FörordKloka Listan 2013Kloka Listan

Förord

Kloka Listan 2013

Kloka Listan 2013 är evidensbaserade rekommendationer av kostnads-effektiva läkemedel för vanliga sjukdomar i öppen och sluten vård samt av läkemedel med stor användning i specialiserad vård.

Kloka Listan är resultatet av ett omfattande arbete. Stockholms läns läkemedelskommittés 21 expertråd ger förslag på rekommenderade läkemedel inom sina respektive terapiområden. Expertrådens förslag presenteras för Stockholms läns läkemedelskommitté, som är en obunden tvärprofessionell medicinsk styrgrupp för läkemedelsarbetet i SLL. Efter noggranna genomgångar av förslagen fastställs läkemedels-rekommendationerna. Inom områden där preventiva insatser och behandling med läkemedel kan förbättras fastställs Kloka råd. Läkemedelskommittén har sedan som huvuduppgift att genom fortbild-ning sprida och få gehör för evidensbaserade rekommendationer samt Kloka råd hos förskrivare i primärvård, specialiserad öppenvård och vid sjukhusen inom Stockholms län.

Vårt mål är en klok introduktion av nya läkemedel. En obunden värdering av nya läkemedel görs av läkemedelskommitténs expertråd och enheten för nya läkemedel vid Klinisk farmakologi, Karolinska Universitetssjukhuset. Med fortbildning, uppföljning och utvärdering av läkemedlens plats i terapin kan bästa medicinska vård erbjudas befolkningen i Stockholms län.

I expertrådens uppdrag ingår även att medverka vid upphandling av läkemedel för sjukvården. Upphandlingen beräknas 2012 ha gett SLL en kostnadsbesparing på 250 miljoner kronor.

Antibiotika överanvänds. Förskrivningen av antibiotika i SLL bör i det när-maste halveras, från dagens nästan 420 till 250 recept per 1000 invånare och år. Tillsammans med Strama Stockholm fokuserar Stockholms läns läkemedelskommitté på att minska antibiotikaförskrivning som inte är medicinskt motiverad.






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Kloka Listan

Medveten läkemedelsbehandling för största patientnytta







1



Förord


Patientsäkerheten är en mycket viktig fråga för vården. Läkemedels-relaterade problem drabbar många patienter. Alla förskrivare har ett stort ansvar att medverka till att patienterna inte skadas av läke-medelsbehandling.

Gå igenom läkemedeIsbehandlingen i varje patientmöte:

• Beakta patientens samtliga läkemedel.

• Ompröva indikationen.

• Beakta njurfunktionen, interaktioner och överkänslighet.

• Håll patientens läkemedelslista i journalen aktuell.

• Ge patienten en aktuell läkemedelslista.

• Dokumentera i journalen vilka läkemedelsförändringar som görs och varför.

Läs mer om Kloka Listan och Kloka råd på www.janusinfo.se som erbjuder producentobundna informations- och kunskapstjänster om läkemedel för sjukvården.

Eva Andersén Karlsson Carl-Gustaf Elinder

Ordförande Vice ordförande

Stockholms läns Stockholms läns

läkemedelskommitté läkemedelskommitté












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Läsaranvisningar

Läsaranvisningar

Terapiavsnitten är sorterade i alfabetisk ordning. Hänvisningar till rekommendationer för enskilda indikationer finns i registret på sid 128, substanser i registret på sid 134. Rekommendationer som endast avser specialiserad vård anges i rutor med rubriken ”Specialiserad vård”.

Utbytbara läkemedel på recept

För att ett läkemedel ska få bytas ut på apotek ska det finnas upptaget i Läkemedelsverkets lista över utbytbara läkemedel; www.lakemedelsverket.se. Utbytbarhet gäller endast läkemedel inom läkemedelsförmånen; www.tlv.se.

Symbolen används i Kloka Listan för de läkemedel som apoteken kankomma att byta ut när de förskrivs på recept.

För generiskt utbytbara preparat rekommenderas principiellt enbart substansen. I Kloka Listan anges samtliga förekommande preparatnamn enligt ovanstående kriterier. Det betyder att en del preparat inte har angivits beroende på att de inte ingår i läkemedelsförmånen och därför inte får bytas ut på apotek.

När uppräkningen av preparatnamn inleds med ”Substansnamn …” anger ”…” att företagsnamn är utelämnat och att generika finns från ett eller flera olika företag.

Vårdgivarnas följsamhet till Kloka Listan följs upp på substansnivå. Följsamheten påverkas inte av vilket generiskt preparat som förskrivits eller expedierats.

