Near Patient Testing - Drugs Requiring Monitoring in Primary Care Guideline
Register
Click above button and pick first ever for first time DMARD prescribed or new event
if changing to another dmard or if there has been a gap in prescribing
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Patient on DMARDS Register:
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< "1/1/1800" AND (EPISODE = "EPI001 " OR EPISODE = "EPI002 ") AND (READ_CODE = "9kD..00 " OR READ_CODE = "9kN6.00 ")'>
Last 1 Medical History Records Where ENDDATE < "1/1/1800" AND (EPISODE = "EPI001 " OR EPISODE = "EPI002 ") AND (READ_CODE = "9kD..00 " OR READ_CODE = "9kN6.00 ")
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To remove from DMARD register edit above entry and add end date
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Any previous entry on DMARD Register
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Last 2 All other Clinical Data Records Where (EPISODE = "EPI001 " OR EPISODE = "EPI002 ") AND (READ_CODE = "9kD..00 " OR READ_CODE = "9kN6.00 ")
Recalls
Last 1 Recall Records Where READ_CODE2 = "9kD..00 "
Patient Hospital Review
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Check if patient still attending secondary care clinics and record date last seen
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<Seen at Rheumatology>
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<Seen at Dermatology>
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<Seen by Gastroenterologist>
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<Seen At Other Clinic>
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Shows last clinic Patient Reviewed in
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Last 1 Medical History Records Where READ_CODE = "9N1O.00 " OR READ_CODE = "9N1S.00 " OR READ_CODE = "9N1g.00 " OR READ_CODE = "9N1y.00 "
Patient Information Required?
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<HTML><A HREF="http://www.arc.org.uk/arthinfo/publist.asp?ProductClassID=2">Arthritis Research Campaign</A></HTML>
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/OurWebsites/TaysideRheumatologyServices/index.htm
">Rheumatology Website</A></HTML>
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<Dmard Leaflet Given>
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<Medication Counselling>
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Last 1 Medical History Records Where READ_CODE = "9kN3.00 "
Last 1 Medical History Records Where READ_CODE = "6774.00 "
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<HTML></HTML> http://www.arc.org.uk/arthinfo/publist.asp?ProductClassID=2<HTML></HTML>
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<HTML></HTML> http://www.arc.org.uk/arthinfo/publist.asp?ProductClassID=2<HTML></HTML>
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Medication Prescribed (Last 3)
Last 3 Acute and Repeat Issue Therapy Records Where READ_CODE = "h71" OR READ_CODE = "h82" OR READ_CODE = "ee1" OR READ_CODE = "j59" OR READ_CODE = "bb4" OR READ_CODE = "h33" OR READ_CODE = "h34" OR READ_CODE = "h3G" OR READ_CODE = "dx1" OR READ_CODE = "lc9 " OR READ_CODE = "h84"
Last 3 Acute and Repeat Issue Therapy Records Where READ_CODE = "j52" OR READ_CODE = "iw1 " OR READ_CODE = "hh1" OR READ_CODE = "j51" OR READ_CODE = "aa6" OR READ_CODE = "j55 " OR READ_CODE = "H8F" OR READ_CODE = "h89" OR READ_CODE = "h8G " OR READ_CODE = "h87" OR READ_CODE = "h8I" OR READ_CODE = "H8B"
Immunisations Pneumococcal or Influenza
Last 1 Immunisations Records Where READ_CODE = "6572" OR READ_CODE = "657P.00 "
Last 1 All other Clinical Data Records Where READ_CODE = "6572" OR READ_CODE = "657P"
Last 1 Immunisations Records Where READ_CODE = "65E..00 " OR READ_CODE = "65E2.00 "
Monitoring Changes
Have secondary care altered monitoring schedule due to stability of blood tests
for example, methotrexate being monitored 3 monthly? Record using button below
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Last 1 Medical History Records Where READ_CODE = "66P9.00 "
Blood Tests Reviewed
Please check last bloods for abnormalities and check history of blood tests
under drug prescribed for any downward trends then Record below
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Last 1 Medical History Records Where READ_CODE = "66P7.00 "
Checking for Adverse Effects
Has patient suffered from a sore throat, fever, rash, abnormal bruising,
oral ulceration or breathlessness or any other significant signs or symptoms?
