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Microsoft word - medication formulary april 2011.doc

Dear Prescribers,
April 2011
Welcome to the Saint Vincent Healthcare Medication Formulary. This formulary was designed to provide you with the most current information possible pertaining to Formulary listings and drug-related policies. Please review this booklet at your leisure so you are familiar with which drugs are approved for use at Saint Vincent
HOW TO USE THIS BOOKLET

Drug Listings
The drugs are listed using the American Hospital Formulary Service (AHFS) classification system. Each drug entry lists the generic name, strengths and formulations available, and common brand names.
Drug-Related Policies
Selected policies have been included to assist you in ordering medications and understanding the Formulary
PLEASE NOTE
It is possible there are a few omissions due to human error which will be corrected in future versions. Please do not panic if something common is not listed! Please call the Pharmacy with questions and concerns. If a desired item was purposefully left off the Formulary, it can be acquired as a non-formulary drug request.
UPDATES TO THE FORMULARY
Updates to the Formulary will be distributed to the medical and hospital staff as drugs are added and deleted from the Formulary. An electronic copy of the formulary may be found on the Communicator. TITLE: PHARMACY & THERAPEUTICS COMMITTEE POLICY NO. 200.40.010

PURPOSE OF THE COMMITTEE
1. Policy Development: The Pharmacy and Therapeutics Committee formulates policies regarding evaluation, selection, & therapeutic use of
drugs for Saint Vincent Hospital and Health Center.
2. Advisory/Educational: The Pharmacy and Therapeutic Committee recommends & formulates programs designed to meet the needs of the
professional staff (physicians, nurses, pharmacists, and other health care practitioners) for complete current knowledge on matters related to drugs and drug use.
FUNCTIONS AND SCOPE OF THE COMMITTEE
The multiplicity of drugs available and the complexities surrounding their safe and effective use make it necessary for hospitals to have an organized,
sound program for maximizing rational drug use. The Pharmacy and Therapeutics Committee is the organizational keystone of this program.
The Pharmacy and Therapeutics Committee is an advisory group of the Medical Staff and serves as the organizational line of communication
between the Medical Staff and the Department of Pharmacy Services. The Pharmacy and Therapeutics Committee is a policy-recommending body
to the Medical Staff and the Administration of the Hospital on matters related to use of drugs.
The Pharmacy and Therapeutics Committee shall be responsible for the development and surveillance of all drug usage policies and practices at
Saint Vincent Hospital and Health Center in order to assure optimum clinical results. The Committee will formulate professional policies regarding
the evaluation, selection, procurement, storage, distribution, use, safety, and all other matters relating to drug usage. It will perform the following
specific functions:
1. Serve in an advisory capacity to the Medical Staff and Hospital Administration in all matters pertaining to the use of drugs (including
investigational drugs). 2. Develop a Formulary of drugs acceptable for use in the Hospital and provide for its ongoing review and revision as indicated. The selection of items to be of Formulary status will be based on objective evaluation of their relative therapeutic merits, safety, and cost. The Committee will minimize duplication of the same basic drug type, drug entity or drug product. 3. Establish programs and procedures that help ensure safe & effective drug therapy. 4. Establish programs adn procedures that help ensure cost-effective drug therapy. 5. Establish or plan suitable educational programs for the Hospital professional staff on matters related to drug use. 6. Participate in continuous quality improvement activities related to procurement, prescribing, distribution, administration, and monitoring of medications. As indicated by review findings, the Committee will make recommendations to the Medical Executive Committee for appropriate action. 7. Monitor & evaluate adverse drug reactions occurring in the Hospital. 8. Initiate and/or direct medication-use review programs and studies. The Committee will review the results of such activities and make recommendations for appropriate action. 9. Advise the Pharmacy in the implementation of effective drug distribution and control procedures. 10. Make recommendations concerning drugs to be stocked in Hospital patient-care areas. 11. Evaluate clinical data concerning new drugs or preparations requested for use in the Hospital. 12. Recommend policies regarding the safe use of investigational and hazardous drugs. THE FORMULARY – Policy TX-100.12

Definition and Composition
The Formulary is a compilation of all drug products approved for use by the medical staff which are considered most useful in patient care. The Formulary System is a method whereby the Medical Staff of the Hospital, working through the Pharmacy and Therapeutics Committee, evaluates, appraises, and selects from among the numerous available drug entities and drug products those that are considered most useful in patient care. The Formulary System is thus an important tool for assuring the quality of drug use. A. The Pharmacy & Therapeutics (P&T) Committee shall be responsible for the development and management of a medication formulary for use in the hospital. Only those medications selected are routinely available from the B. The P&T Committee whall be responsible for reviewing and approving all changes to the formulary including: The addition and deletion of medications The use of generic and therapeutically equivalent products C. The Medical Executive Committee shall be responsible for the review and approval of all actions in relation to formulary decisions.
Procedures
A. Evaluation and Approval of Medications 1. Pharmacy and Therapeutics Committee 1.1 Evaluates & appraises selected medication(s) & medication classes for formulary inclusion. 1.2 Approves all changes to the hospital formulary. 1.3 Recommends formulary actions: a. Add to the formulary with no restrictions. 1.) These are medications approved for use by any member of the medical staff. b. Add to the formulary with restrictions 1.) These are medications approved for use in specific patient care. 2.) These medications may be restricted to use by a specific service or for a specific indication of use. c. Not to add to the formulary 1.) Includes medications in which the Committee feels that additional information is required to determine their usefulness. 2.) Provisionally approved medications are reconsidered by the Committee after 6 months of use. 1.4 Forwards formulary recommendations to the Medical Executive Committee for review & final approval. 2. Medical Executive Committee 2.1 Reviews and approves formulary recommendations. 3. Medical Staff 3.1 Requests the addition of a medication not included on the formulary by submitting a completed "Request for Formulary Addition" form. NOTE: Any member of the medical staff may make a formulary request 4. Pharmacy Services 4.1 Schedules medications for review by the P&T Committee. Medications for review include: a. Medications recently approved by the FDA. b. Medications requested by members of the medical staff. c. Medications or medication classes in which duplication is felt to exist. 4.2 Prepares a formulary evaluation of the medication(s) scheduled for review by the P&T Committee. a. Summarizes clinical information related to a medication(s) safety & efficacy. b. Provides cost information. NOTE: Cost will only be used as a basis for formulary selection when the Committee feels that two or more medications are clinically equivalent. c. Preliminary formulary recommendation 4.3 Presents above information to the P&T Committee 4.4 Communicates information regarding formulary decisions to the medical staff. 4.5 Obtains, stores, & distributes, all medications on the formulary. 4.6 Ensures the maintenance and distribution of the printed formulary. 4.7 Publishes a printed formulary every year. 4.8 Distributes updated formulary to: a. All patient care areas in the hospital b. The medical staff If the medication is given provisional approval: 4.10 Gathers & reviews any new information 4.11 Solicits information & opinions from practitioners who have had experience with the medication. 4.12 Presents above information to the P&T Committee so that a determination may be made concerning full formulary status. B. Non-Formulary Orders Received 1.1 Contacts physician when a non-formulary medication is ordered. NOTE: If the physician determines that the non-formulary medication is necessary for the patient then the pharmacy will obtain a supply of the medication to meet the anticipated needs of the patient. 1.2 Notifies the prescriber and nursing unit caring for the patient if the non-formulary medication cannot be obtained within 4 hours. 1.3 Documents any changes to the medication order in the patient's medical record as authorized by the GENERIC/THERAPEUTIC INTERCHANGE POLICY
