We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
Check for expired indications (e.g. temporary loss of mobility that has now resolved)
Much more effective for stroke prevention in AF than antiplatelets
CAUTION: Bleeding events. Avoid combinations of anticoagulants, antiplatelets, NSAIDs.
Ensure patient adherence to dosing/monitoring regimen
NOTE: Antiplatelets are no longer indicated for primary prevention of CHD.
Aspirin plus clopidogrel indicated for a maximum of 12 months after ACS only.
CAUTION: Bleeding events. Avoid combinations of anticoagulants, antiplatelets, NSAIDs.
Consider anti-platelets as part of secondary prevention strategy after CVD events.
First line anti-platelet for secondary stroke prevention is clopidogrel (rather than dipyridamole)
Usually essential for symptom control in heart failure
Note: Not indicated for dependent ankle oedema (consider medication causes, e.g. CCBs
CAUTION: AKI and electrolyte disturbances.
Advise patient to stop during intercurrent illness (See Sick Day Rule Cards); is U&E monitoring robust?
CAUTION: Hyperkalaemia. Risk factors include: CKD (CI if eGFR<30ml/min), dose >25mg/d, co-treatment with ACEI/ARBs, amiloride, triamterene, potassium supplements.
CAUTION: Toxicity! Risk factors are: CKD, dose>125micrograms daily, poor adherence, hypokalaemia, drug-drug interactions.
Rarely effective; rarely indicated long term
Use short term only when nocturnal leg cramps cause regular disruption of sleep.
Review effectiveness regularly.
Adherence/Patient centeredness
CAUTION: Thrombocytopenia, blindness, deafness.
Consider reducing antianginal treatment if mobility has decreased
CAUTION: Hypotension (consider use of other BP lowering drugs; avoid the combination of nitrates with PDE-5 inhibitors)
Recommended for primary and secondary prevention in patients at high risk of CVD
CAUTION: Rhabdomyolysis: Check interactions (e.g. fibrates, dihydropyridines, antiinfectives).
Consider need for and intensity of treatment in light of life expectancy and ADR risk
Limited evidence supporting tight BP control in the older frail group.
Individualise BP targets for primary and secondary prevention of CVD guidelines.
Consider need for and intensity of treatment in light of CVD risk life expectancy and ADR risk
Usually essential for rate and angina control in CHD and CHF (and often in AF).
BNF recommends up-titration of beta-blocker doses in CHF to evidence based target doses.
CAUTION: Bradycardia in combination with diltiazem/verapamil, digoxin and amiodarone.
Usually essential for symptom control in CHF. For other potential benefits: see NNT Table
BNF recommends up-titration of ACEI/ARB doses in CHF to evidence based doses.
CAUTION: Acute Kidney Injury. Avoid combination with NSAIDs and advise patient to stop when at risk of dehydration (See Sick Day Rule Cards).
CAUTION: Constipation, ankle oedema
Dihydropyridines – CAUTION: Reflex tachycardia/cardiodepression: Avoid nifedipine in CHD/CHF
Diltiazem/verapamil – CAUTION: Bradycardia in comb. with beta-blockers or digoxin (digoxin levels increased)
Recommended in moderate to severe CHF: See NNT section
CAUTION: Hyperkalaemia. Risk factors: CKD, combination with ACEI/ARB, triamterene, amiloride
CAUTION: AKI. Avoid combination with NSAIDs and advise patient to stop when at risk of dehydration
Polypharmacy guidance: realistic prescribing