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Acadiana Market P&T - 2024
LOHH, LOWC, LOLR
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December
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Offsite meeting notes accessible here
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October
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The following policies were reviewed and approved:
The following drug classes were reviewed:
- Ophthalmic Agents: Antivirals (52:04.20)
- Selective Beta-1-Adrenergic Agonists (12:12.08.08)
- Direct Vasodilators (24:08.20)
- Prokinetic Agents (56:32) Metoclopramide monograph
- Protectants (56:28.32) sucralfate monograph
- Sclerosing Agents (24:16, 84:04.08.20)
- Renin Inhibitors (24:32.40)
- Otic Antimicrobials, Part 1 & 2 (52:04.04)
- Entry and Fusion Inhibitors (8:18.08) UPDATED
- Non-Steroidal Antiinflammatory Drugs (NSAIDs) COX-2 Selective (28:08.04.08)
- Ophthalmic Agents: Vasoconstrictors (52:32) UPDATED
- Ustekinumab, biosimilars (92:36)
Formulary Appeal Request:
- Hydroxycobalamin (Cyanokit)
- Revenfenacin (Yupelri)
Formulary Addition Request: none
Consent Agenda (previously reviewed):
- Antimalarial Agents (8:30.08)
- Androgens, Part 1 (68:08)
- Androgens, Part 2 (68:08)
- Topical calcineurin inhibitors (84:92) - updates
- Skeletal muscle relaxants, Part 1 (12:20.04)
- Skeletal muscle relaxants, Part 2 (12:20.12, 12:20.04, 12:20.92)
- Direct Acting skeletal muscle relaxants (12:20.081)
- Calcineurin inhibitor immunosuppressant agent (92:44)
- Antineoplastic, immunosuppressant (10:00); mTOR Kinase Inhibitors (see Fyarro update)
- Mycophenolate (92.44)
- Hydroxyzine formulations
- Coumarin Derivatives (20:12.04.08)
- Direct Oral Anticoagulants
- Direct Thrombin Inhibitors (20:12.04.12)
- LMWHs (20:12.04.16)
- Sodium-glucose cotransporter 2 (SGLT2) Inhibitors (68:20.18)
- Caloric Agents - Fat Emulsions
- Appetite Stimulants
- Anti-Sialorrhea Agents
- Urinary anti-infectives (8:36)
- Antifungals: Echinocandins (8:14.16)
- Vaginal Antifungals (84:04.08.081)
- Intravenous Steroids (68:04)
- Oral Steroids (68:04)
- Topical Steroids (68:04)
- Erythropoiesis stimulating agents, biosimilars (20:16)
- Filgrastim, biosimilars (20:16) - changes
- Pegfilgrastim, biosimilar (20:16) - changes
- Trastuzumab, biosimilars (10:00)
- Bevacizumab, biosimilars (10:00)- changes
- Infliximab, biosimilars (92:36) - changes
- Rituximab, biosimilars (10:00) - changes
Therapeutic Interchange (Automatic) Proposals: none
Protocol Review: none
Antimicrobial Stewardship:
Metronidazole Dosing Frequency Adjustment (pharmacy driven)
•Patients prescribed metronidazole will receive the doses every 12 hours, compared to the traditional every 8 hours
•Pharmacokinetic and clinical outcome data support dosing every 12 hours
•Can reduce the overall medication costs and waste for the health system.
For details of the meeting, including class reviews and consent agendas, click here
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August
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The following policies were reviewed and approved:
- Pitocin Policy Approval- Oxytocin Policy represented, but it was approved at the last PT meeting but small changes were made.
