Important Numbers
Poison Control 1-800-222-1222
Suicide Prevention 1-800-273-TALK
Suicide Crisis 1-800-SUICIDE
West Virginia Board of Pharmacy232 Capitol StreetCharleston, WV 25301Tel. 304.558.0558Fax. 304.558.0572
Area Hospitals
Cabell Huntington Hospital
1340 Hal Greer Blvd
Huntington
304-526-2000
CAMC Health Education and Research Institute3110 MacCorkle Avenue SECharleston WV 25304(304) 388- 9960FAX: (304) 388-9966
CAMC Teays Valley
1400 Hospital Dr
Hurricane
304-757-1700
Highland Hospital
300 56th St
Charleston
304-926-1600
Jackson General Hospital
122 Pinnell St
Ripley
304-372-2731
St Francis
333 Laidley St
Charleston
304-347-6500
St Mary’s
2900 1st Ave
Huntington
304-526-1234
Thomas Memorial
4605 MacCorkle Ave SW
South Charleston
304-776-3600
Health Departments
Boone County Health Dept
213 Kenmore Drive
Post Office Box 209Madison, West Virginia 25130Phone: (304) 369-7967FAX: (304) 369-2832 Cabell County Health Dept
703 7th Avenue
Huntington WV 25701Phone: (304) 523-6483
Fax: (304) 523-6403
Clinic Fax: (304) 697-0365
Jackson County Health Dept
504 South Church Street
Ripley WV 25271
(304) 372-2634
Fax: (304) 372-1096
Kanawha County Health Dept
108 Lee St E
Charleston, WV 25301
304-344-5243
Lincoln County Health Dept
8008 Court St.
Post Office Box 527Hamlin, West Virginia 25523Phone: (304) 824-3330FAX: (304) 824-3334
Putnam County Health Dept
1401 Hospital Drive, Suite 304Hurricane, West Virginia 25526Phone: (304) 757-2541FAX: (304) 757-7287
State Police *77
Boone County
Madison 304-369-7800
Whitesville 304-854-0101
Cabell County 304-528-5555
Clay County 304-587-2201
Jackson County 304-372-7850
Kanawha County
S Charleston 304-558-7777
Quincy 304-949-3136
Lincoln County 304-824-3101
Mason County 304-675-0850
Putnam County 304-586-2000
Roane County 304-927-0950
Drug Enforcement 304-347-5209
FBI 304-346-3232
Thursday, December 3, 2009
Sig Codes
µg, mcg
microgram
1°, 2°
1 hour, 2 hours, etc.
5x/d
five times daily
a
before
aa
of each
ac
before meals ("before a meal" if once daily dosing)
ad
right ear
ad
as directed (used occasionally in error)
AM
morning
amp
ampules
apl
applicatorful (for vaginal creams)
app
applicator
aq
water
as
left ear
au
both ears
bid
twice daily
bp
blood pressure
c
with
cap
capsule(s)
cc
cubic centimeter (same as milliliter or ml)
cd
cycle day (menstrual cycle)
cid
fives times daily (rarely used now)
cmpd
compound
cr or crm
cream
d
daily or day
DAW
Dispense as Written (no generic)
DC, dc, d/c
discontinue (or discharge from hospital)
disp
dispense
DS
double strength
dx
diagnosis
elix
elixir
eq
equivalent
et
and
fid
five times daily
g, gm
gram
gen
generic
gr
grain, about 60 mg
gtt
drop(s)
h, hr
hour(s)
HD
high dose
hs
at bedtime
IM
intramuscularly (for injectables)
inj
inject, injection
IU
international units
IV
intravenously (for injectables)
liq
liquid
lot
lotion
max
maximum
MDI
(metered dose) inhaler
meq, mEq
milliequivalent(s)
min
minute, or minimum
mo
month
neb
nebulizer
noct
night
npo, NPO
nothing by mouth
nr
no refills
od
right eye
os
left eye
ou
both eyes
oz
ounce
p
after
pc
after meals
pc breakfast
after breakfast
per
per (per day, week, etc)
PM
evening or nighttime
po, os
by mouth
PR, pr
rectally (per rectum)
prn
as needed
PV, pv
in the vagina, vaginally
q
every
q 4 h
every 4 hours
Q 4°-6°
every 4 to 6 hours
q 7 PM
every day at 7 PM
qam
every morning
qd
every day or once daily
qhs
every night at bedtime, at bedtime nightly
qid
four times daily
qn
every night
qod
every other day
qpm
every evening
qs
sufficient amount
r, rec
rectally
rept
repeat
rf
refill(s)
s
without
sc
subcutaneous
sid
once daily (written by veterinarians)
Sig
directions
sl
(dissolve) under the tongue [sublingually]
sol
solution
sq
subcutaneous (for injectables)
ss
one-half
ss
sliding scale (for insulin)
stat
immediately
subq
subcutaneous (for injectables)
sup or supp
suppository
susp
suspension
sx
symptoms
syr
syrup
tab
tablet(s)
tbsp
tablespoonful, tablespoonfuls, 15ml
tea or tsp
teaspoonful, teaspoonfuls, 5 ml
tid
three times daily
tiw
three times weekly (also biw, qiw, etc)
tx
treatment
U, u
unit
ud, utd
as directed
ung
ointment
vag
vaginally, in the vagina
wc
with meals ("with a meal" if once daily dosing)
x3d
for 3 days (or maybe 3 doses, caution)
YO
years old
http://www.pharmcatalyst.com/techs/sigcodespub.pharm [11-10-09]
microgram
1°, 2°
1 hour, 2 hours, etc.
5x/d
five times daily
a
before
aa
of each
ac
before meals ("before a meal" if once daily dosing)
ad
right ear
ad
as directed (used occasionally in error)
AM
morning
amp
ampules
apl
applicatorful (for vaginal creams)
app
applicator
aq
water
as
left ear
au
both ears
bid
twice daily
bp
blood pressure
c
with
cap
capsule(s)
cc
cubic centimeter (same as milliliter or ml)
cd
cycle day (menstrual cycle)
cid
fives times daily (rarely used now)
cmpd
compound
cr or crm
cream
d
daily or day
DAW
Dispense as Written (no generic)
DC, dc, d/c
discontinue (or discharge from hospital)
disp
dispense
DS
double strength
dx
diagnosis
elix
elixir
eq
equivalent
et
and
fid
five times daily
g, gm
gram
gen
generic
gr
grain, about 60 mg
gtt
drop(s)
h, hr
hour(s)
HD
high dose
hs
at bedtime
IM
intramuscularly (for injectables)
inj
inject, injection
IU
international units
IV
intravenously (for injectables)
liq
liquid
lot
lotion
max
maximum
MDI
(metered dose) inhaler
meq, mEq
milliequivalent(s)
min
minute, or minimum
mo
month
neb
nebulizer
noct
night
npo, NPO
nothing by mouth
nr
no refills
od
right eye
os
left eye
ou
both eyes
oz
ounce
p
after
pc
after meals
pc breakfast
after breakfast
per
per (per day, week, etc)
PM
evening or nighttime
po, os
by mouth
PR, pr
rectally (per rectum)
prn
as needed
PV, pv
in the vagina, vaginally
q
every
q 4 h
every 4 hours
Q 4°-6°
every 4 to 6 hours
q 7 PM
every day at 7 PM
qam
every morning
qd
every day or once daily
qhs
every night at bedtime, at bedtime nightly
qid
four times daily
qn
every night
qod
every other day
qpm
every evening
qs
sufficient amount
r, rec
rectally
rept
repeat
rf
refill(s)
s
without
sc
subcutaneous
sid
once daily (written by veterinarians)
Sig
directions
sl
(dissolve) under the tongue [sublingually]
sol
solution
sq
subcutaneous (for injectables)
ss
one-half
ss
sliding scale (for insulin)
stat
immediately
subq
subcutaneous (for injectables)
sup or supp
suppository
susp
suspension
sx
symptoms
syr
syrup
tab
tablet(s)
tbsp
tablespoonful, tablespoonfuls, 15ml
tea or tsp
teaspoonful, teaspoonfuls, 5 ml
tid
three times daily
tiw
three times weekly (also biw, qiw, etc)
tx
treatment
U, u
unit
ud, utd
as directed
ung
ointment
vag
vaginally, in the vagina
wc
with meals ("with a meal" if once daily dosing)
x3d
for 3 days (or maybe 3 doses, caution)
YO
years old
http://www.pharmcatalyst.com/techs/sigcodespub.pharm [11-10-09]
Drug Information
Calculations of Pediatric Dosage of Digoxin Based on Age and Weight
Age
Digoxin Dose (ug/kg)
Premature
15 to 25
Full term
20 to 30
1 to 24 months
30 to 50
2 to 5 years
25 to 35
5 to 10 years
15 to 30
Over 10 years
8 to 12
(3/5)
Dr. Kaushal’s lecture on Dilutions and concentrations [10/20/09]
Tamiflu (Compounding Liquid from Capsules)
Instructions and Chart are pulled directly from NIH website.
