Published: 11 June, 2021
Contents
CME Conference: subscription giveaway
If you are attending the GP CME conference in Rotorua this weekend, be sure to come have a chat with our colleagues at the BPAC/South Link stand (99-100).
They can run you through some exciting new product developments and answer any questions you may have about bpacnz publications, BPACNZRx
prescribing software, clinical decision support or anything else you would like to know.
We are running a competition to give away five subscriptions to the bpacnz Primary Care Update Series.
Visit the update series homepage, browse the content,
check out the free topic on atrial fibrillation, and enter
your details for your chance to win a free subscription to the eight topics in our
cardiovascular and musculoskeletal themes.
Not attending the conference? Don't worry, you can still enter – the competition is open to all health care professionals and medical,
pharmacy, nursing and other health science students in New Zealand. Hurry, for a limited time only.
Colchicine: ongoing caution needed
In the latest edition of Prescriber
Update, Medsafe reminds clinicians about the risks associated with colchicine.
Between 2016 and January, 2021, 56 colchicine poisoning incidents were reported to the National Poisons Centre. Reasons
for the incidents included young children finding and taking the medicine, errors in dosing (it is not stated whether
the medicine was prescribed in error or the patients took the medicine inappropriately) and intentional overdose. Prescribers
are reminded that colchicine has a narrow therapeutic index and that there is no effective treatment for colchicine poisoning.
Tips to reduce the risk of harm from colchicine
- Check the NZF or another reference to ensure you are prescribing an
appropriate dose, frequency and duration for
the indication you are treating
- Ensure dosing instructions are clearly understood by the patient; the NZF
has a patient leaflet about colchicine
in English and Te Reo Māori versions
- Discuss appropriate storage of the medicine with the patient, including whether a child-resistant closure might
be appropriate
- Inform patients that they can take any unused medicine to their local pharmacy for safe disposal
N.B. We are currently updating our two-part series on gout, including information on
colchicine dosing – watch this
space, and a gout topic is also available in our Primary Care
Update Series.
Nitrofurantoin prescribing
The June edition of Prescriber
Update includes a reminder about prescribing nitrofurantoin by brand. We also highlighted this issue in
Bulletin
20. Most clinicians prescribe generically but to avoid confusion and minimise prescribing errors it is safer for some medicines to be prescribed by brand.
There are now two funded formulations of nitrofurantoin: 50 and 100 mg immediate release tablets (Nifuran) and 100 mg modified release capsules (Macrobid).
A regimen of 100 mg nitrofurantoin modified release, twice daily, is indicated for the treatment of acute uncomplicated urinary tract infection and is
likely to improve treatment adherence.
NZF updates for June
New sections added to the NZF in the June, 2021, release include:
No new patients to be prescribed oxybutynin: liquid to be discontinued
Oxybutynin is indicated for the treatment of urinary frequency,
urgency and incontinence. Due to the supplier of oxybutynin in New Zealand (Apotex)
withdrawing from the market, this medicine is now in short supply and no suitable alternatives have been able to be sourced. As of 1 June, only patients previously
prescribed oxybutynin tablets or liquid can receive a new prescription (pharmacists can endorse the prescription). It is anticipated that stock of oxybutynin
oral liquid will run out by October, 2021, after which it will be discontinued.
PHARMAC is still seeking an alternative supply of 5 mg tablets, but
tablets may also need to be discontinued in the future. PHARMAC has received clinical advice that solifenacin
may be a suitable alternative for some patients.
Opportunity to participate in research on mental health in ethnic Chinese patients
[Human Ethics Committee Reference Number: D21/174]
We are undertaking a research project around the experiences of ethnic Chinese patients who
have accessed mental health therapy in New Zealand. As a primary healthcare provider and first port of call for many
patients seeking help, we would appreciate your insight into this topic. We would like to invite you to participate in a 13-question
survey regarding your experience around mental health consultations with ethnic Chinese patients. The survey takes around
5 minutes to complete. As a token of gratitude, we will distribute the results of this project to all participants
of this survey, as soon as they are available (expected to be in the first half of 2022).
Click here to complete the survey.
With thanks,
Denzel Chung, Student Researcher and Dr Katherine Hall, Senior Lecturer
Early-bird registrations open for the New Zealand Melanoma Summit
The 2021 New Zealand Melanoma Summit is being held in Auckland from the 10-12th September. The focus is on the changing landscape of melanoma care in
New Zealand and proactive, collaborative action to improve our high incidence rates. The conference will also include the official launch of the Quality
Statements to Guide Melanoma Diagnosis and Care in New Zealand. Be part of this important conversation, improve your knowledge of best practice melanoma
care and connect with other passionate health professionals. With a superb line up of internationally recognised experts, interactive workshops on prevention,
diagnosis, clinical management and research, and an optional Certificate of Fundamental Dermatoscopy on the third day, this is an event not to be missed.
Early bird registrations close 30th June. Click here for Further information and to register
Paper of the week: The news is not good for drinkers
Emerging evidence from two different studies has cast further doubt on what constitutes a safe level of alcohol consumption.
In the first study, the authors analysed
data from the UK Biobank, which includes neuroimaging results and clinical data from over 40,000 people.
They found that alcohol consumption had a negative linear association with global brain grey matter volume and widespread negative associations with
white matter microstructure. Higher blood pressure and body mass index and binge-drinking increased the risk of alcohol-related harm to the brain.
However, no safe level of alcohol consumption was found in terms of adverse effects to the brain structure.
In the second study, presented at the American College of
Cardiology 2021 Scientific Session, the authors found that as little as one alcoholic
drink in a person with atrial fibrillation (AF) doubled the risk of an episode of AF occurring within the following three to four hours. The greater
the volume of alcohol consumed, the higher the risk.
Given the growing bank of evidence of association between alcohol consumption and detrimental effects on cardiovascular health, liver and other
major organs, and association with several different types of cancer, it may just be time to call the last round. At the least, we should be consuming
alcohol sparingly, rather than considering the current recommendations for upper limits of alcohol intake as a target to meet. There is no such thing
as no-risk drinking, but low-risk drinking aims to balance the risk of negative health outcomes with the benefits of socially acceptable levels of
consumption that many people enjoy.
For further reading, see: "Assessment and management of alcohol use by primary care", bpacnz,
https://bpac.org.nz/2018/alcohol.aspx
More on the brain study
There was no evidence that any particular type of alcoholic drink caused more harm than another, i.e. no difference between beer, wine or spirit
consumption. What the study is not able to conclude is whether there is a measurable clinical outcome of alcohol-related brain damage at lower
levels of consumption, or whether the brain may compensate
for these small deficits, and also whether the duration and life stage of drinking (e.g. during adolescence) has an influence on results.
It should be noted that this study is a "pre-print" and has not yet been peer-reviewed.
More on the AF study
- 100 patients with paroxysmal atrial fibrillation (AF) who consumed at least one alcoholic drink per month were
fitted with a continuous ECG monitor and transdermal ankle alcohol monitor for four weeks
- Consumption of any alcoholic drink was associated with a two-fold increase in the odds of an AF event within
four hours (OR 2.26, CI 1.50-3.40) and two or more drinks increased the odds more than three-fold (OR 3.58, CI
1.63-7.89)
- Significant effects of alcohol on the risk of AF peaked between three to four hours but lasted up to nine hours
- Alcohol consumption is a modifiable risk factor for patients with AF; ideally patients should be advised to
abstain from alcohol
- The theory is that alcohol reduces the pulmonary vein atrial effective refractory period,
thereby making the atria more prone to fibrillate
This Bulletin is supported by the South Link Education Trust
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