NICE guidelines

NICE guidelines state that beta-blockers should be used in patients with heart failure due to left ventricular systolic dysfunction after a diuretic and ACE inhibitor regardless of whether symptoms persist or not. 

Mrs TY tells you that she has heard of a new treatment called teriparatide from a friend who came to visit her in hospital. She wonders if it would be good for her. Using the NICE guidelines, discuss whether this would be a suitable option for her. How would you answer Mrs TY s question ... 

First, Mrs TY should be advised that teriparatide is only available as an injection and, therefore, Mrs TY may not find this an acceptable route of administration. Second, the NICE guidelines state that teriparatide should only be used in postmenopausal women who are unable to take bisphosphonates or strontium or who have had an unsatisfactory response bisphosphonates. They must also have experienced more than two fractures and have a T-score which fits into the range specified in the NICE guidance (NICE 2008). 

NICE (National Institute for Health and Clinical Excellence) (2006) Anaemia management in chronic kidney disease. Available at http //www.nice.org.uk/nicemedia/pdf/ AMCKD NICE guideline v8.1. pdf [Accessed 4 July 2008],... 

As a general rule, the treatment of hypertension in patients with renal impairment follows the British Hypertension Society and NICE guidelines, as detailed below. 

National Collaborating Centre for Chronic Conditions (2006) Atrial fibrillation. National clinical guideline for management in primary and secondary care (full NICE guideline). Royal College of Physicians. 

Raloxifene is recommended in patients (NICE, 2008) in whom bisphosphonates are contraindicated, those who cannot comply with the requirements needed to take bisphosphonates, or who have had an unsatisfactory response or are intolerant of bisphosphonates. Strontium ranelate is a suitable alternative if a bisphosphonate cannot be taken. However, NICE guidelines on secondary prevention of osteoporosis does not currently recommend the use of strontium ranelate. 

In the UK the National Institute for Clinical Excellence (NICE) has given guidance supporting the use of olanzapine and valproate semisodium in acute mania. NICE guidelines on the treatment of bipolar disorder are expected in June 2006. 

In the UK, National Institute for Clinical Excellence (NICE) guidelines for treating panic disorder and GAD are due to be published in late 2004. 

Institute for Health and Clinical Excellence (NICE) guidelines currently recommend it is only used in controlled long-term clinical studies. 

Rituximab is a monoclonal antibody that destroys B lymphocytes. It was previously licensed only for the treatment of particular types of leukaemia (see Chapter 10). Since November 2006, rituximab has been licensed for treatment of refractory rheumatoid arthritis, where other treatments, including anti TNF-a have failed to produce an adequate response. NICE guidelines were produced in 2007. 

Neuraminidase inhibitors inhibit an enzyme, neuraminidase, that is produced by virus infected cells and which helps viruses to leave infected host cells. Zanamivir and oselta-mivir are examples, which are used to treat influenza A and B in vulnerable individuals (those over 65 years or those with chronic respiratory disease, cardiovascular disease, renal disease, immunosuppression or diabetes). They must be used within a few hours and up to 48 hours of onset of symptoms to be effective. However, vaccination against influenza is considered the most effective way of preventing influenza and drugs should not be seen as a substitute. There are NICE guidelines on the use of zanamivir and oseltamivir. 

National Institute for Clinical Excellence (2004b, November) NICE guidelines on depression and anxiety. Health Summary 21 16. 

NICE Guideline CG90 Depression in Adults the treatment and management of depression in adults... 

NICE Guideline CG91 Depression in adults with a chronic physical health problem treatment and management. 

Offering extra care and attention to patients with disabilities isn t only kind, but a legal obligation under the Equality Act 2010. All the usual NICE guidelines apply to treatment. 

All self-harming under-16s should be admitted overnight to allow a specialist CAMHS assessment the next day (NICE guidelines). 

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