Full Direct Quote (with small omissions and bolding for clarity):
Number of TAMIFLU 75 mg Capsules and Amount of Vehicle (Cherry Syrup OR Ora-Sweet SF) Needed to Prepare the Total Volume of a Compounded Oral Suspension (15 mg/mL)
Total Volume of Compounded Oral Suspension needed to be Prepared
30 mL
40 mL
50 mL
60 mL
Required number of TAMIFLU 75 mg Capsules
6 capsules (450 mg oseltamivir)
8 capsules (600 mg oseltamivir)
10 capsules (750 mg oseltamivir)
12 capsules (900 mg oseltamivir)
Cherry Syrup (Humco) OR Ora-Sweet SF (Paddock Laboratories)
29 mL
38.5 mL
48 mL
57 mL
1. Carefully separate the capsule body and cap and transfer the contents of the required number of TAMIFLU 75 mg Capsules into a clean mortar.
2. Triturate the granules to a fine powder.
3. Add one-third (1/3) of the specified amount of vehicle and triturate the powder until a uniform suspension is achieved.
4. Transfer the suspension to an amber glass or amber polyethyleneterephthalate (PET) bottle. A funnel may be used to eliminate any spillage.
5. Add another one-third (1/3) of the vehicle to the mortar, rinse the pestle and mortar by a triturating motion and transfer the vehicle into the bottle.
6. Repeat the rinsing (Step 5) with the remainder of the vehicle.
7. Close the bottle using a child-resistant cap.
8. Shake well to completely dissolve the active drug and to ensure homogeneous distribution of the dissolved drug in the resulting suspension. (Note: The active drug, oseltamivir phosphate, readily dissolves in the specified vehicles. The suspension is caused by some
f the inert ingredients of TAMIFLU Capsules which are insoluble in these vehicles.)
Put an ancillary label on the bottle indicating "Shake Gently Before Use". [This compounded suspension should be gently shaken prior to administration to minimize the tendency for air entrapment, particularly with the Ora-Sweet SF preparation.]
9. Instruct the parent or guardian that any remaining material following completion of therapy must be discarded by either affixing an ancillary label to the bottle or adding a statement to the pharmacy label instructions.
STORAGE OF THE PHARMACY-COMPOUNDED SUSPENSION:
Refrigeration: Stable for 5 weeks (35 days) when stored in a refrigerator at 2° to 8°C (36° to 46°F).
Room Temperature: Stable for five days (5 days) when stored at room temperature, 25°C (77°F).
Note: This compounding procedure results in a 15 mg/mL suspension, which is different from the commercially available TAMIFLU for Oral Suspension, which has a concentration of 12 mg/mL.
Dosing Chart for Pharmacy-Compounded Suspension from TAMIFLU Capsules 75 mg
Body Weight (kg)
Body Weight (lbs)
Dose(mg)
Volume per Dose 15 mg/mL
Treatment Dose (for 5 days)
Prophylaxis Dose (for 10 days)
≤15 kg
≤33 lbs
30 mg
2 mL
2 mL two times a day
2 mL once daily
16 to 23 kg
34 to 51 lbs
45 mg
3 mL
3 mL two times a day
3 mL once daily
24 to 40 kg
52 to 88 lbs
60 mg
4 mL
4 mL two times a day
4 mL once daily
≥41 kg
≥89 lbs
75 mg
5 mL
5 mL two times a day
5 mL once daily
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=11065 (5/5)
Age
Digoxin Dose (ug/kg)
Premature
15 to 25
Full term
20 to 30
1 to 24 months
30 to 50
2 to 5 years
25 to 35
5 to 10 years
15 to 30
Over 10 years
8 to 12
(3/5)
Dr. Kaushal’s lecture on Dilutions and concentrations [10/20/09]
Tamiflu (Compounding Liquid from Capsules)
Instructions and Chart are pulled directly from NIH website.
Full Direct Quote (with small omissions and bolding for clarity):
Number of TAMIFLU 75 mg Capsules and Amount of Vehicle (Cherry Syrup OR Ora-Sweet SF) Needed to Prepare the Total Volume of a Compounded Oral Suspension (15 mg/mL)
Total Volume of Compounded Oral Suspension needed to be Prepared
30 mL
40 mL
50 mL
60 mL
Required number of TAMIFLU 75 mg Capsules
6 capsules (450 mg oseltamivir)
8 capsules (600 mg oseltamivir)
10 capsules (750 mg oseltamivir)
12 capsules (900 mg oseltamivir)
Cherry Syrup (Humco) OR Ora-Sweet SF (Paddock Laboratories)
29 mL
38.5 mL
48 mL
57 mL
1. Carefully separate the capsule body and cap and transfer the contents of the required number of TAMIFLU 75 mg Capsules into a clean mortar.
2. Triturate the granules to a fine powder.
3. Add one-third (1/3) of the specified amount of vehicle and triturate the powder until a uniform suspension is achieved.
4. Transfer the suspension to an amber glass or amber polyethyleneterephthalate (PET) bottle. A funnel may be used to eliminate any spillage.
5. Add another one-third (1/3) of the vehicle to the mortar, rinse the pestle and mortar by a triturating motion and transfer the vehicle into the bottle.
6. Repeat the rinsing (Step 5) with the remainder of the vehicle.
7. Close the bottle using a child-resistant cap.
8. Shake well to completely dissolve the active drug and to ensure homogeneous distribution of the dissolved drug in the resulting suspension. (Note: The active drug, oseltamivir phosphate, readily dissolves in the specified vehicles. The suspension is caused by some
f the inert ingredients of TAMIFLU Capsules which are insoluble in these vehicles.)
Put an ancillary label on the bottle indicating "Shake Gently Before Use". [This compounded suspension should be gently shaken prior to administration to minimize the tendency for air entrapment, particularly with the Ora-Sweet SF preparation.]
9. Instruct the parent or guardian that any remaining material following completion of therapy must be discarded by either affixing an ancillary label to the bottle or adding a statement to the pharmacy label instructions.
STORAGE OF THE PHARMACY-COMPOUNDED SUSPENSION:
Refrigeration: Stable for 5 weeks (35 days) when stored in a refrigerator at 2° to 8°C (36° to 46°F).
Room Temperature: Stable for five days (5 days) when stored at room temperature, 25°C (77°F).
Note: This compounding procedure results in a 15 mg/mL suspension, which is different from the commercially available TAMIFLU for Oral Suspension, which has a concentration of 12 mg/mL.
