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.

In this issue

• Supporting people taking antipsychotics
• Patients with chronic conditions need help to deal with their workload
• Some ingredients in medicines can have more than the desired effect
• Smart phones become wise phones with the NPS Medicines List iPhone app
• Learn about your medicines in 10 different languages
  

Supporting people taking antipsychotics

People taking antipsychotic medicines bear a significant burden of adverse effects and managing these remains a considerable challenge for health professionals and the families and carers of the people affected.

The latest NPS education program, Balancing benefits and harms of antipsychotic therapy, promotes the safe and effective use of antipsychotic therapy in three conditions: schizophrenia, bipolar disorder and behavioural and psychological symptoms of dementia.

For health professionals prescribing antipsychotics, the goal is to achieve a favourable balance of clinical benefits and adverse effects for each patient. Individual assessments play a key part in attaining this balance, since the safety and tolerability profile for each patient will differ.

As part of ongoing management, health professionals, including nurses, are encouraged to actively monitor adverse effects. Individual assessments should include a range of symptoms and risk factors for serious adverse effects, including cardiovascular and metabolic risks and extrapyramidal symptoms (movement disorders). Nurses also play a key role in advising patients with a mental illness and their families or carers on how best to manage their lifestyle and antipsychotic therapy to prevent health problems.

It is beneficial to engage patients and their families or carers in recognising and managing adverse effects, since these conversations often translate into a better patient-health professional relationship and improve adherence to therapy.

For people experiencing behavioural and psychological symptoms of dementia however, ensuring clinical effectiveness when taking antipsychotics involves a different set of considerations.

Antipsychotic prescribing is widespread for people with dementia, yet many of the troublesome symptoms such as wandering, shouting and insomnia don’t respond well to treatment with these medicines, and the improvements, if any, are often counterbalanced by significant adverse effects. Not only is tolerability often a problem, but there is evidence of an increased risk of serious problems such as death, stroke or pneumonia.

The Balancing benefits and harms of antipsychotic therapy program encourages health professionals to use non-pharmacological therapies as first line treatment for patients with behavioural and psychological symptoms of dementia whenever possible. When antipsychotics are prescribed, the need for them should be reviewed regularly.

NPS provide the following resources and activities for nurses:

• NPS News 74: Balancing benefits and harms of antipsychotic therapy
• Case study 70
• Prescribing Practice Review 55: Balancing benefits and harms of antipsychotic therapy
• Residential Aged Care Facility Drug Use Evaluation – Antipsychotic use for behavioural and psychological symptoms of dementia in aged care facilities.

More information and resources on antipsychotics.

Patients with chronic conditions need help to deal with their workload

In this month’s Australian Prescriber, Professor Victor Montori of the Mayo Clinic, USA, writes about the need for health professionals to help patients with chronic conditions deal with the increasing workload of looking after themselves.

Current treatment guidelines for doctors advise them to treat their patients to reach certain targets, such as healthy blood sugar or cholesterol levels, yet this approach is based on an assumption that achieving these targets will lead to better outcomes for the patient, which is not necessarily the case.

Treating to target may involve intensification of treatment, including increased use of medicines. This can mean the patient needs to do more intensive self monitoring and self management and make time for more treatments, tests and visits to health professionals.

Eventually, the increasing workload may exceed the capacity of the patient or their caregivers to accommodate its demands, resulting in the patient only doing part of what is expected. To a health professional, this may look like a typical case of patient non-adherence to treatment.

For the doctor working under a treat-to-target approach, patient non-adherence can lead to intensification of therapy, thereby increasing the treatment workload for the patient. This can trigger the non-adherence cycle all over again. The result is ongoing deterioration not only of disease control but also of the patient–doctor relationship.

Professor Montori suggests that the benefits from changes in lifestyle measures or medicines should be balanced against the burden of all this treatment. Health professionals, including nurses, should involve patients in the prioritising of goals when it comes to their treatment. Focusing on treating to the patient goals and making healthcare fit the lives of patients is the basis for minimally disruptive medicine.

Read the full article, Treat the numbers or treat the patient?

Some ingredients in medicines can have more than the desired effect

Additives in medicines, such as colours and flavours in mixtures, and fillers and coatings in tablets, can have adverse effects that range from a mild rash to a potentially life-threatening reaction, according to Alison Haywood of Griffith University and Beverley Glass of James Cook University, writing in the August edition of Australian Prescriber.

The authors explain that these additives or excipients are included in a medicine not only for their therapeutic benefits but to facilitate the manufacture of the medicine, for easy administration to patients and for optimum storage of the medicine.

Common excipients include coatings to protect the active ingredient in a tablet, ensuring that it is released as required once ingested. Ideally, an excipient is inactive, non-toxic, and does not interact with the active ingredient in a medicine. However they may have the potential to cause adverse effects in sensitive individuals.

Nurses can play a role in educating people about the adverse effects of a medicine, which may be due to the excipient rather than the active ingredient. Having these conversations is especially important if a patient has an allergy to a particular excipient, which can be identified due to its presence in another medicine they were taking, or an allergy to a similar ingredient.

A list of the excipients included in a medicine is available in the Consumer medicine information (CMI) leaflet, which is often provided with the medicine or readily available online.

Anyone concerned about any suspected adverse effects should be encouraged to talk to their health professional. They can also phone the Adverse Medicine Events line (1300 134 237) or Medicines Line, a telephone service providing information on prescription, over-the-counter and complementary medicines (1300 MEDICINE or 1300 633 424), Monday to Friday 9am–5pm eastern standard time.

Read the full article, Pharmaceutical excipients – where do we begin?

Smart phones become wise phones with the NPS Medicines List iPhone app

The new NPS Medicines List iPhone app is available for free from iTunes. More than 5000 people are now using the app, keeping essential information about their medicines on hand and ensuring that they are prepared and informed when talking to their health professional.

The NPS Medicines List app allows people to track the brand, active ingredient, strength and dosage of prescription, over-the-counter and complementary medicines. Other features enable people to:

• keep photos of medicines, packaging and dispensing labels
• record any changes to a medicine regimen using the change log
• export, print or email a copy of a Medicines List and change log to discuss with their doctor, pharmacist or nurse
• save personal details and health professionals’ contact details
• note questions to discuss at a medical appointment.

The app is particularly useful for people taking multiple medicines and for those who see several health professionals and may need to provide a list of current medicines as well as a history of medicines.

Read more about the Medicines List iPhone app and download it for free from the iTunes store. 

Learn about your medicines in 10 different languages

An article from Medicines Talk, a quarterly NPS newsletter for consumers about being medicinewise, is now available as a factsheet in 10 languages.

Learn about your medicines is a useful resource for nurses providing basic information about medicines for people from culturally and linguistically diverse backgrounds.

This bilingual factsheet provides information about what a medicine is, how to find the active ingredient and knowing what questions to ask your health professional. It is available in Arabic, Croatian, Greek, Italian, Korean, Macedonian, Spanish, Simplified Chinese, Traditional Chinese and Vietnamese.

Print or order free copies of the factsheet from the NPS online catalogue.

Feed your competency