Browse bulletin items by A-Z

Published: 3 March, 2023


Latest from bpacnz – Tinnitus: the sound of silence

Today (3 March) is World Hearing Day. This year’s theme focuses on the importance of integrating ear health into primary care. Hearing loss can have a significant impact on a person’s ability to interact with the world around them. This week we have published an updated article on tinnitus, a condition that can be associated with hearing loss.

Tinnitus is heterogenous in both its presentation and its causes. It can be frustrating for patients and clinicians as there is much misinformation and misunderstanding around its aetiology and treatment options. In some people, tinnitus can cause significant distress, reduced quality of life and may even contribute to suicidal ideation. However, most cases of tinnitus can be treated successfully, and patients can be reassured that there are many management techniques that can reduce its impact including sound therapy, stress reduction and treatment of other underlying causes.

This article features guidance on how to minimise or prevent noise-induced hearing loss; consider how this may form part of a patient discussion around ear health.

Read the full article here.

A B-QuiCK summary is also available here.

Peer group discussion – Hypertension in adults: the silent killer

In January, we kicked the year off with an update to one of our most popular articles “Hypertension in adults: the silent killer”. This was accompanied by a B-QuiCK summary and quiz. We have now published a peer group discussion for this topic, to be used among peer/study groups or for self-reflection of practice. For example, what do you think about the updated recommendation to initiate most patients on two low-dose antihypertensives if pharmacological treatment is indicated? How low do you think blood pressure targets should be set? Ask your colleagues if they agree, or perhaps they have a different take on these questions.

View peer group discussion

Cyclone Gabrielle: Changes to dispensing rules

In the wake of Cyclone Gabrielle last month, Pharmac has applied rule 5.5 of the Pharmaceutical Schedule, allowing pharmacies in affected areas* to adjust the frequencies and quantities of medicines dispensed depending on patient requirements and their supply of medicines on hand. This rule will apply until 21 March, 2023. The supply of medicines under Rural Practitioner’s Supply Order (PSO) has been extended to all affected areas* as well, allowing any medicine (that meets all requirements of Section B of the Schedule) to be supplied on a Practitioner’s Supply Order to prescribers (including non-rural prescribers).

Other changes implemented by Te Whatu Ora, Health New Zealand, in affected areas include:

  • Prescription co-payments removed
  • Emergency supply provisions extended
  • Locum support
  • Free telehealth consultations (and prescriptions) through HealthLine

*Northland, Coromandel, Tairāwhiti, Tararua and Hawke’s Bay

Cyclone Gabrielle caused major interruptions to the transport of medicines around the country, compounding problems for patients and pharmacists. The following issues relating to medicine supply have recently been updated by Pharmac:

Further information on medicine supply issues can be found on both the NZF website and the medicines notices page on the Pharmac website

Latest edition of Prescriber Update released

The March edition of Prescriber Update has been published; particular items of interest include:

View the full edition here

Monitoring Communication: reports of pericarditis following mpox vaccination

Medsafe has issued a Monitoring Communication to seek more information from clinicians on possible cases of pericarditis following mpox vaccination. This safety communication has been made following two reports to the Centre for Adverse Reactions Monitoring (CARM) of pericarditis suspected to be related to vaccination with mpox. Pericarditis has previously been reported following COVID-19 vaccination.

Healthcare professionals should discuss this potential adverse effect with patients receiving mpox vaccination and advise them to seek medical attention if they experience any symptoms or signs of pericarditis. Any cases of pericarditis after mpox vaccination should be reported to CARM.


GOLD 2023 COPD guidelines are available

Chronic obstructive pulmonary disease (COPD) is underdiagnosed in New Zealand and estimated to be the fourth leading cause of death among adults. National guidelines on the diagnosis and management of COPD were published by the Asthma + Respiratory Foundation NZ in February, 2021. These were largely informed by guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Lung Foundation Australia in 2020.

GOLD has now released updated 2023 guidelines which include a number of key changes, most notably concerning the use of long-acting bronchodilators in treatment.

Given the significant changes in the GOLD 2023 report, we plan to update our COPD prescribing tools on our website, particularly to align with the new “ABE” criteria which prioritises initial use of a combination LABA/LAMA in patients requiring long-acting bronchodilator treatment. However, we will await any revision of New Zealand guidelines in accordance with the GOLD 2023 report. In addition, current Special Authority approval criteria for LABA/LAMA combinations still require patients to be stabilised on LAMA monotherapy first, making these recommendations difficult to apply equitably in practice. Watch this space.

