NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Drugs for Doctors’ Medical Bags

The Drug and Therapeutics Bulletin has published advice on which drugs might be suitable for GPs to carry on home visits. One article looks at adults; one at children.

 

Although GPs now attend fewer emergency or out of hours calls for their patients, there is still a need for some GPs to carry a range of medicines for use in acute situations when on home visits. The drugs chosen will be determined by the medical conditions likely to be met; GP familiarity with medicines; storage requirements, shelf-lives of drugs etc. A range of medicines is discussed which are suitable for GPs for emergency or acute treatment of patients.

 

As a practical means of ensuring that all doctors in the practice, including locum GPs, have access to suitable emergency medication when seeing  patients both within the surgery and during  home visits, GP practices could maintain one or two medical bags within the practice  for use by any doctor.

 

Some of the therapeutic areas and recommended products are listed below for consideration. The intention is not to imply that every doctor should carry every drug but to highlight key treatments in some common clinical scenarios. As usage is likely to be low, consider the appropriate minimum level of stock. There should be systems in place for date checking and stock replacement.

 

Acute mild to moderate pain

  • Paracetamol 500mg tablets (oral suspension / suppositories for children)
  • Ibuprofen 200mg, 400mg tablets (oral suspension for children)
  • Codeine 30mg tablets

 

Acute severe pain

  • Diclofenac sodium 25mg/mL 3mL ampoules or diclofenac 100mg suppositories
  • Diamorphine 5mg or 10mg injection

 

Acute myocardial infarction and angina

  • Aspirin 300mg tablets
  • Glyceryl trinitrate 400microgram sublingual spray

 

Acute left ventricular failure

  • Furosemide 10mg/mL injection
  • Furosemide 40mg tablets

 

Anaphylaxis

(correction 26/11/15; adrenaline is not routinely available in 500 microgram prefilled pen. The preferred route of administration is appropriate IM dose from 1:1,000 injection)

  • Adrenaline 1:1,000 injection (1mg/mL)
  • Adrenaline 150 microgram or 300 microgram prefilled pen. (Auto-injectors are often given to patients at risk of anaphylaxis for their own use. If an adrenaline auto-injector is the only available adrenaline preparation when treating anaphylaxis, healthcare providers should use it. It is important the user has been trained in its use.)
  • Chlorphenamine 10mg/mL injection
  • Hydrocortisone sodium succinate 100mg injection

 

Asthma / croup

  • Salbutamol 100microgram/dose MDI with large volume spacer
  • Prednisolone 5mg tablets (soluble tablets may be required for children)
  • Salbutamol nebules 2.5mg, 5mg
  • Ipratropium bromide nebules 250 micrograms/mL

  

Hypoglycaemia

  • Proprietary quick-acting carbohydrate (e.g. GlucoGel, Dextrogel)
  • Glucagon 1mg injection
  • Glucose 20% injection 50mL  

 

Hypoadrenalism

  • Hydrocortisone sodium phosphate 100mg/mL solution for injection

 

Suspected bacterial meningitis/meningococcal septicaemia

  • Benzyl penicillin 600mg injection
  • Cefotaxime 1g injection

 

Nausea and vomiting

  • Cyclizine 50mg/mL injection
  • Metoclopramide 5mg/mL injection
  • Oral rehydration salts
  • Prochlorperazine 12.5mg/mL injection

 

Opioid overdose

  • Naloxone 400micrograms/mL injection

 

Seizures

  • Diazepam rectal solution 10mg in 2.5mL
  • Midazolam oromucosal solution 5mg/mL

 

Palliative care

  • Hyoscine butylbromide 20mg/mL injection
  • Midazolam 10mg/2ml injection (01/12/15 updated to show NHSGGC preferred product instead of DTB suggested product)
  • Dexamethasone 2mg tablets

 

Diluents for injectable products

  • Water for injection
  • Sodium chloride injection 0.9%