June new final update 2011.pub

June 2011
Volume 3 Issue 4
Express Scripts Drug Information & Wellness Center
Drug Information Updates
National Safety Month:
Special points of interest:
Summer Safety - Be cautious of medications that cause photosensitivity!
 National Safety Month
 Absorption of photons from the sun’s rays (or any major wave source) send some drugs into an “excited” state. This can lead to either free radicals or energy transfer, thus causing either molecu-  New Formulations and Indications
lar change, photooxidation, or toxic reactions. The result is damage to critical cell areas and pho- totoxicity. A list of common medications that can lead to phototoxicity is on page 4. Remind your  New Generic Approvals
patients taking these medications to use extra caution in the summer sun!
 Newly Approved Drugs
New Formulations and Indications:
 Drug Information Question
Lotemax (loteprednol 0.5% ophthalmic ointment) by Bausch and Lomb
Class: Ophthalmic Corticosteroid
 Meds that cause Phototoxicity
Indication: For post-operative inflammation and pain of the eye. MOA: Prevent or suppress inflammation and immune responses. Doses Available: 0.5% ointment in a 3.5 gram tube
Zyclara (imiquimod 3.75% cream) by Graceway
Class: Immune Modulator
Indication: New lower strength cream for actinic keratoses and genital warts.

Banzel (rufinamide oral suspension) by Eisai
Class: Anticonvulsant
Indication: New oral solution formulation for adjunctive treatment of seizures associated with Lennox- Gastaut syndrome (LGS) in children 4 years and older and adults MOA: Uknown. Suggested that it modulates the activity of sodium channels and subsequently prolongs Doses Available: Oral suspension, 40 mg/mL
AndroGel (testosterone 1.62% topical gel) by Abbott
Class: Androgen
Indication: new concentrated formulation for hypogonadism MOA: Replacement of androgen responsible for promoting the growth and development of the male sex organs and maintaining secondary sex characteristics in androgen-deficient males Doses Available: Topical gel 1.62% or 1% June is National Safety
Month. Help others stay safe!
Zutripro (Hydrocodone/chlorpheniramine/pseudoephedrine oral solution) by Cypress
Class: Combination antitussive, antihistamine and decongestant
Indication: New combination for the relief of cough and nasal symptoms associates with the common MOA: Hydrocodone is believed to act on the cough center; chlorpheniramine is an H1-receptor antagonist, and pseudoephedrine is a sympathomimetic amine causing a decongestive effect Doses Available: Oral solution, 5 mg/4 mg/60 mg
New Generic Approvals:
GENERIC
Letrozole tablets— Available (5/11)
Triamcinolone Acetonide nasal spray – Tentative Approval (6/11)
Volume 3 Issue 4
Express Scripts Drug Information & Wellness Center
Newly Approved Drugs
Dificid (fidaxomicin) tablet by Trovis (approved 05/11)
Sylatron (peginterferon alfa-2b) suspension by Merck (approved 03/11)
Class: antiinfective—antiviral; interferon Indication: Clostridium difficle-associated diarrhea Indication: chronic hepatitis C and for the adjuvant treatment of melanoma MOA: bactericidal macrolide antibiotic derived from fermentation of Actinomycete Dactylo- MOA: suppression of cell proliferation, antiviral activity, and immunomodulating effects, sporangium aurantiacum, and is primarily active against Clostridia species including Clos- such as augmentation of macrophage phagocytic activity tridium difficile via inhibition of RNA polymerases Interactions: risk of serious depression, with suicidal ideation and completed suicides, and Dosing: 200 mg ORALLY twice daily with or without food for 10 days other serious neuropsychiatric disorders are increased Dosing: 1.5 mcg/kg/week SUBQ with ribavirin 400 mg orally twice daily for 48 weeks in all Edurant (rilipivirine) tablets by Tibotec (approved 05/11)
Class: Anti-infective agent; non-nucleoside reverse transcriptase inhibitor (NNRTI) Indication: antiretroviral treatment-naive adults with HIV-1 infection Duexis (famotidine/ibuprofen) by Horizon Pharmaceuticals (approved 04/11)
