| Rule that alerts to elevated potassium level in elderly females on potassium replacement who are also on amlopidine, or triamterenne/HCTZ, or digoxin, and whose labs show an elevated dig level, decreased calcium or renal insufficiency; with acceleration. |
| Alerts to the toxic serum level of carbamazepine. |
| Alerts to toxic levels of lithium. |
| Alerts to toxic levels of phenobarbital |
| Alerts to toxic levels of procainamide. |
| Alerts to the sub therapeutic serum level of carbamazepine. |
| Alerts to toxic levels of theophylline. |
| Alerts to sub therapeutic PTT while on heparin. |
| Alerts to sub therapeutic levels of primidone. |
| Alerts to toxic levels of primidone. |
| Alerts to the elevation of glucose for patients on acarbose and a phenothiazine. |
| Rule designed to monitor patients receiving insulin for the development of hypoglycemia |
| Rule designed to monitor for hyperkalemia in patients receiving potassium supplementation. |
| Rule designed to monitor for hyperkalemia in patients receiving potassium supplementation and lisinopril. |
| Rule designed to monitor for thrombocytopenia in patients receiving heparin. |
| Rule designed to monitor for hyperkalemia in patients receiving lisinopril. |
| Rule designed to monitor elevations in liver function tests (ALT) in patients receiving amiodarone. |
| Rule designed to monitor for low trough levels of vancomycin. |
| Thrombocytopenia in patients receiving enoxaparin whose platelets have dropped at least 30% AND are <200 |
| Rule designed to monitor aPTT and Heparin |
| Alerts to hypoglycemia with metformin. |
| Alerts to the possibility of hepatic failure due to valproic acid induced hepatitis, requiring discontinuation of the drug. |
| Alerts to the possibility of hepatic failure due to valproic acid induced hepatitis, requiring discontinuation of the drug. |
| Rule designed to monitor the development of hypoglycemia in patients receiving tolbutamide. |
| Alerts to the need to evaluate phenytoin as the potential cause of neutropenia and/or thrombocytopenia |
| Rule designed to monitor the development of hypoglycemia in patients receiving tolazamide. |
| Rule designed to monitor the development of hypoglycemia in patients receiving acetohexamide. |
| Rule designed to monitor the development of hyperglycemia in patients receiving acetohexamide. |
| Rule designed to monitor increased susceptibility to hypoglyemia in elderly patients receiving chlorpropamide. |
| Rule designed to monitor increased susceptibility to hypoglyemia in elderly patients receiving glyburide. |
| Rule designed to monitor the development of hypoglycemia in patients receiving glipizide. |
| Rule designed to monitor the development of hypoglycemia in patients receiving glimepiride. |
| Rule designed to monitor for hyperkalemia in patients receiving lisinopril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving benazepril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving captopril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving enalapril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving fosinopril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving moexipril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving quinapril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving ramipril and a potassium sparing diuretic |
| Rule designed to monitor for hyperkalemia in patients receiving trandolapril and a potassium sparing diuretic |
| Rule designed to monitor for increased Potassium in patients receiving benazepril. |
| Rule designed to monitor for increased Potassium in patients receiving captopril. |
| Rule designed to monitor for increased Potassium in patients receiving enalapril. |
| Rule designed to monitor for increased Potassium in patients receiving fosinopril. |
| Rule designed to monitor for increased Potassium in patients receiving moexipril. |
| Rule designed to monitor for decreases in renal function (BUN) in patients receiving quinapril. |
| Rule designed to monitor for increased Potassium in patients receiving ramipril. |
| Rule designed to monitor for increased Potassium in patients receiving trandolapril. |
| Rule designed to monitor the development of thrombocytopenia in patients on methotrexate and probenecid |
| Rule designed to monitor the development of thrombocytopenia in patients on methotrexate |
| Rule designed to monitor for hyperkalemia in patients on triamterine and potassium |
| Rule designed to monitor for increased Potassium in patients receiving lorsartan. |
| Rule designed to monitor for increased Potassium in patients receiving valsartan. |
| Rule designed to monitor for increased Potassium in patients receiving irbesartan. |
| Rule designed to monitor for increased Potassium in patients receiving candesartan. |
| Rule designed to monitor for increased Potassium in patients receiving eprosartan. |
| Rule designed to adjust meperidine dosages in patients with decreased renal function. |
| Rule designed to monitor for hyperkalemia in patients receiving captopril and a potassium sparing diuretic |
