Adrenaline Injector Pens
We are writing to patients who have recently been prescribed an adrenaline injector pen in case of anaphylaxis (a severe allergic reaction). It may be that we have just issued this for the first time, that your previous pen has been used/expired, or that supply issues have meant we have had to prescribe you a different kind of pen on this occasion. As anaphylaxis is a medical emergency it is vital that you are aware how your current pen is used and that you are confident that it could be administered should it be needed.
Therefore we have attached a guide to your new pen and how it should be used. We would ask you to please take the time to read this and familiarise yourself with the technique for using it, as well as the other information attached. After reading the instructions, if you are still unsure of how to administer your new pen, please speak to your local pharmacist. In addition, we would ask you to kindly provide an up to date weight measurement if this has recently changed – this is particularly important in children, as a switch to adult doses is needed when body weight reaches 30kg.
Emerade
You must keep two pens with you at all times. Anaphylaxis is a medical emergency requiring immediate medical treatment. Please call an ambulance immediately. The first pen should be administered without delay and after 5-15 minutes, if symptoms are not improving, the second pen should be used. This may happen in the time before an ambulance arrives.
Regularly check the expiry dates and contact the surgery for a further supply in advance of your Emerade expiring.
Sign up for the free expiry alert service, which sends an email to remind you when your Emerade pen is about to expire (link below).
Check the ‘Inspection Window’ regularly to make sure the solution is clear and colourless by lifting the label. If the solution becomes discoloured or contains particles, it will need to be replaced, even if this occurs before the expiry date.
Store your Emerade away from extremes of temperature e.g. avoid leaving in the car on a hot day.
Make sure you know how to use your pen by reading the instructions carefully.
Watch the training video for more information:
https://www.emerade-bausch.co.uk/patient
It is recommended to share Emerade instructions with your family members, carers or teachers as appropriate.
How to use:
Remove the needle shield (only one side of the pen has a cap)
Press against the outer thigh, you will hear a click when the injection goes into the muscle.
Hold in place for five seconds
Massage the injection area gently
Dial 999 (or ask someone else to) and say anaphylaxis
Epipen
You must keep two pens with you at all times. Anaphylaxis is a medical emergency requiring immediate medical treatment. Please call an ambulance immediately. The first pen should be administered without delay and after 5-15 minutes, if symptoms are not improving, the second pen should be used. This may happen in the time before an ambulance arrives.
Regularly check the expiry dates and contact the surgery for a further supply in advance of your Epipen expiring.
Sign up for the free expiry alert service, which sends a text or email to remind you when your Epipen is about to expire (link below).
Check the ‘Viewing Window’ regularly to make sure the solution is clear and colourless. If the solution becomes discoloured or contains particles, it will need to be replaced, even if this occurs before the expiry date.
Store your Epipen in its outer container (to protect from light) and away from extremes of temperature e.g. avoid leaving in the car on a hot day
Make sure you know how to use your pen by reading the instructions carefully
Watch the training video for more information:
https://www.epipen.co.uk/en-gb/patients/your-epipen/how-to-use-your-epipen
If you are still unsure, consider ordering a training pen for free from the Epipen website, which is a reusable pen to practice with as many times as you like.
It is recommended to share Epipen instructions with your family members, carers or teachers as appropriate.
How to use:
Remove Blue safety cap – Hold Epipen in dominant hand and take off blue safety cap. Remember ‘blue to the sky, orange to the thigh’
Position the Orange tip – Hold the Epipen at a 90ᵒ right angle to the thigh, with the orange tip pointing to the thigh
Jab the Orange tip – Jab the Epipen firmly into outer thigh at a right angle, hold for 3 seconds before carefully removing and discarding
Dial 999 – Dial 999 (or ask someone else to) and say anaphylaxis
Jext
You must keep two pens with you at all times. Anaphylaxis is a medical emergency requiring immediate medical treatment. Please call an ambulance immediately. The first pen should be administered without delay and after 5-15 minutes, if symptoms are not improving, the second pen should be used. This may happen in the time before an ambulance arrives.
Regularly check the expiry dates and contact the surgery for a further supply in advance of your Jext expiring.
Sign up for the free expiry alert service, which sends a text or email to remind you when your Jext pen is about to expire (link below).
