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Win with Generics was implemented in July 2003 Since all of the prescription drug data were and ran through October 2003. By using smart edits in automated, vouchers were not needed, Lassen its claims adjudication system, Prime identified BCBpoints out. Instead, targeted members who SKS members who had recently been prescribed one requested generic substitution at the time of refill of 45 multi-source branded drugs -- all for chronic automatically had their copayment waived. By conditions -- for which generic equivalents are considusing claim system edits, the PBM also could idenered therapeutically equivalent. See Figure 1. ; In July tify members who were already using generic med2003, BCBSKS mailed a letter to these members ications and ineligible for the incentive program so informing them to ask their pharmacists or doctors to that pharmacies knew when copays should not be switch their brand-name drugs to therapeutically waived. equivalent generic drugs at their next refill during the "We didn't have to staff a help desk or mail out 90-day period. See Figure 2 on page 82. ; vouchers, so this was a more efficient way to handle The letter explained that, like brand-name a generic drug incentive program, " Lassen says. counterparts, generic drugs are: When structuring the program, BCBSKS sought FDA-approved and regulated, input from an advisory committee of its members equal to the brand-name drug in terms of that meets twice a year. Last year, the health plan safety and effectiveness, and also conducted a comprehensive member education manufactured with the same active ingredients. campaign about the cost drivers of healthcare that "They could try the generic at no cost, which suggested generic substitution as one strategy for actually saved them more than $10 because we have reducing costs. "Maybe we laid the foundation for a tiered prescription drug plan, " Bailey points out. members to be more receptive to the Win with Based on results with other BCBS plans that Generics program, " Bailey muses. have similar programs, Prime had predicted a During periodic face-to-face meetings and in its generic conversion rate of 10% to 30%, says David Lassen, senior director of clinFigure 1: Win with Generics Member Incentive Program ical utilization programs at Prime, which The following listed drugs qualify for the program. is collectively owned by several BCBS plans, subsidiaries, or affiliates. Of the Brand Name Generic Name Most commonly used for: members who received a letter from BCB- Accutane isotretinoin Acne Adalat CC, Procardia XL nifedipine extended-release High blood pressure SKS, 256, or 15.3%, switched to a generic Anexsia, Lorcet, Lorcet Plus, product, and all but 28 of these stayed Pain Lortab, Norco, Vicodin, Vicodin hydrocodone acetaminophen with the generic for six months. ES, Vicodin HP Though the conversion rate may Calan SR, Isoptin SR verapamil extended-release High blood pressure Cardizem CD diltiazem extended-release High blood pressure appear small, it's higher than those Cardura doxazosin High blood pressure, BPH achieved by BCBS plans that have tried Darvocet-N 50, Darvocet-N 100 propoxyphene acetaminophen Pain other generic substitution approaches, Demadex torsemide Diuretic water pill ; Bailey maintains. Win with Generics Dyazide triamterene hydrochlorothiazide Diuretic water pill ; yielded an overall savings of $6.99 per Glucophage metformin Diabetes blood sugar ; terazosin capsules High blood pressure, BPH targeted member -- those who received a Hytrin Klonopin clonazepam Seizures letter as part of the program -- and Lasix furosemide Diuretic water pill ; $45.65 per utilizing member -- those who Lopressor metoprolol High blood pressure, BPH actually switched to the generic equivaMaxzide, Maxzide-25 triamterene hydrochlorothiazide Diuretic water pill ; Mevacor lovastatin High cholesterol lent. Depending on the number of preestropipate Hormone replacement scriptions and the cost of branded drugs, Ogen Percocet, Tylox oxycodone acetaminophen Pain savings were as high as $263, net of the Prinivil, Zestril lisinopril High blood pressure free copay, for some members, according Prinzide, Zestoretic lisinopril hydrochlorothiazide High blood pressure Proventil or Ventolin Inhaler albuterol inhaler Asthma, COPD to Lassen. Provera medroxyprogesterone Hormone replacement "The savings from the initial switch Prozac fluoxetine Depression to the generic equivalent are significant, Relafen nabumetone Pain, inflamation even with the waived copayment facTenormin atenolol High blood pressure tored in, " Lassen says. "But the longUltram tramadol Pain Vasotec enalapril High blood pressure term savings come from the consumers' Xanax alprazolam Nervousness, anxiety continued use of the generic product. Zanttac ranitidine Stomach acid That's our goal, and preliminary results Ziac bisoprolol hydrochlorothiazide High blood pressure show this program is effective in achievSource: Blue Cross Blue Shield of Kansas. Reprinted with permission. ing that and ceclor.
