Extemporaneous Formulations for Pediatric, Geriatric, and Special Needs Patients

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Since its first publication, Extemporaneous Formulations, by Rita Jew, Winson Soo-Hoo, Sarah Erush, and Elham Amiri, has been the go-to guide for treating patients who require any of the 80% of medications not commercially available in appropriate forms or dosages for pediatric, geriatric, or special needs. Now even more comprehensive, the third edition provides the same evidence-based formulation in easy-to-follow "recipes" for 197 nonsterile formulations, 39 of which are new, and two of which have been updated.

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Since its first publication, Extemporaneous Formulations, by Rita Jew, Winson Soo-Hoo, Sarah Erush, and Elham Amiri, has been the go-to guide for treating patients who require any of the 80% of medications not commercially available in appropriate forms or dosages for pediatric, geriatric, or special needs.

Now even more comprehensive, the third edition provides the same evidence-based formulation in easy-to-follow "recipes" for 197 nonsterile formulations, 39 of which are new and two of which have been updated.

Each "recipe" includes: 

  • Ingredients
  • Preparation details and instructions
  • Storage conditions
  • Special instructions
  • Alternatives
  • Expiration dates
  • References
  • Documented stability data

An invaluable resource for practitioners, Extemporaneous Formulations also includes a summary of USP <795>, various state requirements, and the list of standardized concentrations established by the Michigan Pediatric Safety Collaboration. 

Compiled by experts in the field, it's the best guidance you can get for the care you want to give.

Rita K. Jew, PharmD, FASHP

Rita K. Jew is Director of Pharmacy at UCSF Medical Center, Mission Bay Campus, where she directs the robotic production facility and all clinical and operational activities of the UCSF Medical Center at Mission Bay, including the Benioff Children’s Hospital. Prior to this role, she spent 22 years serving in various leadership positions at Children’s Hospital of Orange County and The Children’s Hospital of Philadelphia. Dr. Jew received her Doctor of Pharmacy degree from University of California at San Francisco (UCSF) and completed an ASHP-accredited residency in clinical pharmacy at Thomas Jefferson University Hospital. She received a Master of Business Administration at The Wharton School, University of Pennsylvania.

Dr. Jew is an established neonatal and pediatric practitioner and has presented extensively at local, state and national meetings for pharmacists, nurses, and physicians. Her areas of expertise include neonatal drug therapy, drug use during ECMO, immunizations, sterile and non-sterile extemporaneous compounding, medication safety, and technology and automation. She held adjunct faculty appointments at various Schools of Pharmacy and School of Nursing and is actively involved in local, state, and national pharmacy societies. Dr. Jew received the Jonathan Roberts award from DVSHP in 2004, the Fellow of ASHP in 2007, the Distinguished Service Award from ASHP Section of Clinical Specialists and Scientists in 2010, and Friend of Nursing Award from the Association of California Nurse Leaders in 2012.

 

Winson Soo-Hoo, RPh, MBA

Winson Soo-Hoo is Senior Director of the Department of Pharmacy at The Children’s Hospital of Philadelphia, PA, since 1990, and a Residency Preceptor with the pharmacy residency program. He received his Bachelor of Science in Pharmacy from the Philadelphia College of Pharmacy & Science, Philadelphia, and his MBA at Drexel University. He routinely consults with healthcare institutions on pediatric pharmacy systems and service. 

Soo-Hoo has lectured at various forums on controlled substance security and diversion programs, lean management principles, and pharmacy automation and technology-IV robot technology. He received the Innovation and Collaborative Practice Award from the Pennsylvania Society of Health-System Pharmacists in 1998.

 

Sarah C. Erush, PharmD, BCPS

Sarah C. Erush is Pharmacy Clinical Manager and PGY1 Pharmacy Residency Program Director at The Children’s Hospital of Philadelphia in Philadelphia, PA. Dr. Erush received her Bachelor of Science in Pharmacy from Massachusetts College of Pharmacy and her Doctor of Pharmacy degree from Philadelphia College of Pharmacy and Science. She completed a residency in drug information at Thomas Jefferson University Hospital in Philadelphia. In addition to managing the clinical services, she teaches in three pediatric elective courses throughout the year and coordinates both IPPE and APPE rotations for students at the hospital. 

Dr. Erush is a member of several professional pharmacy organizations, including ASHP, Pennsylvania Society of Health-System Pharmacists, American College of Clinical Pharmacy, and Pediatric Pharmacy Advocacy Group. Erush also holds distinction as a Board Certified Pharmacotherapy Specialist. Her interest areas include dietary supplements, pharmacoeconomics, and medical writing.

