January 18th 2021

We have had some interesting queries over the past few months which have required some time to answer in full. We also had some feedback from previous queries which we respond to below. All our visiting pharmacists are there to respond to your queries and if they can’t answer the question on the spot, we…

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January 18th 2021

The MHRA has repeated its concerns about overuse of opioids based on a set of recommendations from its Opioid Expert Working Group of the Commission on Human Medicines. The first step taken was to put safety warnings on packs of medicines containing opioids. They now want to ensure people are supplied with consistent information on…

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January 18th 2021

It is generally accepted that the management of symptoms in palliative care must involve appropriate polypharmacy. We are comfortable with using more than one medicine to help with one symptom provided the mechanisms of action are different and complementary – for example morphine plus gabapentin for pain with neuropathic characteristics. At the same time, we…

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September 1st 2020

The two opioids available for delivery via a transdermal patch in the UK are fentanyl and buprenorphine. Fentanyl products are licensed for severe and chronic pain that requires long-term opioids or that does not respond to non-opioids. Buprenorphine is available in two sets of products – the stronger patches have a similar license to fentanyl while the lower strengths are indicated for non-malignant pain when an opioid is necessary (they are used for cancer pain in some cases, where patients only require low opioid doses)…

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September 1st 2020

One of the audits collected on our Ashtons Live View system is the number of prescription items for each patient. This information enables us to provide you with comparative data and percentages for our clinical interventions. It is not unusual to count more than twenty items for one patient on a hospice drug chart, although many of these items will be on the PRN pages. We pay great attention to detail with the patient’s response to their medicines, but what are the prompts for reducing the number of items?

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September 1st 2020

Looking back on my emails, I see that my first COVID-related message came in on 3rd March. At first, it was impossible to judge the impact the virus was going to have on our healthcare system and hospices. The shocking lack of their inclusion in the two essential components – PPE and testing – soon became apparent. Many of our senior hospice colleagues have described how they had to ‘fight’ for what was needed –on top of caring for very sick patients who may or may not have the virus and staff having to isolate for the statutory period…

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September 1st 2020

Motilin is a naturally occurring hormone secreted by the small intestine. It increases gastro-intestinal motility and peristalsis and accelerates gastric emptying. It functions mainly between meals and in doing so prepares the gut for the next meal. Erythromycin happens to be a motilin agonist – working in the same way as the hormone – so can be used when metoclopramide or other prokinetics are unsuitable. It is effective in about half of cases, and concerns about the development of bacterial resistance…

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September 1st 2020

The MHRA has decided that stimulant laxatives can be inappropriately used by people wanting to lose weight – especially those who may have an eating disorder. In future, products such as Senna and Bisacodyl will sold in small pack sizes only and to people over 18…

Guy’s and St Thomas’ manufacturing unit has now ceased supply of 2% lidocaine in Lutrol gel and it is now distributed by Oxford Health – the NHS specials and wholesale supplier…

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September 1st 2020

For many years the NHS has struggled to fulfil the NHS Out of Hours (OOH) standards that stated ‘patients should be able to access the medicines they need at the time and place of the OOH consultation’. The Drug Tariff, which determines the list of products which can be prescribed on FP10 and their re-imbursement costs, still includes a rather dated ‘Out of Hours national formulary’ which categorises a wide range of medications for emergencies which include palliative care…

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March 30th 2020

We observe that people have a reduced oral intake at the end of life due to their symptoms or general weakness and level of consciousness. There is inconclusive evidence that artificial hydration is beneficial, with arguments against being the chance of it increasing the likelihood of oedema, ascites and death rattle. Arguments for are that it may alleviate feelings of thirst and reduce the risk of agitation.

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