POLICY NO: 300:10.055 To define the use of generic and therapeutically equivalent drugs within at Saint Vincent Healthcare. Therapeutic interchange of selected drug products will be accomplished according to drug specific guidelines as outlined in this policy. Patient safety and product quality will be the guiding principle in the use of generic and therapeutically equivalent drugs. Medical, pharmacy, government and industry literature will be continually scrutinized to ensure the efficacy of drug products contained on the hospital formulary.
DEFINITIONS:
Generic Interchange: Involves the interchange among nonpropriety and propriety drugs having the same chemical Therapeutic Interchange: Is the selection of a chemically different drug that is considered by the Pharmacy and Therapeutics Committee to be a therapeutic alternative with a comparable effect.
PROCEDURE:
Responsible Party:
Pharmacy and Therapeutics Committee
1.0 Review and approve all changes to the hospital formulary which includes the addition of new and deletion of old drugs, and the use of generic and therapeutically equivalent products.
Pharmacist

1.1 Generic equivalent substitution is approved for drugs deemed to be bioequivalent, and may be applied to all
products on the hospital formulary. Criteria used in the selection of generic products will include: the annual Approved Drug Products with Therapeutic Equivalence Evaluations published by the Food and Drug Administration; affiliation with a major pharmacy buying group; and appropriate medical literature and physician feedback. Generic substitution will not be applied if the prescriber has written on the order, "Do not substitute" or words to that effect. 1.2 Class equivalent substitutions are approved for the following product classes unless specified by the prescriber. In these situations, the pharmacist may dispense a product deemed to be therapeutically equivalent by the Pharmacy and Therapeutics Committee: PRODUCT/PRODUCT Fosphenytoin/Phenytoin Diltiazem Extended-Release Formulations Twice weekly, transdermal estradiol patches Hydrocodone/APAP Combinations September Fluoroquinolones HCTZ/Triamterene (Tylox/Percocet) January 1st Generation Cephalosporins (Injectable) THERAPEUTIC INTERCHANGE POLICY APPENDIX
IF THIS IS ORDERED
THIS IS
DATE
Antacids
Extra-Strength Maalox Extra-Strength Maalox Any tablet Combination Mylanta Tablets ANALGESICS
(Oxycodone 5mg/Tylenol (Oxycodone 5mg/Tylenol HCTZ/Triamterene Combinations
Triamterene 37.5 mg / (Triamterene 37.5 Dyazide 50 capsule Triamterene 37.5 mg / mg/HCTZ 25 mg) Maxzide 25 mg tablet Triamterene 37.5 mg / (Triamterene 37.5 Triamterene 75 mg / Antibiotics
Cephalothin (Keflin) Cefazolin (Ancef) Cephapirin (Cefadyl) Cefazolin (Ancef) Any oral Multivitamin Theragran/Theragran M IF THIS IS ORDERED
THIS IS SUBSTITUTED EFFECTIVE
DATE
H2 Antagonists
Ranitidine 50 mg IV q12h Famotidine 20 mg IV q24h Ranitidine 50 mg IV q6-8hr Famotidine 20 mg IV q12h Ranitidine CI, 150 mg/day (6.25mg/hr) Famotidine 20mg IV bolus, followed Feb. 99 by CI Ranitidine 150 mg qhs Famotidine 20 mg qhs Ranitidine 150 mg BID Famotidine 20 mg po BID Ranitidine 300 mg po qhs Famotidine 40 mg po qhs Cimetidine 300 mg po BID Famotidine 20 mg po qd Cimetidine 300 mg TID – QID Famotidine 20 mg po BID Cimetidine 400 mg po qhs Famotidine 20 mg po qhs Cimetidine 400 mg po BID Famotidine 20 mg po qhs Cimetidine 800 mg po qhs Famotidine 40 mg po qhs Cimetidine 300-400 mg IV q12h Famotidine 20 mg IV QD Cimetidine 300-400 mg IV q6-8 hr Famotidine 20 mg IV q12h Cimetidine CI, 900 mg/day (37.5mg/ hr) Famotidine 20 mg IV bolus, Nizatidine 150 mg po qhs Famotidine 20 mg po qhs Nizatidine 150 mg po BID Famotidine 20 mg po BID Nizatidine 300 mg po qhs Famotidine 40 mg po qhs QUINOLONES
Cipro 500-750 mg po BID Levaquin 500 mg po QD Cipro 250 mg po BID Levaquin 250 mg po QD Cipro 400 mg IV BID Levaquin 500 mg IV QD Cipro 200 mg IV BID Levaquin 250 mg IV QD Trovan 100 mg po QD Levaquin 500 mg po QD Trovan 200 mg po QD Levaquin 500 mg po QD Trovan 200 mg IV QD Levaquin 500 mg IV QD Trovan 300 mg IV QD Levaquin 500 mg IV QD Tequin 400 mg IV/PO QD Levaquin 500 mg IV/PO QD Avelox 400 mg PO QD Levaquin 500 mg PO QD IF THIS IS ORDERED
THIS IS SUBSTITUTED
DATE
Proton Pump Inhibitors
Prilosec 10-40 mg po QD Protonix 40 mg po QD Prilosec 20-40 mg po BID Protonix 40 mg po BID Prevacid 15-30 mg po QD Protonix 40 mg po QD Prevacid 15-30 mg po BID Protonix 40 mg po BID Aciphex 20 mg po QD Protonix 40 mg po QD Aciphex 20 mg po BID Protonix 40 mg po BID Nexium 20-40 mg po QD Protonix 40 mg po QD Hydrocodone/APAP combinations
Hydrocodone/APAP 5/500 Hydrocodone/APAP 5/500 Hydrocodone/APAP 5/500 Hydrocodone/APAP 7.5/500 Hydrocodone/APAP 5/500 Hydrocodone/APAP 5/500 Hydrocodone/APAP 7.5/500 Vicodin ES 7.5/750 Hydrocodone/APAP 7.5/500 Hydrocodone/APAP 10/500 Hydrocodone/APAP 10/500 Hydrocodone/APAP 10/500 Hydrocodone/APAP 10/500 Vicodin HP 10/660 Hydrocodone/APAP 10/500 Rapid Acting Insulin Analogs (Humalog/Novolog)
Humalog Injection Novolog Injection Diltiazem Extended-Release Products
Cardizem CD or LA 120, 180, 240, Generic diltiazem ER (dose for dose) 300, 360, 420 mg Diltia XT 120, 180, 240 mg Generic diltiazem ER (dose for dose) Cartia XT 120, 180, 240, 300 mg Generic diltiazem ER (dose for dose) Dilacor XR 120, 180, 240 mg Generic diltiazem ER (dose for dose) Tiazac 120, 180, 240, 300, 360, Generic diltiazem ER (dose for dose) 1/2004 IF THIS IS ORDERED
THIS IS SUBSTITUTED EFFECTIVE
DATE
Ambien/Ambien CR
Ambien CR 6.25 mg po qhs Ambien 5 mg po qhs Ambien CR 12.5 mg po qhs Ambien 10 mg po qhs Twice Weekly Transdermal Estradial Patches
Estraderm .05 mg twice Vivelle-Dot .05 mg twice Estraderm .1 mg twice Vivelle-Dot .1 mg twice Vivelle .05 mg twice weekly Vivelle-Dot .05 mg twice Vivelle .1 mg twice weekly Vivelle-Dot .1 mg twice Oral Nitrofurantoin Products
Nitrofurantoin 50-100 mg po Macrobid (generic equivalent) 50-100 mg po BID Fosphenytoin/Phenytoin Injection
Phenytoin Injection Fosphenytoin Injection 4:00 ANTIHISTAMINE DRUGS
Amphotericin B, liposomal inj (AMBISOME) Micafungin Inj. Inj. 50 mg, ) Brompheniramine Maleate/ Phenyl-propanolamine Fluconazole tabs 50, 100, 200 mg, SR tab 12 mg/75 mg inj 200 mg, 400 mg (DIFLUCAN) Itraconazole cap 100 mg (SPORONOX) elixir: 2mg/12.5mg Brompheniramine/ Ketoconazole tab 200 mg (NIZORAL) Phenylpropanolamine Nystatin tab, susp, vag tab (MYCOSTATIN) Cetirizine tab 5 mg, 10 mg (ZYRTEC) Posaconazole Oral Susp. 40 mg/mL (NOXAFIL) Chlorpheniramine maleate tab. (CHLORTRIMETON) tablet: 4 mg; elixir: 2mg/5mL Clemastine Fumarate SR tab 1.34 mg 8:12.06 Cephalosporins
SR tab with 75 mg phenyl- FIRST GENERATION Cefazolin inj (ANCEF) Cephalexin cap 250, 500 mg Cyproheptadine tab 4 mg (PERIACTIN) Diphenhydramine cap 25, 50 mg (BENA- DRYL); elixir 12.5 mg/5mL (alcohal free) SECOND GENERATION Inj 50 mg/mL; cream 1% Cefaclor cap 250, 500 mg; susp Fexofenadine cap 60 mg (ALLEGRA) 125 mg/5mL, 250 mg/5mL (CECLOR) Loratadine tab 10 mg Cefoxitin inj 1 gm, 2 gm (MEFOXIN) Loratadine/pseudophedrine tab Cefuroxime axetil tab 250, 500 mg, susp 5 mg/120 mg (CLARITIN-D) Promethazine tab 25 mg; soln 6.25 mg/5mL; Cefuroxime Na inj (ZINACEF) inj: 25 mg, 50 mg amp; rectal supp 12.5, 25mg, 50 mg (PHENERGAN) THIRD GENERATION Promethazine syrup 6.25mg/5mL (PHENERGAN) Cefotaxime inj (CLAFORAN) Promethazine/codeine syrup Ceftazidime inj (FORTAZ, TAZIDIME) 6.25/10 mg/5 mL (PHENERGAN Ceftriaxone inj (ROCEPHIN) Triprolidine/Pseudophedrine (ACTIFED) 8:12.07 Miscellaneous Beta-Lactam Antibiotics
tabs 2.5 mg/60 mg Aztreonam inj (AZACTAM) Imipenem/Cilastatin Na inj (PRIMAXIN) 8:00 ANTI-INFECTIVE AGENTS
8:12.08 Chloramphenicol cap 250 mg, inj,
8:04 AMEBICIDES
susp 150 mg/5mL (CHLOROMYCETIN) Metronidazole (FLAGYL) see 8:40 8:12.12 Macrolides
Azithromycin cap 250 mg, Inj – 1Gm. (ZITHROMAX) Erythromycin SR tab 333 mg, 500 mg (PCE 8:08 ANTHELMINTICS
DISPERSTAB), SR tab 250, 333, 500 mg Mebendazole tab 100 mg (VERMOX) (ERY-TAB, E-MYCIN) Pyrantel Pamoate susp 50 mg/mL Erythromycin estolate susp (ILOSONE) Quinacrine tab 100 mg (ATABRINE) Erythromycin ethylsuccinate tab 400 mg, Thiabendazole susp 500mg/5mL (MINTEZOL) susp (EES, ERYPED), susp 200 mg with 600 mg Sulfisoxazole (PEDIAZOLE) 8:12 ANTIBIOTICS
Erythromycin lactobionate inj (ERYTHRO- 8:12.02 Aminoglycosides
Clarithromycin tab 250, 500 mg (BIAXIN) Amikacin inj (AMIKIN) Gentamicin inj (GARAMYCIN) 8:12.16 Penicillins
