The National Prescribing Service (NPS)is a valued independent resource for good and unbiased prescribing information and education.
Given the marketing pressures applied by global drug companies, Australia is blessed to have such a resource.
Pharmacists are moving closer to a prescribing role within the health system and it is appropriate that i2P promote the message of the NPS.
* Generics tool kit products available to order
* Best practice drug use in aged care
* Lifestyle messages timely for hypertension patients
* Chronic kidney disease common but under-treated
* Hypnotic hazards of z-drugs immeasurable
Generics tool kit products available to order
Pharmacists wanting to purchase more prescription intake forms, ancillary labels or repeat folders that were sent out as part of the generic medicines campaign tool kit are now able to do so.
The products, developed by the National Prescribing Service in partnership with the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia (PSA), are part of the Generics are an equal choice campaign and were sent to all community pharmacies throughout Australia in October.
“The tool kit resources have been designed to be easily integrated into the daily practices of a community pharmacy and aim to provide pharmacy staff with support for best practice when discussing generic medicines with consumers,” NPS Education and Quality Assurance Program Manager, Judith Mackson said.
“This includes only offering a generic brand at the prescription intake point when it’s safe and appropriate to do so. Brand substitution should only occur once a patient has given their consent. When substitution occurs it is important to point out the active ingredient name on the label or packaging to patients.”
Pharmacists are also reminded to train staff on generic medicines using the PSA Pharmacy Self Care storyboard or materials from the NPS website.
The new-look ancillary label included in the tool kit is larger than the existing label 15 and includes an area to write the name of the active ingredient. These provide an alternative to the existing label 15 in the Australian Pharmaceutical Formulary and Handbook (APF) and will be included in the next edition, to be released in January 2009.
To order more prescription intake forms, ancillary labels or repeat folders (which can be overprinted with your pharmacy details) from the tool kit phone Stirling Fildes on 1300 651 118.
Should you have any feedback regarding any of the tools, please send your comments to firstname.lastname@example.org.
Best practice drug use in aged care
Pain is common among aged care residents and is often under-treated. To help address this problem, National Prescribing Service Limited (NPS) has developed a no-cost quality improvement tool to assist pharmacists determine the appropriateness of analgesic use by residents.
Analgesic use for persistent pain in aged care homes Drug Use Evaluation (DUE) is the third DUE toolkit available from NPS. The first focused on reviewing the use of hypnotics (benzodiazepine and non-benzodiazepine) in treating insomnia, while the second DUE centered on antipsychotic drugs in behavioural disturbance of dementia.
“Effective drug use in aged care is a common issue of concern for pharmacists. To help rectify the under-diagnosis and under-treatment of pain, pharmacists can lead the review of choice, frequency and route of drug use,” NPS Education and Quality Assurance Program Manager, Judith Mackson said.
The NPS DUE toolkits promote optimal drug therapy by monitoring drug use through comparisons with
specific standards and offer appropriate actions when drug use is inconsistent with these standards. It is a cyclic process and is most effective if the cycle is undertaken as a quality activity.
Completing this DUE will allow pharmacists to:
- Determine the appropriateness of the use of analgesic medication for managing persistent pain within the aged care home
- Identify opportunities for improving quality use of these drugs, and act on them
- Assist aged care homes to meet components of the Residential Care Standards issued by the Aged Care Standards and Accreditation Agency
- Comply with the Australian Pharmaceutical Advisory Council Guidelines for Medication Management in Residential Aged Care Facilities
- Provide facility focused activities to promote the quality use of medicines (in line with Pharmaceutical Society of Australia Guidelines and Standards).
“Pharmacists working with nursing homes can lead the project and collect the initial data, but the DUE is an ideal opportunity to partner with Medication Advisory Committees and facility staff,” Judith Mackson said.
Pharmacists can register online and upon completion of the DUE, answer the post-activity evaluation survey. Following evaluation, registered pharmacists who are Pharmaceutical Society of Australia (PSA) members are eligible for 25 Continuing Professional Development and Practice Improvement points per year of the DUE. The Australian Association of Consultant Pharmacy (AACP) also recognises the activity with 25 credit points per year of the DUE.
The DUE toolkits are downloadable at: http://www.nps.org.au/health_professionals/drug_use_evaluation_due_programs
For more information about the NPS DUE toolkits, contact Aine Heaney at NPS on (02) 8217 8700 or email@example.com.
Lifestyle messages timely for hypertension patients
Helping patients with hypertension remain healthy over the holiday season is a challenge that affects nearly all healthcare professionals.
In this edition of Australian Prescriber, healthcare professionals are reminded that routinely providing advice on smoking, nutrition, alcohol use, physical activity and body weight to patients with hypertension is particularly important at this time of year.
The article also includes information on integrating lifestyle advice into clinical management and resources for promoting lifestyle management to patients.
“Lifestyle modification is indicated for all patients with hypertension, regardless of drug therapy, because it may reduce or even abolish the need for antihypertensive drugs,” say the authors Dr Nancy Huang, Professor Karen Duggan and Ms Jenni Harman.
Lead author Dr Nancy Huang of the Heart Foundation says that regardless of other treatments indicated, all patients who need to lower their blood pressure should be given advice and support to achieve and maintain healthy behaviours.
