The C&W PT&N Committee welcomed members from Health Authorities outside of PHSA to join our deliberations regarding recommendations to the Provincial Pharmacy and Therapeutics Committee regarding pediatric medication issues. 1. Policies & Procedures: - Ketamine continuous intravenous infusion: Ketamine continuous intravenous infusion has been approved for administration in all areas of hospital (change from restriction to critical care areas) when ordered and monitored by Acute Pain Service prescribers. A Pre-Printed Order has been approved for these orders and should be used when prescribing in non-critical care areas. - Nutrition Orders: Dieticians are permitted to write orders for oral diets and enteral nutrition. Refer to Nutrition Enteral orders and Medication Order Writing policies for more details. - Emergency Department Nurses administration of diphenhydramine for patients presenting with urticaria (hives): Nurses in the Emergency Department are permitted to administer one dose of diphenhydramine to patients over one year of age presenting with urticaria (hives) and no signs of anaphylaxis without a physician’s prescription. This is restricted to the Emergency Department. - Safe Medication Order Writing Policy Update: The use of “=” sign (for equal to) as an acceptable abbreviation has been approved as an acceptable abbreviation. The summary of safe medication order writing practices on the back of the prescriber order forms will be modified to reflect this change and put into circulation in the coming month. 2. Additions to Formulary: - Lacosamide: an anti-epileptic medication (IV and oral forms) has been added to formulary. The proposed use is as an adjunct in treatment resistant focal epilepsy and status epilepticus. - Insulin Detemir: a long acting insulin for maintenance treatment in children with diabetes. 3. Medication Backorders: We continue to face shortages of a number of medications. The Pharmacy Department continues to monitor supplies and usage. In cases where we anticipate supply issues within a period of 4 weeks or less, pharmacy will coordinate alternate source or therapeutic agents for patients. We are reviewing all affected medications in a systematic fashion in order to minimize the impact on direct patient care. Current medications of concern include: - Atropine Prefilled Syringe Shortage - These syringes are stocked in CODE BLUE kits only. When the current stock of atropine prefilled syringes is depleted, they will be replaced by 0.6 mg amps. - Pancuronium (anticipated supply issue at end of August 2012 lasting until late 2013) – alternative is rocuronium. - Loxapine injection (currently unavailable, unknown duration) Please continue to switch to enteral route for all medications as soon as clinically feasible. Updates are being provided on an as needed basis for stock issues that directly affect patients and prescribers at BC Children’s Hospital, BC Women’s Hospital, Sunny Hill and Child & Adolescent Mental Health. 4. Pre-Printed Orders: The following pre-printed orders have been approved: BC Children’s Hospital: - Continuous Renal Replacement Therapy (CRRT) - Acute Pain Service Dexmedetomidine for chimeric antibody (oncology) - Acute Pain Service Continuous Ketamine Infusion - Tocilizumab – revised to reflect changes in concentration of product - Midazolam continuous infusion for treatment of status epilepticus– revised to reflect 3R midazolam guidelines, usual dosing ranges, and standard concentration of 1 mg/mL Please refer to Medworxx for list and print shop order numbers to order pre-printed orders from print shop. Pharmacy Informer Winter 2012 Updates from C&W Pharmacy, Therapeu7cs, and Nutri7on (PT&N) Commi=ee Roxane Carr, BScPharm, PharmD and Don Hamilton, BScPharm Children's and Women's Health Centre of BC, Department of Pharmacy
Transcript
The C&W PT&N Committee welcomed members from Health Authorities outside of PHSA to join our deliberations regarding recommendations to the Provincial Pharmacy and Therapeutics Committee regarding pediatric medication issues.
1. Policies & Procedures:- Ketamine continuous intravenous infusion: Ketamine continuous intravenous infusion has been approved for administration in all areas of hospital (change from restriction to critical care areas) when ordered and monitored by Acute Pain Service prescribers. A Pre-Printed Order has been approved for these orders and should be used when prescribing in non-critical care areas.