Beställning av läkemedel till slutenvård och andra vårdformer

De preparat som rekommenderas vid beställning till läkemedelsförråd anges i ”Kloka Listan – Rekommenderade och upphandlade preparat med synonymer”. Där anges upphandlade preparat och rekommenderade preparat som har valts utifrån sortimentsbredd, lämpliga förpackningar och prisbild.

Genom att ordinera och beställa upphandlade preparat kan sjukvården spara betydande belopp.






4

Läsaranvisningar


Kloka Listan finns i flera versioner

Kloka Listan på www.janusinfo.se innehåller även motiveringar till rekommendationerna och referenser.

Kloka Listans rekommendationer visas i journalsystemen via SIL (Svensk Informationsdatabas för Läkemedel). Läkemedel som rekommenderas för specialiserad vård markeras inte i journalsystemen.

”Kloka Listan – för patienter och allmänhet” är språkligt anpassad för målgruppen och omfattar inom några områden råd och rekommen-dationer för egenvård utöver de som finns i övriga versioner av Kloka Listan. Rekommendationer som endast avser specialiserad vård finns inte med i denna version.

”Kloka Listan – Rekommenderade och upphandlade preparat med synonymer” finns som hjälp vid ordination och beställning till läke-medelsförråd i olika vårdformer.

Alla tryckta versioner kan beställas via e-post: [e-mail].

Kloka råd

Symbolen används för att ange Stockholms läns läkemedels-kommittés Kloka råd för förbättrad läkemedelsanvändning.

Synpunkter på Kloka Listan välkomnas

Kommentarer och synpunkter på Kloka Listan kan lämnas via e-post till [e-mail].













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Kloka råd

Stockholms läns läkemedelskommitté och dess expertråd utarbetar rekommendationer för hur läkemedelsanvändningen i Stockholms län kan förbättras. Bakgrunden till de Kloka råden beskrivs på www.janusinfo.se.

Kloka råd 2013

Beräkna och beakta njurfunktionen vid val och dosering av läkemedel.

Behandla blodtryck bättre – sätt upp målblodtryck tillsammans med patienten, kombinera mera och följ upp.

Välj i första hand warfarin som tromboemboliprofylax vid förmaks-flimmer. Följ riktlinjer för warfarinbehandling.

Behandla inte asymtomatisk bakteriuri hos äldre. Odla endast vid symtom från urinvägarna.

Avvakta med antibiotika i 2–3 dygn vid okomplicerad otit hos barn 1–12 år.

Behandling med protonpumpshämmare är olämpligt vid magont utan känd orsak.

Bisfosfonat är ofta indicerat efter osteoporosfraktur. Ompröva terapin efter 3–5 år då risken för atypiska frakturer ökar med behandlingstiden.

Undvik propiomazin och tramadol till äldre.






6






Anafylaxi och svår allergisk reaktion

Akuta allergiska reaktioner

ADRENALIN

adrenalin Adrenalin Mylan 1 mg/ml im
adrenalin Anapen injektionspenna
Anapen Junior injektionspenna
adrenalin Jext injektionspenna


Det är viktigt att patienten får lära sig att använda adrenalinpennan av läkare eller sjuksköterska. Observera att patienten alltid ska ha två adrenalinpennor till hands, då injektionen kan behöva upprepas.

ANTIHISTAMINER

cetirizin Cetirizin …
loratadin Loratadin ...

STEROID
betametason Betapred


Anafylaxi, angioödem, urtikaria; Akut internmedicin, Behandlings-program (SLL), www.janusinfo.se

Allergisk rinokonjunktivit sid 8

Astma sid 10

Urtikaria sid 55








Kan bli föremål för generisk substitution på recept 7
... Generika från olika företag


Andningsvägar

Vid mer varaktiga besvär från näsa och bihålor har dagliga sköljningar av näshålan med koksaltlösning visat gynnsam effekt. Information om hjälpmedel kan fås på apotek. Nasal steroid kan användas även under graviditet och amning.

Allergisk rinokonjunktivit

Nasala steroider är effektivare än perorala antihistaminer mot nästäppa.

ANTIHISTAMINER

cetirizin Cetirizin …
loratadin Loratadin …

NASALA STEROIDER

Lägsta möjliga underhållsdos bör eftersträvas.

