium Gastrointestinal pancreatic enzymes Pancrelipase Products: Creon 6 Enteric Coated Pancrelipase Products: Cotazym ECS 4 Pancrease MT4 Enteric Coated Pancrelipase Products: Creon 10 Cotazym ECS 8 Pancrease MT 10 cost: $2.51/cap Ultrase MT 12 Enteric Coated Pancrelipase Products Creon 25 Cotazym ECS 20 See over. Original Effective Date: Page 2 of 5

5 Pancrease MT 20 Ultrase MT 16 Non-Enteric Coated Pancrelipase Products Viokace 10,440 Cotazym Nasal anti-inflammatory Any steroid nasal spray (e.g. beclomethasone, fluticasone nasal spray 2 sprays in each budesonide, triamcinolone) nostril once daily Nasal lubricant Nasal lubricant gel/spray Lowest Cost alternative Ophthalmic Artificial tears Artificial tears Lowest Cost alternative Ophthalmic prostaglandin analogues bimatoprost 0.01% and 0.03% latanoprost 0.005% - same dose at HS travoprost latanoprost 0.005% same dose at HS Supplements- electrolytes calcium carbonate with vitamin D3 Elemental Calcium equivalent dose with Vitamin D Units weekly potassium chloride 20 meq powder ( K- Lor)/Liquid potassium citrate potassium chloride liquid 1.33 meq per ml Supplements vitamins/minerals multivitamin with lutein vitamin B complex/vitamin B complex with vitamin C multivitamin and multivitamin with minerals Topicals - NSAIDS Pennsaid or Diclofenac in Diffusimax, any Diclofenac 5% in Diffusimax, apply sparingly concentration Topicals antibacterials/antifungals Topicals antifungals nystatin oral suspension (swish and swallow)- nystatin oral suspension (swish and swallow) doses less than 500,000 units 500,000 units Topicals vaginal antifungals clotrimazole vaginal inserts (any duration) clotrimazole Combi-Pak 1 day clotrimazole 1% vaginal cream Use applicator to place vaginal tablet high in clotrimazole 2% vaginal cream the vagina at HS. Use cream BID PRN x 7 miconazole vaginal inserts (any duration) Days for external vaginal itching. miconazole 2% vaginal cream nystatin vaginal inserts nystatin vaginal cream Hemorrhoid cream or suppository: Any steroid/antibiotic/topical anesthetic (e.g. Proctol, Proctosedyl, Proctomyxin) Topicals -rectal Proctomyxin HC or equivalent suppository or ointment (contains hydrocortisone, framycetin, dibucaine or cinchocaine, esculin) Preparation H zinc sulfate 0.5% ointment Original Effective Date: Page 3 of 5

6 Topicals oral miscellaneous Magic mouthwash Standardized Cancer Care Manitoba recipe: 0.56 ml dexamethasone 4 mg per ml injection 120 ml diphenhydramine elixir 2.5 mg per ml 30 ml nystatin 100,000 units per ml suspension 750 mg tetracycline q.s. to 380 ml with approximately 200 ml sterile water Topicals anti-inflammatory Level 1 betamethasone dipropionate glycol 0.05% halobetasol propionate 0.05% clobetasol propionate 0.05% Topicals anti-inflammatory Level 2 amcinonide 0.1% ointment betamethasone dipropionate 0.05% ointment desoximetasone 0.25% fluocinonide 0.05% Topicals anti-inflammatory Level 3,4,5 amcinonide 0.1% cream beclomethasone dipropionate 0.025% beclomethasone dipropionate 0.05% cream betamethasone valerate 0.1% clobetasol butyrate 0.05% desoximetasone 0.05% diflucortolone valerate 0.1% fluocinolone acetonide 0.025% fluocinolone acetonide 0.01% hydrocortisone valerate 0.2% mometasone furoate 0.1% triamcinolone acetonide 0.1% triamcinolone acetonide 0.025% betamethasone valerate 0.05% hydrocortisone 10% desonide 0.05% Topicals Steroid Level 6 Topicals anti-inflammatory Level 7 hydrocortisone 2.5% hydrocortisone acetate 1% or hydrocortisone acetate 0.5% Miscellaneous framycetin 1% dressing (Sofra-tulle) chlorhexidine 0.5% dressing (Bactigras) levothyroxine all brands levothyroxine (Eltroxin) Synthroid used when dose not available Original Effective Date: Page 4 of 5

7 Insulin glulisine Insulin aspart Novolin ge 30/70 Novolin ge Toronto Novolin ge NPH loratadine 10 mg daily loratadine 10 mg q48h desloratadine 5 mg daily desloratadine 5 mg q48h fexofenadine 60 mg BID fexofenadine 180 mg daily Topical form not specified Insulin lispro same dose and directions Humulin 30/70 same dose and directions Humulin R same dose and directions Humulin N same dose and directions Second generation antihistamines cetirizine 5 mg daily cetirizine 5 mg daily Incomplete orders or clarifications Cream will be supplied Original Effective Date: Page 5 of 5