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Bayne Jones Army Community Hospital Pharmacy Formulary
(Updated Sep 07)
Hours of Operation and Phone Numbers
Monday thru Friday: 0730 to 1800Saturday: 0900 to 1300Sunday, Federal Holidays: ClosedOutpatient Pharmacy: 337-531- 3784Toll Free Phone number: 1-800-752-4658Outpatient Pharmacy Fax: 337-531-3614Website http://bjach.polk.amedd.army.mil
MANDATORY AUTOMATED REFILL CALL IN LINE
The local number for our 24 hour mandatory automated refill call in line is 337-531-DRUG (3784).Or you can call the 800 number and ask for extension 3784, you will be connected to the mandatoryautomated refill call in line.It is mandatory you use this refill system! It saves all of us time, and speeds up the Outpatientwindow service so that those that need new urgent prescriptions filled can be done faster.When you call in your refills on the automated line, they will be ready for pickup
within forty-eighthours.
Once ready, we hold them for 10 days. At that point, if not picked up, we put them back in stock andyou lose the refill. If you need us to hold them longer due to an emergency, give us a call.
TRICARE MAIL ORDER PHARMACY
For information on how to use Express Scripts and receive your medications via mail, visitwww.express-scripts.com or ask a pharmacy representative for a Tricare Mail Order BeneficiaryGuide.
PATIENT IDENTIFICATION
MEDDAC Reg 40-59, Ch. 4-6a requires us to see the Patients Photo ID Card or a Xerox Copy of the IDCard for any patient 10 years or older.
No ID Card, No Prescriptions.
DEFINITIONS:
Bolded items:
These drugs are part of the Basic Core Formulary (BCF), which means they must beavailable upon request at every Military Treatment Facility (MTF). BCF drugs, by DoD policy, are the firstchoice agents for any condition.
Note:
Brand names are provided for reference purposes only and do not imply the recommendation of aspecific product. For multi-source drugs, it is expected that the most favorably priced product will be keptin stock in the pharmacy.
Prescribing Guidelines:
The BJACH prescribing guidelines for COX-2 Inhibitors (Celebrex)are listed below:
BJACH COX-2 Prescribing Criteria
(Current as of June 2005)
The following are BJACH’s prescribing criteria for COX-2 specific NSAID
1.
Use of COX-2 specific NSAIDs may be authorized for peri-operative
anti-inflammatory or analgesia use, including primary dysmenorrhea.
2.Use of COX-2 specific NSAIDs may be authorized for the chronic treatment of rheumatoid arthritis or osteoarthritis when one or more of the following conditions are present:a.Coagulopathy, platelet dtsfunction, or concurrent warfarin therapy. b.Concurrent corticosteroid use.c.Age greater than 65 years.d.Prior peptic ulcer disease or upper GI bleed.e.NSAID-induced gastropathy documented by endoscopy.f.Concurrent chemotherapy or radiation therapy.g.Severe disability level due to arthritis.h.GI intolerance to at least 2 non-selective NSAIDs.
If the patient does not meet these criteria, the prescription CANNOT BE FILLED at BJACH. Alternativetherapies available include: ibuprofen, piroxicam, indomethacin, flurbiprofen, salsalate, naproxen, andmeloxicam.Jeri A. Odom Shawn I. ParsonsGS-12 MAJ, MSClinical Pharmacist Chief, Pharmacy Service
Bayne Jones Army Community Hospital Pharmacy Formulary(Sep 2007)
4:00 ANTIHISTAMINE DRUGS
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Actifed tab (Triprolidine HCl 2.5 mg and Pseudoephedrine HCl 60mg) and syrup (Triprolidine HCl 1.25 mg and Pseudoephedrine HCl30 mg/5 ml)
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Chlorpheniramine (Chlor-Trimeton) 4 mg tab; 2 mg/5 ml syrup
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Cetirizine (Zyrtec) 5mg/5ml syrup
**restricted to pediatrics**
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Cyproheptadine (Periactin) 4 mg tab, 2 mg/5 ml syrup
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Deconamine SR cap (Chlorpheniramine 8 mg and Pseudoephedrine120 mg)
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Diphenhydramine (Benadryl) 25 mg cap; 12.5 mg/5 ml elixir
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Dimetapp Cold and Allergy elixir (Pseudoephedrine 15 mg, brompheniramine 1 mg/5 ml)
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Drixoral tab (Pseudoephedrine 120 mg, Dexbrompheniramine 6 mg)
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Fexofenadine (Allegra) 30 mg, 60 mg, 180 mg tab
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Loratadine (Claritin) 10mg tab,
1mg/1ml syrup
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Rondec drops (Carbinoxamine 1 mg, Pseudeophedrine 15 mg/1 ml);syrup (Carbinoxamine 4 mg, Pseudeophedrine 60 mg/5 ml)
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Rondec DM drops (Carbinoxamine 1 mg, Pseudeophedrine 15 mg,Dextromethorphan 4 ml/1 ml); syrup (Carbinoxamine 4 mg,Pseudeophedrine 45 mg, Dextromethorphan 15 ml/1 ml)
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Trinalin tab (Pseudeophedrine 120 mg, Azatadine 1 mg)
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Tripelennamine (PBZ) 60mg tablet8:00 ANTI-INFECTIVE AGENTS8:08 Anthelmintics
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Mebendazole (Vermox) 100 mg chewable tab
8:12 Antibiotics
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Amoxicillin (Amoxil) 250 mg cap; 125 mg/5 ml, 250 mg/5 mlsuspension,
Amoxicillin 400mg/5ml
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Augmentin 500 mg (Amoxicillin 500 mg, Clavulanatepotassium 125 mg), 875 mg (Amoxicillin 875 mg,Clavulanate potassium 125 mg) tab; 400 mg/5 ml(Amoxicillin 400 mg, Clavulanate potassium 57mg)suspension
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Augmentin XR 1000mg(Amoxicillin 1000mg/clavulanic acid62.5mg)
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Augmentin ES 600 mg/5 ml (Amoxicillin 600 mg,Clavulanate potassium 42.9 mg) suspension
