Greater Glasgow and Clyde Medicines

Key messages

• Preferred list salbutamol inhaler is now an Easyhaler® salbutamol 100 micrograms/puff dry powder inhaler
• Reducing the number of salbutamol metered dose inhalers (MDIs) dispensed would greatly reduce the carbon impact of inhalers in NHSGGC
• The main aims to reduce the environmental impact of inhalers are:
  • To use lower carbon footprint inhalers if appropriate for the patient
  • To improve disease control
  • To promote safe disposal of inhalers through community pharmacies

Key Points:

• Women with an intact uterus prescribed hormone replacement therapy (HRT), require both oestrogen and progestogen. The progestogen provides endometrial protection against the risk of endometrial hyperplasia and endometrial cancer.
• It is the responsibility of the prescriber to ensure robust systems are in place to prevent women with an intact uterus receiving unopposed oestrogen.

Key Medicine Shortages December 2023 here

Includes:

Co-trimoxazole 40mg/200mg/5ml oral suspension sugar free, Dicycloverine 10mg/5ml oral solution, Fluticasone 400microgram/unit dose nasal drops and Rifampicin 150mg capsules

General key messages

• Opioid patches are only suitable for stable pain and in certain circumstances (see below)
• Fentanyl patches are not suitable for opioid naïve patients due to their potency
• As transdermal opioid preparations are not interchangeable, patients should remain on the same preparation, prescribed by brand name
• Where specified brand is not available, to avoid missed doses, an alternative brand can be considered. Monitor closely for loss of pain control/opioid toxicity

Key Points

• Vitamin D levels should NOT be measured routinely.
• Vitamin D loading doses may differ depending on indication.
• Check NHSGGC Formulary for vitamin D preparation of choice prior to prescribing.

Thiamine supplementation is required in patients at risk of re-feeding syndrome regardless of route of nutrition (IV, oral, enteral feeding tube) and should be started immediately before nutrition is re-introduced where possible

Key messages:

• MyPsych has moved to NHS Scotland Right Decisions platform
• Effective from 1st November 2023
• Users are required to download new app to continue to access content

Key Messages:

• Liquid medications incur additional costs compared to other solid dosage formulations and for the majority of adult patients with swallowing difficulties, liquid formulations are not required
• Excipients in liquid medications such as sorbitol often cause GI side-effects and the effects can be cumulative in patients prescribed multiple liquids
• If a liquid medication is prescribed and/or supplied due to an issue sourcing solid dosage formulations, this should be reviewed as soon as the solid dosage formulation is available

Key Medicine Shortages November 2023 here

Includes:

Bisacodyl (Dulcolax®) 5mg suppositories, Bumetanide 1mg and 5mg tablets, Lamotrigine 5mg dispersible tablets, Pancreatin (Pancrease® HL) gastro-resistant tablets and Testosterone enantate 250mg/ml solution for injection ampoules.

These clinical guidelines have been comprehensively updated and coincide with publication of revised European heart failure (HF) guidelines by European Society of Cardiology, August 2023