Kanamycin cap 500 mg; inj Dicloxacillin cap 250, 500 mg; susp (DYNAPEN) Penicillin G Benzathine inj 600,000 units, 1.2 mu, Neomycin tab 500 mg (NEO-TAB) 2.4 mu (BICILLIN-LA) Tobramycin inj (NEBCIN) Penicillin G K/Na inj Penicillin V K tab 250, 500 mg (PEN-VEE-K, 8:12.04 Antifungal Antibiotics
Amphotericin B inj (FUNGIZONE) Penicillin G Procaine inj 600,000 units, 1.2 mu, 8:22 QUINOLONES
Penicillinase-resistant Penicillins Ciprofloxacin tab 250, 500, 750 mg, inj (CIPRO) Nafcillin inj 1, 2 g (UNIPEN) Levofloxacin tab 250, 500 mg, 500 mg, 750 mg inj 25mg/mL, Aminopenicillins Amoxicillin cap 250, 500 mg, susp 8:24 SULFONAMIDES
250 mg chewable tab (AMOXIL) Amoxicillin/Clavulanate K tab vag cream (TRIPLE SULFA) 250 mg, 500 mg, susp 200mg/5 mL, 400mg/5mL, 600 Sulfasalazine tab 500 mg (AZULFIDINE) mg/5mL; chew tabs 250 mg (AUGMENTIN) (AUGMENTIN Sulfisoxazole/Erythromycin Ethylsuccinate susp 600/200 mg/5 ml (PEDIAZOLE, Ampicillin cap 250, 500 mg, susp 125mg/5mL, 250mg/5mL, inj (OMNIPEN) Sulfamethoxazole tab 500 mg, susp 500 mg/5 mL Ampicillin/Sulbactam inj (UNASYN) 2 gm ampicillin/1 gm sulbactam Sulfisoxazole tab 500 mg, susp 500 mg/5 mL 1 gm ampicillin/500 mg sulbactam Extended Spectrum Penicillins 8:36 URINARY ANTI-INFECTIVES
Piperacillin/tazobactam inj 2.25, 3.375, 4.5 g (ZOSYN) Nitrofurantoin cap 50, 100 mg Trimethoprim tab 100 mg (TRIMPEX) 8:12.24 Tetracyclines
Demeclocycline tab 150 mg 8:40 MISCELLANEOUS ANTI-INFECTIVES
Doxycycline cap 50, 100 mg (VIBRAMYCIN), Co-Trimoxazole Trimethoprim/ Sulfamethoxazole tab 80/400, inj, susp Minocycline cap 50 mg, 100 mg (MINOCIN) (BACTRIM), 160/800 mg (BACTRIM DS) Tetracycline cap 250 mg, 500 mg (SUMYCIN) Dapsone tab 25 mg liq 125mg/5mL, inj Metronidazole tab 250, 500 mg, inj 500 mg (FLAGYL) 8:12.28 Miscellaneous Antibiotics
10:00 ANTI-NEOPLASTIC AGENTS
Bacitracin inj (BACI-IM) Aldesleukin inj (PROLEUKIN) Daptomycin inj. 500 mg (Cubicin) Bleomycin Sulfate inj (BLENOXANE) Clindamycin cap 150, inj 300, 600, 900 mg Busulfan tab 2 mg (MYLERAN) Carboplatin inj (PARAPLATIN) Linezolid tab 600 mg, 2 mg/ml inj (ZYVOX)- restricted Carmustine inj (BCNU) Polymyxin B inj 500,000 u (AEROSPORIN) Chlorambucil tab 2 mg (LEUKERAN) Tigecycline Inj., 50 mg vial, (TYGACIL) Cisplatin; inj (PLATINOL) Vancomycin cap 125, 250 mg, soln, inj Cyclophosphamide tab 50 mg; inj (CYTOXAN) Cytarabine inj (ARA-C, CYTOSAR) Dacarbazine inj (DTIC) 8:16 ANTI-TUBERCULOSIS AGENTS
Dactinomycin inj (COSMEGEN) Ethambutol tab 400 mg (MYAMBUTOL) Daunorubicin inj (CERUBIDINE) Isoniazid tab 100 mg, 300 mg, inj Doxorubicin inj (ADRIAMYCIN) Pyrazinamide tab 500 mg Etoposide inj (VP-16, VEPESID) Rifampin cap 300 mg, inj (RIFADIN) Floxuridine inj (FUDR) Fludarabine Phosphate inj (FLUDARA) 8:18 ANTI-VIRAL AGENTS
Fluorouracil inj (5-FU, ADRUCIL) Acyclovir cap 200 mg, inj (ZOVIRAX) Flutamide cap 125 mg (EULEXIN) Amantadine cap 100 mg, soln 50 mg/5mL Hydroxyurea cap 500 mg (HYDREA) Gemcitabine inj. 200 mg; 1 Gm inj (GEMZAR) lamivudine 150 mg/zidovudine 300 mg tab(COMBIVIR) Hydroxyurea cap 500 mg (HYDREA) Oseltamivir cap. 75 mg (TAMIFLU Rimantadine tab 100 mg, syrup 50 mg/5 mL Idarubicin inj (IDAMYCIN) Ifosfamide inj (IFEX) Zidovudine cap 100 mg (RETROVIR) Interferon Alfa 2b inj (INTRON A) Leuprolide Acetate inj (LUPRON 8:20 ANTI-MALARIAL AGENTS
Chloroquine phosphate tab 250 mg, Levamisole tab 50 mg (ERGAMISOL) Hydroxychloroquine Sulfate tab 200 mg Lomustine cap 10, 40, 100 mg (CCNU) Pyrimethamine tab 25 mg (DARAPRIM) Megestrol Acetate oral susp., 40 mg/mL, (MEGACE), Quinine Sulfate cap 325 mg, susp Melphalan tab 2 mg (ALKERAN) Mercaptopurine tab 50 mg (6-MP, 12:12 SYMPATHOMIMETIC (ADRENERGIC)
Mesna inj (MESENEX) Methotrexate tab 2.5 mg, inj 50 mg (MTX) (ADVAIR) Fluticasone/salmeterol oral inhaler Mitomycin inj (MUTAMYCIN) Albuterol oral inhaler, SR tab 4 mg, tab 2, 4 Mitoxantrone inj (NOVANTRONE) mg, soln, powder & soln for inhalation Oxaliplatin inj (ELOXATIN) (PROVENTIL, VENTOLIN) Paclitaxel inj (TAXOL) Bitolterol oral inhaler (TORNALATE) Plicamycin inj (MITHRAMYCIN) Dobutamine inj (DOBUTREX) Procarbazine cap 50 mg (MATULANE) Dopamine inj (INTROPIN) Rituximab inj 10mg/ml (RITUXAN) Tamoxifen Citrate tab 10 mg (NOLVADEX) Epinephrine inj, topical soln (ADRENALIN) Ipratropium bromide oral inhaler, soln (ATROVENT) Vinblastine Sulfate inj (VELBAN) Isoetharine oral inhalation soln 1% Vincristine Sulfate inj (ONCOVIN) Isoproterenol oral inhaler, inj 2 mg Gemcitabine Inj. (GEMZAR) Levalbuterol HCl inhalation 0.63 mg/3ml and 1.25 mg/3 ml 12:00 AUTONOMIC DRUGS
(Xopenex) - restricted Levarterenol bitartrate inj (LEVOPHED) 12:04 PARASYMPATHOMIMETIC (CHOLINERGIC)
Metaproterenol Sulfate soln, oral inhaler, oral inhalation soln (ALUPENT, METAPREL) Bethanechol Chloride tab 10, 25, 50 mg, inj Norepinephrine Bitartrate inj (LEVOPHED) Phenylephrine drops 0.12, 0.25, 0.5, 1%, Donepezil 5, 10 mg tab (ARICEPT) 0.5% nasal spray,1%/Lidocaine 4%, inj 1% Galantamine tab 4, 8, 12 mg (REMINYL) (NEO-SYNEPHRINE) Memantine 5, 10 mg tab (NAMENDA) Pirbuterol acetate oral inhaler (MAXAIR) Neostigmine inj 1:1000,1:2000 (- Pseudoephedrine tab 30, 60 mg liq 30 mg/5 mL (SUDAFED) Physostigmine Salicylate inj (ANTILIRIUM) Ritodrine hydrochloride inj (YUTOPAR) Pyridostigmine Bromide tab 60 mg, inj Salmeterol inhaler (SEREVENT) (MESTINON, REGONOL) Terbutaline Sulfate tab 2.5, 5 mg, inj 1 mg Rivastigmine cap 1.5, 3, 4.5, 6 mg (EXELON) (BRETHINE), oral inhaler (BRETHAIRE) Tiotropium HandiHaler (SPIRIVA) 12:08 ANTICHOLINERGIC AGENTS
12:16 SYMPATHOLYTIC AGENTS
12:08.04 ANTIPARKINSONIAN AGENTS
Ergotamine tartrate tab SL 2 mg (ERGOSTAT) Benztropine Mesylate tab 0.5, 1, 2 mg, inj Ergotamine/caffeine tab 1 mg (CAFERGOT) Ergotamine/caffeine supp 2mg (CAFERGOT) Pramipexole tab 0.25 mg (MIRAPEX) Dihydoergotamine Mesylate inj (DHE-45) Ropinerole tab 0.25, 1 mg (REQUIP) Methylsergide tab 2 mg (SANSERT) Selegiline hydrochloride tab 5mg (ELDEPRYL) Phentolamine Mesylate inj (REGITINE) Trihexyphenidyl tab 2, 5 mg (ARTANE) 12:20 SKELETAL MUSCLE RELAXANTS
Atracurium Besylate inj (TRACRIUM) Doxacurium inj (NUROMAX) Atropine Sulfate/Hyoscyamine/Pheno Mivacurium inj (MIVACRON) barbital/Scopolamine 0.0194/0.1037/ Pancuronium Bromide inj (PAVULON) 16.2/0.0065 mg tab, elixir (DONNATAL) Succinylcholine inj 20 mg/ml (ANECTINE) Atropine Sulfate/Hyoscyamine/Pheno- Vecuronium Bromide inj (NORCURON) barbital/Scopolamine SR tab 0.0582/ Baclofen tab 10 mg (LIORESAL) 0.3111/48.6/0.0195 (DONNATAL Carisoprodol tab 350 mg (SOMA) Cyclobenzaprine tab 10 mg (FLEXERIL) Belladonna/Powdered Opium rectal supp Dantrolene Sodium cap 25 mg; inj (DANTRIUM) 16.2/30 mg (B&O SUPPRETTES) Methocarbamol tab 500, 750 mg, inj (ROBAXIN) Clidinium Bromide/Chlordiazepoxide cap 2.5/5 mg (LIBRAX) 12:92 MISCELLANEOUS AUTONOMIC DRUGS
Dicyclomine cap 10, 20 mg, inj Nicotine Polacrilex gum (NICORETTE) (BENTYL, ANTISPAS) Nicotine transdermal patch 7, 14, 21 mg Glycopyrrolate inj 0.2 mg (ROBINUL) Hyoscyamine SR cap 0.375 mg (LEVSINEX), tab 0.125 mg, SL tab 0.125 16:00 BLOOD DERIVATIVES
mg (ANASPAZ, LEVSIN) Albumin Human inj Scopolamine transdermal 0.5 mg/72 h Plasma Protein Fraction inj (PLASMANATE) (TRANSDERM-SCOP), inj 20:00 BLOOD FORMATION AND COAGULATION
Metoprolol Succinate tab 95 mg 20:04.04 IRON PREPARATIONS
Metoprolol Tartrate tab 50, 100 mg, inj Iron Dextran inj (IMFERON, INFED) Iron sucrose inj. 20 mg/mL (VENOFER) Nadolol tab 40mg, 80 mg (CORGARD) Ferrous Sulfate tab 200 mg, SR cap 159 mg, Propranolol tab 10, 20, 40, 60, 80 mg, LA elixir (FEOSOL), tab 325 mg, syrup (FER- Cap. 60, 80, 120, 160 mg, soln, inj Ferrous Gluconate tab 320 mg (FERGON) CALCIUM CHANNEL BLOCKERS 20:12.04 ANTICOAGULANTS
Amlodipine tab 5 mg (NORVASC) Warfarin Sodium tab 1, 2, 2.5, 5, 7.5, 10 mg Clevidipine Butyrate Inj 0.5 mg/mL; 50 mL (CLEVIPREX Diltiazem tab 30, 60, 90, 120 mg Heparin Sodium inj, flushes Enoxaparin Sodium inj (LOVENOX) Diltiazem tab SR 60, 90, 120 mg Argatroban inj. 100 mg/ml (ACOVA) Fondaparinux inj. 2.5 mg (ARIXTRA) Diltiazem tab CD 120, 180, 240, Bivalirudin Inj. 250 mg vial (ANGIOMAX) 300 mg, (CARDIZEM CD) Diltiazem inj (CARDIZEM) 20:12.08 ANTI-HEPARIN AGENTS
Felodipine tab 5 mg (PLENDIL) Protamine Sulfate inj Isradipine cap 20 mg (DYNACIRC) Nicardipine inj, tab 20 mg 20:12.16 HEMOSTATICS
Antihemophilic Factor VIII inj., recombinant Nifedipine cap 10 mg, CC tab 30, 60, 90 mg (ADALAT, ADALAT CC) Antihemophilic Factor IX inj., recombinant (BENEFIX) Nimodipine cap 30 mg (NIMOTOPP) Von Willebrand Factor VIII inj. (HUMATE-P) Verapamil tab 40, 80, 120 mg, inj (ISOPTIN), Antihemophilic Factor VIIa inj., (NOVOSEVEN) SR tab 120, 180, 240 mg (CALAN SR) Aminocaproic Acid tab 500 mg, inj (AMICAR) Microfibrillar Collagen Hemostat (AVITENE) Thrombin bovine 10,000 u (THROMBOSTAT) Benazepril tab 5, 10, 20 mg (LOTENSIN) Candesartan Cilexetil tab 16 mg (ATACAND) 20:16 HEMATOPOIETIC AGENTS