- Nutrition Orders: Dieticians are permitted to write orders for oral diets and enteral nutrition. Refer to Nutrition Enteral orders and Medication Order Writing policies for more details. - Emergency Department Nurses administration of diphenhydramine for patients presenting with urticaria (hives):Nurses in the Emergency Department are permitted to administer one dose of diphenhydramine to patients over one year of age presenting with urticaria (hives) and no signs of anaphylaxis without a physician’s prescription. This is restricted to the Emergency Department.
- Safe Medication Order Writing Policy Update: The use of “=” sign (for equal to) as an acceptable abbreviation has been approved as an acceptable abbreviation. The summary of safe medication order writing practices on the back of the prescriber order forms will be modified to reflect this change and put into circulation in the coming month.
2. Additions to Formulary:- Lacosamide: an anti-epileptic medication (IV and oral forms) has been added to formulary. The proposed use is as an adjunct in treatment resistant focal epilepsy and status epilepticus.
- Insulin Detemir: a long acting insulin for maintenance treatment in children with diabetes.
3. Medication Backorders:We continue to face shortages of a number of medications. The Pharmacy Department continues to monitor supplies and usage. In cases where we anticipate supply issues within a period of 4 weeks or less, pharmacy will coordinate alternate source or therapeutic agents for patients. We are reviewing all affected medications in a systematic fashion in order to minimize the impact on direct patient care.
Current medications of concern include:- Atropine Prefilled Syringe Shortage - These syringes are stocked in CODE BLUE kits only. When the current stock of atropine prefilled syringes is depleted, they will be replaced by 0.6 mg amps.
- Pancuronium (anticipated supply issue at end of August 2012 lasting until late 2013) – alternative is rocuronium.
Please continue to switch to enteral route for all medications as soon as clinically feasible. Updates are being provided on an as needed basis for stock issues that directly affect patients and prescribers at BC Children’s Hospital, BC Women’s Hospital, Sunny Hill and Child & Adolescent Mental Health.
4. Pre-Printed Orders:The following pre-printed orders have been approved:BC Children’s Hospital:- Continuous Renal Replacement Therapy (CRRT)
- Acute Pain Service Dexmedetomidine for chimeric antibody (oncology)
- Acute Pain Service Continuous Ketamine Infusion
- Tocilizumab – revised to reflect changes in concentration of product
- Midazolam continuous infusion for treatment of status epilepticus– revised to reflect 3R midazolam guidelines, usual dosing ranges, and standard concentration of 1 mg/mL
Please refer to Medworxx for list and print shop order numbers to order pre-printed orders from print shop.
Pharmacy InformerWinter 2012
Updates from C&W Pharmacy, Therapeu7cs, and Nutri7on (PT&N) Commi=ee Roxane Carr, BScPharm, PharmD and
Don Hamilton, BScPharm
Children's and Women's Health Centre of BC, Department of Pharmacy
Pater hoc audiens non potuit filium arguere ulterius
*Erratum - Valganciclovir monograph*Please note that changes have been made to the valganciclovir dosing section. The updated version of the monograph can be found on the online version of drug dosing handbook in the C&W Intranet site
We will be producing an adhesive-backed label with the correction that you'll be able to stick in your copy of the 6th adition of the dosing handbook. Contact the pharmacy secretary at local 2059 to get your copy of the correction label. Thanks.
Roberta Esau, Editor
BackgroundLacosamide (Vimpat®) is an anti-epileptic drug that was recently added to the BC Children’s Hospital formulary by the Pharmacy, Therapeutics, and Nutrition Committee for use in treatment resistant focal epilepsy and treatment resistant status epilepticus. Advantages of lacosamide include its novel mechanism of action, relatively minimal drug interactions, the ability to be taken with or without food, predictable linear pharmacokinetics, and intravenous and oral dose equivalency allowing for easier step-down to oral therapy (1).
Proposed Mechanism of ActionThe exact mechanism by which lacosamide works is not fully understood. However, the main mechanism by which lacosamide exerts it antiepileptic action is by selectively enhancing the slow inactivation of voltage-gated sodium channels. This results in stabilization of hyper-excitable neurons and inhibits further neuronal firing. Lacosamide also appears to bind to collapsin response mediator protein-2 (CRMP-2), found in the central nervous system, which is involved with neuronal structural and regulatory functions. It is currently unknown if the binding of lacosamide to CRMP-2 has antiepileptic action. (11)
EfficacyThe efficacy of lacosamide for treatment resistant focal-onset seizures in adults has been established in three randomized controlled trials. In pediatric patients, it has been found to reduce seizure frequency by at least 50% in up to 37.5% of patients (2-7). It has also been found to control status epilepticus in the majority of pediatric and adult patients who receive it (8-9).
