HPE HPE 85 – Spring 2017 - Page 50

Practical therapeutics Postoperative management of neurological drug therapy This article concentrates on the postoperative drug management of epilepsy, Parkinson’s disease, and myasthenia gravis: three conditions in which medicines play a critical role in their management Ben Dorward DPharm MRPharmS Lead Neurosciences Pharmacist, Sheffield Teaching Hospitals NHS Foundation Trust, UK Neurological diagnoses are remarkably common but encompass a wide array of often-rare conditions. Drug therapy is indicated for many neurological conditions, which may be off-licence or unlicensed. The clinical pharmacy team has a pivotal role to play in minimising and mitigating for potential disruption to the routine drug management brought about by surgery. The initial admission to hospital is identified as one of the highest risk periods for prescribing errors generally; 1 for critical medicines, such as those indicated for these conditions, the risks to patients from omission and errors are amplified, and may hinder recovery from surgery. Several studies of patients with Parkinson’s disease admitted to hospital have demonstrated unacceptably high rates of medication error 2,3 and drug dose omissions. 4 48 The principles to approach Established treatments should be continued where possible and pre- emptive planning is always preferable, with involvement of the neurology team if necessary and, where available, specialist nurses and pharmacists. Where indicated, insertion of a nasogastric feeding tube can ensure that routine oral therapy can continue to be administered and the pharmacy team can advise on drug administration via this route, particularly if there is a requirement to swap from slow-release formulations. Each patient must be treated individually and many will have very hospitalpharmacyeurope.com specific drug regimes. For example, dopaminergic drug therapies for Parkinson’s disease and anticholinesterase drugs for MG (pyridostigmine and neostigmine) may need to be given frequently, and at very specific times, for optimal symptom control. Pharmacist-led research exploring patients with Parkinson’s disease admitted to hospital identified anxiety as a central theme to their experiences. 5 Where feasible and appropriate, medication self-administration can help patients to keep control of their condition. It is imperative that patients and their carers are involved in any necessary therapeutic alterations. The importance of ascertaining an accurate drug history, and ensuring prescribed medicines are available and administered, cannot be overstated. The fluctuant and progressive nature of these conditions, and the pharmacological properties of the drug treatments, can necessitate frequent drug alterations and dose titrations, such that primary care records may not accurately reflect the current regime. Where possible, the patient and/or their carer must be consulted to verify the drug history; recent neurology clinic letters and clinical specialist nurses can also be useful resources for further verification. Furthermore, the involvement of a specialist nurse, who has often built a supportive relationship with patients and their carers over the course of their condition, can provide invaluable