Hospital Formulary - Chapter 5 PDF

THE HOSPITAL FORMULARY UNIT V  The formulary system and formularies have existed in the US since the days of the American Revolution; they listed in European hospitals for centuries prior to this.  The need for hospital formularies becomes increasingly great because...

THE HOSPITAL FORMULARY UNIT V  The formulary system and formularies have existed in the US since the days of the American Revolution; they listed in European hospitals for centuries prior to this.  The need for hospital formularies becomes increasingly great because (1) the increasing number of new drugs being marketed (2) the increasing influence of biased advertising (3) the increasing complexity of unwanted effects of the newer more potent drugs (4) the highly competitive marketing practices of the pharmaceutical industry  (5) the public’s interest in seeing that the health professions are continuously providing the best possible care at the lowest possible cost  In the interest of better patient care, the institution should have a program of objective evaluation, resection and use of medicinal agents in the facility. This program is the basis of appropriate, economical drug therapy.  The formulary concept is a method for providing such a program and has been utilized as such for many years. FORMULARY - DEFINITION  FORMULARY  a continually revised compilation of pharmaceuticals (plus important auxiliary information) that reflects the current clinical judgement of the medical staff  HOSPITAL FORMULARY SYSTEM - DEFINITION  HOSPITAL FORMULARY SYSTEM  A method whereby the medical staff of an institution, working through the pharmacy and therapeutics committee, evaluates, appraises and selects from this the numerous available drug entities and drug products that are considered most useful in patient care  Only those selected are routinely available from the pharmacy.  an important tool for assuring the quality of drug use and controlling its costs  FORMULARY CONTENT AND ORGANIZATION The primary objective of the formulary are to provide the hospital staff with: (1) Information on what drug products have been approved by the pharmacy and therapeutics committee (2) Basic therapeutic information about each approved item (3) Information on hospital policies and procedures governing the use of drugs (4) Special information about drugs such as drug dosing monograms hospital approved abbreviations, etc.  In accordance with the objectives, the formulary should consist of three main parts: Part 1 – Information on hospital policies and procedures concerning drugs Part 2 – Drug products listing Part 3 – Special Information INFORMATION ON HOSPITAL POLICIES AND PROCEDURES CONCERNING DRUGS  The material to be included in this section may vary from hospital to hospital. Generally, the following items may be included: (1) Categories of drugs (2) Brief description of the drug (3) Hospital regulations governing the prescribing, dispensing and administration of drugs (4) Pharmacy operating procedures (5) Information on using the formulary DRUG PRODUCT LISTING  This section is the heart of the formulary and consists of drugs or more descriptive entries for each formulary item plus or the indexes to facilitate the use of the formulary. FORMULARY ITEM ENTRIES  The entries can be arranged in several ways: (1) alphabetically by generic name with entries for synonyms and brand names containing only a “see (generic name)” notation (2) alphabetically within the therapeutic class (3) a combination of systems whereby the bulk of the drug are contained alphabetically in a “general” section which is supplemented by several “special” sections such as opthalmic/otic drugs, dermatologicals and diagnostic agents SPECIAL INFORMATION  Examples of items found in the special information section of hospital formularies are: list of hospital- approved abbreviation, poison antidote charts, etc.  