10 Steps to Develop and Implement a Pharmaceutical Waste Management Program

Step 4 walks you through the steps necessary to perform a drug inventory review. This step can be very tedious and time consuming.

Once an understanding of the regulations is achieved (Step 2) and determines which management practices to adopt (Step 3), the next step is to perform a drug inventory review. Typically, only about 4% to 5% of the drugs in the pharmacy will be subject to the RCRA hazardous waste (HW) regulations, and an additional 10% should be managed as HW based on best management practices. So, the next step is to go through the inventory and determine which drugs must be managed as HW. The steps involved in this activity should be well-documented.

(Note: The yellow highlights provide a summary of this step along with the outline of this step.)

1. Gather Drug Specific Data
   • National Drug Code
   • Brand name
   • Generic name
   • Manufacturer
   • Strength
   • Dosage form, and
   • Package size.

   The next step is to identify all the ingredients in each drug formulation, including preservatives (mercurials, etc.), heavy metals, and alcohol. This can be done using reference books and the Internet

1. Compounded Items and Re-formulations

   It is essential to also consider all:

   • compounded items
   • re-formulations, and
   • IV admixtures

   to determine their HW designation.

2. Making RCRA Hazardous Waste (HW) Determinations

   It is important to identify all the applicable waste codes for each drug in the inventory. This will be of benefit when designing your HW program, selecting your vendor, and when "manifesting" the HWs.

   1. Toxicity
      Determining which drug formulations exhibit "toxicity" is the most challenging waste determination. Using the Tables in the document (URL provided below) can be of great assistance.
   2. Best Management Practices
      1. Documenting Your Decisions
      2. Keeping the Review Current
      3. Employing Alternative Approaches

http://www.hercenter.org/hazmat/tenstepblueprint.pdf

News

A breakdown of 6 of the most promising COVID-19 treatments (Beckers Hospital Review)
There are now hundreds of drugs that are being tested to treat COVID-19. Here are six of them:

1. Remdesivir—Gilead's drug remdesivir, already tested on other viruses, has been a front-runner as a possible COVID-19 treatment. The WHO has called it "the most promising candidate," and there are five active clinical trials testing its effectiveness against COVID-19 taking place in China, the U.S., and South Korea.
   
   
2. Kaletra—Kaletra is an HIV drug made by AbbVie. Although a study published March 18, 2020, in the NEJM said Kaletra didn't show benefits in COVID-19 patients.
   
   
3. Actemra and Kevzara—Actemra, made by Roche, and Kevzara, made by Regeneron and Sanofi, are both classified as IL-6 inhibitors and may work by stopping a biological mechanism that causes overactive inflammatory responses in patients' lungs. Both drugs are being tested in late-stage clinical trials.
   
   
4. Convalescent plasma—Convalescent plasma is blood plasma taken from COVID-19 patients who have recovered from the disease. That plasma contains antibodies that could help sick patients and boost their immune response. So far, two trials have shown promising results.
   
   
5. Chloroquine and hydroxychloroquine—Chloroquine and hydroxychloroquine are both antimalarial drugs. The scientific community has not yet definitively confirmed its clinical effectiveness for this virus.
   
   
6. Avigan—Avigan is a flu drug made by Japan-based Fujifilm Toyama Chemical. A trial conducted in China showed Avigan helped patients recover seven days faster than patients on another antiviral drug called arbidol, and it also reduced the frequency of symptoms like coughing and fever. However, the drug is not approved in the U.S.
   
   

Did You Know ...

...that Will Rogers said the following?

"If pro is the opposite of con, what is the opposite of Congress?"

Tip of the Week

The way the above question is worded, the answer would be "Progress." If we look at the definition of "progress" it is:

"to move forward, proceed, to develop to a higher, better, or more advanced stage."

Will Rogers also said,

"Congress starts off with a prayer, but ends with an investigation!"

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Looking Back

Substitutes resemble,
Tail-chasing pup,
Round and round,
But never catch up!
     Burma-Shave