MOA: inhibits HIV-1 replication by non-competitive inhibition of HIV-1 reverse transcriptase Indication: rheumatoid arthritis and osteoarthritis and to decrease the risk of developing (RT) Interactions: CYP3A4 inhibitors/inducers, NNRTIs, drugs that increase gastric pH MOA: famotidine: inhibits the binding of histamine to H2-receptors on the gastric basolat- Dosing: 25 mg oral y once daily with a meal eral membrane of parietal cells, reducing basal and nocturnal gastric acid secretions; ibuprofen: competitively inhibits both cyclooxygenase (COX) isoenzymes, COX-1 and COX -2, by blocking arachidonate binding resulting in analgesic, antipyretic, and anti- Incivek (telaprevir) tablet by Vertex Pharm. (approved 05/11)
Class: Anti-infective agent; Anti-hepatitis agent Indication: genotype 1 chronic hepatitis C infection Black-box warning for patients with cardiovascular disease and with gastrointestinal issues MOA: Direct renin inhibition, calcium channel blockade, dieresis (ie. Myocardial infarction, GI bleed, anticoagulant therapy, GI perforation) Dosing: 750 mg orally 3 times daily (every 7—9 hours) in combination with peginterferon Afinitor (everolimus) tablets by Norvartis (approved 05/11)
Tradjenta (linagliptin) tablet by Boehringer Ingelheim (approved 05/11)
Class: Antidibetic Agent ; Dipeptidyl Peptidase-4 Inhibitors MOA: inhibits the mammalian target of rapamycin (mTOR), a serine-threonine kinase, downstream of the PI3K/Akt pathway. The mTOR pathway has been shown to be dysregu- lated in several cancers resulting in tumor cell growth and proliferation MOA: selectively and reversibly inhibits dipeptidyl peptidase-IV (DPP-IV) to slow the inacti- Interactions: CYP3A4 inhibitors Zytiga (abiraterone) by Centocor Ortho Biotech (approved 04/11)
Victrelis (boceprevir) capsule by Merck (approved 05/11)
MOA: inhibits 17 alpha-hydroxylase/CYP17, which is used for androgen biosynthesis Indication: chronic hepatitis C infection (genotype 1) MOA: inhibits replication of HCV in host cells by binding to the NS3/4A protease of hepati- Dosing: 1,000 mg administered oral y once daily in combination with prednisone 5 mg Interactions: inducers of CYP3A4/5, such as carbamazepine, may lead to decreased boceprevir plasma concentrations and loss of virologic response Potiga (ezogabine) by Valeant Pharmaceuticals (approved 06/11)
Dosing: 800 mg orally three times daily (every 7—9 hours). Vandetanib tablets by AstraZeneca (approved 01/11)
MOA: reduces excitability through the stabilization of neuronal potassium channels in an Class: Antineoplastic agent: Signal Transduction Inhibitors (STIs) Dosing: 300 mg/day as starting dose, then up to 600-1200 mg/day Indication: symptomatic or progressive medullary thyroid cancer in patients with unresec- table locally advanced or metastatic disease MOA: inhibits epidermal growth factor-stimulated receptor tyrosine kinase phosphorylation in tumor cells and endothelial cells and VEGF-stimulated tyrosine kinase phosphorylation in endothelial cells Interactions: CYP3A4 inducers, prolonged QT syndrome Dosing: 300 mg daily Volume 3 Issue 4
Express Scripts Drug Information & Wellness Center
Recent Guideline Updates
American Academy of Neurology
Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American
Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medi-
cine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2011 April
http://www.neurology.org/content/early/2011/04/08/WNL.0b013e3182166ebe  Clinical Practice Recommendations for 2011. Revisions were made to the guidelines stating that pregabalin is now the preferred recommen- dation for diabetic neuropathy, considering it has better quality of studies than other diabetic peripheral neuropathy medications. Drug Information Question
Are there any reports of carpel tunnel syndrome related to pharmacy job
roles, specifically technicians? Also, are there any studies regarding the inci-
dence or ways to prevent carpel tunnel?

