MODULE 1 TAKE THE FIVE
MINUTE TEST To receive your CPD logsheet and certificate; Visit
www.pharmacyin
focus.co.uk/education
Register your details for the relevant module; Adrenaline autoinjectors in anaphylaxis, Module 1.
Worryingly, one study suggested that only 30–40% of patients were able to correctly demonstrate how they would self-administer adrenaline.2
There is a clear need to improve education on AAI use.2
Training in
both when and how to use the AAI should be provided at the time of prescribing, and the pharmacist is ideally positioned to reinforce this training when dispensing the device.
Pharmacists can also encourage patients and parents/carers to obtain and use trainer pens (free from company websites), as well as accessing other support materials from company websites and videos such as those of the Anaphylaxis Campaign.10
• expiry dates and storage AAIs have a fixed shelf life, and it is important that patients are aware of the upcoming expiry dates for the devices that they carry.2,10,11
for alerts as to when the AAI needs replacing.10
Similarly, it is important
that patients are aware of how to properly store their AAIs (see table 1).
• Dosing The lowest AAI dose, 150 μg, is recommended for infants from the age of 6 months, as the cut-off for this strength is a minimum weight of 15 kg and avoidance should be possible for infants below 6 months of age. The AAI dose of 300 μg is recommended for children over 30 kg in weight, and for adults.10
One study indicated that some children were incorrectly prescribed a low-dose autoinjector even though they reached a weight of 30 kg, which would require a full dose.3,13 Children should be weighed regularly to ensure they are not on an incorrect dose.
This can
be difficult; given that the need to use the device tends to be both unpredictable and infrequent, the importance of checking medication and its expiry date can be forgotten.11 The Emerade, EpiPen and Jext devices all allow patients to register
Manufacturer EpiPen®
• Number of devices The MHRA recommends that two AAIs are prescribed for patients at risk of anaphylaxis, and that these patients carry both AAI devices at all times. This is due to uncertainties about the site of drug delivery and the speed of adrenaline action within the body.14
A UK study of AAI use in Doses Container closure detail
150 μg, Pre-filled cartridge 300 μg
children and teenagers found that almost a third (32%) who used their AAI during anaphylaxis required more than a single dose.15
Available AAI devices AAI devices utilise a multi-step technique that differs from one device to another. Instructions are provided in the package inserts, and manufacturers offer varying degrees of informational materials and support.
The two main types of AAI delivery systems are cartridge-based or syringe delivery.11
Cartridge-based
delivery appears to offer some advantage over syringe delivery,11,16 as adrenaline release only occurs once the needle is fully extended into the tissue. Syringe delivery carries a risk of adrenaline deposition throughout the needle track, potentially reducing the medication that reaches target muscle.11
An overview of available AAIs is provided in table 1 below.17-24
References 1. Song TT et al. Allergy 2014;69:983–991 2. McLeane-Tooke A et al. BMJ 2003;327:1332–1335 3. Kastner M et al. Allergy 2010;65:435–444
Storage TAble 1 Keep the autoinjector in the outer carton. encased in an autoinjector
Do not store above 25 °C. Do not refrigerate or freeze.
Jext®
150 μg, Pre-filled cartridge 300 μg
Emerade® 150 μg, Pre-filled syringe
300 μg, encased in an autoinjector 500 μg
Store below 25 °C. Do not freeze. encased in an autoinjector
Store in the original package, a specially designed case to protect the pen and
the labelling. Store below 25 °C. Do not freeze.
Having studied the module and without referring to it again complete the five minute test. If you need to refer to the text to answer the questions then you may need to study the module again.
ASSESSMENT: Upon completion of the test your answers will be scored and if you are successful you will be issued with your CPD certificate.
4. Gold MS and Sainsbury R. J Allergy Clin Immunol 2000;106:171–176 5. Lange L. Allergo J Int 2014;23:252–60 6. Gallagher M et al. Clin Exp Allergy 2011;41:869–877 7. Resuscitation Council UK. Emergency treatment of anaphylactic reactions. Guidelines for healthcare providers. January 2008 8. Turner PJ and Campbell DE. Curr Opin Allergy Clin Immunol 2016;16:441–50 9. Simons FER et al. World Allergy Organ J 2015;8:32 10.Ewan P et al. Clinical & Experimental Allergy 2016;46:1258–1280
11.Frew AJ. Allergy 2011;66:15–24
12.MHRA. Adrenaline auto-injectors: updated advice after European review. August 2017 13.Blyth TP and Sundrum R. Arch Dis Child 2002;86:26–27
14.MHRA. Drug Safety Update. Volume 11, Issue 1. August 2017
15.Noimark L et al. Clin Exp Allergy 2011;42:284–292
16.Schwirtz A and Seeger H. J Asthma Allergy 2010;3:159–167
17.MHRA. Adrenaline auto-injectors: a review of clinical and quality considerations. June 2014 18.EpiPen Adrenaline (Epinephrine) Auto- Injector 0.3 mg. Summary of Product Characteristics. March 2018 19.EpiPen Jr Adrenaline (Epinephrine) Auto- Injector 0.15 mg. Summary of Product Characteristics. March 2018 20.Emerade, 500 micrograms, solution for injection in pre-filled pen. Summary of Product Characteristics. September 2016 21.Emerade, 300 micrograms, solution for injection in pre-filled pen. Summary of Product Characteristics. September 2016 22.Emerade, 150 micrograms, solution for injection in pre-filled pen. Summary of Product Characteristics. September 2016
23.Jext 300 micrograms Solution for Injection in prefilled pen. Summary of Product Characteristics. June 2018
24.Jext 150 micrograms Solution for Injection in prefilled pen. Summary of Product Characteristics. June 2018
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