Dosing Chart for Pharmacy-Compounded Suspension from TAMIFLU Capsules 75 mg
Body Weight (kg)
Body Weight (lbs)
Dose(mg)
Volume per Dose 15 mg/mL
Treatment Dose (for 5 days)
Prophylaxis Dose (for 10 days)
≤15 kg
≤33 lbs
30 mg
2 mL
2 mL two times a day
2 mL once daily
16 to 23 kg
34 to 51 lbs
45 mg
3 mL
3 mL two times a day
3 mL once daily
24 to 40 kg
52 to 88 lbs
60 mg
4 mL
4 mL two times a day
4 mL once daily
≥41 kg
≥89 lbs
75 mg
5 mL
5 mL two times a day
5 mL once daily
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=11065 (5/5)
Common Herbal Supplements
Common Herbal Supplements and their Cointraindications and Drug interactions
Compiled From Red Book: the Pharmacist’s Fundamental Reference
2009 Edition, Herbal Medicine Guide
(5/5)
C [contraindications] and D [drug interactions]
Alfalfa
C- SLE, gout, pregnancy, internal use
Aloe
C- Intestinal obstruction, acutely inflame intestinal diseases [Crohn's, ulcerative colitis], appendicitis, abdominal pain of unknown origins, ileus, pregnancy and nursing mothers
D- antiarrhytmics, antidiabetics, cardiac glycosides,corticosteroids/glucocorticoids, licorice, thiazide diuretics, loop diuretics
Brewer's Yeast
D- MAO inhibitors [raises blood pressure]
Borage
C- epilepsy, eliptogenic drugs, schizophrenia, pregnancy and nursing mothers
Castor oil
C- Intestinal obstruction, acutely inflame intestinal diseases, appendicitis, abdominal pain of unknown origins, ileus, pregnancy and nursing mothers, immunosuppressant therapies, children under 12
D- cardioactive steroids
Cinnamon
C- pregnancy
Echinecea
C- autoimmune diseases, MS, Leukosis, collagen diseases, AIDS, TB, tendency toward allergies, diabetes, pregnancy
D- corticosteroids, immunosuppressants
Evening Primrose
C- epilepsy, schizophrenia
D- anticoagulants, antiplatelet agents, Heparins of low molecular weight, thrombolytic agents
Flaxseed
C- Ileus, stricture of esophegus, acute imflammation of GI tract
D- delays drug absorption, unspecified
Garlic
C- Nursing mothers, or within 10 days of surgery
Ginger
C- Pregnancy or lactation, morning sickness, gallstones, hemorrhage risk
Gingko [biloba]
C- at risk for intracranial bleeding, hemorrhage, systemic arterial hypertension, diabetes, amyloid senile plaques, seizure risk
D- anticoagulants, antiplatelet agents, Heparins of low molecular weight, thrombolytic agents, NSAIDS, anticonvulsants, SSRIs, Prozac, Buspirone, Insulin, MAO inhibitors, Nicardipine, Nifedipine, Thiazide diuretics, Papvarine
Ginseng
D- conjugated estrogens, hypoglycemic drugs, loop diuretics, MAO inhibitors, Nifedipine
Licorice
D- anticoagulants, antiplatelet agents, Heparins of low molecular weight, thrombolytic agents, antiarrhythmics, antidiabetic agents, antihypertension agents, combination contraceptives, corticosteroids, glucocorticoids, digitalis glycoside perarations, insulin, laxatives, loop diuretics, thiazide diuretics, MAO inhibitors, potassium supplements, testosterone
Saw palmetto
D- alpha andrenergic blockers, androgens hormones, hormone-like drugs, andrenergic drugs, iron, warfarin
St Johns Wort
D- Among may others: anto anxiety medicines, anticoagulants, antodepressants, antiHIVs, calcium channel blockers, cardiac glycosides, oral contraceptives, statins
Wormwood
C- history of seizures, stomach or intestinal ulcers, pregnancy, nursing mothers
D- Iron, phenothiazines, trazodone, tricyclic antidepressants
Compiled From Red Book: the Pharmacist’s Fundamental Reference
2009 Edition, Herbal Medicine Guide
(5/5)
C [contraindications] and D [drug interactions]
Alfalfa
C- SLE, gout, pregnancy, internal use
Aloe
C- Intestinal obstruction, acutely inflame intestinal diseases [Crohn's, ulcerative colitis], appendicitis, abdominal pain of unknown origins, ileus, pregnancy and nursing mothers
D- antiarrhytmics, antidiabetics, cardiac glycosides,corticosteroids/glucocorticoids, licorice, thiazide diuretics, loop diuretics
Brewer's Yeast
D- MAO inhibitors [raises blood pressure]
Borage
C- epilepsy, eliptogenic drugs, schizophrenia, pregnancy and nursing mothers
Castor oil
C- Intestinal obstruction, acutely inflame intestinal diseases, appendicitis, abdominal pain of unknown origins, ileus, pregnancy and nursing mothers, immunosuppressant therapies, children under 12
D- cardioactive steroids
Cinnamon
C- pregnancy
Echinecea
C- autoimmune diseases, MS, Leukosis, collagen diseases, AIDS, TB, tendency toward allergies, diabetes, pregnancy
D- corticosteroids, immunosuppressants
Evening Primrose
C- epilepsy, schizophrenia
D- anticoagulants, antiplatelet agents, Heparins of low molecular weight, thrombolytic agents
Flaxseed
C- Ileus, stricture of esophegus, acute imflammation of GI tract
D- delays drug absorption, unspecified
Garlic
C- Nursing mothers, or within 10 days of surgery
Ginger
C- Pregnancy or lactation, morning sickness, gallstones, hemorrhage risk
Gingko [biloba]
C- at risk for intracranial bleeding, hemorrhage, systemic arterial hypertension, diabetes, amyloid senile plaques, seizure risk
D- anticoagulants, antiplatelet agents, Heparins of low molecular weight, thrombolytic agents, NSAIDS, anticonvulsants, SSRIs, Prozac, Buspirone, Insulin, MAO inhibitors, Nicardipine, Nifedipine, Thiazide diuretics, Papvarine
Ginseng
D- conjugated estrogens, hypoglycemic drugs, loop diuretics, MAO inhibitors, Nifedipine
Licorice
D- anticoagulants, antiplatelet agents, Heparins of low molecular weight, thrombolytic agents, antiarrhythmics, antidiabetic agents, antihypertension agents, combination contraceptives, corticosteroids, glucocorticoids, digitalis glycoside perarations, insulin, laxatives, loop diuretics, thiazide diuretics, MAO inhibitors, potassium supplements, testosterone
Saw palmetto
D- alpha andrenergic blockers, androgens hormones, hormone-like drugs, andrenergic drugs, iron, warfarin
St Johns Wort
D- Among may others: anto anxiety medicines, anticoagulants, antodepressants, antiHIVs, calcium channel blockers, cardiac glycosides, oral contraceptives, statins
Wormwood
C- history of seizures, stomach or intestinal ulcers, pregnancy, nursing mothers
D- Iron, phenothiazines, trazodone, tricyclic antidepressants
Conversions and Calculations
(3/5) (All)
Multiple Prefix Mass Length Volume
1x103 Kilo kg km kL
1x100 basic g m L
1x10-1 Deci dg dm dL
1x10-2 Centi cg cm cL
1x10-3 Milli mg mm mL
1x10-6 Micro μg μm μL
1x10-9 Nano ng nm nL
1x10-12 Pico pg pm pL
Roman Numerals
ss = ½ L or l 50
I or I 1 C or c 100
V or v 5 D or d 500
X or x 10 M or m 1000
Apothecaries System
1 scruple 20 grains
1 dram 60 grains 3 scruples
1 ounce 480 grains 8 drams
1 pound 5760 grains 12 ounces
1 fluidram 60 minims
1 fluidounce 480 minims 8 fluidrams
1 pint 7680 minims 16 fluidounces
1 quart 32 fluidounces 2 pints
1 gallon 128 fluidounces 8 pints
Avoirdupois System
1 ounce [oz] 437.5 grains
1 pound [lb] 7000 grains, 16 oz
Other Conversions
1 inch 2.54 cm 1 L 33.8 fl. oz
1 foot 0.305 m 1 ml 16.2 minims
1 cc 1 mL 1 pint 473 ml
1 tsp 5 mL 1 gm 15.4 gr
1 fl. oz 29.57 mL 1 lb .454 kg
1 oz 28.35 g 1 gr 64.8 mg
1 kg 2.2 lbs 1 gallon 3790 ml
Calculating BSA [Body Surface Area]
BSA m2 = (W0.425 X H0.725 X 71.84)
10,000
BSA m2 = [{H (cm) X W (kg)}/3600]0.5
S = W0.425 X H0.725 X 71.84
Log S = Log W X 0.425 X Log (h) X 0.725 + 1.8564
(S = body surface in cm2, W = weight in kg, H = height in cm)
Rules for Child Dosing [CD]
Young^' s CD= (Age/(Age+12))X Adult Dose
Cowling^' s CD= ((Age at next Birthday)/24)X Adult Dose
Fried^' s CD= ((Age in months)/150)X Adult Dose
BSA CD= BSA of child [m^2 ] X dose per [m^2]
Alt.BSA CD= ((BSA of child [m^2 ])/(1.73 m))X Usual Adult Dose
Other Useful Equations
Molarity[g/l]= moles/Liter
Density [g/ml]= mass/volume
% error rate=(accepted-experimental value)/(accepted value) X 100
Percent of PI in a Product = (ml or gm of PI)/(Total ml or gm of product) X 100
Specific Gravity = (mass of substance)/(mass of equal amount of Water)
Related: grams= ml X SG
Alligation – Final Concentration =((C_1 Q_1 )+ (C_2 Q_2 )+ etc)/(Total Mass or Volume)
% error of Rx Balance= sensitivity/(quantity desired) X 100
Least Weighable Qty= (Sensitivity )/(%error tolerated) X 100
Aliquot Target Dose = ((Drug^' sLMQ)X (Dispensed wt of mix))/(Total Mix wt)
mOsmol/L = (Wt of substance in g/l)/(MW in g) X number of species X 1000
Henderson Hasselbach pH=pK_a+log〖(A-)/HA〗
Dissociation Values (i) 80% (.2+.8+.8)
Substances that dissociate into 2 ions: 1.8
Substances that dissociate into 3 ions: 2.6
Substances that dissociate into 4 ions: 3.4
Substances that dissociate into 5 ions: 4.2
Freezing point of Electrolytes (i X 1.86 C)/(.52 C)= (MW of PI)/(x grams)
E of solution (MW of PI X 1.8)/(58.5 X i of PI) = (1 g)/(x g)
Calculating mEq
mEq= (mg X Valence)/(Atomic or formula wt)
mg= (mEq X Atomic or formula wt)/valence
Step 1: Find the equivalent weight
mol wt/valence = 74.5 g/1 = 74.5 g
Step 2: Determine the mEq weight, which is 1/1000 of the equivalent weight
mEq wt = 74.5 g/1000 = 0.0745 g = 74.5 mg
Step 3: Calculate concentration (1 mEq)/(mEq wt)= 2mEq/(x g)
Cost Effective Analysis (CEA)
CE ratio yields the "cost" to attain a unit of health improvement.