A search was conducted through PubMed, the American Academy of Orthopaedic Surgeons, specifically the carpal tunnel guidelines, and the US Deparment of Labor Bureau of Labor Statistics. Carpal tunnel syndrome is classified as compression neuropathy of the median nerve at the wrist. This causes increased pressure and results in a decreased function of the nerve. Carpal tunnel may be caused by various dis- eases, conditions or events. This disorder may affect various patients unrelated to age, gender, ethnicity, or occupation; however it is associated with systemic disease, local mechanical and other disease factors.1 Based on our findings, there was no information directly linking pharmacy related job roles with carpel tunnel syndrome. However, the nature of pharmacy related jobs may create a risk for the development of upper extremity disorders, due to repetitive movements, unnatural posi- tions of the hands and wrists and the strong gripping of pharmacy products.2 An important key consideration is that multiple factors, including: manual labor (especially repetitive tasks), individual co-morbidities and other personal factors can increase a patient’s risk of developing carpal tunnel syndrome. Manual labor examples specific to pharmacy may include opening bottles and jars, preparing batch syringes and IV bags, type/order entry, and preparing prescription vials. Personal factors and co- morbidities include diabetes, arthritis, hypothyroidism and gout.2

Carpal tunnel may be present if anyone is experiencing pressure or pain in their wrists. Prevention strategies include having correct posture, sufficient rest breaks and stretching, and utilizing properly fitted work spaces. The recommended posture is keeping the shoulders relaxed, no twisting or bending the head to the side, elbows and wrists kept in a straight position, and feet should remain on the stool rung or the floor to alleviate any lower back stress. Work stations should be fitted to the physical statue of the individual worker, to help avoid any unnatural positions or straining and to rotate jobs among workers. Frequent breaks are recommended, as well as the use of cold packs and nonsteroidal anti- inflammatory medications to reduce swelling.2 Below is a list of suggestions to help avoid carpel tunnel syndrome: 3 Chair, armrests causing problems ensure that the chair is adjustable and has armrests that can be removed or added, depending on the individual and the procedure being performed gloves that are too tight can cause unnecessary pressure in the wrist area. Wear the correct glove size to avoid cumulative injury to the wrist and hand maintain wrists in a neutral position; ensure good ergonomic setup at all stations break up tasks into more manageable pieces, take regular breaks, and reduce the speed and try to reduce time spent preparing syringes; rotate preparation among a number of staff; use a peristaltic pump to help with procedures consider an ergonomic assessment to optimize workflow do mental checks to self-monitor posture maintain a healthy, active lifestyle outside work hours 1.Clinical Practice Guideline of The Diagnosis of Carpal Tunnel Syndrome [Internet]. American Academy of Orthopaedic Surgeons; 2007 May. 2.Ashe M. Carpal Tunnel Syndrome in the Pharmacy. (2004) Canadian Pharmaceutical Journal, 137 (8), pp. 24-25. 3.Carpal Tunnel Syndrome Fact Sheet [Internet]. National Institute of Neurological Disorders and Stroke; 2002 Nov. Accessed 2001 May 23 <http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm> . Volume 3 Issue 4
Southern Illinois University Edwardsville      Meds that Cause Phototoxicity 
The following table is not all inclusive. For a complete list, see “Drug-Induced Photosensitivity”1 by Kelly M. Shields, Pharm.D., available through Pharmacist’s Letter. 1.Shields, KM. Drugs that increase photosensitivity. Pharmacist’s Letter/Prescriber’s Letter 2009;25(6):250-606. Therapeutic Class
Examples of Drugs
Therapeutic Class
Examples of Drugs
Antihistamines
Analgesic Agents
Antibiotics
Skin Agents
Cardiovascular
Antidiabetic Agents
Vitamins and
Supplements
Antidepressants
Antipsychotics
Hormones

Source: http://www.siue.edu/pharmacy/about/druginformation/pdf/June_2011.pdf