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Depolarization in steps of 20 mV from a holding potential of 70 mV. Outward currents were also compared from holding potentials of 90, 70, and 50 mV using 500-msec depolarizing pulses to 30 mV. To minimize variation, maximum sustained current was determined from a third degree polynomial function fit to the final 25 msec of the 500-msec depolarizing pulse. The voltage dependence of steady state inactivation was investigated by holding the cells at potentials from 80 to 30 for 15 sec followed by a 5-msec prepulse to 70 and a 500-msec depolarization to 30 mV elicit outward currents. Steady state inactivation curves were fit with a Boltzman function: I Imax 1 [1 exp [V V1 2] where V1 2 is the voltage at which half the channels are inactivated, and s is the slope of the curve. For pharmacological studies, the drug was applied by perfusion for at least 5 min before recording. Outward currents at the end of the 500-msec depolarizing pulse were compared using the t test. RNA Analysis Total RNA was obtained from rat islets 2448 h after isolation ; , rat brain, and HIT-T15 cells using Trizol Life Technologies, Inc. ; as per the manufacturer's instructions. RT-PCR was performed on 1 g total RNA using a GeneAmp RNA PCR kit Perkin-Elmer Corp., Branchburg, NJ ; according to the manufacturer's instructions. PCR primers used were designed to conserved sequences of rat Kv1.1 [Forward F ; : 5 -AAGGATCCGTCATTGTGTCC-3 ; Reverse R ; : 5 -AAAGGCCTAAACATCGGTCAG-3 ], Kv1.2 F: 5 -GTAAAGCACACTTCTCAAGCCCC-3 ; R: 5 -CCTCCCGAAACATCTCAATTGC-3 Kv1.3 F: 5 -GAGATCCGCTTTTACCAGCTGGG3 ; R: 5 -CATGATATTTCTGGAGAAGG-3 Kv1.4 F: 5 GATAGCCATTGTGTCCGTCCTGG-3 ; R: 5 -GGCACACAGGGACCCGACAATC-3 Kv1.5 F: 5 -CTGAGAGGGAGAGAGGCAGGG-3 ; R: 5 -GCAGCTCCTGAGGCATAGGG-3 Kv1.6 F: 5 -GTTGGTGATCAACATCTCCGGG-3 ; R: 5 GGCCGCCTTGCTGGGACAGG-3 Kv1.7 mouse ; F: 5 TCTCCGTACTCGTCATCCGG-3 ; R: 5 -AAATGGGTGTCCACCCGGTC-3 Kv2.1 F: 5 -CGAGGAGCTGAAGCGGGAGG-3 ; R: 5 -GGAAGATGGTGACGTAGTAGGG-3 and Kv2.2 F: 5 -GGATGCCTTTGCTAGAAGTATGG-3 ; R: 5 CGCTGGCACTGTCAGGTTGC-3 ; . PCR was also performed on water blank controls containing no cDNA template and rat brain cDNA as a positive control. PCR was performed with 35 cycles of 94 C for 30 sec, 60 C for 35 sec, and 72 C for 45 sec followed by a 10-min extension at 72 C. PCR products of the expected size were excised from an 1.2% low melt agarose gel and ligated into the pCR2.1 vector and sequenced using the universal M13 reverse primer. Resulting sequences were subjected to analysis by NCBI Blast NCBI, Bethesda, MD ; and nucleotide and amino acid identity analysis with MacDNASIS Hitachi Software, San Francisco, CA ; . Northern analysis was used to detect expression of mRNA transcripts for Kv2.1N in total RNA 7.5 g ; from AdKv2.1Nor AdEGFP-infected HIT cells as described previously 69 ; . Probes were generated by random priming Random Primers DNA Labeling System, Life Technologies, Inc. ; of Kv2.1N cDNA and incorporation of P32-dCTP. Blots were washed twice by shaking in room temperature 0.1% SDS 2 SSC followed by a 30-min wash in 0.1% SDS 0.1 SSC at 55 C. Blots were exposed overnight to X-OMAT AR film Eastman Kodak Co., Rochester, NY ; . Protein Analysis Immunoblotting of Kv channel proteins was performed as previously described 70, 71 ; . Briefly, the islets were washed in ice-cold PBS, solubilized in 2% SDS loading buffer, boiled for 10 min, and passed through a 23G needle. Fifty micrograms of the protein from each sample, determined by Lowry's method, were loaded and separated on a 10% polyacryl.
