MODULE 5 TOPIC 1

HOSPITAL FORMULARY
 Objectives
At the end of the discussion, the students will be able to:
▪ Define the formulary system concept
▪ Understand basic formulary management principles
▪ Describe the benefits of an effective formulary system
▪ Identify criteria used for selection of medicines
 Key Definitions
▪ Formulary—A list of medicines approved for use in the
healthcare system by authorized prescribers

▪ A continually revised compilation of

pharmaceuticals (plus important
ancillary information) that reflects the
current clinical judgment of the
medical staff.
 2 CATEGORIES OF FORMULARY
1. OPEN FORMULARY
A formulary that has no limitation to access to a medication.

2. CLOSED FORMULARY
A list of medications (formulary) which limits access of a
practitioner to some medications.
A closed formulary may limit drugs to specific physicians,
patient care areas, or disease states via formulary restrictions.
 Key Definitions
• Formulary manual—The document that describes
medicines that are available for use in a hospital or clinic
(i.e., indications, dosage, length of treatment, interactions,
precautions, and contraindications)
• In medicine, an indication is a valid reason to use a
certain test, medication, procedure, or surgery.
• The opposite of an indication is a contraindication, a
reason to withhold a certain medical treatment because it
could harm a patient.
• Hypertension • Amlodipine
• Bleeding • Aspirin
• Diabetes • Insulin
• CHF
• Digoxin
 Formulary System
• A method whereby the medical staff of an institution,
working through the PTC, evaluates, appraises, and
selects from among the numerous available drug entities
and drug products those that are considered useful in
patient care.
 Formulary
• It provides information for:
– PROCURING
– PRESCRIBING
– DISPENSING
– ADMINISTRATION OF DRUGS
The primary objective of the formulary are to
provide the hospital staff with:
1.Information on what drug products have been approved
by the pharmacy and therapeutics committee.
2.Basic therapeutic information about each approved item.
3.Information on hospital policies and procedures governing
the use of drugs.
4.Special information about drugs such as drug dosing rules
monograms, hospital approved abbreviations, etc.
 Main Parts of a Formulary
Part I. Information on Hospital Policies and Procedures
Concerning Drugs

Part II. Drug Product Listing

Part III. Special Information

 Part I. Information on Hospital Policies and
Procedures Concerning Drugs
This includes:
1.Categories of Drugs
2.Brief description of the PTC
3.Hospital regulations regarding prescribing, dispensing, and
administration of drugs
4.Pharmacy operating procedures
5.Information on using the formulary
 Part II. Drug Product Listing
• This is the heart of the formulary and consists of
descriptive entries for each formulary item plus one or
more indices to facilitate use of formulary.
• The entries may be arranged in any of the ff. ways:
1.Alphabetically by generic name
2.Alphabetically within therapeutic class
3.Combination of the two systems
 Part II. Drug Product Listing
Those entries must contain the ff. minimum
information:
1.Generic name of the basic drug entity
2.Common synonyms and brand names
3.Dosage form/s, strength/s, packaging/s and size/s
stocked by the formulary
4.Formulation (active ingredients) of a combination product
5.Additional information such as unusual pediatric and
adult dose, special cautions and notes, controlled
substances symbol
 Part III. Special Information

• This varies from hospital to hospital and may

include:
1.List of hospital- approved abbreviations
2.Rules of calculating pediatric dosages
3.Dosing guides for patients with renal impairment
4.List of dialyzable poisons, etc.
Can be removed upon dialysis
 Benefits of the formulary system
The potential benefits of a formulary system are threefold:
1.Therapeutic.
2.Economic.
3.Educational.
Benefits of an Effective Formulary System

▪ The therapeutic aspect of a formulary

system provides the greatest benefit to
the patient and physician in that only the
most efficient products are listed and
available.
Benefits of an Effective Formulary System
▪ The economic merit also has a double benefit
in that the formulary eliminates duplication
thus reducing inventory duplication and the
opportunity for volume purchasing means
lower charges to the patient.
Benefits of an Effective Formulary System
▪ The educational benefit is also significant for
the resident staff, nurses and medical
students because many good formularies
contain various prescribing tips and additional
drug information of educational value.
Benefits of an Effective Formulary
System—Summary
▪ SUPPLY ▪ PRESCRIBING
▪ Easier procurement ▪ More experience with fewer
medicines
▪ Lower amount of stocks
▪ Irrational alternatives not
▪ Improved quality assurance available
▪ Easier dispensing ▪ Focused medicine information
▪ ADRs easier to manage

