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MEP Flashcards

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1
Q

Four principles of medicine optimisation

A

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 medicine optimisation part of routine practice

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2
Q

Max aspirin/paracetamol that can be sold

A

100 non-effervescent tablets (96 in practice- pack sizes of 16 and 32)

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3
Q

Indication for OTC codeine and dihydrocodeine sale

A

Short term treatment of acute, moderate pain that is not relieved by paracetamol, ibuprofen or aspirin alone. (All previous indications e.g. cough, flu, sore throats and minor pain have been removed.

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4
Q

Max OTC codeine and dihydrocodeine quantity

A

32 (including effervescent formulations)

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5
Q

Codeine and dihydrocodeine OTC labelling

A

Can cause addiction. For three days use only.

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6
Q

NHS Prescription requirements

A

1) Signature
2) Address
3) Date (valid for 6 months from appropriate date)
4) Particulars (type of prescriber)
5) Name of the patient
6) Address of the patient
7) Age of the patient- if under 12

Needs to be written in indelible ink
Permissible to issue carbon copies of NHS prescriptions as long as they are signed in ink.

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7
Q

Number of repeats not stated

A

Max ONE repeat (dispensed twice in total) unless it is for an oral contraceptive where it can be repeated FIVE times (dispensed six times in total)
Schedule 2 and 3 can’t be repeated but schedule 4 and 5 can

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8
Q

First dispensing of repeated prescriptions

A

First dispensing must be made within 6 months of the appropriate date, no limit for the remaining repeats
Schedule 4: First dispensing must be made within 28 days of the appropriate date, no limit for the remaining repeats

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9
Q

Repeatable prescriptions

A

Private scripts that contain a direction that they can be dispensed more than once.

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10
Q

Private prescriptions record keeping

A

2 years from the date of supply (or last supply for repeatable prescriptions)

POM register entry required (ideally on the day of supply or the day after)
Not required for oral contraceptives and for Schedule 2s that would need to be documented in the CD register

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11
Q

Private prescriptions CD Schedules 2 and 3

A

Must be submitted to the relevant NHS agency

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12
Q

Validity of POMs and Schedule 5 owings

A

6 months

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13
Q

Validity of P and GSL owings

A

6 months

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14
Q

Validity of Schedule 2, 3 and 4 owings

A

28 days

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15
Q

Faxed prescription

A

Should not be supplied- not a legally valid prescription

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16
Q

Dentists prescribing

A

Can legally write prescriptions for any POM but are restricted to only the medicines on the Dental Prescribers Formulary for NHS dental prescription

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17
Q

EEA and Switzerland prescriptions

A

Legally recognised in the UK and emergency supplies are permitted (except Schedule 1, 2 and 3)
Valid for 6 months (Prescriptions for Schedule 4 CDs- 28 days)
Appropriate date for these prescriptions- the date the prescription was signed
Medicinal products without a MA valid in the UK cannot be dispensed in the UK.

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18
Q

POM register details

A 
Supply date
Prescription date
Medicine details
Prescriber details (Name and address)
Patient details
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19
Q

What details are not legal requirements for POM prescriptions?

A

Details of the medicinal product- such as the name, strength, form, quantity and dose

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20
Q

Medicines for discharged prisoners

A

FP10s aren’t allowed for patients while they are in prison but can be given if they are about to leave the prison.
The name and address of the prison are printed on them and they have HMP in the address.

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21
Q

Legal requirements for the labelling of medicines

A

Name of the patient
Name and address of the supplying pharmacy
Date of dispensing
Name of the medicine
Directions of use
Precautions relating to the use of the medicine

RPS recommendation: ‘Keep out of the sight and reach of children’
NPSA recommendation: Labelling the inside of the cream box

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22
Q

Labelling of medicines broken down from bulk containers for dispensing

A

Name of the medicine
Quantity of the medicine in the container
Quantitative particulars of the medicine (ingredients)
Handling and storage requirements where appropriate
Expiry date
Batch reference number e.g. LOT number or BN

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23
Q

PGD

A

Diamorphine or morphine can be supplied under a PGD for the immediate, necessary treatment of sick or injured persons.

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24
Q

Salbutamol signed order

A

Needs to be kept for 2 years from the date of supply or an entry made into the POM register.