| Tracks digoxin levels for patients on digoxin watching for toxic levels and low serum potassium. |
| Rule designed to monitor for decreased serum potassium levels while receiving digoxin. |
| Rule designed to monitor for hyperkalemia in patients receiving captopril and a potassium sparing diuretic |
| Alerts to patients receiving cimetidine and checking for low platelet levels |
| Ranitidine and PLATELETS has FALLEN 50 percent of previous value & Any of last 1 PLATELETS (PLT) results within last 3 days are < 100 |
| Alerts to patients receiving nizatidine and low platelet count PLATELETS (PLT) has FALLEN 50 percent of previous value & Any of last 1 PLATELETS (PLT) results within last 3 days are < 100 (Check previous PLT levels) |
| Rule designed to monitor elevations in liver function tests (ALT) with lovastatin. |
| Rule designed to monitor elevations in liver function tests with atorvastatin. ALT (SGPT) or AST (SGOT) > 450 & having the minimum ALT/AST results during the last 7 days rising at least 20% from that minimum |
| Rule designed to monitor elevations in liver function tests (ALT) with pravastatin. |
| Alerts to toxic levels of desipramine. |
| Patients who are receiving protamine as antidote for anticoagulation |
| Patients receiving phytonadione while receiving warfarin |
| Patient receiving Flumazenil as antidote to benzodiazepine toxicity |
| Patient receiving naloxone as antidote to opiate toxicity |
| Rule designed to monitor elevations in liver function tests (ALT) with rosuvastatin. |
| Rule designed to monitor elevations in liver function tests (ALT) with fluvastatin. SGOT (AST/GOT) > 450 & the minimum SGOT (AST/GOT) results during the last 7 days has risen 20% from that minimum |
| Patients receiving amphoteracin with declining renal function |
| Elevation in creatinine while receiving acyclovir |
| Patient is on AMIODARONE and DIGOXIN |
| If any of the last 1 PLATELETS (PLT) results during the last 1 days is <50 & patient is on ASPIRIN, CLOPIDOGREL, TICLODIPINE, or NSAIDs. |
| If any of the last 1 PLATELETS (PLT) results during the last 1 days is <50 & patient is on NSAIDs. |
| High quinidine levels |
| Rule designed to monitor elevations in liver function tests with fluvastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with lovastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Rosuvastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with phenytion. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with cyclosporine. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Methotrexate. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Warfarin. ALT (SGPT) or AST (SGOT) > 300 & check any of the last ALT/AST results during the last 7 days is <300 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Isoniazid. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Heparin induced thrombocytopenia identification |
| Elevation in Creatinine while receiving Lisinopril > 1.5 & CREATININE has RISEN 1.0 since previous result. |
| Elevation in Creatinine while receiving enalapril > 1.5 & CREATININE has RISEN 1.0 since previous result. |
| Checking for renal dysfunction in patients receiving repeat administrations of Amikacin Creatinine Value of >1.5 AND check if CREATININE has check if RISEN .5 since previous result. |
| Elevation in Creatinine while receiving Aspirin> 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving celecoxib > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving Diclofenac > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving ibuprofen > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving INDOMETHACIN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving KETOROLAC > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving NABUMETONE > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving NAPROXEN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving PIROXICAM > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving SALSALATE > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving SULINDAC > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving TOLMETIN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving ACYCLOVIR> 1.5 & CREATININE has RISEN 0.5 since previous result. Can mark a SrCr to be alerted for % rise |
| Elevation in Creatinine while receiving AMPHOTERICIN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving FLUCONAZOLE> 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving ITRACONAZOLE > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving CYCLOSPORINE > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving CARBOPLATIN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving CISPLATIN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving IFOSFAMIDE > 1.5 & CREATININE has RISEN 0.5 since previous result. Can mark a SrCr to be alerted for % rise |
| Elevation in Creatinine while receiving METFORMIN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving meperidine > 1.5 |
| Elevation in Creatinine while receiving CIPROFLOXACIN > 1.5 & CREATININE has RISEN 0.5 since previous result. |
| Elevation in Creatinine while receiving RANITIDINE > 2 |
