For Prescribers of medicines

 

DOCTORS - NURSES - Non Medical Prescribers IMPORTANT INFORMATION

A new Prescribing Safety Assessment examination for medical students, may ensure  graduates since 2016 will be better prepared than many of their predecessors. The GMC guidelines on Medical Education 'Tomorrow's Doctors' had excluded Clinical Pharmacology and Therapeutics in the 'Integrated Medicine' model of education prefferred since the early 90's.

https://prescribingsafetyassessment.ac.uk/

Continuing Professional Development (CPD)

 CPD may not currently include the kind of questions students are being asked to prepare for in the Prescribing Safety Assessment on line examination. It would be valuable if GPs could be encouraged to review and even add to the value of the examination, by suggesting more questions to be included.

Drug Safety Updates from MHRA click here for latest update and sign up for pdf of updates.

It is not always easy to keep on top of latest developments concerning patient safety. Black triangles may be suddenly designated for drugs you have been prescribing for years. Warning issued by the FDA, EU or MHRA may be missed.

For psychiatric adverse drug reactions and new advice about support for withdrawal from benzodiazepines, Z drugs and antidepressants, the information may not be easy to find.

APRIL hopes the following information will help you in your endeavours to keep your patients safe from harm.

Articles on ResearchGate may be of value

Clinical data for health professionals information more links

Drug regulator Safety Communications, Warnings and Alerts

FDA Index to drug specific information direct link

UK official government drug safety updates direct link

For a quick check of possible neuropsychiatric adverse effects refer to:

The British Journal of Psychiatry Published bimonthly by The Royal College of Psychiatrists, BJPsych Advances offers a distillation of current clinical knowledge, written by expert clinicians to meet the CPD needs of consultant psychiatrists.

Psychiatric side-effects of medications: recent developments direct link
or download pdf
Journal includes  information on treatment of psychiatric side-effects
Nora Turjanski, Geoffrey G. Lloyd
Advances in Psychiatric Treatment Jan 2005, 11 (1) 58-70; DOI: 10.1192/apt.11.1.58

Abstract  (Full article is from link above and includes treatment of psychiatric side-effects)

Medications often induce neuropsychiatric side-effects. This article reviews psychiatric side-effects that
are well known and describes those induced by recently developed medications. Therapeutic innovationshave been prominent in the treatment of HIV infection, Parkinson’s disease and epilepsy and thereforepsychiatric side-effects caused by these agents are described in more detail.

Serotonin Syndrome Mayo Clinic information - Serotonin syndrome symptoms usually occur within several hours of taking a new drug or increasing the dose of a drug you're already taking. Signs and symptoms include:

Akathisia - Akathisia (Greek “not to sit”) is an extrapyramidal movement disorder consisting of difficulty in staying still and a subjective sense of restlessness. It is a recognised side effect of antipsychotic and antiemetic drugs but may also be caused by other widely prescribed drugs such as antidepressants. It is a difficult condition to detect reliably and may present unexpectedly in a variety of clinical settings. The patient's behaviour may be disturbed, treatment may be refused, or the patient may be suicidal and be mistaken for a psychiatric problem. We report three cases seen in the psycho-oncology service which improved when the offending drug was discontinued.

BMJ Case report Akathisia

 

Statistics re ADRs

Hospital A & E admissions showed a shocking increase over ten years, Imperial College research found.

Professor Munir Pirmohamed's studies Liverpool study of Hospital admissions due to ADRs (does not include psychiatric, ENT or maternity admissions)

ADR hospital admission statistics to 2010 (as published by the Royal Society of Medicine)

  • Increase in ADR related hospital deaths 10%
  • Emergency admissions in hospitals due to ADRs increased by 76.8% 

Reporting ADRs

Less than 10% of serious ADRs are reported - please do report suspected ADRs - you do not have to be sure the prescribed drug was the trigger, as the MHRA explain.

Please report suspected adverse-drug reactions (even if uncertain of causal link)

 

Reporting adverse drug reactions (ADRs) and withdrawal reactions is important.

Please report ADRs to:

UK - https://yellowcard.mhra.gov.uk//

USA and worldwide - https://www.fda.gov/Safety/MedWatch/default.htm

 

 

Page is still in preparation.