▪ PATIENT USE
▪ COST
▪ Focused education efforts ▪Lower prices
▪ Better compliance
▪ Improved availability
Selection of Guiding Principles for Admission or
Deletion of Drugs
Criteria:
1)Drugs must be of proven clinical value based upon
experience.
2)The drugs must be recognized by USP/NF or their
supplement.
3)The manufacturers of these drugs must be of proven
integrity and dependability as well as having the regulation
of initiating and supporting research activities of merits.
Selection of Guiding Principles for Admission or
Deletion of Drugs
Criteria:
4)No preparation of secret composition will be considered
or admitted to the formulary.
5)No product of multiple composition shall be admitted if the
same therapeutic value can be obtained through the use of
a single drug entity.
6)Financial resources available to buy the medicine
Steps to Add or Delete a New Medicine
Physician or Written request
pharmacist DTC Secretary

Transparent decision Drug literature

making evaluation
DTC Meeting

Request Written report;

approved/rejected formulary
Information recommendations
disseminated
 Procedure for addition or deletion of new
medicines in the Formulary:
1. Compile information resources
2. Perform evaluation using established criteria
3. Write medicine monograph describing the evaluation and
results
4. Develop formulary recommendations to present to the DTC
5. Obtain expert opinion and recommendations
6. Make a decision at the DTC meeting
7. Disseminate the results of the evaluation and DTC
recommendations
Formulary Management Principles
1. Select medicines on the basis of need
(diseases and conditions that have been
identified locally)
2. Select “medicines of choice”
3. Maintain a limited number of medicines (avoid
duplications)
4. Use INN (generic) names
5. Use combination (fixed-dose) products only in
specific proven conditions (e.g., tuberculosis)
Formulary Management Principles
6. Use explicit selection criteria that include—
❑Efficacy and effectiveness
❑Safety
❑Quality
❑Cost

7. Select medicines that are consistent with national and

regional formularies and standard treatment guidelines
8. Restrict medicines use to appropriate practitioners
MODULE 5 TOPIC 2

DRUG CLASSIFICATIONS
 Gastrointestinal and hepatobiliary system
•ANTACIDS, ANTIREFLUX AGENTS & ANTIULCERANTS
•GIT REGULATORS, ANTIFLATULENTS & ANTI-
INFLAMMATORIES
•ANTISPASMODICS
•ANTIDIARRHEALS
•LAXATIVE, PURGATIVES
•CHLOAGOGUES, CHOLELITHOLYTICS & HEPATIC
PROTECTORS
•ANORECTAL PREPARATIONS
•ANTIEMETICS
 ANTACIDS, ANTIREFLUX AGENTS &
ANTIULCERANTS
• An antacid is an OTC drug which neutralizes stomach
acidity
• Anti-Reflux Drugs are drugs prescribed by physicians and
are also known as Proton Pump Inhibitors.
• Antiulcerants are drugs used to treat ulcers in the stomach
and the upper part of the small intestine.
 ANTACIDS, ANTIREFLUX AGENTS &
ANTIULCERANTS
• (KREMIL-S®)
• (MAALOX®)
• (TUMS®)
• (NEXIUM®)
• (OMEPRON®)
• (PANTOLOC®)
• (PARIET®)
• (RAXIDE®)
• (H2BLOC®)
• (SIMECO)
• (VOCINTI)
 GIT REGULATORS, ANTIFLATULENTS & ANTI-
INFLAMMATORIES

• GIT regulators are drugs which regulate the motility of the

gastro-intestinal tract
• An antiflatulent agent is a drug used for the alleviation or
prevention of excessive intestinal gas
• Anti-inflammatories are drugs which work by reducing
inflammation or swelling in the intestinal tract thereby
reducing pain and bleeding.
 GIT REGULATORS, ANTIFLATULENTS & ANTI-
INFLAMMATORIES