Paracetamol recommended for under 2s prior to Bexsero vaccination

As reported in Bulletin 65, access to the meningococcal B vaccine, Bexsero, has widened from 1 March, 2023, to include all children aged up to 12 months and people aged 13 to 25 years in their first year of a specified close-living situation.

The Immunisation Advisory Centre recently hosted a webinar covering meningococcal disease and the Bexsero vaccine. Click here to watch the recording.

Although not routinely given with vaccinations, prophylactic paracetamol is recommended thirty minutes before administering Bexsero (on its own or with other vaccines) in children aged under two years to treat injection site pain and fever. This may present some practical challenges; consider your strategy for managing this, e.g. asking parents to give the dose before they arrive for the appointment, utilising MPSO for a supply of paracetamol at the practice. Parents should be advised to give a further two doses of paracetamol six and 12 hours after vaccination.

For further information including paracetamol dosing instructions for parents/caregivers, see:

COVID-19 vaccine updates

  • The Pfizer BA.4/5 COVID-19 bivalent booster vaccine (grey cap 15/15 mcg original/omicron; for use in people aged ≥ 16 years) has replaced the original Pfizer booster vaccine; people who are eligible for a first or second COVID-19 booster dose will now receive the bivalent vaccine. Bivalent vaccines include a component of the original strain of SARS-CoV-2 and an omicron strain.
  • An additional booster dose will be available from 1 April, 2023, for people aged 30 years and older, and for those at higher risk of severe illness from COVID-19 if it has been at least six months since their previous dose or positive COVID-19 test. Eligibility criteria for second boosters and additional boosters (from 1 April) can be found here.
  • The Comirnaty purple cap vaccine (30 mcg; for use in people aged ≥ 12 years) has been replaced with two Comirnaty grey cap vaccines:
    • Comirnaty 30 mcg grey cap (for use in people aged ≥ 12 years) replaces the purple cap and is used for primary courses
    • Comirnaty original/omicron 15/15 mcg grey gap (BA.4/5 bivalent vaccine; for use in people aged ≥ 16 years) is used for boosters

Extra attention must be given when preparing these vaccines due to their similar appearance. Grey cap vaccines do not require dilution. Resources, including a fact sheet are available here.

The Immunisation Advisory Centre recently hosted a webinar on this change, including differences between the vaccines, safety and efficacy and practical issues. For those who missed it, the recording can be found here.

Flu season starts next month

The 2023 Influenza Immunisation Programme is just around the corner, beginning 1 April. Access to funded influenza vaccination has been widened this year to include children aged six months to 12 years, and Māori and Pacific peoples aged 55 – 64 years. Funded access will remain for people aged > 65 years or with chronic health conditions.

A summary of the influenza vaccines available in 2023 can be found here. Further information and resources will be available soon.

The Immunisation Advisory Centre is hosting a symposium about influenza and COVID-19 on 9 March, 2023. This may be attended in person or online.

NZF updates for March

You can read about all the changes in the March release here. Also read about any significant changes to the NZF for Children (NZFC), here.

Paper of the Week: Could listening to your favourite tunes reduce pain?

A 2023 observational study among voluntary participants in the Netherlands evaluated the effect of preferred music versus disliked music on pain thresholds and perceived pain intensity. Previous studies have shown that music affects pain perceptions and thresholds but the mechanism of this is currently unclear. Possible mechanisms include that music acts as a distraction, it induces release of endogenous opioids which can be associated with beneficial effects and that it can modulate pain by inducing positive emotions.

The study found that listening to preferred music during painful stimuli was associated with a significantly higher pain threshold and lower perceived pain intensity compared to listening to disliked music. The highest pain thresholds were achieved when the preferred music was preceded by disliked music.

While this study was not conducted in a clinical setting, the findings could be easily applied in general practice. During a painful procedure, offer to play music of the patient’s choice (or ask if they would like to use their phone or earphones); if you really want to replicate the study for an optimal reduction in pain, play some music they don’t like first! (Our suggestion: Baby shark, doo-doo, doo-doo….)

Timmerman H, van Boekel RLM, van de Linde LS, et al. The effect of preferred music versus disliked music on pain thresholds in healthy volunteers. An observational study. PLOS ONE 2023;18:e0280036. doi:10.1371/journal.pone.0280036

This Bulletin is supported by the South Link Education Trust

If you have any information you would like us to add to our next bulletin, please email:

ASK A COLLEAGUE: Are they receiving these bulletins? Sign up to our mailing list here

© This resource is the subject of copyright which is owned by bpacnz. You may access it, but you may not reproduce it or any part of it except in the limited situations described in the terms of use on our website.

Made with by the bpacnz team

Partner links