Therapeutic Handbook - GGC Prescribing

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Treatment / drug therapy continuedIf no other treatment options then make patient comfortable with sedation. ALWAYS discuss withsenior member of team.• Consider Heliox 80:20 if available (helium oxygen mix which is less viscous than air andeasier to inhale past obstruction).Respiratory SystemPage 154
Initial Management of Superior Vena CavaObstructionIntroductionSuperior Vena Cava Obstruction (SVCO) is an oncological emergency and any patients should bediscussed with a Registrar or above immediately, and with the local Respiratory team or on-callOncology team at the Beatson, as soon as possible to guide investigation and management.SVCO results from the compression of the superior vena cava by either a tumour arising in the rightmain or upper lobe bronchus or mediastinal lymphadenopathy. Initially it is diagnosed clinically in thepresence of neck and facial swelling and distended veins over the anterior chest wall. There mayalso be swelling of one or both arms and symptoms of dyspnoea and headache. Malignancy is thecommonest cause (> 90%), most typically lung cancer, lymphoma, metastatic disease, mesotheliomaand thymoma.Assessment / monitoringThe initial assessment includes:• Obtain full history including:- Details of known malignancies and their treatment- The development of new or worsening respiratory symptoms, arm swelling and headaches,and rapidity of onset- Co-morbidities- Medication including use of and contraindications to corticosteroids and anticoagulation.Examine for distended external and internal jugular veins, collateral veins on the anterior chest wall,facial, arm and neck swelling, and conjunctival redness.• The investigation of choice is a contrast enhanced spiral or multi-slice chest CT (CTPA). Thisdefines tumour extent, and often the site of occlusion or stenosis and the extent of any thrombusformation. Impending SVCO can be an incidental finding on CT.• Confirmation of diagnosis by histology may involve fine needle aspirate of palpable nodes,bronchoscopy, or CT guided biopsy. Seek advice from Respiratory or Oncology as soon aspossible to guide investigation and management.In addition to above, questions that may influence whether the patient should be considered for SVCstent or chemotherapy / radiotherapy are:• Is there a relative contraindication for radiotherapy? E.g. Previous chest / mediastinalradiotherapy? Is the patient able to lie reasonably flat?• Performance status (0 = normal activity, 1 = restricted daily activity, 2 = ambulatory and selfcaring, out of bed > 50% of the day, 3 = capable of limited self care, in bed > 50% time, 4 =unable to self care, chair / bed-bound)• Availability of stenting (performed by interventional radiology)Respiratory SystemPage 155
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ContentsEditorial GroupAcknowledgem
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AppendicesAppendix 1 - Nicotine Rep
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AcknowledgementsA huge number of pe
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Summary of Major changes in Therape
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On discharge• As the discharge pr
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Other examples• Sevredol 10 mg ta
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Antiplatelets and anticoagulants:In
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non-Formulary medicines, a complete
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Quick guide to using the handbookWh
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Sections1. Resuscitation and Anaphy
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Section 1Resuscitation and Anaphyla
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Continued from previous page2. Adre
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Peri-arrest ArrhythmiasGeneral advi
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Broad QRS - continuedNarrow QRS - c
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Guidelines on Blood TransfusionThis
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Management of Major Haemorrhage(See
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Hospital Specific Information on Ma
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Table continued from previous pageG
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Assessment / MonitoringAKI stage I
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Section 2Drug Overdose and Toxicity
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Treatment of Paracetamol OverdoseTh
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Management of paracetamol overdose
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Lithium toxicityNormal range 0.4 -
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Management of DyspepsiaGastrointest
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Table continued from previous pageR
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Management of Gastroduodenal Ulcers
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Management of Upper Gastrointestina
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Post endoscopy continuedb. Arrange
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General management and treatment op
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- SAAG can differentiate ascites re
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General management and drug therapy
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Drug therapy• Unless contraindica
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Consider:• Serum caeruloplasmin,
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Section 4Cardiovascular SystemCardi
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Table 1 - Indicators of patients at
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Continued from previous pageIf the
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Diagnosis and Treatment of VenousTh
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Wells Clinical score should be util
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IV Drug Misusers• Given their cha
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Drug therapy / treatment options co
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RivaroxabanRivaroxaban is an oral d
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Diagnosis of VTE in pregnancy• If
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Referral of Patients to Anticoagula
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Reversal of Anticoagulant TherapyIn
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General management and drug therapy
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Elective admissions - Risk Stratifi
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Elective admissions - restarting an
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Suspected Acute Coronary Syndrome (
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If patient is for PPCI go to Box 1.
