Therapeutic Handbook - GGC Prescribing

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AppendicesGlasgow Royal Infirmary (GRI)0141 211 4000Medicines Information..................................................................24407Pharmacy dispensary...................................................................25004Glasgow and Clyde Anticoagulation Service (GCAS)0141 232 0800Lead Nurse for the Glasgow and ClydeAnticoagulant Service ..................................................................0141 211 8731Anticoagulation pharmacist .......... 01389 754121 pager 53092 (or via pharmacy, Vale of Leven)Golden Jubilee National Hospital0141 951 5000Inverclyde Royal Hospital01475 633 777Medicines Information..................................................................0141 314 6819 (RAH)Pharmacy dispensary...................................................................65421Liaison PsychiatristsDuring work hoursGlasgow Royal Infirmary (East Team)..........................................0141 211 4417 or 24417Ravenscraig .................................................................................01475 633 777 (IRH switchboard)Southern General (South Team)..................................................0141 201 2422 or 62422Stobhill (North Team)...................................................................0141 531 3255 or 43255Vale of Leven Hospital..................................................................01389 817 572 (Christie Ward)Western Infirmary (West Team)...................................................0141 211 2131 or 52131Out-of-hoursDykebar .......................................................................................0141 314 4000Gartnavel Royal............................................................................0141 211 3600Leverndale ...................................................................................0141 211 6400Parkhead .....................................................................................0141 211 8300Ravenscraig .................................................................................01475 633 777 (IRH switchboard)Southern General......................................................................... 0141 201 1100Stobhill .........................................................................................0141 531 3100Vale of Leven ...............................................................................01389 754 121 (Christie Ward)Liver Transplant Unit(Edinburgh Royal Infirmary) .........................................................0131 242 2068 / 2069Continues on next pagePage 350
Outpatient Parenteral Antibiotic Therapy (OPAT)During work hours........................................................................0141 211 1053or extension 51053or 0141 211 3000, and radiopage07939585652Out of working hours(Brownlee Centre)........................................................................0141 211 3000, page 5295Medicines Information See under individual hospitalMicrobiology contact numbers during working hoursSouthern General ....................... ................................................page 7077Victoria Infirmary ....................... ..................................................page 7997Glasgow Royal / Stobhill / Western Infirmary /Gartnavel General .......................................................................page 3702RAH / VoL / IRH .......................................................................... 314 6904Out with working hours: phone switchboard and ask for the oncall microbiologistNational Poisons Information Service (NPIS)0844 892 0011Parkinson’s disease nurse specialistsDrumchapel hospital .................................................................... 0141 211 6012Glasgow Royal and Lightburn .....................................................0141 211 1522Inverclyde Royal ..........................................................................0141 314 6833Royal Alexandra ..........................................................................0141 314 6833SGH Institute of Neurological Sciences .......................................0141 201 2590 / 2747Southern General......................................................................... 0141 201 2453Stobhill ......................................................................................... 0141 355 1480Vale of Leven ............................................................................... 0141 314 6833Victoria Infirmary........................................................................... 0141 201 6319Pharmacy Dispensary See under individual hospitalPublic Health Protection Unit (NHS<strong>GGC</strong>)0141 201 4444Royal Alexandra Hospital (RAH)0141 887 9111Medicines Information..................................................................46819Pharmacy dispensary...................................................................47070Sandyford CentreSandyford Centre (Sexual Health Service)...................................0141 211 8130or page on-call GUM via Gartnavel General switchboardContinues on next pageAppendicesPage 351
Page 4:
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
Page 23 and 24:
Quick guide to using the handbookWh
Page 25 and 26:
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
Page 35 and 36:
Guidelines on Blood TransfusionThis
Page 37 and 38:
Management of Major Haemorrhage(See
Page 39 and 40:
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
Page 61 and 62:
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
Page 83 and 84:
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
Page 93 and 94:
Referral of Patients to Anticoagula
Page 95 and 96:
Reversal of Anticoagulant TherapyIn
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Page 99 and 100:
Elective admissions - Risk Stratifi
Page 101:
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
Page 116 and 117:
Algorithm for Cardioversion of AFSt
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Cardiovascular SystemVentricular ra
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Prevention of stroke / thromboembol
Page 122 and 123:
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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Page 130 and 131:
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
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
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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
Page 187 and 188:
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
Page 215 and 216:
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
Page 258 and 259:
Meningitis Contacts• All suspecte
Page 260 and 261:
Viral infectionsViral Encephalitis
Page 262 and 263:
Guideline updated 11/10/13Genito-ur
Page 264 and 265:
Genito-urinary infections (continue
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
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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
Page 294 and 295:
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
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 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: Drug MisuseHospital Liaison Addicti
Page 363 and 364: IndexPage 353
Page 365 and 366: AnticoagulantsIn treatment of VTE/P
Page 367 and 368: CiprofloxacinAlert Antibiotic Polic
Page 369 and 370: EEmergency sedationGeneral principl
Page 371 and 372: Hyoscine butylbromideIn palliative
Page 373 and 374: Mesalazine, oralIn inflammatory bow
Page 375 and 376: PhenytoinDosing and monitoring guid
Page 377 and 378: TeicoplaninDosing and monitoring...
Page 379 and 380: Notes
Page 381 and 382: Notes
Page 384: © NHS Greater Glasgow and ClydeAug
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Therapeutic Handbook - GGC Prescribing

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