- LA State Law states that Misoprostol will be a controlled medication, CIV beginning 10/1/24
The following drug classes were reviewed:
- Antigout Agents (92:16) (40:40)
- Rifamycins (8:12.28.30) (8:16.04)
- Phosphodiesterase-4 (PDE4) Inhibitors (92:36, 84:06.92, 84:92, 48:32)
- Antiparathyroid Agents (Calcimimetics) (68:24.04):
- Antihelmintics (8:08)
- Leukotriene Modifiers (48:10.24)
- Antilipemic Agents (24:06.05) (24:06.92)
- Antithyroid Agents (63:36.08)
- Hepatitis C Virus (HCV) Inhibitors (8:18.40.20, 8:18.40.24, 8:18.40.16)
- Plasma Volume Expanders (16:00, 40:12)
- Cardiac Drugs, Misc (24:04.92)
- Vasopressin Antagonists (40:28.28)
Formulary Appeal Request:
Bevacizumab (Avastin) for intralesion/intralaryngeal injections for recurrent respiratory papillomatosis; studies showing safety and effectiveness only used the branded product. Will be outpatient only for specialized ENT procedures. In-hospital using biosimilar.
Formulary Addition Request: none
Consent Agenda (previously reviewed):
- Rabies Immune Globulin
- RhoD Immune Globulin
- Vitamin D analogs
- Potassium replacement products (oral)
- Potassium replacement products (IV)
- First Generation Antihistamines (4:04)
- Second Generation Antihistamines (4:08)
- Insulins (68:20.08)
- Probiotics
- Progestins
- Estrogens
- Opiate Agonists (28:08.08)
- Opiate Partial Agonists
Therapeutic Interchange (Automatic) Proposals:
Phosphorus Binder Formulations
Sucroferric Oxyhydroxide (Velphoro) chewable will be switched to Renvela TID with meals
Antimicrobial Stewardship:
Azithromycin 3-day duration (pharmacy driven)
Antibiograms Complete for 2023
1. Adult Urine/Non-Urine
2. Pediatrics Combined antibiogram
3. Trends in Susceptibility over 3 years
Antibiotic usage was presented for LOLR, LOHH, and LOWC campuses.
For details of the meeting, including class reviews and consent agendas, click here
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June
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The following policies were reviewed and approved at WCH:
1) Misoprostol
2) Oxytocin Induction
The following drug classes were reviewed:
- Polymyxins (8.12.28.28)
- Anesthesia Gases (N/A)
- Post-menopausal Osteoporosis Treatments, non-bisphosphonates (92:24, 24:22, 64:24.08, 68:16.12)
- Opiate Antagonists (28:10)
- Azole Antifungals (UPDATE) (8:14.08)
- Amphotericin B (UPDATE) (8:14.28)
- Guanylate Cyclase-C (GC-C) Agonists (56:92)
- Central Alpha Agonists (24:08.16)
- Oxytocics (76:00) (56:28.28)
- PDE3 Inhibitors (20:12.14) (20:12.18) (24:04.08)
- Mydriatics, Ophthalmic (52:24)
- Dopamine (D2) Agonists, Ergot-derived (28:36.20.04)
- Miotics, Ophthalmic (52:40.20)
- Complement Inhibitors, C5 and C3 (92:21.08) - wording update
- Soliris is formulary restricted to outpatient use (not preferred) and inpatient use for atypical hemolytic uremic syndrome only.
- Ultomiris is formulary restricted to outpatient use only (preferred).
- Empaveli and Veopoz will be nonformulary.
- Somatostatin Analogs (68:29.04) - wording update
- Octreotide (regular) will be formulary.
- Octreotide acetate LAR will be formulary-restricted to outpatient and in conjunction with Lutathera administration in same day admissions ONLY
- Lanreotide will be formulary-restricted to outpatient use only.
- Pasireotide will be non-formulary.
Formulary Appeal Request: Advair and Symbicort at the system level, not to be affected in Acadiana. Acadiana marked will continue to use nebs, not inhalers.
Formulary Addition Request: none
Consent Agenda (previously reviewed):
- PAMORA: GI Drugs, Misc (56:92)
- Surfactant (48:36)
- Selective Serotonin Agonists (28:32.28)
- Fibric Acid Derivatives (24:06.06)
- Cephalosporins (8:12.06)
- Add cefpodoxime; restrict cefdinir to patients < 2 months of age.
- Keep ceftazidime formulary but remove restriction criteria
- Penicillins (8:12.16)
- Penicillin g sodium will be formulary.
- Aminoglycosides (8:12.02)
- Fluoroquinolones (8:12.18)
- Carbapenems (08:12.07.08)
- Remove meropenem/vaborbactam from formulary
- Magnesium Replacement Products
- Phosphate Binders (40.18.19)
- Oral Iron Replacement
- Ferrous sulfate tablets, enteric coated tablets, and suspension oral liquid will be formulary.