CE ratio:
[Expected cost of treatment ] - [expected cost of alternative ]
[Expected health outcome from treatment] –[ expected health outcome from alternative]
Is CEA necessary?
Treatment Health Outcome vs Alternative
Treatment Cost vs Alternative Better Worse
Higher Do CEA Use Alternative
Lower Use Treatment Do CEA
(4/5)
[Humanistics/Pharmacoeconomics Outcomes (9/23/2009 & 9/28/2009)
Fadi Alkhateeb, BSPharm, Ph.D.]
Perenteral and Enteral Calculations and Nutritional Information
Prepared By: Aladin A. Siddig, Ph. D.
Dept of Pharmaceutical and Administrative Sciences
(4/5)
Macronutrients:
Carbohydrate (e.g., dextrose)
Protein (e.g., amino acids)
Fat (e.g., lipid emulsions)
Micronutrients:
Electrolytes
Vitamins
Trace elements
Parameter Water Requirement
Based on age:
Neonates 120-180 ml/kg/day
1-12 months 150 ml/kg/day
(maximum, 200 ml)
Based on Weight
< 10 kg 1000 ml/kg/day
10-20 kg 1000 ml + 50 ml/kg/day over 10 kg
< 20 kg 1500 ml + 20 ml/kg/day over 20 kg
Base on Body Surface Area
m2 X 1500 ml/day/m2 __ml/day
Based on Caloric Requirement
1.2 ml/kcal X kcal/day __ml/day
Caloric Requirements
For males:
BEE = 66.67 + {13.75 X weight (kg)} + {5 X Height (cm)} – {6.76 X Age (yr)}
For females:
BEE = 655.1 + {9.56 X weight (kg)} + {1.86 X Height (cm)} – {4.68 X Age (yr)}
The total daily expenditure (TDE) of energy, as calculated, may be adjusted for activity and stress factor
BEE X activity factor X stress factors = TDE
Activity factors:
Confined to bed: 1.2
Ambulatory: 1.3
Stress Factors:
Surgery: 1.2
Infection: 1.4 –1.6
Trauma: 1.3 –1.5
Burns: 1.5 –2. 1
Dextrose provides 3.4 kcal of energy per gram, each 100 ml of 25% dextrose injection provides 85 kcal of energy. For enteral nutrition, the factor used is 4 kcal/g.
Protein Requirements
In TPN, protein is provided as protein hydrolysate or amino acids.
The purpose of the protein support is not to produce energy; although energy is produced by proteins by a factor of 4 kcal/g but rather to build tissue and body strength. A patient’s caloric needs should be provided by nonprotein calories.
The daily quantity of protein required in adults is generally estimated to be about:
0.8 g/kg/day in unstressed patient;
0.8 to 1 g/kg of body weight for a mildly stressed patient
1.2 g/kg for a renal dialysis patient
1.1 to 1.5 g/kg for moderately stressed patient
1.5 to 2 g/kg for severely stressed patient and those with critical illness or trauma, and
3 g/kg for severely burned patient.
Infants may require 2 to 3 g/day/day, children 1.5 to 2 g/kg/day, and teenagers 1 to 1.5 g/kg/day of protein
Lipid (Fat) Requirements
The proportion of calories provided by lipids is usually too restricted to 30% to 40% of the total daily calories.
Lipids provide 9 kcal of energy per gram.
Micronutrients
Standard quantities of electrolytes may be used as parenteral nutrition or modified as required.
Parenteral Nutrition
Step-1 Calculate the total calories using BEE-equation and stress the stress factors.
Step-2 Calculate the daily quantity (g) of amino acids (protein) required based on 0.8 g/kg of body weight and adjusted as needed for stress factors and certain disease states.
Step-3 Calculate the number of calories by amino acids (from step 2) at 4 kcal/g.
Step-4 Calculate the kcal of lipid required for 30% to 40% of the total daily calories.
Step-5 Calculate the grams of lipids required (from step-4) based on 9 kcal/g or based on the lipid emulsion used.
Step-6 Calculate the quantity of carbohydrate required based on 3.4 kcal/g after accounting for the contribution of the lipids
Step-7 Calculate the daily fluid requirements using 30 ml/kg/day.
Body Mass Index (BMI)
According to the National Institutes of Health (NIH), individuals with a BMI:
Less than 18.5 may be considered underweight;
Between 18.5 and 24.9 may be considered normal
Between 25 and 29.9 are considered overweight;
30 and above are considered obese;
Over 40 are considered extremely obese.
For an elderly person, a BMI of less than 21 can be a sign of malnutrition.
BMI in most people is an indicator of high body fat (this may not be the case for persons who are especially muscular).
BMI= (wt [lb])/(height〖[in]〗^2 ) X 704.5
DRVs [Daily reference values] also have been established for cholesterol, sodium, and potassium, which do not contribute calories.
DRVs for the energy-producing nutrients are calculated as follows:
Total fat based on 20-35 percent of calories
Saturated fat based on less than 10 percent of calories
Carbohydrate based on 45-65 percent of calories
Protein based on 10-35 percent of calories (applicable only to adults and children over 4 years of age)
Fiber based on 11.5 g of fiber per 1000 calories
The following quantities of nutrients are considered the upper limit for the maintenance of good health:
Total fat: less than 65 g
Saturated fat: less than 20 g
Cholesterol: less than 300 mg
Sodium: less than 2300 mg (persons with hypertension, less than 1500 mg).