Download the Jext app if you have a smartphone for instructions on how to use and information on anaphylaxis.
Check the ‘Inspection Window’ regularly to make sure the solution is clear and colourless. If the solution becomes discoloured or contains particles, it will need to be replaced, even if this occurs before the expiry date.
Store your Jext in its outer container (to protect from light) and away from extremes of temperature e.g. avoid leaving in the car on a hot day.
Make sure you know how to use your pen by reading the instructions carefully.
Watch the relevant training video for more information: Adults – https://adults.jext.co.uk/
Teenagers (12-18 years) – https://teens.jext.co.uk/
Children (7-11 years) – https://kids.jext.co.uk/
It is recommended to share Jext instructions with your family members, carers or teachers as appropriate.
How to use:
Hold the Jext pen in your dominant hand with your thumb closest to the yellow cap.
Remove yellow cap with your other hand.
Place the black injector tip against your outer thigh, holding at a 90ᵒ right angle.
Push the black tip firmly into your outer thigh until you hear a ‘click’, then keep it pushed in. Hold the injector firmly in place against the thigh for 10 seconds, then remove. The black tip will extend automatically and hide the needle.
Massage the injection area for 10 seconds.
Dial 999 (or ask someone else to) and say anaphylaxis
Therefore we have attached a guide to your new pen and how it should be used. We would ask you to please take the time to read this and familiarise yourself with the technique for using it, as well as the other information attached. After reading the instructions, if you are still unsure of how to administer your new pen, please speak to your local pharmacist. In addition, we would ask you to kindly provide an up to date weight measurement if this has recently changed – this is particularly important in children, as a switch to adult doses is needed when body weight reaches 30kg.
Emerade
You must keep two pens with you at all times. Anaphylaxis is a medical emergency requiring immediate medical treatment. Please call an ambulance immediately. The first pen should be administered without delay and after 5-15 minutes, if symptoms are not improving, the second pen should be used. This may happen in the time before an ambulance arrives.
Regularly check the expiry dates and contact the surgery for a further supply in advance of your Emerade expiring.
Sign up for the free expiry alert service, which sends an email to remind you when your Emerade pen is about to expire (link below).
Check the ‘Inspection Window’ regularly to make sure the solution is clear and colourless by lifting the label. If the solution becomes discoloured or contains particles, it will need to be replaced, even if this occurs before the expiry date.
Store your Emerade away from extremes of temperature e.g. avoid leaving in the car on a hot day.
Make sure you know how to use your pen by reading the instructions carefully.
Watch the training video for more information:
https://www.emerade-bausch.co.uk/patient
It is recommended to share Emerade instructions with your family members, carers or teachers as appropriate.
How to use:
Remove the needle shield (only one side of the pen has a cap)
Press against the outer thigh, you will hear a click when the injection goes into the muscle.
Hold in place for five seconds
Massage the injection area gently
Dial 999 (or ask someone else to) and say anaphylaxis
Epipen
You must keep two pens with you at all times. Anaphylaxis is a medical emergency requiring immediate medical treatment. Please call an ambulance immediately. The first pen should be administered without delay and after 5-15 minutes, if symptoms are not improving, the second pen should be used. This may happen in the time before an ambulance arrives.
Regularly check the expiry dates and contact the surgery for a further supply in advance of your Epipen expiring.
Sign up for the free expiry alert service, which sends a text or email to remind you when your Epipen is about to expire (link below).
Check the ‘Viewing Window’ regularly to make sure the solution is clear and colourless. If the solution becomes discoloured or contains particles, it will need to be replaced, even if this occurs before the expiry date.
Store your Epipen in its outer container (to protect from light) and away from extremes of temperature e.g. avoid leaving in the car on a hot day
Make sure you know how to use your pen by reading the instructions carefully
Watch the training video for more information:
https://www.epipen.co.uk/en-gb/patients/your-epipen/how-to-use-your-epipen
If you are still unsure, consider ordering a training pen for free from the Epipen website, which is a reusable pen to practice with as many times as you like.
It is recommended to share Epipen instructions with your family members, carers or teachers as appropriate.
