Yes, but many MTFs are "loosening" criteria to get a NF request through, in light of the Fenoglide situation.

Bleeding risk was commented on in the ACC/AHA/ACG document which is available here. Bleeding risk is determined by the patient's risk factors, including history of ulcer disease or ulcer complication, GI bleeding, dual antiplatelet therapy, concomitant anticoagulant therapy, steroids, NSAIDs, H. pylori infection, and advanced age. The risk of bleeding increases as the number of risk factors increase.

Event rates by time are not included in the COGENT publication, just a kaplan-Meier curve of "probability of remaining free from adverse CV events".

Dabigatran etexilate (Pradaxa) will be reviewed late 2011 or early 2012. This delay allows for greater clinical experience with the drug; to see where its true place in therapy lies and to attain more information about its adverse event profile. Additionally, it allows for the market entry of other newer anticoagulants which facilitates competition among these agents. Rivaxaban, another anticoagulant, is likely to be approved in 2011.

No, Percocet is still on the formulary.

A sub-group of the Pharmacy and Therapeutics committee will be conducting a review at the beginning of next year.

The Pharmacy Operation Center (POC) will place the restrictions on the patient's profile
at the request of the provider at the MTF. The MTF Rx Restriction Request Form is
available here. The MTF has the responsibility of initiating and maintaining the
restrictions; for example, when a patient is removed from the program, the MTF must contact the POC and request the removal of the restrictions from the patient's profile.
This process should be a collaborative effort between the Pharmacist(s) and the Primary care manager (PCM), but at the directive of the PCM.

No, there are no overarching guidelines, created by the services, on the criteria for adding
a patient to this program. Each MTF is responsible for developing a policy and
procedure to govern their respective facility.

The PCM, pharmacist, and others involved in the care of these soldiers will determine the candidates for the program and it could be based on several factors to include the high-risk nature of the medications and potential of accidental or deliberate self-harm. These high risk medications include, but are not limited to, narcotic analgesics, anxiolytics,
anti-seizure and insomnia medications which when used in combination with alcohol and illicit drugs can increase the potential for adverse events and death. Once an individual is selected for the program, a sole provider or an alternate will be designated and
authorized to prescribe, countersign, or telephonically approve all prescriptions. The Pharmacy Operations Center (POC) is here to provide advice or assistance with the enrollment and disenrollment processes. For more information, please click here.

Click here for the MTF Prescription Restriction program.

The POC highly recommends that the PCM discuss with the patient prior to initiation into the program. Each MTF will determine if an agreement or consent is required from
each patient. However, the POC does not require patient consent, only the provider's signature.

If you are unable to load the slides through DCO, the slides are available on the PEC website on the MTF Webcast page.