- Ferrous sulfate extended-release tablets, ferrous gluconate, ferrous fumarate, iron polysaccharide complex, and ferric maltose will be non-formulary.
- For ferric citrate formulary status see Phosphate Binder Class Review.
- SNRIs
- SSRIs
- 5-ASA Derivatives (56:36)
- Prostacyclin (48:48)
- Potassium-Removing Agents (40:18.18)
- AntiMRSA Antibiotics (8:12.28)
- Tetracyclines (8:12.24)
- Monobactam (8:12.07.16)
- Sulfonamide (8:12.20)
- Lincosamide (8:12.28.20)
- Antibacterials, Misc - Nitroimidazoles (8:12.28)
- Macrolides (8:12.12)
Therapeutic Interchange (Automatic) Proposals:
Inhalers to Nebs
- Steroid/beta blocker combos -> albuterol + budesonide
- Anticholinergic/beta bocker combos -> albuterol + ipratropium
- Steroid/beta blocker/anticholingeric combos -> albuterol + ipratropium with budesonide
- Long acting anticholinergics -> Ipratropium
- Beta Blockers -> albuterol
Thiamine IV to PO per protocol
Omnicef removal from formulary to Augmentin or Vantin
Ophthalmic Fluoroquinolones
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- Cipro ointment to erythromycin ointment
- FQ Ophthalmic solutions to Ofloxacin
Protocol Review: none
Antimicrobial Stewardship: Review of 2024 Q1 usage at all three campuses
For details of the meeting, including class reviews and consent agendas, click here
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April
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Burn Fluid Order Set was updated at MEC and taken to local P&T.
Policy PCS-378: Peripheral Parenteral Nutrition was reviewed and discussed
The following drug classes were reviewed:
- Antidiarrheal agents
- Alpha-glucosidase inhibitors
- GLP-1 receptor agonists
- Bile acid sequestrants
- Scabicides/pediculicides
- Barbiturates: updated to include pentobarbital
- Nucleoside Reverse Transcriptase Inhibitors
- Vemlidy (tenofovir/alafenamide) added for Hep B patients
- Alpha-adrenergic blocking agents:
- Prazosin with restriction to use by psych in PTSD & nightmares
- Protease Inhibitors: Keletra (lopinavir/ritonavir) oral solution will be restricted to peds
- Anticonvulsants Succinimide: Ethosuximide oral suspension will be restricted to peds.
- Botulinum Toxins (92:92)
- Alpha-1 Proteinase Inhibitors (48:92)
- Asthma Biologics (48:10.20, 48:92)
- Neuraminidase Inhibitors (8:18.28, 8:18.92)
- Complement Inhibitors:
- Angioedema Treatment (92:32)
- Complement Inhibitors, C5 and C3 (92:21.08)
Formulary Appeal Request: none
Formulary Addition Request: none
Consent Agenda (previously reviewed):
- Antihemorrhagic Agents: Andexxa
- Praxbind (20:28.92)
- Loop Diuretics (24:08.24.08)
- Thiazide Diuretics (24:08.24.20)
- Diuretics, misc (24:08.24.92)
- Calcium Channel Blockers
- Non-Dihydropyridine (24:28.92)
- Calcium Channel Blockers, DHP (24:28.08)
- Benzodiazepines (28:12:08)
- Alpha-Adrenergic Blocking Agents (24:08.4)
- 5-alpha Reductase Inhibitors (92:08)
- Antivirals, topical (84:04.06)
- Nucleoside Reverse Transcriptase Inhibitors (NRTIs) (8:18.08)
- Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (8:18.08)
- Protease Inhibitors (PIs) (8:18.08)
- Integrase Inhibitors (8:18.08)
- Entry Inhibitors (8:18.08)
- Fixed-dose Combinations (8:18.08)
- Anticonvulsants Pyrrolidine (28:12.92)
- Anticonvulsants Succinimide (28:12.20)
- Anticonvulsants Valproates (28:12.92)
- Anticonvulsants Misc 2 (28:12.92)
- Anticonvulsants Misc 3 (28:12.92)
- Angiotensin II (Giapreza)
