Correct.state.ak.us

DEPARTMENT OF CORRECTIONS
CENTRAL PHARMACY
FORMULARY
PREFACE
The formulary is a listing of the therapeutic agents which have approved for use in the
Alaska correctional system and which are routinely stocked by the Central Pharmacy.
Physicians, dentist, and medical staff should use formulary items when possible.
Non-formulary items, if justified, can be ordered through the Central Pharmacy. In order to
make use of the formulary system and conserve monetary resources, prescriptions may be
filled with exact generic equivalents.
Normal operating hours for the Central Pharmacy are 7:00 a.m. - 3:00 p.m., Monday through
Friday, excluding holidays. Medication may be requested at all times by using the telefax
machine, 269-7335 (Pharmacy).
In the event that a drug is required on an emergency basis and the department pharmacist is
not available, the Institution Health Care Officer is authorized to locally purchase enough to
allow for medication until the department pharmacy can respond to the need.
Formulary additions, deletions, and use of non-formulary drugs is covered in Appendix 1 of
this formulary. A request to use non-formulary drugs must be completed by staff from the
requesting institution.
Central Pharmacy Formulary Addition/Deletion List
October 21, 2003

ADDITIONS:


DELETIONS:

ADDITIONS TO STOCK LIST

ALASKA DEPARTMENT OF CORRECTIONS FORMULARY
TABLE OF CONTENTS
Page

Biological and Immunologic Agents. 1
Diagnotisic Tests. 1 Toxoids` . 1 Vaccines . 1 Cardiovascular Agents. 2
Alpha 1 Adrenergic Blockers. 2 Antiadrenergic Agents – Centrally Acting. 2 Antiadrenergics/Sympatholytics Beta-adrenergic Blocking Agents . 2 Antiarrhythmic Agents. 2 Antihyperlipidemic Agents. 2 Calcium Channel Blocking Agents . 2 Inotropic Agents . 2 ACE Inhibitors . 2 Angiotensin II Receptor Antagonists……………………………………………………2 Sympathomimetic Agents-Adrenergics, Vasopressors . 2 Vasodilators . 2
Central Nervous System Agents . 3
Agents for Migraine. 3 Analgesics . 3 NonSteroidal Anti-inflammatory Agents…………………………………………….3 Analgesics – Opiate Agonists……………………………………………………….3 Antianxiety Agents…………………………………………………………………….3 Anticonvulsants……………………………………………………………………….3 Antidepressants……………………………………………………………………….4 Antiemetics……………………………………………………………………………. 4 Antimuscarinics/Antispasmodics…………………………………………………….4 Antiparkinson Agents…………………………………………………………………4 Antipsychotics…………………………………………………………………………4,5 Benzodiazepines………………………………………………………………………5 Injectable Local Anesthetics………………………………………………………….5 Opiate Antagonists…………………………………………………………………….5 Respiratory and Cerebral Stimulants……………………………………………….5 Skeletal Muscle Relaxants……………………………………………………………5
Skin and Mucous Membrane Agents . 6

Analgesic……………………………………………………………………………….6 Antibiotics………………………………………………………………………………6 Antifungals…………………………………………………………………………….6 Antihistamine Agents…………………………………………………………………6 Anorectal Agents…………………………………………………………………….6 Preparations……………………………………………………………………6 Corticosteroids……………………………………………………………………….6 Emollients, Demulcents, and Protectants…………………………………………6 Solutions……………………………………………………………………7 Agents……………………………………………………………………7 Agents…………………………………………………………………7 Anesthetics…………………………………………………………………….7 Antiinfectives………………………………………………………………….7 Agents……………………………………………………………….7 Agents……………………………………………………………………7
Endocrine/Metabolic Agents . 8

Adrenal Corticosteroids…………………………………………………………….8 Agents for Gout………………………………………………………………………8 Agents – Injectable……………………………………………………8 Antidiabetic Agents – Oral………………………………………………………….8 Antidiabetic Agents – Miscellaneous…………………………………………….8 Agents……………………………………………………………………8 Estrogens/Progestins……………………………………………………………….8 Miscellaneous……………………………………………………………………….8 Oral Contraceptives…………………………………………………………………9 Agents……………………………………………………………………….9
Gastrointestinal Agents . 10

Ammonia Detoxicant……………………………………………………………….10 Antacids………………………………………………………………………………10 Anticholinergics/Antispasmodics………………………………………………….10 Antidiarrheal Agents……………………………………………………………….10 Antiflatulents…………………………………………………………………………10 Digestants……………………………………………………………………………10 Emetics……………………………………………………………………………….10 Histamine Antagonists………………………………………………………… 10 Laxatives…………………………………………………………………………….10 Miscellaneous Agents………………………………………………………………10 Mouth and Throat Products……………………………………………………….10 Proton Pump Inhibitors…………………………………………………………….10 Softeners………………………………………………………………………10 Sulfasalazine…………………………………………………………………………10
Hematological Agents . 11

