MEP Flashcards
(215 cards)
1
Q
What is the 4 principles of medicine optimisation?
A
1) Aim to understand patient experience
2) Evidence based choice of medicines
3) Ensure medicines are safe as possible
4) Make medicine optimisation part of routine practice
2
Q
What are the goals of medicine optimisation?
A
Improve adherence
Improve patient outcomes
reduce wastage of medicines
Avoid taking unnecessary medicines
3
Q
What does evidence based choice of medicines mean?
A
It is cost effective and clinically effective
4
Q
What is a profession?
A
An occupation that is recognised by the public as a profession ‘
Has a professional body
Benefits from professional standards and codes of conducts
Is regulated to ensure the maintenance of standards and codes of conduct
5
Q
What is professional judgement?
A
It is the use of accumulated knowledge and experience as well as critical reasoning to make an informed professional decision.
Takes into account the law, ethical considerations, relevant standards and all other relevant factors.
6
Q
How do we exercise professional judgement
A
1) Identify the dilemma e.g. deciding whether to supply medication or not
2) Gather all the relevant information
3) Identify all the possible options
4) Weigh up benefits and risks
5) Choose an option and record your reasoning
7
Q
Where can you obtain information from in primary care?
A
Prescription Patient or their representative Patient GP PMR SCR
In secondary care also have medical notes, ward chart, laboratory results
8
Q
What are the areas you need to consider when doing a clinical check?
A
1) Patient characteristics
2) Medication regimen
3) How treatment administered and monitored
9
Q
What are the factors related to patient characteristics that should be considered during a clinical check?
A
PATIENT TYPE i.e
are they elderly or are they a child or Pregnant/BF
gender- female or male, this is important as Finasteride should not be handled by female
Ethnicity - important as Rosuvastatin in Asian the max dose should be 20mg.
CO-MORBIDITIES
Does patient have renal/hepatic or heart failure
PATIENT PREFERENCE
10
Q
What are the aspects of prescribed medication regimen that should be considered during a clinical check?
A
INDICATION CHANGES IN REGULAR TREATMENT DOSE,FREQUENCY, STRENGTH DOSING OF FORMULATION COMPATABILITY MONITORING REQUIREMENTS
11
Q
What are the aspects of administration and monitoring of a medicine that should be considered during a clinical check>
A
IS THE ROUTE CORRECT
ARE ANY AIDS REQUIRED TO SUPPORT ADMINISTRAION E.G spacers, eye drop devices, braille or large type or pictogram labels ,or MCAs
12
Q
What infomation should you obtain when taking a medication history?
A
Generic name of drug
Brand name of drug
Dose
Strength of medicine taken
Formulation used - Phenytoin 100mg liquid dose does not deliver same dose as 100mg tablet
Route of admin (this could be an unlicensed route e.g. ciprofloxacin eye drops for the ear
Frequency of administration-
Length of therapy if antibiotic
Administration devices and brand for injecatables
Day or date of administration for medicine taken on specific days of the week or month
13
Q
Which medications need monitoring booklet?
A
Warfarin
Methotrexate
Lithium
Insulin
14
Q
What is a ‘just Culture’?
A
A culture based upon fairness and is achieved when attitudes behaviours and practices are fair.
You want to learn from your mistakes and share lessons in order to reduce mistakes
15
Q
What is a ‘Punitive Culture’?
A
Based upon assigning blame and punishment
16
Q
What is a ‘no blame culture?
A
Blame is never assigned and there is a lack of accountability
17
Q
What are the 4 Just Culture (right culture) priniciples?
A
1) Patient safety is paramount
2) Deliberate harm and unacceptable risk impacting on patient safety must not be tolerated (deliberate harm is a no no)
3) Forthcoming in raising concerns and learning from incidents
4) Accountability is fair and proportionate, and view issue in context to find root cause, any contributing factors or system deficiencies
18
Q
How many CPD cycles do we need to do?
A
Four CPD records( at least 2 planned)
A peer discussion
A reflective account
19
Q
What is RPS FACULITY?
A
Its a recognition programme for RPS members who have competed their early/foundation years of practice
20
Q
What is RPS FOUNDATION PROGRAMME?
A
For recently qualified, those that have returned after career breaks and for those who may be changing their scope of practice.
The foundation programme framework provides a structure for you to realise your competence, demonstrate your experience or develop special interests.
21
Q
Pharmacist can refuse to sell any medication
A
TRUE
22
Q
Who can sell GSL?
A
Can be sold in registered pharmacies but also in other retail outlets that can close so as to exclude the public.
23
Q
What are PO
A
PO is where manufacturers restrict supply through pharmacies only e.g. 30 Sachets packs of Fybogel. They are actually GSL medicine tho
24
Q
What is a P medicine?