The daily values of sodium and cholesterol are the same regardless of the calorie diet
Multiple Prefix Mass Length Volume
1x103 Kilo kg km kL
1x100 basic g m L
1x10-1 Deci dg dm dL
1x10-2 Centi cg cm cL
1x10-3 Milli mg mm mL
1x10-6 Micro μg μm μL
1x10-9 Nano ng nm nL
1x10-12 Pico pg pm pL
Roman Numerals
ss = ½ L or l 50
I or I 1 C or c 100
V or v 5 D or d 500
X or x 10 M or m 1000
Apothecaries System
1 scruple 20 grains
1 dram 60 grains 3 scruples
1 ounce 480 grains 8 drams
1 pound 5760 grains 12 ounces
1 fluidram 60 minims
1 fluidounce 480 minims 8 fluidrams
1 pint 7680 minims 16 fluidounces
1 quart 32 fluidounces 2 pints
1 gallon 128 fluidounces 8 pints
Avoirdupois System
1 ounce [oz] 437.5 grains
1 pound [lb] 7000 grains, 16 oz
Other Conversions
1 inch 2.54 cm 1 L 33.8 fl. oz
1 foot 0.305 m 1 ml 16.2 minims
1 cc 1 mL 1 pint 473 ml
1 tsp 5 mL 1 gm 15.4 gr
1 fl. oz 29.57 mL 1 lb .454 kg
1 oz 28.35 g 1 gr 64.8 mg
1 kg 2.2 lbs 1 gallon 3790 ml
Calculating BSA [Body Surface Area]
BSA m2 = (W0.425 X H0.725 X 71.84)
10,000
BSA m2 = [{H (cm) X W (kg)}/3600]0.5
S = W0.425 X H0.725 X 71.84
Log S = Log W X 0.425 X Log (h) X 0.725 + 1.8564
(S = body surface in cm2, W = weight in kg, H = height in cm)
Rules for Child Dosing [CD]
Young^' s CD= (Age/(Age+12))X Adult Dose
Cowling^' s CD= ((Age at next Birthday)/24)X Adult Dose
Fried^' s CD= ((Age in months)/150)X Adult Dose
BSA CD= BSA of child [m^2 ] X dose per [m^2]
Alt.BSA CD= ((BSA of child [m^2 ])/(1.73 m))X Usual Adult Dose
Other Useful Equations
Molarity[g/l]= moles/Liter
Density [g/ml]= mass/volume
% error rate=(accepted-experimental value)/(accepted value) X 100
Percent of PI in a Product = (ml or gm of PI)/(Total ml or gm of product) X 100
Specific Gravity = (mass of substance)/(mass of equal amount of Water)
Related: grams= ml X SG
Alligation – Final Concentration =((C_1 Q_1 )+ (C_2 Q_2 )+ etc)/(Total Mass or Volume)
% error of Rx Balance= sensitivity/(quantity desired) X 100
Least Weighable Qty= (Sensitivity )/(%error tolerated) X 100
Aliquot Target Dose = ((Drug^' sLMQ)X (Dispensed wt of mix))/(Total Mix wt)
mOsmol/L = (Wt of substance in g/l)/(MW in g) X number of species X 1000
Henderson Hasselbach pH=pK_a+log〖(A-)/HA〗
Dissociation Values (i) 80% (.2+.8+.8)
Substances that dissociate into 2 ions: 1.8
Substances that dissociate into 3 ions: 2.6
Substances that dissociate into 4 ions: 3.4
Substances that dissociate into 5 ions: 4.2
Freezing point of Electrolytes (i X 1.86 C)/(.52 C)= (MW of PI)/(x grams)
E of solution (MW of PI X 1.8)/(58.5 X i of PI) = (1 g)/(x g)
Calculating mEq
mEq= (mg X Valence)/(Atomic or formula wt)
mg= (mEq X Atomic or formula wt)/valence
Step 1: Find the equivalent weight
mol wt/valence = 74.5 g/1 = 74.5 g
Step 2: Determine the mEq weight, which is 1/1000 of the equivalent weight
mEq wt = 74.5 g/1000 = 0.0745 g = 74.5 mg
Step 3: Calculate concentration (1 mEq)/(mEq wt)= 2mEq/(x g)
Cost Effective Analysis (CEA)
CE ratio yields the "cost" to attain a unit of health improvement.
CE ratio:
[Expected cost of treatment ] - [expected cost of alternative ]
[Expected health outcome from treatment] –[ expected health outcome from alternative]
Is CEA necessary?
Treatment Health Outcome vs Alternative
Treatment Cost vs Alternative Better Worse
Higher Do CEA Use Alternative
Lower Use Treatment Do CEA
(4/5)
[Humanistics/Pharmacoeconomics Outcomes (9/23/2009 & 9/28/2009)
Fadi Alkhateeb, BSPharm, Ph.D.]
Perenteral and Enteral Calculations and Nutritional Information
Prepared By: Aladin A. Siddig, Ph. D.
Dept of Pharmaceutical and Administrative Sciences
(4/5)
Macronutrients:
Carbohydrate (e.g., dextrose)
Protein (e.g., amino acids)
Fat (e.g., lipid emulsions)
Micronutrients:
Electrolytes
Vitamins
Trace elements
Parameter Water Requirement
Based on age:
Neonates 120-180 ml/kg/day
1-12 months 150 ml/kg/day
(maximum, 200 ml)
Based on Weight
< 10 kg 1000 ml/kg/day
10-20 kg 1000 ml + 50 ml/kg/day over 10 kg
< 20 kg 1500 ml + 20 ml/kg/day over 20 kg
Base on Body Surface Area
m2 X 1500 ml/day/m2 __ml/day
Based on Caloric Requirement
1.2 ml/kcal X kcal/day __ml/day
Caloric Requirements
For males:
BEE = 66.67 + {13.75 X weight (kg)} + {5 X Height (cm)} – {6.76 X Age (yr)}
For females:
BEE = 655.1 + {9.56 X weight (kg)} + {1.86 X Height (cm)} – {4.68 X Age (yr)}
The total daily expenditure (TDE) of energy, as calculated, may be adjusted for activity and stress factor
BEE X activity factor X stress factors = TDE
Activity factors:
Confined to bed: 1.2
Ambulatory: 1.3
Stress Factors:
Surgery: 1.2
Infection: 1.4 –1.6
Trauma: 1.3 –1.5
Burns: 1.5 –2. 1
Dextrose provides 3.4 kcal of energy per gram, each 100 ml of 25% dextrose injection provides 85 kcal of energy. For enteral nutrition, the factor used is 4 kcal/g.
Protein Requirements
In TPN, protein is provided as protein hydrolysate or amino acids.
The purpose of the protein support is not to produce energy; although energy is produced by proteins by a factor of 4 kcal/g but rather to build tissue and body strength. A patient’s caloric needs should be provided by nonprotein calories.
The daily quantity of protein required in adults is generally estimated to be about:
0.8 g/kg/day in unstressed patient;
0.8 to 1 g/kg of body weight for a mildly stressed patient
1.2 g/kg for a renal dialysis patient
1.1 to 1.5 g/kg for moderately stressed patient
1.5 to 2 g/kg for severely stressed patient and those with critical illness or trauma, and
3 g/kg for severely burned patient.
Infants may require 2 to 3 g/day/day, children 1.5 to 2 g/kg/day, and teenagers 1 to 1.5 g/kg/day of protein
Lipid (Fat) Requirements
The proportion of calories provided by lipids is usually too restricted to 30% to 40% of the total daily calories.
Lipids provide 9 kcal of energy per gram.
Micronutrients
Standard quantities of electrolytes may be used as parenteral nutrition or modified as required.
Parenteral Nutrition
Step-1 Calculate the total calories using BEE-equation and stress the stress factors.
Step-2 Calculate the daily quantity (g) of amino acids (protein) required based on 0.8 g/kg of body weight and adjusted as needed for stress factors and certain disease states.
Step-3 Calculate the number of calories by amino acids (from step 2) at 4 kcal/g.
Step-4 Calculate the kcal of lipid required for 30% to 40% of the total daily calories.
Step-5 Calculate the grams of lipids required (from step-4) based on 9 kcal/g or based on the lipid emulsion used.
Step-6 Calculate the quantity of carbohydrate required based on 3.4 kcal/g after accounting for the contribution of the lipids
Step-7 Calculate the daily fluid requirements using 30 ml/kg/day.
Body Mass Index (BMI)
According to the National Institutes of Health (NIH), individuals with a BMI:
Less than 18.5 may be considered underweight;
Between 18.5 and 24.9 may be considered normal
Between 25 and 29.9 are considered overweight;
30 and above are considered obese;
Over 40 are considered extremely obese.
For an elderly person, a BMI of less than 21 can be a sign of malnutrition.
BMI in most people is an indicator of high body fat (this may not be the case for persons who are especially muscular).
BMI= (wt [lb])/(height〖[in]〗^2 ) X 704.5
DRVs [Daily reference values] also have been established for cholesterol, sodium, and potassium, which do not contribute calories.