Antianemia Agents………………………………………………………………….11 Anticoagulants……………………………………………………………………….11 Hemorrheologic Agents…………………………………………………………….11
Nutritional Agents . 12

Alkalizing Agents………………………………………………………………….12 Electrolytes/Minerals………………………………………………………………12 Solutions…………………………………………………………….12 Vitamins…………………………………………………………………………….12
Ophthalmic Agents. 13
Allergy/Decongestants…………………………………………………………….13
Antibiotic
Agents………………………………………………………………….13 Agents…………………………………………………………….13 Agents………………………………………………………………….13 Solutions…………………………………………………………………13 Local Anesthetic Agents………………………………………………………….13 Agents…………………………………………………………………13 Agents…………………………………………………….13
Otic Agents . 14

Renal and Genitourinary Agents . 15

Benign Prostatic Hyperplasia Agents……………………………………………15 Agents…………………………………………………………………….15 Agents………………………………………………………………15 Respiratory Agents. 16

Allergy/Cough/Cold Combination Products…………………………………….16 Antihistamines………………………………………………………………………16 Antihistamine – Long Acting………………………………………………………16 Bronchodilators…………………………………………………………………….16 Glucocorticosteroids……………………………………………………………….16 Intranasal Anti-inflammatory Agents…………………………………………….17 Decongestants………………………………………………………………17 Stimulant………………………………………………………………17 Inhalers…………………………………………………………………….17
Systemic Anti-Infective Agents……………………………………………………………………….18

