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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates - February 2022

During February 2022 Clinical Knowledge Summaries were published or updated in the following areas.

The Faecal incontinence in adults topic is new. The remaining topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Prostate cancer topic has been updated to include amended recommendations on risk stratification and age-specific prostate-specific antigen (PSA) thresholds for referral. The Scrotal pain and swelling topic contains updated recommendations on assessment and management and a prescribing information section has been added that includes antibiotic treatment options for suspected acute epididymo-orchitis.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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NICE Guidance - February 2022

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2022. This month there is one guideline that impacts upon primary care.

The Type 2 diabetes in adults: management guideline has been updated. The update reviewed the evidence on drug treatment and made new recommendations. The new recommendations place SGLT2 inhibitors earlier in drug treatment for patients with established atherosclerotic cardiovascular disease and heart failure. It is specifically recommended to offer an SGLT2 inhibitor with proven cardiovascular benefit in addition to metformin to such patients. It is also recommended to consider this intervention in patients at high risk of CVD characterised as a QRISK2 ≥ 10%. In patients who do not meet either of these criteria, SGLT2 inhibitors remains a second line treatment option along with DPP‑4 inhibitors, pioglitazone and sulfonylureas.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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CKS Updates - January 2022

During January 2022 Clinical Knowledge Summaries were published or updated in the following areas.

The Safeguarding adults in care homes topic is new. The remaining topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Nausea/vomiting in pregnancy topic has been updated in line with current NICE guidance, the definition of hyperemesis gravidarum has been amended and two additional treatments have been added to the Management section.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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NICE Guidance - January 2022

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of January 2022. This month there is one guideline, two technology appraisals and one innovation briefing that impact upon primary care.

The Glaucoma: diagnosis and management guideline has been updated. It covers diagnosing and managing glaucoma in people aged 18 and over. It includes recommendations on testing and referral (case-finding) for chronic open-angle glaucoma and ocular hypertension and on effective diagnosis, treatment and reassessment to stop these conditions progressing. This update reviewed the evidence and recommendations on treatment for ocular hypertension and chronic open-angle glaucoma and organisation of care.

The Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy technology appraisal has been published. This treatment is recommended as an option for treating excessive daytime sleepiness in adults with narcolepsy with or without cataplexy. This recommendation applies only after modafinil and either dexamfetamine or methylphenidate have not worked well enough or are not suitable. It is expected that this medication would normally be requested by a specialist.

The Sodium zirconium cyclosilicate for treating hyperkalaemia technology appraisal has been updated. This treatment is recommended as an option for treating hyperkalaemia in adults under specific criteria. This update takes account that this treatment in now available in both primary and secondary care.

The Smart Peak Flow for monitoring asthma innovation briefing has been published. The briefing notes that Smart Peak Flow could replace mechanical peak flow meters. But evidence is needed on its validation against the current gold standard in peak flow meters, asthma-related outcomes, use and adherence, and the effect on clinical decision making and resource use. These briefings are usually used to guide local commissioning decisions and therefore clinicians should confirm local arrangements for this device.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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NICE Guidance - December 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2021. This month there are three guidelines and two technology appraisals that impact upon primary care.

The Headaches in over 12s: diagnosis and management guideline has been updated. It covers advice on the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster headache and medication overuse headache in young people (aged 12 years and older) and adults. This update changed the strength of the recommendations on metoclopramide or prochlorperazine for acute migraine from 'offer' to 'consider', to better reflect the balance of benefits and risks of these treatments.

The Suspected cancer: recognition and referral guideline has been updated. It covers identifying children, young people and adults with symptoms that could be caused by cancer. This update reviewed the evidence on fixed and age-adjusted thresholds for prostate-specific antigen testing and updated the recommendations on referral for suspected prostate cancer.

The Pelvic floor dysfunction: prevention and non-surgical management guideline has been published. It covers the prevention, assessment and non-surgical management of pelvic floor dysfunction in women aged 12 and over. It is noted that this guideline uses the term 'women' throughout, but this should be taken to include those who do not identify as women but who have female pelvic organs.

The Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders technology appraisal has been published. This treatment is recommended, within its marketing authorisation, as an option for treating the symptoms of myotonia in adults with non-dystrophic myotonic disorders. It is recommended only if the company provides mexiletine (Namuscla®) according to the commercial arrangement. Based on the commercial arrangement it is expected that treatment will be issued by secondary care.

The Liraglutide for managing obesity in people aged 12 to 17 years technology appraisal has been terminated. The manufacturer did not provide an evidence submission and as such NICE is unable to make a recommendation.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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