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What are the FOUR principles of medicines optimisation?

1) Aim to understand the patient's experience
2) Evidence-based choice of medicines
3) Ensure medicines use is as safe as possible
4) Make medicines optimisation part of routine practice


How many CPDs must pharmacists record per year?
How many of these must start at reflection?

9 minimum

3 starting at reflection


What is a GSL medicine?

Sold in a registered pharmacy or retail outlet that can close to the public
Hold an EU/ UK Marketing Authorisation or Traditional Herbal registration or GSL homeopathic product.


Can GSL medicines be sold in the absence of the responsible pharmacist?

Yes! Providing they have signed in as RP on the pharmacy Record. Unless they have been absent for over 2 hours- then you can't unless another pharmacist becomes the RP.

If they have not (i.e. they are late) then GSL sale can only commence once the RP has signed in.


Can P medicines be sold in the absence of the RP? What if a second pharmacist becomes RP?

NO- not in absence of RP, unless a second pharmacist is present.

NB: P medicines should not be available for self-selection!


What cannot take place when the Responsible pharmacist is absent for under 2 hours?

Sale of P Medicines
Handing out prescriptions and bagged meds
Handing prescriptions to delivery driver
These CAN all take place if a second Pharmacist is present.


What is the only activity that can be done if the RP is absent for over 2 hours and there is no second pharmacist?

Taking in prescriptions- the pharmacy would be closed in this situation but could take prescriptions at door.


What two drugs used in Cold and Flu must you NOT sell together at the same time?

Products containing Pseudoephedrine and Ephedrine


Who can suspicions of possible misuse of OTC products be reported to?

Local GPhC inspector
Local Controlled Drugs liaison police officer
Accountable officer


What are the two licensed EHC drugs that can be obtained from a pharmacy?

Levonorgestrel 1500 mcg (Levonelle One Step)

Ulipristal Acetate 30mg (Ella One)


How many days after unprotected sex is Levonorgestrel licensed for?
What about Ulipristal Acetate?

Levonorgestrel= 3 days (72 hours)
Ulipristal acetate= 5 days (120 hours)


What age is Levonorgestrel licensed for?
What about Ulipristal Acetate?

Levornorgesterol is licensed for use in over 16 years. Can be given to under 16's only if a locally commissioned PGD is in place.

Ella One can be used in any girl of child-bearing age- so can be used in under 16's!!
Bear in mind- children under 13 are legally too young to consent to any sexual activity. Any younger requesting this should be reported to social services. Children under 16 also not legal although its may be consensual- i.e. with a boy also under 16.


Can pharmacists provide an advanced supply of EHC?



If you decided to supply a child under 16 with EHC, can patient information be disclosed without consent?

No- still need to obtain consent in order to disclose information. Info can be shared if safeguarding an issue- judge on a case by case basis.


EHC: If the patient vomits within how many hours of Levonelle/ Ella One should they take another dose?

2 hours of taking Levonorgesterel

3 hours of taking Ella One (Ulipristal acetate)


At what point in the menstrual cycle should EHC be taken? Can it be taken more than once per cycle?

Can be taken at any point.
SPC for Levonelle states It is not advisable to take more than 1 per cycle as it can disrupt the cycle.
NB: RPS guidance says that women can take more than one if appropriate but should be advised about cycle disruption.


A patient, who you are aware has alcoholic liver cirrhosis, asks for EHC. What do you do?

EHC- levonorgestrel and Ulipristal- both not recommended in severe liver dysfunction. Try and find out how severe the liver disorder is- refer.


What medication can Levonorgestrel increase the toxicity of?

Ciclosporin (immunosuppressant used after transplants)


Can EHC be used in breast feeding women?

Levonorgestrel appears in small amounts in breast milk- should not be harmful, but take tablet after a feed to allow maximal team until next feed.

Ulipristal acetate is present in breast milk for 1 week after administration. Advise mother not to BF in this time but express and discard the milk to maintain lactation.


Which EHC drug can reduce the efficacy of COC and POP pills?

Ulipristal acetate. Patients should use barrier methods until next period as their normal contraceptive cover will be reduced


A patient has received EHC, and asks if they have unprotected sex again before their next period, will the be okay?

No- it does not provide protection against pregnancy for the rest of the cycle- they will need to use contraceptive measures if they want to have sex again such as start the pill or condoms.


What is the max number of paracetamol non effervescent and aspirin non effervescent you can buy OTC?

100 of each
but remember they come in packs of 16 and 32 so you would not be able to sell this amount anyway!


What is OTC codeine/ dihydrocodeine products indicated for?

Short term (3 days max) treatment of acute - moderate pain not relieved by paracetamol, ibuprofen or aspirin alone.

NOT for cold, flu sore throat etc.


What is the largest pack size of codeine/ dihydrocodeine products available OTC?

anything bigger requires an MA as a POM
RPS recommends the sale of just one pack of 32 at any one time.

NB: Extra warning label needed: "Can cause addiction. For three days use only". Users can get an 'overuse headache if they use it for longer.


Why are many cough and cold remedies now no longer used in children under 6 years?

No evidence they are effective
Sometimes the ingredients can be linked to SEs including allergies, sleep disturbances and hallucinations.


Medicines containing what 4 types of cough and cold remedy ingredients have been deemed unsuitable for children under 6 years?

Antitussives (eg dextromethorphan, pholcodine)
Expectorants (eg Guaifenesin)
Nasal decongestants (pseudoephidrine, phenyephidrine, oxymetazoline)
Antihistamines- but these may still be used in hayfever

These medications should only be used second line in children 6-12 years, for a maximum of 5 days


A 2 year old child presents to the pharmacy with their mother saying that they have a raised temperature. What do you do?

Take their temperature- use a digital thermometer under their armpit (always under armpit in child under 5 years) for around 15 seconds. If the reading >37.5 degrees then it is likely to be a fever.

What to offer:
Paracetamol or ibuprofen.
Do not use these at the same time in children under 5 years (however if one doesn't seem to be helping, it's OK to try the other one before the next dose is due)
Dose in this child:
Paracetamol- 2 years old- 180mg (7.5ml) every 4-6 hours.
Ibuprofen- 100mg TDS


What is first line treatment for nasal congestion in children?

Saline nasal drops
Vapour rubs
Decongestants- e.g. Karvol decongestant drops


What is first line treatment for a cough in a child?

Warm, clear fluids, honey and lemon if child is OVER 1 year old.
Simple cough mixtures- eg. glycerol or simple linctus


Can podiatrists and physiotherapists independent prescribers prescribe POMs? What about CDs?

POMs- Yes- if in their area of expertise

They can only prescribe the following CDs for oral administration:

Physiotherapist IPs can also prescribe: Oxycodone (oral)
Morphine (oral or injection)
Fentanyl (transdermal)