Antibiotics……………………………………………………………………………18 Agents………………………………………………………………….19 Agents…………………………………………………………………19 Agents……………………………………………………………….19 Antituberculosis Agents……………………………………………………………19 Antiviral Agents…………………………………………………………………….19 Urinary Anti-Infective Agents………………………………………………………19 Generic Name
Trade Name
Strength
Diagnostic TestsPurified Protein Derivative, PPD ToxoidsTetanus and Diphtheria ToxoidsVaccinesHepatitis B Vaccine(Recombinant) Influenza Virus VaccineMeasles, Mumps, and Rubella Live MMR II Pneumococcal 23 Valent Generic Name
Trade Name
Strength
Antiadrenergic Agents-Centrally ActingClonidine Antiadrenergics/SympatholyticsBeta-adrenergic Blocking AgentsAtenolol Tablets -10mg, 20mg, 40mg, 60mgLA- 60mg, 80mg, 120mg, 160mgInjection 1mg/ml 1ml Calcium Channel Blocking AgentsDiltiazem CD Renin Angiotensin System AntagonistsACE InhibitorsCaptopril tablet Angiotensin II Receptor AntagonistsLosartan tablet (restricted to use after) Sympathomimetic Agents,Adrenergics, VasopressorsDopamine VasodilatorsAmyl Nitrite AspirolsDipyridamole tablet Generic Name
Trade Name
Strength
Agents for MigraineErgotamine with Caffeine tablets Dichloralphenzone 100mgAcetaminophen 325mg Percogesic, Phenylgesic 325mg with phenyltoloxamine 30mgEnhanced Analgesic 50mg, monitor usage if on SSRI, may lowerseizure threshhold NonSteroidal Anti-Inflammatory AgentsIbuprofen tablet 25mg - restricted to treatment of acute goutfor 3 days, available as stock card 12x25mg 12.5mg, 25mg, 50mg for acute pain only,limited to 5 days, not refillable Analgesics - Opiate AgonistsCodeine Phosphate with Acetaminophen Hydrocodone 5mg Acetaminophen 500mgHydrocodone 7.5mg Acetamin 500mg Propoxyphene Napsylate &Acetaminophen Darvocet N 100 Generic Name
Trade Name
Strength
Antimuscarinics/ AntispasmodicsAtropine Sulfate Injection Antiparkinson AgentsAmantadine HCL capsules Olanzaprine immediate dissolving tablets Zyprexa Zydis Generic Name
Trade Name
Strength
Antipsychotic Agents cont.
Risperidone tablets Lidocaine 1% with EpinephrineLidocaine 2% with EpinephrineMepivacaine Carbocaine restricted to court ordered programs at HMCC, PCC, MSPT CIPT, Anc. JailRespiratory and Cerebral StimulantsAromatic Ammonia SpiritSkeletal Muscle RelaxantsCyclobenzaprine Generic Name
Trade Name
Strength
AnalgesicAnalgesic BalmAntibioticsBacitracin ointment 2% 30gm, 45gm vaginal cream, vag. Supp.
Antihistamine agentsPramoxine with Calamine lotion Anorectal agentsDibucaine rectal ointment Burn PreparationsSilver Sulfadiazine cream CorticosteroidsBetamethasone diproprionate Emollients, Demulcents, and ProtectantsHydrophor Generic Name
Trade Name
Strength
Irrigating Solutions0.9% Sodium Chloride for Irrigation Keratolytic AgentsSalicylic Acid with Colloidal Sulfur Ethyl Chloride sprayLocal AntiinfectivesSelenium sulfide Scabicides and PediculicidesCrotamiton cream Sunscreen AgentsSunblock-must be ordered by psych. for diagnosed neuroleptic induced photosensitivity Generic Name
Trade Name
Strength
Adrenal CorticosteroidsDexamethasone Sodium Phosphate Antidiabetic Agents - InjectableInsulin Human Lente Antidiabetic Agents - Oral
Biguanides
Metformin tablets
Sulfonylureas
Glipizide tablets
Antidiabetic Agents - MiscellaneousGlucagon Antithyroid AgentsPropylthiouracil tablets Estrogens/ProgestinsConjugated Estrogens tablets Conjugates Estrogens Vaginal Cream Premarin Vaginal Cream 0.625mg/gmMedroxyprogesterone tablets Generic Name
Trade Name
Strength
Oral ContraceptivesAll brands are on the formulary, generic Will be provided oral contraceptives one month prior to releaseEthinyl Estradiol with Norgestrel Generic Name
Trade Name
Strength
Ammonia DetoxicantLactulose Oral Solution Anticholinergics/AntispasmodicsAtropine Sulfate injection Antidiarrheal AgentsBismuth Subsalicylate tablets Lipase 4000, Amylase 20,000, Protease 25,000 Histamine H2 AntagonistsFamotidine tablets Polyethylene Glycol Electrolyte Conc.
Metamucil sugar free 10 oz, 23 oz., packets Sodium Phosphate, dibasic & monobasic Fleets EnemaSodium Phosphate Oral Solution Mouth and Throat ProductsChlorhexidine gluconate oral rinse Proton Pump InhibitorsPantoprazole tablets Generic Name
Trade Name Strength
Hemorrheologic AgentsPentoxifylline tablets Generic Name
Trade Name Strength
Alkalizing AgentsSodium Bicarbonate Injection Electrolytes/MineralsCalcium Carbonate tablets Intravenous SolutionsDextrose 5% in water Multivitamin tabletsMultivitamin with Folic acid 1mg tablets Generic Name
Trade Name
Strength
Allergy/DecongestantsNaphazoline Hydrochloride ophthalmic Tetrahydrazoline hydrochloride ophthalmic VisineAntibiotic agentsBacitracin ophthalmic ointment Corticosteroid agentsPrednisolone Acetate ophthalmic Glaucoma AgentsBrinzolamide opthalmic solution Local Anesthetic agentsProparacaine Hydrochloride ophthalmic Lubricating agentsHydroxypropylmethylcellulose ophthalmic Mydriatic/Cycloplegic agentsCyclopentolate ophthalmic solution Generic Name
Trade Name
Strength
Neomycin, Polymyxin, and Hydrocortisone Cortisporin Otic Solution, Suspension Generic Name
Trade Name Strength
Benign Prostatic Hyperplasia AgentsTerazosin capsules Diuretic AgentsAmiloride with HCTZ tablets Genitourinary AgentsOxybutynin Chloride tablets Generic Name
Trade Name
Strength
Allergy/Cough/Cold Combination AgentsTriprolidine with Pseudoephedrine tablets Antihistamine - Long ActingFexofenadine HCL GlucocorticosteroidsMethyprednisolone Sodium Succinate Generic Name
Trade Name
Strength
Intranasal Anti-Inflammatory AgentsCromolyn sodium Solution Nasal DecongestantsOxymetazoline HCL Nasal Spray Respiratory StimulantAmmonia InhalantSteroid InhalersBeclomethasone Dipropionate Aerosol Beclovent, Vanceril 42mcg/spray, 200 dose inhalerTriamcinolone Acetonide Oral Inhaler Generic Name
Trade Name Strength
Antibiotics
Aminoglycosides
Gentamicin Sulfate Injection
Cephalosporins
Cefazolin Injection
Fluoroquinolones
Ciprofloxacin tablets
Lincosamides
Clindamycin capsules
Macrolides
Azithromycin tablets
Erythromycin Ethyl Succinate tablets EES 400 Metronidazole
Metronidazole tablets
Penicillins
Amoxicillin capsules
Generic Name
Trade Name Strength
Sulfonamides
Sulfamethoxazole/Trimethoprim DS Septra DS
Tetracyclines
Doxycycline tablets
Antimalarial AgentsQuinine Sulfate capsules Urinary Anti-Infective AgentsNitrofurantoin capsules

Source: http://www.correct.state.ak.us/corrections/pnp/pdf/AKFormulary10-03.pdf