• (MOTILIUM®)
• (GANATON®)
• (RESTIME)
 ANTISPASMODIC

• An antispasmodic is a pharmaceutical drug or other agent

that suppresses muscle spasms.
– (Buscopan®)
– (Duspatalin ®)
– (Relestal®)
 ANTI-DIARRHEAL
• An anti-diarrheal drug is any medication which provides
symptomatic relief for diarrhea.
– (Imodium®)
– (Erceflora®)
– (Ercefuryl®)
– (Hidrasec®)
 LAXATIVES
• Laxatives (purgatives) are substances that loosen stools
and increase bowel movements.
– (Duphalac®)
– (Dulcolax®)
– (Senokot/Senokot Forte®)
– (Surelax)
 CHOLAGOGUES, CHOLELITHOLYTICS AND HEPATIC
PROTECTORS
• Cholagogues, cholelitholytics and hepatic protectors
are medicines provide protection to liver from hepatotoxic
agents i.e : Fatty acids, alcohol, and hepatotoxic drugs.
– (Ursofalk ®)
– (Essentiale Forte®)
 ANORECTAL PRODUCTS

• Anorectal products generally contain a local anesthetic

and a pain reliever or an anti-inflammatory agent in
combination as an ointment or suppository.
• They are applied topically either to treat internal or external
hemorrhoids.
– (Daflon ®)
– (Doxium®)
– (Venoruton Forte®)
– Faktu®, Hirudoid®, Proctosedyl®, Ultraproct®
 ANTIEMETIC

• An antiemetic is a drug that is effective against vomiting

and nausea.
– (Bonamine®)
– (Plasil®)
 Cardiovascular & Hematopoietic System
• Cardiac Drugs
• Anti-Anginal drugs
• ACE Inhibitors
• Beta Blockers
• Calcium Antagonists
• Angiotensin II Antagonists
 CARDIAC DRUGS
• Cardiac Drugs are prescription drugs for diseases
relating to the structure and function of the heart and
blood vessels.
– (Cordarone®)
– Dobutamine
– Dopamine
– (Lanoxin®)
– Epinephrine
 ANTIANGINAL
• An antianginal is any drug used in the treatment of
angina pectoris, a symptom of ischaemic heart disease.
– (Aprior ®)
– (Vastarel ®)
– (Elantan ®)
– (Isoket®) (Isordil®)
– (Transderm-Nitro®)
ANGIOTENSIN CONVERTING ENZYME INHIBITOR

• An angiotensin-converting-enzyme inhibitor is a
pharmaceutical drug used primarily for the treatment of
hypertension and congestive heart failure.
– (Accupril®)
– (BP Norm®)
– (Coversyl ®)
– (Hypace ®)
– (Vascor ®)
– (Tritace®)
– (Zestril ®)
 BETA BLOCKERS
• Beta blockers are a class of drugs that are particularly
used to manage cardiac arrhythmias, and to protect the
heart from a second heart attack after a first heart attack.
– (Betaloc®)
– (Tenormin®)
– (Dilatrend®)
– (Concore®)
– (Inderal®)
– (Nebicar®)
 CALCIUM ANTAGONISTS

• Calcium channel blockers, calcium channel antagonists or

calcium antagonists are several medications that disrupt the
movement of calcium through calcium channels.
– (Norvasc®)
– (Calcibloc®)
– (Caldine®)
– (Lacipil®)
– (Plendil®)
– (Dilzem®)
– (Isoptin®)
ANGIOTENSIN II RECEPTOR BLOCKERS
• Angiotensin II receptor blockers (ARBs) are medications
that block the action of angiotensin II by preventing
angiotensin II from binding to angiotensin II receptors on
the muscles surrounding blood vessels.
– (Blopress®)
– (Lifezar®)
– (Diovan®)
– (Micardis®)
– (Olmetec®)
– (Teveten®)
 Cardiovascular & Hematopoietic System
• Other antihypertensives
• Diuretics
• Peripheral Vasodilators & Cerebral Activators
• Vasoconstrictors
• Dyslipidaemic Agentss
• Haemostatics
• Anticoagulants, Antiplatelets & Fibrinolytics
• Phlebitis & Varicose Preparations
• Haematopoietic Agents
 OTHER HYPERTENSIVES