I första hand

budesonid Desonix
I andra hand
mometason  Nasomet, Nasonex
ÖGONDROPPAR
I första hand
natriumkromoglikat  Lecrolyn, Lomudal
I andra hand – vid otillräcklig effekt
emedastin Emadine







8 Kan bli föremål för generisk substitution på recept
... Generika från olika företag


Andningsvägar
Pseudokrupp

betametason Betapred

Specialiserad vård
adrenalin Adrenalin Mylan 1 mg/ml
Späds för inhalation i nebulisator

Astma
Målet med astmabehandlingen är symtomfrihet och normal lungfunk-
tion. Eftersom astmasjukdomen varierar i svårighetsgrad över tid bör
behandlingen anpassas därefter. Astma behandlas på samma sätt under
graviditet och amning.
Det finns flera olika inhalatorer. Det är lämpligt att tillsammans med
patienten välja den typ av inhalator som passar bäst.
Astma hos vuxna; www.viss.nu
Astma/obstruktiv bronkit hos barn och ungdomar; www.viss.nu
Farmakologisk behandling vid astma; www.lakemedelsverket.se
Steg 1
Astmabesvär enstaka gånger per vecka
KORTVERKANDE BETA-2-STIMULERARE
I första hand
salbutamol Buventol Easyhaler
salbutamol Airomir spray (med spacer)
Vid svårighet att hantera pulverinhalator
terbutalin  Bricanyl Turbuhaler, Terbasmin Turbuhaler
I andra hand – om novolizerinhalator är att föredra

salbutamol Ventilastin Novolizer



10 Kan bli föremål för generisk substitution på recept


Andningsvägar

Persisterande icke-allergisk rinit

NASALA STEROIDER

Lägsta möjliga underhållsdos bör eftersträvas.
budesonid
Desonix
mometason Nasomet, Nasonex
LOKALT ANTIKOLINERGIKUM
Vid hypersekretion

ipratropium Atrovent Nasal

Näspolypos

Vid näspolypos rekommender

Αποτελέσματα (Αγγλικά) 1:

Preface

wise list in 2013

wise list in 2013 are evidence-based recommendations for cost-effective medicines for common illnesses in outpatient and inpatient care, as well as drugs great use of specialized care.

wise list is the result of extensive work.Stockholm county drug committee 21 expert offers suggestions on recommended medicines in their respective therapeutic areas. expert councils' proposals presented to the Stockholm county Pharmaceutical Committee, which is an independent multidisciplinary steering committee for medical drugs work in sll. after careful reviews of the proposals set out drug recommendations.in areas where preventive measures and treatment with drugs can be improved down wise advice. Medicines Committee has as its primary mission through continuing education spread and gain support for evidence-based recommendations, and the wise counsel of prescribing in primary care, specialist outpatient and at hospitals in Stockholm County.

our goal is a wise introduction of new drugs.an independent evaluation of new drugs made by pharmaceutical expert committee and the unit for new drugs in clinical pharmacology, Karolinska University Hospital. with training, monitoring and evaluation of medicinal place in therapy can best medical care offered to the population of Stockholm county.

in expert councils' mission is also to participate in the procurement of drugs for health care. contract is expected in 2012 have given sll a cost of 250 million.

antibiotics are overused. antibiotic prescribing in sll should be in the next few halved, from today's nearly 420 to 250 prescriptions per 1000 inhabitants per year.together with tight Stockholm focuses stockholm county drug therapeutic in reducing antibiotic prescribing is not medically justified.






2





















wise list

conscious drug treatment for most patients benefit







1






preface patient safety is a very important issue for health care. drug-related problems faced by many patients.all prescribers have a great responsibility to help ensure that patients are not harmed by the drug treatment.

go through läkemedeisbehandlingen in every patient encounter:

• take into account the patient's overall medication.

• reconsider the indication.

• take account of renal function, interactions, and hypersensitivity.

• hold the patient's drug list in the medical record to date.

• give the patient a current drug list.

• document in the medical record which drugs changes being made and why.

Read more about wise list and wise advice on www.janusinfo.se offering producer-independent information and knowledge services on medicines for health care.

Eva Andersén Jones Carl-Gustaf elinder

Chairman Vice Chairman

Stockholm County Stockholm County

drug therapeutic drug therapeutic












3



reader instructions browser instructions

therapy sections are sorted alphabetically. reference to recommendations of individual indications listed in the Register, page 128, substances in the register on page 134. recommendations relating only to specialized care provided in boxes headed "specialized care".

interchangeable prescription drugs

for a drug to get replaced in pharmacies should be included in pharmaceutical plant list of interchangeable drugs; www.lakemedelsverket.se. interchangeability applies only medicines in the pharmaceutical benefit; www.tlv.se.

  symbol is used in wise list of the drugs that pharmacies can  be replaced when they are prescribed on prescription.

for generic interchangeable drugs recommended in principle only substance. wise specified in the list of all used preparations names under the above criteria. it means that some drugs are not specified because they are not included in the drug benefit and therefore must not be changed in pharmacies.

when the list of preparations names begin with "substance name ..." indicates "..." that company names are omitted and that generics are from one or several different companies.

caregivers' adherence to wise list are monitored on a substance level. compliance is not affected by which generic drugs as prescribed or dispensed.

ordering of medications to inpatient and social care

the preparations recommended in order for medical supplies listed in "wise list - recommended and procured preparations with synonyms." therein procured preparation and recommended products that have been chosen by the wide range of product, suitable packages and pricing.

by prescribing and order procured drugs, healthcare can save significant amounts.