Captopril tab 12.5, 25, 50, 100 mg Darbopoeitin alfa, Inj, 100 mcg/mL, 300 mcg/mL vial Capropril/Hydralazine tab 25/15 mg, Epoetin Alfa inj 2,000 u, 3000 u, 4000 u, 10,000 u, 20,000 u 50/15 mg, 25/25 mg, 50/25 mg Filgastrim inj (G-CSF, NEUPOGEN) Enalaprilat inj (VASOTEC) Pegfilgrastim inj (NEULASTA) Enalapril tab 2.5, 5, 10, 20 mg (VASOTEC) Enalapril/Hydralazine tab 10mg/25 mg 20:24 HEMORRHEOLOGIC AGENTS
Pentoxifylline tab 400 mg (TRENTAL) Fosinopril Sodium tab 10 mg (MONOPRIL) Irbesartan tab 100, 300 mg (AVAPRO) 20:40 THROMBOLYTIC AGENTS
Lisinopril tab 5, 10, 20 mg (PRINIVIL, Alteplase inj (t-PA) Reteplase inj (RETAVASE) Lisinopril/HCTZ tab 20mg/12.5 mg, Streptokinase inj 750,000, 1.5 mu 20 mg/25mg (ZESTORETIC) Ramipril tab 2.5, 5 mg (ALTACE 24:04:08 CARDIAC DRUGS
Losartan tab 25, 50, 100 mg (COZAAR) DIGITALIS GLYCOSIDES Candesartan tab. 4, 8, 16, 32 mg (ATACAND) Digoxin tab 125, 250 mcg, elixir, inj (LANOXIN, LANOXICAPS) Doxazosin Mesylate tab 1, 2, 4, 8 mg Acebutolol cap 200, 400 mg (SECTRAL) Atenolol tab 25, 50, 100 mg (TENORMIN) Terazosin tab 1, 2, 5, 10 mg (HYTRIN) Atenolol/Chlorthalidone tab 50mg/25mg ANTI-ARRHYTHMICS Carvedilol 3.125 mg, 6.25 mg, 12.5 mg, 25 mg tabs. Adenosine inj (ADENOCARD) (COREG); 10 mg, 20 mg, 40 mg extended release tablets Amiodarone tab 200 mg, inj (CORDARONE) Bretylium Tosylate inj (BRETYLOL) Esmolol inj (BREVIBLOC) Disopyramide cap 100, 150 mg, CR cap 100, Labetalol tab 100, 200, 300 mg, inj 150 mg (NORPACE) (NORMODYNE, TRANDATE) Dofetilide 125 mcg, 250 mcg caps (TIKOSYN) Flecainide Acetate tab 100 mg(TAMBOCOR) 2.5 mg/5ml (LORTAB) Lidocaine inj (XYLOCAINE) Celecoxib cap 100, 200 mg (CELEBREX) Mexiletine cap 150, 200, 250 mg (MEXITIL) Choline Magnesium Trisalicylate tab 500, Procainamide cap 250, 375, 500 mg, inj 750 mg (TRILISATE) (PRONESTYL), ER tab 500, 1000 mg Diclofenac Sodium tab 50, 75 mg Propafenone tab 150, 300 mg (RYTHMOL) Etodolac cap 200, 300 mg (LODINE) Quinidine Sulfate tab 200, 300 mg Ibuprofen tab 200, 300, 400, 600, 800 mg (MOTRIN, Sotalol tab 80 mg (BETAPACE) ADVIL), 100 mg/5 ml susp Indomethacin cap 25, 50 mg, SR cap 75 mg, rectal supp 50 Aliskiren tab., 150 mg, 300 mg (TEKTURNA) Imamrinone Lactate inj (INOCOR) Indomethacin inj (INDOCIN) Clonidine tab 0.1, 0.2, 0.3 mg (CATAPRES), Ketoprofen cap 75 mg (ORUDIS) transdermal 0.1, 0.2, 0.3 mg/24 h Ketorolac Tromethamine tab 10 mg, inj 15, 30 mg Diazoxide inj (HYPERSTAT) Nabumetone tab 500 mg (RELAFEN) Guanfacine tab 1 mg (TENEX) Naproxen tab 250, 375, 500 mg; susp Hydralazine tab 10, 25, 50 mg, inj 25 mg/mL (NAPROSYN) Oxaprozin tab 600 mg (DAYPRO) Methyldopa tab 250 mg, inj (ALDOMET) Piroxicam cap 10 mg, 20 mg (FELDENE) Milrinone inj (PRIMACOR) Salsalate tab 500 mg, 750 mg tab Papaverine hydrochloride inj Prazocin cap 1, 2, 5 mg (MINIPRESS) Sulindac tab 150 mg, 200 mg (CLINORIL) Nitroprusside inj (NITROPRESS) 28:08.08 OPIATE AGONISTS
24:06 ANTILIPEMIC AGENTS
Codeine Phosphate tab 15, 30, 60 mg Atorvastatin tab. 10, 20, 40, 80 mg (Lipitor) Codeine Phosphate inj 30mg, 60 mg Cholestyramine Resin granules (QUESTRAN) Codeine Phosphate liq 15 mg/5mL Ezetimibe tab 10 mg (ZETIA) Codeine Phosphate/Acetaminophen 120/12 Gemfibrozil tab 300 mg (LOPID) mg/5 ml elixir (TYLENOL WITH CODEINE) Lovastatin tabs 10, 20 mg Codeine Phosphate/Acetaminophen tab Niacin tab 100 mg 325 mg w/30mg, 60 mg (TYLENOL #3,#4) Pravastatin tab. 10, 20 mg (Pravachol) Fentanyl Citrate transdermal 12.5, 25, 50, 75 Rosuvastatin 10, 20 mg tab (CRESTOR) 100 mcg/hr, (DURAGESIC) Simvastatin tab 10, 20, 40, 80 mg (ZOCOR) Fentanyl Citrate inj (SUBLIMAZE) Fentanyl transmucosal 200 mcg ACTIQ 24:12 VASODILATING AGENTS
Hydrocodone Bitartrate/Acetaminophen tab Isosorbide Mononitrate tab 30 mg, 5/500 mg, (LORTAB-5) soln (LORTAB) 60 mg, 120 mg (IMDUR) Hydrocodone Bitartrate/Acetaminophen tab Isosorbide Dinitrate tab 5, 10, 20, 40 mg, 7.5 mg/650 mg, (ANEXSIA) SL tab 2.5 mg, SA tab 40 mg (ISORDIL) Hydromorphone tab 2 mg 4 mg (DILAUDID) Nitroglycerin lingual aerosol 0.4 mg/spray Hydromorphone supp 3mg; inj (DILAUDID) (NITROLINGUAL SPRAY) Meperidine tab 50 mg, inj (DEMEROL) Nitroglycerin SR cap 2.5, 6.5 mg, Meperidine inj PCA syringe, 50 mg/mL (NITRO-BID, NITROGLYN) Methadone tab 5, 10 mg (DOLOPHINE) Nitroglycerin SL tab 0.4 mg (NITROSTAT) Morphine Sulfate tab 30 mg, Nitroglycerin ointment Morphine Sulfate tab ext release Nitroglycerin Transdermal 0.1, 0.2, 0.3, 0.4, 15, 30, 60, 100 mg (MS CONTIN) 0.6 mg/hr (TRANSDERM-NITRO) Morphine Sulfate inj, soln 10 mg/5 mL Nitroglycerin inj (TRIDIL) Morphine sulfate inj. 0.5 mg/mL, 1 mg/mL Dipyridamole tab 25, 50, 75 mg preservative free (ASTRAMORPH) Morphine sulfate rectal supp 10 mg Morphine sulfate, PCA syringe 1 mg/mL 28:00 CENTRAL NERVOUS SYSTEM AGENTS
Opium/Belladonna supp 30/15 mg, 28:08 ANALGESICS AND ANTIPYRETICS
60/15 mg (B&O SUPPRETTES) Oxycodone/Acetaminophen tab 5/325 mg 28:08.04 NON-STEROIDAL ANTI-INFLAMMATORY
Oxycodone/Aspirin tab 5/325 mg (PERCODAN) Aspirin tab 325, 650 mg, chewtab 81 mg, EC tab 325 mg Propoxyphene H Cl cap 65 mg (DARVON PULVULES) (ECOTRIN), rectal supp 300 mg, 600 mg Propoxyphene Napsylate/Acetaminophen tab Aspirin/Oxycodone 325/5 mg (PERCODAN) 100/650 mg (DARVOCET-N 100) Sufentanil Citrate inj (SUFENTA) Hydrocodone Bitartrate liq Tramadol tab 50 mg (ULTRAM) Amoxapine tab 50, 100 mg (ASCENDIN) 28:08.12 OPIATE PARTIAL AGONISTS
Citalopram tab 20 mg (CELEXA) Buprenorphine inj (BUPRENEX) Desipramine tab 10, 25, 50, 100 mg Butorphanol Tartrate inj (STADOL) Nalbuphine inj (NUBAIN) Desvenlafaxine Succinate tab 50 mg ER Tab PRISTIQ Pentazocine tab 50 mg; inj 30 mg, 60 mg (TALWIN) Doxepin cap 10, 25, 50, 100 mg Duloxetine cap. 30, 60mg (Cymbalta) 28:08.92 MISCELLANEOUS ANALGESICS AND
Escitalopram tab 10, 20 mg (LEXAPRO) Fluoxetine cap 10, 20 mg, soln (PROZAC) Acetaminophen tab 325, 500 mg, supp 120, 325, 650 mg; Imipramine Hydrochloride tab 10, 25, 50 mg liq 80 mg/0.8 mL, 160 mg/5mL (TYLENOL) Maprotiline tab 25, 50 mg (LUDIOMIL) Nortriptyline cap 10, 25, 50, 75 mg cap 325/65/100 mg (MIDRIN) Ziconotide Inj. 25 mcg/mL, 20 mL vial (PRIALT)
Paroxetine tab 10, 20, 30, 40 mg (PAXIL) Restricted to Northern Rockies Pain Clinic
Sertraline tab 50, 100 mg (ZOLOFT) Trazadone tab 50, 100, 150 mg (DESYREL) 28:10 OPIATE ANTAGONISTS
Venlafaxine, tab 37.5, 75, 150 mg, tab (EFFEXOR XR) Naloxone inj 0.4mg/mL, 1 mg/mL (NARCAN) 28:12 ANTICONVULSANTS
28:16.08 TRANQUILIZERS
28:12.04 BARBITURATES Chlorpromazine Hydrochloride soln, tab 10, 25, 100 mg, inj Phenobarbital tab 15, 30, 60, 100 mg elixir 4 mg/mL, inj Primidone tab 50, 250 mg Fluphenazine Hydrochloride tab 1, 2.5, 5 mg, elixir 250 mg/5 mL (MYSOLINE) elixir (PROLIXIN) Mesoridazine Besylate tab 25, 50 mg 28:12.08 BENZODIAZEPINES Clonazepam tab 0.5, 1 mg (KLONOPIN) Perphenazine tab 2, 4, 8 mg (TRILAFON) Prochlorperazine rectal supp 2.5, 5, 25 mg (COMPAZINE) 28:12.12 HYDANTOINS Prochlorperazine Maleate cap 10 mg, tab Phenytoin chew tab 50 mg, susp 30 mg/5ml, 125 mg/5 ml 5, 10, 25 mg; inj (COMPAZINE) Thioridazine Hydrochloride tab 10, 25, 50, 100 mg, soln Phenytoin Sodium SR cap 30 mg, 100 mg, 300 mg Trifluoperazine tab 2, 5, 10 mg, Fosphenytoin Inj. 150mg/2mL, 750mg/10mL (Cerebyx) 150 liq 10 mg/mL (STELAZINE) mg fosphenytoin equivalent to 100 mg phenytoin sodium. Droperidol inj (INAPSINE) Haloperidol tab 0.5, 1, 2, 5, 10 mg, soln, inj (HALDOL) 28:12.20 SUCCINIMIDES Haloperidol Decanoate inj Ethosuximide cap 250 mg, Loxapine cap 5, 25 mg (LOXITANE) liq 250 mg/5 ML (ZARONTIN) Mirtazipine 15 mg tab. 28:12.92 MISCELLANEOUS ANTICONVULSANTS Olanzapine 2.5, 5, 10 mg tabs (ZYPREXA) Carbamazepine tab 100 mg (chewable), 200 mg, susp Olanzapine ODT 5, 10 mg (ZYPREXA ZYDIS) 100mg/5mL (TEGRETOL) Olanzapine 10 mg inj (ZYPREXA IM) Gabapentin cap 100, 300 mg (NEURONTIN) Quetiapine 25, 100 mg tabs (SEROQUEL ) (SEROQUEL) Levetiracetam tabs., 500 mg; Inj 500 mg/5mL vial Risperidone 0.25, 0.5, 1, 2 mg tabs (RIS:ERDAL) Thiothixene cap 1, 2, 5, 10 mg; inj (NAVANE) Oxcarbazepine tab 150, 300, 600 mg (TRILEPTAL) Ziprasidone 20 mg inj (GEODON IM) Valproate Sodium tab 125, 250 mg oral soln (DEPAKENE), inj 500mg/5mL 28:20 RESPIRATORY AND CEREBRAL
STIMULANTS
Valproic Acid cap 250 mg; liq 250 mg/5 mL (DEPAKENE) Caffeine tab 100 mg; inj Divalproex Sodium cap 125 mg, tab 250, 500 mg Caffeine citrate Inj. 60mg/3mL (CAFCIT) Dextroamphetamine tab 5 mg (DEXEDRINE) Divalproex Sodium tab 500 mg (DEPAKOTE ER) Doxapram inj (DOPRAM) Methylphenidate tab 5, 10, 20 mg (RITALIN) 28:16.04 ANTIDEPRESSANTS
MONOAMINE OXIDASE INHIBITORS Phenelzine Sulfate tab 15 mg (NARDIL) Tranylcypromine tab 10 mg (PARNATE) 28:24.04 BARBITURATES
Pentobarbital 25 mg/mL, 20 mL vial Amitriptyline tab 10, 25, 50, 75, 100, 150 mg (ELAVIL) Phenobarbital tab 15, 30, 60, 100 mg, elixir 4mg/mL, inj Diatrizoate Meglumine (RENO-M-30) Thiopental inj. (PENTOTHAL) 28:24.08 BENZODIAZEPINES
36:84 TUBERCULOSIS
Alprazolam 0.25, 0.5, 1 mg tab (XANAX) Purified Protein Derivative (PPD) Chlordiazepoxide cap 5, 10, 25 mg, inj Chlordiazepoxide/Clidinium Bromide cap 40:04 ACIDIFYING AGENTS
5/2.5 mg LIBRAX) Ammonium Chloride inj Chlordiazepoxide/Amitriptyline tab 5/12.5, 10/25 mg 40:08 ALKALINIZING AGENTS
