With the publication of the latest edition of the BNF, we highlight significant changes to its clinical content and to the way that you use the BNF.
We encourage you to complete the BNF case study which focuses on adverse drug reactions and has been written in conjunction with our clinical advisers and the MHRA.
Also, the way you search for information on online BNF has changed — today's tip takes you through the new features. |
| BNF UPDATE ON SIGNIFICANT CHANGES |
Prescribing in hepatic and renal impairment, pregnancy, and breast-feeding
BNF 59 now includes information on prescribing for patients with hepatic or renal impairment, or who are pregnant or breast-feeding, within the relevant chapters instead of as separate appendices. This information can now be read in context with the other prescribing information. The layout is similar to that in BNF for Children, with the messages adjacent to bold headings so that they can be found easily.
General advice on the principles of prescribing in hepatic or renal impairment, and in pregnancy or breast-feeding is now included in the General Guidance section. For further information click on hepatic and renal impairment, pregnancy and breast-feeding.
How to use the BNF
Teaching sessions on Getting the Best Out of Your BNF have revealed that healthcare professionals (from the recently qualified to those who have been practising for many years) and students training to join these professions have much to learn about the BNF. The section on How to Use the BNF has been expanded in BNF 59 to make this information accessible to all those who use the BNF. How to Use the BNF is linked to the main elements of rational prescribing, such as, using the BNF to select drugs that minimise harm in patients with co-morbidities, and writing prescriptions in a way that helps to reduce medication errors. The generic structure of this section means that it can be adapted easily for teaching and learning in different clinical settings. Separate versions are available for the print and online versions of the BNF. For further information click on how to use the BNF.
Community-acquired pneumonia
Guidance on the antibacterial treatment of community-acquired pneumonia has been updated in Table 1, section 5.1 to take into account the recommendations of the British Thoracic Society (Thorax 2009; 64 (supp III): iii1-45). Advice is provided on the empirical treatment of low-severity, moderate-severity, and high-severity community-acquired pneumonia in order to reflect the severity classification used to assess the infection. Either doxycycline or clarithromycin is recommended as an alternative to amoxicillin for the treatment of low-severity community-acquired pneumonia. A quinolone is included as an alternative to a macrolide if Legionella infection is suspected. For further information click on pneumonia.
Prescribing and dispensing of ciclosporin by brand name
Information on the use of ciclosporin products has been updated in light of advice issued by the Medicines and Healthcare products Regulatory Agency (MHRA) and Commission on Human Medicines (CHM), and the availability of new ciclosporin products in the UK. Patients should be stabilised on a single brand of oral ciclosporin because switching between formulations without close monitoring may lead to clinically important changes in bioavailability. Prescribing and dispensing of ciclosporin should be by brand name to avoid inadvertent switching. If it is necessary to switch a patient stabilised on one brand of ciclosporin to another brand, the patient should be monitored closely for side-effects, blood-ciclosporin concentration, and transplant function. For further information click on ciclosporin.
Management of stable angina and acute coronary syndromes
The prescribing notes on stable and unstable angina have been reorganised and relocated to section 2.10.1, under the revised title 'Management of stable angina and acute coronary syndromes'. Section 2.10.1 now includes prescribing notes on stable and unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction. For further information click on stable angina and acute coronary syndromes.
Withdrawal of sibutramine
The marketing authorisation for sibutramine (Reductil®) has been withdrawn by the European Medicines Agency. A large clinical study designed to investigate the cardiovascular safety of sibutramine (Sibutramine Cardiovascular OUTcomes (SCOUT) study) in obese and overweight patients with cardiovascular risk factors has shown a significant increase in cardiovascular events. General practitioners must not issue prescriptions for sibutramine and pharmacists must not dispense prescriptions for sibutramine. Patients who are taking sibutramine must have their treatment reviewed. For further information click on treatment of obesity.
Equivalent doses of morphine sulphate and diamorphine hydrochloride table
The table showing equivalent doses of morphine sulphate and diamorphine hydrochloride in Prescribing in Palliative Care has been revised to improve the clarity of the table. The updated version shows equivalent doses of morphine sulphate and diamorphine hydrochloride over 24 hours. For further information click on palliative care.
Safe use of cytotoxic medicines
The introductory notes on cytotoxic drugs in section 8.1 have been revised following recommendations made by the National Patient Safety Agency (NPSA) working in collaboration with a multidisciplinary group of specialists. This section now includes additional information on issues concerning the safe use of cytotoxic drugs, particularly by non-cancer specialists in primary care. For further information click on cytotoxic drugs.
Azathioprine and thiopurine methyltransferase (TPMT) testing
The enzyme TPMT metabolises azathioprine; the risk of myelosuppression is increased in those with a carrier phenotype, particularly in the few individuals who are TPMT deficient. Depending on the clinical speciality, consideration should be given to measuring TPMT activity before starting patients on azathioprine. Patients with deficient TPMT activity should not receive azathioprine. Further information has also been included on the use of azathioprine in severe refractory eczema. For further information click on TPMT testing and eczema.
Other changes
To review other changes in BNF 59, click on changes.
return to top |
|
| BNF CASE STUDY |
To help you identify and report adverse-drug reactions, please follow this link to a BNF case study written in conjunction with BNF clinical advisers and the MHRA.
return to top |
|
| PROVIDE YOUR FEEDBACK ON BNF SIDE-EFFECTS |
BNF Publications need your feedback
BNF Publications has set up 'Virtual User Group's' that enable healthcare professionals to provide feedback on using the BNF and BNF for Children. Brief questionnaires will be available via the BNF/BNF for Children e-newsletters and this edition's survey focuses on side-effect information in BNF Publications. Practising professionals who would like to contribute can simply follow the link below. Thank you in advance and we look forward to receiving your comments and contributions. The survey will close on 31.3.10.
Click here to take part
return to top |
|
| TIPS ON USING THE BNF EFFECTIVELY |
For guidance on searching online versions more effectively, click here.
return to top |
|
| BNF QUALITY MANAGEMENT SYSTEM |
BNF Publications receives ISO 9001:2008 certification
BNF Publications is delighted to announce that SGS, one of the world leaders in quality management assessment, has confirmed that the BNF quality management system is ISO 9001:2008 certified.
ISO 9001:2008 certification demonstrates that the procedures that underpin the production of BNF products are robust and carried out to the highest of standards; that we engage with and respond to our users; that we train our staff to promote excellence in performance; and that we are committed to ongoing innovation to meet the needs of healthcare professionals in the future.
return to top |
|
| LEARNING WITH THE BNF |
BNF e-learning modules for pharmacists
BNF Update is an e-learning programme developed in collaboration with the Centre for Pharmacy Postgraduate Education (CPPE). BNF 59 Update will be released in March 2010. There are two e-learning programmes: one for pharmacists working in the community and other primary care settings, and another aimed at hospital pharmacists. Using a series of clinical case studies, each programme enables pharmacists to identify and assess how significant changes in the latest BNF affect their clinical practice. Recognised as an essential component of every pharmacist's continuing professional development, BNF Update can be accessed free of charge by pharmacists and pre-registration pharmacists in England at http://www.cppe.ac.uk.
return to top |
|
| FEEDBACK ON OUR E-NEWSLETTER |
Please let us know if there are any issues that you would like us to address in e-newsletters. We welcome your feedback. If you have any comments or suggestions please let us know at enewsletter@bnf.org.
To subscribe to this e-newsletter visit www.bnf.org/newsletter.
return to top |
|
|
|
