Preston Pharmacy News - March 2011

March is Professional Social Work Month.

Preston Pharmacy would like to thank social workers for their dedication to patients and families. Don’t forget to recognize your social worker on March 15, “World Social Work Day”.

Tylenol Limits in RX products

The FDA has recently asked manufacturers of prescription combination products containing acetaminophen to limit the amount of acetaminophen to no more than 325 milligrams in each tablet or capsule. They are also requiring labeling changes of such products which will warn of the potential risk for severe liver injury. These actions will not affect OTC acetaminophen products. According to the FDA, “the risk of liver injury primarily occurs when patients take multiple products containing acetaminophen at one time and exceed the current maximum dose of 4,000 mg in a 24-hour period.” Higher-dose prescription combination acetaminophen products will be phased out over the next three years.1

Pradaxa added to Guidelines

In 2006 the ACC/AHA/ESC Guidelines for the Management of Patients with Atrial Fibrillation were released. These guidelines have been updated to include Pradaxa (dabigatran), a direct thrombin inhibitor approved in October 2010 for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. The guidelines state Pradaxa is a useful alternative to warfarin in certain patients. Individual features to evaluate when considering Pradaxa as an alternative include the patient’s ability to comply with twice-daily dosing, patient preferences, cost, and the availability of an anticoagulation management program to sustain routine monitoring of INR.2

Pradaxa Short Stability

Due to stability issues, once a bottle of Pradaxa is opened, its contents must be used within 30 days.3 In order to decrease the potential for expired medication, Preston Pharmacy is dispensing Pradaxa in unit dose packaging.

Abbreviations to Avoid

The following is a list of abbreviations which the Joint Commission has deemed inappropriate for use on handwritten, computer free-text entries, or pre-printed orders. It is recommended to avoid use of these abbreviations to improve patient safety.4,5

U - write “unit”
IU - write “international unit”
Q.D., QD, q.d., qd - write “daily”
Q.O.D, QOD, q.o.d., qod - write “every other day”
Trailing zero (X.0 mg) - write “X mg”
Lack of leading zero (.X mg) - write “0.X mg”
MS - write “morphine sulfate”
MSO4 and MgSO4 – write “magnesium sulfate”

In Time for Allergy Season

Allegra (fexofenadine) products and Allegra-D (fexofenadine/pseudoephedrine) have been approved by the FDA for over the counter (OTC) use and should be available in early March 2011 without a prescription. Allegra is used for allergies in adults and children 2 years of age and older. Allegra-D relieves nasal congestion and sinus pressure.6

New Drugs

Viibryd (vilazododne) – combination selective serotonin reuptake inhibitor and 5HT1A receptor partial agonist approved for the treatment of major depressive disorder in adults.7

Gralise (Gabapentin ER) – extended-release formulation of gabapentin for the treatment of postherpetic neuralgia.8

Quote of the Month

“For each petal on the shamrock
This brings a wish your way –
Good health, good luck, and happiness
For today and every day ” ~Author unknown

References for March, 2011 Issue

U.S. Food and Drug Administration. FDA limits acetaminophen in prescription combination products; requires liver toxicity warnings. Available at: www.fda.gov. Accessed February 2, 2011.
Wann LS, Curtis AB, Ellenbogen KS. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (update on Dabigatran): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines [published online ahead of print February 14, 2011]. Circulation. 2011. circ.ahajournals.org. Accessed February 28, 2011.
American Pharmacists Association. 30 days: patients need “use by” dates with Pradaxa. Available at: www.pharmacist.com. Accessed February 28, 2011.
Joint Commission website. The official “do not use” list of abbreviations. Available at: www.jointcommission.org. Accessed February 28, 2011.
Dangerous abbreviations. Pharmacist’s Letter/Prescriber’s Letter. 2003;19(12): 121215. (Updated May 2008).
Allegra Web Site. Available at : www.allegra.com. Accessed January 31, 2011.
U.S. Food and Drug Administration. FDA approves Viibryd to treat major depressive disorder. Availabe at: www.fda.gov. Accessed February 2, 2011.
U.S. food and Drug Administration. FDA approved drug products. Available at: www.accessdata.fda.gov. Accessed February 28, 2011.

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March, 2011