BNF for Children 2011-2012

BNFC 2011–2012 General guidance 3medicines containing cariogenic sugars, or their carers,should be advised of dental hygiene measures to preventcaries. Sugar-free preparations should be usedwhenever possible, particularly if treatment is requiredfor a long period.Where information on the presence of alcohol, aspartame,gluten, sulphites, tartrazine, arachis (peanut) oilor sesame oil is available, this is indicated in BNF forChildren against the relevant preparation.Information is provided on selected excipients in skinpreparations (section 13.1.3), in vaccines (section 14.1),and on selected preservatives and excipients in eyedrops and injections.The presence of benzyl alcohol and polyoxyl castor oil(polyethoxylated castor oil) in injections is indicated inBNF for Children. Benzyl alcohol has been associatedwith a fatal toxic syndrome in preterm neonates, andtherefore, parenteral preparations containing the preservativeshould not be used in neonates. Polyoxylcastor oils, used as vehicles in intravenous injections,have been associated with severe anaphylactoid reactions.The presence of propylene glycol in oral or parenteralmedicines is indicated in BNF for Children; it can causeadverse effects if its elimination is impaired, e.g. in renalfailure, in neonates and young children, and in slowmetabolisers of the substance. It may interact withmetronidazole.The lactose content in most medicines is too small tocause problems in most lactose-intolerant children.However in severe lactose intolerance, the lactose contentshould be determined before prescribing. Theamount of lactose varies according to manufacturer,product, formulation, and strength.ImportantIn the absence of information on excipients in BNFfor Children and in the product literature (availableat www.emc.medicines.org.uk), contact the manufacturer(see Index of Manufacturers) if it is essentialto check details.Health and safety When handling chemical or biologicalmaterials particular attention should be given tothe possibility of allergy, fire, explosion, radiation, orpoisoning. Care is required to avoid sources of heat(including hair dryers) when flammable substances areused on the skin or hair. Substances, such as corticosteroids,some antimicrobials, phenothiazines, and manycytotoxics, are irritant or very potent and should behandled with caution; contact with the skin and inhalationof dust should be avoided. Healthcare professionalsand carers should guard against exposure to sensitising,toxic or irritant substances if it is necessary to crushtablets or open capsules.whether the prescriber is a doctor or dentist, and shouldbe signed by the prescriber.Security and validity of prescriptions The Councilsof the British Medical Association and the RoyalPharmaceutical Society have issued a joint statement onthe security and validity of prescriptions.In particular, prescription forms should:. not be left unattended at reception desks;. not be left in a car where they may be visible; and. when not in use, be kept in a locked drawer withinthe surgery and at home.Where there is any doubt about the authenticity of aprescription, the pharmacist should contact the prescriber.If this is done by telephone, the number should beobtained from the directory rather than relying on theinformation on the prescription form, which may befalse.Patient group direction (PGD) In most cases, themost appropriate clinical care will be provided on anindividual basis by a prescriber to a specific child.However, a Patient Group Direction for supply andadministration of medicines by other healthcare professionalscan be used where it would benefit the child’scare without compromising safety.A Patient Group Direction is a written direction relatingto the supply and administration (or administrationonly) of a licensed prescription-only medicine by certainclasses of healthcare professionals; the Direction issigned by a doctor (or dentist) and by a pharmacist.Further information on Patient Group Directions isavailable in Health Service Circular HSC 2000/026(England), HDL (2001) 7 (Scotland), and WHC (2000)116 (Wales) and at www.nelm.nhs.uk/en/Communities/NeLM/PGDs.NICE and Scottish Medicines Consortium Adviceissued by the National Institute for Health and ClinicalExcellence (NICE) and by the Scottish Medicines Consortium(SMC) is included in BNF for Children whenrelevant. If advice within a NICE Single TechnologyAppraisal differs from SMC advice, the Scottish Executiveexpects NHS Boards within NHS Scotland to complywith the SMC advice. Details of the advice togetherwith updates can be obtained from www.nice.org.uk andfrom www.scottishmedicines.org.General guidanceEEA and Swiss prescriptions Pharmacists candispense prescriptions issued by doctors and dentistsfrom the European Economic Area (EEA) or Switzerland(except prescriptions for controlled drugs in Schedules1, 2, or 3, or for drugs without a UK marketing authorisation).Prescriptions should be written in ink or otherwiseso as to be indelible, should be dated, should statethe name of the patient, should state the address of theprescriber, should contain particulars indicating