Diazepam tab 2, 5, 10 mg, inj (VALIUM), rectal gel Sodium Bicarbonate tab 325, 650 mg, inj 10 mg twin packs (DIASTAT) Potassium Citrate/Citric Acid syrup Flurazepam cap 15, 30 mg (DALMANE) 1100/334 mg/5 ml (POLYCITRA-K) Lorazepam tab 0.5, 1, 2 mg, inj (ATIVAN) Sodium Citrate/Citric Acid soln Midazolam inj (VERSED) 500/334 mg/5ml BICITRA) Temazepam cap 15, 30 mg (RESTORIL) Tromethamine inj (THAM) Triazolam tab 0.125, 0.25 mg (HALCION) Zolpidem tab 5, 10 mg (AMBIEN) 40:10 AMMONIA DETOXICANTS
Lactulose soln 10 Gm/15 mL (CHRONULAC) 28:24.92 MISCELLANEOUS ANXIOLYTICS,
SEDATIVES, AND HYPNOTICS
40:12 REPLACEMENT PREPARATIONS
Buspirone tab 5, 10 mg (BUSPAR) Calcium Carbonate tab 500 mg (TUMS) Choral hydrate syrup 500 mg/5mL, cap 500 mg (NOCTEC) Calcium Chloride inj Dexmedetomidine inj 200 mg/2 ml (PRECEDEX) Calcium Gluconate tab 500 mg, inj Hydroxyzine HCl tab 10, 25, 50 mg, syrup 10 mg/5mL; inj Hetastarch inj (HESPAN) Potassium acetate inj Hydroxyzine Pamoate susp 25 mg/5 mL, cap 25, 50, 100 mg, Potassium Phosphate/Sodium Phospate mixture (NEUTRA- Promethazine tab 25 mg, supp 12.5, 25 mg, syrup Potassium Chloride tab 10, 20 mEq (PHENERGAN), inj (KDUR), oral soln, powder, inj Potassium Phosphate inj 28:28 ANTIMANIC AGENTS
Sodium acetate inj Lithium Carbonate SR tab 300 mg, (LITHOBID), Sodium Chloride tab 650 mg, inj Lithium Citrate soln 300 mg/5 mL Sodium phosphate inj 36:00 DIAGNOSTIC AGENTS
40:18 POTASSIUM-REMOVING RESINS
Fluoroscein strips (FLUOR-I-STRIP) Sodium Polystyrene Sulfonate/Sorbitol susp, Fluoroscein inj 10% (FLUORESCITE) Fluoroscein drops 2% Coccidioidin Skin Test inj 40:28 DIURETICS
Dermatophyton Skin Test inj Thiazides
Histoplasmin Skin Test inj Chlorthalidone tab 25, 50, 100 mg 36:04 ADRENOCORTICAL INSUFFICIENCY
Chlorothiazide tab 250, 500 mg; inj; susp (DIURIL) Cosyntropin 0.25 mg inj (CORTROSYN) Hydrochlorothiazide tab 25, 50 mg, HCTZ) Protirelin inj (THYPINONE) Hydrochlorothiazide/Triamterene cap 25/37.5, 50/75 mg Thyrotropin inj (THYTROPAR) Indapamide tab 2.5 mg (LOZOL) Metolazone tab 2.5, 5, 10 mg (ZAROXOLYN, DIULO) 36:26 DIABETES MELLITUS
Acetest reagent tablets Loop Diuretics
Chemstrip 6L, 7, 9 Bumetanide tab 0.5, 1, 2 mg, inj (BUMEX) Chemstrip BG ACCU-II Furosemide tab 20, 40, 80 mg, soln, inj Clinitest reagent tablets Dextrostrip test strips Torsemide tab. 10mg, 20mg (DEMADEX) Ketostix test strips Osmotic Diuretics
36:40 KIDNEY FUNCTION
Indigotindisulfonate Sodium inj Potassium-Sparing Diuretics
Amiloride tab 5 mg (MIDAMOR) 36:56 MYASTHENIA GRAVIS
Amiloride/HCTZ tab 5mg/50mg Neostigmine inj 1:1000,1:2000 ( Spironolactone tab 25, 50, 100 mg 36:68 ROENTGENOGRAPHY
Spironolactone/HCTZ tab 25mg/25mg, 50mg/50mg otic susp, soln 0.5/1%/10,000 u/ml (CORTISPORIN OTIC) Triamterene cap 50, 100 mg (DYRENIUM) Polymyxin/Trimethoprim oph soln (10,000 u/ Hydrochlorothiazide/Triamterene cap 0.1%) (POLYTRIM) 25/37.5, 50/75 mg Oxytetracycline/Polymyxin B oph oint (0.5%/ 10,000 u/g (TERRAMYCIN OPH OINT) 40:36 IRRIGATING SOLUTIONS
Tetracycline oph oint 1% (ACHROMYCIN) Acetic Acid irr soln 0.25% Tobramycin oph oint, soln 0.3% (TOBREX) Aminoacetic Acid irr soln 1.5% (GLYCINE) Tobramycin/Dexamethasone oph oint, susp Renacidin irr solution 10% 0.3/0.1% (TOBRADEX) Sterile Water irr soln Sodium Chloride irr soln 0.9% 52:04.06 ANTI-VIRALS
Vidarabine oph oint 3% (VIRA-A) 40:40 URICOSURIC AGENTS
Probenecid tab 500 mg (BENEMID) 52:04.08 SULFONAMIDES
Sulfacetamide oph oint 10% (CETAMIDE, 44:00 Enzymes
(SODIUM SULAMYD) Hyaluronidase inj (WYDASE) Sulfacetamide/Prednisolone oph susp 10%/ 0.2% (BLEPHAMIDE) 48:08 ANTITUSSIVES
Benzonatate cap 100 mg (TESSALON PERLES) 52:08 ANTI-INFLAMMATORY AGENTS
Codeine Phospate tab 30 mg Beclomethasone dipropionate nasal aerosol Codeine Phosphate/Guaifenesin syrup BECONASE, VANCENASE) 10/100 mg/5 ml (ROBITUSSIN AC) Beclomethasone dipropionate monohydrate nasal susp Dextromethorphan/Guaifenesin syrup 10/100 mg/5 ml (ROBITUSSIN DM) Dexamethasone/Neomycin/Polymyxin B Promethazine/codeine syrup oph oint, susp 0.1/0.5%/10,000 u/g or ml 6.25/10 mg/5 mL (PHENERGAN Dexamethasone/Tobramycin oph oint, susp 48:16 EXPECTORANTS
Dexamethasone oph oint 0.05% Guiafenesin/phenylpropanolamine tab SR (DECADRON, MAXIDEX) 400mg; soln 100 mg/5 mL Dexamethasone oph soln 0.1% Potassium Iodide soln (SSKI) (DECADRON, MAXIDEX) Dexamethasone/Neomycin oph oint 48:24 MUCOLYTICS
0.05/0.5% (NEODECADRON) Acetylcysteine sodium soln 10%, 20% MUCOMYST) Flunisolide nasal soln 0.025% (NASALIDE) Fluorometholone oph susp 0.1% (FLAREX), 52:00 EYE, EAR, NOSE AND THROAT
0.25% (FML FORTE) Hydrocortisone/Neomycin/Polymyxin B otic 52:04.04 ANTIBIOTICS
soln, susp (CORTISPORIN OTIC) Bacitracin oph oint 500 u/g Bacitracin/Polymyxin oph oint 500 u/ um otic susp 1/0.3/0.5/0.05% (COLY- 10,000 u/g (POLYSPORIN OPH) Chloramphenicol oph oint 1% CHLOROMYCETIN, Medrysone oph susp 1% (HMS) Chloramphenicol opth soln 0.5% CHLOROPTIC) Prenisolone oph susp 0.12% (PRED MILD), Ciprofloxacin oph soln 0.3% (CILOXAN) 0.25% (ECONOPRED PLUS, PRED Gentamicin Sulfate oph soln, oint 0.3% GENOPTIC) Neomycin/Bacitracin Zinc/Polymyxin B Sulfacetamide/Prednisolone oph oint, susp oph oint 0.5%/400 u/10,000 u/g 10/0.2% (BLEPHAMIDE) (NEOSPORIN OPH OINT) Neomycin/Dexamthasone/Polymyxin B Sulfacetamide/Prednisolone susp 10/0.5% oph oint 0.5%/0.1%/10,000 u/g Prednisolone/Neomycin/Polymyxin B oph Neomycin/Dexamethasone oph oint susp 0.5/0.5/10,000 u/ml (POLY-PRED) 0/5/0.05% (NEODECADRON) Prednisolone oph soln 0.125% (INFLAMASE Neomycin/Hydrocortisone/Polymyxin B MILD), 1% (INFLAMASE FORTE) oph susp 0.5/1%/10,000 u/ml (CORTISPORIN OPH SUSP) 52:10 CARBONIC ANHYDRASE INHIBITORS
Acetazolamide cap 500 mg (DIAMOX otic susp 0.5/0.3/1/0.05% SEQUEL), tab 250 mg, inj (DIAMOX) (COLY-MYCIN S OTIC) Methazolamide tab 25, 50 mg (NEPTAZANE) Neomycin/Hydrocortisone/Polymyxin B 52:16 LOCAL ANESTHETICS
Benzocaine/Antipyrine otic soln 1.4/5.4% Triethanolamine Polypeptide 10% Benzocaine aerosol 20% (HURRICAINE) Acetic Acid in mod. Burow's soln 2% Cocaine topical soln 4% Dyclonine liq 0.5% (DYCLONE) Acetic Acid otic soln 2% (VOSOL) Proparacaine oph soln 0.5% (ALCAINE) Tetracaine oph oint, soln 0.5% PONTOCAINE) 56:04 ANTACIDS AND ABSORBENTS
Benzocaine/Cetylpyridinium anesthetic Aluminum Hydroxide/Magnesium Hydroxide/ lozenges 10/1.4 mg (CEPACOL) Simethicone 675/600/75 mg/15 ml 52:20 MIOTICS
Aluminum Hydroxide/Magnesium Hydroxide/ Carbachol oph soln 0.75, 1.5, 3%(ISOPTO-CARBACHOL) Simethicone 1500/1350/120 mg/15 ml Echothiophate Iodide oph soln 0.06, 0.125% (EXTRA STRENGTH MAALOX PLUS) (PHOSPHOLINE IODIDE) Aluminum Hydroxide tab 500 mg, susp Pilocarpine oph gel 4% (PILOPINE HS) Pilocarpine oph soln 0.25, 0.5, 1, 2, 4, 6% Calcium Carbonate tab 500 mg (TUMS) (PILOCAR, ISOPTO CARPINE) Activated Charcoal Magraldate susp 400 mg/5mL (RIOPAN PLUS) 52:24 MYDRIATICS
Atropine oph oint 1%, soln 1% (ATROPISOL, 56:08 ANTIDIARRHEA AGENTS
ISOPTO-ATROPINE) Diphenoxylate/Atropine Sulfate 2.5/0.025 Cyclopentolate oph soln 0.5, 1, 2% mg/5 ml (LOMOTIL SYRUP) Diphenoxylate/Atropine Sulfate 2.5/0.025 mg Dipivefrin oph soln 0.1% (PROPINE) tab (LOMOTIL TABS) Epinephrine oph soln 2% (EPIFRIN) Kaolin and Pectin Homatropine oph soln 2, 5% (ISOPTO-HOMATROPINE) Lactobacillus Acidophilus Phenylephrine oph soln 2.5% (MYDFRIN) Loperamide cap 2 mg, tab 2 mg, soln Phenylephrine/Sulfacetamide oph soln 0.125/15% (VASOSULF) Opium tincture liq, (PAREGORIC) Tropicamide oph soln 1% (MYDRIACYL) 56:10 ANTIFLATULENTS
52:32 VASOCONSTRICTORS
Epinephrine nasal soln 0.1% (ADRENALIN)
Simethicone tab 80 mg (GAS-X, PHAZYME) Naphazoline/Pheniramine Maleate oph soln Simethicone drops 40 mg/0.6 ml (PHAZYME 0.025/0.3% (NAPHCON-A) Naphazoline/Antazoline oph soln 0.05/0.5% 56:12 CATHARTICS AND LAXATIVES
Phenylephrine oph soln 10% (NEO- Anthraquinone Laxatives Phenylephrine nasal soln 0.125% (NEO- SYNEPHRINE PEDIATRIC), 0.25% Senna syrup 30 ml (SENOKOT SYRUP) (MILD), 0.5% (REGULAR STRENGTH), Senna/Docusate tab 187 mg/50 mg (SENOKOT-S) 1% (EXTRA STRENGTH) Docusate Na/Casanthranol 100/30 mg cap, syrup (PERI-COLACE) 52:36 MISCELLANEOUS EENT DRUGS
Bulk-Forming Laxatives Balanced Salt Soln (BSS) Polycarbophil tab 500 mg (FIBERCON) Betaxolol oph soln 0.5% (BETOPTIC) Psyllium pkt 3.6 g/pkt (METAMUCIL) Bimatoprost 0.03% soln (LUMIGAN) Latanoprost 0.005% soln (XALATAN) Diphenylmethane Laxatives Levobunolol oph soln 0.25, 0.5% Bisacodyl supp 10 mg, tab 5 mg Timolol Maleate oph soln 0.25, 0.5% Hyperosmotic Laxatives Eyewash (DACRIOSE) Glycerin Child, Adult supp Fluoroscein strips 9 mg (FLUOR-I-STRIP) Sorbitol 70% soln 30 ml Fluoroscein oph soln 2% Artificial tears oph soln (HYPO-TEARS) Mineral Oil 30 ml Polyvinyl alcohol oph soln 1.4% (DRY EYES) White Petrolatum/Mineral Oil oph oint Saline Laxatives (DURA-TEARS, LACRI-LUBE) Magnesium Citrate (CITRATE OF Dapiprazole oph soln 0.5% (REV EYES) Sodium Chloride Hypertonic oph soln 5% Magnesium Hydroxide susp (MILK OF MAGNESIA) Dibasic Na Phosphate/Monobasic Na Cortisone Acetate tab 5, 25 mg Phosphate soln (FLEET PHOSPHO SODA oral soln) Dexamethasone 0.5, 0.75, 1.5, 2, 4 mg tab inj, liq 0.5 mg/5 Fludrocortisone Acetate tab 0.1 mg (FLORINEF) Docusate calcium cap 240 mg (SURFAK) Flunisolide oral inhaler (AEROBID) Docusate Na cap 50, 100 mg, Hydrocortisone 5, 10, 20 mg tab; (CORTEF) Hydrocortisone Sodium Succinate inj Docusate Na/Casanthranol 100/30 mg cap, syrup (PERI-COLACE) Methylprednisolone 4, 8, 16 mg tab (MEDROL) Docusate Potassium cap 100 mg (DIALOSE) Methylprednisolone Acetate inj, soln Methylprednisolone Sodium Succinate inj (SOLU- Lactulose syrup 30 ml (DUPHALAC) Prednisolone Sodium Phosphate oral soln 56:16 DIGESTANTS
