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93.

For many of the nnrsing home patients for whom an ACE inhibitor was indicated

becanse of their high blood pressure, Monopril/fosinopril was not the "drng of choice." Among

its many adverse side effects, Monopril tends to increase liver function impairment when

compared to other ACE inhibitors. Monopril also has a very high phannokinetic protein binding

rate; therefore, if a patient was, for example, anemic, Monopril was not the "drng of choice." If

a patient had certain heart conditions (such as a heart attack), and was suffering from congestive

heart

failure,

other

ACE

inhibitors

(specifically,

ramipril

and

trandolapril)

-

not

Monopril

-

were

specifically

indicated.

If

patients

had

had

a

heart

attack

and

were

suffering

from

left

ventricular dysfunetion, captopril and trandolapril, not Monopril, were specifically indicated.

94.

During Lisitza's tenure at Omnicare, the Omnicare computer-based pharmacy

system was designed in such a way that it was tillable to flag patients with a medical history

indicating that Monopril was not a preferred medication.

95.

Omnicare compounded these serious complications by failing to monitor the care

of the nursing home patients victimized by the switch. Hence, an Omnicare pharmacist would

not know that a patient was anemic and for his or her health and safety should be switched from

Monopril to another more effective or appropriate ACE inhibitor (or maintained on the originally

preseribed,

appropriate

ACE

inhibitor).

Whether

or

not

the

switch

caused

any

measurable

impact, the unlawful Market Share Agreements resulted in such patients failing to receive the

best

medication

for

their

individual

conditions.

Omnicare

used

its

pharmacist

staff

to

lull

physicians, ostensibly the gatekeepers when it comes to prescribing medications, into signing

PALs thinking Omnicare would exercise due diligence to "catch" those instances where a switch

was medically problematic. This did not happen, and elderly patients were put at risk.

26

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