Adverse ReactionsThe following adverse reactions have been associated with lacosamide. - Dose related side effects include: somnolence, dizziness, ataxia, headache, diplopia, blurred vision, and nausea/vomiting (1-11)- Idiosyncratic side effects include: depression, suicidal behaviour or ideations, PR interval prolongation on ECG, elevation in transaminases, multiorgan hypersensitivity reaction (1-11)
- With the IV formulation, infusion related reactions like injection site pain and/or discomfort, irritation and erythema may occur (11)
Dosing and Administration- Refractory focal epilepsy in children 3 years and older:
• 1-10 mg/kg/24 hours PO/IV divided twice daily to a maximum of 400 mg daily
• May increase dose weekly- Refractory status epilepticus:
• 2-2.5 mg/kg/dose IV over 30 minutes • maximum dose reported was 400 mg in adults
(9)
Drug InteractionsConcomitant use of enzyme inducing medications such as phenytoin, phenobarbital, or carbamazepine may reduce lacosamide plasma concentration (1,11)
Important to know:- Lacosamide is reserved for treatment resistant focal onset epilepsy and treatment resistant status epilepticus when usual therapy has failed or is not appropriate.- Neurology must be consulted before initiating lacosamide for a patient- A baseline ECG is required before initiation of lacosamide
References1. Takemoto C (ed.) Pediatric Dosage Handbook. 17th
edition. Lexi Comp Inc. Cleveland: 20102. Ben-Menachem E et al. Efficacy and safety of oral
lacosamide as adjunctive therapy in adults with partial-onset seizures. Epilepsia 2007;48:1308-17
3. Chung S et al. Lacosamide as adjunctive therapy for partial-onset seizures: a randomized controlled trial. Epilepsia 2010;51:958-67
4. Gavatha M et al. Efficacy and tolerability of oral lacosamide as adjunctive therapy in pediatric patients with pharmacoresistant focal epilepsy. Epilepsy Behav 2011;20:691-3
5. Guilhoto LM et al. Experience with lacosamide in a series of children with drug-resistant focal epilepsy. Pediatr Neurol 2011;44:414-9
6. Heyman E et al. Preliminary efficacy and safety of lacosamide in children with refractory epilepsy. Eur J Paediatr Neurol 2012; 16: 15-19
7. Halasz P et al. Adjunctive lacosamide for partial-onset seizures: efficacy and safety results from a randomized controlled trial. Epilepsia 2009;50:443-53
8. Jain V. Treatment of refractory tonic status epilepticus with intravenous lacosamide [Letter to the editor]. Epilepsia 2012; 53(4): 761-764.
9. Hofler J, Unterberger I, Dobesberger J, et al. Intravenous lacosamide in status epilepticus and seizure clusters. Epilepsia 2011;10:148-52.
10. Fountain NB et al. Safety and tolerability of adjunctive lacosamide intravenous loading dose in lacosamide-naïve patients with partial-onset seizures. Epilepsia 2012 (accepted 23 Apr 2012).
11. Product Information: VIMPAT ® tablets and solution for injection, 2011. Hospira.
Lacosamide for Treatment Resistant Focal Epilepsy & Treatment Resistant Status Epilepticus
Laura Carney, B.Sc.(Pharm.), ACPRReviewed by Dr. Mary Connolly, Clinical Professor, Dept of Pediatrics, UBC and Head Division of Pediatric
Neurology
BackgroundVoriconazole (Vfend®) is a broad-spectrum triazole antifungal agent with activity against yeast and moulds (1). Its primary mechanism of action is the inhibition of fungal cytochrome P450-mediated 14α-sterol demethylation. Interruption of this process inhibits cell membrane ergosterol synthesis, which alters membrane permeability resulting in cell lysis and death. Voriconazole is fungistatic against Candida species including glabrata and krusei and fungicidal against Aspergillus species. Approved indications by Health Canada include (1):- Invasive aspergillosis (adults)- Candidemia in non-neutropenic (adult) patients- Disseminated Candida infections of the skin, abdomen, kidney, bladder wall, and wounds (adults)
Effectiveness and safety of voriconazole in pediatric subjects less than 12 years of age has not been established (1). In Europe, voriconazole has been approved for children who are at least 3 years of age or older for a variety of fungal infections (2). Despite these age restrictions, voriconazole has been used in children of all ages, including neonates (3-5).