Prednisone tab 1, 2.5, 5, 10, 20, 50 mg (ORASONE, Pancrealipase cap (ULTRASE MT-12), (ULTRASE MT20), DELTASONE), oral soln (PANGESTYNE MT10), (LIPRAM 20 PN), (LIPRAM 10 Triamcinolone Acetonide inj (KENALOG-10, PN), (LIPRAM 4500), (KU-ZYME HP) KENALOG-40), oral inhaler 100 mcg/spray 56:20 EMETICS
Triamcinolone Diacetate inj (ARISTOCORT) Triamcinolone Hexacetonide inj 56:22 ANTIEMETICS
68:08 ANDROGENS
Danazol cap 100, 200 mg (DANOCRINE) Dolasetron Mesylate inj 12.5mg/0.625mL Fluoxymesterone tab 5, 10 mg ampules (ANZEMET) Meclizine tab 12.5, 25 mg (ANTIVERT) Testosterone inj (DEPOTEST) Ondansetron tab 8 mg, inj (ZOFRAN) Palonosetron 0.25 mg inj (ALOXI) 68:16 ESTROGENS
Prochlorperazine tab 5, 10 mg, supp 25 mg. (COMPAZINE) Triethylperazine maleate tab 10 mg, supp 10 mg, inj Diethylstilbestrol tab 0.1 mg (DES) Estradiol transdermal 0.05, 0.1 mg/24 hr (VIVELLE DOT) Trimethobenzamide cap 100, 250 mg, inj., supp 100, 200 mg (ESTRADERM), tab 1, 2 mg (ESTRACE) Estradiol cypionate inj (DEPOESTRADIOL) Estradiol valerate inj (DELESTROGEN) Estrogens, conjugated tab 0.3, 0.625, 0.9, 1.25 mg, vag 56:36: ANTI-INFLAMMATORY AGENTS (GI
cream; inj (PREMARIN) Estropipate tab 1.25 mg (OGEN) Raloxifene tab 60 mg (EVISTA) Inflixumab Inj. 100 mg vial REMICADE 68:20.08 INSULINS
56:92 MISCELLANEOUS GI DRUGS
Insulin Aspart Recombinant (NOVOLOG) Alvimopan Caps. 12 mg (ENTEREG)
Insulin, glargine (LANTUS) Famotidine tab 20 mg, 40 mg, Inj. Insulin detemir 100 units/mL Inj. (DETEMIR) Insulin, human regular 100 units/mL; 500 units/mL Lansoprazole 15 mg Solutab (PREVACID)
Mesalamine 500 mg rect supp (ROWASA) Insulin human, NPH, NOVOLIN-N), Metoclopramide 5, 10 mg tab, soln, inj (REGLAN) Insulin, Ultra-lente (HUMULIN ULTRALENTE) Misoprostol 100, 200 mcg tab (CYTOTEC) Insulin, human regular/isophane 50/50 Pantoprazole tab 40 mg, Inj. 40 mg (PROTONIX) units/ml (HUMULIN 50-50) Sucralfate 1 g tabs (CARAFATE) Insulin, human regular/isophane 30/70 units/ml (NOVOLIN 70-30) 64:00 HEAVY METAL ANTAGONISTS
Deferoxamine inj (DESFERAL) 68:20.20 SULFONYLUREAS
Penicillamine 250 mg caps (CUPRIMINE) Acetohexamide tab 500 mg (DYMELOR) Chlorpropamide tab 100, 250 mg 68:04 ADRENAL CORTICOSTEROIDS
Beclomethasone dipropionate oral inhaler Glipizide tab 5, 10 mg (GLUCOTROL) (BECLOVENT, VANCERIL) Glipizide XL tab 5, 10 mg (GLUCOTROL XL) Betamethasone tab 0.6 mg,inj Glyburide tab 3 mg (GLYNASE), tab 1.25, 2.5, 5 mg (MICRONASE, DIABETA) Cortisone Acetate inj (CORTONE) Tolazamide tab 100 mg, 250 mg Tolbutamide tab 500 mg (ORINASE) 80:04 SERUMS
Antivenin, Crotalidae inj. (CROFAB) 68:20.92 MISCELLANEOUS ANTIDIABETIC
Hepatitis B Immune Globulin (H-BIG) Immune Globulin (CARIMUNE NF, GAMUNEX) Rabies Immune Globulin (IMOGAM RABIES) Nateglinide tab 60, 120 mg (STARLIX) Tetanus Immune Globulin (HYPER-TET) Pioglitazone tab 30 mg (ACTOS) Repaglinide tab 0.5, 1 mg (PRANDIN) 80:08 TOXOIDS
Rosiglitazone tab 4 mg (AVANDIA) Diphtheria and Tetanus Toxoids Absorbed Sitagliptan 50 mg, 100 mg tabs. (JANUVIA) Diphtheria and Tetanus Toxoids Absorbed 68:24 PARATHYROID AGENTS
Calcitonin (salmon), inj (CALCIMAR) Tetanus Toxoid Absorbed, Ultrafined Calcitonin (salmon), nasal spray 80:12 VACCINES
BCG vaccine (TICE BCG) 68:28 PITUITARY AGENTS
Haemophilus B conjugate vaccine (HibTITER) Corticotropin inj (ACTHAR, ACTH) Hepatitis B Virus vaccine inactivated Desmopressin acetate nasal soln (DDAVP Influenza Virus vaccine NASAL SPRAY), inj (DDAVP) Meningococcal vaccine Inj. (MENOMUNE, MENACTRA) Vasopressin inj (PITRESSIN) Pneumococcal Vaccine Polyvalent (PNEUMOVAX 23) Poliovirus Vaccine Live Oral Rabies Vaccine (IMOVAX 68:32 PROGESTINS
Medroxyprogesterone acetate tab 2.5, 5, 10 Rotavirus vaccine, oral susp. (ROTATEQ) mg (PROVERA), inj (DEPO-PROVERA) Rubella Virus Vaccine Live (MERUVAX II) Progesterone inj Tetanus/diphtheria/acellular/pertussis vaccine (ADACEL) Varicella Zoster Vaccine Inj. (ZOSTAVAX) 68:36.04 THYROID AGENTS
Varicella virus vaccine live, attenuated, Inj. (VARIVAX) Levothyroxine sodium tab 25, 50, 75, 88,100, 125, 150, 200, 84:00 SKIN AND MUCOUS MEMBRANE
Liothyronine sodium tab 25 mcg (CYTOMEL) Thyroid tab 1, 2, 3 grains 84:04.04 ANTIBIOTICS
Bacitracin oint 500 u/g 68:36.08 ANTI-THYROID AGENTS
Bacitracin/Polymyxin B oint, powder Methimazole tab 10 mg (TAPAZOLE) 500/10,000 u/g (POLYSPORIN) Propylthiouracil tab 50 mg (PTU) Clindamycin gel, lotion, soln 1% (CLEOCIN-T) Gentamicin cream, oint 0.1% (GARAMYCIN) 72:00 LOCAL ANESTHETICS
Mupirocin oint 2% (BACTROBAN) Bupivicaine inj 0.25, 0.5, 0.75% Neomycin/Polymyxin B cream 0.5%/10,000 Bupivicaine w Epinephrine inj 0.25, Neomycin/Bacitracin Zinc/Polymyxin B oint 0.5, 0.75% (MARCAINE & EPI) Chloroprocaine inj 1, 2, 3 0.5%/400 u/5000 u/g (NEOSPORIN) Dibucaine oint 1% 84:04.06 ANTIVIRALS
Etidocaine inj 1% (DURANEST-MPF) Acyclovir oint 5% (ZOVIRAX) Lidocaine inj 0.5%, 1%, 2%, 4%; 84:04.08 ANTIFUNGALS
Lidocaine w Epinephrine inj 1%, Butaconazole nitrate cream 1% (FEMSTAT) 2% (XYLOCAINE w EPI) Ciclopirox Olamine cream 1% (LOPROX) Lidocaine/Prilocaine cream (EMLA) Clotrimazole cream 1% (MYCELEX) Mepivacaine inj 1, 1.5, 2% Clotrimazole lotion, soln 1% (MYCELEX, (CARBOCAINE, POLOCAINE) Tetracaine inj (PONTOCAINE) Clotrimazole/Betamethasone Dipropionate cream 1/0.05% (LOTRISONE) 76:00 OXYTOCICS
Ketoconazole cream, shampoo 2% Dinoprostone vag supp, 20 mg Miconazole cream 2% (MONISTAT-DERM) Methylergonovine maleate tab 0.2 mg, inj (METHERGINE) Nystatin cream, oint, powder 100,000 u/g Oxytocin inj (PITOCIN) Dinoprostone vag supp 3 mg (CERVIDIL) 84:04.12 SCABICIDES AND PEDICULICIDES
84:32 KERATOPLASTIC AGENTS
Lindane lotion, shampoo 1% (KWELL) Coal Tar gel, shampoo (BALNETAR) 84:04.16 MISCELLANEOUS LOCAL ANTI-
84:36 MISCELLANEOUS SKIN AND MUCOUS
INFECTIVES
MEMEBRANE AGENTS
Metronidazole gel 0.75% (METRO-GEL) Benzoyl Peroxide gel 2.5% (PAN OXYL AQ) Silver Sulfadiazine cream 1% (SILVADENE) Benzoyl Peroxide gel 5, 10% (DESQUAM E) Calcipotriene oint 0.005% (DOVONEX) 84:06 ANTI-INFLAMMATORY AGENTS
Dextranomer topical beads 4 g (DEBRISAN) Alclometasone Dipropionate cream 0.05% oint 0.05% Fibrinolysin/Desoxyribonuclease oint 1/666.6u/g (ELASE) phenicol oint 1/666.6 u/g/1% (ELASE- Betamethasone Dipropionate cream, lotion, gel, oint 0.05% (DIPROLENE, Isotretinoin cap 40 mg (ACCUTANE) Capsaicin cream 0.025, 0.075% (ZOSTRIX) Betamethasone/Clotrimazole cream 0.05/1% (LOTRISONE) Chlorhexidine Gluconate oral rinse 0.12% (PERIDEX) Clobetasol Propionate cream, oint 0.05% (TEMOVATE) Hydrogen Peroxide Desonide cream, oint 0.05% (DESOWEN, Lidocaine jelly 2%, oint 2.5, 5% (XYLOCAINE) Lidocaine/Procaine cream 2.5/2.5% (EMLA) Desoximetasone cream 0.05, 0.25%, gel 0.05%, oint 0.25% Mineral Oil, light topical Permethrin 1% rinse (NIX), cream 5% (ELIMITE) Fluocinolone Acetonide cream 0.01%, soln 0.01% Povidine-Iodine oint 10% (BETADINE) Fluocinonide cream, oint, gel, soln 0.05% (LIDEX) Zinc Oxide oint 40% (DESITIN) Hydrocortisone cream 0.5, 1, 2.5%, lotion 1%, oint 0.5, 1% (HYTONE, SYNACORT) Hydrocortisone/Bacitracin Zinc/ 86:12 GENITOURINARY SMOOTH MUSCLE
Neomycin/Polymyxin B oint 1%/400 RELAXANTS
u/0.5%/500 u/g (CORTISPORIN) Oxybutynin Chloride tab 5 mg, syrup (DITROPAN), Hydrocortisone Acetate/Neomycin/Polymyxin extended release tab 5 mg (DITROPAN XL) B cream 0.5/0.5%/10,000 u/g Tolterodine tab 1 mg (DETROL) Triamcinolone Acetonide cream 0.025, 0.1, 0.5%, oint 0.1% 86:16 RESPIRATORY SMOOTH MUSCLE
(KENALOG), paste 0.1% (KENALOG IN ORABASE) RELAXANTS
Aminophylline inj, tab 100, 200 mg
84:08 ANTIPRURITICS AND LOCAL
liq 105 mg/5mL (equiv to 90 mg theoph) ANESTHETICS
Theophylline SR tab 100, 200, 300, 400 mg , SR cap 75 mg Dyclonine soln 0.5, 1% (DYCLONE) (THEODUR SPRINKLE), elixir 80 mg/15 mL Ethyl Chloride soln Phenazopyridine tab 100, 200 mg (PYRIDIUM) 88:00 VITAMINS

84:16 CELL STIMULANTS AND
88:08 VITAMIN B COMPLEX
Folic Acid tab 1 mg, soln, inj (FOLVITE)
Niacin tab 100 mg Tretinoin cream 0.025, 0.05, 0.1%, gel 0.01, 0.025% (RETIN- Pyridoxine tab 50 mg, inj (VIT B-6) Thiamine tab 50, 100 mg, inj (VIT B-1) Cyanocobalamin inj (VIT B-12) 84:24 EMOLLIENTS, DEMULCENTS, AND
PROTECTANTS
88:12 VITAMIN C
A&D ointment AQUAPHOR Ascorbic Acid tab 500 mg, inj (VIT-C) CETAPHIL Cleanser 88:16 VITAMIN D
