Aust Prescr
-
Penicillin allergies are not always lifelong. Approximately 50% are lost over five years A reaction to penicillin during a childhood infection is unlikely to be a true allergy Only 1–2% of patients with a confirmed penicillin allergy have an allergy to cephalosporins. In patients with a low risk of severe allergic reactions, cephalosporins are a relatively safe treatment option Patients with a history of delayed non-severe reactions, such as mild childhood rashes that occurred over 10 years ago, may be suitable for an oral rechallenge with low-dose penicillin. This should be done in a supervised hospital environment In many cases, with appropriate assessment and allergy testing, it may be possible to remove the penicillin allergy label
-
Amiodarone is a highly effective antiarrhythmic drug, but can have serious adverse effects, particularly in older patients. If possible it should not be used purely for controlling the heart rate If a prescription for amiodarone is contemplated, particularly for an older patient, consult a cardiologist. ⋯ Maintain a high level of suspicion if a patient taking amiodarone is experiencing adverse reactions and presents with new symptoms Consider potential drug interactions when other drugs are prescribed with amiodarone. The effects and toxicities of amiodarone may persist weeks after it is stopped
-
In general, specialist advice should be sought when stopping or switching antipsychotics While antipsychotics are often needed long term, there are circumstances when clinicians, patients and families should reconsider the benefits versus the harms of continuing treatment Withdrawal syndromes, relapse and rebound can occur if antipsychotics are discontinued, especially if they are stopped abruptly. Generally, they should be reduced and stopped slowly, ideally over weeks to months Relapse of psychosis and exacerbation occur in most patients with psychotic disorders, occasionally with drastic consequences. Sometimes this occurs many months after stopping antipsychotics Switching from one antipsychotic to another is frequently indicated due to an inadequate treatment response or unacceptable adverse effects. It should be carried out cautiously and under close observation
-
Drugs excreted by the kidney require dose reduction in chronic kidney disease. This adjustment depends on the severity of the disease and what proportion of the drug is eliminated by the kidneys The estimated glomerular filtration rate can generally be used to guide dose adjustment in patients with stable kidney function. ⋯ Close monitoring of drug effect and toxicity is also needed and can be supported by therapeutic drug monitoring For short courses of drugs with a wide therapeutic index, dose adjustment may not be needed Alternative methods for quantifying kidney function include the Cockcroft-Gault formula (estimates creatinine clearance) or direct measures of glomerular filtration rate using exogenous isotope compounds. These are not commonly required