A
A medicine that needs to be sold under the supervision of a pharmacist?
25
What is a POM medicine?
Medicine that is subject to the restriction of requiring a prescription written by an appropriate practitioner.
26
How much Pseudoephedrine and ephedrine can you supply?
```
Do not sell more than
Pseudoephedrine 720mg
Ephedrine 180mg.
Also do not sell as same time
As can make crystal meth
```
27
What are the signs of possible misuse?
Lack of symptoms - not suffering from cold or flu symptoms
Rehearsed answers
Impatient or Aggressive
Waiting for busy periods or until less experienced staff available
Asking for specific products
Paraphenalia - wanting to also purchase batteries
Quantities
Frequencies - make frequent requests
28
Who can we report suspicious activity of pseudoephedrine to?
Local GPHC Inspector
Accountable officer
Police officer
29
Can Pharmacist provide an Advanced supply of EHC?
Yes if its clinically appropriate and patient is competent to use it appropriately
30
Where could you refer patients to if cannot sell EHC?
Family planning clinic
PGD Pharmacist
GP
GUM CLINIC
31
What's the max paracetamol non-effervescent quantity that you can sell OTC?
100 ( so max 3 boxes of 32= 96)
32
What's the max limit for paracetamol effervescent tablets?
No limit but should use professional judgement
33
What is the maximum Non effervescent Aspirin that can you can sell OTC?
100
| and no limit for effervescent
34
Max Codeine and Dihydrocodeine that you can sell OTC?
Max 32 (any pack containing more than 32 is POM)
35
When can you give Codeine and Dihydrocodeine OTC?
For the relief of short term acute moderate pain that has not responded to Aspirin , Paracetamol or ibuprofen?
36
What should the label of codeine state?
Should state 'can cause addiction so for 3 days use only'
Packaging should state the indication, and that the medication can cause addiction and headache if used continously for more than 3 days.
PIL should also information about the warning signs of addiction
37
Which ingredients are unsuitable for children under 6 for cough and colds?
Antihistamines:
Antitussives:
Expectorants
Nasal decongestants
* in over 6 can be used as 2nd line only for 5 days only!!
38
If under 6 came in with a cough what would be first line?
Warm clear fluids
| Warm honey and lemon
39
If Under 6 came in with nasal congestion what would be first line?
Steam inhalation
vapour rubs
saline nasal drops
40
Codeine not suitable for children?
TRUE only for over 18 due to potential of abuse?
41
POM to P switches?
```
Amorolfine nail lacquer
Azithromycin
Chloramphenicol
Sumatriptan
Orlistat
```
42
What can Podiatrist Prescribe?
| Hint : only 4 CDs they can prescribe?
All POM within there competence
| In regards to CDs can only prescribe diazepam, dihydrocodeine, lorazepam and Temazepam.
43
What can physiotherapist prescribe?
| Hint: can prescribe 3 extra CDs compared to Podiatrist
All POM within there competence
In regards to CDs can prescribe diazepam, dihydrocodeine, lorazepam and Temazepam. ALSO Oxycodone (orally) , Morphine (oral or IV) , fentanyl (transdermal)
**remember the additional 3 additional meds physiotherapist independent prescriber can prescribe compared to podiatrist.
44
What are the prescription requirements?
1) Name of patient
2) Address of patient
3) Age if under 12
4) Signature
5) Date
6) Prescriber address
7) Particular of prescriber - indicate type of prescriber
45
What does appropriate date mean?
Within 6 months for POM and schedule 5 drugs
| 28 days for CD schedule 2, 3, 4
46
Can you dispense Welsh prescription?
Yes as long as can understand it.
| The medicine should be labelled in English
47
Can Schedule 2,3,4, and 5 be repeated?
Only 4 and 5 are repeatable
48
What is a repeatable prescription?
It is a private prescription which contains a direction that they can be repeated more than once e.g. repeat x 5
49
If have private prescription and it states repeat, how many times can you repeat this?
Can only be repeated ONCE
| So dispense twice
50
If repeatable prescription has a contraception, how many times can you repeat this?
5 times
| so dispensed 6 times in total
51
How long is a repeatable prescription valid for?
If schedule 5 drug and it is on repeatable script then as long as first dispensing is within 6 months then after that there is no limit..
Also for schedule 4 drug if first dispensing is within 28 days of appropriate date then after that there is no time limit for remaining repeats.
52
If patient wants to get next repeat from another pharmacy what do you need to do on that repeatable prescription?
Mark prescription with the Pharmacy name and address, and date of supply.
Therefore other pharmacy knows when they have been supplied
53
What is validity of an owning of a P med,
6 Months for P,GSL, POM, Schedule 5
| 28 days for schedule 2, 3, 4
54
What is the destination of private scripts?
