WA Country Health Services
Kimberley Health
KSDL Review Committee Meeting
Minutes from the meeting held on April 9th 2008 9am -11am Broome Resource room
Attendance
Dr Jaye Martin, WACHS Regional Physician (Chair)
Roy Finnigan WACHS Regional Pharmacist (secretary)
Dr Siew-Lee Thoo, District Medical Officer, Kununurra Hospital (via phone from Kununurra)
Dr Carmel Nelson, Medical Director KAMSC (via phone from Perth)
Dr David Atkinson, Medical Officer, KAMSC
Cathy Larkin, KAMSC Pharmacist
Dr Alex Balzarelli, Medical Officer, KAMSC (via VC from Perth)
Monica Frain, Remote Area Nurse Coordinator
Lesley- Ann Nieuwoudt, RAN, OAP clinic
Apologies
Nil
1. Business arising from previous minutes:
Item
number
1a
1b
Description
Action or outcome
Anastrozole tablets
The committee agreed to seek advice from oncologists regarding use of
anastrozole versus alternative anti-oestrogens, including tamoxifen
which is currently KSDL listed.
Statins and myopathy
The Committee discussed the differences in the incidence of myopathy
between the statins (as presented by Jaye). The committee noted the
higher incidence associated with atorvastatin but did not believe that this
warranted a change in KSDL listing. The committee considered that
pravastatin may be a useful alternative for patients who were at high risk
of myopathy but that this could be prescribed on an individual basis if
required.
Advice from
oncologists to be
sought
CL to action
No action
2. Medicines listed on the PBS for indigenous Australians since the last review meeting
2a
Terbinafine cream and tablets
The committee agreed to add terbinafine 1% cream to the
essential drug list on the basis of its once daily application and
possible compliance advantage.
All other topical antifungal preparations, currently listed on the
KSDL are to remain.
It was noted that terbinafine tablets are already KSDL listed.
Add cream to
essential list
Robinson Street, Broome, Western Australia 6725 1
Telephone (08) 9192 9373
3. New drugs added to the PBS since the last review meeting
Vareniciline tablets
Concern was expressed with the reported psychiatric ADRs and with the
relative paucity of safety and clinical data available. The committee
agreed not to add to the KSDL at this time.
Irbesartan/Hydrochlorothiazide 300mg/25mg
It was noted that the 25mg dose of thiazide diuretic did not offer
significant therapeutic advantage over the 12.5mg dose. It was agreed
not to list this preparation on the KSDL
Insulin glulisine
The committee agreed not to list this on the KSDL.
Olmesartan and Olmesartan Plus
It was noted that these preparations did not confer a clinical benefit over
the existing KSDL listed ARB and ARB/diuretic combinations. It was
agreed not to list this preparation on the KSDL
Topiriamate (new indication: migraine prophylaxis)
The committee agreed that whilst this was a useful alternative migraine
prophylactic there was unlikely to be a high demand for this and that
individual supply was appropriate.
3a
3b
3c
3d
3e
No action
No action
No action
No action
No action
4. KSDL Modification request forms
No forms were received however a verbal request was made for an IV
preparation for the treatment of migraine (chlorpromazine was
suggested in the verbal request). The committee agreed to further
investigate what IV treatments were recommended prior to making a
decision.
Any information
gathered by
committee to be sent
to Roy.
5. Medications to be considered due to frequent Individual Supply forms.
Individual supply forms submitted were tabled
No action
6. Miscellaneous drugs to consider.
6a
6b
G
A
O
U
V
S
Obstetric Emergency Drugs
Misoprostol, Magnesium Sulphate and Hydralazine and Syntometrine®
The committee noted the email from the Regional Obstetrician which
supported the addition of these drugs. There was some discussion
around the risks of inexperienced staff using these drugs against the
risks of not using them in emergency situations particularly where there
are significant delays in transferring patients out of remote sites.
It was agreed to add the above drugs to the Emergency Drug List and to
support this with the provision of RFDS protocols (where such exist).
Additionally, the committee will advise the RFDS of these additions and
seek their advice regarding other essential emergency drugs.
Non-sedating anti-histamines
It was suggested that these could be purchased from community shops
but noted that not all remote sites had community shops. Whilst the
committee was broadly sympathetic to the need for them, it was
considered that their listing could potentially direct resources away from
other areas of higher priority. It was agreed to investigate the cost of
Add misoprostol
200mcg tablets,
Magnesium sulphate
injection and
hydralazine 20mg
injection and
syntometrine injection
to the Emergency
Drug List
E
T
S
R
R
N
A
M E N
L I A
T
O
F
W
E
Non-sedating antihistamine costs to be
sought by RF and CL
T
E
R
N
2
these drugs prior to making a decision.
7. Miscellaneous topics for discussion
Insulins
The committee discussed the need for a rapid acting insulin analog, it
was agreed that this was not warranted as most diabetic patients in the
Kimberley were Type 2 diabetics and that Actrapid was well established
and suitable for use in pregnancy. The committee agreed to list Insulin
Glargine Solostar disposable pens as up to 80units can be administered
with a single injection.
Treatment of SVT
The treatment options were discussed; it was agreed to seek the advice
of RFDS on the most appropriate drugs for the remote setting.
7a
7b
Add Lantus Solostar to
the Essential list
Seek advice from
RFDS
8. Business without notice
Nicotine Gum
It was noted that nicotine patches were not suitable in all instances and
that an alternative from of NRT was appropriate. The committee agreed
to list both 2mg and 4mg strengths of nicotine gum
Cal-Sup
As Cal-Sup is now PBS listed it was agreed that this brand of calcium
should be added to the KSDL but reviewed at the next meeting.
Contrary views on the palatability of Cal-sup tablets were presented.
Sevelamer
The committee considered that the small numbers of patients who might
require this new phosphate binder was small and that inclusion on the
KSDL was not warranted at this time.
Add Nicotine Gum
2mg and 4mg to
essential list
Add Cal-Sup to
essential list
Meeting closed 11.04am
Addendum
Meeting held on 28th May, 12noon CAPTER room KAMSC to resolve outstanding issues
Present
Roy Finnigan
Cathy Larkin
Dr Alex Balzarelli
Dr David Atkinson
Anastrozole
Previously agreed (email correspondence) that anastrozole will not be added.
Obstetric drugs
G
A
O
U
V
S
E
T
R
R
N
A
M E N
L I A
T
O
F
W
E
S
T
E
R
N
3
It was agreed that Magnesium Sulphate premixed infusion bags would be added to the Emergency
Drug List. Other obstetric drugs as previously agreed would be added to the Emergency Drug List.
Non-sedating antihistamines
It was agreed to add Loratadine tablets to the supplementary list. The possibility of purchasing
through Derby Hospital Pharmacy would be explored.
Drugs for SVT
Email correspondence from RFDS was noted. It was agreed not to add any IV treatments for SVT at
this time.
Treatment of persistent migraine
It was agreed that current treatment options available on the KSDL for acute migraine were
satisfactory.
Meeting closed at 1.04pm
G
A
O
U
V
S
E
T
R
R
N
A
M E N
L I A
T
O
F
W
E
S
T
E
R
N
4