Unique Plan Description: Tikosyn (dofetilide) (JE)
Plan Selection Display: Tikosyn (dofetilide) (JE)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-13 16:34:48
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 12:23:24
Available at all facilities: Yes

Tikosyn (dofetilide) (JE)
Vital Signs
	Vital Signs
		T;N, Q8H
Laboratory
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
Diagnostic Tests
Cardiac
	ECG
		T;N, Stat
			Comment: baseline 12-lead, Notify MD for QTc > 440msce (> 500msec in patients with ventricular conduction abnormalities ie: BBB.)
Medications

	Discontinue Medication
		T;N, See comment
			Comment: Discontinue any of the following medications now and keep off during hospital stay: verapamil, Tagamet, Nizoral, Bactrim, Megace, Compazine, hydrochlorothiazide (even combinations), Amiodorone (off for 3 months or level <0.3mg/mL), other antiarrhythmics must be off for 3 t ½
		Contraindicated if CrCl <20mL/min. K+<4mmol/L and or Mg+<2mEq/L(NOTE)*
		If calculated CrCl 20 to <40 then select below orderable:(NOTE)*
	Tikosyn
		125 mcg, Capsule, By Mouth, Q12H-Sch
			Comment: Order ECG 2 hours post medication administration.  Pharmacy to schedule at 0700 & 1900.
		If calculated CrCl 40 to 60 then select below orderable:(NOTE)*
		250 mcg, Capsule, By Mouth, Q12H-Sch
			Comment: Order ECG 2 hours post medication administration.  Pharmacy to schedule at 0700 & 1900.
		If calculated CrCl >60 then select below orderable:(NOTE)*
		500 mcg, Capsule, By Mouth, Q12H-Sch
			Comment: Order ECG 2 hours post medication administration.  Pharmacy to schedule at 0700 & 1900.
Patient Care
	Cardiac Telemetry Monitoring Continuous
		T;N
	Order ECG
		T;N, Enter order for ECG to be done 2 hours post medication administration for each dose; use same lead as baseline ECG, or after introduction of any potential QTc prolonging drugs.
	Notify MD
		T;N, Ordering MD if K+<4mmol/L and/or Mg+<2mEq/L
		T;N, Ordering MD if QT increases by 15% or exceeds 500ms (550ms in patients with venticulary conductions abnormaities ie: BBB).
Consults/Follow-up
	Pharmacy Consult
		T;N, See comment
			Comment: To dose Tikosyn, "RP to refer to Tikosyn certified MD if creatinine clearance, baseline QTc or subsequent QTc deviate from protocol." Discontinue any of the following medications now and keep off during hospital stay: verapamil, Tagamet, nizoral, Bactrim, megace, compazine, hydrocholorthiazid (even combinations). Dispense first weeks supply when patient discharged.
	Consult Care Management
		T;N
			Comment: Evaluate for Tikosyn Rx coverage after patient tolerates 3rd dose.  Pt needs follow up appt 1 week after discharge. Needs ECG and BMP at that time.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase