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A patient was scheduled to receive an intramuscular (I.M.) injection of 75 mg of meperidine (Demerol) mixed with 50 mg of hydroxyzine (Vistaril) every 4 hours as needed for pain. Because this patient was also severely hypertensive, the doctor had written a p.r.n. order for hydralazine (Apresoline), 20 mg I.M.
As in most hospitals, the pharmacist frequently dispensed generic drugs. So generic forms of Vistaril and Apresoline were in the patient's drug bin.
One afternoon, a nurse was preparing the injection of Demerol and Vistaril. She noticed that the vial of medication she thought was the generic equivalent of Vistaril contained a 20-mg dose. She needed 50 mg, which is how the Vistaril had previously been dispensed. A co-worker was also puzzled at first. Then she noticed that the vial contained hydralazine, not hydroxyzine.
When the pharmacy substitutes a generic drug for a drug that was ordered by its trade name, you must double-check to make sure you've got the right drug. If you're unfamiliar with generic equivalents, you should have a drug reference book handy.
Your pharmacist could help, too. When permitted by law, he could include both the generic and the trade names on labels and computer-generated medication administration records. In some states, this is considered misbranding, though. Others allow the pharmacist to make statements like "similar to Vistaril" or "substitute for Vistaril. "
Also, the pharmacist can notify you of appropriate inventory changes. And unit-dose packaging will ensure that the dispensed medication retains its identity until you're ready to use it.