Greater Glasgow and Clyde Medicines

Key messages:

• Following discussion at the West of Scotland Cardiology Prescribing Group, the decision has been made to change to prescribing of prasugrel in the majority of future patients undergoing percutaneous coronary intervention (PCI)

• Prasugrel will replace ticagrelor, in combination with aspirin, as the dual antiplatelet therapy (DAPT) agent of choice post-PCI for the majority of patients from Monday 06th November 2023

NSAID – Guideline update here

The NHSGGC guideline Oral Non-Steroidal Anti-Inflammatory (NSAID) has been updated.

Summary of Changes

As per NICE Clinical Knowledge Summary (CKS):

• Risk of NSAID-induced GI adverse events (AEs) now categorised as low, moderate or high risk.
• Further information added on how to define GI risk factors.
• COX-2 inhibitors (celecoxib and etodolac) in combination with a PPI added as a treatment option for patients at high risk of GI AEs.
• Ibuprofen dosing advice changed (as per BNF maintenance dose).
• Prescribing notes updated to include sick day rules and prescribing guidance for COX-2 inhibitors.

Guideline News September 2023 here

The NHSGGC Adult Infection Hospital Management Guideline (IMG) has been updated.

Drug-Induced QTc Prolongation in Adults - Risk Factors here

Key Messages

• Causes of QTc prolongation may be either inherited or acquired
• Drug induced QTc prolongation is the most common aetiology of acquired QTc prolongation
• Risk factors for QTc prolongation may be modifiable or non-modifiable
• Ensure that risk factors are reviewed and any modifiable risk factors such as electrolyte disturbance are corrected
• The concurrent use of more than one drug which prolongs the QTc interval increases the risk of Torsades de Pointes (TdP) and ventricular arrhythmia
• Some drugs which do not prolong the QTc interval themselves can increase the risk of QTc prolongation by affecting the metabolism of drugs which do
• Some drugs can increase the risk of QTc prolongation by causing electrolyte disturbances (in particular hypokalaemia, hypomagnesaemia and more rarely hypocalaemia) especially when given with QTc prolonging drugs
• Prescribers should ensure that the potential benefits of prescribing a QTc prolonging medication outweigh the associated risks, and that when a QTc prolonging medication is prescribed, appropriate mitigations and monitoring are in place

Anticholinergic burden here

• Anticholinergic drugs are associated with an increased risk of falls, confusion, and are linked to increased mortality in the older population (aged 65 years and older) 
• Adverse effects are cumulative and include constipation, urinary retention, postural hypotension, dizziness, and confusion 
• Review anticholinergic medications regularly to ensure treatment is still effective and the benefit outweighs the risk of harm

Key Medicine Shortages October 2023 here

Includes:

Medicines for the treatment of attention deficit hyperactivity disorder (ADHD), Estradiol valerate/medroxyprogesterone acetate (Indivina®) 1mg/5mg tablets, Lixisenatide (Lyxumia®) 20micrograms/0.2ml solution for injection, Hyoscine hydrobromide (Scopoderm®) 1.5mg patches, Midazolam (Epistatus®) 2.5mg/0.25ml and 10mg/1ml oromucosal solution pre-filled oral syringes and products used in the treatment of scabies.

Myasthenia Gravis in Acute Care here

• Do not withhold, omit or delay doses of medicines for MG (e.g. pyridostigmine or
  steroids) as there is a risk of myasthenic crisis if not administered on time.
• Where a patient does not have an individual supply of pyridostigmine this must be
  obtained urgently from pharmacy during working hours or via the local emergency
  cupboard, ward 67 at QEUH or the on call pharmacist if out of hours.
• Contact on call neurology registrar as soon as possible after admission (including out
  of hours) for patients with a history of MG that are experiencing MG related issues.
• Contact on call neurology routinely to inform them of admission for patients with a
  history of MG that are not experiencing any symptoms.
• High risk situations for patients with MG include: nil by mouth (NBM) status, infection
  and surgical procedures
• Some medicines can worsen or induce myasthenia gravis. Before prescribing any
  new medicines check the safety in the following guideline link

MHRA Drug Safety Update September 2023 here

Access to the correct medications at the right time can be a problem for patients with PD when they are admitted to hospital.

Ensure medicines reconciliation is undertaken within 24 hours of admission – include the following: drug name, formulation, strength, dose and frequency. Exact dose timing of PD medications should be clearly annotated on HEPMA.