©2008 Express Scripts, Inc. 33
(10/15/2007)
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
mefenamic acid
|
|
1
|
|
meloxicam
|
|
1
|
[QLL]
|
nabumetone
|
|
1
|
|
naproxen, sodium
|
|
1
|
|
oxaprozin
|
|
1
|
|
piroxicam
|
|
1
|
|
sulindac
|
|
1
|
|
tolmetin sodium
|
|
1
|
|
|
OTROS MEDICAMENTOS PARA LA ARTRITIS
|
CUPRIMINE
|
penicillamine
|
2
|
|
gold sodium thiomalate [INJ]
|
|
1
|
|
myochrysine [INJ]
|
|
1
|
|
RIDAURA
|
auranofin
|
2
|
|
SYPRINE
|
trientine
|
2
|
|
|
SALICILATOS Y MEDICAMENTOS RELACIONADOS
|
aspirin ec, sr
|
|
1
|
|
choline mag trisalicylate
|
|
1
|
|
diflunisal
|
|
1
|
|
mst 600
|
|
1
|
|
salsalate
|
|
1
|
|
tricosal
|
|
1
|
|
|
NUTRICIÓN, MODIFICADORES DE SANGRE, ELECTROLITOS
|
MEDICAMENTOS ANTIPLAQUETARIOS
|
AGGRENOX
|
aspirin/dipyridamole
|
2
|
|
cilostazol
|
|
1
|
|
dipyridamole tab
|
|
1
|
|
PLAVIX
|
clopidogrel
|
2
|
|
DESINTOXICANTES DE LA SANGRE
constulose
|
|
1
|
|
enulose
|
|
1
|
|
generlac
|
|
1
|
|
lactulose
|
|
1
|
|
RENAGEL
|
sevelamer
|
2
|
|
ELECTROLITOS, SOLUCIONES DE IRRIGACIÓN, ETC.
|
alburx [INJ]
|
|
1
|
|
albutein [INJ]
|
|
1
|
|
alcohol in dextrose [INJ]
|
|
1
|
|
©2008 Express Scripts, Inc. (10/15/2007)
34
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
AMINOSYN II, 3.5% M/DEXTROSE 5%, 3.5%/DEXTROSE 25%, 3.5%/DEXTROSE 5%, 4.25% M/DEXT 10%, 4.25%/DEXTROSE 25%, 5% IN 25% DEXTROSE, 8.5%, IN DEXTROSE, W/ELEC IN DE W/CA, W/ELEC IN DEX W/CA [INJ]
|
aminoácidos
|
2
|
|
AMINOSYN, M, W/ELECTROLYTESE, -HBC, -HF, -PF, -RF [INJ]
|
aminoácidos
|
2
|
|
AMMONIUM CHLORIDE [INJ]
|
ammonium chloride
|
2
|
|
BRANCHAMIN [INJ]
|
aminoácidos
|
2
|
|
calcium chloride, gluconate [INJ]
|
|
1
|
|
CALPHOSAN [INJ]
|
cal glycer/calcium lactate
|
2
|
|
CLINIMIX, E [INJ]
|
aminoácidos
|
2
|
|
CLINISOL [INJ]
|
aminoácidos
|
2
|
|
CYSTAGON
|
cysteamine
|
2
|
|
delflex w/1.5% dextrose, w/2.5% dextrose, w/4.25% dextrose [INJ]
|
|
1
|
|
dextrose 10%-1/4ns, 5%-1/2ns-kcl, 5%-1/3ns-kcl, 5%-1/4ns-kcl, 5%-ns-kcl, in lactated ringers, in ringers injection, in water, with sodium chloride [INJ]
|
|
1
|
|
DEXTROSE 10%-1/4NS-KCL, 5%-ELECTROLYTE #48,5%-ELECTROLYTE #75 [INJ]
|
potassium chloride/d10-0.25ns
|
2
|
|
dextrose 5%-potassium chloride 10 meq/l, 30 meq/l [INJ]
|
|
1
|
|
DIANEAL W/1.5% DEXTROSE, W/2.5% DEXTROSE [INJ]
|
soluciones para diálisis
|
2
|
|
FREAMINE III [INJ]
|
aminoácidos
|
2
|
|
FRUCTOSE [INJ]
|
fructose (str unspec)
|
2
|
|
HEPATAMINE [INJ]
|
aminoácidos
|
2
|
|
HEPATASOL [INJ]
|
aminoácidos
|
2
|
|
IONOSOL B W/DEXTROSE 5%, MB-DEXTROSE 5%, T-DEXTROSE 5% [INJ]
|
soluciones de electrolitos
|
2
|
|
ISOLYTE H W/DEXTROSE, M W/DEXTROSE, P W/DEXTROSE [INJ]
|
dextrose/electrolytes
|
2
|
|
ISOLYTE S, W/DEXTROSE [INJ]
|
soluciones de electrolitos
|
2
|
|
l-cysteine [INJ]
|
|
1
|
|
lactated ringers
|
|
1
|
|
magnesium chloride, sulfate [INJ]
|
|
1
|
|
MAGNESIUM SULFATE-D5W [INJ]
|
magnesium sulfate/d5w
|
2
|
|
mannitol [INJ]
|
|
1
|
|
MONOJECT PREFILL [INJ]
|
sodium chloride
|
2
|
|
NEPHRAMINE [INJ]
|
aminoácidos
|
2
|
|
NEUT [INJ]
|
sodium bicarbonate
|
2
|
|
normal saline, flush [INJ]
|
|
1
|
|
NORMOSOL-M AND DEXTROSE [INJ]
|
dextrose/electrolytes
|
2
|
|