• Other hypertensives:
– (Aldomet®)
– (Catapres®)
– (Hytrin®)
 DIURETIC
• A diuretic is any substance that promotes the production
of urine.
– (Aldactone®)
– (Hytaz®)
– (Lasix®)
 PERIPHERAL VASODILATORS/CEREBRAL
ACTIVATOR
• Peripheral vasodilators are medicines that are used to treat
conditions that affect blood vessels in outer (peripheral) parts
of the body such as the arms and legs.
• A cerebral activator, or cerebral metabolic enhancer, is a
type of drug that "activates" the central nervous system in the
context of cerebrovascular diseases such as stroke.
– (Stugeron ®)
– (Zynapse ®)
 VASOCONSTRICTORS

• Medications causing vasoconstriction, also known as

vasoconstrictors, are one type of medicine used to raise
blood pressure.
– (Levophed®)
 DYSLIPIDAEMIC AGENTS
• Dyslipidaemic agents are used in the treatment of
hyperlipidaemia.
– (Crestor®)
– (Lipitor®)
– (Vidastat®)
– (Pravaz®)
– (Ezetrol ®)
– (Lofibra®)
– (Lopid®)
– (Lorelco®)
– (Omacor®)
 HAEMOSTATICS
• Haemostatics are agents that arrest the flow of blood within
the vessels.
– (Hemostan®)
– (Konakion®)
 THROMBOLYTIC DRUGS
• Thrombolytic drugs (Anticoagulants, antiplatelets and
fibrinolytics) are used in medicine to dissolve blood clots in a
procedure termed thrombolysis.
– (Aspilets®)
– Heparin
– (Grendis®)
– (Persantin ®)
– (Plavix®)
– (Pletaal ®)
– (Vessel Due-F®)
 PHLEBITIS & VARICOSE
PREPARATIONS
• Phlebitis & Varicose Preparations
– (Daflon®)
– (Doxium®)
– (Venoruton Forte ®)
– Hirudoid ®
 HAEMATOPOIETIC AGENTS
• Haematopoietic Agents are agents that promotes
hematopoiesis.
– (Epokine®)
– (Recormon®)
 Respiratory System
• Antiasthmatic & COPD Preparations
• Cough & Cold Preparations
• Nasal Decongestants & Other Nasal Preparations
ANTI-ASTHMATIC & COPD PREPARATIONS
• Antiasthmatic & COPD Preparations
– (Ansimar®)
– (Bricanyl®)
– (Budecort®)
– (Combivent®)
– (Singulair®)
– (Meptin ®)
– (Nuelin®)
– (Onbrez ®)
– (Seretide ®)
– (Spiriva ®)
– (Ventolin ®)
– (Zaditen®)
 COUGH & COLD PREPARATIONS
• Cough & Cold Preparations
– (Mucosolvan ®)
– (Bisolvon ®)
– (Fluimucil ®)
– (Levopront®)
– (Robitussin Expt®)
– (Sinecod Forte®)
– (Solmux ®)
– (Zertin ®)
 NASAL DECONGESTANTS & OTHER NASAL
PREPARATIONS

• Nasal Decongestants & Other Nasal Preparations

– (Avamys®)
– (Drixine ®)
– (Nasoflo ®)
– (Muconase ®)
– (Nasonex ®)
 Central Nervous System
• Anxiolytics
• Hypnotics & Sedatives
• Antidepressants
• Antipsychotics
• Anticonvulsants
• Neurodegenerative Disease Drugs
• Antiparkinsonian Drugs
• Antivertigo Drugs
• Analgesics (Opioid)
• Analgesics (Non-Opioid) & Antipyretics
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
• Antimigraine Preparations
• Nootropics & Neurotonics/Neuotrophics
 ANXIOLYTICS
• Anxiolytics
– (Lexotan®)
– (Tranxene®)
– (Valium ®)
– (Xanor ®)
 HYPNOTICS & SEDATIVES
• Hypnotics & Sedatives
– (Dormicum ®)
– (Stilnox ®)
 ANTIDEPRESSANTS