Private prescription retained in pharmacy for 2 years.
NHS FP10 are sent to NHS BSA
55
What record is kept for a private Rx?
Records made in the POM register and retained for 2 years from the date of last entry in the register.
Record must include 2 names,2 addresses, 2 dates and medication details
1) Name &Address of Patient
2) Name & Address of prescriber
3) Date on prescription
4) Supply Date- date the medicine is supplied
5) Medicine details- name, quantity, formulation and strength of medicine when not apparent from name
56
What is exempt from recording keeping?
Oral contraceptives -
| Schedule 2 CDs - as already in CD register
57
What is not a legal requirement on a prescription?
Medication information i.e. name, strength, form, quantity and dose are not legal requirement for POM prescriptions
But is needed clinically to know what to supply
58
Prescriptions for Discharged prisoners?
Can be given a FP10 or FP10MDA prescription to take to community pharmacy if going to be discharged from prison without usual methods for ensuring continuity of supply of their medicines,
These FP10 forms have the name and address of prison printed on them and patient is EXEMPT FROM PAYMENT BY VIRTUE OF HAVING HMP IN THE ADDRESS.
59
Is a fax prescription legal?
Not legal as not written in indelible ink and has not been signed in ink by appropriate practitioner
But can supply against it using professional judgement
60
What can Dentist prescribe?
Any POM legally but if prescribing on FP10 NHS DENTAL PRESCRIPTION then can restricted to the medicines listed on the Dental prescribers formularly.
61
Who would we report forged prescriptions to?
Discuss with patient or prescriber if feel this can resolve it .. otherwise
Refer to police or NHS counter fraud services (for NHS prescriptions only)
62
Which EEA or SWISS prescribers than can be recognised?
Doctors
Dentist
Prescribing Pharmacist
Nurses
63
What countires are in the EEA?
```
Austria
Belgium, Bulgaria
Croatia, Cyprus, Czech Republic
Denmark
Estonia
Finland, France,
Germany, Greece
```
64
Can EEA or Swiss Prescriber do an emergency Supply?
Yes but no schedule 2 or 3
65
What are the prescription requirements for a EEA OR Swiss prescription?
1) Patient details - First name and Surname and DOB
2) Prescriber Details- first name, surname, professional qualifications, direct contact details including email address AND telephone or fax number, work address (including the country they work in)
3) Medicine details- Name, form , quantity , strength and dosage
* LR on eea/swiss not on normal POM Rx
4) Signature
5) Date
66
What cant EEA OR SWISS prescribers supply?
Schedule 1, 2 and 3 CDs cannot be prescribed
Also if medicine product does not have a marketing authorisation within the UK then cannot prescribe on an EEA prescription
67
How to check registration status of EEA or Swiss Prescriber
If unable to check registration status of a prescriber, then can still make a supply but need to make record
68
What can EEA prescribers emergency supply?
Requirements are the same i.e. prescription within 72hrs
For EEA or swiss prescribers cannot emergency supply schedule 1,2 3, even phenobarbital for epilepsy cannot be supplied to a patient.
A schedule 4 and 5 CD can be supplied as an emergency supply to a patient of an EEA or Swiss prescriber
69
Who dispenses Military prescriptions?
Only Pharmacies who have Ministry of Defense (MOD) contract can dispense military script
A military script is called an FMED 296
70
If FMED 296 is presented to a non contracted pharmacy then how would you treat this script?
Should be treated as a private prescription and charge the patient.
Give them the receipt and they can recover any costs incurred from their military unit.
A CD written on an MOD FMED296 form it cannot be legally dispensed by community pharmacies.
71
What is legally required on a label?
1) Name of patient
2) Name and Address of pharmacy
3) Date of dispensing
4) Name of medicine
5) Directions for use
6) Precaution relating to the use of the medicine
72
What is considered good practice for a label?
Keep out of the reach and sight of children
| Use this medicine only on your skin where applicable
73
If labelling medicine for someone in prison what should it include?
Prisoner number also included in order to identify patient
74
Is it true the inner container must legally be labelled e.g. bottle of amoxicillin?
NO
Only legal requirement to label the outside because it is good practice to label inner bottle as people could throw packaging away
75
What is required for labelling medicines broken down from bulk containers?
1) Name of medicine
2) Quantity in container
3) Batch number e.g. LOT number or BN
4) Expiry date
5) Ingredients
6) Any handling or storage requirements
76
Parenteral POMs can only be administered to another person in accordance with directions of an appropriate practitioner or by appropriate practitioner. What are exemptions?
pg.54
Can administer parenteral POM to save a life in an emergency eg. adrenaline for anaphylaxis
Also administration of smallpox vaccine
Specific classes of people such as midwives, paramedics and others can also administer POMs under certain conditions
77
What is a Patient Specific Direction?