DRVs for the energy-producing nutrients are calculated as follows:
Total fat based on 20-35 percent of calories
Saturated fat based on less than 10 percent of calories
Carbohydrate based on 45-65 percent of calories
Protein based on 10-35 percent of calories (applicable only to adults and children over 4 years of age)
Fiber based on 11.5 g of fiber per 1000 calories
The following quantities of nutrients are considered the upper limit for the maintenance of good health:
Total fat: less than 65 g
Saturated fat: less than 20 g
Cholesterol: less than 300 mg
Sodium: less than 2300 mg (persons with hypertension, less than 1500 mg).
The daily values of sodium and cholesterol are the same regardless of the calorie diet
WV Drug Law
From Pharmacy Laws and Legislative Rules of West Virginia,
2008 Edition
West Virginia State Board of Pharmacy
(5/5)
15-1-11
Transferring prescription orders between pharmacies
11.2.1
The transferring pharmacist:
a. Writes the word "VOID" on the face of the original prescription order;
b. Records on the reverse of the original prescription the name, address, and Drug Enforcement Administration (DEA) registry number of the pharmacy to which the prescription was transferred and the name of the pharmacist receiving the prescription information; and
c. Records the date and time of the transfer and his or her first and last name;
11.2.2
The pharmacist receiving the transferred prescription order information:
a. Writes the word "TRANSFER" on the face of the transferred prescription; and
b. Provides all the information required to be on a prescription and includes:
1. Date of issuance if the original prescription;
2. Number of refills on the original prescription;
3. The date the original prescription was dispensed;
4. The number of valid refills remaining and date of last refill;
5. The pharmacy's name, address, DEA registry number and the original prescription number from which the prescription information was transferred; and
6. The first and last name of the transferring pharmacist;
11.2.4
A computer record may be used if it reflects the fact that the original prescription order has been voided and shall contain all the other information required in this subsection.
15-2-7
Prescriptions
7.6.1
Each controlled substance prescription shall be written on a separate blank and no non- controlled substance can be ordered on a blank with a controlled substance…
… No more than one controlled substance may be written per prescription blank. A controlled substance prescription issued by a practitioner located outside the state of West Virginia that does not comply with this section may be accepted by the pharmacist if it is issued pursuant to the laws in the state in which the practitioner resides.
15-1-19
19.31.1
To accept all new prescription orders from authorized prescribers transmitted by oral communication, immediately reduce them to writing and document the prescription by entering on the prescription order form:
a. The name of the caller;
b. The time and date of transmission; and
c. The hand-written initials if the receiver.
2008 Edition
West Virginia State Board of Pharmacy
(5/5)
15-1-11
Transferring prescription orders between pharmacies
11.2.1
The transferring pharmacist:
a. Writes the word "VOID" on the face of the original prescription order;
b. Records on the reverse of the original prescription the name, address, and Drug Enforcement Administration (DEA) registry number of the pharmacy to which the prescription was transferred and the name of the pharmacist receiving the prescription information; and
c. Records the date and time of the transfer and his or her first and last name;
11.2.2
The pharmacist receiving the transferred prescription order information:
a. Writes the word "TRANSFER" on the face of the transferred prescription; and
b. Provides all the information required to be on a prescription and includes:
1. Date of issuance if the original prescription;
2. Number of refills on the original prescription;
3. The date the original prescription was dispensed;
4. The number of valid refills remaining and date of last refill;
5. The pharmacy's name, address, DEA registry number and the original prescription number from which the prescription information was transferred; and
6. The first and last name of the transferring pharmacist;
11.2.4
A computer record may be used if it reflects the fact that the original prescription order has been voided and shall contain all the other information required in this subsection.
15-2-7
Prescriptions
7.6.1
Each controlled substance prescription shall be written on a separate blank and no non- controlled substance can be ordered on a blank with a controlled substance…
… No more than one controlled substance may be written per prescription blank. A controlled substance prescription issued by a practitioner located outside the state of West Virginia that does not comply with this section may be accepted by the pharmacist if it is issued pursuant to the laws in the state in which the practitioner resides.
15-1-19
19.31.1
To accept all new prescription orders from authorized prescribers transmitted by oral communication, immediately reduce them to writing and document the prescription by entering on the prescription order form:
a. The name of the caller;
b. The time and date of transmission; and
c. The hand-written initials if the receiver.
List of References
Pulled From Drug Literature Evaluation Lectures
Dr. Shelley Schliesser, PharmD [Fall 2009]
(4/5)
Cross referenced
Drug Interactions
Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (American Pharmacists Association)
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Evaluations of Drug Interactions (First DataBank )
Drug-Reax
Pregnancy
Drugs in Pregnancy and Lactation
Medications and Mothers’ Milk
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Clinical Pharmacokinetics (American Society of Health-System Pharmacists)
Compounding/Injectables
Remington: the Science and Practice of Pharmacy (Lippincott Williams & Wilkins)
Handbook of Injectable Drugs (American Society of Health-System Pharmacists)
International Pharmaceutial Abstracts (IPA)
Thomson
Method of Actions
Natural Medicines Comprehensive Database
Evaluations of Drug Interactions (First DataBank )
Quick Reference
Sanford Guide to Antimicrobial Therapy
Medications and Mothers Milk
Pharmacokinetics
Drug-Induced Diseases: Prevention, Detection and Management (American Society of Health-System Pharmacists)
Clinical Pharmacokinetics (American Society of Health-System Pharmacists)
Thomson
Identification
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Ident-a-drug
MicroMedex - identidex
Clinical Pharmacology
Pharmacists Letter
Natural Medicines Comprehensive Database
Pharmacists Letter
Ident-a-drug
Critical Care
Consider what you would need to do if your patient could not even maintain the most basic of body activities
ICU Book
Management of intensive care patients
Breathing, hemodynamic stability, circulation, oral intake, movement , etc
.
Pregnancy & Lactation
Drugs in Pregnancy and Lactation
Considered a “gold standard” of pregnancy and lactation related information
Alphabetical listing of drug monographs (>1000)
Notes the level of severity in pregnancy
Medications and Mothers’ Milk
Quick look monograph
Many drugs addressed
Also, shows pregnancy listing
Focus on lactation including the pharmacokinetics related to breast milk
Addresses recommendations from the American Academy of Pediatrics (AAP)
Alternative Medicine
Natural Medicines Comprehensive Database
Comprehensive monographs
MOA, ADRs, interactions, therapeutic indications and rankings on use, safety rating
Links for brand and generic names
Extensively referenced
In Pharmacist’s Letter – from Wal-Mart
Review of Natural Products
300 monographs
Scientific names, source, chemistry, toxicology, MOA
Herbal, mineral and hormonal therapies
Extensive referencing
Therapeutic and alphabetic listing
Infectious disease
Usually complex questions of what can I do with what I’ve got
Sanford Guide to Antimicrobial Therapy
Quick listing
Pocket version (also available in other versions)
Principles and Practice of Infectious Diseases
Extensive discussion of specific infectious diseases
Treatments discusses
Laboratory evaluation
Lab values can help in continued patient care. But, just exactly what lab is applicable to what you are monitoring?