4

Browser instructions


wise list is available in several versions

wise list of www.janusinfo.se also includes justifications for the recommendations and references.

wise list's recommendations appear in the journal system through strainer (Swedish database of information on drugs). drugs recommended for specialized care is not marked in the patient record systems.

"Wise list - for patients and the public" is linguistically appropriate for the target audience and covers in some areas advice and recommendations for self-care in addition to those found in other versions of wise list. recommendations relating only to specialized care is not included in this version.

"Wise list - recommended and procured preparations with synonyms" is to aid in the prescription and order to the drug store in different types of care.

All printed versions can be ordered by e-mail: [e-mail].

Good advice

symbol used to indicate the Stockholm county drug committee wise advice for improving medication use.

comments on wise list welcomed

Comments and views on wise list can be submitted via email to [e-mail].













5








wise advice stockholm county's Pharmaceutical and its expert prepares recommendations for the use of drugs in stockholm county can be improved. background to the wise advice described on www.janusinfo.se.

wise counsel in 2013

calculate and take into account renal function in the selection and dosing of drugs.

treat blood pressure better - set up the goal blood pressure with the patient, combining more and follow up.

select primarily warfarin as tromboemboliprofylax in atrial fibrillation. follow guidelines for warfarin therapy.

not treating asymptomatic bacteriuria in the elderly. grow only in urinary tract symptoms.

hold off on antibiotics for 2-3 days in uncomplicated otitis media in children 1-12 years.

treatment with proton pump inhibitors is inappropriate for stomach pain with no known cause.

bisphosphonate is often indicated for osteoporotic fracture. reconsider therapy after 3-5 years when the risk of atypical fractures increases with duration of treatment.

avoid propiomazine and tramadol in the elderly.






6






anaphylaxis and severe allergic reaction

acute allergic reactions

adrenaline

adrenaline adrenaline mylan 1 mg / ml im
adrenaline Anapen pen
Anapen pen
adrenaline jext pen


it is important that the patient is taught to use epinephrine pen by a medical professional. note that the patient should always have two epinephrine pens on hand when the injection may be repeated.



antihistaminescetirizine cetirizine ...    
loratadine loratadine ...


steroid betamethasone Betapred


anaphylaxis, angioedema, urticaria; acute internal medicine, treatment program (sll), www.janusinfo.se

allergic rhinoconjunctivitis page 8

asthma page 10

urticaria page 55








  may be subject to generic substitution of prescription 7
... generics from different companies




respiratorythe more persistent discomfort in nose and sinuses have daily rinsing of the nasal cavity with saline demonstrated beneficial effect. Information about accessibility is available in pharmacies. topical steroid can be used even during pregnancy and breastfeeding.



allergic rhinoconjunctivitis nasal steroids are more effective than oral antihistamines for nasal congestion.



antihistamine cetirizine   cetirizine ...
  loratadine loratadine ...



nasal steroids lowest possible maintenance dose should be sought.

in the first place


budesonide budesonide nasal spray in the alternative
mometasone  nasomet, Nasonex

Eye drops in the first place
cromolyn sodium  lecrolyn, Lomudal
in secondly - insufficient efficacy
emedastine EMADINE







8   may be subject to generic substitution of prescription
... generics from different companies



Respiratory pseudo-croup



betamethasone Betapred specialized care
adrenaline adrenaline mylan 1 mg / ml
diluted for inhalation in asthma nebulizer


goal of asthma treatment is free from symptoms and normal lung function
tion. as asthma disease varies in severity over time should
treatment adjusted accordingly. asthma treated in the same way during
pregnancy and lactation.
There are several different inhalers. it is advisable to work with
patient choose the type of inhaler that fits best.
Asthma in adults; www.viss.nu
asthma / obstructive bronchitis in children and adolescents; www.viss.nu
pharmacological treatment of asthma; www.lakemedelsverket.se