SELECTION OF GUIDING PRINCIPLES FOR ADMISSION OR DELETION OF DRUG CRITERIA: 1. Drugs must be of proven clinical value based upon experience. 2. The drugs must be recognized by USP, NF or their supplement. 3. The manufacturers of these drugs must be of proven integrity and dependability as well as having the regulation of initiating and supporting research activities of merits.  SELECTION OF GUIDING PRINCIPLES FOR ADMISSION OR DELETION OF DRUG CRITERIA: 4. No preparation of secret composition will be considered or admitted to the formulary. 5. No product of multiple composition shall be admitted in the same therapeutic value can be obtained through the use of a single drug entity.  Hospital pharmacists have viewed the formulary system as a means for the pharmacist to assume professional responsibilities in drug-product selection.  Essentially, the formulary system provided a mechanism to avoid brand duplication and therapeutic duplication, as well as promoting rational drug therapy.  The success of this system is due to “peer review” of a hospital, whereby the physicians agree to practice by the policies and procedures established by the committee process.  An active pharmacy and therapeutics committee with a well-developed formulary system provides assurance that the medical staff, the pharmacy staff and the administration of the hospital have taken the necessary steps to assure the patient of a rational drug therapy program.  SAMPLE PHARMACOLOGICAL CLASSIFICATION 1. DRUGS ACTING ON THE NERVOUS SYSTEM 1.1 Analgesics 1.1.1 Non-opioids 1.1.2 Opioid Analgesics 1.2 Anesthetics 1.2.1 General Anesthetics 1.2.1.1 Inhalation 1.2.1.2 Intravenous Agent 1.2.1.3 Adjuvants 1.2.1.3.1 Opioid Analgesics 1.2.1.3.2 Neuromuscular Blockers 1.2.1.3.3 Cholinesterase Inhibitors 1.2.1.3.4 Anxiolytics and Neuroleptics 1.2.1.3.5 Anticholinergics 1.2.2 Local Anesthetics 1.3 Anticonvulsants 1.4 Anti-Migraine 1.5 Anti-Parkinsonism 1.6 Antipyretic 1.7 Drugs to Reduce Cerebral Edema 1.8 Psychopharmacologic Agents 1.8.1 Hypnotic 1.8.2 Anxiolytics 1.8.3 Anti-depressants 1.8.4 Mood stabilizing 1.8.5 Antipsychotics 1.8.6 Nootropic/Neurotonic 1.9 Anti-Vertigo 1.10 Peripheral Vasodilator 2. DRUGS ACTING ON THE MUSCULOSKELETAL SYSTEM 2.1 Non-steroidal Anti-inflammatory Drugs (NSAIDs) 2.2 Skeletal Muscle Relaxants 2.2.1 Spasmolytics 2.2.2 Neuromuscular Blockers 2.3 Anti-Gout 3. ANTI-INFECTIVES 3.1 Antibacterials 3.1.1 Aminoglycosides 3.1.2 Cephalosporins 3.1.3 Chloramphenicol 3.1.4 Flouroquinolones 3.1.5 Lincosamides 3.1.6 Macrolides 3.1.7 Monobactams 3.1.8 Nitroimidazoles 3.1.9 Penicillin 3.1.10 Sulfonamides 3.1.11 Spectinomycin 3.1.12 Tetracycline 3.1.13 Vancomycin 3.1.14 Anti-Leprosy 3.1.15 Anti-Tuberculosis Drugs 3.1.16 Urinary Antiseptics 3.1.17 Furazolidone  3.2 Antifungals 3.3 Antiparasitics 3.3.1 Anthelmintics 3.3.2 Antiprotozoals 3.3.2.1 Amoebecides 3.3.2.2 Anti-Malarials 3.4 Antivirals 4. IMMUNOLOGICALS 4.1 Sera and Immunologicals 4.2 Vaccines 5. CARDIOVASCULAR DRUGS 5.1 Cardio-Active Agents 5.1.1 Inotropic Agents 5.1.1.1 Cardiac Glycosides 5.1.1.2 Adrenergic Agents 5.1.2 Anti-anginal Agents 5.1.2.1 Nitrates 5.1.2.2 Beta Adrenoceptor Blockers 5.1.2.3 Calcium Channel Blocker 5.1.3 Anti-arrhythmic Agents 5.2 Antihypertensives 5.2.1 Diuretics 5.2.2 Anti-adrenergics  5.2.2.1 Adrenoceptor Blockers 5.2.2.2 Adrenergic Neuron Blocker 5.2.2.3 Centrally Acting 5.2.3 Direct Vasodilators 5.2.4 Calcium Channel Blockers 5.2.5 Angiotensin-Converting Enzyme Inhibitor 5.3 Drugs for Blood Lipid Disorders 5.4 Antiplatelet Drugs 5.5 Drugs Used in Shock 5.5.1 Anaphylactic 5.5.2 Cardiogenic/Vascular 5.5.3 Hemorrhagic 5.5.4 Neurogenic 5.5.5 Septic 6. DIURETICS 7. RESPIRATORY DRUGS 7.1 Anti-asthma 7.1.1 For Acute Attack 7.1.2 For Prophylaxis 7.2 Cough Suppressant 7.3 Mucolytic 7.4 Nasal Decongestant 7.5 Respiratory Stimulant 8. ANTI-ALLERGICS 8.1 Antihistamines 8.2 