Gentian Violet

Gentian Violet, pronounced JEN shun VYE oh let, is a topical antibiotic/antifungal used for the treatment of cutaneous or mucocutaneous infections caused by Candida albicans and other superficial skin infections; external treatment of minor abrasions or cuts. It is not to be confused with Gentamicin. While they might sound similar they definitely don't look similar. Gentamicin is a mostly colorless liquid and Gentian Violet is violet in color. Also, Gentian Violet is not intended for the IV route and could cause serious harm if given IV. Fortunately, following sound-a-like/look-a-like medication safety practices, Gentian Violet is stored separately from the Gentamicin in the cabinet above the sink, also known as the "weird stuff area". Please look here if needed or ask Doug where it is at. Renal and hepatic dosing is not necessary as Gentian Violet absorption does not appear to be significant. Please plan ahead if additional supplies are needed as Gentian Violet is extremely cheap and only one bottle is kept in the pharmacy.

Tikosyn

Per Katie, when a patient comes in on Tikosyn from home, then Pharmacy should not send a dose until an order has been written that it has been cleared by Cardiology. Hospitalists do not have these privileges and it should be somebody from Cardiology.

Muscle Rigidity after Rapid Fentanyl Administration

From Susan's patient case presentation:

Fentanyl, 50-100 x's more potent than morphine, may produce muscle rigidity in particular chest wall rigidity. High doses and/or too rapid administration have been implicated as causal factors. This has also been seen with morphine.

Reversal with naloxone has shown to be effective....but use caution with cardiac patients b/c naloxone can cause changes in cardiovascular hemodynamics. Also, giving too much naloxone or giving it too fast can cause pulmonary edema.

Usual rate of administration of fentanyl IV push is over 5 minutes, diluted 1:1 with normal saline.

All this snow really succs

According to Hospira (Kim Vanvervoog at 800-615-0187 2/16/10 @1455)and the insert, precipitation in the succinylcholine vials should be returned for credit. We had several vials in a flat that looked like those cute-little snow globes you see in the dime store. White fluffy critters floating around and wouldn't go back into solution when warmed in the hand.

Here is something I learned from Matt and Nick:

-Calcium gluconate is more stable than calcium chloride in TPNs.

-One way to decrease risk of precipitation of calcium and phosphorus is to increase the amount of amino acids in the TPN.

-Calcium chloride is usually given via central vein because it is alot more concentrated than calcium gluconate and is therefore more irritating to the veins.

Synagis (palivizumab)

Just a reminder -- Synagis is only approved for children under 2 y/o. Also, for IM injection, if the volume is >1ml it needs to be in 2 syringes for kids.

Calculating Iron IV dose and LBW

I found out this morning when calculating an iron dextran iv dose using the formula in lexi {Dose (mL) = 0.0442 (desired Hgb - observed Hgb) x LBW + (0.26 x LBW)} that LBW is the same as IBW. There is also a calculator for iron dosing in GlobalRph.com that is easier and very helpful.

Redirecting a GE Printer when it goes down!

This is a good thing to do when a label printer goes down and you don't want to have to remember to reprint a label to the right printer. For instance, this will print all labels to the "STAT" printer until reversed. We used this when the label printer queue was hung on Sunday and nobody could fix it.




In GE, pick File, Substitute Printer. A window will open. Select the printer you want to redirect (RxLabel1 for example) and press the Add button. The system will then ask you which printer to use. (STAT in this example.) Press Save to move it to the Unavailable Printers window.


All labels that would normally print on the LABEL printer will now print on the STAT printer.

To remove the redirection just use the Remove button in the same window.

Hope this makes life a bit easier. Much easier than just having to remember to reprint a label!

Diastat

Diastat is available in 3 different forms:
-20mg adult Accudial that provides 12.5 mg, 15 mg, 17.5 mg, and 20 mg doses
-10mg adult/pediatric Accudial that provides 5 mg, 7.5 mg, and 10 mg doses
-2.5/0.5ml prefilled syringe

We only have the 10mg accudial. If you turn past a dose you cannot go backward. Our cost for these are $225. So, if you get a STAT call for one...you may want to ask the dose and dial it up for them. Directions on how to dial the syringe are in the product packaging.

Diastat is dosed 0.5mg/kg for status epilepticus. So as long as the child is 10kg (22lbs) the 5mg dose should be OK. Also, there has been no safety/efficacy studies done in children under 2. If however you need a smaller dose...the parenteral solution can be given rectally.

Propoven 1%

Due to a shortage of Propofol, the FDA has allowed the US market to purchase Propoven (a European propofol). Although the active ingredient is the same, there are some differences in the products.


PROPOFOL 1%
Contains EDTA
Contains Long-Chain triglycerides
US Barcode

PROPOVEN 1%
No Anti-microbial retardant
Contains Medium and Long-Chain triglycerides
Barcode may not be recognized by US scanning systems

See below for detailed information:
http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM190862.pdf

Can Cymbalta be crushed? By Chandaleah

Cymbalta cannot be crushed. However, you may open the capsule and sprinkle on applesauce as long as you keep the little pellets inside the capsule intact. If NG tube, can put it in 30 ml apple juice. Information is in the drawer of knowledge under "meds that cannot be crushed".