Written instruction from a doctor, dentist or other independent prescriber for a medicine to be supplied or administered to a named patient after the prescriber has assessed that patient on an individual basis.
e.g. is an inpatient drug chart which is used by nurses to administer meds
Also directions within inpatient chart copied onto an order form for the pharmacy to prepare discharge medicines
78
What is a Patient Group Direction?
•A written direction that allows the supply and/or administration of a specified medicine or medicines by named authorised health professionals to a well-defined group of patients requiring treatment for a specific condition
E.g. PGD for Coronovirus Vaccine
79
What can Pharmacist supply under a PGD to a sick or injured person?
Pharmacist can supply, offer to supply and administer diamorphine or morphine under a PGD for the immediate necessary treatment of sick or injured person.
80
What are the conditons of prescriber requesting emergency supply?
Must be appropriate prescriber
Must be emergency
Prescription within 72 hours
Prescriber Must give directions e.g. how to take
Not for CDs 1,2,3 except phenobarbital and schedule 4 and 5
Record in POM register
81
What would you write in POM register for emergency supply at request of prescriber?
3dates
1) Date POM Supplied
2) Name (including strength and from where appropriate) and quantity of medicine supplied
3) Name and Address of prescriber
4) Name and Address of patient
5) Date on prescription
6) Date on which prescription is received
82
What are the conditions for an emergency supply at the request of the patient?
*never going to get prescription
Interview patient
Assess immediate need
Have they previously had it
Dose- need to be satisfied knowing the dose they take i.e. refer to PMR, prescription repeat slip, labelled medicine box
Not for CDs 1,2,3, except phenobarbital for epilepsy and also can supply schedule 4 and 5
83
What length of treatment would you give if patient requesting emergency supply?
Phenobarbital or CD4/5 - Only 5 day supply
POM- No more than 30 days
If POM (Insulin, ointment, cream or inhaler) then give smallest pack available
If POM oral contraceptive give full treatment cycle e.g. 21 days or 28 days for zoely as 24 tBs and 4 inactive
84
What would you record in POM register for emergency supply at request of patient?
1) Patient name and address
2) Date POM supplied
3) Name ( including strength and form where appropriate) and quantity of medicine supplied
4) Information on the nature of emergency such as why patient needs POM and why prescription cannot be obtained
85
What does label need to include for medicine supplied via emergency supply at request of patient?
In addition to standard labelling requirements the words ' Emergency Supply' needs to be added to the dispensing label
86
Refusal of emergency supply?
Then advise patient how to obtain prescription i.e. referal to doctor, NHS walk in center or A&e department
87
In a Pandemic does a pharmacist need to supervise supply?
No
| Also collection points would not need to be registered pharmacies premises.
88
Can optometirst or podiatrist write prescriptions?
No cant write prescriptions unless independent or supplementary prescriber. If they are not they can only give signed order. But has to be medicine which can be legally sold or supplied by the optometrist
Pg 60 MEP
89
What is an 'additional supply optometrist'?
These are optometrist who have undertaken additional training and can issued patient orders for an extended range of medicines.
90
What are the legal requirements of a signed order?
No legal requirements but should be satisfied that they have provided sufficient advice to allow patient to use medicine safely and effectively.
91
Self prescribing and for family?
Is considered poor practice to self prescribe or to person for person who there is close relationship with but legal for doctors.
92
Oral retinoids used for severe skin conditions but high risk of causing severe and serious foetal malformations and can increase risk of spontaneous abortion. What does the PPP involve?
No repeat prescriptions
No fax prescriptions for isotretinoin
Prescription valid for only 7 days - need negative pregnancy test.
Max quantity is 30 days supply
93
Can UK doctors prescribe CDs?
Yes
Need Home office for prescribing Cocaine, Diamorphine and Dipipanone for treating addition.
If EEA/swiss can only prescribe schedule 4 &5 CD?
94
Can optometrist independent prescriber prescribe CDs?
No
95
Can physiotherapist independent prescriber prescribe CDs?
Yes Dihydrocodeine, temezepam, lorazepam, diazepam, oxycodone for oral admin, Morphine IV or Oral and fentanyl patches
96
Can Veterinary surgeons and practitioners prescribe CDs?
Yes for animals. Address must be in UK unless it is for schedule 4/5
97
Can EEA OR Swiss Doctors and dentist prescribe CDs?
Yes if its for schedule 4 or 5 only
98
Can community practitioner nurses (CPN) prescribe CDs?
NO.
| They are restricted to dressing, appliances and licensed medicines which are listed in the nurse prescriber formulary
99
Who can prescribe unlicensed medicines?