• Antidepressants
– (Lexapro ®)
– (Prodin ®)
– (Remeron Soltab®)
– (Zoloft®)
– (Surmontil ®)
 ANTIPSYCHOTICS
• Antipsychotics
– (Abilify®)
– (Serenace ®)
– (Laractyl ®)
– (Olanzapro ®)
– (Risperdal ®)
– (Seroquel ®)
– (Solian ®)
 ANTICONVULSANTS
• Anticonvulsants
– (Depakene ®)
– (Depakote ®)
– (Dilantin ®)
– (Neurontin ®)
– (Keppra ®)
– (Lamictal ®)
– (Lyrica ®)
– Phenobarbital
– (Rivotril ®)
– (Tegretol ®)
– (Topamax ®)
– (Trileptal ®)
– (Zonegran ®)
 NEURODEGENERATIVE DISEASE
DRUGS
• Neurodegenerative Disease Drugs
– (Abixa®)
– (Aricept®)
– (Exelon ®)
 ANTIPARKINSONIAN DRUGS
• Antiparkinsonian Drugs
– (Akidin®)
– (Requip®)
– (Sinemet ®)
 ANTIVERTIGO DRUGS
• Antivertigo Drugs
– (Serc®)
– (Stugeron ®)
 ANALGESICS (OPIOIDS)
• Analgesics (Opioid)
– (Dolcet®)
– (MST Continus®)
– (Nubain ®)
– (Oxycontin®)
– (Tramal ®)
 ANALGESICS (NON-OPIOID) &
ANTIPYRETICS
• Analgesics (Non-Opioid) & Antipyretics
– (Tylenol®)
– (Dolo-Neurobion®)
 NSAIDS
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
– (Advil ®)
– (Arcoxia®)
– (Cataflam ®)
– (Celebrex®)
– (Fastum Gel ®)
– (Feldene®)
– (Flanax®)
– (Mobic®)
– (Ponstan®)
 ANTIMIGRANE PREPARATIONS
• Antimigrane Preparations
– (Imigran®)
– (Sibelium®)
– (Zomig®)
 NOOTROPICS &
NEUROTONICS/NEUROTROPHICS
• Nootropics & Neurotonics/Neurotrophics
– (Arcalion ®)
– (Nurocer ®)
 Musculo-Skeletal System

• Hyperuricemia & Gout Preparations

• Muscle Relaxants
• Neuromuscular Disorder Drugs
 HYPERURICEMIA & GOUT
PREPARATIONS
• Hyperuricemia & Gout Preparations
– (Goutnil ®)
– (Llanol ®)
 MUSCLE RELAXANT
• Muscle Relaxant
– (Lioresal ®)
– (Myonal ®)
– (Sirdalud®)
NEUROMUSCULAR DISORDER DRUGS
• Neuromuscular Disorder Drugs
– (Mestinon®)
 Anti-infectives
• Aminoglycosides
• Cephalosporins
• Penicillins
• Other beta-lactams
• Chloramphenicols
• Macrolides
• Quinolones
• Tetracycline
• Antibacterial combinations
 AMINOGLYCOSIDES
• Aminoglycosides
– (Amikacide ®)
– (Servigenta®)
 CEPHALOSPORIN
• Cephalosporin
– (Ceclor®)
– (Cefalin ®)
– (Forgram ®)
– (Fortum®)
– (Tergecef®)
– (Zinnat®)
 PENICILLINS
• Penicillins
– (Amoxil®)
– (Ampicin®)
– (Augmentin®)
– (Tazocin®)
– (Stafloxin®)
– (Sumapen®)
– (Unasyn®)
 OTHER BETA-LACTAMS
• Other beta-lactams
– (Meronem®)
– (Tienam ®)
 CHLORAMPHENICOL
• Chloramphenicol
– (Pediachlor®)
 MACROLIDES
• Macrolides
– (Ilosone ®)
– (Klaz®)
– (Zithromax®)
 QUINOLONES
• Quinolones
– (Avelox®)
– (Ciprobay®)
– (Inoflox ®)
– (Levox®)
 TETRACYCLINE
• Tetracycline
– (Doxicon®)
– (Minocin®)
– (Tetralysal®)
– (Tygacil ®)
 ANTIBACTERIAL COMBINATIONS
• Antibacterial combinations
– (Bactrim®)
 Anti-infectives

