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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Blood Pressure Top Tips

The Medicines and Healthcare products Regulatory Agency has released a Measuring Blood Pressure - Top Ten Tips leaflet.

The tips include ensuring that only validated and regularly calibrated blood pressure monitors are purchased and used to assess blood pressure, having available and using correctly sized cuffs and supporting the arm during measurement to assure accuracy.

The recently published NICE Hypertension Guideline also stresses the need for accurate assessment of blood pressure. Implementing these tips has the potential to improve the accuracy of blood pressure measurements. This could mean there will be improvements in the diagnosis of hypertension and in the drug treatment of these patients.

Action: All clinicians who measure blood pressure should read this leaflet and ensure that their practice involves using as many of these tips as possible.

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MeReC Extra 23

The National Prescribing Centre has published MeReC Extra 23, it details the results of the CATIE Study, changes to non-medical prescribing and how to avoid information overload.

The CATIE Study was a randomised controlled study of antipsychotic medication set up to examine the time-to-discontinuation over an 18-month period. Approximately 75% of the participants discontinued their medication at some point in the study due to side effects, lack of efficacy or for some other reason. MeReC concludes that there is no ideal antipsychotic for all patients and that treatment choice should be based upon the trade off between efficacy and side effects.

The rest of this MeReC details the changes in legislation affecting nurse and pharmacist prescribing and clarifies the differences in practical terms between independent and supplementary prescribing. The final section contains pointers to valuable sources of evidence-based information such as NICE, The Cochrane Library and Clinical Evidence.

Action: Clinicians who treat mental illness will find the review of the CATIE study of interest. This MeReC will also be useful to non-medical prescribers and their employers.

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Childhood Vaccination Changes Announced

The Department of Health has announced that changes to the Childhood Immunisation Programme will be implemented fro 4th September 2006. A letter from the Chief Medical, Nursing and Pharmaceutical Officers provides a background to the changes, the new immunisation programme schedule and details of a catch up campaign.

In summary, the new programme introduces pneumococcal conjugate vaccine (PCV) into the schedule and modifies the schedule of the Meningococcal C (MenC) and haemophilus influenzae type b (Hib) vaccinations. The letter also details the new immunisation schedule in Annex 1, recommendations on how to proceed with vaccinations in children who are part way through the existing programme and detailed information of the target population for the catch up campaign.

The NHS Immunisation website containing information for parents and health professionals will be updated with the new programme details and an advertising campaign will be used to raise awareness of the new programme.

Action: Clinicians involved in delivery of the Childhood Immunisation Programme should familiarise themselves with the changes to the schedule in preparation for the implementation date.

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Obesity and Cardiometabolic Risk Factors

The launch of Rimonabant (Acomplia)® has generated significant media interest. The launch of the product was reported at the BBC and in the Guardian.

Rimonabant is being promoted based upon reductions in weight and waist circumference but also reductions in cardiometabolic risk factors.

Reductions in weight and waist circumference are obviously good outcomes for a medicine licensed for the treatment of obesity, but what are cardiometabolic risk factors?

In the studies of rimonabant versus placebo data were collected on several biological markers, for example HbA1c, HDL-Cholesterol and triglycerides. All of these markers showed improvements compared to placebo that are estimated to be greater than those expected from weight loss alone. It should be noted that there have been no studies published as yet linking these improvements to reductions in cardiovascular morbidity or mortality.

The Journal of the American Medical Association published the RIO-North America Study earlier this year. This paper concluded that the weight reductions achieved with rimonabant were modest and that the longer-term effects require further study. It is also noted that the drop out rate from the study was high.

Action: Clinicians should not prescribe rimonabant solely based on the reductions in cardiometabolic risk factors. Diet and Exercise is key to weight loss before any drug treatment is considered.

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NICE Atrial Fibrillation Guideline Published

The National Institute for Health and Clinical Excellence (NICE) has published the Guideline for Atrial Fibrillation (AF).

The publication was overshadowed by the introduction of the Guideline for Hypertension however the AF Guideline contains some very helpful information.

The Guideline includes information on:

  • Case finding and diagnosis with ECG
  • Treatment strategies for Paroxysmal AF, Persistent AF and Permanent AF
  • Stroke Risk Stratification
  • Thromboprophylaxis
  • Rhythm and Rate control

Action: All clinicians involved in the diagnosis and treatment of AF will find the guideline of interest. The flowcharts contained within the Guideline are a useful aid to guide treatment decisions.

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