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BPJ 62 July 2014

Best Practice Journal

Bipolar disorder: Identifying and supporting patients in primary care

Bipolar disorder can be challenging to diagnose and manage. It is often assumed to be recurrent major depression, until an episode of mania/hypomania occurs and the diagnosis of bipolar disorder is confirmed, usually by a Psychiatrist. Mood stabilising medicines, e.g. lithium and valproate, are the mainstay of pharmacological treatment. Monotherapy with antidepressants for a patient with bipolar disorder is associated with an increased risk of an episode of mania and should be avoided. A key role of general practice in the long-term management of patients with bipolar disorder is to educate the patient and their family about their condition, to encourage treatment adherence and a healthy lifestyle, to assess for treatment efficacy and monitor for adverse effects.

There is also a Peer Group Discussion on this article

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Atypical antipsychotics: one fully subsidised brand for quetiapine, risperidone and olanzapine

At present there are multiple brands of some of the fully subsidised antipsychotics on the Pharmaceutical Schedule. View Article

Oxycodone: how did we get here and how do we fix it?

Following on from the interview with Dr Jeremy McMinn in the last edition of Best Practice Journal, we examine in more detail what the actual problem is with oxycodone, and how we ended up in this situation.

There is also a Peer Group Discussion on this article

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The role of triptans in the treatment of migraine in adults

Paracetamol or a non-steroidal anti-inflammatory drug (NSAID) can be used first-line for pain relief in acute migraine. A triptan can then be trialled if this was not successful. Combination treatment with a triptan and paracetamol or NSAID may be required for some patients. Most triptans are similarly effective, so choice is usually based on formulation, e.g. a non-oral preparation may be more suitable for patients with nausea or vomiting. To avoid medication overuse headache, triptan use should not exceed ten or more days per month. View Article

Gout update: Febuxostat now subsidised on Special Authority

Febuxostat was added to the New Zealand Pharmaceutical Schedule on 1 June, 2014. It is now available as a third-line preventive treatment (after allopurinol and probenecid) for patients with gout and is fully subsidised under Special Authority, subject to specific criteria. Febuxostat is a relatively new medicine indicated for the treatment of long-term hyperuricaemia in people with gout. Allopurinol remains the first choice of medicine to lower serum urate levels, however, febuxostat now provides a new subsidised treatment option if patients have been unable to tolerate allopurinol or have not achieved target serum urate levels with allopurinol and probenecid. Benzbromarone remains available as a third-line preventive treatment for gout and is also fully subsidised subject to Special Authority criteria. View Article

Upfront: The Integrated Performance and Incentive Framework (IPIF): What has changed and how does it affect primary care?

On June 30, 2014, the PHO Performance Programme (PPP) ceased and was replaced with an interim arrangement based on five targets previously used by the PPP. View Article

Safer prescribing of high-risk medicines: Clozapine

Pharmacological treatment is an integral part of the practice of medicine, and is one of the most significant factors in improving patient health. However, some medicines, when used outside of therapeutic indications or doses, or even when used appropriately, can become a “poison” rather than a “cure”.

There is a newer article with updated information on this subject. See: "Clozapine: safe prescribing"

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News Updates

Evidence that alternate dosing of paracetamol and ibuprofen in children with fever may reduce temperature: other benefits uncertain View Article

Correspondence: prescribing restrictions for oxycodone; Re-infection with H. pylori

Are prescribing restrictions for oxycodone appropriate? | Re-infection with H. pylori does occur | View Article

Peer Group Discussion

We look back at the key messages and practice points from selected articles in Best Practice Journals View Article