Most common adverse effects include transient visual disturbances, potential toxicity to the developing retina, elevated hepatic enzymes, skin photosensitization, and rash.
Please refer to the BCCH Drug Dosage Guidelines for recommended doses.
Therapeutic Drug Monitoring (TDM) Majority of the pharmacokinetic data in children are derived primarily from un-randomized observational literature in the form of retrospective chart reviews or case reports/series that collected plasma trough or random voriconazole levels or is extrapolated from adult literature. TDM assumes that plasma drug concentrations serve as a mirror of tissue drug concentrations at the receptor site/site of infection (7). There are four primary characteristics of drugs that may
warrant TDM (7):- The drug displays inter-patient pharmacokinetic variability- The drug has a narrow therapeutic range- There is a definable relationship between dose and plasma/blood concentration and between concentration and therapeutic effects and/or toxicity- The drug’s pharmacologic response cannot be readily/easily assessed
Inter-patient Pharmacokinetic Variability Reports in adults suggest inter and intra-patient voriconazole pharmacokinetic variability, which has lead to investigations regarding the role of TDM (8,9). Similar investigations have trickled down to the pediatric population, as well. There currently are no formal or validated TDM guidelines for pediatric patients (10). There are multiple factors that influence inter and intra-patient pharmacokinetic parameters, including, age, gender, genetic polymorphisms (primarily with CYP2C19), disease state (e.g. hepatic dysfunction), variable absorption of oral formulations and administration with food, saturable metabolism, auto-induced metabolism, and drug interactions (9,11). Walsh et al demonstrated a difference in kinetic properties between adults and children when they administered a standard dose of voriconazole (3-4 mg/kg IV every 12 hours). This difference was attributed to children having greater elimination capacity of voriconazole per kilogram of body weight compared to adults (12). Children may exhibit enhanced systemic metabolism and greater first pass effect with higher hepatic blood flow. When higher doses (example 7 mg/kg IV every 12 hours) were administered to children from 2-12 years of age, they demonstrated similar kinetics as adults, likely due to saturable metabolism. Other studies have demonstrated variability in plasma concentrations achieved between patients when similar empiric dosing was implemented, amongst critically ill children, and children less than 3 years of age (3,13,14).
Voriconazole Therapeutic Drug Monitoring: Weighing the Pros and Cons In Pediatrics Patients
Maria Paiva (PharmD student)Reviewed by Kendra Sih (Clinical Pharmacist, PharmD)
Narrow Therapeutic Range (TR)The most common TR targeted is a voriconazole trough level between 1-6 mg/L (8). This range has been extrapolated from the adult population and from studies that were not designed to define a TR. Lewis et al comment that most data regarding the TR is based on small, retrospective, single center studies, which limits the robustness and generalizability to various patient populations, with different comorbidities (especially immune status), type and site of fungal infection, and prophylaxis or treatment regimens (15).
A Definable RelationshipLow voriconazole trough concentrations have been associated with treatment failures and high concentrations with various types and severity of toxicity. The TR for voriconazole trough concentrations range from 0.25-9 mg/L (10). Within this span, treatment failure and toxicity has been observed, making defining a range and appropriate interpretation of plasma levels with subsequent dose adjustments in various clinical situations a challenge. Prospective validation of a TR is still needed.
