Therapeutic Handbook - GGC Prescribing

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Management of HypercalcaemiaThis guideline is under review. Please see the online version of the handbook for the most up to dateguidance. In addition, for guidance on bisphosphonate use in cancer patients see www.intranet.woscan.scot.nhs.uk / Systemic anti-cancer therapy protocols / Supportive careIntroductionThe reference range for adjusted serum calcium is 2.1 - 2.6 mmol/L.N.B. In patients presenting with hypercalcaemia in an emergency setting always consider occultmalignancy. Low serum albumin is another pointer to this being the cause.Assessment / monitoring• Serum calcium should be monitored daily.• U&Es to assess hydration status.Electrolyte DisturbancesDrug therapy / treatment optionsIf hypercalcaemia is life-threatening (adjusted calcium > 4 mmol/L), start:Sodium chloride 0.9% IV 1 litre over 4 hours and contact senior medical staff for adviceimmediately. Dialysis may be needed.Otherwise carefully rehydrate with:Sodium chloride 0.9% IV infusion 2 - 3 L over 24 hours to maintain urine output andpromote calcium excretion.• More cautious rehydration will be necessary if the patient has a history of heart failure, renalfailure or is elderly.• Ensure thiazide diuretics are discontinued.• After 24 - 48 hours of rehydration, consider intravenous pamidronate if the condition remainsunresolved (see Table 1).Table 1 – IV Pamidronate dosingInitial serum calcium (adjusted)mmol/LRecommended total dose (mg) for tumour-inducedhypercalcaemiaUp to 3 mmol/L 15 - 303 - 3.5 mmol/L 30 - 603.5 - 4 mmol/L 60 - 90> 4 mmol/L 90Continues on next pagePage 304
Drug therapy / treatment options continuedGive as a single infusion of pamidronate or in divided doses (infusions) over 2 - 4 consecutivedays.• The infusion rate should never exceed 20 mg/hour.• The concentration of pamidronate in the infusion solution should not exceed 60 mg/250 ml.• Pamidronate should not be used if CrCl < 30 ml/minute.• Full effect of pamidronate may take 3 - 7 days.• If corrected serum calcium continues to rise or has not returned to the reference range within5 days zoledronic acid may be considered but its use is currently restricted within NHS<strong>GGC</strong>to “consultants treating tumour-induced hypercalcaemia and by specialist oncologists for theprevention of skeletal-related events in patients with breast cancer and multiple myeloma”.Electrolyte DisturbancesPage 305
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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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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
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Atherosclerotic arterial disease is
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Algorithm for Cardioversion of AFSt
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Cardiovascular SystemVentricular ra
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Prevention of stroke / thromboembol
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Drugs for atrial fibrillation conti
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CPAP in cardiogenic pulmonary oedem
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Management of HypertensionCardiovas
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Cardiovascular SystemGeneral manage
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Management of Acute Stroke 3Transie
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Secondary prevention of stroke and
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Cardiovascular SystemPage 126
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Guidelines for Blood Gas AnalysisRe
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Respiratory SystemNext consider aci
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Management of Acute Severe Asthmain
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Management of Acute Severe Asthma i
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Management of Chronic ObstructivePu
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Acute Exacerbation of Chronic Obstr
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Treatment options continued• If p
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Step 4 - Initiation of NIVAIM = To
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Investigation of Unilateral Pleural
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Investigation of unilateral pleural
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General management• Oxygen as app
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Management of PneumothoraxIntroduct
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Management of StridorIntroductionSt
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Initial Management of Superior Vena
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Section 6Central Nervous SystemCent
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Analgesics for acute painSTEP 3STEP
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Analgesics for acute pain - prescri
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Management of Postoperative Nausea
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Management of Acutely Disturbed Pat
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Pharmacological Management - Patien
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Guidance on Night SedationPatients
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Management of Alcohol Withdrawal Sy
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Continued from previous pageUnable
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Continued from previous pageImporta
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Flow diagram for use with Hospital
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Continued from previous pageMethado
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Management of Suspected Subarachnoi
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Sampling requirements for the Bioch
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Referral to Neurosurgical Unit cont
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Management of Status EpilepticusInt
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OtherInitiating Long-term Anti-epil
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Continued from previous page2. 'Top
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Decision making algorithm for the a
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Drug therapy / treatment optionsNil
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Section 7InfectionsInfectionsPage 1
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• In patients with sepsis -- Star
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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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Page 266 and 267: Patients with absent or non-functio
Page 268 and 269: MRSA Eradication Policy• In newly
Page 270 and 271: InfectionsDosage regimens for antib
Page 272 and 273: Gentamicin dosing guidelines (For p
Page 274 and 275: Step 2 continued from previous page
Page 276 and 277: Vancomycin dosing guidelines (For p
Page 278 and 279: Continued from previous page - If t
Page 280 and 281: B. Vancomycin continuous infusionSt
Page 282 and 283: Vancomycin - continuous infusion re
Page 284 and 285: InfectionsPage 274
Page 286 and 287: Management of Diabetic Ketoacidosis
Page 288 and 289: Endocrine System5. Signs of cerebra
Page 290 and 291: Assessment / monitoring• Glucose
Page 292 and 293: Important points1. This regimen is
Page 294 and 295: Diabetes therapy continued• Retro
Page 296 and 297: Insulin Sliding Scale (Not for use
Page 298 and 299: Management of HypoglycaemiaIntroduc
Page 300 and 301: Endocrine SystemContinued from prev
Page 302 and 303: Oral antidiabetic drugs continued3.
Page 304 and 305: Other InformationGeneral advice on
Page 306: Guideline updated 18/09/13Managemen
Page 309 and 310: Drug therapy / treatment options co
Page 311 and 312: Management of hypomagnesaemia in ad
Page 313: Drug therapy / treatment options co
Page 317 and 318: Management of Hyponatraemia• Earl
Page 319 and 320: Section 10Musculoskeletal and Joint
Page 321 and 322: Treatment optionsManagement of acut
Page 323 and 324: Treatment options continuedNSAIDs a
Page 325 and 326: Section 11Palliative CarePalliative
Page 327 and 328: Analgesic Step LadderStep 1: Mild P
Page 329 and 330: Opioid Conversion ChartThis is advi
Page 331 and 332: Palliative Care - SymptomsSee BNF,
Page 333 and 334: Table continued from previous pageP
Page 335 and 336: Management of symptoms present in l
Page 337 and 338: Section 12Oncological EmergenciesOn
Page 339 and 340: Malignant Spinal Cord Compression (
Page 341 and 342: Raised intracranial pressure in can
Page 343 and 344: Treatment /drug therapy continued5.
Page 345 and 346: N.B.• Laboratory TLS = > 2 labora
Page 347 and 348: • Avoid serum CA125 testing as it
Page 349 and 350: AppendicesAppendicesPage 339
Page 351 and 352: Appendix 2Preparation of Intravenou
Page 353 and 354: Glyceryl Trinitrate (GTN) infusionG
Page 355 and 356: Table 2 - Other drugsDrug Time to s
Page 357 and 358: Appendix 5Normal ImmunoglobulinsNor
Page 359 and 360: Drug MisuseHospital Liaison Addicti
Page 361 and 362: Outpatient Parenteral Antibiotic Th
Page 363 and 364: 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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