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BPJ 64 October 2014

Best Practice Journal

Polypharmacy in primary care: Managing a clinical conundrum

Polypharmacy can be appropriate and beneficial for patients. However, polypharmacy also increases the risk of problematic prescribing and is associated with adverse health outcomes. Two “golden rules” which reduce problematic prescribing are to always enquire if patients are taking their medicines as prescribed, and to never assume that all of the medicines a patient is taking are known. Prescribers can take further steps to reduce problematic prescribing by being clear about the goals of care, adopting a systematic approach to new prescribing, being aware of medicines and conditions commonly associated with adverse outcomes and identifying patients at high risk of being affected by problematic prescribing, e.g. patients taking ten or more medicines simultaneously. Medicine reviews should be periodically conducted for all patients with multiple long-term conditions.

There is also a Peer Group Discussion on this article

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Identifying and managing addiction to opioids

The increased use of opioid analgesics in recent years, particularly oxycodone, has resulted in misuse and addiction issues associated with prescription opioids becoming more evident in New Zealand. Clinicians need to be aware of what these issues are, and how to identify and manage patients with inappropriate opioid use. All patients with non-malignant pain who have been taking opioids for longer than a few weeks should be reviewed, to consider whether treatment is still appropriate and how adequate controls can be ensured. View Article

Topical antibiotics: very few indications for use

Topical antibiotics in general have been excessively used in New Zealand in recent years. The increasing prevalence of resistance to fusidic acid in Staphylococcus aureus means that treatment will often be ineffective. Topical antibiotics may be considered for patients with localised areas of impetigo. Antibiotic treatment, whether given topically or orally, is rarely indicated for the treatment of patients with furuncles (boils) or carbuncles (multiple headed lesions). Oral antibiotics, but not topical antibiotics are indicated for wound infections, cellulitis or other deeper skin infections. It is important to reconsider the use of topical antibiotics in skin infections and reduce inappropriate prescribing.

There is also a Peer Group Discussion on this article

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Smoking cessation beyond the ABC: Tailoring strategies to high-risk groups

Smoking rates are declining in New Zealand as more and more people are successfully quitting. However, rates remain unacceptably high among deprived communities, Māori and Pacific peoples and in people with mental health disorders. It is often helpful to think of smoking as a chronic relapsing disease, thereby acknowledging the difficulties of smoking cessation and the likelihood of relapse. Ideally, health professionals should be providing smoking cessation support in the ABC format to every patient who smokes, at every consultation. It is also important to individualise cessation support by understanding why a patient’s previous quit attempts have failed and encouraging a wave of social support for future attempts, particularly in groups with high rates of smoking. Health professionals who are able to do this increase the chances that patients will be able to stop smoking long-term. View Article

Safer prescribing of high-risk medicines - Methotrexate: potentially fatal in overdose

Low-dose methotrexate is commonly used in the treatment of patients with rheumatoid arthritis and other rheumatologic diseases, as well as severe psoriasis. It is an effective medicine for these indications, however, it can also be highly toxic. View Article

News Updates

Medicines update: removal of Special Authority status | Antianginal medicines: perhexiline maleate (Pexsig), nicorandil (Ikorel) | Immunosuppressant: mycophenolate mofetil (MMF; Cellcept) | Prostate cancer treatment: bicalutamide (Bicalaccord) | Warts and superficial skin lesions: imiquimod (Aldara, Apo-Imiquimod cream 5%) | Paracetamol and acute liver failure in children in New Zealand and Australia | Extended use of copper and levonorgestrel intrauterine contraceptive devices (IUDs) View Article

Correspondence: Bone health; Infant formula; Oxycodone

Feedback from the field - Bone health | Infant formula for cows’ milk protein allergy | Oxycodone View Article

Peer Group Discussion

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