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Table 1 Pharmacotherapeutic categories and subcategories used to define the clinical rulesa

From: Development and implementation of “Check of Medication Appropriateness” (CMA): advanced pharmacotherapy-related clinical rules to support medication surveillance

 

Category (and subcategories)

Example of a clinical rule

1

Overrules of alerts for very severe DDIs generated by the CDSS

Reduced effect of valproic acid by carbapenems leading to an increased risk of convulsions

2

Drugs with a restricted indication or dosing

Patient with high dose meropenem

3

Medication use potentially leading to biochemical changes

 

* Drug use in renal insufficiency

Patient with a CrCl < 30 ml/min and treated with metformin

* Drugs with high potential of QTc interval prolongation

Patient with a QTc > 450/470 ms and treated with haloperidol

* Drug use associated with hyperpotassemia

Patient with a K > 5.5 mmol/L and treated with an ACE inhibitor

* Drug use associated with hypopotassemia

Patient with a K < 3.5 mmol/L and treated with flucloxacillin without potassium supplementation

* Drug use associated with supratherapeutic INR

Patient with a supratherapeutic INR (INR > 4) and treated with a VKA

* Drug use associated with bone marrow suppression

Patient with an absolute neutrophil count < 1.5*109/L and treated with clozapine

4

Potential sequential therapy for bio-equivalent drugs

Potential sequential therapy for levofloxacine

5

Others

Patient treated with non-crushable drugs administered through enteral feeding tube

  1. aDDI drug-drug interaction, CDSS clinical decision support system, INR international normalized ratio, CrCl creatinine clearance, ACE angiotensin converting enzyme, VKA vitamin K antagonist