Step 1 asthma occasional times per week + short acting beta-2 Agonists
primarily
salbutamol Buventol Easyhaler
salbutamol Airomir spray (with spacer)
at difficulty dealing powder inhaler
terbutaline  Bricanyl Turbuhaler terbasmin Turbuhaler
secondly - if NOVOLIZER inhaler is preferred

salbutamol Ventilastin NOVOLIZER



10   amenable for generic substitution of prescription




respiratory persistent non-allergic rhinitis

nasal steroids

lowest possible maintenance dose should be sought.

budesonide budesonide nasal spray mometasone
  nasomet, Nasonex

anticholinergic locally at hypersecretion

ipratropium Atrovent nasal polyposis



at polyposis recomme

Αποτελέσματα (Αγγλικά) 2:

Foreword

Wise List 13

Wise List of 2013 is evidence-based recommendations for cost-efficient drugs for common ailments in the open and inpatient care as well as of drugs with great use in specialized care.

Wise List is the result of extensive work. Stockholm County pharmaceutical Committee 21 expert advice makes suggestions on recommended remedies in their respective therapeutic areas. Expert Councils ' suggestions are presented for the Stockholm County pharmaceutical Committee which is an unbound interprofessional medical advisory group for pharmaceutical work of SLL. After careful reviews of the proposals defined dosage recommendations. In areas where prevention and treatment with drugs can be improved provided wise counsel. The Committee has as its main task to through ongoing training-ing spread and get a hearing for evidence-based recommendations and wise advice for prescribers in primary care, specialized outpatient and at hospitals within Stockholm County.

our goal is a wise introduction of new drugs. An independent appraisal of new drugs made by pharmaceutical Committee's expert advice and the drive for new drugs in clinical pharmacology, Karolinska University Hospital. With training, follow-up and evaluation of the site in the therapy can best medical care offered the population of Stockholm County.

In the expert Councils ' mission is to participate in the procurement of pharmaceuticals for medical care. The contract is expected in 2012 have been SLL a cost savings of 250 million.

Antibiotic through excessive use. Prescribing of antibiotics in SLL should in the once-maste halved, from today's almost 420 to 250 recipes per 1000 inhabitants per year. Together with Tight Stockholm Stockholm County pharmaceutical Committee focuses on reducing antibiotic prescribing who is not medically justified.






2





















Wise List

Conscious pharmaceutical treatment for maximum patient benefit







1






Foreword patient safety is a very important issue for health care. Drug-related problems faced by many patients. All prescribers have a great responsibility to help ensure that patients are not harmed by medical-medelsbehandling.

going through läkemedeIsbehandlingen in every patient encounter:

• observe the patient's medication.

• Reconsider indication.

• Observe the renal function, interactions and hypersensitivity.

• Keep patient's drug list in the current journal.

• Give the patient a topical drug list.

• Documents in the register which pharmaceutical changes being made and why.

Read more about Wise list and wise advice on www.janusinfo.se offering producentobundna services information and knowledge about medicines for health care.

Eva Andersén K Carl-Gustaf Elinder

Chairman Deputy Chairman

Stockholm County Stockholms läns

pharmaceutical Committee the pharmaceutical Committee












3



Browser Browser instructions instructions

Therapy topics are listed in alphabetical order. References to recommendations for individual indications, see table on page 128, substances in the table on page 134. Recommendations for specialized care given in boxes titled "Specialized care".

Interchangeable drugs on prescription

to a medicinal product should be replaced at pharmacies there shall be included in the Swedish medical products Agency's list of interchangeable drugs; www.lakemedelsverket.se. Substitutability applies only to drugs in the pharmaceutical benefit scheme; www.tlv.se. Fourth Council Symbol used in

 Wise List of the drugs that pharmacies may Fourth Council come to replace when they are prescribed on the prescription.

For generic interchangeable drugs recommended in principle only substance. In Wise List listed all the occurring specimen name according to the above criteria. This means that some preparations have not been identified because they are not part of the drug benefit scheme, and therefore cannot be replaced at the pharmacy.

When the list of preparations name begins with "Substance name ...", "..." the company name is omitted and that generic is available from one or more different companies.

care providers ' adherence to Wise List are followed up at the net level. The company is not affected by which generic drugs as prescribed or fulfilled.

Ordering of drugs to hospital care and other care

The preparation is recommended when ordering to pharmaceutical stocks listed in "Wise List – recommended and procured preparations with the synonyms". Where specified procured drugs and recommended preparations which have been selected from the assortment width, appropriate packaging and pricing;

by prescribing and order contracted preparations can health care save substantial amount.






4

Browser instructions


Wise List exists in several versions

Wise List on www.janusinfo.se also includes justifications for the recommendations and references.

Wise List of recommendations appears in the journal systems via STRAINER (Swedish information database for Drugs). Medications recommended for specialized care are not marked in the journal systems.

