HOSPITAL FORMULARY

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 Definition  Origin  Advantages  Disadvantages  Guidelines  Pre-requisites  Preparation  In case of change in formulary  Types of formulary  Examples  Our Responsibilities  References

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The hospital formulary is a list of pharmaceutical agents with its important information’s which reflects the current clinical views of the medical staff. The hospital formulary system is a method whereby the medical staff of a hospital with the help of pharmacy and therapeutic committee selects and evaluate medical agents and their dosage form which are considered to be most useful in the patient care. The hospital formulary system provides the information for procuring prescribing dispensing and administering of drugs under nonproprietary or proprietarybrandsnames in instances where drugs have both names

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The first scientific hospital formulary in India was published in 1968 by the pharmacy department of CMC Vellore. The first HF for a government teaching hospital in India was published in 1997 at Govt. Medical college Trivandrum.

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Increasing complexity of untoward effects of modern potent drugs . The increasing no. of new drugs manufactured and marketed by drug companies. Newer sales promotion strategies of pharmaceutical industry. The public interest in getting possible health care at lowest possible cost.

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Deprive the physician of his right and privilege to prescribe and obtain the brand of his choice. Permits the pharmacist to act as the sole judge of which brands of drugs to be purchased dispensed.

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A multidisciplinary PTC is appointed for organization of various hospital day to day activities. The formulary system shall be sponsored by the medical staff based upon the recommendations of the PTC. The medical staff should adopt the principles of the system to the needs of the particular institution. The PTC shall adopt written policies procedures governing the formulary system.

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Non proprietary names should be included in the formulary. Limiting the number of drug entities and drug products routinely available from the pharmacy can produce substantial patient care and financial benefits. The formulary system is informed to the entire medical and nursing staff. The pharmacist shall be responsible for the specification as to the quality source of supply of all drugs chemicals biological pharmaceutical preparations.

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Establish a formulary committee Establish and secure agreement on content structure and format of the formulary Appointing an editor Reviewing the draft Revise and produce new editions

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Acknowledgement List of abbreviations Intended usage of the formulary manual

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 Generic Name Dosage Form Strength  Indications  Pharmacological Actions  Precautions  Side effects  Dosage Form – Frequency  Instructions  Drug Interactions

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 Price  Regulatory Category  Storage Guidelines  Patient Counselling Information  Brand Names

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 Principles of prescription writing  Name and address of the patient  Prescribed drug should be written in formulary terminology  Strength of prescribed medication must be given in accepted metric system  Correct dispensing guidelines  Prevention and Reporting of ADRs

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 Use of IV drugs  Special situations like pregnancy breastfeeding liver/kidney diseases  Poisoning information and Antidotes  Treatment of snake bites and insect bites

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 Children’s dose  Renal adjustments  Metric units  Diagnostic aids

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 Pharmacist decides the format before commencing work on printing and publishing in the hospital.  He has to collect formularies of some leading hospitals as well as their format.  Copies of finally published formulary may be sent to bodies like directorate general of health services Govt of India PCI etc.

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 It is sufficiently small in size so that it could be easily carried by clinicians nurses etc in the pockets of their uniform or lab coats.  The hospitals may determine their own size of the formulary.

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 Loose leaf or Bound  Printed or Mimeographed  Indexing and Assigning categories

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SECTION 1 PSYCHIATRIC MEDICINES 1.1-ANTI PSYCHOTICS Dopamine Receptor Antagonist a Typical Antipsychotics: 1. Haloperidol Tab 5 mg 10 mg Inj 5 mg / ml depot inj 100 mg deconate Liquid 2 mg / ml 2. Chlorpromazine Tab 25 mg 100 mg Inj 50 mg/ 2ml 3. Trifluoperazine Tab 5 mg 4. Flupenthixol Tab 0.5 mg 1 mg 3 mg Depot Inj 20 mg /1ml 40 mg / 2ml 100 mg / 1ml 5. Zuclopenthixol Tab 10 mg 25 mg Accuphase Inj 50 mg 100 mg Depot 200 mg / ml 6. b Fluphenazine Decanoate Inj 25 mg / ml Depot Atypical Antipsychotics: 1. Risperidone Tab 1 mg2 mg3 mg 4mg Oral solution 1 mg / ml

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2. Olanzapine Tab 5 mg10 mg 3. Quetiapine Tab 25mg100 mg 200mg 4. Clozapine Tab 25 mg 100 mg 5. Levosulpiride Tab 25 mg 50 mg 100 mg 6. Aripiprazole Tab 15 mg 7. Ziprasidone Tab 20 mg 40 mg 60 mg Cautions: CNS depression hepatic impairment renal impairment cardiovascular disease parkinson’s disease epilepsy prostatic hypertrophy pregnancy and breast feeding. General Recommendation: Prescribing of more than one antipsychotic at same time is not recommended. Neuroleptic malignant syndrome is a rare but potentially fatal side effect of some drugs. Discontinuation of antipsychotic drugs is essential because there is no proven effective treatment but cooling bromocriptine has been used.

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 Drug selection  Promoting formulary adherence  Review and take action on all non-formulary drug use in the hospital.  Provide a copy of the hospital formulary to all doctors in the hospital.  Involve the medical staff in various formulary implementing programs.  Give much advertisement and publicity regarding formulary.  Revision of formulary

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 1. Hospital pharmacy by William E. Hassan JR 5 th edition. Pg no.124-153.  2. A textbook of pharmacy practice by K.G. Revikumar B.D.Miglani . 1st edition.pg no.82.  3. Remington –The science and practice of pharmacy 21st edition volume 2 pg no.2259.  4. Merchant and Qadry’s-A text book of Hospital Pharmacy. Pg no.39-50

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