PRESCRIBING TO PRIMARY CARE. The request for shared care should include individual patient information, outlining all relevant aspects of the patients care and which includes direction to the information sheets at xxx.xxxxxxxx.xxx.
PRESCRIBING TO PRIMARY CARE. ▪ The request for shared care should include individual patient information, outlining all relevant aspects of the patient’s care and including direction to the information sheets at xxxxx://xxx.xxxxxxxx.xxx.xx/shared-care/. ▪ If the GP does not agree to share care for the patient, he/she will inform the Specialist of his/her decision in writing within 14 days. ▪ In cases where shared care arrangements are not in place, or where problems have arisen within the agreement and patient care may be affected, the responsibility for the patient’s management, including prescribing reverts to the specialist. CONDITION TO BE TREATED Unlike the pulsed release of insulin from the pancreas, the production of dopamine in the brain is near-constant throughout 24 hours. The principal aim of treatment in Xxxxxxxxx’x disease (PD) is therefore to provide a near-constant supply of dopamine or a dopamine agonist to the brain. The majority of patients are treated with a dopamine agonist first - either ropinirole, pramipexole or rotigotine. Ropinirole and pramipexole are available in prolonged release formulations and rotigotine is a patch. All usually give quite smooth symptom control, but all three can cause significant side effects including compulsive/addictive behaviours such as gambling, compulsive shopping and hypersexuality (which patients rarely recognise as side effects and do not report unless specifically asked). Within 1-5 years most patients also need to take a levodopa preparation (Madopar (co- beneldopa) or Sinemet (co-careldopa)). They may also require supplementary drugs to try and smooth out the delivery of levodopa to the brain (using a Catechol-O-Methyltransferase [COMT] inhibitor such as entacapone, which is also available in a combined tablet with levodopa called Sastravi® or Xxxxxx® or Stalevo® (Stalevo® is less cost effective than other brands)) or to reduce the breakdown of dopamine within the brain [using MAO-B inhibitors such as selegiline or rasagiline]. At night-time patients may need slow-release levodopa preparations and in the morning, they may need dispersible madopar which releases levodopa more quickly. They may need to time when they take levodopa preparations so as to avoid meals with a heavy protein load. If they develop involuntary movements (dyskinesias) these may respond to amantadine or to changes in the size and timing of their levodopa doses. Common additional problems include dementia (which usually merits a referral to old age psych...
PRESCRIBING TO PRIMARY CARE. The request for shared care should include individual patient information, outlining all relevant aspects of the patients care and which includes direction to the information sheets at xxxxx://xxx.xxxxxxxx.xxx.xx/shared-care/. If the GP does not agree to share care for the patient then he/she will inform the Specialist of his/her decision in writing within 14 days. In cases where shared care arrangements are not in place, or where problems have arisen within the agreement and patient care may be affected, the responsibility for the patient’s management including prescribing reverts back to the specialist.
PRESCRIBING TO PRIMARY CARE. ▪ Prescribing responsibility will only be transferred when it is agreed by the Specialist and the primary care prescriber, that the patient’s condition is stable.
PRESCRIBING TO PRIMARY CARE. The request for shared care should include individual patient information, outlining all relevant aspects of the patients care and which includes direction to the prescribing information sheets at xxx.xxxxxxxx.xxx.xx. If the GP does not agree to share care for the patient then he/she will inform the specialist of his/her decision in writing within 14 days. In cases where shared care arrangements are not in place or where problems have arisen within the agreement and patient care may be affected, the responsibility for the patients’ management including prescribing reverts back to the specialist. CONDITION TO BE TREATED Attention deficit hyperactivity disorder (ADHD) in adults. ADHD has onset in childhood and frequently persists into adolescence and adult life. ADHD has an estimated prevalence of 2% in the adult population. ADHD is a heterogeneous behavioural syndrome characterised by the core symptoms of inattention, hyperactivity and impulsivity. Not every person with ADHD has all of these symptoms – some people are predominantly hyperactive and impulsive; others are mainly inattentive. Symptoms of ADHD are distributed throughout the population and vary in severity; only those people with at least a moderate degree of psychological, social and/or educational or occupational impairment in multiple settings should be diagnosed with ADHD. BACKGROUND INFORMATION In adults with ADHD, medication should be offered if symptoms are causing a significant impairment after environmental modifications have been implemented and reviewed. Following a decision to start medication in adults with ADHD, methylphenidate or lisdexamfetamine should be offered as first line pharmacological treatment by the specialist. After a 6-week trial at an adequate dose, but where enough benefit has not been derived, consider switching from methylphenidate to lisdexamfetamine or vice versa. Dexamfetamine should be considered in adults who are responding to lisdexamfteamine but cannot tolerate the longer effect profile. Atomoxetine should be considered in adults who either cannot tolerate methylphenidate or lisdexamfetamine or for those whose symptoms have not responded to separate 6-week trials of methylphenidate and lisdexamfetamine. The same medication choices should be offered to people with ADHD and anxiety disorder, tic disorder or autism spectrum disorder as people with sole ADHD. Medication for adults with ADHD who also misuse substances should only be prescribed by an appropr...
