This podcast makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through new and updated guidelines published in October 2023 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only.  I am not giving medical advice; this video is intended for health care professionals, it is only my interpretation of the guidelines and you must use your clinical judgement.   There is a YouTube version of this and other videos that you can access here:  The Practical GP YouTube Channel:  https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulleting for October 2023 can be found here: ·      https://www.nice.org.uk/guidance/published?from=2023-10-01&to=2023-10-31&ndt=Guidance&ndt=Quality+standard The links to the update guidance covered can be found here: Rimegepant for treating migraine: ·      https://www.nice.org.uk/guidance/ta919 Thyroid disease: assessment and management ·      https://www.nice.org.uk/guidance/ng145 Tirzepatide for treating type 2 diabetes ·      https://www.nice.org.uk/guidance/ta924 Suspected cancer: recognition and referral ·      https://www.nice.org.uk/guidance/ng12 Suspected neurological conditions: recognition and referral ·      https://www.nice.org.uk/guidance/ng127 Hearing loss in adults: assessment and management ·      https://www.nice.org.uk/guidance/ng98 Daridorexant for treating long-term insomnia ·      https://www.nice.org.uk/guidance/ta922   Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]     Music provided by Audio Library Plus    Watch: https://youtu.be/aBGk6aJM3IU   Free Download / Stream: https://alplus.io/halfway-through  TranscriptHello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in October 2023, focusing on what is relevant in Primary Care only. We will be covering: migraines, thyroid function tests, diabetes, suspected cancer and insomnia.   So let’s jump into it. The first clinical area is an update on a new migraine medication, rimegepant. And NICE says that Rimegepant is recommended, only if: ·      at least 2 triptans have been tried before but were ineffective or ·      if triptans cannot be used, and Paracetamol and NSAIDs are not effective. What is Rimegepant? Well, gepants are a new class of drugs that have been developed specifically for the treatment of migraines. Rimegepant is a calcitonin gene-related peptide receptor antagonist so it works by blocking this CGRP receptor. And although the mechanism of action is not fully understood, we know that this receptor is involved in the development of migraines. Gepants can be used as an acute treatment and, although rimegepant has a licence for migraine prophylaxis, NICE does not recommend it for this indication. Unlike triptans, gepants do not cause vasoconstriction so they do not have the same cardiovascular contraindications and cautions as triptans. Rimegepant is an oral lyophilisate that should be placed on the tongue or under the tongue and it will disintegrate in the mouth and can therefore be taken without liquid. The next update refers to thyroid disease and it says that when ordering thyroid function tests, patients should be routinely asked about biotin use. This is because the MHRA has reported that biotin may cause thyroid test results to be falsely increased or decreased, leading to inappropriate management. Biotin is increasingly found in dietary supplements which are typically t