Approved Hospital Formulary
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Approved Hospital Formulary
07/09/20 ww Covid Respiratory Medications (Nebulization vs Inhaler)
July 9, 2020
From: "Wade Williams" <wade.williams@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Thursday, July 9, 2020 2:16:16 PM
Subject: COVID Respiratory Medications (Nebulization vs. Inhaler)
Since we have new pharmcists/residents on site and because its always good to have a refresher, below is the info that Adam sent out in late March regarding respiratory meds in our COVID+/PUI.
All approved therapeutic interchange programs remain in place for any patient not under investigation for COVID-19 infection.
For patients with suspected [(i.e patient under investigation ( PUI )] or confirmed COVID-19 infection, respiratory therapy may request an interchange from nebulization therapy to inhalers.
Recommendations for albuterol, ipratropium, and budesonide are listed below along with other expectations.
Verification Expectations
1. Pharmacists are NOT expected to automatically interchange nebs to inhalers at order verification.
For patients who have been tested for or have suspected COVID-19, it is considered APPROPRIATE to verify inhalers (current formulary is to interchange inhalers to nebs).
At this time, we are trying to conserve our supply of inhalers and give them to the most appropriate patients.
We are leaving this decision up to the prescriber, as well as respiratory therapy, to evaluate and determine the current needs of each patient.
2. If a patient is currently ventilated with suspected COVID-19, nebulized meds are appropriate .
If an inhaler is ordered on a ventilated patient, please call to verify with respiratory or MD. Of course, this is subject to change if RT runs out of Aerogen closed vent systems.
Interchange Expectations
1. Respiratory therapist, or prescriber, will contact pharmacist to request interchange to inhaler in non-ventilated patients with suspected or confirmed COVID-19 infection on nebulization therapy.
ADULT Interchange Recommendations
* Albuterol
Nebulizations ----> albuterol MDI 2 puffs at the same dosing interval
* Ipratropium
Nebulizations ---> tiotropium (SPIRVIA RESPIMAT) 2.5 mcg/actuation 2 inhalations q24 hrs
* Budesonide
Nebulization ---> mometasone (ASMANEX Twisthaler) 220 mcg/inh 2 puffs q24 hrs
If patient on systemic corticosteroids, discuss with prescriber possible discontinuation of inhaled corticosteroid therapy.
* As always, use your clinical judgement. The prescriber may be contacted for a new order any time a nebulization to inhaler interchange is questionable.
Dispensing Expectations
1. ALBUTEROL inhalers should not be dispensed at time of order verification/label print. Nursing or Respiratory can complete a med request when the inhaler is truly needed.
2. Resupply of inhalers may be refused once suspected patient is confirmed negative
(The dispensed inhaler may continue to be utilized until exhausted, then the patient can be converted back to nebulization therapy)