Medications that require special handlingDrugs that require IV infusion sets that don’t

have PVC or DHEP plasticizer (soft Plastic)NitroglycerinNitroprussidePaclitaxel,Fat Emulsions AmiodaroneShould 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 requirementsPhenytoin Injection (Dilantin ®)

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

Sulfametoxazole/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Outdated Medication WarningRemember that expired tetracycline products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 BookOrange Book publishes ratings data on drug

therapeutic equivalence between drugsMost 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

FDA restricted drugsSome 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 programsDrug REMS Special

requirementsFentanyl 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

Alosetron (Lotronex) PPL (Prescribing program for lotronex)

Prescribers must enroll, patients must sign form, pharmacy to dispense with PPL sticker on RX

Commercially Prepared dehydrated powder medications for oral useProducts: Amoxicillin, Augmentin,

Clindamycin, Zithromycin, and may other antibiotics

Once mixing these antibiotics with water: a 14 day expiration is used under refrigerationExceptions: Augmentin (amoxicillin/clavulunate

potassium) and Biaxin (clarithromycin) are both 10 days

Remember these, very common

Medications that should be dispensed in Original ContainerSome 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 mositure

Drugs that require original container dispensingPradaxa®capsules: (Dabigatran)Tekturna ®: Aliskiren TabletsAugmentin XR® Tablets:

(amoxicillin/Clavulanate)Sandimmune®, Gengraf ® Capsules and oral

solution: CyclosporineNitroglycerin SL tablets: all brandsPancrelipase capsules: Creon®, Viokase ®Most HIV meds: Truvada ®, Atripla ®, Norvir

®