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25
Doses of adrenaline to administer for anaphylaxis
1 month–5 years: 150 micrograms For Child 6–11 years: 300 micrograms 12 years +: 500 micrograms
26
Obtaining naloxone
Human Medicines Reg 2015 allows staff engaged in "lawful drug treatment services" to obtain naloxone from a wholesaler and make direct supplies without a prescription, PGD or PSD. (Now includes nasal naloxone)
27
PPP
Pregnancy Prevention Programme- to protect females ar risk of pregnancy from becoming pregnant whilst using oral retinoids and for one month after stopping them.
28
Special distribution controls for women at risk of pregnancy
Prescriptions only valid for 7 days (if longer, the patient needs to be referred to prescriber and may require a new pregnancy test) Maximum 30 days supply
29
Isotretinoin monitoring
Measure hepatic function and serum lipids before treatment, 1 month after starting and then every 3 months
30
Contraception whilst on isotretinoin
Must agree to using one reliable method of contraception e.g. IUD or implant or two effective methods e.g. hormonal contraceptive pill and a condom. Oral progestogen-only contraceptives are not considered effective.
31
Valproate indications
Bipolar disorder Epilepsy Unlicensed- migraine prophylaxis
32
Drs prescribing cocaine, diamorphine for addiction or dipipanone
Require Home Office licence All other prescriber types cannot prescribe these.
33
Physiotherapist Independent Prescribers can only prescribe the following CDs
``` ORAL Diazepam Dihydrocodeine Lorazepam Oxycodone Temazepam ``` ORAL/INJ Morphine TRANSDERMAL Fentanyl
34
Podiatrist Independent Prescribers can only prescribe the following CDs
``` ORAL Diazepam Dihydrocodeine Lorazepam Temazepam ```
35
Conditions where a WDA(H)- Wholedealer's License is not required for transactions such as commercial dealing and pharmacies
Takes place on an occasional basis Quantity of medicines is small Supply is made on a not-for-profit basis Supply is not for onward wholesale distribution
36
When registered pharmacies supply POMs to healthcare professionals or organisations what record keeping needs to be done?
The signed order/invoice needs to be retained for two years from the date of supply. Good practice to make a record in the POM register for audit purposes.
37
Supply record in the POM register
Date the POM was supplied Name, quantity, formulation and strength of the POM Name and address, trade, business or profession of the person Purpose for which it was sold or supplied
38
Prescription requirements for Schedule 2 and 3 CDs POM-V, POM-VPS and medicines supplied under the veterinary cascade
Royal College of Veterinary Surgeons (RCVS) registration number of the prescriber The item has been prescribed for an animal or herd under the care of the veterinarian
39
Standardised forms for CD Sch 2 and 3 prescriptions
Required for humans but not for animals
40
Filing of CD Sch 2 and 3 prescriptions
Submit to relevant NHS agency for humans and retain for 5 years for animals
41
Maximum supply of CDs
All CDs- good practice for 28 days in animals | Sch 2, 3 and 4- max 30 days in humans
42
Veterinary cascade
Supply licensed vet med If this is not possible, supply existing licensed vet med for another species or different indication If this is not possible, a licensed human med or EU-licensed vet med can be considered If this is not possible, supply extemporaneous or specially manufactured med
43
Dispensing label for meds not prescribed under the Cascade
Veterinary Medicines Regulations do not specify that it is required
44
Wholesale dealer's authorisation for Veterinary Medicines
Only the manufacturer of a veterinary medicine or a holder of a wholesale dealer's authorisation (WDA) can routinely supply authorised retailers with veterinary medicines.
45
Roles of accountable officers
Responsible for supervising and managing the use of CDs - oversight of monitoring and auditing of the management, prescribing and use of CDs - ensuring systems are in place for recording concerns and incidents involving CDs - attendance of Local Intelligence Network meetings - submission of occurrence reports that include details of any concerns the organisation have regarding CDs - appointment of authorised witnesses for CD destruction
46
Which CD schedules required retaining of invoices for 2 years?
Sch 3 and 5
47
Which CDs need a license to be imported or exported?
All except schedule 5 and sch 4 part II (if it is being used for self-administration)
48
Schedule 1 administration or prescribing
Only with Home Office Licence
49
Prescribing cocaine, diamorphine or dipipanone for addiction
Only if medical prescribers hold special licence from the Home Secretary or Scottish Government's Chief Medical Officer But the licence isn't needed if treating organic injury or disease
50
Personal CD export/import licence
