Sheldon S. Sones, RPh, FASCP: To address this surveyor expectation, I use what I call my “bucket list.” The bucket list is a list of potential crossovers when a patient declares an “allergy” to a particular medication. I place drugs in a common “bucket” as alerts for possible cross-allergenicity.
The list is based on drugs commonly used in the ambulatory surgical and endoscopy centers of Sheldon S. Sones and Associates. It is still work in progress, and comes with the caveat that it is not all-inclusive, nor does it infer that a cross allergenicity will occur.
It calls for caution and does not include all feasible drugs, just ones that — from my data — are the most commonly appearing in organization’s formularies.
The Buckets
Aminoglycosides
- Gentamicin
- Garamycin
- Nebcin
- Tobramycin
- Tobradex Ophthalmic
Cephalosporins
- Cefazolin
- Ancef
- Kefzol
- Cephalexin
- Keflex
- Cefaclor
- Duricef
- Mefoxin,
- Cefoxitin
- Cephradine
- Cephalothin
- Keflin
- Zinacef
- Cefuroxime
- Possible Penicillins
Codeines
- Percocet
- Oxycodone
- Vicodin
- Hydrocodone
- Oxycontin
NSAIDs
- Ibuprofen
- Motrin
- Aleve
- Naproxen
- Vioxx (discontinued)
- Celebrex
Penicillins
- Penicillin
- Amoxacillin
- Ampicillin
Quinolones
- Cipro
- Ciprofloxacin
- Levaquin
- Levofloxacin
- Vigamox & Zymar Ophthalmic
“Sulfas”
- Bactrim
- Septra
- TMP/SMX
- Diamox
- Acetazolamide
- Furosemide
- Lasix
Note: This is meant as a guideline only.
One final piece of advice: “Allergy” declarations by patients should be screened to distinguish between side effects and true allergy. Patients sometimes will list drugs they have had a negative experience with as an “allergy”, leading you to remove that drug from your choices when sometimes that drug could be the agent of choice.
For example, someone may say, “I’m allergic to Benadryl; it makes me drowsy,” or “I can’t take Colace; it gives me loose stools.”
Before you remove those drugs from your list of choices, interview the patient to gain a better understanding of whether the drug allergies are true allergies.
For example, if a patient says they are allergic to penicillin, ask, “You indicated to me that you are allergic to penicillin. What exactly happens when you receive it?”
If the patient says he or she break out in a rash, then, in your allergy section, write: Penicillin -> Rash.
Note: This article comes from a recent edition of Pharm-ASC, a weekly e-mail publication by Sheldon S. Sones, RPh, FASCP, a Newington, Conn.-based consultant, pharmacist and safe medication officer serving more than 100 ASCs in the Northeast. Learn more at www.sheldonsones.com.