How to use:
Remove Blue safety cap – Hold Epipen in dominant hand and take off blue safety cap. Remember ‘blue to the sky, orange to the thigh’
Position the Orange tip – Hold the Epipen at a 90ᵒ right angle to the thigh, with the orange tip pointing to the thigh
Jab the Orange tip – Jab the Epipen firmly into outer thigh at a right angle, hold for 3 seconds before carefully removing and discarding
Dial 999 – Dial 999 (or ask someone else to) and say anaphylaxis
Jext
You must keep two pens with you at all times. Anaphylaxis is a medical emergency requiring immediate medical treatment. Please call an ambulance immediately. The first pen should be administered without delay and after 5-15 minutes, if symptoms are not improving, the second pen should be used. This may happen in the time before an ambulance arrives.
Regularly check the expiry dates and contact the surgery for a further supply in advance of your Jext expiring.
Sign up for the free expiry alert service, which sends a text or email to remind you when your Jext pen is about to expire (link below).
Download the Jext app if you have a smartphone for instructions on how to use and information on anaphylaxis.
Check the ‘Inspection Window’ regularly to make sure the solution is clear and colourless. If the solution becomes discoloured or contains particles, it will need to be replaced, even if this occurs before the expiry date.
Store your Jext in its outer container (to protect from light) and away from extremes of temperature e.g. avoid leaving in the car on a hot day.
Make sure you know how to use your pen by reading the instructions carefully.
Watch the relevant training video for more information: Adults – https://adults.jext.co.uk/
Teenagers (12-18 years) – https://teens.jext.co.uk/
Children (7-11 years) – https://kids.jext.co.uk/
It is recommended to share Jext instructions with your family members, carers or teachers as appropriate.
How to use:
Hold the Jext pen in your dominant hand with your thumb closest to the yellow cap.
Remove yellow cap with your other hand.
Place the black injector tip against your outer thigh, holding at a 90ᵒ right angle.
Push the black tip firmly into your outer thigh until you hear a ‘click’, then keep it pushed in. Hold the injector firmly in place against the thigh for 10 seconds, then remove. The black tip will extend automatically and hide the needle.
Massage the injection area for 10 seconds.
Dial 999 (or ask someone else to) and say anaphylaxis
Medication and Dehydration: Sick Day Rules
What is the potential problem?
Taking certain medicines when you are dehydrated can result in you developing a more serious illness. The ‘Medicine Sick Day Rules’ lists medicines that should be temporarily stopped during a dehydrating illness.
ACE inhibitors: a medicine for high blood pressure and heart conditions. If you are dehydrated, these medicines can stop your kidneys working properly.
Examples: names ending in ‘pril’ such as lisinopril, perindopril, ramipril
ARBs: a medicine for high blood pressure and heart conditions. If you are dehydrated, these medicines can stop your kidneys working properly.
Examples: names ending in ‘sartan’ such as losartan, candesartan, valsartan
Diuretics: sometimes called ‘water pills’ for excess fluid and high blood pressure. These medicines can make dehydration more likely.
Examples: furosemide, bendroflumethiazide, indapamide, spironolactone
Metformin: a medicine for diabetes. Dehydration can make it more likely that you will develop a serious side effect called lactic acidosis.
NSAIDs: anti-inflammatory pain killers. If you are dehydrated, these medicines can stop your kidneys working properly.
Examples: ibuprofen, naproxen, diclofenac
SGLT2 inhibitors: A medication used in the treatment of Diabetes, Kidney disease or Heart Failure. These medicines can make dehydration more likely and if you have diabetes can cause acid to build up if you are unwell.
Examples: names ending in flozin’ such as canagliflozin, dapagliflozin, empagliflozin, ertugliflozin
Which illnesses cause dehydration?
Dehydration is the loss of fluid from your body. Vomiting, diarrhoea and fever (high temperature, sweats, shaking) can make you dehydrated. If you are sick once or have diarrhoea once, then you are unlikely to become dehydrated. Having two or more episodes of vomiting or diarrhoea can lead to dehydration: in these cases, you should follow the advice on this page.
What actions should I take?
If you develop a dehydrating illness, you should temporarily stop taking any medicine listed on this page and any other medicine identified by your health professional. It is very important that you restart your medicine once you have recovered from the illness. This would normally be after 24 to 48 hours of eating and drinking normally. When you restart your medicine, just take them as normal. Do not take extra for the doses you have missed.