Calcitriol cap 0.25 mcg, 0.5 mcg Calcitriol inj (CALCIJEX) LUBRIDERM Lotion Ergocalciferol cap 50,000 unit PETROLATEUM, (VASELINE) 84:28 KERATOLYTIC AGENTS
88:20 VITAMIN E
Vitamin E cap 400 IU, drops (AQUASOL E)
Salicylic Acid wart remover 17% (DUOFILM)
88:24 VITAMIN K ACTIVITY
Phytonadione tab 5 mg (MEPHYTON), inj (AQUA-MEPHYTON)
88:28 MULTIVITAMIN PREPARATIONS
Multivitamin inj (Adult, Pediatric)
Therapeutic Multivitamin tab
Therapeutic Multivitamin with Minerals tab
NEPHROCAPS
STUART PRENATAL tab

92:00 UNCLASSIFIED THERAPEUTIC
AGENTS
Allopurinol tab 100, 300 mg (ZYLOPRIM)
Anagrelide cap 0.5 mg (AGRYLIN)
Aprotinin inj (TRASYLOL)
Azathioprine tab 50 mg, inj (IMURAN)
Beractant susp (SURVANTA)
Bromocriptine Mesylate tab 2.5 mg (PARLODEL)
Carboprost
Clopidogrel tab 75 mg (PLAVIX)
Colchicine tab 0.6 mg
Cromolyn Sodium nasal soln
(NASALCROM), oral inhaler, powder & soln for
nebulization (INTAL)
Cyclosporine soln (SANDIMMUNE)
Dexrazoxane inj. 500 mg vial/kit (TOTECT)
Drotrecogin alfa inj (XIGRIS)
Etidronate Disodium inj (DIDRONEL)
Finasteride tab 5 mg (PROSCAR)
Flumazenil inj (ROMAZICON)
Glucosamine tab 500 mg (GLUCOSAMINE)
Glucosamine/Chondroitin tab 250/200 mg
(GLUCOSAMINE/CHONDROITIN)
Fomepizole sln for inj (1g/mL) 1.5 mL vial (ANITZOL)
Leucovorin Calcium tab 5 mg;
inj (WELLCOVORIN)
Carbidopa/Levodopa tab 10/100, 25/100, 25/250, SR tab
50/200 mg (SINEMET)
Carbidopa/Levodopa CR tab 50mg/200mg (SINEMET CR)
Methylene Blue inj
Montelukast Sodium tab 10 mg
SINGULAIR)
Melatonin 3 mg Cap (MELATONIN)
Natalizumab Inj., 300 mg vial (TYSABRI) - Restricted
Octreotide Acetate inj (SANDOSTATIN)
Pamidronate Disodium inj (AREDIA)
Palivizumab inj 100 mg/vial (SYNAGIS)
Sumatriptan inj (IMITREX)
Tamsulosin cap 0.4 mg (FLOMAX)
Talc powder, 5 Gm sterile
Ticlopidine tab 250 mg (TICLID)
Zoledronic acid inj.,
4 mg/5mL (ZOMETA)
Aluminum Hydroxide, 18 Aluminum Hydroxide/ Magnesium Hydroxide/ Simethicone, 18 A&D ointment, 21 Aluminum Hydroxide/Magnesium Trisalicylate, 18 Alvimopan Caps, 19 Acetaminophen, 15 Acetaminophen/Butalbital/Caffeine, 15 Acetaminophen/Isometheptane Mucate/Dichloralphenazone, 15 Acetazolamide, 17 Amcinonide cream, oint, 21 Acetic Acid in mod. Burow's soln, 18 Acetic Acid irr soln, 17 Acetic Acid otic, 18 Acetohexamide, 19 Acetylcholine oph, 18 Aminocaproic Acid, 13 Acetylcysteine, 17 Aminophylline, 21 ACHROMYCIN, 11, 17 Amitriptyline, 15 Ammonia spirit, aromatic, 15 Ammonium Chloride, 16 Activated Charcoal, 18 Amoxicillin/Clavulanate, 11 Amphotericin B, 10 Acyclovir oint, 20 Amphotericin B, liposomal, 10 Ampicillin/Sulbactam, 11 ADRENALIN, 12, 18 Antihemophilic Factor IX inj, 13 Antihemophilic Factor VIIa inj, 13 Albumin Human, 12 Alclometasone Dipropionate, 21 Aproclonidine oph soln, 18 AQUA-MEPHYTON, 21 Aliskiren tab, 14 Artificial tears oph soln, 18 Benzocaine/Antipyrine/Phenylephrine otic, 18 Ascorbic Acid, 21 Benzocaine/Cetylpyridinium anesthetic lozenges, 18 Aspirin/Butalbital/Caffeine/Codeine, 14 Benzoyl Peroxide, 21 Aspirin/Oxycodone, 14 Benztropine Mesylate, 12
Betamethasone, 19 Betamethasone Dipropionate, 21 Betamethasone Dipropionate aerosol, 21 Atenolol/Chlorthalidone, 13 Betamethasone/Clotrimazole cream, 21 Betaxolol oph soln, 18 Atorvastatin, 14 Atracurium Besylate, 12
Atropine oph, 18 Atropine Sulfate/Hyoscyamine/Phenobarbital/Scopolamine, 12 Bismuth subnitrate/Castor Oil, 21 Bitolterol oral inhaler, 12 AUGMENTIN ES, 11 Bleomycin Sulfate, 11 Azatadine Maleate/Pseudoephedrine, 10 Azithromycin, 10 Azothioprine, 22 Bromocriptine Mesylate, 22 B&O SUPPRETTES, 12, 14 Brompheniramine Maleate/ Phenylpropanolamine, 10 Bacitracin oint, 20 Bacitracin oph oint, 17 Bupivicaine w Epinephrine, 20 Bacitracin/Polymyxin B oint, powder, 20 Bacitracin/Polymyxin oph oint, 17 Buprenorphine, 14 Beclomethasone dipropionate monohydrate, 17 Caffeine citrate, 15 Beclomethasone dipropionate nasal aerosol, 17 Beclomethasone dipropionate oral inhaler, 19 Belladonna/Powdered Opium, 12 Calcipotriene, 21 Calcitonin (salmon), 20 Calcitonin (salmon), nasal spray, 20 Calcium Carbonate, 16, 18
Calcium Chloride, 16 Benzocaine aerosol, 17 Calcium Gluconate, 16 Benzocaine/Antipyrine otic soln, 17 Chlorothiazide, 16 Capropril/Hydralazine tab, 13 Chlorotrianisene, 19 Chlorpheniramine maleate, 10 Chlorpromazine, 15 Chlorpropamide, 19 Carbachol oph soln, 18 Chlortalidone, 16 Carbamazepine, 15 CHLORTRIMETON, 10 Carbidopa/Levodopa, 22 Cholestyramine, 14 Carbinoxamine Maleate/Pseudoephedrine, 10 Choline Magnesium Trisalicylate, 14 Carbinoxamine Maleate/Pseudoephedrine/Dextromethorphan, 10 Choral hydrate, 16 Ciclopirox Olamine cream, 20 Carboxymethylcellulose oph soln, 18 Ciprofloxacin oph soln, 17 CITRATE OF MAGNESIA, 18 Carisoprodol, 12 Clarithromycin, 10 Clemastine Fumarate, 10 CATAPRES TTS, 14 Clidinium Bromide/Chlordiazepoxide, 12 Clindamycin gel, lotion, soln, 20 Clobetasol Propionate, 21 Cefuroxime axetil, 10 Clotrimazole cream, 20 Clotrimazole lotion, soln, 20 Clotrimazole/Betamethasone Dipropionate, 20 Coal Tar extract, 21 Coal Tar soln, 21 Cocaine topical soln, 18 Coccidioidin Skin Test inj, 16 Codeine Phospate, 17 Codeine Phosphate, 14 Codeine Phosphate/Acetaminophen, 14 Codeine Phosphate/Aspirin, 14 Codeine Phosphate/Aspirin/Butalbital/Caffeine, 14 Codeine Phosphate/Guaifenesin, 17 Chlorambucil, 11 Chloramphenicol, 10
Chloramphenicol oph oint, 17 Chloramphenicol opth soln, 17 Chlordiazepoxide, 16 Chlordiazepoxide/Amitriptyline, 16 COLY-MYCIN S OTIC, 17 Chlordiazepoxide/Clidinium Bromide, 16 Chlorhexidine Gluconate, 21 COMPAZINE, 15, 19 CHLOROMYCETIN, 10, 17 Chloroprocaine, 20 Demeclocycline, 11 Corticotropin, 16, 20 CORTISPORIN OPH SUSP, 17 DEPOESTRADIOL, 19 CORTISPORIN OTIC, 17 DEPO-PROVERA, 20 Dermatophyton Skin Test, 16 Co-Trimoxazole, 11 Desmopressin, 20 Cromolyn Sodium, 22 Desoximetasone, 21 Crotamiton cream, lotion, 20 Desvenlafaxine Succinate tab 50 mg ER Tab, 15 Cyanocobalamin, 21 Cyclobenzaprine, 12 Dexamethasone, 19 Cyclopentolate oph soln, 18 Dexamethasone oph oint, 17 Cyclophosphamide, 11 Dexamethasone oph soln, 17 Cyclosporine, 22 Dexamethasone Sodium Phosphate cream, 21 Dexamethasone/Neomycin oph oint, 17 Cyproheptadine, 10 Dexamethasone/Neomycin oph soln, 17 Dexamethasone/Neomycin/Polymyxin B, 17 Dexamethasone/Tobramycin oph, 17 Dexmedetomidine, 16 Dexrazoxane inj, 22 Dextroamphetamine, 15 Dextromethorphan/Guaifenesin, 17 Dactinomycin, 11 Dantrolene Sodium, 12 Dapiprazole oph soln, 18 DIAMOX SEQUEL, 17 Diatrizoate Meglumine, 16 Darbopoeitin, 13 DARVOCET-N 100, 14 Dibasic Na Phosphate with Monobasic Na Phosphate soln, 18 Dibucaine oint, 20 Daunorubicin, 11 Dicloxacillin, 10 DECADRON, 17, 19 Deferoxamine, 19 Dihydoergotamine Mesylate, 12
Dinoprostone, 20 EFFEXOR/EFFEXOR XR, 15 Diphenhydramine, 10 Diphenoxylate/Atropine Sulfate, 18 ELASE-CHLOROMYCETIN, 21 Diphtheria and Tetanus Toxoids Absorbed Adult, 20 Diphtheria and Tetanus Toxoids Absorbed Ultrafined Pediatric, 20 Electrolyte inj, 16 Diphtheria and Tetanus Toxoids and Pertussis Vaccine, 20 Dipivefrin oph soln, 18 Dipyridamole, 14 Enalapril/Hydralazine, 13 Disopyramide, 13 ENTEREG, 19
Divalproex Sodium, 15 Epinephrine nasal soln, 18 Epinephrine oph soln, 18 Epinephryl Borate oph soln, 18 Docusate Na/Casanthranol, 18, 19 Epoetin Alfa, 13
Ergocalciferol, 21 Ergotamine/caffeine, 12 DONNATAL EXTENTABS, 12 Erythromycin, 10 Erythromycin estolate, 10 Erythromycin ethylsuccinate, 10 Erythromycin lactobionate, 10 Escitalopram, 15 Estradiol cypionate, 19 Estradiol cypionate/testosterone cypionate, 19 Estradiol valerate, 19 Estrogens, conjugated, 19 DURANEST-MPF, 20 Ethosuximide, 15 Ethyl Chloride, 21 Etidronate Disodium, 22 Echothiophate Iodide oph soln, 18 ECONOPRED PLUS, 17 Fentanyl transmucosal, 14 GARAMYCIN, 10, 20 GASTROGRAFIN, 16 Ferrous Gluconate, 13 Ferrous Sulfate, 13 Fexofenadine, 10 Fibrinolysin/Desoxyribonuclease, 21 Gentamicin cream, oint, 20 Gentamicin Sulfate oph, 17 Gentian Violet soln, 20 FLEET PHOSPHO SODA, 18 GLUCOSAMINE/CHONDRIOTIN, 22 Glucosamine/Chondroitin, 22 Fludrocortisone, 19 Glycopyrrolate, 12 Flunisolide nasal soln, 17 Flunisolide oral inhaler, 19 Fluocinolone Acetonide, 21 Fluocinonide, 21 Guaifenesin SR tab, 17 FLUOR-I-STRIP, 16, 18 Fluorometholone oph susp, 17 Guaifenesin/Phenylpropanolamine, 17 Gum Mastic, Styrax, 21 Fluoroscein oph soln, 18 Haemophilus B conjugate vaccine, 20 Fluoroscein strips, 18 Fluoroscein/Benoxinate oph soln, 18 Fluorouracil, 11 Fluorouracil, 21 Haloperidol Decanoate, 15 Flurandrenolide, 21 Flurbiprofen oph soln, 18 Heparin Sodium, 13 Hepatitis B Immune Globulin, 20 Hepatitis B Virus vaccine inactivated, 20 Fondaparinux, 13 Histoplasmin Skin Test, 16 Fosphenytoin, 15 Homatropine oph soln, 18 HUMULIN 50-50, 19 HUMULIN ULTRALENTE, 19 Insulin Aspart, 19 Hyaluronidase, 17 Insulin detemir, 19 Insulin human regular, 19 Insulin human, NPH, 19 Hydrochlorothiazide, 16 Insulin, glargine, 19 Hydrochlorothiazide/Spironolactone, 16 Insulin, human regular, 19 