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Charlotte:
I used to work in a pharmacy, and the pharmacists did not actually consider a PDR to be the best source of information when looking for more info than can be found in the package insert. This is what a pharmacist told me - the PDR is essentially a compilation of package inserts. The drug manufacturer pays to have this information included in the PDR. Often, after a drug is off patent and generics of it are available, the manufacturer will stop paying to have the drug included in the PDR. This is why there are drugs missing from the PDR. (Note that you cannot find "valium" in there, but you can find generics of it.) This is the real reason that pharmacists don't have a lot of respect for the PDR - it is essentially an advertisement, for which not only the advertiser (drug manufacturer) is paying, but also many of the people to whom the drugs are being advertised (those of us purchasing PDRs for reference) also pay. Facts and Comparisons is the standard book that our pharmacy used which included ALL drugs, plus updates. They also used Trissels, especially when seeking additional information about experiences with the drugs.
All this does not mean that the information in the PDR is invalid. The package insert information is very relevant. It just isn't the only information we need at times. Skip using the term "PDR", and just pull the package insert for reference. They cannot ignore it. The FDA didn't (since they have chosen to play "the FDA card").
Leigh Ann
Leigh Ann Bowe-Geddes, RN, CRNI
IV Therapy Specialist
Infusion Services Department
University of Louisville Hospital
Louisville, KY
502-562-3530
>>> "Feckers, Charlotte" <[EMAIL PROTECTED]> 3/2/2006 9:54 AM >>>
Thank you to everyone who came to my rescue what this particular pharmacist is telling me is that the PDR is a terrible source and they done even stock one, they take all of there rec.'s from the FDA. I guess I am not wanting to get into a all out fight. I found it really interesting that from the pharmacy point of view they(or at least this one) don't really care how much it hurts going in or if it is hard on the vessel. Her come back was "we give a lot of meds with worse ph and osmolality then this peripheral" humm what is that saying about two wrongs...
Charlotte Feckers RNCRNI
Waterloo
-----Original Message-----
From: Lynn Hadaway [mailto:[EMAIL PROTECTED]
Sent: Wednesday, March 01, 2006 2:52 PM
To: Feckers, Charlotte; Kilbourne, Susan; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: [vascular] RE: phenergan
It is a good drug, but it is dangerous to give IV. The IV route requires as much attention to careful administration as any antineoplastic drug. Promethazine is a vesicant and the nurse must determine absolute vein and catheter patency before it is given. Also drug literature now recommends that it be given only through an infusing IV fluid.
Here is a link to a newspaper article about a $7.4 million jury award from a promethazine infiltration case.
http://www.timesargus.com/apps/pbcs.dll/article?AID=/20040316/NEWS/403160343&SearchID=732215378965
More than half my lawsuits that I have reviewed over the past 6 years have involved this drug. Lynn
At 2:16 PM -0600 3/1/06, Feckers, Charlotte wrote:
To the group: I read this e-mail this am and sure enough we had a Doc order phenergan 12.5 Iv I spoke up and said it had just been on the link how bad it was. He and the pharmacist both told me it was fine to give as long as you make sure you have a good vein.... Not a central line but a good vein. The pharmacist told me if it was as bad as I was saying we would have had it pulled from the shelves. Anyone out there this afternoon with some good come backs I don't have a lot of time this afternoon to research articles.
Thanks in advance Charlotte RNCRNI
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Wednesday, March 01, 2006 10:54 AM
To: Kilbourne, Susan; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: phenergan
While there are numerous lawsuits involving promethazine injuries, there is not much that has ever been published. The following are the only ones that I know of:
Extravasation of I.V. promethazine M. Malesker, P. Malone, C. Cingle, R. Cochran American journal of health-System pharmacy unusual drug experiences, FDA, promethazine injection, intra-arterial injection, extravasation, dominal hysterectomy 05-14-01 Vol. 56, September 1, 1999 1742-1743 2049 Case Report
Accidental intra-arterial injection of promethazine HCI during general anesthesia: report of a case H. Mostafavi, M. Samimi Anesthesiology intra-arterial injection, promethazine hydrochloride (Phenergan), anesthesia 10-30-02 Vol. 35, No. 6, December 1971 645-646 2836 Case Report
Promethazine adverse events after implementation of a medication shortage interchange. H. Sheth, M. Verrico, S. Skedar, A. Towers Ann Pharmacother promethazine, adverse events, 11-11-5 Volume 39, Number 2, February 2005 255-261 5265 Abstract
Adverse reactions related to phenergan C. Blankenship Gastroenterology Nursing Phenergan, arterial misplacement, PICC, pediatrics, seizure activity 11-04-04 Volume 24, Number 3 149-150 3985 Review
At 5:23 PM -0800 2/28/06, Kilbourne, Susan wrote:
We are finally having a team meeting at our hospital to discuss the use of IV phenergan through peripheral lines after having two problems in the past year. The problem is convincing the MDs. Can anyone point me to some specific literature to support of dangers of infiltrated phenergan?
Thanks in advance,
Sue Kilbourne CRNI, OCN
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Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociatescom
office 770-358-7861
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