Corticosteroids 8.3 Adrenergic Agent 9. ANTINEOPLASTICS AND IMMUNOSUPPRESSANTS 9.1 Cytotoxic Agents 9.1.1 Alkylating Agents 9.1.2 Cytotoxic Antibiotics 9.1.3 Antimetabolites 9.1.4 Mitotic Inhibitors 9.1.5 Other Cytotoxics 9.2 Sex Hormones and Antagonist in Malignant Diseases 9.3 Immunosuppressants 10. DRUGS AFFECTING THE BLOOD 10.1 Anti-anemics 10.2 Anti-coagulants 10.3 Anti-platelet Drugs 10.4 Antifibrinolytic 11. ANTIDOTES 11.1 General Antidote 11.2 Specific Antidotes 12. GASTROINTESTINAL DRUGS 12.1 Antacid 12.2 Anti-cholinergics  12.3 Anti-emetics 12.4 Anti-flatulent 12.5 Anti-motility 12.6 For Bile Acid Malabsorption 12.7 Cytoprotector 12.8 Digestant 12.9 Direct Smooth Muscle Relaxant 12.10 H2 Antagonists 12.11 Laxative/Cathartics 12.12 Prokinetic 12.13 Proton Pump Inhibitor 13. CHOLINERGIC STIMULANT 13.1 Urinary Bladder Atony 14. HORMONES AND HORMONE ANTAGONISTS 14.1 Adrenal Corticosteroids 14.2 Anterior Pituitary Hormone 14.3 Posterior Pituitary Hormone 14.4 Sex Hormone and Antagonist 14.4.1 Androgens 14.4.2 Estrogens 14.4.3 Anti-estrogen 14.4.4 Progestogens 14.5 Thyroid Hormones and Anti-thyroid Drugs 14.5.1 Thyroid Replacements 14.5.2 Anti-thyroid Drugs 14.5.3 Iodides 14.5.4 Adjunct for Crisis States  14.6 Insulin and Other Anti-diabetic Agents 14.6.1 Insulin 14.6.1.1 Short-Acting 14.6.1.2 Intermediate-Acting 14.6.2 Oral Hypoglycemics 15. DRUGS ACTING ON THE UTERUS 15.1 Oxytocics 15.2 Tocolytics (Uterine Relaxants) 16. SOLUTIONS CORRECTING WATER ELECTROLYTES, ACID-BASE AND CALORIC DISTURBANCES 16.1 Oral 16.2 Parenteral  16.3 Electrolyte or IV Additive Solutions 16.4 Alkalinizing Agent 16.5 Caloric Agents 16.6 Amino Acids, Crystalline 16.7 Peritoneal Dialysis Solution 16.8 Hemodialysis Solution 16.9 Plasma/Volume Expanders 17. DIAGNOSTIC AGENTS 17.1 Radio Contrast Media 18. VITAMINS AND MINERALS 18.1 Vitamins 18.2 Minerals 19. DERMATOLOGICALS 19.1 Anti-infectives 19.1.1 Antibacterial 19.1.2 Antifungals 19.1.3 Antiviral 19.1.4 Scabicide 19.2 Anti-inflammatory Drugs 19.2.1 Steroidal 19.2.2 Non-steroidal 19.3 Anti-seborrheic Agent 19.4 Astringent 19.5 Depigmenting Agent 19.6 Keratolytic 19.7 Local Anesthetics 20. OPHTHALMOLOGICAL PREPARATIONS 20.1 Adjuvant to Surgery 20.2 Anti-infectives 20.2.1 Antibacterials 20.2.2 Anti-viral 20.3 Corticosteroids 20.4 Vasoconstrictors 20.5 Drugs for Glaucoma 20.5.1 Topical 20.5.2 Systemic 20.6 Mydriatics 20.6.1 Parasympatholytics 20.6.2 Sympathomimetics  20.7 For Cataract 20.8 For Diabetic Neuropathy 20.9 Miscellaneous 21. EAR PREPARATIONS 21.1 Antiseptics with Corticosteroids 21.2 Anti-infectives and Antiseptics 21.3 Miscellaneous 22. MOUTH/THROAT PREPARATIONS 23. TOPICAL NASAL PREPARATIONS 24. ANTISEPTICS AND DISINFECTANTS  SAMPLE TEXT OF THE FORMULARY Ascorbic Acid (Vitamin C) Usual Dose: (Therapeutic) IN, CH - 100-200 mg or more daily, po or IV - 500 mg daily, po or IV Preparation: Oral : 100 mg, 250 mg, 500 mg tablet 1 g effervescent tablet 100 mg/5 mL, 120 mL syrup 100 mg/mL, 10 mL drops 60 mg/0.6 mL, 15 mL drops Inj : 250 mg/mL, 2 mL ampul Aspirin (Acetylsalicylic Acid) Usual Dose: IN, CH - As an anti-inflammatory/antirheumatic: 65-130 mg/kg/day div q4-6h As anti-platelet: 3 mg/kg/day (max 40-80 mg/day) - 600 mg po q4h prn; 3-6 g/day po in div. doses for rheumatoid arthritis 5-8 g/day po in div. doses for Acute Rheumatic Fever 40-80 mg/day po antithrombotic effect Preparation: Oral: 80 mg, 325 mg tablet Precaution: - Preferably taken with food, milk or glassful of water - Use with caution in patient with gastric ulcer, bleeding tendencies or hypoprothrombinemia, history of asthma and during anti-coagulant therapy - Use with caution in children below 12 years because of its association with Reye Syndrome during viral infections especially varicella and influenza. Not recommended for routine antipyresis and analgesia in this age group. LEGEND: IN – Infant A – Adult CH – Children po – by mouth END