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

PostScript Community Pharmacy (January 2012)

In this edition:

  • Flu Vaccination
  • Methadone Pumps
  • Keeping Drugs Cool
  • Trimethoprim PGD study
  • Citalopram
  • Holiday Addictions Services
  • Stoma Services
  • Language Line

 To download a PDF version, click here.

Flu Vaccination

 The recent CMO letter 28th September 2011 issued guidance about the use of some brands of seasonal influenza vaccine in children  because of an increased risk of fever. The revised age indication of the vaccines available for administration is available under the NHSGGC PGD.  

It should be noted that although the licensed age  indication for Enzira® and CSL Biotherapies generic  influenza Ph. Eur. is 5 years and for Viroflu® 6 months, for simplicity, the PGD excludes the use of these vaccines in children under 9 years of age. Please bear this in mind when supplying practices with influenza vaccine.  

Clinicians administering Enzira® vaccine or CSL Biotherapies generic influenza Ph. Eur. vaccine to children in the age group five to less than nine years are being asked to ensure that advice is given to parents on the management of vaccine-induced fever.  Viroflu® vaccine marketed by Crucell UK Ltd should not be given to children under 5 years but if used, parents should be advised to monitor for fever for 2 - 3 days following vaccination.

While appropriate doses of paracetamol or ibuprofen may be used to treat symptoms of fever it is not recommended that these drugs are used routinely following vaccination as there is some evidence that prophylactic administration of antipyretic drugs around the time of vaccination may lower antibody responses to some vaccines. The ‘Green Book’ gives appropriate advice for the management of adverse events post vaccination 

 

Methadone Pumps

 Correct care and maintenance of the pump will ensure that the pumps measurement remains accurate. Cleaning of the pump with warm water on a daily basis will remove traces of methadone syrup, and prevent the stickiness caused by methadone syrup residue. If the pump is not cleaned regularly, the ball valves and spring in the pump may malfunction, resulting in drips, leaks and loss of  accuracy.

It is important that you check the accuracy of the pump regularly and recalibrate as necessary to ensure correct dosing.

The instruction booklet provided with the pump gives clear advice regarding the cleaning and maintenance of the pump. Pumps should be serviced and calibrated annually by the manufacturer. The care and maintenance is the responsibility of the Chemist Contractor.

The contact details for the companies with the  maintenance contracts are:

EPPENDORF PUMPS: McQuilkin 01355 590511

SOROCREX PUMPS: CamLab 01954 233110

 

Baby it’s cold outside......... Keeping drugs cool?

Although the temperature is dropping quickly outside, thermostats are getting cranked up inside. Variations in temperature can have adverse effects on some  medicines, with sensitivity to changes being dependant on the medicine. Insulin, vaccines and some eye drops are particularly susceptible.

Community pharmacies should ensure that medicines sensitive to temperature change are clearly identified and that staff, patients or carers involved in the  transport of these products are aware of these items and any special storage / transport requirements. The use of appropriate warnings such as “Store in Fridge” and novel ideas such as clear bags for fridge items can be helpful but they do not circumvent the need to impart the information directly to the patient or carer.

When supplying items that require cold storage in the home to patients, pharmacy staff are asked to remind patients of the need to keep the medication cool.

 

Trimethoprim PGD study

Last year a study undertaken in a number of NHS GGC community pharmacies, in collaboration with NES and  University of Strathclyde, identified both patient and  pharmacist support for the availability of antibiotics  without prescription for patients with urinary tract  infections (UTIs).  Antibiotic resistance was a concern for participating pharmacists but they welcomed the  opportunity to supply antibiotics under controlled  conditions.

A letter has been distributed to all NHS GGC community pharmacies inviting participation in the next phase of the study which will assess the implementation of a patient group direction for trimethoprim.  Data will be collected over an eight week period, February to April 2012, on  patients presenting with symptoms suggestive of a UTI. Patients will be invited to complete a short questionnaire on their symptoms and participate in a brief telephone interview with the project pharmacist, Jill Booth.  The letter also describes the fees payable for participating. Pharmacists interested in participating need to apply by January 6th. For more information, please contact Jill Booth, Pharmacy Public Health on 0141-201-4464.

 

Citalopram

Lundbeck in collaboration with the MHRA, have issued a letter warning of new lower dose recommendations for citalopram due to the risk of a dose-dependent QT prolongation. 

These are as follows:

  • Citalopram should not be used above 40mg/day in adults (unlicensed in under 18s)
  • Citalopram should not be used above 20mg/day in the elderly (specified as over 65 years of age on Summary of Product Characteristics) and people with reduced hepatic function
  • Citalopram is contraindicated in people with a known QT prolongation or congenital long QT syndrome or taking other medicines known to prolong QT  interval
  • Citalopram should only be used with caution in people with higher risk of developing Torsades de Pointes e.g. CHF, recent MI, bradyarrhythmias, or hypokalaemia or hypomagnesaemia 

 

Holiday Addictions Services

There are more “take-home” doses for methadone,  buprenorphine and other Controlled drugs (CDs) around Christmas and New Year. This year, the public holidays fall on the Monday and Tuesday of both weeks, so some  pharmacies could be closed for up to four days. Prescriptions for instalment dispensing of CDs must state the dose plus the amount to be supplied per instalment and the interval between instalments. Directions for take home instalments must be unambiguous. The wording approved by the Home Office to cover supplies when pharmacies are closed is included on the stamps supplied to GP practices. Use of the Home Office wording allows pharmacies to make supplies to patients in advance of any pharmacy closure.

Please remind patients of the importance of safe storage of methadone, buprenorphine and other CDs and the risks of overdose when taken with alcohol and other illicit or prescribed drugs. Medicines should be kept out of reach and out of sight of children, locked away if possible.

The pharmacy team at Glasgow Addictions Services can be contacted on 0141 276 6600 for further help, advice and for extra supplies of safe storage leaflets and take-home dose warning stickers if needed.

 

Stoma Services

New arrangements for the supply of stoma appliances to patients in the community came into effect on 1 July 2011 and appear to be working well although the number of forms received to date is less than anticipated. Community pharmacies and appliance contractors are reminded that they are required to submit a Stoma Appliance Claim Form to Moira Hanley at PSD by the 7th of the month giving  details of the number of stoma items dispensed in accordance with these new arrangements along with the number of customisation and delivery fees claimed. Copies of the claim forms can be downloaded from the CPS Website. Please contact David Thomson on david.thomson@ggc.scot.nhs.uk and 0141 201 5311 for further details

 

Language Line

Community pharmacists facing difficulties in communicating with patients who have a poor  understanding of English can now access a dedicated  telephone language line offering translation services to help with this predicament. Covering nearly all of the  foreign languages likely to be encountered, the facility provides 24 hours access to a world wide network of translators. To monitor activity levels, community  pharmacists will gain access by quoting their contractor code before being referred on to the appropriate translator. Please contact David Thomson at david.thomson@ggc.scot.nhs.uk or 0141 201 5311 should you require any additional information. Full details of the service are available on this link.

Copies of leaflets on the Minor Ailment Service, translated in to Romanian and Slovak, will be available to download shortly from the same site.

 

Business Continuity Plans

The recent spell of adverse weather has highlighted the fact that several pharmacies may not have effective plans in place to ensure that a reasonable level of continuity can be maintained should their business be disrupted. With more bad weather forecast in the coming weeks  heightening the risk of disruption, community pharmacists are reminded to ensure that Business Continuity Plans are updated to contain accurate information on key contacts, etc and that the appropriate action to take should you fail to open model hours, e.g. if affected by power cuts or flooding, is known to all staff, including locums.