DMARD Shared Care Guidelines. Sam Thomson 8/9/2010. DMARDS. DMARDs. Azathioprine = 6 Mercaptopurine Ciclosporin Sodium Aurothiomalate = Myocrisin = Gold Hydroxychloroquine Leflunomide Methotrexate Penicillamine Sulfasalazine. JAPC Shared Care Agreement.
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1. Ensure compatibility with other concomitant medication.
2. Prescribe the dose and formulation recommended.
3. Monitor FBC, U&E, creatinine, LFTs at recommended frequencies and refer if abnormal.
4. Adjust the dose as advised by the specialist.
5. Stop treatment on the advice of the specialist or immediately if any urgent need to stop treatment arises.
6. Report adverse events to the specialist and CSM.
7. Update the patient’s methotrexate booklet
8. Always prescribe oral methotrexate using multiples of the 2.5mg strength tablet, AVOID USING THE 10mg STRENGTH.
1. Discuss the possible benefits and side effects of treatment with the patient.
2. Perform baseline tests (FBC, U&E, & LFT, CXR. PFTs may be undertaken in some patients
3. Provide results of baseline tests
4. Prescribe methotrexate for the first month or until the patient is stable.
5. Recommend dose of the drug and frequency of monitoring.
6. Periodically review the patient and advise the GP promptly on when to adjust the dose, stop treatment or consult with the specialist.
7. Ensure that clear backup arrangements exist for GPs to obtain advice and support.
8. Report adverse events to the CSM and GP.
9. Provide the patient with the NPSA hand held methotrexate booklet
10. Where parenteral methotrexate is used ensure that the patient is trained and able to administer their methotrexate injections or alternative appropriate arrangements for administration are in place
1. Report to the specialist or GP if there is not a clear understanding of the treatment and share any concerns in relation to treatment.
2. Inform specialist or GP of any other medication being taken including over-the-counter products.
3. Report any adverse effects or warning symptoms to the specialist or GP whilst taking the drug.
4. Carry and present their methotrexate booklet to their GP and community pharmacy at each prescribing and dispensing activity
Or how the GP gets paid!
- £5.00 a month per patient on the register
BSR Guidelines and therefore would not normally be familiar with is encompassed in Dept. of Health EL(91)127 “Responsibility for prescribing between Hospitals and GPs”.
- 01332 787710
Out of hours, On call Pharmacist
- 01332 340131 bleep 1395