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Azithromycin (Zithromax) 250 mg tab; 100 mg/5 ml, 200mg/5 ml suspension : 500mg tab
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Cefpodoxime (Vantin) 100 mg, 200 mg tab; 50 mg/5 ml, 100mg/5 ml suspension
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Cefprozil (Cefzil) 500 mg tab; 125 mg/5 ml, 250 mg/5 mlsuspension
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Cephalexin (Keflex) 250 mg cap; 125 mg/5 ml suspension
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Clarithromycin (Biaxin) 500 mg tab
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Clindamycin (Cleocin) 150 mg cap
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Clindamycin (Cleocin Pediatric) 75 mg/5 ml suspension
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Dicloxacillin (Dynapen) 250 mg cap;
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Doxycycline (Vibratab) 100 mg tab
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Erythromycin (E-mycin) base 250 mg tab; 200 mg/5 mlsuspension
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Neomycin 500 mg tab
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Nitrofurantoin (Macrobid) 100 mg cap
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Nitrofurantoin (Macrodantin) 25 mg, 50 mg, 100 mg cap; 25ml/5 ml suspension
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Penicillin V potassium (Veetids) 250 mg tab; 250 mg/5 mlsuspension
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Sultrin (Sulfathiazole 3.42%, Sulfacetamide 2.86%,Sulfabenzamide 3.7%) vaginal cream
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Tetracycline 250 mg cap8:16 Antituberculosis Agents
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Ethambutol (Myambutol) 100 mg, 400 mg tab
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Isoniazid (Nydrazid) 300 mg tab, 50 mg/5 ml syrup
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Pyrazinamide 500 mg tab
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Rifampin (Rifadin) 150 mg cap
8:18 Antivirals
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Acyclovir (Zovirax) 200 mg cap; 800 mg tablet; 5% topicalointment; 200 mg/5 ml suspension
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Amantadine (Symmetrel) 100 mg cap; 50 mg/ml syrup
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Valcyclovir (Valtrex) 500mg, 1Gm tab8:20 Antimalarial Agents
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Chloroquine (Aralen) 500 mg tab
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Hydroxychlorquine (Plaquenil) 200 mg tab
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Mefloquine (Lariam) 250 mg tab
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Primaquine phosphate 26.3 mg tab8:22 Quinolones
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Levofloxin (Levaquin) 500mg tab, 750mg tab
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Ciprofloxacin (Cipro) 500mg tab
8:24 Sulfonamides
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Bactrim (Sulfamethoxazole 200 mg, Trimethoprim 40 mg/5ml) suspension
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Septra DS/Bactrim DS (Sulfamethoxazole 800 mg,Trimethoprim 160 mg) tab
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Sulfasalazine (Azulfadine) 500 mg tab; 500 mg EC tab
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Sulfisoxazole (Gantrisin) 500 mg/5 ml suspension8:26 Sulfones
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Dapsone 25 mg, 100 mg tab8:40 Miscellaneous Anti-infectives
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Metronidazole (Flagyl) 250 mg tab10:00 ANTINEOPLASITIC AGENTS
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Fluorouracil (Efudex) 5% cream
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Hydroxyurea (Hydrea) 500mg cap
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Leuprolide (Lupron) 3.75 mg, 7.5 mg injection
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Megestrol (Megace) 40 mg tab
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Methotrexate 2.5 mg tablet;
25 mg/ml injection12:00 AUTONOMIC DRUGS12:04 Parasympathomimetic (Cholinergic) Agents
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Bethanechol (Urecholine) 10 mg, 25mg tab12:08 Anticholinergic Agents
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Bellergal-s (Belladonna alkaloids 0.2 mg, Phenobarbital 50 mg,Ergotamine tartrate 0.6 mg) tab
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Dicyclomine (Bentyl) 10 mg cap; 20 mg tab
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Donnatal tab (Phenobarbital 16.2 mg, Hyoscyamine 0.1037 mg,Atropine sulfate 0.0194 mg, Scopolamine 0.0065 mg);elixir (Phenobarbital 16.2 mg, Hyoscyamine 0.1037 mg,Atropine sulfate 0.0194 mg, Scopolamine 0.0065 mg/5 ml)
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Hyoscyamine (Levsin/Levsinex) 0.125 mg tab; 0.375 SR cap
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Ipratropium (Atrovent ) Inhaler 18 mcg/actuation; 0.02%nebulizer solution12:12 Sympathomimetic (Adrenergic) Agents
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Advair (Fluticasone propionate 100 mcg, Salmeterolxinafoate 50 mcg), (Fluticasone propionate 250 mcg,Salmeterol xinafoate 50 mcg), (Fluticasone propionate 500mcg, Salmeterol xinafoate 50 mcg) inhaler
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Albuterol (Proventil) 0.083% premixed, 0.5% inhalationsolution; 2 mg/5 ml syrup
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Combivent (Ipratropium 18 mcg, Albuterol 103mcg/actuation) inhaler
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Epinephrine (Epipen/Epipen JR) 0.3 mg, 0.15 mg autoinjectors
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Levalbuterol (Xopenex) HFA 45 mcg/ spray MDI
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