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Preston Pharmacy News - August 2011

Medicare Part D Enrollment Open enrollment for Medicare Part D plans has changed this year. This year’s time frame is October 15 – December 7.

Proper Storage Reminder

Insulin pens and vials should be refrigerated until first use. After the first use, insulin pens should be kept at room temperature. Please be aware that different pen devices and insulin cartridges have different expiration dates from the time they are first used or removed from the refrigerator.1 Vials and pens should always be dated with “open” and “expiration” dates. Byetta should be refrigerated prior to first use, then can be stored at room temperature.2 Symlin pens can be stored in the refrigerator or at room temperature after first use.3

Drug-Induced Parkinsonism

Medications cause approximately 10% of all Parkinson-like motor symptoms. Symptoms often include rigidity, tremors, falls, and slow movement. Motor symptoms caused by Parkinson’s Disease are often asymmetrical and usually develop slowly as the disease progresses. Drug-induced motor symptoms are usually symmetrical and they develop quickly, usually within weeks to months of medication initiation. Symptoms will usually subside a few months after stopping the medication. Medications likely to induce Parkinson’s symptoms include typical antipsychotics (haloperidol, fluphenazine), atypical antipsychotics (risperidone, olanzapine), antiemetics (metoclopramide, prochlorperazine), and antihypertensives (methyldopa, reserpine). As healthcare providers in the long-term care setting, it is important to be aware of this condition.4

Fruit Juice Interactions

You may have seen television ads warning that Allegra should not be taken with orange juice. This is due to a drug interaction that exists between some fruit juices and a drug transporter (organic anion transporting peptide [OATP]) which aids in the absorption of Allegra. OATPs transport drugs into cells. Grapefruit, orange, and apple juice have been shown to inhibit OATP. Consuming about 6 ounces of these juices may decrease levels of Allegra by 40%, Tekturna by ~60%, Atenolol by ~ 40%, Cipro by ~20%, Levothyroxine by ~11%, and Levofloxacin by ~7%. It is recommended to avoid grapefruit, orange, and apple juice within four hours of these medications. There is currently no evidence that suggests eating these fruits will result in drug interactions.5

Medication Safety

Dangerous Drug Interaction6
Coumadin (warfarin) and Quinolones (ciprofloxacin, levofloxacin, moxifloxacin) – increased effects of warfarin, with potential for bleeding. INR should be monitored during co-administration. Monitor regularly for signs and symptoms of an active bleed with attention to the formation and appearance of bruises.

Coumadin (warfarin) and Dilantin (phenytoin) – increased effects of warfarin and/or phenytoin. INR and phenytoin levels should be monitored regularly. Monitor for signs and symptoms of an active bleed with particular attention to the formation and appearance of bruises.

Look-Alike and Sound-Alike Names7
Celexa confused with Zyprexa
Celexa confused with Cerebyx
Cetirizine confused Sertraline
Clonazepam confused with Clonidine
Clonazepam confused with Lorazepam
Clonidine confused with Klonopin
Codeine confused with Lodine
Colace confused with Cozaar
Coumadin confused with Avandia
Coumadin confused with Cardura

Quote of the Month

“They may forget your name but they will never forget how you made them feel” -Maya Angelou

References for August, 2011 Issue
  1. Diabetes. Pharmacist’s Letter/Prescriber’s Letter 2006;22.
  2. Byetta Web Site. Available at: www.byetta.com. Accessed July 21, 2011.
  3. Symlin Web Site. Available at: www.symlin.com. Accessed July 21, 2011.
  4. Drug-induced parkinsonism. Pharmacist’s Letter/Prescriber’s Letter 2010; 26(12):261211.
  5. PL Detail-Document, OATP Fruit Juice Drug Interactions. Pharmacist’s Letter/Prescriber’s Letter. June 2011.
  6. Medication Management. List of top ten dangerous drug interactions in long-term care. Available at: www.scoup.net. Accessed July 15, 2011.
  7. Institute for Safe Medication Practices. ISMP’s list of confused drug names. Available at: www.ismp.org. Accessed July 15, 2011.



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August, 2011