```
UK registered Doctor
Dentist
Pharmacist/ independent prescribers
Supplementary prescribers
Vets
```
*EEA/Swiss prescribers cannot prescribe unlicensed medicines
100
Can Vets prescribe unlicensed medicines?
Yes for the treatment of animals under the treatment of veterinary cascade
101
Who can supply Emergency supply including phenobarbital for epilepsy but not 1/2/3
UK doctors
Dentist
Pharmacist/Nurse independent prescribers
Supplementary prescribers
102
Can physiotherapist and podiatrist independent prescribers supply emergency supply?
Yes but not schedule 1,2,3, including phenobarbital.
103
Can VETS do emergency supply?
n/a
104
Can Community Practitioner Nurse or Optometrist Independent prescribers authorise an emergency supply?
Yes but no CDs
105
UK DENTIST?
Should restrict prescribing to treatment of dental conditions but legally can prescribe within clinical expertise. But for NHS dental prescriptions they restricted to formulary
106
Supplementary prescribers must prescribe in competence with?
An agreed clinical management plan
107
Nurse/Pharmacist Independent prescribers
Prescribe within there competence
108
Optometrist independent prescribers must prescribe for
Only ocular conditions affecting eye and surrounding tissue only.
109
Physiotherapist and Podiatrist independent prescribers must prescribe
Within there competence
110
EEA/SWISS PRESCRIBERS MUST PRESCRIBE
Only items which have a marketing authorisation within the UK
111
A person trading in medicines must hold?
Wholesale dealers license 35minn
112
Who can a wholesaler deal to?
Other wholesalers
Pharmacies
People authorised to supply medication
113
TRUE/FALSE: Pharmacist can hold medications in a pharamcies and take small quantities from another pharmacy?
TRUE
| Under provision of healthcare services
114
What are the conditions which allow pharmacies to obtain small quantities of medicines from other pharmacies without a having to hold a WDA(H)?
1) Takes Place on occasional basis
2) Small quantity
3) Not for profit
4) Supply is not for onward wholesale distribution
115
If 2 Pharmacies are part of the same legal entity, can the other one wholesale?
No its only the pharmacy registered for wholesaling that can wholesale
116
Who can not receive medicines from wholesalers?
Non-medical prescribers e.g. Pharmacist or nurse independent prescribers
117
How long should a signed order be kept for?
2 years
118
Is it a legal requirement to make a POM register entry for signed orders?
No its good practice as signed order is retained
119
Does signed order have to be written?
No its good practice
120
What would be included in POM register entry for a signed order?
Date POM supplied
Name, quantity, form, strength
Name, Address , profession of person supplied
Purpose of supply
121
What must be included in a signed order?
No requirements just need to be satisfied it is safe. But minimum is knowing the details so can fill out POM entry
122
What does 'Use by 06/2019 mean?
Product should not be used after 31st May 2019
| i.e. by the time it hits june want it to be used
123
What does an expiry date of 12/2019 mean?
The product should not be used after 31st December 2019
124
Can scotish Pharmacist recieve waste?
Yes
125
Where should waste medicines be stored?
Kept in secure waste containers in a designated area preferably away from medicine that are fit for use. If sharps accepted they should be stored in sharps container.
126
How should you deal with confidential information?
Ensure patient identifiable information is destroyed or totally obscured.
127
How should tablets and capsule be thrown away?
Tablets and capsules should not be de-blistered.
128
How should liquids be thrown away?
The whole bottle should be placed into pharmaceutical waste container
129
How should sharps be thrown away?
Dispose syringes and needles in a sharps container
130
What advice should you give to patients regarding waste?
Advice that unused, unwanted medicines should be returned to pharmacy for safe disposal.
131
What is a secure environment?
Includes prison, police custody sites, secure hospitals, immigration removal centres and other places where persons are detained.
132
An in house pharmacy within a pharmacy does not need to be registered with the GPHC
True
| But pharmaceutical legal and good practice guidelines should be followed
133
Where can you check the registration of Vets?
RCVS
134
For Animal CDs, do we need a standard form?
NO
135
Unlicenced medicine prescribed by Vet?
Should be under cascade
136
When do we not need to give a child resistant container?
1) Specific Request - i.e. pt requests as have difficulty opening it
2) Original pack may not be child resistant
137
How to contact X-directory?
Dial 100 to contact patients in emergencies
| Must be life or death situation
138
Homeopathy?
Treating like with like
| Involves administering dilute and ultra dilute products
139
Herbal preperations?
Plant derived materials either as raw or processed ingredients which may be from one or more plan
140
What is the evidence for homeopathy?
NO EVIDENCE - advice pts on lack of evidence
| Also ensure pts do not stop taking prescribed meds
141
What is the difference between herbal and homeopathic licensing?