Needed if 3 months or more supply
51
Emergency supply of Schedule 2 or 3 CDs to Dr or Dentist
Requisition must be supplied within 24 hours of supply
52
Processing requisition forms for Schedule 1, 2 or 3 CDs
Legal requirement to mark requisition indelibly with the supplier's name and address, where a pharmacy stamp is used this must be clear and legible Send the original requisition to the relevant NHS agency Good practice- retain copy for 2 years (Legal requirement if dispensed and supplied at a hospital, care home, hospice, prison or ambulance services) These requirements do not apply to wholesalers or manufacturers
53
Which CDs can be obtained by registered midwives?
Pethidine Diamorphine Morphine
54
What must be included in midwife supply orders?
Name of the midwife Occupation of the midwife Name of the person to whom the CD is to be administered or supplied Purpose for which the CD is required Total quantity of the drug Signature of an appropriate medical officer- doctor authorised (in writing) by the local supervising authority
55
Requirement post supply of CDs
Mark the prescription with the date of supply at the date of supply
56
Instalment prescription directions
Amount of medicine per instalment | Interval between each time the medicine can be supplied
57
Instalment prescription expiry
First instalment within 28 days of the appropriate date
58
Home office approved wording for instalment prescribing
Please dispense instalments due on pharmacy closed days on a prior suitable day. If an instalment's collection day has been missed, please still dispense the amount due for any remaining day(s) of that instalment. Consult the prescriber if three or more consecutive days of a prescription have been missed Supervise consumption on collection days Dispense daily doses in separate containers
59
Private prescription requirements for Sch 2 and 3 CDs
Must be on standardised form (not needed if within the legal entity) Prescriber identification number (not professional number but number issued by relevant NHS agency) Submit original private prescriptions to relevant NHS agency Do not put other POM items on the same prescription as those scripts need to be retained for 2 years
60
How long should private POM scripts be retained for?
2 years
61
CDs that must be kept under safe custody
Sch 1 Sch 2- except some liquid preparations and quinalbarbitone (secobarbital) Sch 3- except phenobarbital, gabapentin, pregabalin, mazindol, meprobamate, midazolam, tramadol, pentazocine and phentermine
62
Which common Sch 3 drugs require safe custody?
Buprenorphine | Temazepam
63
CDs that need to denatured before disposal
Schedules 2, 3 and 4 (part 1)
64
Which CDs need to have an authorised witness for denaturing?
Schedule 2 expired/obsolete/unwanted stock and an entry needs to be made in the CD register Good practice for schedule 3 to have another member of staff witness denaturing
65
CD register
Schedule 1 Schedule 2 Records of Sativex (Schedule 4 Part 1) must be kept, recommended to keep register
66
How long do CD registers need to be kept?
2 years from the last entry
67
Electronic CD register
``` Must be accessible from the premises and capable of being printed The entries must be: - attributable - capable of being audited - compliant with best practice ```
68
What class of Misuse of Drugs Regulations 2001 are CBPM?
2
69
Licensing of Sativex by the MHRA
Spasticity in multiple sclerosis | Currently NICE does not recommend prescribing due to not being cost-effective
70
Nabilone
Synthetic cannabinoid licensed for use in treatment resistant N&V caused by chemo
71
Epidiolex
``` Pure cannbidiol (CBD) that is approved by the US FDA for Lennox-Gastaut syndrome or Dravet syndrome in patients 2 and over. Not currently licensed in UK but being assessed by the European Medicines Agency. Can be supplied as unlicensed special ```
72
Dronabinol
Does not have a MA from MHRA in UK but approved by FDA to treat loss of appetite in patients with AIDS and to treat severe N&V caused by chemo
73
What does 'Use by/before mean' compared to 'expiry date'?
Use by or use before- product should be used before the end of the previous month Expiry date- product should not be used after the end of the month stated
74
Who is the enforcement body for waste arrangements in England and Wales?
Environment Agency
75
Disposing of blister packs
Blister strips can be removed from their inert outer packaging but tablets and capsules should not be de-blistered (exemption for CD tablets and capsules which need to be denatured)
76
Disposing of liquids
``` Whole bottle (including empty bottle that may contain residue) should be paced into pharmaceutical waste container because the mixing of different medicines could be hazardous. Exemption for CD liquids as they require denaturing first. ```

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