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You have been following a 59-year-old female who has had dietcontrolled type 2 diabetes for the past 4 years. One year ago, her HbA1C was 6.3% and she had no microalbuminuria. She takes no medications. At the current visit, the urine albumin is 120 mg g creatinine. Her blood pressure is 132 84. Which of the following statements is the most appropriate to tell her at this time?.
Contraindications: Patients with complete A-V block with an A-V junctional or idioventricular pacemaker; in patients with intraventricular conduction defects marked widening of QRS complex patients with cardiac glycoside induced A-V conduction disorders; hypersensitivity reaction to the drug or cinchona derivatives. Usual Dosage Adult Oral: 100-600 mg dose every 4-6 hours; begin at 200 mg dose and titrate to desired effect Dosage Form Tablet: 200 mg, 300 mg Authorized Prescribers: MD only Comments: None Quinine Trade Name: Quinine Therapeutic Class: 08: 20 Antimalarial Agents Contraindications: Patients with complete A-V block with an A-V junctional or idioventricular pacemaker; in patients with intraventricular conduction defects marked widening of QRS complex patients with cardiac glycoside induced A-V conduction disorders; hypersensitivity reaction to the drug or cinchona derivatives. Usual Dosage Adult Oral: 10 mg kg every 8 hours for 7 days. Dosage Form Tablet: 260 mg, 300 mg, 325 mg Authorized Prescribers: MD only Comments: When treating uncomplicated malaria medication should be given in combination with either tetracycline or doxycycline. Ranitidine Hydrochloride Trade Name: Aantac Therapeutic Class: 56: 40 Miscellaneous GI Drugs Contraindications: Hypersensitivity to ranitidine or any component Usual Dosage Adult Oral: 150 mg dose twice daily or 300 mg at bedtime Dosage Form Tablet: 150 mg, 300 mg Authorized Prescribers: MD NP PA Comments: NP PA: For use in peptic ulcer disease in adults only; must consult with MD prior to initiating. Rifampin Trade Name: Rifadin Therapeutic Class: 08: 16 Antituberculosis Agents Contraindications: Hypersensitivity to rifampin or any component Usual Dosage Tuberculosis Children Oral: 10-20 mg kg 24 hours given in 1-2 divided doses Adult Oral: 10 mg kg 24 hours up to a maximum of 600 mg 24 hours Dosage Form Capsule: 150 mg, 300 mg Authorized Prescribers: MD only Comments: For more information regarding the use of rifampin please see DIHS Infectious and clomid.
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This booklet is an information source for pharmacists who wish to take the Qualifying Examination of The Pharmacy Examining Board of Canada referred to as "PEBC" or "the Board" ; . It is published every November. Copies of this publication are available from the PEBC office at 717 Church Street, Toronto, Ontario M4W 2M4. the provincial regulatory authorities referred to as "PRAs" or "licensing bodies" ; the Canadian schools of pharmacy for Canadian students ; the PEBC website: pebc Section: The Qualifying Examination and fluoxetine.
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Chemistry: fasting glucose, BUN, sodium, potassium, chloride, CO2, creatinine, total protein, albumen, total bilirubin, calcium, alkalynphosphotase, AST SGOT ; , ALT SGPT ; NPO after midnight Zantac, 150 mg PO H.S. and 150 mg PO at 6: 30 a.m. day of treatment Robinul 0.2 mg IM prn Day of ; Valium 10mg PO prn Day of ; Continue routine a.m. seizure meds cardiac meds a.m. behavior modification drugs omitted.
Encephalopathy?, prolonged postictal state? has an underlying problem?, e.g. encephalitis? ; , status psychomotor seizures? EEG? ; , new headache?; coma nyd? include gastric lavage?, and charcoal?; CT scan?, MRI?, lumbar puncture? Increased intracranial pressure + reflex hypertension? ; Avoid hypoxemia, hypercapnia, agitation, seizures, pyrexia, and cerebral edema. L ACBC's, intubate prn and hyperventilate prn with 100% O2 to a pCO2 of 25-30 prn, mannitol 20% 5-10cc kg I.V. prn caution ; , lasix 1-2mg kg I.V. prn caution ; , dexamethasone decadron ; prn, initial dose 1mg kg to 50mg I.V. plus Zanhac 50mg I.V. for stress ulcer prophylaxis? ; , reverse trendelenburg position if not contraindicated. L seizures prn e.g. I.V. valium dilantin, consider giving dilantin prophylactically: 15mg kg I.V. over 30-60 minutes ; , L agitation prn e.g. I.V. haldol 5-10mg and or ativan1-2mg prn ; , L.
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