BNF for Children 2011-2012

BNFC 2011–2012vent caries. Sugar-free preparations should be usedwhenever possible.Where a drug has several preparations, those of asimilar type may be grouped together under a heading(e.g. ‘Modified-release’ for theophylline preparations,p. 143). Where there is good evidence to show thatthe preparations for a particular drug are not interchangeable,this is stated in a Note either in the Dosesection of the monograph or by the group of preparationsaffected. When the dose of a drug varies accordingto different formulations of that drug, the right doseshould be prescribed for the preparation selected.In the case of compound preparations, the prescribinginformation of all constituents should be taken intoaccount for prescribing.Unlicensed preparations that are available from ‘Specialorder’ manufacturers and specialist importing companiesare included (e.g. midazolam buccal liquid, p. 639).The availability of an extemporaneous formulation of adrug is shown after its other preparations (e.g. captopril,p. 102).Writing prescriptionsGuidance is provided on writing prescriptions that willhelp to reduce medication errors, see p. 4. Prescriptionrequirements for controlled drugs are also specified onp. 9.Administering drugsBasic information on the route of administration isprovided in the Indication and Dose section of a drugmonograph or the Dose section of a preparation record.Further details, such as masking the bitter taste of somemedicines, may be provided in the Administration sectionof a drug monograph (e.g. proguanil, p. 336). Practicalinformation is also provided on the preparation ofintravenous drug infusions, including compatibility ofdrugs with standard intravenous infusion fluids, methodof dilution or reconstitution, and administration rates(e.g. co-amoxiclav, p. 263). The Administration sectionis located within preparation records when this informationvaries according to different preparations of thatdrug (e.g. amphotericin, p. 305). If a class of drugs (e.g.topical corticosteroids, p. 559) share the same administrationadvice, this may be presented in the prescribingnotes.Information on intravenous infusions for neonatal intensivecare can also be found in Appendix 4, p. 791.Advising children (and carers)The prescriber, the child’s carer, and the child (if appropriate)should agree on the health outcomes desired andon the strategy for achieving them (see Taking Medicinesto Best Effect, p. 1). Taking the time to explain tothe child (and carers) the rationale and the potentialadverse effects of treatment may improve adherence.For some medicines there is a special need for counselling(e.g. recognising signs of blood, liver, or skin disorderswith carbamazepine); this is shown in Counsellingstatements, usually in the Cautions or Indicationand Dose section of a monograph, or within a preparationrecord if it is specific to that preparation.xvChildren and their carers should be advised if treatmentis likely to affect their ability to perform skilled tasks(e.g. driving).Cautionary and advisory labels that pharmacists arerecommended to add when dispensing are included inthe preparation record (see fig. 1). Details of these labelscan be found in Appendix 3 (p. 788).Monitoring drug treatmentChildren should be monitored to ensure they are achievingthe expected benefits from drug treatment withoutany unwanted side-effects. The prescribing notes or theCautions in the drug monograph specify any specialmonitoring requirements. Further information on monitoringthe plasma concentration of drugs with a narrowtherapeutic index can be found in the Pharmacokineticssection or as a Note under the Dose section of the drugmonograph.Identifying and reporting adverse drugreactionsClinically relevant Side-effects for most drugs areincluded in the monographs. However, if a class ofdrugs (e.g. tetracyclines, p. 274) share the same sideeffects,these are presented in the prescribing noteswhile those unique to a particular drug in that classare included in its individual drug monograph. Occasionally,side-effects may be included within a preparationrecord if they are specific to that preparation or ifthe preparation is not accompanied by a monograph.Side-effects are generally listed in order of frequencyand arranged broadly by body systems. Occasionally arare side-effect might be listed first if it is considered tobe particularly important because of its seriousness. Thefrequency of side-effects is described in fig. 1.An exhaustive list of side-effects is not included fordrugs that are used by specialists (e.g. cytotoxic drugsand drugs used in anaesthesia). Recognising that hypersensitivityreactions can occur with virtually all medicines,this effect is generally not listed, unless the drugcarries an increased risk of such reactions. BNFC alsoomits effects that are likely to have little clinical consequence(e.g. transient increase in liver enzymes).The prescribing notes in BNFC may highlight importantsafety concerns and differences between drugs in theirability to cause certain side-effects. Safety warningsissued by the Commission on Human Medicines(CHM) or Medicines and Healthcare products RegulatoryAgency (MHRA) can also be found here or in thedrug monographs.Adverse Reactions to Drugs (p. 12) provides advice onpreventing adverse drug reactions, and guidance onreporting adverse drug reactions to the MHRA. Theblack triangle symbol T identifies those preparations inBNFC that are monitored intensively by the MHRA.