Prescribing

Practice Leads

  • Doctors: Ramesh Mehay & Pardip Sandhu & Sadia Khan
  • Admin:

Date Reviewed

Sept 2017

Date of Next Review

Sept 2018

Some Specifics

Osteoporosis

If there is osteoporosis on DEXA scan…

  • arrange for blood tests first (Bone Profile – FBC, Ca, vit D levels and U&E).
  • Bring patient back 3w later – make sure bloods okay (esp Ca and vit D).
    • If Ca or vit D low, it must be treated and corrected first (i.e.  levels back to normal) before bisphosphonate therapy.
    • If eGFR <35, seek advice from doctor as bisphosphonates should not be routinely used in CKD where eGFR<35.
  • If bloods okay
    • Give patient PIL on osteoporosis (www.patient.co.uk or this one  http://www.shef.ac.uk/NOGG/NOGG_Information_for_patients.pdf )
    • Start Ca, Vit D and Bisphosphates if report says so
    • Educate – bisphosphonates can cause indigestion, so stay upright 60mins after taking it.
    • Educate – bisphosophonates are associated with a very very small risk of osteonecrosis (decay and infection) of the jaw – emphasise this is rare.  So good oral hygiene important as well as yearly dental checks.   Also check to make sure no dental IMPLANTS are planned.
    • Educate – Lifestyle on more exercise, stop smoking and reduce alcohol à consider use of health trainer, alcohol adviser and smoking cessation in-house services.
    • If there is a high chance of falls – refer to DNs for falls risk assessment.

PRESCRIBING IN CHILDREN

  • Slow down with children doses and esp infants  >>>  make sure doses are correct
  • For liquids, put down the dose not the ml.
  • For example, write 30mg bd rather than 1.5ml bd   (the dispensing pharmacist will work out the ml).

Terms and Short Hand You May Be Unfamiliar With

  • Abdominal Aorta – 5cm or more – should be followed up (the aorta is normally about 2-2.5 cm)
  • Angiogram – a test to see if blood vessels are obstructed.  Eg Coronary angiogram check the cornonaries (blood vessels which supply the heart)
  • BCC – a slow growing skin cancer called Basal Cell Carcinoma
  • BMD (Bone Mineral Density) / T scores / Z scores – this is all about bone scans and whether the patient has weak bones (a condition called osteoporosis, which is NOT the same as osteoarthritis – the latter is wearing of the bones).
  • COPD – Chronic Obstructive Pulmonary Disease (permanent lung condition, usually from smoking).
  • FESS – functional endoscopic sinus surgery – basically surgery on the sinuses.
  • Incidentally/Incidental finding – something picked up by chance
  • L3 L4 L5 S4 S5 – back problems – spine.  L1, 2, 3 etc are different levels of the spine.  Each building block of the spine has a corresponding number.
  • LUTS – lower urinary tract symptoms
  • Melanoma – a very serious skin cancer that kills people quickly if not picked up early.
  • Squamous Cell Carcinoma – can happen anywhere – often the skin, but can be any where that has a lining like the lungs or even the tongue or mouth.
  • STEMI – ST elevation Myocardial Infact = Heart Attack.
  • Vasovagal syncope – fancy name for a simple faint; not serious
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