Hydrochlorothiazide/Triamterene, 16 Insulin, human regular/isophane 30/70, 19 Insulin, Ultra-lente, 19 Hydrocodone Bitartrate/Acetaminophen, 14 Hydrocortisone, 19, 21 Interferon Alfa 2b, 11 Hydrocortisone Acetate, 21 Hydrocortisone Acetate/Pramoxine, 21 Hydrocortisone Sodium Succinate, 19 Iodoquinol/Hydrocortisone, 21 Hydrocortisone Valerate, 21 Hydrocortisone/Bacitracin Zinc/Neomycin/Polymyxin B, 21 Hydrocortisone/Colistin/Neomycin/Thonzonium otic, 17 Iron Dextran, 13 Hydrocortisone/Neomycin/Polymyxin B otic, 17 Iron sucrose, 13 Hydrogen Peroxide, 21 Isoetharine oral inhalation soln, 12 Hydromorphone, 14 Isoproterenol, 12 Hydroxyzine H Cl, 16 ISOPTO CARPINE, 18 Hydroxyzine Pamoate, 16 ISOPTO-ATROPINE, 18 ISOPTO-CARBACHOL, 18 ISOPTO-HOMATROPINE, 18 Isosorbide Dinitrate, 14 Isosorbide Mononitrate, 14 Isotretinoin, 21 Itraconazole cap, 10 Kaolin and Pectin, 18 Imipenem/Cilastatin, 10 KENALOG IN ORABASE, 21 Immune Globulin, 20 Ketoconazole, 10 Ketoconazole cream, shampoo, 20 IMOGAM RABIES, 20 IMOVAX RABIES, 20 Ketorolac Tromethamine oph, 17 INDIGO CARMINE, 16 Indigotindisulfonate Sodium, 16 Lactobacillus Acidophilus, 18 Indomethacin, 14 Lactulose, 16, 19 Lamivudine 150 mg/zidovudine 300 mg, 11 INFLAMASE MILD, 17 INFLAMASE FORTE, 17 Influenza Virus vaccine, 20 Lansoprazole, 19 Leucovorin Calcium, 22 Leuprolide Acetate, 11 Levalbuterol, 12 LUPRON DEPOT, 11 Levarterenol, 12 Magnesium Citrate, 18 Levetiracetam, 15 Magnesium Hydroxide, 18 Levobunolol oph soln, 18 Levofloxacin, 11 Levothyroxine, 20 MARCAINE & EPI, 20 Measles, Mumps and Rubella Virus Vaccine Live, 20 Lidocaine, 13, 20, 21 MEDIHALER-ISO, 12 Lidocaine w Epinephrine, 20 Lidocaine/Prilocaine, 20 Medroxyprogesterone, 20 Lidocaine/Procaine, 21 Medrysone oph, 17 Lindane lotion, shampoo, 20 Liothyronine, 20 LIPRAM 10 PN, 19 LIPRAM 20 PN, 19 Meningococcal vaccine, 20 Lisinopril/HCTZ, 13 Lithium Carbonate, 16 Lithium Citrate, 16 Mercaptopurine, 11 Mesoridazine, 15 Metaproterenol, 12 Loratadine/pseudophedrine, 10 Metaraminol Bitartrate, 12 Methazolamide, 17 Methenamine Mandelate, 11 LOTRISONE, 20, 21 Methocarbamol, 12 Methotrexate, 11 Methylene Blue, 22 Methylergonovine, 20 Methylphenidate, 15 Methylphenidate, 15 Methylprednisolone, 19 Methylprednisolone Acetate, 19 Methylprednisolone Sodium Succinate, 19 Methylsergide, 12 Methyltestosterone/esterified estrogens, 19 Metoclopramide, 19 Naftifine cream, 20 Metoprolol Succinate, 13 Metoprolol Tartrate, 13 Metronidazole, 11 Naphazoline/Antazoline oph soln, 18 Metronidazole gel, 21 Naphazoline/Pheniramine Maleate oph, 18 Micafungin Inj, 10 Miconazole cream, 20 Microfibrillar Collagen Hemostat, 13 MILK OF MAGNESIA, 18 Mineral Oil, light topical, 21 Neomycin/Bacitracin Zinc/Polymyxin B, 17 Neomycin/Bacitracin Zinc/Polymyxin B oint, 20 Neomycin/Colistin/Hydrocortisone/Thonzonium, 17 Neomycin/Dexamethasone oph oint, 17 Neomycin/Dexamethasone oph soln, 17 Neomycin/Gramicidin/Polymyxin B oph soln, 17 Neomycin/Hydrocortisone/Polymyxin B/Bacitracin Zinc, 17 Neomycin/Polymyxin B cream, 20 NEOSPORIN OPH OINT, 17 Mitoxantrone, 12 Neostigmine, 12, 16 NEO-SYNEPHRINE, 12, 18 MONISTAT-DERM, 20 Morphine Sulfate, 14 Multitest CMI strips, 16 Multivitamin inj, 22 Nicotine Polacrilex, 12 MYCAMINE, 10
Nicotine transdermal, 12 Pamidronate Disodium, 22 Pancuronium Bromide, 12 PANGESTYNE MT10, 19 Nitrofurantoin, 11 Pantoprazole, 19 Nitrofurazone cream, 21 Nitroglycerin, 14 NITROLINGUAL SPRAY, 14 Nitroprusside, 14 NO RINSE shampoo, 21 PEDIA-PROFEN, 14 PEDIAZOLE, 10, 11 Pegfilgrastim, 13 Norepinephrine Bitartrate, 12 Penicillamine, 19 Penicillin G Benzathine, 10 Penicillin G K/Na, 10 Penicillin G Procaine, 10 Nortriptyline, 15 Penicillin V K, 10 Pentazocine/Aspirin, 15 NOVOLIN 70-30, 19 PENTOBARBITAL, 15 Pentoxifylline, 13
PERI-COLACE, 18, 19 Nystatin cream, oint, powder, 20 Nystatin/Triamcinolone cream, oint, 20 Octreotide Acetate, 22 Perphenazine, 15 Ofloxacin oph soln, 17 Petrolatum/Mineral Oil/Shark Liver Oil/Phenylephrine, 21 Olanzapine ODT, 15 PHAZYME DROPS, 18 Phenazopyridine, 21 PHENERGAN, 10, 16 Opium/Belladonna, 14 PHENERGAN WITH CODEINE, 10, 17 Phenobarbital, 15 Phentolamine, 12 Phenylephrine, 12 Phenylephrine nasal soln, 18 Phenylephrine oph soln, 18 Oxcarbazepine, 15 Phenylephrine/Sulfacetamide oph soln, 18 Oxybutynin Chloride, 21 Oxycodone/Acetaminophen, 14 Oxycodone/Aspirin, 14 PHOSPHOLINE IODIDE, 18 Oxytetracycline/Polymyxin B oph oint, 17 Physostigmine, 12 Phytonadione, 21 Pilocarpine oph gel, 18 Palonosetron, 19 Pilocarpine oph soln, 18 Pioglitazone, 20 Pipecuronium, 12 Piperacillin /tazobactam, 11 Procainamide, 14 Pirbuterol acetate, 12 Prochlorperazine, 15, 19 Progesterone, 20 Plasma Protein Fraction, 12 Promethazine, 10, 16 Promethazine/Codeine, 10, 17 Promethazine/Dextromethorphan, 10 Promethazine/Phenylephrine, 10, 17 Promethazine/Phenylephrine/Codeine, 10, 17 Pneumococcal Vaccine Polyvalent, 20 PNEUMOVAX 23, 20 Poliovirus Vaccine Live Oral, 20 Proparacaine oph soln, 18 Polycarbophil, 18 Propoxyphene, 14 Propoxyphene Napsylate/Acetaminophen, 14 Propylthiouracil, 20 Polymyxin/Trimethoprim oph soln, 17 PROSTIGMIN, 12, 16 POLYSPORIN OPH, 17 Protamine Sulfate, 13
Polyvinyl alcohol oph soln, 18 PONTOCAINE, 18, 20 Posaconazole, 10 Potassium Chloride, 16 Potassium Citrate/Citric Acid, 16 Pseudoephedrine, 12 Potassium Iodide, 17 Potassium Phosphate, 16 Potassium Phosphate/Sodium Phospate, 16 Purified Protein Derivative, 16 Povidine-Iodine, 21 Pyrantel Pamoate susp, 10 Pyrazinamide, 11 Pyridostigmine, 12 Pyrimethamine, 11 Quinacrine tab, 10 Prednisolone oph soln, 17 Quinidine Sulfate, 14 Prednisolone Sodium Phosphate, 19 Quinine Sulfate, 11 Prednisolone/Gentamicin oph susp, 17 Rabies Immune Globulin, 20 Prednisolone/Neomycin/Polymyxin B oph, 17 Rabies Vaccine, 20 Racepinephrine, 12 Prenisolone oph susp, 17 PREVACID, 19
PRIALT, 15
RECOMBIVAX HB, 20 Silver Sulfadiazine, 21 Sodium Bicarbonate, 16
Sodium Chloride, 16 Sodium Chloride Hypertonic oph soln, 18 Sodium Chloride irr soln, 17 Sodium Citrate/Citric Acid, 16 Sodium Nitroprusside, 14 Sodium phosphate, 16 Sodium Polystyrene Sulfonate, 16
SODIUM SULAMYD, 17 Rivastigmine, 12 Spironolactone, 16 ROBITUSSIN AC, 17 Spironolactone/Hydrochlorothiazide, 16 ROBITUSSIN DM, 17 Rosiglitazone, 20 Rosuvastatin, 14 Sterile Water, 17 Sterile Water irr soln, 17 Rotavirus vaccine, 20 Streptokinase, 13 Streptomycin, 10 Rubella Virus Vaccine Live, 20 Streptozocin, 12 STUART PRENATAL, 22 Salicylic Acid, 21 STUARTNATAL PLUS, 22 Salicylic Acid wart remover, 21 Salicylic Acid/Coal Tar soln, 21 Succinylcholine, 12 Salicylic Acid/Precip Sulfur, 21 Salicylic Acid/Sublimed Sulfur, 21 Salmeterol inhaler, 12 Sulfabenzamide/Sulfacetamide/Sulfathiozole, 11 Sulfacetamide oph oint, 17 Sulfacetamide/Phenylephrine oph soln, 17 Scopolamine transdermal, 12 Sulfacetamide/Prednisolone, 17 Sulfacetamide/Prednisolone oph, 17 Sulfacetamide/Prednisolone susp, 17 Senna/Docusate, 18 Sulfamethoxazole, 11 SENOKOT SYRUP, 18 Sulfasalazine, 11 Sulfisoxazole, 11 Sulfisoxazole/Erythromycin Ethylsuccinate, 11 Sulfur Precip/Sulfacetamide Sodium, 21 Tobramycin oph oint, soln, 17 Tobramycin/Dexamethasone oph, 17 TALWIN COMPOUND, 15 TRANSDERM-NITRO, 14 TRANSDERM-SCOP, 12 Terbutaline Sulfate, 12 Tranylcypromine, 15 TERRAMYCIN OPH OINT, 17 Testosterone, 19 Tetanus Immune Globulin, 20 Triamcinolone Acetonide, 19 Tetanus Toxoid Absorbed, Ultrafined, 20 Triamcinolone Acetonide, 21 Tetanus/diphtheria/acellular/pertussis vaccine, 20 Triamcinolone Diacetate, 19 Tetracaine oph oint, soln, 18 Triamterene/Hydrochlorothiazide, 17 Tetracycline, 11 Tetracycline oph oint, 17 Tetrahydozoline nasal soln, 18 Triethanolamine Polypeptide, 18 Triethylperazine, 19 Theophylline, 21 Trifluoperazine, 15 Therapeutic Multivitamin, 22 Trihexyphenidyl, 12 Therapeutic Multivitamin with Minerals, 22 Thiabendazole susp, 10 Thioridazine, 15 Trimethobenzamide, 19 Trimethoprim, 11 Trimethoprim/Sulfamethoxazole, 11 TRIPLE SULFA, 11 Triprolidine/Pseudophedrine, 10 Tromethamine, 16 Tropicamide oph soln, 18 TYLENOL WITH CODEINE, 14 ULTRACE MT-12, 19 ULTRASE MT20, 19 Timolol Maleate oph soln, 18 Valproate Sodium, 15 Valproic Acid, 15 VANCENASE AQ, 17 Ziconotide Inj, 15 Zinc Oxide oint, 21 Zinc Pyrithione, 21 Varicella virus vaccine, 20 Varicella Zoster Vaccine, 20 Zoledronic acid, 22 Vecuronium Bromide, 12 ZYPREXA ZYDIS, 15 VERSED, 16
VIBRAMYCIN, 11
VICODIN, 14
Vidarabine, 17
Vinblastine Sulfate, 12
VINCASAR PFS, 12
Vincristine Sulfate, 12
VIRA-A, 17
VIRAZOLE, 11
VISTARIL, 16
VIT B-1, 21
VIT B-12, 21
VIT B-6, 21
Vitamin E, 21
VIT-C, 21
VIVELLE DOT, 19
VOLTAREN, 14
Von Willebrand Factor VIII inj, 13
VOSOL, 18
VP-16, 11
Warfarin Sodium, 13
WELLCOVORIN, 22
White Petrolatum/Mineral Oil oph oint, 18
Witch Hazel/Glycerin pads, 21
WYCILLIN, 10
WYDASE, 17
XANAX, 16
Xopenex, 12
XYLOCAINE, 13, 20, 21
XYLOCAINE w EPI, 20

Source: http://www.svh-mt.org/~/media/stvincent/stvincentfiles/damaged/formulary2011.pdf