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Dr Geraint Preest, Clinical Section Editor at BMJ OnExamination, gives you some hints and tips for shared care prescribing.
When revising for the AKT, bare in mind areas of medicine that you may be less familiar with. One example is the area of Shared Care Prescribing. Now shared care prescribing is done for a number of different drug groups, rheumatological drugs such as methotrexate and leflunomide. Cardiology drugs such as amiodarone and drugs used in psychiatry. These are the dementia drugs or methylphenidate to give a few examples.
Methotrexate is perhaps one of the most common shared care drugs so you ought to familiarise with this and you may not be actively involved with this is your practice so make sure you check with someone beforehand so that you’re knowledgeable. Now patients now having methotrexate need regular blood monitoring. This is because of bone marrow suppression, they can have pulmonary toxicity and hepatic problems. We monitor liver function tests and full blood count regularly. The important points with methotrexate prescribing are that first of all it’s weekly dosing, you ought to dose in 2.5mg tablets, the reason for this is that tablets come in different strengths and patients often get used to taking for example six tablets a week or eight a week, if you suddenly change the strength of tablet from a 2.5 then patients can mix up their doses and get a lot more than you intended. This is a common area of error. You should also prescribe folic acid to patients. Also from the point of view of bone marrow suppression, warn patients about sore throats, fevers, ulcers, that sort of thing.
Amiodarone is another shared care drug. You should bare in mind that patients need pre-dosing bloods and ECG. They should get regular testing then of their liver function test and thyroid function usually around 6 months. Inform patients about the possibility of corneal micro deposits. They should get regular eye tests with the optician. There are a few important interactions with amiodarone, that you should be aware of because you may be tested in the exam setting. I’m going to give you three interactions with amiodarone, the first relates to hepatitis C medication which can cause bradycardias and heart block. You should beware of drug that prolong the QT interval, citalopram and escitalopram for example with amiodarone that’s not a combination you want to use. It’s not just medication taken orally, eye drops can also cause problems and a good example is beta blocker eye drops. You shouldn’t use those with amiodarone.
Shared care protocols are really important so make sure you are familiar with it. If you’re not then ask your trainer or one of the GPs working at your practice, as you may be tested on it in the exam.
Citalopram and escitalopram: QT interval prolongation (External Site)