Welcome to the latest issue of Nurse Update, a digest of evidence-based information to help you improve your knowledge of medicines use, prescribing practices and medical tests.

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In this issue

• National Medicines Symposium 2012
  
• NPS supports TGA decision to cancel 4 pain relief medicines
• Medicines in pregnancy
• Medicines safety and multiple medicine brands
• Medicine reminders added to NPS Medicines List iPhone app
• Latest edition of Australian Prescriber out now
• Feed your competency
• Clinical resources and publications
• Consumer publications
  

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National Medicines Symposium 2012

NPS takes great pleasure in announcing the seventh biennial National Medicines Symposium (NMS) to be held 24–25 May 2012 at the Sydney Convention & Exhibition Centre.

NMS provides the opportunity to network and share your expertise at the leading symposium on quality use of medicines in Australia, bringing together the partners to Australia’s National Medicines Policy along with international representatives to learn, discuss and debate contemporary quality use of medicines issues. The theme for NMS 2012 is building a medicinewise community and we will explore the challenges we face and the opportunities available to make this a reality.

Early bird registrations are now open.

Abstract submissions close 20th February.

To view the preliminary program, register, or submit an abstract visit the NMS web pages.

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NPS supports TGA decision to cancel 4 pain relief medicines

NPS has applauded the Therapeutic Goods Administration’s (TGA) decision to cancel 4 prescription pain relief medicines containing dextropropoxyphene from 1 March 2012.

The TGA has decided to cancel the products known by the brand names Capadex, Di-Gesic, Doloxene and Paradex following an extensive review about the medicines’ safety and efficacy.

NPS CEO Dr Lynn Weekes said that the decision to cancel the medicines was a logical step given the available evidence, and their withdrawal from sale in many other countries.

Dextropropoxyphene, the active ingredient in these medicines, has been shown in many studies to affect the electrical activity of the heart, increasing the risk of serious arrhythmias. The TGA review of its efficacy also found that only limited pain relief is provided by these medicines.

In a previous review of the evidence, NPS concluded that taking medicines containing a combination of paracetamol and dextropropoxyphene (including Capadex, Di-Gesic and Paradex) is no more effective than taking paracetamol alone.

Fixed-dose combinations, such as those found in these medicines, are also generally taken at a frequency that increases the risk of adverse effects from accumulation of the active ingredient, dextropropoxyphene, and its cardiotoxic metabolite.

Nurses should encourage anyone who has been taking Capadex, Di-Gesic, Doloxene or Paradex regularly for chronic pain, or from time to time for short-term pain, to speak to their doctor about alternative pain relief medicines. Patients should not stop taking their medicine as prescribed until they have spoken to their doctor, since suddenly stopping a medicine can cause a range of withdrawal symptoms.

Read more about the TGA decision or the NPS media release.

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Medicines in pregnancy

Whether a medicine is safe to take while pregnant or breastfeeding can depend on many factors, including the stage of pregnancy, age of the baby and general health of the mother. The decision to take a medicine in pregnancy or while breastfeeding should always be based on consideration of the benefits and risks.

While there are risks in taking some medicines during pregnancy or breastfeeding, in some cases there may be more harm than good by not taking them. Conditions like asthma, depression, diabetes and hypertension — if left untreated — can lead to complications for both mother and baby.

For many medicines, particularly complementary medicines, there is limited or poor quality information about their use during pregnancy and breastfeeding. The Australian categorisation system for prescribing medicines in pregnancy is a guide only, and for some medicines, advice against prescribing in pregnancy is simply based on lack of data.

NPS has prepared a Medicines in pregnancy resources page to help patients and health professionals understand some of the issues relating to medicines in pregnancy and lactation.

Nurses can encourage patients to talk to their doctor or pharmacist for medicines advice while pregnant or breastfeeding, or call Medicines Line on 1300 MEDICINE (1300 633 424) from anywhere in Australia. For more tips on finding good quality information about medicines, patients can also be directed to the NPS Medicinewise choices pages.

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Medicines safety and multiple medicine brands

Choosing between different medicine brands can be confusing for patients, according to research recently conducted by NPS and the Federation of Ethnic Communities’ Councils of Australia (FECCA). The different shapes, colours and sizes of the same medicine offered in hospital are a particular cause of uncertainty. Nurses can help alleviate this confusion by starting a conversation with their patients about medicine brand choices and referring them to their doctor or pharmacist if needed.

To support these conversations in pharmacies, NPS, together with the Society of Hospital Pharmacists of Australia, has provided resources to community and hospital pharmacies that inform patients about bioequivalence and active ingredients when negotiating different medicine brands. Copies of the NPS Medicines List were also provided to encourage patients to record and keep track of their medicines. Both the medicines list and other brand choices resources are available to order.

From November  2011 to January 2012, NPS is also running television commercials and advertorial segments on Channel 7 that focus on finding the active ingredient in your medicine, preventing medicine double ups, knowing what a medicine is and keeping track of your medicines.

To read more on informing patients about multiple brands, see NPS News 76.

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Medicine reminders added to NPS Medicines List iPhone app

NPS has introduced a range of new features to its award-winning Medicines List iPhone app that allow people to schedule in reminders to prompt them to take their medicine. People can also now record whether they took their medicine on time — and if not, why not.

Nurses can encourage their patients to use the app to gather useful information that creates a record of adherence over time.

With the iPhone app upgrade, people can now:

• set the frequency of how often they should take each medicine from a range of default options, or they can set the times to their own custom preferences
• set reminders to help them take the right doses of their medicines at the right time
• respond to the reminders by selecting whether they took their medicine on time, late or did not take it at all
• record why they didn’t take a dose, so they can later share this information with their health professional.

The NPS Medicines List iPhone app can be downloaded for free from the Apple iTunes store, and for those who already have the app, the upgraded features will be available automatically when you next update your apps.

For more information, including how-to videos outlining the app’s features, visit the iPhone Medicines List app web page.

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Latest edition of Australian Prescriber out now

The December edition of Australian Prescriber  looks at the following topical issues.

The prescribing cascade

A ‘prescribing cascade’ occurs when a new medicine is prescribed to ‘treat’ an adverse reaction to another drug in the mistaken belief that a new medical condition requiring treatment has developed, writes Lisa Kalisch and colleagues from the University of South Australia. Read the full article.

Appropriate primary prevention of cardiovascular disease: does this mean more or less statin use?

It is likely doctors are over-prescribing statins to low-risk patients, according to Associate Professor Jane Smith of Bond University. Treatment should focus on those who are more likely to benefit from statin treatment. Read the full article.

New drugs for osteoporosis

Despite the numerous treatments available, the majority of Australians with osteoporosis remain untreated. New treatments for osteoporosis may offer advantages over oral bisphosphonates, particularly regarding adherence. Read the full article.

This edition also includes a list of the top 10 drugs used in Australia. To read this entire edition and more visit the Australian Prescriber website.

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