nhs forth valley formulary 11 - Community Pharmacy

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Forth Valley Formulary Eleventh Edition 2012/13Appendix 6Pharmacy ServicesGuidance on Issuing Steroid CardsThis advice has been produced by the Forth Valley Airways GroupInhaled SteroidsSteroid Cards should be issued to the following patients 1,2,3Inhaled Steroid Threshold Dose (per day)Adults Beclometasone Dose > 1000mcg 4Budesonide Dose > 800mcg 4Fluticasone Dose > 500mcg 4Mometasone (Non Dose > 800mcg 4– Formulary)Ciclesonide (Non – Dose > 320mcg 4 Unlicensed doseFormulary)Children Beclometasone Dose > 400mcg 1 (age not stated)Budesonide Dose > 800mcg 1 (12 years and under)Fluticasone Dose > 400mcg 1 (4-16 years)Mometasone (Non Dose > 800mcg 1 (12-16 years)– Formulary)Ciclesonide (Non –Formulary)Dose > 320mcg 4 (12-16 years)Unlicensed doseSystemic SteroidsSteroid Cards should be issued to the following patients 1,2,3Adults• Receiving repeated courses, 2-3 courses per year (particularly if takenfor longer than 3 weeks)• Taking a short course within 1 year of stopping long-term therapy• Receiving more than 40mg prednisolone daily (or equivalent)• Receiving repeated doses in the evening• Receiving more than 3 weeks treatment• Patients with other possible causes of adrenal suppressionChildren• As above except 5 :- Receiving more than 20mg prednisolone daily for children < 5years- Receiving more than 30mg prednisolone daily for children > 5yearsThese patients are at risk of disease relapse and/or hypoadrenalism if treatment is withdrawn rapidly 2Chemotherapy Patients – Acute Pharmacy ServicesPharmacists providing clinical check on chemotherapy prescriptions will endorse any prescription thatrequires a steroid card to be givenReferences:1. CSM. Current problem in pharmacovigilance. May 2006; 31:5 2. Scottish Executive. Steroid treatment cards. SEHD/CMO(2006) 10. 26 th July 2006 3. BNF 52. BMJ/RPS. September 2006 4. GINA Guideline 2006 5. Personal correspondance. Dr. McFadyen.Consultant Paediatrician. Stirling Royal Infirmary. 27.10.2006. Lead Pharmacsit Clare Colligan Review August 2014Page 64
Forth Valley Formulary Eleventh Edition 2012/13Appendix 7The Use Of Oral Analgesics For Pain In Primary CareThe World Health Organisation’s three-step analgesic ladder for cancer pain (see below) mayalso be used for non-malignant chronic or acute nociceptive pain. Analgesics should bestarted at the ‘step’ most appropriate to the patient’s level of pain. Decision on analgesicchoice depends on the type of pain, patient factors and supporting clinical evidence. For painthat is present constantly, analgesia should be prescribed regularly and not on an “as required”basis. For more detailed guidance on the management of pain in palliative care- Please refer tothe Forth Valley Palliative Care guidelines and specialist formulary.STEP 2 MILD TO MODERATE PAINOpioid (for mild to moderate pain)e.g Dihydrocodeine, Co-codamol 30/500(Note 2)+/- Non Opioid+/- Adjuvant*STEP 3 MODERATE TO SEVERE PAINOpioid (for moderate to severe pain)e.g Morphine, pethidine (Note 3)+/- Non Opioid+/- Adjuvant*STEP 1 MILD PAINNon Opioide.g Paracetamol, co-codamol 8/500 (Note 1), NSAIDSe.g Ibuprofen, diclofenac sodium, naproxen+/- Adjuvant**AdjuvantAnti-inflammatory- NSAIDs eg ibuprofen, diclofenacsodium, naproxenNeuropathic pain- See Appendix 13 FV Guideline forTreatment of Neuropathic PainTrigeminal Neuralgia- carbamazepine-see BNF fordosage titration (licensed indication)NOTE 1:Compound analgesics containing a low dose of opioid (e.g 8mg of codeine phosphate per tablet) are commonly used, but theadvantages have not been substantiated. Effervescent preparations of compound analgesics may contain high levels of sodium. Forpatients requiring low sodium intake please refer to individual Summary of Product Characteristics.NOTE 2:Prescribe regular laxatives when opioids are being taken regularlyNOTE 3 : Advice regarding strong opioidsUse oral route first, start with normal release oral morphine eg 5-10mg every 4 hours and as required for breakthrough pain.A 2.5mg dose may be enough in the elderly or those with renal impairment. Consider alternative opioids ony if experiencing sideeffects to morphine or can no longer manage oral routeEvery patient on regular opioid should have access to breakthrough analgesia (equivalent to 1/6th total dose oralmorphine).Reserve use of pethidine for short term use- eg changing of painful dressings. Start regular laxative and prophylactic antemeticas required for 7-10 daysDate of Approval June 2006Review Date June 2007References BNF March 2006,Relief of Pain and Related Symptoms – The Role of Drug Therapy - ScottishPartnership AgencyPharmacist Lead: Moira BailliePage 65
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