Assessing Pharmacologic Response Health care professionals use a combination of clinical, laboratory, radiological, and diagnostic indices to assess a patient’s response to anti-infective therapy and TDM is often not required. Challenges in assessing response to therapy may arise when the host is immunocompromised, common to patients who develop fungal infections that require voriconazole therapy. Due to the slow growing nature of fungi, prolonged durations of treatment are typically indicated. It has been proposed that when surrogate markers of response such as resolving leukocytosis or defervescence cannot be trended, drug concentrations may be used as an intermediate end point to guide therapy (10). In this context, there may be a role for TDM of voriconazole in immunocompromised pediatric patients, however, as previously mentioned, the TR range of 1-6 mg/L has not been prospectively validated. In addition, the drug concentration must always be interpreted in conjunction with the clinical situation. It has also been debated that the majority of voriconazole toxicities one would hope to prevent with TDM can be assessed by other means such as liver function tests for hepatotoxicity, ECG monitoring for QT prolongation, and regular screening for visual disturbances, thus negating the need for voriconazole drug levels.
ConclusionThere are a variety of practices regarding voriconazole TDM ranging from routine troughs to random sampling. Chen et al composed a checklist of situations that may warrant a voriconazole trough level, including (10): - Initiation of therapy (once at steady state)- Post dosage adjustment- Change in patient’s physiological state- Interacting drugs administered concomitantly- Change in route of administration from oral to IV (or vice versa)- Suspicion of non-adherence - Risk factors predisposing patient to variable pharmacokinetics, such as poor or rapid metabolizer of CYP2C19
Variable inter and intra-patient pharmacokinetics have been demonstrated in the pediatric population. It is debatable that voriconazole has a narrow TR as multiple investigators have come to different conclusions regarding the upper and lower thresholds. It may also be premature to conclude that a predictable and consistent relationship exists between dose and plasma concentration and between concentration and therapeutic effects and/or toxicity. TDM may provide another piece of data in monitoring patient response in the immunocompromised patient, but it is not a universally implemented practice.
The literature is grey regarding the necessity of voriconazole TDM as well as its utility, due to mixed results that it improves cure rates or survival or reduces adverse events. The majority of trials are retrospective with inherent methodological limitations, include a wide age range of pediatric patients with inherent pharmacokinetic differences, as well as a variety of fungal infections treated with combination antifungal therapy that differs from the Canadian approach. Until more evidence is gathered and the TR is validated, voriconazole TDM should be assessed on a case-by-case basis and when a plasma concentration will ultimately influence clinical decision-making.
[online] Retrieved from: www.etherapeuticsca.ezproxy.library.ubc.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=voriconazole [Accessed: 30 Oct 2012].
2. Leveque D, Nivoix Y, Jehl F, et al. Clinical pharmacokinetics of voriconazole. Int J Antimicrob Agents. 2006;27:274–284.
3. Santos RP, Sanchez PJ, Mejias A, et al. Successful medical treatment of cutaneous aspergillosis in a premature infant using liposomal amphotericin B, voriconazole and micafungin. Pediatr Infect Dis J. 2007;26: 364–366.
4. Walsh TJ, Lutsar I, Driscoll T, et al. Voriconazole in the treatment of aspergillosis, scedosporiosis and other invasive fungal infections in children. Pediatr Infect Dis J. 2002;21:240–248.
5. Muldrew KM, Maples HD, Stowe CD, et al. Intravenous voriconazole therapy in a preterm infant. Pharmacotherapy. 2005;25:893–898.
6. Dodds, A. et al. (2006). Pharmacology of Systemic Antifungal Agents. Clinical Infectious Diseases, 43 pp.S29-38.
7. Kang, J. et al. (2009). Overview of Therapeutic Drug Monitoring. Korean Journal of Internal Medicine, 24 (1), pp.1-10.
8. Bruggemann RJ, Donnelly JP, Aarnoutse RE, et al. Therapeutic drug monitoring of voriconazole. Ther Drug Monit. 2008;30:403–411.29.
9. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–535.
10. Chen, J. et al. (2012). Therapeutic drug monitoring of voriconazole in children. The Drug Monit, 34 (1), pp.77-84.
11. Neely M, Rushing T, Kovacs A, et al. Voriconazole pharmacokinetics and pharmacodynamics in children. Clin Infect Dis. 2010;50:27–36.
12. Walsh TJ, Karlsson MO, Driscoll T, et al. Pharmacokinetics and safety of intravenous voriconazole in children after single- or multiple-dose administration. Antimicrob Agents Chemother. 2004;48:2166–2172.