• Other Antibiotics
• Antifungals
• Antivirals
• Anthelminthics
• Antiamoebics
• Other Antiprotozoal Agents
 OTHER ANTIBIOTICS
• Other Antibiotics
– (Dalacin C ®)
– (Flagyl ®)
– (Lincocin®)
– (Vancocin ®)
 ANTIFUNGALS
• Antifungals
– (Afunginal ®)
– (Diflucan®)
– (Sporanox®)
– (Lamisil®)
– (Nizoral®)
 ANTIVIRALS
• Antivirals
– (Baraclude®)
– (Immunosin®)
– (Isoprinosine®)
– (Tamiflu®)
– (Valtrex®)
– (Zovirax®)
 ANTHELMINTHICS
• Anthelminthics
– (Antiox®)
– (Combantrin®)
– (Quantrel®)
 Oncology

• Cytotoxic Chemotherapy
• Cancer Hormone Therapy
 CYTOTOXIC CHEMOTHERAPY
• Cytotoxic Chemotherapy
– (Alkeran ®)
– (Emthexate®)
– (Leukeran®)
– (Xeloda®)
 CANCER HORMONE THERAPY
• Cancer Hormone Therapy
– (Arimidex®)
– (Bondronat®)
– (Tamoplex®)
 Genito-urinary System
• Preparations for Vaginal Conditions
• Urinary Antiseptics
• Drugs Acting on the Uterus
• Drugs for Erectile Dysfunction & Ejaculatory Disorders
• Drugs for Bladder and Prostate Disorders
• Other Drugs Acting on the Genito-urinary System
 PREPARATIONS FOR VAGINAL
CONDITIONS
• Preparations for Vaginal Conditions
– (Albothyl ®)
– (Canesten® Vaginal Tablet)
– (Flagystatin®)
 URINARY ANTISEPTICS
• Urinary Antiseptics
– (Macrodantin ®)
 DRUGS ACTING ON THE UTERUS
• Drugs Acting on the Uterus
– (Methergin ®)
– (Syntocinon®)
 DRUGS FOR ERECTILE DYSFUNCTION &
EJACULATORY DISORDERS
• Drugs for Erectile Dysfunction & Ejaculatory
Disorders
– (Viagra®)
 DRUGS FOR BLADDER & PROSTATE
DISORDERS
• Drugs for Bladder and Prostate Disorders
– (Atepros®)
– (Avodart®)
– (Driptane®)
– (Duodart®)
– (Xatral®)
– (Harnal®)
– (Uriflow®)
– (Vesicare ®)
 OTHER DRUGS ACTING ON THE GENITO-
URINARY SYSTEM
• Other Drugs Acting on the Genito-urinary System
– (Acalka®)
– (Ketosteril®)
– (Re-leaf®)
– (Rowatinex ®)
 Endocrine & Metabolic System
• Insulin Preparations
• Antidiabetic Agents
• Thyroid Hormones
• Antithyroid Agents
• Agents Affecting Bone Metabolism
 INSULIN PREPARATIONS
• Insulin Preparations
– (Apidra®)
– (Lantus®)
– (Levemir®)
– (Novorapid ®)
– Mixtard®, Novomix®, Scilin M30®, Scilin N ®, Scilin R®
 ANTIDIABETIC AGENTS
– (Actos®)
– (Aforglim ®)
– (Basen®)
– (Euglocon®)
– (Glucophage®)
– (Diamicron ®)
– (Galvus®)
– (Januvia®)
– (Minidiab®)
– (Novonorm®)
– (Starlix®)
– (Trajenta ®)
 THYROID HORMONES
• Thyroid Hormones
– (Eltroxin ®)
 ANTITHYROID AGENTS
• Antithyroid Agents
– (Neomerdin®)
– Propylthiouracil
– (Strumazol®)
– (Tapazole ®)
AGENTS AFFCTING BONE METABOLISM
• Agents Affecting Bone Metabolism
– (Bonviva®)
– (Evista®)
– (Fosavance®)
– (Rocaltrol ®)
– (Zometa®)
 Allergy & Immune System
• Antihistamines & antiallergics
– (Aerius ®)
– (Benadryl ®)
– (Claritin®)
– (Iterax®)
– (Xyzal®)
– (Virlix®)
– (Telfast®)