QT Drug List

The Arizona CERT (Center for Education and Research on Therapeutics) is an independent research and education center whose mission is to improve therapeutic outcomes and reduce adverse events caused by drug interactions and drugs that prolong the QT interval, especially those affecting women, through research and a broad range of educational programs for medical professionals and consumers.

The center maintains a QT Drug Lists on its website - four separate lists of drugs, based on risk category, that may prolong the QT interval.
1. Drugs with Risk of Torsades de Pointes
2. Drugs with Possible Risk of Torsades de Pointes
3. Drugs to be Avoided by Congenital Long QT patients Torsades de Pointes
4. Drugs Unlikely to Cause Torsades de Pointes
The website address is http://www.torsades.org/

Opium Tincture and Paregoric

There is a potentially dangerous situation that invites serious medication errors between opium tincture (deodorized) and paregoric (camphorated tincture of opium). Paregoric is camphorated tincture of opium. Paregoric has just 0.4mg/mL of morphine while opium tincture contains 10mg/mL – a 25-fold difference.

IMSP has issued a medication safety alert. Please follow the following two links:
http://www.ismp.org/hazardalerts/recruting.asp
http://www.pharmacytimes.com/article.cfm?ID=492

Acamprosate (Campral): Alcoholism, Maintenance of Abstinence

Order came in for a psychiatry patient, Acamprosate 666mg tid.
Campral is made by Forrest Pharmaceuticals Inc., and it is available as Campral Delayed-Release Tablet 333 mg. Acamprosate is used as an adjunct to comprehensive management programs and psychosocial support to help alcoholics maintain abstinence following ethanol withdrawal. As single therapy, acamprosate offers a better safety profile in comparison to disulfiram or naltrexone. The FDA approved acamprosate on July 29, 2004.
The usual dose for adult patients is 666mg orally three times daily. The drug requires renal dosing. For renally impaired patients, the dose is 333mg tid if CrCl is between 30-50 mL/min; use is not recommended for patients with CrCl less than or equal to 30 mL/min.
Acamprosate has a FDA pregnancy category C rating.

Double Plavix Dose (600mg) Reduces Risk After Stent Procedures

Today there was an order for Plavix (Clopidogrel) 600mg for a patient in the ED. Plavix is manufactured by Bristol-Myers Squibb, and it is an anti-clotting medication (http://www.plavix.com). Plavix blocks the ADP receptors, which prevent fibrinogen binding at that site and thereby reduce the possibility of platelet adhesion and aggregation. Usually the most common loading dose is Plavix 300mg. There is an article in the Pharmaceutical Business Review titled “Double Plavix dose reduces risk after stent procedures”. Here is the link: http://www.pharmaceutical-business-review.com/article_news.asp?guid=7FF46A1A-2F08-4F2E-8736-D6452DF44377. In the article it reports that according to a study, pretreatment with double-dose Plavix 600mg rather than the standard 300mg dose just before stenting cuts the combined risk of heart attack and cardiac death by half. In addition, the higher dose did not increase the risk of serious bleeding.
In the article it says interventional cardiologists give patients a loading dose of this medication before percutaneous coronary intervention (PCI) to protect against blood clotting. After the procedure, most patients take a lower daily dose (75mg) for up to a year, depending on the type of stent used to prop open the clogged coronary artery.

Chinese Recipe: Spicy Jumbo Scallops with Baby Bok Choy

Spicy Jumbo Scallops with Bay Bok Choy (蒜蓉大干贝).


Ingredients
5 frozen jumbo scallops
1 cup cooking oil
1 cup shredded carrot
5 heads baby bok choy
1 tsp cornstarch
3 cups cooking oil
Group A
1/8 tsp salt
1/2 egg white
1 tablespoon cornstarch
1 tablespoon cooking oil
Group B
4 oz shredded fresh papaya
1 shredded red chili pepper
pinch rau ram (vietnamese herb)
1/2 tsp fresh minced garlic
1/8 tsp salt
1 tablespoon sugar
1 tablespoon lemon juice
2 tsp sesame oil
Group C
1 tsp minced ginger
1 tsp scallion
1 tsp minced fresh garlic
1 tablespoon minced garlic chili sauce
Group D
1 1/2 tablespoon sugar
1 1/2 tablespoon lemon juice
1 tsp cooking wine
1/3 cup chicken broth
2 tsp cornstarch/water mix (1 tsp of each)
2 tsp sesame oil
1/8 tsp white pepper salt to taste
Cooking Method
1. Defrost, clean, and dry jumbo scallops. Marinate in Group A for several hours
2. Heat 1 cup oil in wok until hot and stir-fry shredded carrot. Drain and set aside
3. Combine Group B ingredients and mound in center of plate
4. Wash baby bok choy and cut in half (from top to bottom). Steam until cooked. Set aside.
5. Toss marinated scallops with 1 tsp cornstarch. Heat 3 cups cooking oil until hot and fry scallops until golden brown. drain nd set aside.
6. Heat 1 tablespoon oil until hot, then stir-fry Group C ingredients. combine Group D and cook until sauce thickens.
7. Add scallops and toss well. Remove contents to plate. Place baby bok choy around scallops
8. Garnish with fried carrot

Distance Pathway for Doctor of Pharmacy

Interested in becoming a pharmacist? Want to get a Doctor of Pharmacy degree? Want to get the PharmD degree without living in dorms? Take a look at the innovative distance-based doctor of pharmacy degree program offered by Creighton University, Omaha, NE. Creighton University offers the first and only accredited Doctor of Pharmacy Program Distance Pathway (Online Pharmacy Program) providing a full-time educational method to obtain a Doctor of Pharmacy degree.
You can find out more information on the school web site: http://pharmacy.creighton.edu/

Web Site for ER Pharmacist

More and more hospitals are hiring ER pharmacist. The University of Rochester maintains a web site dedicated to ER pharmacist. Here is the link: http://www.emergencypharmacist.org/. There are valuable resources and tools for ER pharmacist.

Treatment of Acetaminophen Overdose in ER

I had two cases of acetaminophene (Tylenol) overdose in the ER this week. Both cases patients require IV Acetadote (Acetylcysteine). There is a web site published by Cumberland Pharmaceuticals, maker of Acetadote. Here is the link: http://www.acetadote.net/. There is a dosing calculator on the web site which can do the calculations for you. You can also downloade the calculator to your PDA The website also offers information or how to order Acetadote and emergency locator.









Below are some keypoints:
1. Acetadote, administered intravenously within 8 to 10 hours after ingestion of a potentially
hepatotoxic quantity of acetaminophen, is indicated to prevent or lessen hepatic injury.

2. Three-bag treatment (for patients >=40kg)
The total dose of Acetadote is 300 mg/kg administered over 21 hours.
Loading Dose: Dilute 150 mg/kg in 200 mL of 5% dextrose and administer over 60 minutes.
Second Dose: Dilute 50 mg/kg in 500 mL of 5% dextrose and administer over 4 hours.
Third Dose: Dilute 100 mg/kg in 1000 mL of 5% dextrose and administer over 16 hours.
The total volume administered should be adjusted for patients less than 40 kg (88 lbs) and for those requiring fluid restriction. To avoid fluid overload, the volume of 5% dextrose should be reduced as needed.


3. Renal adjustment/Hepatic adjustment
No data on renal/hepatic dosing adjustment