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Drugs for acute coronary syndrome /
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Secondary Prevention of Coronary He
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Cardiovascular SystemTroponin posit
Page 114 and 115: Atherosclerotic arterial disease is
Page 116 and 117: Algorithm for Cardioversion of AFSt
Page 118 and 119: Cardiovascular SystemVentricular ra
Page 120 and 121: Prevention of stroke / thromboembol
Page 122 and 123: Drugs for atrial fibrillation conti
Page 124 and 125: CPAP in cardiogenic pulmonary oedem
Page 126 and 127: Management of HypertensionCardiovas
Page 128 and 129: General management and drug therapy
Page 130 and 131: Cardiovascular SystemGeneral manage
Page 132 and 133: Management of Acute Stroke 3Transie
Page 134 and 135: Secondary prevention of stroke and
Page 136 and 137: Cardiovascular SystemPage 126
Page 138 and 139: Guidelines for Blood Gas AnalysisRe
Page 140 and 141: Respiratory SystemNext consider aci
Page 142 and 143: Management of Acute Severe Asthmain
Page 144 and 145: Management of Acute Severe Asthma i
Page 146 and 147: Management of Chronic ObstructivePu
Page 148 and 149: Acute Exacerbation of Chronic Obstr
Page 150 and 151: Treatment options continued• If p
Page 153 and 154: Step 4 - Initiation of NIVAIM = To
Page 155 and 156: Investigation of Unilateral Pleural
Page 157 and 158: Investigation of unilateral pleural
Page 159 and 160: General management• Oxygen as app
Page 161 and 162: Management of PneumothoraxIntroduct
Page 163: Management of StridorIntroductionSt
Page 167 and 168: Section 6Central Nervous SystemCent
Page 169 and 170: Analgesics for acute painSTEP 3STEP
Page 172 and 173: Analgesics for acute pain - prescri
Page 174 and 175: Management of Postoperative Nausea
Page 177 and 178: Management of Acutely Disturbed Pat
Page 179 and 180: Pharmacological Management - Patien
Page 181 and 182: Guidance on Night SedationPatients
Page 183 and 184: Management of Alcohol Withdrawal Sy
Page 185 and 186: Continued from previous pageUnable
Page 187 and 188: Continued from previous pageImporta
Page 189 and 190: Flow diagram for use with Hospital
Page 191 and 192: Continued from previous pageMethado
Page 193 and 194: Management of Suspected Subarachnoi
Page 195 and 196: Sampling requirements for the Bioch
Page 197 and 198: Referral to Neurosurgical Unit cont
Page 199 and 200: Management of Status EpilepticusInt
Page 201 and 202: OtherInitiating Long-term Anti-epil
Page 203 and 204: Continued from previous page2. 'Top
Page 205 and 206: Decision making algorithm for the a
Page 207 and 208: Drug therapy / treatment optionsNil
Page 209 and 210: Section 7InfectionsInfectionsPage 1
Page 211 and 212: • In patients with sepsis -- Star
Page 213 and 214: Gentamicin and Vancomycin: Reducing
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IV-Oral Antibiotic Switch Therapy (
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Alert Antibiotic Policy(The full ve
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Table 1 - Alert Antibiotics continu
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Infection Management GuidelinesSeve
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Sepsis Source Unknown (not immunoco
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Table continued form previous pageI
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Table continued from previous pageE
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UTI in non-pregnant women Antibioti
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UTI in pregnant women Antibiotic Th
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Table continued from previous page
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Catheter-related UTI Antibiotic The
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Table continued from previous pageU
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Table continued from previous pageU
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Pneumonia(Also see page 148 for man
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Table continued from previous pageC
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Pneumonia (continued from previous
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InfectionsTable continued from prev
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Treatment of Clostridium difficile
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InfectionsSkin and soft tissue infe
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InfectionsSkin and soft tissue infe
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Central nervous system infectionsBa
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Meningitis Contacts• All suspecte
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Viral infectionsViral Encephalitis
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Guideline updated 11/10/13Genito-ur
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Genito-urinary infections (continue
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Patients with absent or non-functio
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MRSA Eradication Policy• In newly
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InfectionsDosage regimens for antib
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Gentamicin dosing guidelines (For p
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Step 2 continued from previous page
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Vancomycin dosing guidelines (For p
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Continued from previous page - If t
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B. Vancomycin continuous infusionSt
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Vancomycin - continuous infusion re
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InfectionsPage 274
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Management of Diabetic Ketoacidosis
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Endocrine System5. Signs of cerebra
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Assessment / monitoring• Glucose
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Important points1. This regimen is
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Diabetes therapy continued• Retro
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Insulin Sliding Scale (Not for use
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Management of HypoglycaemiaIntroduc
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Endocrine SystemContinued from prev
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Oral antidiabetic drugs continued3.
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Other InformationGeneral advice on
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Guideline updated 18/09/13Managemen
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Management of hypomagnesaemia in ad
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Management of Hyponatraemia• Earl
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Section 10Musculoskeletal and Joint
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Treatment optionsManagement of acut
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Treatment options continuedNSAIDs a
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Section 11Palliative CarePalliative
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Analgesic Step LadderStep 1: Mild P
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Opioid Conversion ChartThis is advi
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Palliative Care - SymptomsSee BNF,
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Table continued from previous pageP
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Management of symptoms present in l
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Section 12Oncological EmergenciesOn
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Malignant Spinal Cord Compression (
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Raised intracranial pressure in can
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Treatment /drug therapy continued5.
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N.B.• Laboratory TLS = > 2 labora
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• Avoid serum CA125 testing as it
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AppendicesAppendicesPage 339
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Appendix 2Preparation of Intravenou
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Glyceryl Trinitrate (GTN) infusionG
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Table 2 - Other drugsDrug Time to s
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Appendix 5Normal ImmunoglobulinsNor
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Drug MisuseHospital Liaison Addicti
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Outpatient Parenteral Antibiotic Th
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IndexPage 353
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AnticoagulantsIn treatment of VTE/P
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CiprofloxacinAlert Antibiotic Polic
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EEmergency sedationGeneral principl
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Hyoscine butylbromideIn palliative
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Mesalazine, oralIn inflammatory bow
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PhenytoinDosing and monitoring guid
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TeicoplaninDosing and monitoring...
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Notes
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Notes
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© NHS Greater Glasgow and ClydeAug
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Therapeutic Handbook - GGC Prescribing

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