This information is taken from https://ihub.scot/media/1401/20180424-web-medicine-sick-day-rules-patient-leaflet-web-v20.pdf
Taking certain medicines when you are dehydrated can result in you developing a more serious illness. The ‘Medicine Sick Day Rules’ lists medicines that should be temporarily stopped during a dehydrating illness.
ACE inhibitors: a medicine for high blood pressure and heart conditions. If you are dehydrated, these medicines can stop your kidneys working properly.
Examples: names ending in ‘pril’ such as lisinopril, perindopril, ramipril
ARBs: a medicine for high blood pressure and heart conditions. If you are dehydrated, these medicines can stop your kidneys working properly.
Examples: names ending in ‘sartan’ such as losartan, candesartan, valsartan
Diuretics: sometimes called ‘water pills’ for excess fluid and high blood pressure. These medicines can make dehydration more likely.
Examples: furosemide, bendroflumethiazide, indapamide, spironolactone
Metformin: a medicine for diabetes. Dehydration can make it more likely that you will develop a serious side effect called lactic acidosis.
NSAIDs: anti-inflammatory pain killers. If you are dehydrated, these medicines can stop your kidneys working properly.
Examples: ibuprofen, naproxen, diclofenac
SGLT2 inhibitors: A medication used in the treatment of Diabetes, Kidney disease or Heart Failure. These medicines can make dehydration more likely and if you have diabetes can cause acid to build up if you are unwell.
Examples: names ending in flozin’ such as canagliflozin, dapagliflozin, empagliflozin, ertugliflozin
Which illnesses cause dehydration?
Dehydration is the loss of fluid from your body. Vomiting, diarrhoea and fever (high temperature, sweats, shaking) can make you dehydrated. If you are sick once or have diarrhoea once, then you are unlikely to become dehydrated. Having two or more episodes of vomiting or diarrhoea can lead to dehydration: in these cases, you should follow the advice on this page.
What actions should I take?
If you develop a dehydrating illness, you should temporarily stop taking any medicine listed on this page and any other medicine identified by your health professional. It is very important that you restart your medicine once you have recovered from the illness. This would normally be after 24 to 48 hours of eating and drinking normally. When you restart your medicine, just take them as normal. Do not take extra for the doses you have missed.
This information is taken from https://ihub.scot/media/1401/20180424-web-medicine-sick-day-rules-patient-leaflet-web-v20.pdf
Wasted Medication
The cost of wasted medication
Unused prescription medicines cost the NHS in the UK an estimated £300million every year. This could pay for:
11,778 MORE community nurses or
80,906 MORE hip replacements or
19,799 MORE drug treatment courses for breast cancer or
300,000 MORE drug treatment courses for Alzheimer’s or
312,175 MORE cataract operations
How Can You Help?
1. Only order the medicines that you need
Please let your GP or Pharmacist know if you’ve stopped taking any of your medicines
Check what medicines you still have at home before re-ordering
Discuss your medication with your GP or Pharmacist on a regular basis
Think carefully before ticking all the boxes on your repeat prescription forms and only tick those you really need
If you don’t need the medicine please don’t order it! If you need the medicine in the future you can still request it.
If you need to go into hospital, please remember to take all your medicines with you in a clearly marked bag.
Please also remember that your medicines are prescribed only for you; it’s not safe to share them with anyone else.
2. Remember that unused medicines cannot be recycled
Even if you never open them, once medicines have left the Pharmacy, they cannot be recycled or used by anyone else.
Please bring your unused medicines to the Pharmacy for safe disposal.
NEVER dispose of your unused or unwanted medicines down the toilet
3. Unused medicines are a safety risk
Return out of date medicines to your pharmacy or dispensary for safe disposal
If your medicines change – return your old medicines to the pharmacy for safe disposal to avoid mixing them up with your new medicines
Don’t stockpile medication – it is a safety risk for children and others who might take them
Store medicines in an appropriate place out of reach of children
This information has come from the following source: http://www.medicinewaste.com/help
Unused prescription medicines cost the NHS in the UK an estimated £300million every year. This could pay for:
11,778 MORE community nurses or
80,906 MORE hip replacements or
19,799 MORE drug treatment courses for breast cancer or
300,000 MORE drug treatment courses for Alzheimer’s or
312,175 MORE cataract operations
How Can You Help?