| If OSMOLARITY has risen 20% of the previous value and patient is on ATIVAN (LORAZEPAM) (prn orders excluded) (route=IV) |
| Patient with a Mg lab result over 3.5 & creatinine over 3.0 -- Check if on any Magnesium |
| COLCHICINE and serum creatinine in last 1 day is greater than or equal to 2.0 |
| Patient is ordered for Heparin and fondaparinux |
| Patient is ordered for COLCHICINE and CYCLOSPORINE |
| Patient is ordered for COLCHICINE and TACROLIMUS |
| Patient has order for concurrent use of AZATHIOPRINE and ALLOPURINOL |
| Patient ordered for voriconazole and SIROLIMUS |
| Rule designed to monitor elevations in liver function tests with atorvastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with lovastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Simvastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Simvastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Rosuvastatin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Isoniazid. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with phenytion. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with cyclosporine. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Methotrexate. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Rule designed to monitor elevations in liver function tests with Warfarin. ALT (SGPT) or AST (SGOT) > 450 & check any of the last ALT/AST results during the last 7 days is <450 has risen 20% of the previous value |
| Warning with CK 5X ULN, Rhabdo definitive at 10X. Check if patient has a history of being on a Statin. Check if CK elevation is of non-cardiac origin (CK-MB is >5 and the CK Index is <3.5) |
| Monitors for rising creatinine in a male adult on rosuvastatin |
| Monitors for rising creatinine in a female adult on rosuvastatin |
| Monitors for bile duct release of gamma glutamyl transpeptidase in an adult on rosuvastatin. |
| Monitors and alerts to when a hypothyroid patient is on rosuvastatin, indicating a higher predilection for rhabdomyolysis. |
| Monitors for candesartan induced hypokalemia |
| Monitors for rising creatinine for a person on candesartan |
| Monitors for elevated serum transaminase for person on candesartan |
| Monitors for elevated serum transaminase for person on candesartan |
| Monitors for possible rhabdomyolysis in a person on candesartan. |
| Alerts to the need to change the levofloxacin dose to a max of 250 mg/day or 750 mg q48h for a CrCl=20-49 ml/min |
| Alerts to the need to lower the levofloxacin dose: max 250 mg/day or 500 mg q48h for CrCl <20 ml/min |
| Alerts to the need to increase levofloxacin dose with CrCl >50 ml/min to 500-750 mg/day |
| Alerts to the need to increase prophylaxis dose of enoxaparin if CrCl>30 ml/min and age<65 and wt>50kg to 40 mg q24h |
| Alerts to the need to lower enoxaparin prophylaxis dose to 30 mg q24h if AGE>65 and WT<50 kg even though CrCl is >30 ml/min |
| Alerts to the need to increase enoxaparin prophylaxis dose in obesity with CrCl >30 and wt >150kg to 40 mg q12h |
| Alerts to the need to reduce enoxaparin to 1mg/kg q24h with a CrCl <30 ml/min if pt on >1 mg/kg/day |
| Alerts to the need to reduce famotidine dose to max of 20 mg/day with CrCl <50 ml/min |
| Alerts to the possible need to decrease digoxin dose (check for DIG levels, if any) |
| Alerts to the possible need to decrease digoxin dose in a patient <50 kg (check for DIG levels) |
| Alerts for the need to decrease colchicine dose: max of 0.6 mg/day with CrCl 10-50 ml/min |
| Alert for need to discontinue colchicine in a patient with CrCl <10 ml/min |
| Alerts to the need to reduce the enoxaparin dose to 30 mg q24h for a CrCl <30 ml/min (if prophylaxis) |
| Alerts to the need to reduce the daily allopurinol dose in a patient with CrCl <10 ml/min to 100 mg/day |
| Alerts to the need to change vancomycin dosing to approx 15 mg/kg q48h if CrCl 10-30 ml/min |
| Alerts to the need to increase famotidine dosing to 40 mg/day if CrCl > 50 ml/min |
| Alerts to the possible need to reduce digoxin dosing in patients >65 yo. Screening tool |
| Alerts to the need to adjust vancomycin dosing to approx 15 mg/kg/day with CrCl= 30-60 ml/min |
| Alerts to the need to reduce the dose of allopurinol to a max of 200 mg/day if CrCl 10-20 ml/min |
| Alerts to the need INCREASE enoxaparin dose to 1 mg/kg q12h dosing in ACS if CrCl >30 ml/min |
Alerts to the need to increase enoxaparin dose:
consider 1.5 mg/kg/day for non-ACS use if CrCl=30-45 ml/min, for CrCl >45 either 1 mg/kg q12h or 1.5 mg/kg/day is OK for DVT/PE |
| Alerts to possible need to DC ACEI/ARB if K>5.0 |
| Alerts to toxic levels of total phenytoin (corrected)in patients receiving amiodarone, allopurinol, or warfarin. |
| Alert to the need to use metformin with caution for CrCl=30-60, and DC if CrCl<30 |
| Alerts to possible linezolid induced thrombocytopenia |
| Alerts to possible drop in RBC due to linezolid induced myelosupression |
| Alerts to possible linezolid induced leucopenia or neutropenia secondary to myelosuppression |
Alerts to the possibility of HIT with a positive heparin associated platelet antibody result.