Record Discussed with patient below
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<DMARD Side Effects Checked for >
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Last 1 Medical History Records Where READ_CODE = "Z4A3.00 "
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If yes let GP/Seconday Care know and record as drug allergy/adverse effect.
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drug allergy & Adverse Reactions>1D 001MVDrug Allergies & Adverse Reactions
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If no adverse effects record below
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Last 1 Medical History Records Where READ_CODE = "8BIJ.00 "
DISEASE MODIFYING DRUGS LINKS TO HOSPITAL DOSE AND MONITORING SCHEDULES
AND RECORD OF BLOOD TESTS
Anti-TNF
Anti-TNFS>1D 002qVWhite blood count 002VVPlatelets 002PVNeutrophil count
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Dose and monitoring schedule
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk//NHSTaysideDocs/groups/rheumatology/documents/documents/docs_072532.pdf">Anti-TNFs</A> </HTML>
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Azathioprine
Blood Results>1D 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 002MVMean corpuscular volume 001uVAlanine Aminotransferase (ALT) 001sVAlkaline Phosphatase 00?MVeGFR
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Dose and monitoring schedule
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk/NHSTaysideDocs/groups/pharmacy/documents/documents/docs_060440.doc">Gastroenterology Azathioprine</A> </HTML>
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_070618.pdf">Rheumatology Azathioprine</A> </HTML>
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_066683&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
">Respiratory Azathioprine</A> </HTML>
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_066682&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
">Azathioprine and Mercaptopurine in IBD</A> </HTML>
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Ciclosporin (Neoral)
Patient Results>1D 000sVBlood pressure 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 001uVAlanine Aminotransferase (ALT) 001sVAlkaline Phosphatase 002WVPotassium 0022VSerum cholesterol 002DVHigh Density Lipoprotein 0024VSerum creatinine 008cVTotal Cholesterol / HDL Ratio 00?MVeGFR
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Dose and monitoring schedule
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If Neoral being used for transplant then confirm with transplant centre the
appropriate monitoring
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_062169.pdf ">Rheumatology Ciclosporin</A> </HTML>
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Dapsone
Dapsone>1D 002qVWhite blood count 002MVMean corpuscular volume 002VVPlatelets 002PVNeutrophil count 002cVReticulocytes 001uVAlanine Aminotransferase 001sVAlkaline Phosphatase 001qVAlbumin 002dVSodium 002WVPotassium 002nVUrea - blood 0024VSerum creatinine 00?MVegfr 002BVHaemoglobin
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=PROD_150541&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1 ">Dapsone</A> </HTML>
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Dronedarone
Dronedarone>1D 0024VSerum creatinine 001uVAlanine Aminotransferase 001sVAlkaline Phosphatase 001qVAlbumin 001sVAlkaline Phosphatase 00?MVeGFR
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_066160&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1 ">Dronedarone</A> </HTML>
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Leflunomide
results leflunomide>1D 000sVBlood pressure 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 001uVAlanine Aminotransferase (ALT) 001sVAlkaline Phosphatase
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_062178.pdf ">Rheumatology Leflunomide</A> </HTML>
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Mercaptopurine
Bloods>1D 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 002MVMean corpuscular volume 001uVAlanine Aminotransferase(ALT) 001sVAlkaline Phosphatase 00?MVeGFR
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/idcplg?IdcService=GET_FILE&dDocName=DOCS_066682&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1
">Azathioprine and Mercaptopurine in IBD</A> </HTML>
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Methotrexate
result methotrexate>1D 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 002MVMean corpuscular volume 001qVAlbumin 001uVAlanine Aminotransferase (ALT) 00?MVeGFR
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Dose and monitoring schedule
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk/NHSTaysideDocs/groups/pharmacy/documents/documents/docs_060441.doc">Gastroenterology Methotrexate</A>
</HTML>
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_062179.pdf ">Rheumatology Methotrexate</A>
</HTML>
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If Methotrexate Dermatology guidance is unavailable please follow rheumatology guidance
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Minocycline