1. Only order the medicines that you need
Please let your GP or Pharmacist know if you’ve stopped taking any of your medicines
Check what medicines you still have at home before re-ordering
Discuss your medication with your GP or Pharmacist on a regular basis
Think carefully before ticking all the boxes on your repeat prescription forms and only tick those you really need
If you don’t need the medicine please don’t order it! If you need the medicine in the future you can still request it.
If you need to go into hospital, please remember to take all your medicines with you in a clearly marked bag.
Please also remember that your medicines are prescribed only for you; it’s not safe to share them with anyone else.
2. Remember that unused medicines cannot be recycled
Even if you never open them, once medicines have left the Pharmacy, they cannot be recycled or used by anyone else.
Please bring your unused medicines to the Pharmacy for safe disposal.
NEVER dispose of your unused or unwanted medicines down the toilet
3. Unused medicines are a safety risk
Return out of date medicines to your pharmacy or dispensary for safe disposal
If your medicines change – return your old medicines to the pharmacy for safe disposal to avoid mixing them up with your new medicines
Don’t stockpile medication – it is a safety risk for children and others who might take them
Store medicines in an appropriate place out of reach of children
This information has come from the following source: http://www.medicinewaste.com/help
Testosterone Replacement Treatment (TRT)
What is testosterone?
Testosterone is a hormone produced by the testicles. It can be given to men as replacement therapy when the body’s natural testosterone levels fall too low. The aim of treatment is to restore testosterone levels to the normal state without any adverse effects.
How to take or use testosterone
A doctor has decided that testosterone replacement therapy may be of benefit to you. Before you start this treatment;
Please read the manufacturer’s printed information leaflet from inside your pack. The leaflet gives information about the specific brand of testosterone you have been given.
Take or use the testosterone exactly as your doctor has directed (your dose will be printed on the label of your medication pack to remind you).
If you are using Testim®, Testogel® or Tostran® gels: apply the gel at about the same time each day, to a clean, dry area of your skin. The manufacturer’s information leaflet will explain which areas of your skin your gel can be applied to – please read this carefully before you use the gel.
If you are having injections: these are usually given by the practice nurse on a regular basis, so please make sure you know when your next treatment is due and book an appointment for this.
Please note: if you are using a gel, testosterone can be transferred to other people through close skin contact. This may cause side-effects in the other person. To prevent this from happening, cover the treated area with clothes or wait for at least four hours after applying the gel before you have close contact. It is very important that pregnant women avoid contact with any areas of your skin which have been treated with testosterone gel.
Getting the most from your testosterone treatment
It is important to have regular monitoring of your treatment, especially in the first year.
You will need a blood test followed by an appointment with your GP at 3, 6 and 12 months after treatment commences (and annually thereafter).
It is very important that you book an appointment with the phlebotomist at the surgery for a blood test at these time intervals.
After the blood tests, book an appointment with your GP to review the results and check your blood pressure, weight and the effectiveness of treatment.
Can testosterone cause problems?
Along with beneficial effects, many medicines can have unwanted side-effects although not everyone experiences them. Testosterone therapy can cause skin reactions. For example, if you are receiving the testosterone via an intra-muscular injection, skin redness, bruising or swelling may occur at the injection site. Other potential side effects will be listed in the manufacturer’s leaflet. Please report any problems to your pharmacist or GP.
Why are regular blood tests needed?
Whichever type of testosterone replacement therapy you use, you need to have your blood levels of testosterone measured to check that you are getting the right amount of hormone.
In patients over the age of 40, the prostate gland should be checked regularly by a blood test (the PSA – further information is available on the surgery’s website) and by physical examination (which includes a ‘digital rectal examination’ to examine the prostate gland. This is when a doctor inserts a gloved finger through the back passage to feel the back of the prostate gland). These tests are needed because testosterone can stimulate growth of the prostate and it is important to ensure the gland remains healthy while you are on treatment. Men with a history of prostate cancer should not take testosterone.
It is also important to have regular checks of your ‘full blood count’ because on testosterone treatment, the blood can sometimes become too thick.
Is there anything I can do to improve the effectiveness of my treatment?
Absolutely! Even mild changes to your lifestyle can improve testosterone levels.
In some patients, a reduction of 10% in bodyweight was associated with increased levels of testosterone in the blood. Weight loss can be achieved through dietary changes.