"Wise List – for patients and the general public" is linguistically adapted to the target audience and include in a few areas, advice and recommendations of the European medicines for self-care in addition to those found in other versions of Wise list. Recommendations for specialized care are not included in this version.

"Wise List – recommended and procured preparations with the synonyms" is available to aid in the prescription and ordering of medicinal medelsförråd in various care.

All printed versions can be requested via e-mail: [e-mail].

wise advice

Symbol is used to indicate Stockholm County pharmaceutical Committee's wise advice for improved drug use.

comments on the Wise List are welcomed

Comments and opinions on Wise List can be submitted via email to [e-mail].



















5
wise advice

Stockholm County pharmaceutical Committee and the expert advice of recommendations for how the drug usage in Stockholm can be improved. The background to the wise councils described on www.janusinfo.se.

wise advice 2013

Calculate and consider the kidney function in the choice and dosage of drugs.

Treating blood pressure better – way up the target blood pressure together with the patient, combine more and follow up.

Select primarily warfarin as tromboemboliprofylax for atrial fibrillation. Follow the guidelines for warfarinbehandling.

do not treat asymptomatic bakteriuri in the elderly. Grow only at the symptoms of the urinary tract,

Delaying antibiotics for 2 – 3 days for uncomplicated otitis media in children 1–12 years.

Treatment with Proton pump inhibitors is inappropriate when stomach pain with no known cause.

Bisphosphonate is often indicated for osteoporotic fracture. Reconsider the therapy after 3-5 years when the risk of atypical fractures increases with the duration of treatment.

tramadol to Avoid propiomazin and older.






6






Anaphylaxis and severe allergic reaction

Acute allergic reactions



adrenalin EPINEPHRINE Adrenaline Mylan 1 mg/ml im
adrenaline Anapen injection pen
Anapen Junior injectable Jext adrenalin injection pen pen



it is important that the patient must learn to use epinephrine pen by a doctor or nurse. Note that the patient should always have two epinephrine pens handy, then injection may need to be repeated.

ANTIHISTAMINES

cetirizine  Fourth Council Cetirizine ...
Loratadine Loratadine  Fourth Council ...

Betapred



the STEROID betamethasone Anaphylaxis, angioedema, urticaria; Emergency medicine, treatment programs (SLL), www.janusinfo.se

Allergic rhinoconjunctivitis sid 8

Asthma sid 10

Urticaria p.55








 Fourth Council may be subject to generic substitution of prescription 7
... Generic medicines from different companies


respiratory

For longer-lasting symptoms from the nose and sinuses have daily rinses of nasal cavity with saline demonstrated a beneficial effect. Information about accessibility is available in pharmacies. Nasal steroid can be used even during pregnancy and lactation.

Allergic rhinoconjunctivitis

Nasal steroids are more effective than oral antihistamines to nasal congestion.

ANTIHISTAMINES cetirizine  Fourth Council Cetirizine

...
Loratadine Loratadine  Fourth Council ...

NASAL STEROIDS

the lowest maintenance dose should be sought.

in the first place

budesonide Desonix
Secondly,
mometason,
Nasomet  Nasonex EYEDROPS
primarily
natriumkromoglikat Lecrolyn Lomudal
, second – in case of insufficient effect
emedastin







Emadine 8  Fourth Council may be subject to generic substitution of prescription
... Generic medicines from different companies





Respiratory Pseudokrupp betamethasone Betapred

Specialized care
adrenaline Adrenaline Mylan 1 mg/ml nebuliser is diluted for inhalation in



the goal of asthma treatment Asthma is asymptomatic and normal lungfunk-
tion. Because asthma the disease varies in severity over time should
treatment adjusted accordingly. Asthma is treated in the same way during
pregnancy and nursing.
There are several different inhalers. It is appropriate to join
patient choose the type of inhaler that works best.
Asthma in adults; www.viss.nu
Asthma/obstructive bronchitis in children and adolescents; www.viss.nu
pharmacological treatment of asthma; www.lakemedelsverket.se
Step 1
Asthma symptoms occasional times per week
SHORT-ACTING BETA-2-STIMULANT in the first place

Buventol Easyhaler
Airomir salbutamol salbutamol spray (with spacer)
at the difficulty to handle powder inhaler Turbuhaler, Samaneh_l
terbutaline  Terbasmin Turbuhaler
secondly – if novolizerinhalator is preferred

salbutamol Ventilastin Novolizer



10  Fourth Council may be subject to generic substitution of prescription




Persistent respiratory non-allergic rhinitis

NASAL STEROIDS

the lowest maintenance dose should be pursued.
Desonix
mometason
budesonide  Fourth Council Nasomet, ANTIKOLINERGIKUM
At
Nasonex LOCALLY hypersecretion ipratropium Atrovent Nasal



