Published: 6 August, 2021
Contents
What's new: latest articles online
We have been working on updating some of our previous topics and have three new series online now:
Based on the updated New Zealand guidelines, along with best practice guidance, this series of five articles guides primary care health
professionals to help patients select the right contraceptive option for them. The series includes comprehensive information on each method
of contraception, along with a CME quiz and peer group discussion.
Over a two-part series we discuss the challenges of ensuring that gout is well managed in our communities, treatment for gout flares,
prompt initiation and effective titration of urate-lowering treatment and ongoing monitoring and follow-up support.
Emollients form the basis of treatment for all people with eczema, however, they are often not used as well as they could be. The first article
in this series covers the range of pharmacological treatments for eczema, along with self-care techniques and support for caregivers at home.
The second article focuses on topical corticosteroids; how much to use and what potency for where.
New Primary Care Update Series topic now available: Rheumatology Trio
We have recently published a new topic in the Update Series Musculoskeletal theme – the Rheumatology Trio. To purchase this update, or to
browse other available topics in the musculoskeletal and cardiovascular systems,
click
here. The first topic on Atrial Fibrillation is free!
The Rheumatology Trio includes three 30-minute episodes (narrated slide-casts) discussing the detection and management of polymyalgia
rheumatica, systemic lupus erythematosus and axial spondyloarthritis, with guest commentary from Associate Professor Simon Stebbings.
Although these conditions vary in terms of pathophysiology, clinical presentation and treatment approach, they are all linked in that they are sources of chronic pain and can
affect the quality of life for many patients in primary care, particularly if they are not recognised early. The Trio topic also includes key practice
point resources and a CME quiz.
For a sneak preview of this topic, click here.
Get ready for your Annual Pharmaceutical Report
This year our Annual Report takes a first look at how the challenges and changes to general practice during the COVID-19
pandemic have impacted medicine use in New Zealand.
In the National Report (available to everyone), we seek answers to the following questions:
- Were there changes in the number of dispensed prescriptions overall and was there any evidence of worsening inequities in dispensing by ethnicity?
- What happened to antibiotic dispensing?
- Were more people dispensed antidepressants, anti-anxiety or insomnia medicines?
- Did people keep taking their medicines for long-term conditions, e.g. statins, anti-hypertensives, glucose-lowering medicines?
The second part of the report is the interactive personalised section for primary care prescribers. Here you will find detailed information on your
prescribing trends for 2020, as well as for your practice. You will be able to compare your own data against national trends and those of other prescribers like you.
The Annual Report is coming very soon so make sure you have your Mybpac account and login details ready. Check your
Mybpac login here.
Don’t have a Mybpac account?
Anyone can create an account, but this is especially important if you are a primary care prescriber as you will be able to access personalised
reports and other features. Register your details and start today. It’s free.
Have an account but forgot your username and password?
Reset your password and/or retrieve your login details
here.
New Zealand Formulary updates for August
Significant changes to the NZF in the August, 2021, release include new monographs for rasagiline
and topical tacrolimus, some changes to existing monographs, including empagliflozin, and new therapeutic notes for bronchiectasis, endometriosis and contraceptives.
Read more
- A new monograph for rasagiline, a monoamine-oxidase-B inhibitor for the treatment of
Parkinson's disease;
for more information on the decision to fund rasagiline, see
Bulletin 30
- A new monograph for topical tacrolimus which will be funded from 1 October,
2021, subject to Special Authority
criteria, for people with eczema on the face who are unable to use topical corticosteroids; for further information
on managing eczema, see: Childhood eczema: improving adherence
to treatment basics
- Changes to medicine monographs including calcium salts,
colestipol, empagliflozin
and itraconazole, e.g.
updated dosing regimens, changes to cautions, contra-indications and adverse effects
- New therapeutic notes section added for bronchiectasis and
endometriosis
- Therapeutic notes for contraceptives revised to be in accordance
with New Zealand guidelines (2020)
PHARMAC medicine funding and supply issues
The following issues relating to medicine funding and supply have been recently announced by PHARMAC:
Hydrocortisone with natamycin and neomycin cream (Pimafucort cream) is to be discontinued
The cream will be discontinued from 1 February, 2022 as one of the ingredients is unavailable. However,
PHARMAC advise that the supply of
hydrocortisone with natamycin and neomycin ointment will continue
to be available in New Zealand. A partially funded cream with similar ingredients is also available - triamcinolone
+ neomycin + gramicidin + nystatin cream (Viaderm KC). Prescribers should also note that topical preparations containing
antimicrobials should only be prescribed for localised infections in certain circumstances, e.g. children with angular
chelitis. In most cases, good skin hygiene, a topical antiseptic or an oral antibiotic are likely to be more appropriate.
Regular supplies of paracetamol have resumed
however, dispensing restrictions
will still apply in the short-term until it is felt that the supply has stabilised. Several
of the brands that were made available to “fill the gap” will be delisted on 1 February, 2022.
Varenicline remains out of stock
New Ministry of Health guidelines for mercury exposure
The Ministry of Health has published new
guidelines for the investigation and environmental case management of people exposed to mercury in non-occupational settings.
The guidelines are largely aimed at a Public Health Unit response but contain some practical information for initial detection and management of cases. Common sources
of mercury in the home include broken thermometers and fluorescent light bulbs, amalgam fillings, cosmetics and traditional medicines. Mercury can also accumulate in
food sources such as fish and shellfish (read
more about this here).
A reminder that any suspected or confirmed cases of mercury exposure should be reported via the
Hazardous
Substances Disease and Injury Reporting Tool (HSDIRT);
this is available via Medtech, Indici, MyPractice and Profile patient management systems.
Paper of the week: Electronic devices may affect pacemakers and other implanted medical devices
In May, 2021 the US Food & Drug Administration (FDA)
issued a warning that magnets in cell phones, smart watches and other personal electronic devices with high field strength magnets may interfere with pacemakers and
some other implanted medical devices. The magnets in the electronic devices cause the medical device to enter "magnet mode" and cease functioning until the magnet is
removed; this function is built into medical devices so users can undergo MRI or other scans.
Read more
- The FDA recommends that people with pacemakers, cardioverter defibrillators or other implanted electronic
medical devices should keep personal electronic devices, including cell phones and smart watches, at least 15
cm away from their medical device
- Electronic devices should not be carried in pockets over a medical device
- Apple has published a list of products that should be kept at a
safe distance from implanted electronic medical
devices; this includes iPhone 12 models, Apple Watches, AirPods, iPads and MacBooks
- Apple advises customers to keep Apple products at least 15 cm away from their implanted medical device or
at least 30 cm away while wirelessly charging an Apple device
- A small study has found
evidence that the iPhone 12 Pro Max interfered with implanted cardiac devices tested
both in vivo (three people) and ex vivo (11 devices)
This Bulletin is supported by the South Link Education Trust
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