Pharmacy Pearls


Pharmacy Pearls

These recommendations are to serve as non-peer reviewed guidelines. They have been compiled in response to ongoing clinical questions posed by inpatient medicine services and pharmacy at OHSU. These pearls are based on MD and PharmD clinical experience, and/or treatment guidelines, pharmaceutical product insert information, as well as background resources (i.e. textbooks, UpToDate, review articles). They are not meant to replace sound clinical judgement.

Anticoagulation Cardiovascular
Enoxaparin Guidelines Cardovascular TDM
Enoxaparin Guidelines (Morning Report) CHF and Drugs
Heparin Protocol Role of Beta Blockers in CHF
Management of Elevated INR Treatment of Hypertension
DVT Protocol Hypertension Algorithm in DM Patients
Warfarin Dosing Before Surgery Appropriate Dose of Asprin
Warfarin Initiation Cardiovascular Toxicity of NSAIDs
Warfarin Protocol Key Issues Regarding Dual Therapy (Clopidogrel + Aspirin)
  Myotoxicity of Statins
Critical Care Pharmacotherapy of ADHF
Order Set for Conivaptan  
  Endocrine
Electrolytes Blood Glucose and Steroid Therapy
Issues in the Treatment of Hyperkalemia CHF and Drugs
Drug-Induced Hyperkalemia Differences Among PDE5 Inhibitors
Electrolyte Replacement Protocol DM and ARB
Hyperkalemia DM Drug Class
  Drug-Induced Hypoglycemia
Gastrointestinal Eplerenone
Drugs and LFT's Monitoring Fenofibrate Vs Gemfibrozil
Guidelines for Treatment of C.Difficile Steroids Stress Dose
IBD Agents Thiazolidinedione
NV Non-Cancer Patients Pramlintide (Symlin)
Pruritis In Cholestatic Liver Disease Hypercalcemia Algorithm
Statins and Liver Toxicity Hypertension Algorithm in DM Patients
Treatment of Constipation Treatment of SIADH
Treatment of H.Pylori Fast Acting Insulin
Albumin Use and Paracentesis  
Pegylated Inteferon and Ribavirin Therapy General Care
Rifaximin for Hepatic Encephalopathy Drug-Induced Fever
Prokinetic and Antiemetic Chart Drug Interaction Overview
  Drug Therapy of Hiccups
Hematology NV Non-Cancer Patients
Injectable Iron Preperations Prevention of Contrast-Induces Nephropathy
  Treatment of Constipation
Nephrology Vancomycin Dosing and Monitoring in Adults
Antibiotic Dosing in Renal Imparment Vancomycin (Morning Report)
Colchicine Toxicity Warfarin Protocol
Darbepoetin Perioperative Steroid Coverage
Diuretic Cyanocobalam - Vitamin B12
Drug-Induced Hyperkalemia Smoking Cessation
Electrolyte Replacement Protocol Determination of Tacrolimus Area Under the Curve
OHSU Protocol for Aranesp Amiodarone Monitoring
Prevention of Contrast-Induced Nephropathy Amioglycoside Treatment in Dialysis Patients
HIV Meds and Renal Failure Aspirin Hypersensitive Therapy
Dosing of Anti-Gout Drugs in Renal Disease Drug-Induced QT Prolongation
Antiviral Drug-Induced Kidney Injury ICU Medications
Drug Dosing in CWHD Pharmacologic Properties of Beta Blockers
Treatment of Hepatorenal Syndrome  
Treatment of SIADH Infectious Disease
Clinical Review of Diuretic Agents Anti-TB
Effects of Drugs on RAS Antibiotic Dosing in Renal Imparment
  Anti-Flu Agents
Psych/CNS/Neuro Azole Cross-Resistance
Anticonvulsants TDM  
Benzodiazepine Drug Withdrawal Taper Daptomycin
Comparison of Duloxetine & Other Commonly Used Antidepressants Drug-Induced Fever
Drugs for the Treatment of Insomnia Drugs for the Treatment of Flu
Heroin Addiction Fluoroquinolone
Important Notes About Phenytonin Dosing Foscarnet
Monitoring the Metabolic Effects of Atypical Antipsychotics Oral TMP-SMX for MRSA Infections
Side Effects of Atypical Anti-Psychotic Agents Penicillin P and B (Drug Labeling & Safety)
Steroid-Induced Psychosis Steroids Stress Dose
Medications for Depression in the Elderly Tobramycin Guideline
  Tobramycin - OHSU Hospital and Clinics
Pain Management Vancomycin Dosing and Monitoring in Adult Patients
Appropriate Use of COX-2 Vancomycin (Morning Report)
Methadone Conversion Aminoglycoside Dosing Guideline
Morphine to Fentanyl Patch Cystic Fibrosis Tobramycin Dosing Guidelines
Treatment of Constipation Monitoring TB Medications
Treatment of Neuropathic Pain Comparison of Anti-Viral Drugs for HVB Invection
Treatment of Opioid-Induced Sedation Monitoring Guidelines for Parenteral Antimicrobial Therapy
Appropriate Use of NSAID Echinocandin Antifungals
   
  Pulmonary
  Inhaled Drugs Cost at OHSU
  Steroid-Induced Psychosis
  Tiotropium
  Cystic Fibrosis Tobramycin Dosing Guidelines
   
  Rheumatology
  Appropriate Use of COX-2
  Colchicine Toxicity