Homeopathic products only need to show safety and quality , not efficacy.
Herbal products must have MA based upon safety, quality and efficacy. Or can have a traditional herbal registration THR which proves safety, quality and evidence of traditional use.
142
Can a child collect a prescription?
See pg 119
143
If suspect child abuse what should you do?
In emergency call the police
Or Take advice and refer to social services
Pg 120
144
What age of sexual activity should be reported to social services?
Under 13s
| As legally too young to consent to any sexual activity
145
What do you do if suspect abuse of a vunerable adult?
Emergency- call police
As adult if they have capacity need to obtain there consent to escalate
If they are incapcitated or unsure they have capacity then take advice/check with GP
Pg123
146
All medical devices must have CE?
Means it is fit for purpose
| Pg 124
147
What is anaphylaxis?
Severe, life threatening systemic hypersensitivity reaction resulting in rapidly developing airway and/or breathing difficulty and/or hypotension.
Other features= skin and mucosal changes e.g. urticaria and angioedema (swelling of lips/throat)
148
VET PRESCRIPTION- WHAT IS A POM V?
POM that can only be prescribed by vet surgeon and supplied by vet surgeon or a pharmacist with a WRITTEN PRESCRIPTION
149
What is a POM- VPS?
POM that can be prescribed and supplied by a veterinary surgeon, a pharmacist, or suitable qualified person on a oral or written prescription. Written prescription only required if supplier is not the prescriber.
150
What is NFA-VPS?
A category of medicine for non-food animals that can be supplied by Vet surgeon, pharmacist or suitably qualified person . Written prescription not required.
151
AVM-GSL?
Authorised Veterinary Medicine that is available on general sale
152
What is the Small animal exemption scheme (SAES)?
These are unlicensed veterinary medicine that do not require a MA because it meets criteria laid out in schedule 6 of the veterinary medicines regulation
153
Unauthorised veterinary medicine?
An unlicensed medicine that does not have MA. So can only be prescribed by vet surgeon under the cascade
154
What are the prescription requirements for VET prescription?
1) Name, address, telephone number, qualification and signature of prescriber.
RCVS reg number if schedule 2 or 3 CD prescribed
2) Name and address of owner
3) Identification and species of animal and its address if different from owner
4) Date
5) Name, quantity, dose and administration instruction of the medicine (normal prescription this is not LR but for vet and EEA prescription it is)
6) Warning and withdrawal period
7) If medicine prescribed under cascade it must state this on prescription
8) If schedule 2 or 3 CD need statement ' this item has been prescribed for an animal or herd under the care of the veterinarian
9) If prescription repeatable the number of times it must be repeated
155
What is the difference between Veterinary and Human Controlled drug prescriptions?
Human schedule 2 or 3 need standard form but don't need for VET. But need statement to say its been prescribed for treatment of animal or herd under my care
Vet Rx retained for 5 years while human private rx submitted to NHS BSA
Human CDs it is good practice for only 30 days worth of treatment but for animal CD its 28 days
156
What is similarities between vet and human CD Rx?
Both valid for 28 days
| Usual cd prescription content requirements apply to both
157
When can a medicine be prescribed under the cascade?
When there is no existing licensed Vet medicine?
158
Veterinary Medicine
Is there a licensed Vet medicine it should be supplied
if not
Is there an existing licensed vet medicine for another species or a different condition
if not possible
is there a licensed human medicine or an EU licensed vet met
Only when above not possible
can give extemporaneous or specially manufactured medicine can be considered
159
Label requirements for Vet medicine?
1) Name of veterinary surgeon *
2) Name and address of owner *
3) Name and address of pharmacy
4) identification and species of animal *
5) Date of supply
6) Expiry date of product *
7) Dosage and administration instruction
8) Name or description or active ingredient
9) Any necessary warning for the user
10) Any applicable withdrawal period *
11) The words ' for animal treatment only'
The words keep out of reach and sight of children is also recommended by the RPS
160
When is a dispensing label for a veterinary medicine required?
Only when prescribed under the cascade.
Don't need if not prescribed under the cascade but RPS advises it would be appropriate to generate dispensing label for all vet medicines particularly for individual animals.
161
What record do we need to keep for POM-V and POM-VPS products?
*records kept for 5 years
It is legal requirement to keep records of receipt and supply of these products
1) Name of medicine
2) date of receipt or supply
3) Batch number
4) N&A of supplier or recipient
If there is written prescription record name and address of prescriber and keep copy of prescription
Also pharmacy that supply these medicine must undertake an annual audit?
162
Can GSL or P medicine be supplied for animals?
NO even if vets asks you verbally
| Unless this takes place under the veterinary cascade
163
Supply of NFA-VPS and POM-VPS medicines?