 

Elham Amiri, CPhT, BS

Elham Amiri is a Technician Supervisor in the Department of Pharmaceutical Services at UCSF Medical Center at Mission Bay. She received a BS from San Francisco State University, with an emphasis in physiology, and earned a national certification from PTCB. Ms. Amiri has 18 years of experience in healthcare and the pharmaceutical industry with a wide scope of specialties including inpatient, retail, and biotechnology.  Her healthcare experience is enhanced by a background in human resources stemming from involvement with two international start-up companies, and she has obtained her Human Resources Management Certification from Employers Group. 

At UCSF Medical Center, Ms. Amiri is a project manager, particularly in the areas of pediatrics and sterile and non-sterile compounding. She is involved in personnel training emphasizing USP <797>, standard work review, and quality improvement initiatives.  She establishes and performs operational evaluations and was heavily involved in operationalizing pharmaceutical services at the newly opened UCSF Medical Center at Mission Bay, including Benioff Children’s Hospital. Alongside her project management responsibilities, Ms. Amiri has oversight of all technician staff at the Mission Bay Campus.
 

Doody’s Review Services, May 2016

[REVIEWER] 

Jennifer L. Colon, PharmD, MS, MBA (Temple University School of Pharmacy)

Description

This reference compiles a comprehensive literature search identifying new drugs with extemporaneous formulations to provide an accurate and efficient resource for pharmacists who compound. It provides ingredients and compounding directions as well as stability data for compounds that are not commercially available. This third edition is updated with 39 new formulations.

Purpose

The authors note that there is still a gap in pharmaceuticals with appropriate pediatric formulations, and there continues to be a need for pharmacists to prepare extemporaneous formulations. Additionally, compounding legislation continues to evolve, making it important that pharmacists who compound extemporaneous formulations must be vigilant in consulting updated references as well maintaining compliance with state regulations. This book is designed to meet these needs.

Audience

The intended audience is pharmacists and pharmacy technicians who compound extemporaneous formulations as part of their practice, particularly for pediatric patients. The authors are experienced authorities in this area and hold administrative level positions in their institutions.

Features

This is an extensive compilation of extemporaneous compounds including elixirs, solutions, suspensions, syrups, topical/ophthalmic solutions, and commercially available products, as well as appendixes covering USP 795 compounding, ASHP technical assistance bulletin on compounding nonsterile pharmacy products, and the Michigan Pediatric Safety Collaboration: Standardized Concentrations of Compounded Oral Liquids. The best part of this book is how inclusive it is and how efficient it is to navigate. The appendixes are especially useful to ensure appropriate and safe nonsterile compounding, which is prevalent in pharmacies that service pediatrics.

Assessment

This exceptional, high-quality reference is crucial for those who perform extemporaneous compounding as this specialized area of pharmacy continues to evolve. It stands alone in its completeness and accuracy.

Weighted Numerical Score: 95 - 4 Stars!

 

The Pharmaceutical Journal 24 JUN 2016

Reviewer: Laurence A. Goldberg

The first edition of this book was published in 2003. This current edition, now revised and updated, provides evidence-based formulations in easy-to-follow “recipes” for 197 non-sterile preparations, including 39 preparations new to this edition.

A comprehensive literature search was carried out to identify new drugs with extemporaneous formulations and new formulations of drugs that appeared in the previous edition of the book. Multiple published formulations of medicines with the same concentration, as well as formulations with differing concentrations, are offered to enable pharmacists to select the most appropriate formulation for their patients. Each formulation includes ingredients, preparation details and instructions, storage conditions, special instructions, alternatives, expiration dates, references and documented stability data.

The book is divided into three parts, elixir/solution/suspension/syrup, topical/ophthalmic solution and commercially available products. At first sight, the need to include commercially available products seems to be unnecessary, but with drug shortages being such a problem it is helpful for pharmacists to be able to prepare, if required, medicines for this group of patients.

The four appendices relate to US practice but still make interesting reading. Appendix A offers an overview of USP 795 — pharmaceutical compounding of non-sterile preparations. Appendices B and C are American Society of Health System Pharmacists (ASHP) documents reproduced in full – ASHP Technical Assistance Bulletin on compounding non-sterile products in pharmacies and ASHP Guidelines on pharmacy-prepared ophthalmic products.

The most interesting appendix is the Michigan Pediatric Safety Collaboration: standardised concentrations of compounded oral liquids. This project marks the first attempt to standardise concentrations of compounded oral liquids in the United States. It is interesting to note that as part of an initiative to reduce preventable harm from medicines, the US Food and Drug Administration has awarded a three-year contract to ASHP to develop and implement national standardised concentrations for intravenous and oral liquid medicines.

It is worth noting that some of the excipients, such as Ora-Sweet, Ora-Plus and Ora-Blend, that appear in many of the formulations are branded products made in the United States but are available in the UK.

This book has value to pharmacists who are required to prepare, extemporaneously, liquid oral medicines or ophthalmic solutions for children or older patients.