Clinical focus from the BNF and Stockley editorial teams, information on adverse drug reactions and case reports from practice.
Managing pneumocystis pneumonia
BNF case study: Eye problems with cancer treatment
Interstitial nephritis caused by PPIs
March 2013
Although PPI-linked acute interstitial nephritis is relatively rare, pharmacists are increasingly likely to encounter this adverse effect, say David Woods and Marta Fonteles
Management of malignant glioma
Could you recognise serotonin sydrome?
BNF case study: Review with a patient taking long-term proton pump inhibitors: what to consider
Lower respiratory tract infection: which antibiotics should be given?
October 2012
A BNFC case study looks at treating lower respiratory tract infection in a 20-month-old
Over-the-counter domperidone and an interaction with erythromycin
September 2012
The Stockley editorial team present a theoretical case to illustrate how the risk of QT interval prolongation with domperidone may be increased with taking other medicines
Bronchiectasis: a complex condition
July 2012
A case report highlighting bronchiectasis, is an endpoint that results from many disease processes, including immune defects, cystic fibrosis, ciliary dysfunction, aspiration and infections
BNF case study: Considerations when treating patients with resistant high blood pressure
July 2012
A BNF case study explores resistant hypertension and cardiovascular risk management
Optimal and appropriate drug therapy for patients with neurosyphilis
May 2012
A 55-year-old, 73kg man with a diagnosis of encephalitis was transferred to our specialist neuro-medical ward from an acute general hospital. He had already received 10 days’ treatment with intravenous aciclovir and was on day 22 of IV cefotaxime (to treat the encephalitis of unknown origin). The revised diagnosis was symptomatic late tertiary syphilis — neurosyphilis.
Warfarin and oral miconazole: a major interaction overlooked in practice
April 2012
A patient, MC, takes warfarin for atrial fibrillation. His target international normalised ratio range is 2.0–3.0 and his control was stable. At his regular INR appointment he mentioned that he had seen his GP the week before, for haematuria.
Research needed to investigate the use of bael fruit in ulcerative colitis
March 2012
34-year-old male had been diagnosed with ulcerative colitis (UC) two years earlier. His other past medical history included beta thalassaemia trait (he had a microcytic anaemia, MCV [mean corpuscular volume] 65.
BNF case study: Pioglitazone: consider bladder cancer
A case study from the BNF looks at issues for pioglitazone prescribing and management
BNF case study: Can we prevent rebound acid after a PPI?
January 2012
A case study from the BNF looks at advice to give patients starting a proton pump inhibitor
Pulmonary toxicity with nitrofurantoin — an under-recognised adverse reaction
December 2011
Vigilance for pulmonary reactions with nitrofurantoin can reduce the risk of serious consequences, say David Woods and Marta Fonteles
BNF case study: Which antibiotics and vaccines should be used for meningococcal disease?
October 2011
A BNF case study looks at the management of suspected meningitis in a four-year-old
Drug management of ischaemic stroke
July 2011A BNF case study focuses on prescribing after a stroke
When a patient with myasthenia gravis can have intravenous immunoglobulin
July 2011A 55-year-old, 76kg man was admitted, as a planned case, for starting high-dose steroids and to consider intravenous immunoglobulin (IvIg) to treat deteriorating myasthenia gravis
BNF case study: Choice of a suitable oral contraceptive
June 2011A case study from the BNF turns attention to how pharmacists can help women to choose an oral contraceptive and to use it safely
P-glycoprotein: why is it significant?
May 2011The Stockley editorial team gives an overview of knowledge of this protein and explains why pharmacists need to be aware of it
BNF case study: What to prescribe after a man has an MI
April 2011A case study from the British National Formulary presents prescribing issues that need consideration after a heart attack
BNF case study:How to cope with nocturnal leg cramps
March 2011This case study from the BNF highlights when prescribing quinine for leg cramps may be appropriate
BNF case study: Choosing a treatment for COPD
January 2011This case study, from the British National Formulary, illustrates how spirometry is used to inform the management of chronic obstructive pulmonary disease
BNF case study: Why patients on lithium need attention
December 2010A BNF case study that reminds pharmacists of the valuable role they have to play in preventing harm from lithium therapy
Test yourself and put the BNF to best use
November 2010September 2010 saw the publication of the 60th edition of the British National Formulary but when was the last time you reviewed whether or not you are using this resource most effectively? Using a series of scenarios, split across two articles, the BNF editorial team challenges readers to update their clinical knowledge and highlights some of the recent key changes to how the BNF works
BNF case study: Fever and febrile convulsions in a child
September 2010All children will have feverish illnesses but some may also experience a febrile convulsion. These most commonly occur between the ages of 18 months and three years and about 3 per cent of children have a febrile convulsion before their sixth birthday. This case study from the BNF for Children investigates some of the issues involved
Emerging concerns with PPI therapy
September 2010Proton pump inhibitors have transformed the management of upper gastrointestinal acid-related disorders but potential consequences of potent acid suppression are now emerging. With this year marking the 21st anniversary of the launch of these medicines in the UK and pantoprazole recently joining omeprazole as an over-the-counter option, Angus Thompson highlights some of the concerns
BNF case study: A look at rash and pancreatitis as side effects of antidiabetic drugs
May 2010A 67-year old woman with an extensive rash is referred urgently to hospital. The rash started on the backs of her hands and quickly spread to her arms, trunk, neck, and face
Orlistat and possible drug interactions that can affect over-the-counter sales
May 2010A recent Drug Safety Update from the Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines highlighted the updated information regarding the drug interactions of orlistat with levothyroxine and antiepileptic drugs (February 2010)
BNF case study: Choice of antibiotic for acute prostatitis
March 2010A 62-year-old man presents with a prescription for ciprofloxacin, 500mg bd for 28 days. Because the duration of treatment is unusual, you talk to the patient to find out more. He describes feeling feverish. He has back pain and difficulty passing urine. His GP has told him he has an infection of the prostate
Choosing a suitable wound dressing
February 2010A 75-year old woman fell over and cut her leg. She presents today with a prescription for Sorbsan Silver dressing for the wound. You are concerned about the high number of prescriptions you have been seeing for this dressing and decide to review this case
Dealing with irritable bowel syndrome
January 2010A 35-year old woman was diagnosed with irritable bowel syndrome (IBS) two months ago
Drug interactions and gout treatment
January 2010Mr Jones, a 56-year old man with a history of myocardial infarction, and taking aspirin, metoprolol, lisinopril and simvastatin presents with an acute episode of gout. Acute gout is usually treated with a non-steroidal anti-inflammatory drug or colchicine but what would be best for this patient?