Näspolypos

By näspolypos recommended

Αποτελέσματα (Αγγλικά) 3:

Introduction



Wise Wise List 2013 List 2013 is evidence-based recommendations of cost-effective medicines for diseases common in the open and closed, as well as care of medicinal products with great use in specialized care.

wise the list is the result of a comprehensive work.Stockholm county läkemedelskommittés 21 expert advice gives suggestions on recommended drugs within their respective therapeutic areas. Expertrådens proposal is presented to the Stockholm county pharmaceutical committee, which is an unbound undergraduate medical steering group for läkemedelsarbetet in SLL. After careful reviews of the proposals laid down drug-recommendations.In areas where preventive measures and treatment with drugs can be improved laid down wise advice. Then Formulary Committee has as its primary mission to by fortbild-ning spread and get evidence-based recommendations, as well as wise advice of prescribers in primary care, specialized care and hospitals in Stockholm county.

our goal is a wise introduction of new drugs.A unbound valuation of new medicinal products is carried out by the opinion expert advice and the device for new medicinal products in Clinical pharmacology, Karolinska University Hospital. With training, follow-up and evaluation of the medicinal product in the therapy can best be offered medical care population in the county of Stockholm.

IN expertrådens task also includes to participate in the procurement of medicines for the health care sector. Procurement is calculated by 2012 have given SLL a cost savings of SEK 250 million.

antibiotics overused. Prescription of antibiotics in SLL should in the once-must be halved, from today's nearly 420 to 250 Recipes per 1000 inhabitants and year.Together with tight Stockholm Stockholm county pharmaceutical committee focuses on reducing antibiotics that are not medically justified.






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Wise List

aware drug therapy for largest patientnytta







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Introduction


patient safety is a very important issue for health care. Drug-related problems affecting many patients.All prescribers have a great responsibility to contribute to patients is not damaged by drug-medelsbehandling.

Go through läkemedeIsbehandlingen in each patientmöte:

• Take into account all the patient's medicines.

• Review indication.

• Take kidney functions, interactions and hypersensitivity.

• Hold patient pharmaceuticals in question in the case record.

• Give the patient a pharmaceuticals in question.

• Document in the record which läkemedelsförändringar made and why.

Read more about Wise list and wise advice at www.Janusinfo.se, which offers producentobundna information and kunskapstjänster on medicinal products for the health care sector.

Eva Hans Andersén Karlsson Carl-Gustaf Elinder

President Vice president

Stockholm county Stockholm county

Pharmaceutical Committee pharmaceutical committee












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Läsaranvisningar

Läsaranvisningar

Terapiavsnitten are sorted in alphabetical order. Summary of the recommendations for individual indications are in the register on page 128, substances in the register on page 134. Recommendations which only refers to specialized care indicated in boxes with the heading "specialized care" .

Interchangeable medicines on prescription

to a medicinal product should be replaced in a pharmacy, it is busy in the toughening list of interchangeable medicines; www.lakemedelsverket.se. Substitutability applies only medicinal products within the framework of the pharmaceutical benefits scheme; www.TLV.see.

Symbolen used in wise the list for the medicinal products which pharmacies kankomma to replace when they provided for the recipe.

For generic interchangeable preparations is recommended in principle only substance. IN wise the list specified all where preparatnamn according to the above criteria. This means that a component preparations has not been entered depending on that they are not included in pharmaceutical and therefore may not be replaced in a pharmacy.

When the list of preparatnamn begins with "Substansnamn ... " indicates "... " that company name is omitted and that generics are available from one or more different companies.

carers compliance wise this list is followed up on substansnivå. Compliance is not affected by which generic preparations ; or dispatched.

Order of medicinal products to hospital care and other care

The preparations that are recommended in order to pharmacies in "Wise List - Recommended and bought preparations with synonyms". Where specified contracting preparations and recommended preparations which have been selected based on breadth, appropriate packaging and a price quote.

through to prescribe and order purchased health care preparations can save significant amount.






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Läsaranvisningar


wise the list is available in several versions

wise the list at www.Janusinfo.See also contains justifications to the recommendations and references.

wise recommendations will be shown in the list journalsystemen via strainer (Swedish database for medicinal products). Medicinal products that are recommended for specialized care not highlighted in journalsystemen.

"Wise List - for patients, and the general public" are linguistically adapted to the audience, and includes advice in some areas and recommen-care in addition to the recommendations made by the other versions of wise list. Recommendations which only refers to specialized care not available in this version.

