Preston Pharmacy News - June 2011

CE Coming Soon! We are excited to announce that Preston Pharmacy is preparing to launch a new education program that will offer continuing education to employees at each of its facilities. More information will follow.

We Need Your Help

According to the CMS State Operations Manual, “each resident’s drug regimen must be free from unnecessary drugs.” Noncompliance for F329 may include use of a medication without an adequate indication for use.1 Because of this guideline it is important that all medication orders contain a supporting diagnosis for use. It is therefore necessary for pharmacists and nurses to work together to ensure that each order contains all the pertinent information. Ensuring that the correct diagnosis is documented will inform all involved in the resident’s care of the medication’s need, aid in medication administration and the medication review process, as well as improve patient safety. If you notice that an order does not contain an indication for use, you can alert the consultant pharmacist the next time you see them or clarify the diagnosis with the physician and notify the pharmacy. For telephone orders, ask the physician for a diagnosis at the time the order is taken. Thank you for your help and support with this matter.

OIG report on Antipsychotic Use

In a medication record review, the Office of Inspector General (OIG) determined that 14% of nursing home residents had at least one claim for antipsychotic medications. 83% of Medicare claims for these medications were associated with off-label conditions (conditions other than schizophrenia and/or bipolar) and 88% were associated with dementia which is specified in the FDA boxed warning. OIG has recommended CMS “assess whether survey and certification processes offer adequate safeguards against unnecessary antipsychotic drug use in nursing homes”.2 To address this, we recommend administrative personnel discuss this topic with your consultant so that a plan can be developed and implemented

Medication Safety

Dangerous Drug Interaction:5
Coumadin (warfarin) and Sulfa drugs (Bactrim, Cotrim, Gantanol,Septra, sulfamethizole, sulfamethoxazole, sulfisoxazole) – increases the effects of warfarin with the potential for bleeding. Alert the physician that the resident is taking warfarin as dosage may need to be adjusted. INR should be monitored frequently during co-administration and resident should be monitored regularly for signs and symptoms of an active bleed and the appearance of bruises.
**note: this is not a complete list of all sulfa medications, please refer to additional references as needed**

Look-Alike and Sound-Alike Names:6
Alprazolam confused with Lorazepam
Amantadine confused with Amiodarone
Amiloride confused with Amlodipine
Antacid confused with Atacand
Aricept confused with Azilect
Aripiprazole confused with PPI’s (Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole)

New Drugs

Tradjenta (linagliptin) – dipeptidyl peptidase-4 inhibitor (DPP-4) for the treatment of adults with type 2 diabetes.7

Quote of the Month

“Kindness is a language which the deaf can hear and the blind can read” - Mark Twain

References for June, 2011 Issue

Centers for Medicare and Medicaid Services (2011). State Operations Manual, Appendix PP. Available at: cms.gov. Accessed May 13, 2011.
Office of Inspector General. U.S. Department of Health & Human Services. Medicare atypical antipsychotic drug claims for elderly nursing home residents. Available at: hhs.gov. Accessed May 16, 2011.
U.S. Food and Drug Administration. FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age. Available at: fda.gov. Accessed May 13, 2011.
PL Detail-document, Newer Lower Age Limit for Zostavax (Herpes Zoster Vaccine). Pharmacist’s Letter/Prescriber’s Letter. May 2011.
Medication Management. List of top ten dangerous drug interactions in long-term care. Available at: scoup.net. Accessed May 13, 2011.
Institute for Safe Medication Practices. ISMP’s list of confused drug names. Available at: ismp.org. Accessed May 13, 2011.
American Pharmacists Association. Linagliptin: Newest DPP-4 inhibitor. Available at: pharmacist.com. Accessed May 13, 2011.

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June, 2011