How to approach prescriptions for patients with renal impairment
October 2009Clinical pharmacists regularly encounter patients with compromised renal function. A basic understanding of renal disease is necessary to ensure prescriptions for such patients are appropriate
How to predict what medicines might interact with Ginkgo biloba
Octber 2009A 62-year-old woman comes into the pharmacy to buy a Ginkgo biloba product to try to improve her memory. Before she pays, she asks if she can take it with her usual medicines. She has been taking enalapril and metoprolol for a number of years and has recently started solifenacin
BNF case study: Counselling and labelling requirements to remember when giving topical corticosteroids
October 2009You receive the following prescription for a seven- year-old girl who suffers from severe atopic eczema
“Bisphossy jaw”: an adverse drug reaction with bisphosphonates
September 2009Bisphosphonates are used to treat osteoporosis, other bone diseases, multiple myeloma and skeletal events associated with metastatic neoplasm. There have been concerns of an association between oral bisphosphonate use and osteonecrosis of the jaws (ONJ), which we have termed “bisphossy jaw”
Drug interactions: Potential interactions with antidiabetic drugs
September 2009A 50-year-old woman with type 2 diabetes, hypertension and osteoarthritis, and who takes aspirin 75mg daily, ramipril 10mg daily, glipizide 10mg twice daily and diclofenac modified release 75mg once daily, was diagnosed with recurrent vaginal candidiasis
Implications of immunosuppressant therapy
August 2009A five-year-old boy presents with severe earache in his right ear. He has a fever (37.8C) and appears miserable. There is no discharge from the ear or other signs of note. His parents inform you that he had a cold five days ago and he has no history of ear infections
Supplements and absorption of levothyroxine
August 2009A 55-year-old female with hypothyroidism and taking levothyroxine 100µg daily, was seen in clinic for a general review of her thyroid function because she had been complaining of fatigue and poor concentration
BNF case study: Identifying the drug that may be causing hypertension
June 2009A 58-year-old man has arranged a “heart check” appointment at the community pharmacy. His blood pressure is found to be 160/95mmHg >
Adverse drug reactions: Neuraminidase inhibitors: widespread use for influenza may reveal more adverse effects
May 2009The neuraminidase inhibitors (NAIs), oseltamivir (Tamiflu) and zanamivir (Relenza), are indicated for prophylaxis and treatment of influenza. Both antivirals are included within the current UK Health Protection Agency guidance for the treatment and prophylaxis of infection from the novel swine influenza A (H1N1) virus
Recommending a suitable smoking cessation aid for a patient suffering from depression
April 2009BNF Case Study: A 27-year-old woman comes into the pharmacy with a prescription for a starter pack of varenicline, written by a practice nurse. After eight years of smoking 20 cigarettes a day, the patient has decided to quit because she wants to improve her general health
Can I take herbal products or dietary supplements with my warfarin?
April 2009The market for dietary supplements and herbal medicines in the UK is huge and the advent of internet shopping has vastly extended the range of products available. Surveys of people who take warfarin have confirmed that they use dietary supplements and herbal medicines. Compared with that for conventional medicines, information is sparse about whether these products do or do not interact with warfarin
BNF case study: Managing a patient at risk of cardiovascular disease
March 2009A 51-year old Caucasian man is reviewed for the management of hypertension. His body mass index is 26kg/m2, he has never smoked and does not have diabetes. He has a history of asthma and uses a Qvar inhaler. His brother had a heart attack at the age of 53 years
Co-trimoxazole: take risk of pharmacokinetic and pharmacodynamic interactions into account
February 2009Co-trimoxazole (sulfamethoxazole with trimethoprim) can sometimes cause severe adverse effects (eg, Stevens-Johnson syndrome, and blood dyscrasias, notably bone marrow depression and agranulocytosis), such that the Commission on Human Medicines has issued guidance recommending that it is only used in the treatment of Pneumocystis jiroveci pneumonia (previously known as Pneumocystis carinii pneumonia), toxoplasmosis and nocardiasis