Recently updated guidelines for the management of hypertension from the Heart Foundation recommend lifestyle modification as an important and effective first-line treatment strategy.
“The '5As' approach − Ask, Assess, Advise, Assist and Arrange − is often useful for primary care health professionals to provide brief interventions for lifestyle modification,” Dr Huang said.
“The article lists practical resources which are now widely available to help Australian health professionals effectively promote positive lifestyle changes.”
“The resources will help health professionals to broach the subject with patients, negotiate goals, give tailored advice including written information, and refer patients to more information and other medical and support services,” Dr Huang said.
Hypertension is a major risk factor for stroke and coronary heart disease, and is a major contributor to the onset and progression of chronic heart failure and chronic kidney failure.
For the complete article visit the Australian Prescriber website www.australianprescriber.com or click on this link
Chronic kidney disease common but under-treated
One in seven Australian adults has at least one marker of kidney damage or dysfunction, although it is often unrecognised.
A major health concern on its own, chronic kidney disease is also one of the most potent risk factors for cardiovascular disease.
In the latest edition of Australian Prescriber, Brisbane nephrologists Dr Ken-Soon Tan and Professor David Johnson discuss the best ways to treat this combination of chronic illnesses. The article also highlights under-treatment of ischaemic heart disease in people with chronic kidney disease.
“Patients with advanced chronic kidney disease are up to 20 times more likely to die from cardiovascular disease than to survive to require dialysis. However, patients with chronic kidney disease who also have cardiovascular disease are more likely to progress to renal failure than those without cardiovascular disease,” Professor Johnson says.
If the progression of chronic kidney disease can be slowed, cardiac risk may be reduced. As chronic kidney disease accelerates cardiovascular disease, management of the risk factors should begin as soon as possible.
Evidence shows that timely intervention can substantially reduce the progression of renal failure, and can cut cardiovascular risk by up to 50 per cent.
Effective treatment options include lifestyle modification, early intervention and management of risk factors such as anaemia, dyslipidaemia and hypertension.
“Lifestyle modification underpins all other therapeutic approaches and must continue to be practised throughout the treatment of chronic kidney disease,” Professor Johnson writes. “Particular attention should be paid to smoking, nutrition, alcohol and physical activity."
Ischaemic heart disease is very common in patients with chronic kidney disease. It progresses at a more rapid rate than in people without chronic kidney disease and is often undertreated.
“Even though patients with chronic kidney disease had a higher prevalence of diabetes mellitus and hypertension, the rate of prescription of evidence-based cardiovascular therapies (aspirin, beta blockers, ACE inhibitors, statins) was lower than for those with normal renal function.
“This situation is undesirable, but may be caused in part by the perception of a higher number of complications, fear of adverse effects, and less evidence from controlled trials in this population.
All guidelines recommend a reduction of dietary sodium for patients with hypertension and chronic kidney disease. Other recommendations are discussed in the full article which is available on the Australian Prescriber website www.australianprescriber.com or click here.
Hypnotic hazards of z-drugs immeasurable
It is difficult to know the extent of the use and adverse effects of zolpidem and other z-drugs (zopiclone and zaleplon) because they have never been listed on the Australian Pharmaceutical Benefits Scheme, senior Sleep Disorders Physician Dr Les Olson writes in the latest edition of Australian Prescriber.
Following the media attention given to side effects in patients taking zolpidem, Dr Olson reviews the known adverse reactions of the z-drugs.
“Although the media have been impressed with the outlandish adverse events reported with zolpidem, these events are not unprecedented. Amnesia, hallucinations and bizarre behaviour were also seen frequently in patients taking the short-acting benzodiazepine, triazolam, for insomnia,” Dr Olson writes.
"All of the bizarre behaviours reported, such as sleep eating, sleep sex and sleep driving, are more likely to represent 'wakeful behaviour with amnesia' than behaviour while asleep."
“Z-drugs have few advantages over benzodiazepines, and there is no good reason for their use in insomnia. It is possible to manage insomnia without ever using hypnotic drugs and this approach should be the rule rather than the exception.”
“If patients are prescribed z-drugs they should be made aware that sedation, confusion and disinhibition may occur. They should be advised to avoid alcohol, and the hypnotic should always be taken once the patient is in bed, not on the way to bed.”
“Evidence that z-drugs, especially zolpidem, commonly cause adverse effects not predictable from their pharmacology is weak. Zolpidem may cause hallucinations relatively frequently (as triazolam did), but reports of 'abnormal behaviour with amnesia' probably reflect predictable effects.”
Dr Olson says these adverse effects are not unique to z-drugs and could be limited by reduced prescribing.
“If there were fewer prescriptions for zolpidem and other z-drugs there would be fewer adverse events,” Dr Olson writes.
Non-medicine strategies for managing insomnia and guidance for counselling patients are available from the National Prescribing Service Limited (NPS) website www.nps.org.au.
For all hypnotics, NPS advises that doctors use the lowest dose for the shortest time possible (ideally for less than two weeks and no longer than four weeks) and re-evaluate within seven to 14 days of starting therapy.
The complete article is available on the Australian Prescriber website www.australianprescriber.com or click here.