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Welcome to our September e-newsletter, designed to alert you to all the significant changes in the new edition of the BNF (BNF 56).
This time, our case study focuses on the prevention of osteoporosis and endocarditis, and on the management of anticoagulation prior to dental surgery. Be sure to read our BNF tip to help you ensure that a drug is safe to prescribe during pregnancy and breast-feeding.
Look out for our competition and your opportunity to win the latest edition of the BNF for PDA and the handheld device. |
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| BNF update on significant changes |
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Lipid-regulating drugs for prevention of cardiovascular disease
Guidance on the use of lipid-regulating drugs to reduce cardiovascular risk has been updated in BNF 56. A statin remains the drug of first choice for the primary and secondary prevention of cardiovascular events. Doses of lipid-regulating drugs may be adjusted for the secondary prevention of cardiovascular events if a total cholesterol concentration of less than 4mmol/litre or a LDL-cholesterol concentration of less than 2mmol/litre are not achieved with initial treatment.
For further information click on lipid-regulating drugs. |
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Atrial fibrillation
What should you do if the ventricular rate is not controlled adequately with a beta-blocker? How should you treat haemodynamically unstable patients with acute onset atrial fibrillation? What can you do to improve the success of electrical cardioversion? Which patients should receive warfarin? The revised prescribing notes on atrial fibrillation in BNF 56 answer these questions and more.
For further information click on atrial fibrillation. |
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Hypersensitivity to penicillins and cephalosporins
Evidence suggests that the rate of cross-sensitivity between penicillins and cephalosporins is closer to 0.5-6.5% than the widely quoted rate of 10% (BMJ 2007; 335: 991). BNF 56 advises that patients with a history of immediate hypersensitivity to penicillin should not receive a cephalosporin. If a cephalosporin is essential in these patients because a suitable alternative antibacterial is not available, then cefixime, cefotaxime, ceftazidime, ceftriaxone, or cefuroxime can be used with caution; cefaclor, cefadroxil, cefalexin, and cefradine should be avoided. Cephalosporins can be used in patients with a history of a minor rash or a rash that occurs more than 72 hours after penicillin administration.
For further information click on penicillin hypersensitivity. |
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Suicidal behaviour and antiepileptic drugs
Antiepileptic drugs have been associated with a small increased risk of suicidal thoughts and behaviour; this can occur as early as one week after starting treatment (Drug Safety Update 2008; 2(1): 2). BNF 56 reflects these safety concerns and recommends that patients should seek medical advice if they develop mood changes or suicidal thoughts.
For further information click on anti-epileptic drugs. |
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Management of acute asthma
The table on Management of Acute Asthma has been updated in the light of the latest BTS/SIGN British Guideline on the Management of Asthma (May 2008; www.brit-thoracic.org.uk ). The table includes key clinical parameters to assess the severity of each exacerbation, and provides advice on the treatment of moderate, severe, and life-threatening acute asthma.
For further information click on acute asthma. |
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HRT risk table
Information on the risks associated with hormone replacement therapy is now also displayed in an easy-to-read table format.
For further information click on HRT. |
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Aciclovir, colchicine, and vancomycin
What's the connection? Changes have been made to the treatment doses of aciclovir for genital herpes, colchicine for acute gout, and intravenous vancomycin for infections caused by Gram-positive bacteria.
For further information click on aciclovir, colchicine, vancomycin. |
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Erythropoietins
Studies show an unexplained excess mortality and an increased risk of tumour progression in patients who received erythropoietins for anaemia associated with cancer (Drug Safety Update 2008; 1(12): 10 and 2(1): 3-4). In many of these trials erythropoietins were used beyond their licensed indications (i.e. haemoglobin concentrations were overcorrected or erythropoietins were given to patients who had not received chemotherapy). BNF 56 advises that the decision to use erythropoietins should be based on an assessment of the benefits and risks for individual patients and that blood transfusion may be the preferred treatment for anaemia associated with cancer chemotherapy, particularly in those with a good prognosis.
For further information click on erythropoietins. |
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Application and labelling of topical corticosteroids
BNF 56 continues to provide guidance on the correct application of topical corticosteroids. Pharmacists should reinforce this advice when counselling patients. If a patient is using topical corticosteroids of different potencies, the patient should be told when to use each corticosteroid. The potency of each topical corticosteroid should be included on the dispensary label together with the directions for use.
For further information click on topical corticosteroids. |
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Other changes
To review other changes in BNF 56, click on: changes. |
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| BNF case study |
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To help you put BNF advice on the prevention of osteoporosis and endocarditis, and on the management of anticoagulation prior to dental surgery 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 how to prescribe safely to those pregnant or breast-feeding, please click here. |
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| Learning with the BNF |
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BNF Prescribing Practice for Medical Students
Produced in collaboration with BMJ Onexamination, this new online revision aid provides students with a collection of clinically rich questions that stimulate problem solving and improve patient management while using the latest BNF. Designed to support best prescribing practice, the questions cover topics as diverse as asthma, cardiology, diabetes, infections, drug interactions, adverse drug reactions, prescribing in pregnancy and much more.
For further information click on BNF Prescribing Practice for Medical Students.
A dentist's guide to using the BNF
The British Dental Journal recently published A Dentist's Guide to Using the BNF (Br Dental J 2008; 204: 437-9 and Br Dental J 2008; 204: 487-91). These articles illustrate how dentists can keep track of the significant changes that occur in a new edition of the BNF and how to navigate to the dental information in it. With the help of clinical scenarios, the authors go on to explain how the BNF can be used as a tool to achieve rational prescribing. |
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| BNF Digital Developments |
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Alphabetisation of appendix 2-5 entries in BNF
In order to aid navigation, the entries in Appendixes 2 - 5 of the digital BNF are now displayed in alphabetical order of the generic drug names and drug groups. Alternatively, you can continue to access this information from links within the drug monograph. See today's tip for further guidance. |
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| BNF competition! |
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 Identify at least 3 ways in which this e-newsletter will change your clinical practice.
In less than 150 words, email us the details at enewsletter@bnf.org.
The submissions will be judged by the editorial team, and the winning entry will receive BNF 56 for PDA and a handheld device.
Deadline for submissions is 31st October.
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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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