Legal requirement for pharmacists who supply or prescribe these meds to :
Advise on how to use product
Advice on any warning or CI
Be satisfied that that person intends to use medicine correctly and is competent
Prescribe or supply the minimum quantity required for treatment
164
When is the physical presence of pharmacist required for Vet meds?
When POM-V, POM-VPS and NFA-VPS (like p meds) medicines are to be supplied.
165
What human caution is there with animal meds?
Vet meds can cause adverse reactions in humans as well as in animals exposed to vet medicine.
Any reaction experienced by animal or human should be reported to the adverse reaction scheme (equivalent of yellow card scheme)
166
What is a Schedule 1 (CD Lic POM)?
No therapeutic use and license generally required for their production, possession or supply.
E.g. LSD, raw opium, ecstasy and cannabis
167
What is a Schedule 2 (CD POM)?
Opiates e.g. diamorphine, morphine, methadone, pethidine
Major stimulants e.g. amphetamines, methylphenidates, dexamphetamine , lisdexamphetamine
Quinalbarbitone (Secobarbital)
And Ketamine
168
What is Schedule 3 (CD No Register POM)?
Minor stimulants and other drugs e.g.
Buprenophine, Temazepam, Tramadol, midazolam and phenobarbital
Also Gabapentin and Pregabalin rescheduled 1st april 2019
169
What are Schedule 4 (CD BENZ POM OR CD ANAB POM)
Split into 2 categories
1) Part 1- contains most the benzodiazepines such as diazepam, non-benzodiazepines hypnotics e.g. zopiclone and Sativex (Cannabinoid oromucousal moth spray)
2) Part 2- Anabolic and androgenic steroids , also clenbuterol (adrenoreceptor stimulant) and growth hormones
170
What is schedule 5 (CD INV POM OR CD INV P)?
Codeine, pholcodine and morphine <13mg/5ml
171
What two schedules do CD prescriptions requirements apply to?
2 & 3
172
Prescriber address must be in the UK for which controlled drug schedule?
2 & 3
173
Prescriptions are not repeatable for which schedules?
2&3
174
Which schedules require a requisition?
Schedule 2 and 3
| Requisition must be marked by supplier
175
What schedules do invoices need to be kept for?
3 and 5 - keep invoices for 2 years
But NICE advices that organisations should consider retaining all CD invoices for 6 years for the purpose of HM Revenue and customs
176
What schedule need a licence to import or export?
2,3,4,
| But dont need if schedule 4 part 2 if imported or exported by person for self administration
177
What is the special exception with Sativex?
Need to keep a record even though it is schedule 4
178
Apart from Doctors, dentist, Pharmacist, or IP, who else can possess CDS
Museums hold home office license to possess cds
Home office group authority- Paramedic
Class of of person- Postal operator
Pg 92
179
What are the 2 exceptions where pharmacist can possess a Schedule 1 CD without having to obtain home office license?
1) If removing it from patient for purpose of destruction
| 2) Purpose of handing over to a police officer
180
Who can possess schedule 1?
Need home office licence
181
Who can prescribe Cocaine, Diamophine or dipipanone for treating addiction?
Only medical prescribers that hold a special licence from home secretary.
Others can prescribe it for organic disease or injury but not addiction.
182
Which CDs require a license to import or export?
Schedule 1,2,3 and 4 part 1 CDs
Also license needed for schedule 4 part 2 CDs unless the substance is imported or exported by person for self administration
183
Travelling and CDs?
If carrying less than 3 months supply of a CD, then do not require a personal licence.
But advised to obtain covering letter signed by prescriber that confirms name of patient, travel plans , name of prescribed CDs, dose and quantities.
Also check with travel operators.
184
Legal requirements for a CD Requisition?
1) Signature of recipient
2) Name of recipient
3) Address of recipient
4) Profession or occupation
5) Total quantity of drug
6) Purpose of requisition
There is approved form in the community for the requisitioning of CD 2 and 3s
185
Do we need a written requisition to supply CD 2 AND 3s?
Yes
But if supply between 2 registered pharmacies then do not need written but it is good practice to only make supply once received written requisition on approved form.
186
When is a requisition not needed before supply?
In an emergency A doctor or dentist can be supplied with Schedule 2 or 3 CD on the undertaking that a requisition will be supplied within the next 24hours.
187
Can stock be collected by a messenger ?
No unless there is written authorisation providing to the pharmacy that allows messenger to collect on behalf of purchaser.
Need to keep this written authorisation for 2 years?
188
What is the FP10CDF?
Standard Requisition form for CD2/3s
189
What is FP10 PCD?
Standard private CD prescription form
190
How do we process requisition forms?
Mark the requisition with suppliers name and address ( ie name of pharmacy), use stamp if available
Send original requisition to NHS BSA
Retain copy for 2 years for date of supply
Pg 95
191
What can a midwife obtain on a supply order?
