| Dear e-newsletter subscriber, |
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We continue to alert you to the significant changes in the latest BNF (BNF 57).
Recognising drug interactions is important, but doing everything we can to reduce the chances of them occurring in the first place is just as crucial - a message that is echoed by our case study on preventing cardiovascular disease. Meanwhile, today's tip shows you a time-saving way to search for interactions between several drugs at the same time while using the digital BNF.
We apologise for the technical problems that prevented some of you from entering last year's competition. To make up for this, we are running a new competition - look out for another opportunity to win the latest edition of the BNF for PDA and the handheld device.
If you find our email news service useful, please forward this message to your colleagues. |
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| BNF update on significant changes |
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Irritable bowel syndrome
The fibre intake of patients with irritable bowel syndrome should be reviewed, and if an increase in dietary fibre is required, soluble fibre (e.g. ispaghula husk, sterculia, or oats) is recommended; bran should be avoided. An osmotic laxative, such as a macrogol, is preferred for the treatment of constipation. Low doses of a tricyclic antidepressant can be used to treat abdominal pain or discomfort in patients who have not responded to laxatives, loperamide, or antispasmodics. A selective serotonin re-uptake inhibitor may be considered in those who do not respond to a tricyclic antidepressant. For further information click on irritable bowel syndrome |
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Metformin and lactic acidosis
Metformin can provoke lactic acidosis very rarely. It should be used cautiously in renal impairment; the dose should be reviewed if the estimated glomerular filtration rate (eGFR) falls below 45mL/minute/1.73m2, and metformin should be avoided if the eGFR is less than 30mL/minute/1.73m2. To reduce the risk of lactic acidosis, metformin should be stopped or temporarily withdrawn in those at risk of tissue hypoxia or sudden deterioration in renal function, such as those with dehydration, severe infection, shock, sepsis, acute heart failure, respiratory failure or hepatic impairment, or those who have recently had a myocardial infarction. For further information click on metformin. |
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Type 2 diabetes during pregnancy and breast-feeding
During pregnancy, women with either gestational diabetes or pre-existing type 2 diabetes may be treated with metformin, either alone or in combination with insulin. In women with pre-existing diabetes, metformin can be continued during breast-feeding. Other oral hypoglycaemic drugs, including sulphonylureas, continue to be contraindicated during pregnancy and breast-feeding. For further information click on antidiabetic drugs. |
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Tendon damage with quinolones
Tendon damage is a rare, but well recognised side-effect of quinolones. The factors that predispose patients to this side-effect have been revised. The risk of tendon damage is increased in patients over 60 years of age, in recipients of kidney, heart, or lung transplants, and in those receiving concomitant treatment with corticosteroids. While tendon rupture may occur within 48 hours of starting treatment, cases have also been reported several months after stopping a quinolone. For further information click on quinolones. |
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Prevention of osteoporotic fractures in postmenopausal women
Are Crohn's disease and rheumatoid arthritis indicators of low bone mineral density? Is alendronate the drug of choice for the primary and secondary prevention of osteoporotic fractures in postmenopausal women? You will find all the answers in a summary of the latest NICE guidelines in BNF 57. For further information click on osteoporosis. |
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Emergency use of oxygen
While the aim is to achieve a normal or near-normal oxygen saturation in most acutely ill patients, a lower target of 88-92% oxygen saturation is indicated in those at risk of hypercapnic respiratory failure. Patients who have had an episode of hypercapnic respiratory failure should be given an oxygen alert card endorsed with the oxygen saturations required during previous exacerbations. The card should be shown to emergency healthcare providers in the event of an exacerbation. For further information click on oxygen
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Fibrotic reactions and ergot-derived dopamine receptor agonists
Did you know that echocardiography is necessary before starting these drugs for Parkinson's disease or chronic endocrine disorders? The European Medicines Agency has recommended new warnings and contra-indications for ergot-derived dopamine agonists (bromocriptine, cabergoline, and pergolide) because of a risk of fibrosis associated with their chronic use. The maximum licensed doses of these drugs have also been reduced. For further information click on Parkinson's disease
or endocrine disorders. |
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HIV infection
Treatment is initiated with 2 nucleoside reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor. Regimens containing a boosted protease inhibitor are reserved for patients with resistance to first-line regimens, women wishing to become pregnant, or patients with psychiatric illness. Advice on reducing the cardiovascular risk of patients receiving antiretrovirals has been expanded to include information on monitoring plasma lipids and blood glucose. BNF 57 also addresses the differences between protease inhibitors in their ability to cause dyslipidaemia and impair glucose tolerance. For further information click on HIV infection. |
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Other changes
To review other changes in BNF 57, click on changes. |
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| BNF case study |
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To help you put BNF advice on the prevention of cardiovascular disease into practice, please follow this link to a BNF case study.
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| Tips on using the BNF and BNFC effectively |
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| For guidance on the best way to search for interactions between several drugs at the same time, please click here. |
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| BNF competition! |
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 Spare a few minutes to take part in our short quiz:
- What type of dietary fibre is suitable for a patient with irritable bowel syndrome?
- Which factors can predispose patients to tendon damage with quinolones?
- When is it necessary to stop a statin in a patient complaining of muscle pain?
- How is a hazardous drug interaction displayed in the digital version of the BNF?
- When can strontium ranelate be prescribed for the primary prevention of osteoporotic fractures in postmenopausal women?
You will find all the answers to these questions in this e-newsletter and its associated links. Please email your answers to us at enewsletter@bnf.org
The submissions will be judged by the editorial team, and the winning entry will receive BNF 57 for PDA and a handheld device.
Deadline for submissions is 30th April.
The winner of our September 2008 competition was Sonia Garner. Congratulations!
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| Feedback on our e-newsletter |
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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.
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