HP Newsletter - Hospice Pharmacia
HP Newsletter - Hospice Pharmacia
HP Newsletter - Hospice Pharmacia
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Passionate for the Appropriate Use of Medication 3<br />
<strong>HP</strong>’s Seventh Edition of the Medication Use Guidelines<br />
- Douglas J. Weschules, PharmD, BCPS, VP of Clinical Services<br />
<strong>HP</strong> announces the release of the seventh<br />
edition of the Medication Use Guidelines<br />
(MUGs)! excelleRx has been hard at work<br />
for the past twelve months creating this new<br />
volume, and we cannot wait to place it in<br />
your hands. The workload assumed by the<br />
MUGs committee was the most aggressive in<br />
excelleRx’s history, with over 500 hours spent<br />
in the authorship of guidelines, protocols<br />
and monographs alone. Over 40 different<br />
topics were included in the development<br />
of this seventh edition of the MUGs, 28 of<br />
which were suitable for external review. <strong>HP</strong><br />
sincerely thanks each of the 34 development<br />
clinicians and 11 internal review editors and<br />
staff for rising to this challenge.<br />
The changes associated with the seventh<br />
edition of the MUGs are not limited to just<br />
the review topics themselves, however. The<br />
process associated with MUGs development<br />
also continues to mature every year.<br />
Noteworthy examples of this evolution<br />
this year include the development and use<br />
of guideline templates for Development<br />
Clinicians (authors) to follow, as well as the<br />
grading of evidence associated with these<br />
documents.<br />
So, what will you see in this new edition?<br />
Completely new guidelines include:<br />
• Urinary Incontinence<br />
• Bowel Obstruction<br />
• Failure to Thrive/Debility, Unspecified<br />
New medications and therapy options for<br />
existing guidelines include:<br />
• Roxicodone tablets, 15 and 30 mg<br />
• Valproic acid-based SeizureKit<br />
Additional detail and enhancements have<br />
also been added to the following guidelines:<br />
• Alzheimer’s Disease<br />
• Anxiety<br />
• Agitation<br />
• Congestive Heart Failure<br />
• COPD<br />
• Nociceptive Pain<br />
• Urinary Tract Infections<br />
Many medications were reviewed but not<br />
added to the seventh edition of the MUGs,<br />
either because of a lack of evidence to<br />
support their use in the hospice population<br />
or because MUG alternatives exist that are<br />
comparable and/or more cost effective.<br />
Medications included in the external review<br />
process that were not added to the MUGs are<br />
outlined below by reason:<br />
Not enough evidence to support their<br />
addition to the MUGs:<br />
• Antihypertensives for the palliation of<br />
end stage CVA<br />
• Donepezil (Aricept®)<br />
• Galantamine (Razadyne®)<br />
• Hydromorphone sustained-release<br />
(Palladone®)<br />
• Memantine (Namenda®)<br />
• Nebulized dexamethasone for COPD or<br />
dyspnea<br />
• Nebulized lidocaine for cough<br />
• Pregabalin (Lyrica®)<br />
• Tiagabine (Gabitril®)<br />
• Tiotropium (Spiriva®)<br />
• Valproic acid for the management of<br />
agitation associated with dementia<br />
A comparable MUG medication already exists<br />
and/or is more cost-appropriate:<br />
• Albuterol sulfate/ipratropium bromide<br />
(DuoNeb®)<br />
• Citalopram (Celexa®)<br />
• Clopidogrel (Plavix®)<br />
• Dalteparin (Fragmin®)<br />
• Enoxaparin (Lovenox®)<br />
• Levetiracetam (Keppra®)<br />
• Morphine sulfate sustained-release<br />
capsule (Avinza®)<br />
• Olanzapine (Zyprexa®)<br />
• Torsemide (Demadex®)<br />
• Tramadol (Ultram®)<br />
In addition, the following medications were<br />
reviewed internally, but were not part of the<br />
external review process:<br />
• Acetylcysteine (Mucomyst®)<br />
• Carvedilol (Coreg®)<br />
• Magnesuim oxide (Mag Ox®)<br />
• Oral ketamine (Ketalar®)<br />
• Quinine sulfate<br />
As you can see, the external review process<br />
was robust. Many clinicians from partnering<br />
hospices and programs participated in<br />
this process. The vast majority of external<br />
reviewers agreed that each document they<br />
reviewed provided a thorough analysis of<br />
each topic, a complete literature review, and<br />
agreed with the findings of the author. A few<br />
questions and concerns were highlighted<br />
throughout this process, all of which helped<br />
to influence the MUGs committee’s ultimate<br />
decisions for the seventh edition of the<br />
MUGs. If you are interested in participating<br />
in the external review process in the future,<br />
please let us know!<br />
The Seventh Edition of the MUGs will be<br />
mailed to <strong>Hospice</strong> <strong>Pharmacia</strong> partners in<br />
the next several weeks and will be effective<br />
on November 1st, 2005. Information<br />
regarding the preparatory teleconferences<br />
is available on our website.<br />
If you have any questions regarding the<br />
release of the MUGs, or about any of<br />
its content, please contact the MUGs<br />
committee at MUGs@excellerx.com.<br />
www.hospicepharmacia.com