Chapter 4 – DRUGS ACTING ON CENTRAL NERVOUS SYSTEM
Category Drug name Strength / dose / form BCU Comments 4.1 – Hypnotics and anxiolytics 4.1.1 Hypnotics Benzodiazepine mazepam 4.1.2 Anxiolytics Benzodiazepine Beta blockers 4.2 – Drugs used in psychoses and related disorders 4.2.1 Antipsychotic Restricted to specialist psychiatric use only Restricted to specialist psychiatric use only - for rapid tranquillisation only Atypical antipsychotic Orodispersible – restricted patients with swallowing/compliance Consultant psychiatric use only for treatment of resistant schizophrenia
i/m injection for rapid tranquillisation – specialist psychiatric inpatient use only. NB Olanzapine depot – NOT included (Not AWMSG approved) Orodispersible – restricted patients with swallowing/compliance issues XL preparation is approved as a treatment option for schizophrenia by AWMSG Orodispersible – restricted patients with swallowing/compliance issues Category Drug name Strength / dose / form BCU Comments Antipsychotic injections Injection hospital supply only as needs refrigeration 4.2.3 Antimanic drugs Carbamazepine Valproate
“Epilim” and “Epilim Chrono” – unlicensed use Antipsychotic
i/m injection for rapid tranquillisation – specialist psychiatric inpatient use
only Orodispersible – restricted patients with swallowing/compliance issues
XL preparation is NOT approved as a treatment option for manic episodes associated with bipolar disorder by AWMSG
Orodispersible – restricted patients with s swallowing/compliance issues Lamotrigine 4.3 – Antidepressant drugs 4.3.1 Tricyclic and related antidepressant Tricyclic related antidepressant s 4.3.2 Monoamine- oxidase inhibitors (MAOIs) Category Drug name Strength / dose / form BCU Comments Reversible MAOIs 4.3.3 Selective serotonin reuptake inhibitors 4.3.4 Other Initiated by mental health team only antidepressant Initiated by mental health team only 2nd choice When other drugs are not tolerated or are ineffective specialist initiation only – high doses ≥ 300mg daily hosp Scriptswitch VENLALIC XL MR tablets or VENAXX XL MR capsules 4.4 – CNS stimulants and drugs used for attention deficit hyperactivity disorder
CAMHS use only shared care needed
CAMHS use only shared care needed
only shared care needed 4.5 – Drugs used in the treatment of obesity 4.5.1 Anti-
As per NICE guidance - Limited value without behavioural and diet obesity drugs acting on the gastro- intestinal tract 4.6 – Drugs used in nausea and vertigo Antihistamines Phenothiazines and related Palliative care use only Domperidone metoclopramide 5HT antagonists Hyoscine Neurokinin
Not listed but approved 2nd line. Anti-emetic policy review request. Funding
Receptor Antagonist Category Drug name Strength / dose / form BCU Comments (Steroid) palliative review Other drugs for Meniere’s disease 4.7 - Analgesics 4.7.1 Non- analgesics (special) 1g/100mL infusion ▼ as an alternative to opiates or NSAIDs where their use is contra- indicated or inappropriate, or where oral or rectal administration is not tolerated. 1st line choice on basis of safety
Hospital only - Use post-op in patients NBM in order to get NSAID into
3rd line agent following MHRA warning 3rd line agent following MHRA warning 3rd line agent following MHRA warning 2nd line choice Non-opioid and weak opioid Hospital only - use post-surgery compound analgesic preparations 4.7.2 Opioid analgesics
Patches prescribe by brand name. Matrifen preferred
Category Drug name Strength / dose / form BCU Comments palliative review palliative review palliative review palliative review
Morphine sulphate immediate Liquid, tablets and
Liquid – “Oramorph” , Tablets – “Sevredol”
palliative review Neuropathic
Included in the NICE CG for Neuropathic Pain
Included in the NICE CG for Neuropathic Pain. Use bd
Trigeminal neuralgia 4.7.4 – Antimigraine drugs 4.7.4.1 Treatment of acute migraine Analgesics 5HT1 agonists
Tablets 1st line choice – off patent and most cost effective product Antiemetics Prophylaxis of migraine
Category Drug name Strength / dose / form BCU Comments 4.8 Antiepileptic drugs 4.8.1 Control of
The Walton Centre does not have any epilepsy guidelines. epilepsy
New NICE CG for epilepsy due in spring 2011.
Carbamazepine Prescribe by brand and related antiepileptics Ethosuximide analogues Lamotrigine Prescribe by brand Levetiracetam Phenobarbital
Included for continuation therapy only (not usually initiated)
and other barbiturates Phenytoin
Included for continuation therapy (not usually initiated) Prescribe by brand Topiramate Valproate Prescribe by brand Vigabatrin Zonisamide Benzodiazepine 4.8.2 Drugs used in status epilepticus
Special - Buccal midazolam Alternative to IV lorazepam in times of supply issues
4.9 – Drugs used in parkinsonism and related disorders 4.9.1 Dopaminergic drugs used in parkinsonism Dopamine receptor agonists
for those patients for whom oral treatments have been tried and are found to be either ineffective or not tolerated
Category Drug name Strength / dose / form BCU Comments Levodopa Monoamine- oxidase-B inhibitors COMT inhibitors Amantadine Antimuscarinic drugs used in parkinsonism 4.9.3 Drugs choreas, tics and related disorders 4.10 – drugs used in substance dependence Alcohol dependence Cigarette
If a 16 hour patch is required, use the 24 hour patch and remove after 16
21mg over 24 hours) Nicotinell® 2mg, 4mg chewing gum in fruit and mint flavour Nicotinell® 1mg, 2mg mint lozenge Nicorette® 10mg inhalator
For continuation of therapy as per NICE guidance Category Drug name Strength / dose / form BCU Comments
As advised by substance abuse consultant only
dependence
As advised by substance abuse consultant only
As advised by substance abuse consultant only
Only initiated after patient reviewed by Drug & Alcohol Service
As advised by substance abuse consultant only
4.11 – Drugs for dementia
A FRIGIDITÁSRÓL ÉS AZ IMPOTENCIÁRÓL Mindkét fogalom mára már kiment a divatból. Maga a probléma nem, csak a kifejezés… Ugyanis ennek a problémakörnek mára már annyira árnyalt formáit ismerjük, hogy igen felelőtlen dolog volna bármelyiket úgy használni, hogy a mögött egyértelmű problémakört véljünk felismerni. A kérdéskört sokkal összetettebben érdemes
Fundamento científico-biológico Evolución SM ediciones REVISIÓN CIENTÍFICA-BIOLÓGICA DE LIBRO CIENCIAS 1 Dra. Alejandra Huerta-Zepeda Raúl Valadez, Rocío Téllez, Alejandra Alvarado Serie Caleidoscopio Evolución Secundaria México, 2006 184 pp . Bloque 4. Reproducción. Introducción La valoración de este libro pretende hacer un análisis de los fundament