Minocyline>1D 002qVWhite blood count 002VVPlatelets 002MVMean corpuscular volume 002PVNeutrophil count 001uVAlanine Aminotransferase 001sVAlkaline Phosphatase 001qVAlbumin 0024VSerum creatinine 00?MVegfr
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Dose and monitoring schedule
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk//NHSTaysideDocs/groups/rheumatology/documents/documents/docs_073991.pdf ">Minocycline</A> </HTML>
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Mycophenolate
Mycophenolate>1D 001uVAlanine Aminotransferase(ALT) 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 001sVAlkaline Phosphatase 00?MVeGFR
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Dose and monitoring schedule
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If Mycophenolate is being used for transplant then confirm with transplant
centre the appropriate monitoring
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_070617.pdf ">Rheumatology Mycophenolate</A> </HTML>
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Penicillamine
results penicillamine>1D 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 005gVUrinalysis - Protein
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_062182.pdf ">Rheumatology Penicillamine</A> </HTML>
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Riluzole
Riluzole Results>1D 002qVWhite blood count 001uVAlanine Aminotransferase(ALT) 002PVNeutrophil count 002VVPlatelets 001sVAlkaline Phosphatase 0024VSerum creatinine 00?MVeGFR
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Dose and monitoring schedule
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RILUZOLE
Dose:- One tablet (50mg) twice daily, there is no indication for increasing this dose.
Initial Monitoring
FBC - monthly for first three months
LFTs - monthly for first three months
Creatinine - monthly for first three months
Monitoring of bloods after first three months: Every three months - FBC, LFTs, Creatinine. Refer for specialist opinion in the event of abnormal result.
Discontinuation of Therapy
(Discontinue therapy and refer immediately to neurologist)
Agranulocytosis
LFTs more than double normal limits (>90u/1)
Creatinine>200 micromol/1
Reviewed 12th Dec 2008
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Rituximab (Biologic)
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Blood forms come from Hospital therefore need to check Clinical Portal for this Information
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Dose and monitoring schedule
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk//NHSTaysideDocs/groups/rheumatology/documents/documents/docs_088423.pdf ">Rituximab</A> </HTML>
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Sodium Aurothiomalate (Myocrisin)
result myocrisin>1D 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 005gVUrinalysis - Protein
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_062181.pdf ">Rheumatology Myocrisin</A> </HTML>
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Sulfasalazine
result sulphasalazine>1D 002qVWhite blood count 002PVNeutrophil count 002VVPlatelets 002MVMean corpuscular volume 001uVAlanine Aminotransferase (ALT) 001sVAlkaline Phosphatase 001qVAlbumin 00?MVeGFR
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Dose and monitoring schedule
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk/NHSTaysideDocs/groups/pharmacy/documents/documents/docs_060445.doc
">Gastroenterology Sulfasalazine</A></HTML>
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_070616.pdf">Rheumatology Sulfasalazine</A></HTML>
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Tocilizumab (Biologic)
Tocilizumab>1D 002qVWhite blood count 002VVPlatelets 002MVMean corpuscular volume 002PVNeutrophil count 001uVAlanine Aminotransferase 001sVAlkaline Phosphatase 001qVAlbumin 0022VSerum cholesterol 002DVHDL 008cVTotal HDL/LDL Ratio 00?MVegfr
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Dose and monitoring schedule
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<HTML><A HREF="http://eds.tayside.scot.nhs.uk//NHSTaysideDocs/groups/rheumatology/documents/documents/docs_072531.pdf ">Tocilizumab</A> </HTML>
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Methotrexate and Sulfasalazine
Methotrexate and Sulfasalazine>1D 002qVWhite blood count 002PVNeutrophil count 002MVMean corpuscular volume 001qVAlbumin 001uVAlanine Aminotransferase (ALT) 002VVPlatelets 00?MVeGFR
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_062183.pdf ">Rheumatology Methotrexate and Sulfasalazine</A> </HTML>
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Hydroxychloroquine (Rheumatology for Information Only - No Monitoring Required)
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Dose and monitoring schedule
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<HTML><A HREF="http://staffnet.tayside.scot.nhs.uk/NHSTaysideDocs/groups/rheumatology/documents/documents/docs_062175.pdf ">Rheumatology Hydroxychloroquine</A> </P> <A </HTML>
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