- Remdesivir (Veklury)
- Rolvedon: restricted to outpatient use only
- Surfactants (simethicone)
- Ophthalmic Agents: NSAIDS
- Ophthalmic Agents: Mast Cell Stabilizers
- Ophthalmic Agents: Beta Blockers
- Ophthalmic Agents: Prostaglandins
- Ophthalmic Agents: Alpha2 Agonists
- Ophthalmic Agents: Carbonic Anhydrase Inhibitors
- Ophthalmic Agents: Combo Products
- Hemostatic: Factor VII (20:28.16)
- Hemostatic: Factor VIII (20:28.16)
- Hemostatic: Factor IX (20:28.16)
- Hemostatic: von Willebrand Factor (20:28.16)
- Beta Blockers (24:24)
- Intranasal Steroids (52:08.08)
- Inhaled Corticosteroids (68:04)
- Selective Beta-2-Adrenergic Agonists (48:12.04.12)
- Anticholinergic Agents (48:12.08)
Therapeutic Interchange (Automatic) Proposals:
Kcentra to Balfaxar Conversion: will proceed in EPIC on April 2nd, 2024
Biosimilar Interchanges (Inpatient):
- Avastin Interchange (to Zirabev)
- Herceptin Interchange (to Ogivri)
- Neulasta Interchange (to Fulphila)
- Neupogen Interchange (to Granix)
- Remicade Interchange (to Renflexis)
- Rituxan Interchange (to Ruxience)
Protocol Review: none
Antimicrobial Stewardship: CRRT/SLED Antimicrobial Dosing Guidelines
For details of the meeting, including class reviews and consent agendas, click here
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February
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The following was clarified: Infliximab-abda (Renflexis) will be the formulary product for inpatient use if needed . Truxima will be used instead of Rituxan.
The following drug classes were reviewed:
- 4 Factor PCC
- Balfaxar will be formulary, replacing KCentra
- Aromatase Inhibitors
- Estrogen Receptor Antagonists
- Antigonadotropins
- Gonadotropin Releasing Hormone (GnRH) Agonists
- Lupron Depot available via the non-formulary process for patients with Prostate Cancer with spinal metastasis
- Gonadotropin Releasing Hormone (GnRH) Agonists, Other
- CGRP antagonists
Formulary Appeal Request:
Trihexphenidyl Liquid was approved for use in pediatrics.
Formulary Request:
Cefiderocol (Fetroja): was presented and approved for the use in Multi-Drug Resistant Organisms with the restriction to ordering by
1. Infectious Disease Providers only
2. Critical Care providers if a facility does not have an ID provider.
Consent Agenda (previously reviewed):
- Anticonvulsants Hydantoin (28:12.12)
- Anticonvulsants Barbiturates (28:12.04)
- Anticonvulsants Dibenazapine (28:12.92)
- Anticonvulsants GABA (28:12.92)
- Anticonvulsants Misc 1 (28:12.92)
- Antiparkinsons agents MOAB inhibitors (28:36.32)
- Antiparkinsons agents Misc (28:92) and (28:36.08)
- Antiparkinsons agents COMT inhibitors (28:36.12)
- Antiparkinsons agents Dopamine agonists (28:36.04) and (28:36.20.08)
- Ophthalmic Antimicrobials, fluoroquinolones (52:04.04)
- Bone Resorption Inhibitors (92:24)
- P2Y12 Inhibitors (20:12.18)
- Calcitonin
- ACE-Inhibitors (24:32.04)
- Angiotensin Receptor Antagonists (24:32.08)
- HMG Co-A Reductase Inhibitors (24:06.06)
- Proton-Pump Inhibitors (56:28.36)
- 5-HT3 Receptor Antagonists (56:22.20)
- Gleolan
Therapeutic Interchange (Automatic) Proposals:
- Topical Antifungals
- Moduretic to Dyazide
Antimicrobial Stewardship
Antibiotic usage was presented for LOLR, LOHH, and LOWC campuses.
For details of the meeting, including class reviews and consent agendas, click here
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