Page 43 - FOCUS December 2017

FORMULARY UPDATE | OCTOBER 2017
FORMULARY ADDITIONS
Hyperkalemia most often occurs when these drugs are given
to patients who already have underlying comorbid disease
states. Examples include chronic and acute kidney dysfunction, rhabdomyolysis, and tumor lysis syndrome. In addition, medications that can cause or exacerbate these conditions can also lead to hyperkalemia. To demonstrate, most drugs in the RAAS pathway were associated with approximately a 1.5 times increased incidence of hyperkalemia in hospitalized patients2. The incidence was observed as 2.5 times when evaluated in an elderly outpatient population, many of whom had renal impairment as a comorbidity3.
Medication induced hyperkalemia can be caused by a number of different agents through many different mechanisms. Recognizing which medications are contributing to elevated potassium levels
is a vital step in preventing hyperkalemia. Medications ought to be evaluated along with other disease states in order to get a complete view of the patient’s disease state and determine risk. In more severe or symptomatic cases, medications such as insulin with dextrose, inhaled beta agonists, sodium polystyrene sulfonate, sodium
bicarbonate, and even dialysis may be used to lower potassium levels4. Often times, however, correcting hyperkalemia is as simple as identifying the causative agent and being able to alter therapy to reverse the abnormality. ●
References
1. Ben Salem C, Badreddine A, Fathallah N, Slim R, & Hmouda H. (2014). Drug-induced hyperkalemia. Drug Safety, 37(9), 677-692.
2. Nilsson E, Gasparini A, Ärnlöv J, Xu H, Henriksson KM, Coresh, J, Carrero JJ (2017). Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. International Journal of Cardiology, 245, 277-284.
3. Turgutalp K, Bardak S, Helvacı I, İşgüzar G, Payas E, Demir S, & Kıykım A. (2016). Community-acquired hyperkalemia in elderly patients: Risk factors and clinical outcomes. Renal Failure, 38(9), 1405-1412.
4. Henneman A, Guirguis E, Grace Y, Patel D, & Shah B. (2016). Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting. American Journal of Health-System Pharmacy, 73(2), 33-44.
5. Lafrance J, & Miller D R (2012). Dispensed selective and nonselective nonsteroidal anti- inflammatory drugs and the risk of moderate to severe hyperkalemia: A nested case-control study. American Journal of Kidney Diseases, 60(1), 82-89.
6. Pearce C J, Gonzalez F M, & David Wallin J (1993). Renal failure and hyperkalemia associated with ketorolac tromethamine. Archives of Internal Medicine, 153(8), 1000-1002.
PHARMACY SERVICES
Medication – Generic/Brand Name
Docetaxel Injection
Leuprolide Acetate Injection
Lorazepam Oral Solution
Ranitidine Tablet
Silver Sulfadiazine Cream 1%
Umeclidinium/Vilanterol Oral Inhaler (Anoro Ellipita)
Strength/Size
160 mg/8mL 8 mL vial
45 mg kit
2 mg/mL 30 mL bottle
75 mg
25 gm tube
62.5/25 mcg per inhalation / 7 inhalations
Use/Indication
Treatment of several types of cancer
Treatment of prostate cancer
Treatment of anxiety and other indications
Treatment of several gastric acid-related diseases
Adjunct to the treatment and prevention of wound sepsis
Treatment of chronic obstructive pulmonary disease
Comment
• Line-item extension
• High-alert medication
• Safe handling precautions for hazardous medications • Prescribing limited to oncologists
•Line-item extension
•High-alert medication
•Safe handling precautions for hazardous medications
Line-item extension
Line-item extension
Line-item extension
CHRISTIANA CARE COMPLIANCE HOTLINE
Christiana Care’s Compliance Hotline can be used to report a violation of any regulation, law or legal requirement as it relates to billing or documentation, 24 hours a day, 7 days a week. Callers may remain anonymous. The toll-free number is: 877-REPORT-0 (877-737-6780).
To learn more about Corporate Compliance, review the Corporate Compliance Policy online or contact Christine Babenko at 302-623-4693.
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