13. Bruggemann RJ, van der Linden JW, Verweij PE, et al. Impact of therapeutic drug monitoring of voriconazole in a pediatric population. Pediatr Infect Dis J. 2011;30:533–534.
14. Alffenaar JW, Doedens RA, Groninger E, et al. High-dose voriconazole in a critically ill pediatric patient with neuroblastoma. Pediatr Infect Dis J. 2008;27:189–190.
15. Lewis, R. (2008). What is the therapeutic range for voriconazole . Clinical Infectious Diseases, 46 (2), pp.212-214.
FDA Communication regarding Safety of Sildenafil (Revatio®) in Children
Karen Ng (Pharm D Student) and Alison MacDonald, BSc PharmReviewed by Dr. Martin Hosking, Cardiology
On Aug 30 2012, the FDA raised safety concerns regarding the off label use of sildenafil (Revatio® from Pfizer) in children with pulmonary arterial hypertension(1). As a result the FDA has notified health care professionals in the US not to prescribe sildenafil to children 1-17 years of age.
The above decision was based on information from the STARTS-1 study, which was published in 2011. Their primary objective was to assess the efficacy of sildenafil monotherapy in children, 1-17 years of age, with either idiopathic or hereditary pulmonary arterial hypertension (PAH) or pulmonary arterial hypertension associated with congenital heart disease (APAH group) (2). The study was a double-blind, placebo controlled, parallel group, multi centre, dose ranging study. Patients were either randomized to placebo or sildenafil low dose (10 mg po TID), medium dose (20 mg po TID) or high dose (40 mg po TID) for 16 weeks. A total of 106 patients, who were developmentally able to complete exercise testing, were analyzed for the primary outcome. No statistically significant difference in peak oxygen consumption (pVO2) was found for low, medium, high or combined treatment group versus placebo indicating that sildenafil did not improve exercise capability in children regardless of dose.
For secondary and tertiary outcomes, 234 patients were included with respect to hemodynamics and functional class. Statistical significance was shown in a decrease in pulmonary vascular resistance index (PVRI) in the medium, high and combined treatment groups and an increase in cardiac index in the high dose group. The most frequent adverse events reported were headache (13%), pyrexia (12%), upper respiratory tract infection (12%) and vomiting (11%).
STARTS-2 was an extension study of STARTS-1 with the primary objective of assessing safety and tolerability of long-term treatment with oral sildenafil monotherapy. This was an open label, observational, multi centre, dose ranging study without a placebo group and followed patients from STARTS-1. A total of 229 patients were followed for a mean duration of 3 years (range 0-7 years). Patients from the STARTS-1 were maintained on their same blinded dose. Placebo patients from STARTS-1 were randomized to receive low, medium or high dose sildenafil. Kaplan-Meier survival estimates from day 1 of treatment were analyzed using a last observation carried forward approach up until June 2011. Patients randomized to the high dose had an overall increased mortality at 3 years compared to lower dose groups. Most patients died from disease progression. This extension study did not account for severity of disease at enrollment. The 5 year follow up was not a predefined end point and not everybody carried forward to 5 year. Patients lost to follow up were not reported.
A recent Consensus statement released by the Scientific Leadership Council noted the majority of deaths were in the group who had idiopathic or hereditable PAH, with 74% of deaths. Patients with pulmonary arterial hypertension in the congenital heart disease group (APAH) and those who weighed less than 20 kg were not shown to have increased mortality. However, overall survival rates for treatment groups were favorable compared with historical controls (3 year survival in patients on low dose was 91%). Other risk factors for increased mortality were a higher pulmonary artery pressure and PVRI at baseline. All patients being treated with sildenafil in STARTS-1 had higher mean pulmonary artery pressure, PVRI and right atrial pressure percentage numbers above the median compared with the placebo group, which may have had less severe disease. STARTS-2 was not designed or powered for mortality outcomes.
So far, Health Canada has not issued any such warning. The Pediatric Pulmonary Hypertension Network (PPHNet), a group of specialists from the major pediatric centers across North America are not in agreement with the FDA recommendation (4). However, they have decided to recommend the following doses of sildenafil as a precaution until more information is available:
In children weighing more than 45 kg, the sildenafil 40 mg dose is no longer recommended, rather dual therapy should be considered in patients who are not improving on the suggested maximum doses of sildenafil 20 mg po TID. If sildenafil therapy is to be discontinued, they remind clinicians that a weaning schedule is required and that the drug not be discontinued abruptly.