"Wise the list - Recommended and bought preparations with synonyms" is to help prescription and order to drug-medelsförråd in different treatments.

all printed versions can be ordered via e-mail: [e-mail] .

Wise advice

the symbol is used to indicate the Stockholm county pharmaceutical committee Wise advice for improved utilisation of drugs.

comments on wise the list is to be welcomed

Comments and observations on wise The list can be submitted via e-mail to [e-mail] .













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Wise advice

Stockholm county pharmaceutical committee and its expert advice drawing up recommendations for how the use of drugs in the county of Stockholm can be improved. The background to the wise advice described on www.Janusinfo.see.

Wise advice 2013

Calculate kidney functions and take into account in the selection and dosage of drugs.

treat blood pressure better - way up målblodtryck together with the patient, combining more and follow up.

Select in the first hand Warfarin which tromboemboliprofylax at atrial fibrillation. Follow guidelines for warfarinbehandling.

do not treat asymptomatic bakteriuri of the elderly. Growing only when symptoms from urinary tract.

Wait with antibiotics in 2-3 days at uncomplicated otitis media in children 1-12 years.

treatment with proton pump inhibitors are inappropriate at tummy upsets with without known cause.

bisphosphonate is often indicated in after osteoporosfraktur. Review the therapy after 3-5 years as the risk for atypical fractures increases with treatment time.

Avoid propiomazin and Tramadol to older.






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anaphylaxis and severe allergic reaction

Acute allergic reactions

adrenaline

adrenaline Adrenaline Mylan 1 mg/ml im
adrenaline Anapen injektionspenna
Anapen Junior injektionspenna
adrenaline Jext injektionspenna


it is important that the patient may learn to use adrenalinpennan by a doctor or nurse. Please note that the patient should always have two adrenalinpennor to hand, then the injection may be repeated.

antihistamines

Cetirizin Cetirizin ...
loratadin Loratadin ...

steroid
betamethasone Betapred


anaphylaxis, angioödem, urticaria; acute (internal) medicine, treatment programs (SLL), www.Janusinfo.See

allergic rhinoconjunctivitis SID 8

asthma asthma asthma asthma asthma page 10

urticaria page 55








Kan be the subject of generic substitution in recipes 7
... Generics from various companies


Respiratory

For more sustained effort from the nose and sinuses have daily rinses of the nasal cavity with saline proved beneficial effect. Information about utility can be obtained in a pharmacy. Nasal steroid can also be used during pregnancy and breastfeeding.

allergic rhinoconjunctivitis

nasal steroids are more effective than oral antihistamines against nasal congestion.

antihistamines

cetirizin Cetirizin ...
Loratadin Loratadin ...

NASAL steroids

Lowest possible underhållsdos should be pursued.

IN first hand

budesonide Desonix
IN other hand
mometason  Nasomet, Nasonex
eyedrops
in the first place
natriumkromoglikat  Lecrolyn, Lomudal
in the other hand - in case of insufficient power
emedastine Emadine







8 Kan be the subject of generic substitution on recipes
... Generics from various companies


Respiratory
Pseudokrupp

betamethasone Betapred

specialized care
adrenaline Adrenaline Mylan 1 mg/ml
diluted for inhalation in nebulizer


The aim of asthma asthma asthma asthma asthma asthma is lack of symptoms from food hypersensitivity and normal lungfunk-
tion. Since astmasjukdomen vary in difficulty over time should
reading should be adapted accordingly. Asthma is treated in the same way under
pregnancy and breastfeeding.
There are several different inhalers. It is appropriate that together with
patient select the type of inhaler that best fits.
Asthma in adults; www.Some.now
asthma/obstructive bronchitis in children and young people; www.Some.now
pharmacological treatment of asthma; www.lakemedelsverket.se
Step 1
persistent asthma symptoms single times per week
TODAY BETA-2-KARO BIO
in the first hand

Easyhaler salbutamol salbutamol Buventol Airomir spray (with spacer)
in difficulty to manage pulverinhalator
terbutalin  Bricanyl Turbuhaler ® dry, Terbasmin Turbuhaler ® dry
in the other hand - if novolizerinhalator is preferable

salbutamol Ventilastin Novolizer



10 Kan be the subject of generic substitution on recipes


Respiratory

persistent non-allergic rhinitis

Nasal steroids

lowest underhållsdos should be pursued.
budesonide
Desonix
mometason Nasomet, Nasonex
locally ANTIKOLINERGIKUM
at hypersecretion

ipratropium Atrovent Nasal

Näspolypos

at näspolypos is highly recommended