Diamorphine
Morphine
Pethidine
192
What should a midwife supply order contain?
1) Name of midwife
2) Occupation of midwife
3) Name of person to whom CD is to be administered or supplied
4) Purpose for which CD is required
5) Total quantity of the drug to be obtained
6) Signature of an appropriate medical officer - a doctor authorised in writing by the local supervising authority or the person appointed by supervision authorise to exercise supervision over midwives
193
What are the prescription requirements for Schedule 2 and 3 CDs?
1) Signature
2) Date - 28 days validity fo
3) Prescriber address - must be in uk
4) Dose- must be clearly defined
5) Formulation
6) Strength if available in more than 1 strength
7) Total quantity in words and figures
8) Quantity prescribed- Max quantity for schedule 2,3,4CDs should not exceed 30 days unless justifiable
9) Name of patient
10) Address of patient- NFA if homeless
11) Dental wording - FOR DENTAL TREATMENT ONLY
12) Instalment direction
194
What must you do with a schedule 2 or 3 prescription?
Mark it with the date of supply
| If instalment then mark date of each supply
195
Is as directed valid on a schedule 2 or 3 script?
NO
See Pg 98 for doses that are not legally acceptable
'1 as directed' is legally acceptable
'Decrease dose by 3.5ml every 4 days is not valid as should be on instalment prescription
196
What 2 pieces of information should an instalment direction contain?
1) Amount of medicine per instalment
| 2) Interval between each time the medicine can be supplied
197
What is validity of instalment prescription?
First instalment dispensed within 28 days and the rest is in accordance with the instructions.
198
What can a pharmacist amend on a schedule 2 or 3 RX?
Minor typographical errors
Where missing total quantity in either words/figures
Need to mark Rx with name,signaure, date and GPHC number
199
What are the requirements for private Rx for Schedule 2 or 3 CDs?
1) Must be on standardised form which is submitted to NHS agency
2) Prescriber identification number must be on the standardised private prescription form -- this is not the same as GMC number.
Prescribing other items that are not CDs should not be prescribed on same form as different destinations.
200
When do we not need a standardised form if supplying private rx for CD2/3?
Vet prescriptions for CD do not need to be on standardised form
Also if issued and dispensed within the same legal entity
201
If HCP wants to collect scheduled 2 controlled drug for a patient?
Unless already known, need to obtain
1) Name of HCP
2) Address of HCP
ALSO request ID
202
If a representative wants to collect for a drug misuser?
Need letter from patient which authorises and names the representative, even if in police custody.
Also need separate letter each time
203
If a representative comes to collect methadone but they are on supervised consumption what should you do?
Ring prescriber who can verbally agree this is ok.
| But make sure keep record
204
To denature CDs do pharmacist need a licence?
NO
| But need to get exemption which is issued by environment agency which is known as T28 exemption
205
Which CDs need to be dentured before disposal?
Schedule 2,3 and 4 part 1s
| to ensure they are rendered irretrievable
206
Which CDs need an authorised person to witness the dentauring of CD?
Schedule 2
Typically destruction of pharmacy stock of schedule 2 CDs needs to be witnessed. Also need to record in CD register as its stock
But patient returned CDs does not require witnessing by an authorised person. However should record in a seperate register?
207
Can an Accountable officer authorise himself to be a witness?
NO
208
Destruction of Controlled Drugs?
Grind or crush solid dose formulation before adding to CD denaturing kit. Use of water whilst grinding or crushing may assist in minimising particles of dust being released into air
Liquid dose forms-
Ampoules and Vials-
Patches- Remove the backing and fold the patch over on itself
Aerosol formulations
SEE Pg 105
209
For controlled drugs received what must we record in CD register?
1) Date supply received
2) Name and address from whom received
3) Quantity received
210
For controlled drugs supplied, what should you record in CD register?
1) Date supplied
2) Name and address of recipient
3) details of authority to possess- prescriber or license holder details
4) quantity supplied
5) Details of person collecting - Pt/ pt rep or HCP (if latter also record name and address)
6) Whether proof of identity requested
7) Whether proof of identity provided
211
Entries in a CD register must be?
Entered chronologically
Entered promptly
in ink or indelible
Unaltered - corrections made by dated marginal notes or footnotes but need to show who the amendments made are attributable to
212
What are the requirements for record keeping of CD register?
Kept for 2 years from date of last entry
Records can be kept in original form or copied and kept in computerised form
kept at premises
Can be inspected by inspector
213
How often should a running balance be done?
at least Weekly but may be more or less frequent
| Running balance is good practice
214
Sativex
Pg 110?
215
APPENDICES?????
Pg 149 onwards need to read??
