To: Physicians, Nursing, Pharmacy
From: Maryna Shayuk, MD, Chair Pharmacy and Therapeutics
Alan Mader, Pharmacy Operations Coordinator
Date: October 15, 2018
Re: Diphenhydramine Injection Shortage
|Diphenhydramine injection supply is critically low. Estimates indicate less than a 2 week supply throughout NM Northwest system.|
|Diphenhydramine has been on shortage. Pharmacy Purchasing has been able to obtain orders up to this point.|
|In order to maintain the limited supply for crash cart exchange, sequestering to pharmacy and therapeutic substitution will need to be instituted.|
|Pharmacy will sequester remaining supply from Pyxis machines to the Pharmacy Department. Therapeutic Substitution will take place as follows:|
Injection to PO – For all patients who can take PO in equivalent dose.
If unable to take PO – Therapeutic substitution to Promethazine Injection in equivalent dose. Doses greater than 25 mg – consult with MD.
Centegra lab will now perform an e-test on all MRSA isolates obtained from a sterile site with microscan mic >=2.
With additional testing e-testing many isolates may have lower had mic of <1.5 expanding options for treatment.
This additional step will take an additional day to report out.
ABIM MOC completion can be done through Uptodate.com
Please see here for more information on the program.
Centegra offers access to uptodate.com for all providers in the health system. Just login from any network computer in the system.
Instructions on remote or mobile access can be found here.
Morphine Injection Shortage 10.18.2017
There is a nationwide shortage of morphine injection that expected to last until early to mid-November. The Pharmacy Department is running very low on supply and expects that the drug will become unavailable. Please consider ordering an alternate injection product for pain management. An opioid dose conversion chart is included below for your convenience.
Oral: Parenteral Ratio
Oral Morphine: Analgesic Ratio
|Morphine||30 mg||10 mg||3 : 1||1 : 1||4 – 6 hrs||3 hrs|
|Oxycodone||20 mg||—||—||1.5 : 1||3 – 5 hrs||4 – 5 hrs|
|Hydromorphone||7.5 mg||2 mg|| 4: 1||4: 1||3 – 4 hrs||2 – 3 hrs|
|Fentanyl||—||100 mcg||—||See Table B on page 2||1 hr||3 – 12 hrs|
|Methadone||20 mg||10 mg||2 : 1||See Table C on page 2||4 – 12 hrs||15 – 50 hrs|
|Codeine||200 mg||130 mg||1.5 : 1||1 : 7||4 – 6 hrs||3 hrs|
|Hydrocodone||30 mg||—||—||1 : 1||3 – 6 hrs||3 – 4 hrs|
|Meperidine||300 mg||75 mg||4 : 1||1 : 10||2 – 4 hrs||2 – 3 hrs|
|Nalbuphine||—||10 mg||—||1 : 1||3 – 6 hrs||5 hrs|
Starting at 00:00 on Monday, October 2, 2017, the PTT Goal Range for patients at all Centegra hospital campuses will be 45 to 70, with alerts being triggered for values greater than 100.
All “Per Pharmacy Heparin” will be adjusted to the new range with PTT draws after this time.
Keytruda (pembrolizumab) in Patients with Multiple Myeloma: FDA Statement – Two Clinical Trials on Hold
ISSUE: Based on data from two recently halted clinical trials, the U.S. Food and Drug Administration today is issuing this statement to inform the public, health care professionals, and oncology clinical investigators about the risks associated with the use of Keytruda (pembrolizumab) in combination with dexamethasone and an immunomodulatory agent (lenalidomide or pomalidomide) for the treatment of patients with multiple myeloma. Keytruda (pembrolizumab) is not approved for treatment of multiple myeloma.
The FDA statement is based on review of data from two clinical trials (KEYNOTE-183 and KEYNOTE-185) evaluating the use of Keytruda (pembrolizumab) combined with other treatments in patients with multiple myeloma. On July 3, 2017, the FDA required that all patients in these trials be discontinued from further investigation with this drug, because interim results from both trials demonstrated an increased risk of death for patients receiving Keytruda (pembrolizumab) when it was combined with an immunomodulatory agent as compared to the control group (see statistical analysis section below). Merck & Co., Inc. was made aware of the issue through an external data monitoring committee recommendation and suspended the trials to enrollment on June 12, 2017. Continue reading
Pharmacy Services has subscribed to Johns Hopkins ABX Guide for use by all associates at Centegra Health System to support our multidisciplinary approach to the Antimicrobial Stewardship Program Clinical Decision Support Tools and Education
Johns Hopkins ABX Guide is a comprehensive web source that provides regularly updated, evidence-based decision resources regarding antibiotics, diagnosis, pathogens, management of infections and vaccines.
Prior to the Guide, CHS did not have a specific detailed resource for antibiotics clinical decision support.
Johns Hopkins ABX Guide may be accessed through Unbound Medicine’s uCentral as follows:
[4-20-2017] The Food and Drug Administration (FDA) is restricting the use of codeine and tramadol medicines in children. Codeine is approved to treat pain and cough, and tramadol is approved to treat pain. These medicines carry serious risks, including slowed or difficult breathing and death, which appear to be a greater risk in children younger than 12 years, and should not be used in these children. These medicines should also be limited in some older children. Single-ingredient codeine and all tramadol-containing products are FDA-approved only for use in adults. We are also recommending against the use of codeine and tramadol medicines in breastfeeding mothers due to possible harm to their infants. Continue reading