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 Formulary Chapter 99: Miscellaneous Resources - Full Chapter
99.02  Expand sub section  Information on Medicines Resources
 note 

The following information resources have been reviewed by the Leeds Medicines Advice Service and may be helpful in answering questions about medicines in Leeds.

Don't forget the BNF and BNFc, Leeds Formulary, and your ward or practice pharmacy teams.

If you need further advice within LTHT, or about medicines started by LTHT, ring the Leeds Medicines Advice Service on ext 65377.

Core General Resources
(Resources)
Formulary
  • The BNF and BNFc have basic information which will answer most general questions. They are also available as an app for iOS and Android
  • Manufacturers' information is available via their SPCs
  • Your ward or practice pharmacy team will be able to help with most queries - contact details will be on your ward in LTHT
  • The Leeds Medicines Advice Service (ext. 65377) can also help for questions from Leeds Teaching Hospitals staff, or for questions about medicines started by Leeds Teaching Hospitals
     
  •    
    Breast feeding and medicines
    (Resources)
    Formulary
  • The BNF and SPCs (section 4.6) are useful starting points, but can be very cautious.
  • Information from the UK Drugs in Lactation Advisory Service make their advice available via the SPS website. Search for your individual medicine then scroll down to information in breastfeeding. Remember that all guidance only applies to full-term and healthy infants.
  • Lactmed is an American resource that may have some useful content. However, it does have lots of information that may need interpretation.
  • If not clear, or if the baby isn't full-term and healthy, contact the Leeds Medicines Advice Service on ext 65377, or the neonatal pharmacy team
  •    
    Fridges for medicines
    (Resources)
    Formulary

    All medicines fridges should be managed such that the temperatures are kept between 2 and 8C. The following resources should not be used to support poor practice. Inform pharmacy if you have any fridge problems

    • LTHT fridge monitoring forms are available here.
    • SPCs have information on the licensed storage conditions for products. Note that this can vary between different manufacturers of the same product, so take care to pick the right SPC.
    • The SPS website has some information on fridge storage. Search for your medicine, then scroll down to the refrigeration section.
    • Section 4 of the HPA Vaccine Incident Guidance covers actions to take when there have been breaks in the cold chain for vaccines.
    • If not clear, contact the Leeds Medicines Advice Service on ext 65377.
     
       
    Interactions
    (Resources)
    Formulary
    • The BNF and SPCs are useful starting points, but may not have much detail on how likely an interaction is, or how to manage it.
    • Medscape Drug Interaction Checker has lots of information, but is very cautious and will flag up theoretical interactions which may not be relevant in practice.
    • Within LTHT, FirstDatabank interaction checker is available via eMEDs - click on 'reference viewer' and select the interaction checker.
    • If not clear, contact the Leeds Medicines Advice Service on ext 65377.
     
       
    IV administration and compatibility
    (Resources)
    Formulary
  • The Medusa IV Administration Guide has adult and paediatric versions.
  • Neonatal IV administration monographs are available via the neonatal formulary.
  • Paediatric ICU and paediatric cardiology IV administration monographs are also available via the Leeds Formulary.
  • SPCs may also have some useful information, though this is sometimes limited.
  • If not clear, contact your ward pharmacy team, who may have local information, or the Leeds Medicines Advice Service on ext 65377. 
  •    
    Pregnancy and medicines
    (Resources)
    Formulary
  • The BNF and SPCs (section 4.6) are useful starting points, but can be very cautious.
  • Summaries of information from the UK Teratology Information Service are available at UKTIS.org. Note that these are summaries only, and more information is available via UKTIS themselves.
  • Patient information leaflets are available via BUMPS. The content can be quite detailed, and may need some explanation by a healthcare professional.
  • For complex or retrospective questions, contact UKTIS directly on 0334 8920909.
  • If not clear, contact the Leeds Medicines Advice Service on ext 65377. 
  •    
    Stock Shortages Advice
    (Resources)
    Formulary

    The following information is provided for the management of current stock shortages where the Leeds Medicines Advisory Service have provided guidance for LTHT. It is not intended to be a comprehensive list of all shortages, or to provide guidance outside of LTHT.

     
    Link  Current stock shortage briefings
    Link  Stock shortage - bile acid sequestrants (updated 6 Aug 19)
    Link  Stock shortage - bupivicaine and fentanyl bags
    Link  Stock shortage - diamorphine 5mg (May 2019)
    Link  Stock shortage - Emerade (adrenaline) injections (August 2019)
    Link  Stock shortage - ketamine 200mg in 20mL (August 2019)
    Link  Stock shortage - phenytoin (Epanutin) liquid (July 2019)
    Link  Stock shortage - sodium thiosulfate 3% injection in extravasation kits (ongoing July 19)
    Link  Stock shortage - urokinase 25,000 units (May 2019)
    Link  Stock shortage - water for inhalation (valid July 19)
    Link  Recently resolved stock shortage briefings
    Link  Stock shortage - Diazemuls (June 2018)
    Link  Stock shortage - fentanyl injection (May 2019)
    Link  Stock shortage - lofepramine (Dec 18)
    Link  Stock shortage - midazolam 5mg in 5mL clinical area briefing (May 2019)
    Link  Stock shortage - midazolam 5mg in 5mL pharmacy briefing (May 2019)
    Link  Stock shortage - levomepromazine (May 2019)
    Link  Stock shortage: Epipens (DoH advice on extending expiry) (Sept 18)
       
     ....
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Green

    Medicines which are appropriate for initiation and ongoing prescribing in both primary and secondary care.  

    Amber 1

    Amber Level 1- Specialist Recommendation
    These medicines are considered suitable for GP prescribing following specialist recommendation.
     
    There is no requirement for full Amber Drug Guidance. Generic Amber Level 1 Drug Guidance detailing responsibilities and information sources is available here
      

    Amber 2

    Amber Level 2- Specialist Initiation but no monitoring requirements
    These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy.
    Some Amber Level 2 products will have an associated Amber Level 2 Drug Guidance document, available by clicking on the traffic light symbol to the right of the drug name. If this is not available, generic Amber Level 2 Drug Guidance is available here  

    Amber 3

    Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)
    Medicines that should be initiated by a specialist, and which require significant monitoring on an ongoing basis. Full agreement to share the care of each specific patient must be reached under the amber drug agreement, and Amber Drug Guidance must be provided to the GP (available by clicking on the traffic light symbol to the right of the drug name).   

    Red

    Guidance on the responsibilities for Red Drugs can be found here. Red Drugs would usually by prescribed by the hospital for the duration of the course. Primary care prescriber initiation or continuation of treatment not recommended except by Specialist GP and community paediatric prescribing.   

    Grey

    Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy.   

    Black

    These drugs are not recommended for use within the Leeds Health Economy  

    Multiple

    Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information the indications for which it has a Traffic Light List classification.  

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