Greater Glasgow and Clyde Medicines

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• When a specialist recommends initiating a new medicine or adjusting existing therapy, written communication should be sent to the GP practice electronically.
• All communications to GP practices regarding medication requests - whether via out-patient letters or the Clinical Portal eForm ‘Request to GP to prescribe medication’ - must clearly indicate if the individual making the request is a prescriber or non-prescriber.
• Increasingly, non-prescribing pharmacy team members are responsible for processing medication requests and outpatient letters, rather than GPs or other prescribers. Therefore, it is crucial that there is sufficient information supplied to ensure timely processing of the request.
• The rationale for the request and indication for the medication should be stated, along with clear details on drug name, dosage, preparation, frequency and duration.
• Non-urgent medication requests will be processed within five working days, in line with pharmacy hub processing times (with an additional two working days for the community pharmacy to dispense). Urgent medication requests (requiring same-day or within 24-hour supply) will be managed through Hospital Pharmacy, HBP prescription pads, or to take out (TTO) medicines.

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• NHSGGC Coronary Heart Disease and Stroke, Primary and Secondary Prevention (cholesterol) Clinical Guideline has been published on the Right Decisions platform.
• This iteration of the guideline (v7) has been extensively updated, with changes to advice around lipid management for both primary and secondary prevention of coronary heart disease and stroke.
• The threshold for initiation of lipid lowering therapy in primary prevention (cardiovascular risk event of 10% or more over ten years) has been reduced from 20%, aligning with contemporary risk calculation tools and national guidelines.
• Indications for statin therapy in patients with diabetes mellitus have been updated to reflect national guidelines.
• Targets for low density lipoprotein and non-high density lipoprotein cholesterol have been revised to align with national guidelines.
• Greater emphasis has been placed on use of ezetimibe to support achievement of low density lipoprotein cholesterol targets in secondary prevention.

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• As little as one adverse drug reaction (ADR) report can generate a safety signal, so every report counts.
• All healthcare professionals involved in patient care have a responsibility to report suspected ADRs.
• Reporting ADRs to the Yellow Card Scheme is quick and easy and can be done via the Yellow Card website or through the Yellow Card app (available on the App Store or Google Play). The MHRA has implemented Multi-Factor Authentication (MFA) to the Yellow Card website and app to enhance security to protect personal data.
• When reporting, provide as much information as possible. Only four pieces of information are required to submit a report: medicine name, suspected reaction (with as much detail as possible), at least one patient identifier and reporter details.
• Anyone can report an issue with medicines (including herbal or homeopathic), vaccines or nicotine containing e-cigarette and/or e-liquid to the Yellow Card Scheme. Healthcare professionals in Scotland should report issues related to medical devices (including blood glucose monitors, apps or insulin pumps) to the Incident Reporting & Investigation Centre (IRIC) and blood products to the Scottish National Blood Transfusion Service.
• ALL suspected ADRs to new medicines and vaccines under additional monitoring (black triangle scheme) should be reported regardless of severity and if they are already included in the Summary of Product Characteristics (SmPC). Information on black triangle medicines can be found in the BNF, BNFC or SmPC.

This post summarises the latest NHS Greater Glasgow and Clyde decisions relating to new medicines assessed by SMC and considered by the Area Drug and Therapeutics Committee (ADTC) and uses a nationally developed format specifically aimed for patients and the public.

For full details of the medicines included in this post that are available for use, including any restrictions on prescribing, please see the relevant entry in the GGC Formulary.

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New published chapters: gastrointestinal and respiratory

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• The NHSGGC Heparin Dose Adjustment in the Presence of Renal Impairment guideline has been updated.
• The updated NHSGGC guideline includes:
• Updated advice for thromboprophylaxis and monitoring requirements in patients with creatinine clearance (CrCl) <15mL/min.
• Updated advice for therapeutic heparin dosing for patients with CrCl <15mL/min.
• Updated guidance for anticoagulation during haemodialysis.

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