medications, medication combinations, and their associated pharmacodynamic effects. Each drug or group is listed twice, by name alphabetically and 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 Advisory Committee on Borderline Substances (ACBS), as such, they 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 considerations
You are looking after a lady for an extended period of time. It is common to offer her a supplement pudding as she only eats small amounts. You support her with her eating and drinking. On discussion with your practice supervisor, you realise this is not prescribed for her and she is being prepared for a transfer of care to a community care setting.
What implications does this practice have? Jot down your initial thoughts.
1 For her (both now and post transfer of care)?
2 For you as a healthcare professional or student?
3 For discharge planning?
4 For the doctors responsible for her medications?
Revisit these considerations and your initial thoughts when you have explored more about the legal and ethical considerations, as well as pharmacokinetics and pharmacodynamics.
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 3 has a 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 both in Appendix 3 and in the back pages of the print BNF.
Skills in practice
Using the index, find olanzapine in the BNF.
Using the drug monograph, find the medicinal form section.
Identify the cautionary and advisory label number given for oral tablets.
Use Appendix 3 to identify what the label states.
What additional information is provided?
How would you discuss this with the patient?
Wound management products and elasticated garments
Appendix 4 offers details of products that are used for wound management and garments that require a prescription. Best practice and clinical recommendations should be consulted to ensure the most appropriate item is chosen. Often in acute or inpatient settings, the clinical environment has a stock of regularly used dressings or bandages or other medicinal devices, such as surgical adhesive tapes. These remain individual prescribed patient items and should be considered as such on discharge or transfer of care. It is essential that the supply of wound care products, and associated treatment information, should be prepared and documented as per any other medication or medical product or device. This information is paramount for community care providers, practice nurses and general practitioners in order to maintain high‐quality care standards.
Emergency care protocols, units, conversions and abbreviations
The BNF print version acts as a reference guide for practitioners in emergency situations. The adult advanced life‐support algorithm and an overview of community‐based medical emergency management provides a valuable resource in emergency situations.
Conversions 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 BNF
In an increasingly paper‐free healthcare system, you may not have access to paper copies of the BNF. The BNF 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 online https://bnf.nice.org.uk or BNF for children https://bnfc.nice.org.uk is updated monthly and as such is often 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 BNF 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 webpage. 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.
Figure 2.2 Contraindication and class monograph.
Cautionary and advisory labels are indicated when a 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 is integrated throughout the chosen drug monograph and 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