©2008 Express Scripts, Inc. 35
(10/15/2007)
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
NORMOSOL-R, AND DEXTROSE, PH 7.4 [INJ]
|
soluciones de electrolitos
|
2
|
|
nutrilyte, ii [INJ]
|
|
1
|
|
PLASMA-LYTE 148, IN DEXTROSE [INJ]
|
soluciones de electrolitos
|
2
|
|
PLASMA-LYTE 56 IN DEXTROSE, A PH 7.4 [INJ]
|
d5w/electrolyte-56 solution
|
2
|
|
posiflush saline [INJ]
|
|
1
|
|
potassium chl/normal saline [INJ]
|
|
1
|
|
potassium chloride in d5lr 40 meq/l [INJ]
|
|
1
|
|
potassium phosphate 3 mm/ml vial [INJ]
|
|
1
|
|
POTASSIUM PHOSPHATE 3 mm/ml IV solution [INJ]
|
potassium phosphate
|
2
|
|
potassium/0.5 normal saline [INJ]
|
|
1
|
|
PREMASOL [INJ]
|
aminoácidos
|
2
|
|
PROCALAMINE [INJ]
|
aa 3%/electrolyte-tpn/glycerin
|
2
|
|
QUICK MIX W/LYTES [INJ]
|
aminoácidos
|
2
|
|
R-GENE 10 [INJ]
|
arginine
|
2
|
|
RENAMIN [INJ]
|
aminoácidos
|
2
|
|
ringer's lactated
|
|
1
|
|
ringers injection [INJ]
|
|
1
|
|
ringers irrigation
|
|
1
|
|
saline flush [INJ]
|
|
1
|
|
sodium acetate, bicarbonate, lactate, phosphate [INJ]
|
|
1
|
|
SODIUM CHLORIDE inj 2.5 meq/ml [INJ]
|
sodium chloride
|
2
|
|
sodium chloride inj (0.45 %, 0.9 %, 2.5 meq/ml, 3%, 4 meq/ml, 5 %), soln
|
|
1
|
|
syrex [INJ]
|
|
1
|
|
tis-u-sol
|
|
1
|
|
TPN ELECTROLYTES, II [INJ]
|
soluciones de electrolitos
|
2
|
|
TRAVASOL, W/DEXTROSE, W/ELECTROLYT ES [INJ]
|
aminoácidos
|
2
|
|
TRAVERT, IN NORMAL SALINE, -1/2NORMAL SALINE W/KCL, -ELECTROLYTE NO.2 [INJ]
|
azúcar invertida
|
2
|
|
TROPHAMINE [INJ]
|
aminoácidos
|
2
|
|
water
|
|
1
|
|
PRODUCTOS DE FLUORURO
|
denta 5000 plus
|
|
1
|
|
dentagel
|
|
1
|
|
ethedent
|
|
1
|
|
fluor-a-day (tabletas masticables)
|
|
1
|
|
neutragard advanced
|
|
1
|
|
perio med
|
|
1
|
|
pharmaflur
|
|
1
|
|
sf, 5000 plus
|
|
1
|
|
©2008 Express Scripts, Inc. (10/15/2007)
36
Nombre del medicamento
|
Composición química
|
Nivel
|
Requisitos/
Límites
|
sodium fluoride
|
|
1
|
|
stannous fluoride
|
|
1
|
|
|
ANTICOAGULANTES INYECTABLES
|
ARIXTRA [INJ]
|
fondaparinux sodium
|
3
|
|
heparin sodium, in 0.45% nacl, in 0.9% nacl, in 5% dextrose (excepto heparin lock y flush) [INJ]
|
|
1
|
|
LOVENOX [INJ]
|
enoxaparin
|
3
|
|
|
ANTICOAGULANTES ORALES, VITAMINA K
|
jantoven
|
|
1
|
|
warfarin sodium
|
|
1
|
|
RESINAS REMOVEDORAS DE POTASIO
|
marlexate
|
|
1
|
|
sodium polystyrene sulfonate oral susp, polvo
|
|
1
|
|
SODIUM POLYSTYRENE SULFONATE rectal
|
sodium polystyrene sulfonate
|
2
|
|
sps oral susp
|
|
1
|
|
SPS rectal
|
sodium polystyrene sulfonate
|
2
|
|
|
SUPLEMENTOS DE POTASIO
|
cytra-2
|
|
1
|
|
dextrose 5%-potassium chloride 10 meq/l, 30 meq/l [INJ]
|
|
1
|
|
effer-k 25 meq tablet
|
|
1
|
|
k effervescent
|
|
1
|
|
kaon-cl 10
|
|
1
|
|
klor-con pkt (20 meq), tab sa
|
|
1
|
|
klor-con 10, m10, m15, m20
|
|
1
|
|
klor-con/ef
|
|
1
|
|
phospha 250 neutral
|
|
1
|
|
potassium acetate [INJ]
|
|
1
|
|
potassium bicarbonate, chloride
|
|
1
|
|
potassium chloride in d5lr 40 meq/l [INJ]
|
|
1
|
|
sodium citrate & citric acid
|
|
1
|
|
vis-phos n
|
|
1
|
|
|
VITAMINAS Y MINERALES TERAPÉUTICOS
|
calcitriol
|
|
1
|
|
HECTOROL
|
doxercalciferol
|
2
|
|
levocarnitine
|
|
1
|
|
PHOSLO
|
calcium acetate
|
2
|
|
| |