Exercise has long been associated with an increase in male testosterone levels and recent studies have shown that regular aerobic exercise in overweight individuals produces a significant rise in testosterone levels.
The illicit use of drugs such as marijuana and opiates is associated with reduced testosterone production in males and should be avoided.
Alcohol consumption needs to be moderated to avoid liver disease, which is also associated with testosterone deficiency. The Chief Medical Officers’ (CMO) guidelines for men states that it issafest not to drink more than 14 units of alcohol per week on a regular basis. If you regularly drink as much as 14 units per week, it’s best to spread your drinking evenly over three or more days and have several alcohol-free days in the week.
Testosterone is a hormone produced by the testicles. It can be given to men as replacement therapy when the body’s natural testosterone levels fall too low. The aim of treatment is to restore testosterone levels to the normal state without any adverse effects.
How to take or use testosterone
A doctor has decided that testosterone replacement therapy may be of benefit to you. Before you start this treatment;
Please read the manufacturer’s printed information leaflet from inside your pack. The leaflet gives information about the specific brand of testosterone you have been given.
Take or use the testosterone exactly as your doctor has directed (your dose will be printed on the label of your medication pack to remind you).
If you are using Testim®, Testogel® or Tostran® gels: apply the gel at about the same time each day, to a clean, dry area of your skin. The manufacturer’s information leaflet will explain which areas of your skin your gel can be applied to – please read this carefully before you use the gel.
If you are having injections: these are usually given by the practice nurse on a regular basis, so please make sure you know when your next treatment is due and book an appointment for this.
Please note: if you are using a gel, testosterone can be transferred to other people through close skin contact. This may cause side-effects in the other person. To prevent this from happening, cover the treated area with clothes or wait for at least four hours after applying the gel before you have close contact. It is very important that pregnant women avoid contact with any areas of your skin which have been treated with testosterone gel.
Getting the most from your testosterone treatment
It is important to have regular monitoring of your treatment, especially in the first year.
You will need a blood test followed by an appointment with your GP at 3, 6 and 12 months after treatment commences (and annually thereafter).
It is very important that you book an appointment with the phlebotomist at the surgery for a blood test at these time intervals.
After the blood tests, book an appointment with your GP to review the results and check your blood pressure, weight and the effectiveness of treatment.
Can testosterone cause problems?
Along with beneficial effects, many medicines can have unwanted side-effects although not everyone experiences them. Testosterone therapy can cause skin reactions. For example, if you are receiving the testosterone via an intra-muscular injection, skin redness, bruising or swelling may occur at the injection site. Other potential side effects will be listed in the manufacturer’s leaflet. Please report any problems to your pharmacist or GP.
Why are regular blood tests needed?
Whichever type of testosterone replacement therapy you use, you need to have your blood levels of testosterone measured to check that you are getting the right amount of hormone.
In patients over the age of 40, the prostate gland should be checked regularly by a blood test (the PSA – further information is available on the surgery’s website) and by physical examination (which includes a ‘digital rectal examination’ to examine the prostate gland. This is when a doctor inserts a gloved finger through the back passage to feel the back of the prostate gland). These tests are needed because testosterone can stimulate growth of the prostate and it is important to ensure the gland remains healthy while you are on treatment. Men with a history of prostate cancer should not take testosterone.
It is also important to have regular checks of your ‘full blood count’ because on testosterone treatment, the blood can sometimes become too thick.
Is there anything I can do to improve the effectiveness of my treatment?
Absolutely! Even mild changes to your lifestyle can improve testosterone levels.
In some patients, a reduction of 10% in bodyweight was associated with increased levels of testosterone in the blood. Weight loss can be achieved through dietary changes.
Exercise has long been associated with an increase in male testosterone levels and recent studies have shown that regular aerobic exercise in overweight individuals produces a significant rise in testosterone levels.
The illicit use of drugs such as marijuana and opiates is associated with reduced testosterone production in males and should be avoided.
Alcohol consumption needs to be moderated to avoid liver disease, which is also associated with testosterone deficiency. The Chief Medical Officers’ (CMO) guidelines for men states that it issafest not to drink more than 14 units of alcohol per week on a regular basis. If you regularly drink as much as 14 units per week, it’s best to spread your drinking evenly over three or more days and have several alcohol-free days in the week.