References1) www.fda.gov/Safety/MedWatch/SafetyInformation/2) Barst RJ, Ivy DD, Gaitan G, et al. A randomized,
double-blind, placebo-controlled, dose-ranging study of oral sildenafil citrate in treatment-naïve children with pulmonary arterial hypertension. Circulation 2012;125:324-334
*Update – BACID® content* in Pharmacy Informer Summer 2011
Edition
For the article Probiotics for the Prevention and Treatment of Antibiotic Associated Diarrhea - the probiotic available in hospital, Bacid® capsules contains: Lactobacillus rhamnosus H1101 (1 billion CFU/capsule).
ResearchKiang TKL, Schmitt V, Ensom MHH, Chua B, Häfeli UO. Therapeutic Drug Monitoring in Interstitial Fluid: A Feasibility Study Using a Comprehensive Panel of Drugs. J Pharm Sci. 2012 Aug 31. doi: 10.1002/jps.23309. [Epub ahead of print]
Kiang TKL, Sherwin CM, Spigarelli MG, Ensom MHH. Fundamentals of Population Pharmacokinetic Modelling: Modelling and Software. Clin Pharmacokinet. 2012;51:515-25.
Sherwin CM, Kiang TKL, Spigarelli MG, Ensom MHH. Fundamentals of Population Pharmacokinetic Modelling: Validation Methods. Clin Pharmacokinet. 2012;51:573-90.
Tulloch J, Carr RR, Ensom MHH. Pharmacokinetics of Antiepileptic Drugs in Neonates with Refractory Seizures: A Systematic Review. Journal of Pediatric Pharmacology and Therapeutics. 2012;17:31-44.
Ng K, Mabasa VH, Chow I, Ensom MHH. Systematic Review of Efficacy, Pharmacokinetics and Administration of Intraventricular Vancomycin in Adults. Neurocrit Care. 2012 Oct 23. [Epub ahead of print] DOI 10.1007/s12028-012-9784-z.
Shiu JR, Ensom MHH. Dosing and Monitoring of Methadone in Pregnancy: Literature Review. Can J Hosp Pharm. 2012;65:380-6.
AwardsMs. Laura Carney is the recipient of the 2012/2013 Canadian Society of Hospital Pharmacists (CSHP) BC Branch Pharmacy Practice Residency Award for “The Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit”.
Ms. Laura Carney, Dr. Jennifer Kendrick and Dr. Roxane Carr are the recipients of the CSHP 2012/2013 Pharmacotherapy Best Practices Award for “The Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit”.
Ms. Kathleen Collin received the Lower Mainland Pharmacy Services – Pharmacy Practice Residency Program (UBC) 2012 Veteran Preceptor of the Year Award.
Dr. Mary Ensom is the recipient of the American Society of Health-System Pharmacists – Research and Education Foundation’s 2012 Award for Sustained Contributions.
Dr. Jennifer Kendrick received the Lower Mainland Pharmacy Services – Pharmacy Practice Residency Program (UBC) 2012 New Preceptor of the Year Award.
PublicationsQuaia, C. A Bitter Pill to Swallow. Positive Living Magazine. 2012;80:19.
Brand Change Alert: Pediatric Hepatitis B Vaccine
Spencer Tuttle, Pharmacy Distribution Supervisor Reviewed by Eva Cho, BSc Pharm, ACPR
The C&W Pharmacy supply of pediatric hepatitis B vaccine has been changed from Recombivax® to Engerix-B®. Please note the difference in concentration between the products.
The BC Centre for Disease Control has confirmed that despite the difference in concentration between each product, Engerix-B® 10 mcg/0.5 mL is considered interchangeable and equivalent to Recombivax® 5 mcg/0.5 mL. Engerix-B® is also a thimerosal-free preparation.
This change has been implemented, and all remaining stock of Recombivax® has been removed from the hospital site. All orders for pediatric heptatis B vaccine will now be supplied as Engerix-B® 10 mcg/0.5 mL.
