1 provides tables and details of specific medications, medication combinations, and their associated pharmacodynamics effects. Each drug or class listed, by name alphabetically and/or with the specific drug or group that it interacts with.
Borderline Substances
In some conditions, such as coeliac disease, food products and toilet preparations may have characteristics of drugs. These products are reviewed and determined by the ACBS, as such, may be treated as a prescribed medication. Some examples are enteral feeds, nutritional supplements, gluten‐free or low‐protein foods and nutritional supplements given to treat metabolic diseases (e.g. maple syrup urine disease) alongside toilet preparations for topical use (for example, E45® or Aveeno Cream® for the treatment of dermatitis).
Nutritional supplements are common in care settings. Providing support with supplement drinks and puddings, for example, may form part of your everyday practice, but these should be treated as medication and prescribed based on individual patient need as with any medication.
Clinical Consideration
You have been looking after young person for an extended period of time. It is common to offer her a feeding supplement, as she has an eating disorder. You support her to build her oral diet and the supplement is given after each attempt at eating three times a day. On discussion with your practice supervisor you realise this is not prescribed for her and she is being prepared for discharge back home with community care services.
What implications does this practice have? Jot down your initial thoughts:
1 For her? And her family? (both now and post transfer of care)
2 For you as a healthcare professional or student?
3 For discharge planning?
4 For the healthcare practitioners responsible for her medications?
Revisit these considerations and your initial thoughts when you have explored more about the legal and ethical considerations (Chapter 3 of this text) as well as pharmacokinetics and pharmacodynamics (Chapter 5 of this text).
Cautionary and Advisory Labels for Dispensed Medication
Many medications come with cautionary or advisory information that should be added by pharmacists when dispensing the requested medication. Appendix three of the BNFc is has list of approved cautionary and advisory labels each with a specific code number. The number associated with the label is found in the drug monograph in the medicinal forms section below the preparation chosen. It is important to advise the patient on the additional advice or directions given for taking their medication. A full list of the labels and wording is found in appendix three and a shorter version in the back pages of the print BNFc.
Skills in Practice
Using the index, find ranitidine in the BNFc
Using the drug monograph, find the medicinal form section
Identify the cautionary and advisory label number given for effervescent tablets
Use appendix three of the BNFc to identify what the label states
What additional information is provided?
How would you discuss this with the CYP and their parent/carer?
How would you discuss this with the CYP and their parent/carer?
Emergency Care Protocols, Units, Conversions and Abbreviations
The BNFc print version acts as a reference guide for practitioners in emergency situations. The newborn life support, paediatric basic life support and paediatric advanced life support algorithms are provided along with body surface area and weight charts, and an overview of community‐based medical emergency management. Additional conversion and unit tables are presented as a reference followed by the cautionary and advisory label wordings discussed previously. The inside back page lastly provides a guide to the abbreviations and symbols used which are internationally recognised.
Online and Mobile Application BNFc
In an increasingly paper‐free healthcare system, you may not have access to paper copies of the BNFc. The BNFc has an online platform accessed via the National Institute for Health and Care Excellence (NICE), or via Medicines Complete (https://about.medicinescomplete.com/) as well as an offline app that can be used on smart phones and tablets. The BNF for Children (https://bnfc.nice.org.uk/) and BNF online (https://bnf.nice.org.uk/) are updated monthly and as such is more up‐to‐date than the print version and does not require a specific log in. The app is automatically updated monthly (when connected to Wi‐Fi).
When you visit the home page of the BNFc online (via NICE) you are presented with clear options for navigation. All the same information is held online as in print – but navigation is different. Drugs (as drug monographs), interactions and treatment summaries can be searched for by browsing an alphabetised list or the search bar at the top of the web page. The home page also has a ‘type’ organisation where quick access to areas such as wound management, borderline substances and nurse prescribers’ formularies can be found.
Searching for atenolol (for example) and opening its page displays information under the atenolol drug monograph. A table of contents is provided for rapid navigation of the subsections available. On scrolling down the opening page, indications and dose are clearly presented alongside routes of administration. Next, licensing information, safety information and contraindications are displayed.
Cautionary and advisory labels are indicated when medicinal form is selected both by label number and the associated text. In addition, the schedule of any controlled drug is clearly documented in its medicinal form information.
Associated class monograph information are integrated throughout the chosen drug monograph and are indicated by the phrasing ‘for all … ’ . An example of this can be seen in the contraindications for atenolol (Figure 2.2)
Searching for interactions is managed within a dedicated interactions section by an initial drug search and then matching to a subsequent alphabetical list. The associated interaction is discussed in terms of potential effects of the interaction, signposting to relevant additional sections of the BNFc such as ‘safety in the home’ in ‘Guidance on prescribing’ and have associated hyperlinks for ease. Severity of interactions are defined using terms of severe, moderate, mild and unknown to support decision making alongside the type of evidence underpinning the interaction information.
Figure 2.2 Contraindication
