Hospital Formulary Overview

Hospital Formulary - Definition and Purpose

• A continually revised compilation of pharmaceuticals and important information reflecting current clinical judgement of the medical staff
• Reflects the current state of medical knowledge and practices for ensuring efficient and accurate drug treatment within the hospital setting
• A method for providing a program of objective evaluation, resection, and use of medicinal agents by the hospital staff
• Serves as a tool for assuring the quality of drug use and controlling its costs

Hospital Formulary System - Definition and Purpose

• A method whereby the medical staff of an institution evaluates, appraises, and selects the most useful available drug entities and drug products for patient care
• The selection of drugs in the formulary are routinely available from the pharmacy
• Provides a framework for standardized drug therapy practice

Formulary Content and Organization

• The formulary is divided into three main parts:

  Part 1: Information on Hospital Policies and Procedures Concerning Drugs

  • Provides information on categories of drugs, brief descriptions of each drug, regulations governing drug prescribing and dispensing, pharmacy operating procedures

  Part 2: Drug Product Listing

  • The heart of the formulary, containing a listing of formulary drugs with descriptive entries for each item
  • May be arranged alphabetically by generic name, alphabetically within the therapeutic class, or a combination of both systems

  Part 3: Special Information

  • Contains information such as lists of hospital-approved abbreviations, poison antidote charts, and other pertinent information

Guiding Principles for Admission or Deletion of Drugs

• The drugs must be of proven clinical value based upon experience
• The drugs must be recognized by USP, NF or their supplement
• The manufacturers of these drugs must have proven integrity and dependability as well as support for research activities
• No preparations of secret composition will be considered or admitted to the formulary
• No product of multiple composition shall be admitted if the same therapeutic value can be obtained through one drug entity

Drug Categories within the Formulary

• Anti-infectives: Antibacterials, Antifungals, Antiparasitics, Antivirals
• Immunologicals: Sera and Immunologicals, Vaccines
• Cardiovascular Drugs: Cardio-Active Agents, Antihypertensives, Drugs for Blood Lipid Disorders, Antiplatelet Drugs, Drugs Used in Shock
• Diuretics
• Respiratory Drugs: Anti-asthma, Cough Suppressant, Mucolytic, Nasal Decongestant, Respiratory Stimulant
• Anti-allergics: Antihistamines, Corticosteroids, Adrenergic Agent
• Antineoplastics and Immunosuppressants: Cytotoxic Agents, Sex Hormones and Antagonist in Malignant Diseases, Immunosuppressants
• Drugs Affecting the Blood: Anti-anemics, Anti-coagulants, Anti-platelet Drugs, Antifibrinolytic
• Antidotes: General Antidote, Specific Antidotes
• Gastrointestinal Drugs: Antacid, Anti-cholinergics, Anti-emetics, Anti-flatulent, Anti-motility, For Bile Acid Malabsorption, Cytoprotector, Digestant, Direct Smooth Muscle Relaxant, H2 Antagonists, Laxative/Cathartics, Prokinetic, Proton Pump Inhibitor
• Cholinergic Stimulant: Urinary Bladder Atony
• Hormones and Hormone Antagonists: Adrenal Corticosteroids, Anterior Pituitary Hormone, Posterior Pituitary Hormone, Sex Hormone and Antagonist, Thyroid Hormones and Anti-thyroid Drugs, Insulin and Other Anti-diabetic Agents
• Drugs Acting on the Uterus: Oxytocics, Tocolytics (Uterine Relaxants)
• Solutions Correcting Water Electrolytes, Acid-Base and Caloric Disturbances: Oral, Parenteral, Electrolyte or IV Additive Solutions, Alkalinizing Agent, Caloric Agents, Amino Acids, Crystalline, Peritoneal Dialysis Solution, Hemodialysis Solution, Plasma/Volume Expanders
• Diagnostic Agents: Radio Contrast Media
• Vitamins and Minerals: Vitamins, Minerals
• Dermatologicals: Anti-infectives, Anti-inflammatory Drugs, Anti-seborrheic Agent, Astringent, Depigmenting Agent, Keratolytic, Local Anesthetics
• Ophthalmological Preparations: Adjuvant to Surgery, Anti-infectives, Corticosteroids, Vasoconstrictors, Drugs for Glaucoma, Mydriatics, For Cataract, For Diabetic Neuropathy, Miscellaneous
• Ear Preparations: Antiseptics with Corticosteroids, Anti-infectives and Antiseptics, Miscellaneous
• Mouth/Throat Preparations
• Topical Nasal Preparations
• Antiseptics and Disinfectants

Example Drug Entries with Dosage Information

• Ascorbic Acid (Vitamin C):

  • Usual Dose: 100-200mg daily, orally or intravenously
  • Preparation: 100mg, 250mg, 500mg tablets, 1g effervescent tablet, 100mg/5mL, 120mL syrup, 100mg/mL, 10mL drops, 60mg/0.6mL, 15mL drops, 250mg/mL, 2mL ampul

• Aspirin (Acetylsalicylic Acid):

  • Usual Dose: 65-130mg/kg/day in divided doses every 4-6 hours for anti-inflammatory/antirheumatic action
  • Usual Dose: 3mg/kg/day (max 40-80mg/day) as anti-platelet
  • Preparation: 80mg, 325mg tablets
  • Precaution: Preferably taken with food, milk, or glassful of water, use with caution in patients with gastric ulcers, bleeding tendencies, hypoprothrombinemia, history of asthma, and during anti-coagulant therapy. Not recommended for routine antipyresis and analgesia in children below 12 years due to its association with Reye Syndrome during viral infections.