Basic Skills in Interpreting Laboratory Data
Focus specifically for pharmacists Gold standard for pharmacists
Tumor markers noted
Laboratory Test Handbook
Written to physicians
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Clinical information (sugar free, alcohol free products, pregnancy rating, common lab tests)
Strengths, sizes, formulations
FedWatch, Vaccine forms, drug information centers
State boards of pharmacy
Manufacturer directory
Full color pictures of product
Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (American Pharmacists Association)
Focus is on self-care
Address multitudes of diseases and issues not necessarily discussed elsewhere
Pain, fever, reproductive, genital, cold and allergy, gastrointestinal, nutritional agents, ophthalmic and otic, dermatological, miscellaneous, medical equipment, alternative medicine
Drug Interactions
Evaluations of Drug Interactions (First DataBank )
Generic names of drugs interacting
Summary
Similar drugs
MOA of the interaction
Clinical recommendation
References
Tables
Code 1 (highly clinically significant) – Code 4 (not clinically significant)
Meyler’s Side Effects of Drugs (Elsevier)
Chapters discuss major drug classes and side effects seen
Search by two means
Drug
Side effect
Drug-Induced Diseases: Prevention, Detection and Management (American Society of Health-System Pharmacists)
Drug-induced diseases on healthcare Allergic/ immunologic diseases
Neurological/ psychiatric diseases
Respiratory/ cardiovascular diseases
Endocrine diseases
Gastrointestinal diseases
Pharmacokinetics
Clinical Pharmacokinetics (American Society of Health-System Pharmacists)
Calculating creatinine clearance
Specific agents reviewed
Aminoglycosides, Antiepileptics, Immunosuppressants, Antidepressants, Digoxin, Heparin and LMWH, Antiarrhythmics, Lithium, Theophylline, Vancomycin, Warfarin
Use of agents in multitude of patients
Neoatal, pediatric, geriatric, renal dosing
Drug Prescribing in Renal Failure: Dosing Guidelines for Adults (American College of Physicians)
Tables identify dose based on CrCl
>50, 50-10, <10
Dialysis elimination also identified (Hemo, CAPD, CAVH)
Compounding and Preparing
Remington: the Science and Practice of Pharmacy (Lippincott Williams & Wilkins)
Multiple issues discussed
Calculations, manufacturing, pharmacokinetics and dynamics, pharmaceutical and medicinal agents
Handbook of Injectable Drugs (American Society of Health-System Pharmacists)
Focus on injectable drugs
Stability
Administration
Compatibility
Stability sterility administration and compatibility
Specific to environment
IV compatibility
International Pharmaceutial Abstracts (IPA) (http://proxy.ucwv.edu:2197/gw1/ovidweb.cgi?New+Database=Single|0&S=IDNJHKELLBJOFO00)
Abstracts drug specific information
More than just articles sited
Pharmacy information
Administration
Clinical
Specific to pharmacists – COMPOUNDING TIPS
Also lectures, symposiums, poster presentation as well as articles
Pubmed/ Medline (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed, http://proxy.ucwv.edu:2197/gw1/ovidweb.cgi?New+Database=Single|2&S=IDNJHKELLBJOFO00)
Abstracting medical information
Not all necessarily in english or drug related
Free online
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
http://proxy.ucwv.edu:2189/ehost/search?hid=5&sid=e3c4e89c-cd53-4e7e-b0f8-2a6cd4a1c68d%40sessionmgr2)
Indexing in nursing and allied health
Book good for psychology of the patient
Dealing with human nature
Personal level of information – not as source based
Iowa Drug Information System (IDIS) (http://proxy.ucwv.edu:2202/)
Indexing of drug information
Retrieval of full text articles
Full, drug-related articles
Government agencies
Food and Drug Administration (FDA) (www.fda.gov)
New Drugs and Biologics updated constantly (http://www.accessdata.fda.gov/scripts/cder/drugsatfda/, http://www.fda.gov/cber/products.htm)
Orange Book (AB equivalence, patent expiration) (http://www.fda.gov/cder/ob/default.htm)
Medwatch forms and reports (http://www.fda.gov/medwatch/index.html)
Alert sections
Centers for Disease Control and Prevention (CDC) (www.cdc.gov)
Vaccine information and guidelines
MMWR
Growth charts
Issues
Infectious disease, chronic diseases, workplace hazards, environmental threats
National Institutes of Health (NIH) (www.nih.gov)
Medical research (27 separate institutes and centers)
Sites of interest
ClinicalTrials.gov (http://clinicaltrials.gov/ct;jsessionid=3AF38B6D4CA5DA90562C27CDCB35FCCB)
National Center for Complementary and Alternative Medicines (NCCAM) (http://nccam.nih.gov/)
MedlinePlus (http://medlineplus.gov/)
Institute for Safe Medication Practices (ISMP) (www.ismp.org)
Nonprofit group
Nongovernmental but work collaboratively
Focus is on medication errors and how to reduce or eliminate
Ismp recent addition – goal is to reduce med errors – non-profit org
Even report all near misses so as to proactively fix issues
West Virginia Board of Pharmacy (www.wvbop.com)
Search for who is a pharmacist and intern
State newsletter
Local requirements and licensure information
Complaint form
National Association of Boards of Pharmacy (NABP) (www.nabp.net)
50 states represented and then some
NAPLEX/ MPJE
State newsletters
Foreign Pharmacy and Reciprocation
American Society of Health-System Pharmacists (www.ashp.org)
Drug shortages page VERY helpful!!!
References to purchase
Guidelines
Drug shortages CE
Residency accreditation
News headlines
Meeting information
AJHP journal
The ashp bookstore is very helpful
West Virginia Society of Health-System Pharmacists (www.wvshp.org)
Local activities (meetings)
Legislation
Membership information
American Pharmacists Association (www.aphanet.org)
Publications
Pharmacy Today, JAPhA, Pharmacy Student
Meetings
Reference to purchase
Latest information
American College of Clinical Pharmacy (www.accp.com)
Board Certification
Clinically focused
References to purchase
Meetings
Clinical and academia
Board study info
Pharmacists Letter (www.pharmacistsletter.com)
Available online, newsletter and PDA
Rumors vs. Truth Monthly updates, CE
Searching capabilities Charts (example: diabetes treatment)
Patient handouts
Natural Medicines Database (www.pharmacistsletter.com)
Ident-a-drug (www.pharmacistsletter.com)
ID (imprint code) NDC code
Merck Medicus www.merckmedicus.com
Cochrane Collaboration(www.cochrane.org)
International, nonprofit
Reviews of practice
Access requirements
Martindale
Information on a multitude of products
International drugs
Investigational
Herbal
Diagnostic
Pesticides
Coloring agents and preservatives
Martindale updated several times a year
Drug-Reax
Drug Interactions
Drug
Food
Disease
Alcohol
Laboratory
In micromedex system also
Will run ultimate drug interaction reaction as far as kinetics not additive drug effects
Thomson
IV Index – IV compatibility (Trissel)
Kinetidex – kinetic parameters
Pharmaceutical MSDS – Material Safety Data Sheets
P&T Quik – Reviewing drugs under consideration
PDR – PDR books
Red Book – AWP
USPDI - I & III
Clinical Pharmacology
Gold Standard Product
Greater than 10 years old
US products (prescription, OTC, herbal, investigational)
PDA version
Monthly updates (Intranet)
CD-ROM updates (Quarterly)
Drug information – prescription, OTC, herbal, nutritional
Find by condition, ADR, classification, specific clinical criteria
Multiple agents for interactions and ADRs
Therapeutic equivalents
Tablet identification
Patient Education
Dr. Shelley Schliesser, PharmD [Fall 2009]
(4/5)
Cross referenced
Drug Interactions
Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (American Pharmacists Association)
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Evaluations of Drug Interactions (First DataBank )
Drug-Reax
Pregnancy
Drugs in Pregnancy and Lactation
Medications and Mothers’ Milk
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Clinical Pharmacokinetics (American Society of Health-System Pharmacists)
Compounding/Injectables
Remington: the Science and Practice of Pharmacy (Lippincott Williams & Wilkins)
Handbook of Injectable Drugs (American Society of Health-System Pharmacists)
International Pharmaceutial Abstracts (IPA)
Thomson
Method of Actions
Natural Medicines Comprehensive Database
Evaluations of Drug Interactions (First DataBank )
Quick Reference
Sanford Guide to Antimicrobial Therapy
Medications and Mothers Milk
Pharmacokinetics
Drug-Induced Diseases: Prevention, Detection and Management (American Society of Health-System Pharmacists)
Clinical Pharmacokinetics (American Society of Health-System Pharmacists)
Thomson
Identification
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Ident-a-drug
MicroMedex - identidex
Clinical Pharmacology
Pharmacists Letter
Natural Medicines Comprehensive Database
Pharmacists Letter
Ident-a-drug
Critical Care
Consider what you would need to do if your patient could not even maintain the most basic of body activities
ICU Book
Management of intensive care patients
Breathing, hemodynamic stability, circulation, oral intake, movement , etc
.
Pregnancy & Lactation
Drugs in Pregnancy and Lactation
Considered a “gold standard” of pregnancy and lactation related information
Alphabetical listing of drug monographs (>1000)
Notes the level of severity in pregnancy
Medications and Mothers’ Milk
Quick look monograph
Many drugs addressed
Also, shows pregnancy listing
Focus on lactation including the pharmacokinetics related to breast milk
Addresses recommendations from the American Academy of Pediatrics (AAP)
Alternative Medicine
Natural Medicines Comprehensive Database
Comprehensive monographs
MOA, ADRs, interactions, therapeutic indications and rankings on use, safety rating
Links for brand and generic names
Extensively referenced
In Pharmacist’s Letter – from Wal-Mart
Review of Natural Products
300 monographs
Scientific names, source, chemistry, toxicology, MOA
Herbal, mineral and hormonal therapies
Extensive referencing
Therapeutic and alphabetic listing
Infectious disease
Usually complex questions of what can I do with what I’ve got
Sanford Guide to Antimicrobial Therapy
Quick listing
Pocket version (also available in other versions)
Principles and Practice of Infectious Diseases
Extensive discussion of specific infectious diseases
Treatments discusses
Laboratory evaluation
Lab values can help in continued patient care. But, just exactly what lab is applicable to what you are monitoring?
