Blue Boxes Flashcards
Propylene Glycol interactions
Disulfiram and metronidazole
Prescribing Unlicensed Medicines
Prescribing medicines outside the recommendations of their marketing authorisation alters (and probably increases) the prescribers professional responsibility and potential liability.
Measurements of HbA1c
HbA1c values are expressed in mmol of glycosylated haemoglobin per mol of haemoglobin (mmol/mol)
Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (type 1)
Is an option in adults and children over 12 with type one diabetes. Who suffer repeated or unpredictable hypoglycaemia whilst attempting to achieve optimal glycemic control with multiple injection regimens. Or those whose glycaemic control remains inadequate (HbA1c over 8.5%) despite optimised multiple injection regimens
Pioglitazone cardiovascular safety (December 2007 and January 2011)
Incidence of heart failure is increased when pioglitazone is combined with insulin especially in patients with predisposing factors e.g. Previous MI. Patients who take pioglitazone should be closely monitored for signs of heart failure, treatment should be discontinued if cardiac deterioration occurs.
Pioglitazone should not be used in patient with heart failure.
Pioglitazone risk of bladder cancer
The EMA has advised that there is a small increase in the risk of bladder cancer with Pioglitazone use. Pioglitazone should not be used in patients with active bladder cancer or a past hiatory of bladder cancer, or those who have uninvestigated macroscopic haematuria. Pioglitazone should be used in caution with elderly patients in which the risk of bladder cancer increases.
Exenatide modified-release or lirglutide for the treatment of type 2 diabetes. (February 2012)
MR exenatide (or lirglutide) in triple therapy regimens (in combination with metformin and a sulphonylurea, or metformin with a thiazolidinedione) is recommended fir the treatment of type 2 diabetes only when glycaemic control is inadequate and the patient has:
- BMI greater then or equal to 35kg/m2 (in those of European decent with appropriate adjustment for other ethnic groups) and weight related physiological or medical problems, or,
- BMI less then 35 and insulin would be unacceptable for occupational reasons, or weight loss would benefit other significantly obesity related comorbidities.
Modified release exenatide in dual therapy regimens (in combination with metformin or a sulfonylurea) is recommended only if:
- Treatment with metformin or sulfonylurea is contraindicated or not-tolerated and treatment with thiazolidinedione and dipeptidylpeptidase-4 inhibitors is contraindicated or not tolerated.
Dapagliflozin in combination therapy for treating type 2 diabetes (June 2013)
Dapagliflozin in a dual therapy regimen in combination with metformin is recommended for the treatment of type 2 diabetes, only if glycaemic control is inadequate, and the patient has a significant risk of hypoglycaemia or if sulfonylurea is contraindicated or not tolerated.
Dapagliflozin in combination with insulin (alone or with other antidiabetic drugs) is an option for the treatment of type 2 diabetes.
Dapagliflozin in combination with metformin and a sulfonylurea as triple therapy is not recommended for the treatment of type 2 diabetes (except in a clinical trial)
Neutopenia and agranulocytosis with anti thyroid drugs
Doctors are reminded of the importance of recognising bone marrow suppression induced by CARBIMAZOLE and the need to stop treatment promptly.
Patients should be asked to report symptoms and signs of infection, especially sore throat. A white blood cell count should be performed if there is any clinical evidence of infection. CARBIMAZOLE should be stopped promptly if there is clinical or laboratory evidence of neutropenia.
Advice to patients about corticosteroids
IMMUNOSUPRESSION: prolonged courses can increased susceptibility to infection and serious infection can go unrecognised. Patients may be at severe risk of Chickenpox and shingles.
ADRENAL SUPPRESSION: if CS is given for longer then 3 weeks, treatment must not be stopped abruptly. Adrenal suppression can last for a year or more after stopping treatment and the patient must mention the CS when receiving treatment for other conditions.
MOOD & BEHAVIOURAL CHANGES: CS treatment, especially with high doses, can alter mood and behaviour early in treatment (confusion, irritation delusion and suicidal thoughts may occur)
Somatropin for the treatment of growth failure in children (may 2010)
So atropine is recommended for children with growth failure who have growth hormone deficiency , Turner syndrome, Prader-Willi syndrome, chronic renal insufficiency etc
Alendronate, Etidronate, Risdronate, Raloxifene and Strontium Ranelate for the primary prevention of osteoporosis fragility fractures in postmenopausal women (October 2008)
Alendronate is recommended as a treatment option for the primary prevention of osteoporosis fractures in the following susceptible postmenopausal women.
Women over 70 years who have an independent risk factor for fracture or an indicator of low bone mineral density and confirmed osteoporosis.
Women aged 65-69 years who have an independent risk factor and confirmed osteoporosis
Women under 65 years who have an independent risk factor for fracture and at least one additional indicator of low bone mineral density and confirmed osteoporosis.
Risdronate can be used in those contraindicated to Alendronate
Bisphosphonates: osteonecrosis of the jaw
The risk of osteonecrosis of the jaw is substantially greater for patients receiving IV bisphosphonates in the treatment of cancer then for patients receiving oral bisphosphonates for osteoporosis or Paget’s disease.
All patients should have a dental check-up, and should maintain good dental hygiene during treatment.
Denosumab for the prevention of osteoporotic fractures in postmenopausal women (October 2010)
Denosumab is the recommended treatment for primary prevention of osteoporotic fragility fractures in postmenopausal women at increased risk of fractures.
- who are unable to comply with the special instructions for administering Alendronate and either Risdronate or Etidronate, or have intolerance of, or a contraindication to, those treatments and
- who comply with particular combinations of bone mineral density measurements, age, and independent risk fractures, as indicated in the full NICE Guidence
Denosumab is recommended as a treatment option for the secondary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures who are unable to comply with the special instructions for administering Alendronate or have contraindication.
Denosumab: atypical femoral fractures (February 2013)
Atypical femoral fractures have been reported rarely in patients receiving denosumab for the long-term treatment (2.5 or more years) of postmenopausal osteoporosis. Patients should be advised to report any new or unusual thigh, hip or groin pain during treatment with denosumab.