Check for heparin/enoxaparin use and need for DTI |
Fluconazole and CrCl <50 ml/min
Alerts to the need to reduce dose by 50% if CrCl <50 ml/min. (Normal dose can be up to 800 mg/day for serious fungal infections) |
| Naloxone taken from Pyxis. Evaluate for possible ADR |
Flumazenil taken from Pyxis.
Evaluate for possible ADR. |
Glucagon taken from Pyxis.
Evaluate for possible ADR-hypoglycemia or beta blocker toxicity |
Digoxin level >2.0, evaluate for possible ADR
or dose adjustment |
| Elevated theophylline >20, evaluate for possible ADR or dose adjustment |
| Elevated carbamazepine level >12, evaluate for possible ADR, or dose adjustment |
| Elevated lithium level >1.2, evaluate for possible ADR, or dose adjustment |
D50/W IV, or glucose tablet or glucose gel given.
Evaluate for possible hypoglycemia ADR |
| Gentamicin trough level >2 alert. |
| Tobramycin trough level >2 alert, |
Gentamicin dose assessment using adjusted BW.
ODA protocol is 6 mg/kg/day.
(r/o gram + synergy dosing) |
Gentamicin dose assessment using adjusted body weight.
(r/o adjusted gram + synergy dosing) |
Gentamicin dose assessment using adjusted body weight.
(r/o gram + synergy dosing) |
Gentamicin dose assessment using adjusted body weight (ABW).
(r/o gram + synergy dosing) |
Gentamicin dose assessment using adjusted BW.
Should not exceed 2 mg/kg/day if CrCl <30 ml/min
(r/o gram + synergy dosing) |
| Tobramycin dosing assessment using adjusted body weight (ABW). |
Digoxin dose assessment using Ideal Body Weight.
Check for dig levels and stable renal function. |
Alerts to the possible need to DC Aranesp or reduce the dose for a rising Hgb >12 which is
associated with adverse outcomes. |
Alerts to the possible need to dose adjust gabapentin for creatinine clearance = 30-59.
If stable dose, query patient for side effects. |
Alerts to the possible need to dose adjust gabapentin for creatinine clearance = 15-30
If stable dose, query patient for side effects. |
Alerts to the possible need to dose adjust gabapentin for creatinine clearance=7.5-15.
If stable dose, query patient for side effects. |
Alerts to the possible need to dose adjust gabapentin for creatinine clearance <7.5 ml/min.
If stable dose, query patient for side effects. |
| Alerts to a possible dose adjustment for amikacin to 15 mg/kg/day for a CrCl >80 ml/min using Adjusted Body Weight (ABW) |
| Alerts to a possible dose adjustment for amikacin to 12 mg/kg/day for a CrCl = 60-80 ml/min using Adjusted Body Weight (ABW) |
| Alerts to a possible dose adjustment for amikacin to 7.5 mg/kg/day for a CrCl = 40-60 ml/min using Adjusted Body Weight (ABW) |
| Alerts to a possible dose adjustment for amikacin to 4 mg/kg/day for a CrCl = 30-40 ml/min using Adjusted Body Weight (ABW) |
| Alerts to a possible dose adjustment for amikacin to 7.5 mg/kg q48h for a CrCl =20-30 ml/min using Adjusted Body Weight (ABW) |
| Alerts to a possible dose adjustment for amikacin to 4 mg/kg q48h for a CrCl = 10-20 ml/min using Adjusted Body Weight (ABW) |
| Alerts to the need for a possible dose adjustment for amikacin to 3 mg/kg q72h for a CrCl <10 ml/min using Adjusted Body Weight (ABW) |
| Consider q12h dosing interval with cefazolin and CrCl=10-50 |
| Consider q24h frequency with cefazolin and CrCl <10 ml/min |
| Alerts to elevated lactic acid levels in diabetics on metformin. |
| Alerts to the possibility of pancreatis with acidosis due to valproic acid, requiring rapid discontinuation of the drug. |
| Alerts to the possibility of pancreatis with acidosis due to valproic acid, requiring rapid discontinuation of the drug. |
| Alerts to toxic levels of total phenytoin. |
| Alerts to toxic levels of total phenytoin in patients receiving amiodarone, allopurinol, or warfarin. |
| Alerts to toxic levels of valproic acid. |
| Phenytoin level greater than 18 and Albumin less than 3.3 |
| Alerts to the possible need to discontinue enoxaparin in a patient with INR >2 |
| Elevated valproic acid level >100, evaluate for possible ADR. Normal range=50-100, some seizure patients may need 80-150 for seizure control. |