Basic Skills in Interpreting Laboratory Data
Focus specifically for pharmacists Gold standard for pharmacists
Tumor markers noted
Laboratory Test Handbook
Written to physicians
Red Book: Pharmacy’s Fundamental Reference (Thomson PDR)
Clinical information (sugar free, alcohol free products, pregnancy rating, common lab tests)
Strengths, sizes, formulations
FedWatch, Vaccine forms, drug information centers
State boards of pharmacy
Manufacturer directory
Full color pictures of product
Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (American Pharmacists Association)
Focus is on self-care
Address multitudes of diseases and issues not necessarily discussed elsewhere
Pain, fever, reproductive, genital, cold and allergy, gastrointestinal, nutritional agents, ophthalmic and otic, dermatological, miscellaneous, medical equipment, alternative medicine
Drug Interactions
Evaluations of Drug Interactions (First DataBank )
Generic names of drugs interacting
Summary
Similar drugs
MOA of the interaction
Clinical recommendation
References
Tables
Code 1 (highly clinically significant) – Code 4 (not clinically significant)
Meyler’s Side Effects of Drugs (Elsevier)
Chapters discuss major drug classes and side effects seen
Search by two means
Drug
Side effect
Drug-Induced Diseases: Prevention, Detection and Management (American Society of Health-System Pharmacists)
Drug-induced diseases on healthcare Allergic/ immunologic diseases
Neurological/ psychiatric diseases
Respiratory/ cardiovascular diseases
Endocrine diseases
Gastrointestinal diseases
Pharmacokinetics
Clinical Pharmacokinetics (American Society of Health-System Pharmacists)
Calculating creatinine clearance
Specific agents reviewed
Aminoglycosides, Antiepileptics, Immunosuppressants, Antidepressants, Digoxin, Heparin and LMWH, Antiarrhythmics, Lithium, Theophylline, Vancomycin, Warfarin
Use of agents in multitude of patients
Neoatal, pediatric, geriatric, renal dosing
Drug Prescribing in Renal Failure: Dosing Guidelines for Adults (American College of Physicians)
Tables identify dose based on CrCl
>50, 50-10, <10
Dialysis elimination also identified (Hemo, CAPD, CAVH)
Compounding and Preparing
Remington: the Science and Practice of Pharmacy (Lippincott Williams & Wilkins)
Multiple issues discussed
Calculations, manufacturing, pharmacokinetics and dynamics, pharmaceutical and medicinal agents
Handbook of Injectable Drugs (American Society of Health-System Pharmacists)
Focus on injectable drugs
Stability
Administration
Compatibility
Stability sterility administration and compatibility
Specific to environment
IV compatibility
International Pharmaceutial Abstracts (IPA) (http://proxy.ucwv.edu:2197/gw1/ovidweb.cgi?New+Database=Single|0&S=IDNJHKELLBJOFO00)
Abstracts drug specific information
More than just articles sited
Pharmacy information
Administration
Clinical
Specific to pharmacists – COMPOUNDING TIPS
Also lectures, symposiums, poster presentation as well as articles
Pubmed/ Medline (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed, http://proxy.ucwv.edu:2197/gw1/ovidweb.cgi?New+Database=Single|2&S=IDNJHKELLBJOFO00)
Abstracting medical information
Not all necessarily in english or drug related
Free online
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
http://proxy.ucwv.edu:2189/ehost/search?hid=5&sid=e3c4e89c-cd53-4e7e-b0f8-2a6cd4a1c68d%40sessionmgr2)
Indexing in nursing and allied health
Book good for psychology of the patient
Dealing with human nature
Personal level of information – not as source based
Iowa Drug Information System (IDIS) (http://proxy.ucwv.edu:2202/)
Indexing of drug information
Retrieval of full text articles
Full, drug-related articles
Government agencies
Food and Drug Administration (FDA) (www.fda.gov)
New Drugs and Biologics updated constantly (http://www.accessdata.fda.gov/scripts/cder/drugsatfda/, http://www.fda.gov/cber/products.htm)
Orange Book (AB equivalence, patent expiration) (http://www.fda.gov/cder/ob/default.htm)
Medwatch forms and reports (http://www.fda.gov/medwatch/index.html)
Alert sections
Centers for Disease Control and Prevention (CDC) (www.cdc.gov)
Vaccine information and guidelines
MMWR
Growth charts
Issues
Infectious disease, chronic diseases, workplace hazards, environmental threats
National Institutes of Health (NIH) (www.nih.gov)
Medical research (27 separate institutes and centers)
Sites of interest
ClinicalTrials.gov (http://clinicaltrials.gov/ct;jsessionid=3AF38B6D4CA5DA90562C27CDCB35FCCB)
National Center for Complementary and Alternative Medicines (NCCAM) (http://nccam.nih.gov/)
MedlinePlus (http://medlineplus.gov/)
Institute for Safe Medication Practices (ISMP) (www.ismp.org)
Nonprofit group
Nongovernmental but work collaboratively
Focus is on medication errors and how to reduce or eliminate
Ismp recent addition – goal is to reduce med errors – non-profit org
Even report all near misses so as to proactively fix issues
West Virginia Board of Pharmacy (www.wvbop.com)
Search for who is a pharmacist and intern
State newsletter
Local requirements and licensure information
Complaint form
National Association of Boards of Pharmacy (NABP) (www.nabp.net)
50 states represented and then some
NAPLEX/ MPJE
State newsletters
Foreign Pharmacy and Reciprocation
American Society of Health-System Pharmacists (www.ashp.org)
Drug shortages page VERY helpful!!!
References to purchase
Guidelines
Drug shortages CE
Residency accreditation
News headlines
Meeting information
AJHP journal
The ashp bookstore is very helpful
West Virginia Society of Health-System Pharmacists (www.wvshp.org)
Local activities (meetings)
Legislation
Membership information
American Pharmacists Association (www.aphanet.org)
Publications
Pharmacy Today, JAPhA, Pharmacy Student
Meetings
Reference to purchase
Latest information
American College of Clinical Pharmacy (www.accp.com)
Board Certification
Clinically focused
References to purchase
Meetings
Clinical and academia
Board study info
Pharmacists Letter (www.pharmacistsletter.com)
Available online, newsletter and PDA
Rumors vs. Truth Monthly updates, CE
Searching capabilities Charts (example: diabetes treatment)
Patient handouts
Natural Medicines Database (www.pharmacistsletter.com)
Ident-a-drug (www.pharmacistsletter.com)
ID (imprint code) NDC code
Merck Medicus www.merckmedicus.com
Cochrane Collaboration(www.cochrane.org)
International, nonprofit
Reviews of practice
Access requirements
Martindale
Information on a multitude of products
International drugs
Investigational
Herbal
Diagnostic
Pesticides
Coloring agents and preservatives
Martindale updated several times a year
Drug-Reax
Drug Interactions
Drug
Food
Disease
Alcohol
Laboratory
In micromedex system also
Will run ultimate drug interaction reaction as far as kinetics not additive drug effects
Thomson
IV Index – IV compatibility (Trissel)
Kinetidex – kinetic parameters
Pharmaceutical MSDS – Material Safety Data Sheets
P&T Quik – Reviewing drugs under consideration
PDR – PDR books
Red Book – AWP
USPDI - I & III
Clinical Pharmacology
Gold Standard Product
Greater than 10 years old
US products (prescription, OTC, herbal, investigational)
PDA version
Monthly updates (Intranet)
CD-ROM updates (Quarterly)
Drug information – prescription, OTC, herbal, nutritional
Find by condition, ADR, classification, specific clinical criteria
Multiple agents for interactions and ADRs
Therapeutic equivalents
Tablet identification
Patient Education
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