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MEP > MEP > Flashcards

MEP Flashcards

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

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2
Q

What are the goals of medicine optimisation?

A

Improve adherence
Improve patient outcomes
reduce wastage of medicines
Avoid taking unnecessary medicines

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3
Q

What does evidence based choice of medicines mean?

A

It is cost effective and clinically effective

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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

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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.

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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

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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

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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

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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

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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
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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

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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

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13
Q

Which medications need monitoring booklet?

A

Warfarin
Methotrexate
Lithium
Insulin

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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

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15
Q

What is a ‘Punitive Culture’?

A

Based upon assigning blame and punishment

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16
Q

What is a ‘no blame culture?

A

Blame is never assigned and there is a lack of accountability

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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

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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

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19
Q

What is RPS FACULITY?

A

Its a recognition programme for RPS members who have competed their early/foundation years of practice

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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.

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21
Q

Pharmacist can refuse to sell any medication

A

TRUE

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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.

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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

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24
Q

What is a P medicine?

A

A medicine that needs to be sold under the supervision of a pharmacist?

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25
Q

What is a POM medicine?

A

Medicine that is subject to the restriction of requiring a prescription written by an appropriate practitioner.

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26
Q

How much Pseudoephedrine and ephedrine can you supply?

A 
Do not sell more than 
Pseudoephedrine 720mg
Ephedrine 180mg.
Also do not sell as same time 
As can make crystal meth
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27
Q

What are the signs of possible misuse?

A

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

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28
Q

Who can we report suspicious activity of pseudoephedrine to?

A

Local GPHC Inspector
Accountable officer
Police officer

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29
Q

Can Pharmacist provide an Advanced supply of EHC?

A

Yes if its clinically appropriate and patient is competent to use it appropriately

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30
Q

Where could you refer patients to if cannot sell EHC?

A

Family planning clinic
PGD Pharmacist
GP
GUM CLINIC

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31
Q

What’s the max paracetamol non-effervescent quantity that you can sell OTC?

A

100 ( so max 3 boxes of 32= 96)

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32
Q

What’s the max limit for paracetamol effervescent tablets?

A

No limit but should use professional judgement

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33
Q

What is the maximum Non effervescent Aspirin that can you can sell OTC?

A

100

and no limit for effervescent

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34
Q

Max Codeine and Dihydrocodeine that you can sell OTC?

A

Max 32 (any pack containing more than 32 is POM)

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35
Q

When can you give Codeine and Dihydrocodeine OTC?

A

For the relief of short term acute moderate pain that has not responded to Aspirin , Paracetamol or ibuprofen?

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36
Q

What should the label of codeine state?

A

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

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37
Q

Which ingredients are unsuitable for children under 6 for cough and colds?

A

Antihistamines:

Antitussives:

Expectorants

Nasal decongestants

  • in over 6 can be used as 2nd line only for 5 days only!!
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38
Q

If under 6 came in with a cough what would be first line?

A

Warm clear fluids

Warm honey and lemon

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39
Q

If Under 6 came in with nasal congestion what would be first line?

A

Steam inhalation
vapour rubs
saline nasal drops

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40
Q

Codeine not suitable for children?

A

TRUE only for over 18 due to potential of abuse?

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41
Q

POM to P switches?

A 
Amorolfine nail lacquer
Azithromycin 
Chloramphenicol
Sumatriptan
Orlistat
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42
Q

What can Podiatrist Prescribe?

Hint : only 4 CDs they can prescribe?

A

All POM within there competence

In regards to CDs can only prescribe diazepam, dihydrocodeine, lorazepam and Temazepam.

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43
Q

What can physiotherapist prescribe?

Hint: can prescribe 3 extra CDs compared to Podiatrist

A

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.

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44
Q

What are the prescription requirements?

A

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

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45
Q

What does appropriate date mean?

A

Within 6 months for POM and schedule 5 drugs

28 days for CD schedule 2, 3, 4

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46
Q

Can you dispense Welsh prescription?

A

Yes as long as can understand it.

The medicine should be labelled in English

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47
Q

Can Schedule 2,3,4, and 5 be repeated?

A

Only 4 and 5 are repeatable

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48
Q

What is a repeatable prescription?

A

It is a private prescription which contains a direction that they can be repeated more than once e.g. repeat x 5

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49
Q

If have private prescription and it states repeat, how many times can you repeat this?

A

Can only be repeated ONCE

So dispense twice

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50
Q

If repeatable prescription has a contraception, how many times can you repeat this?

A

5 times

so dispensed 6 times in total

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51
Q

How long is a repeatable prescription valid for?

A

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.

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52
Q

If patient wants to get next repeat from another pharmacy what do you need to do on that repeatable prescription?

A

Mark prescription with the Pharmacy name and address, and date of supply.
Therefore other pharmacy knows when they have been supplied

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53
Q

What is validity of an owning of a P med,

A

6 Months for P,GSL, POM, Schedule 5

28 days for schedule 2, 3, 4

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54
Q

What is the destination of private scripts?

A

Private prescription retained in pharmacy for 2 years.

NHS FP10 are sent to NHS BSA

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55
Q

What record is kept for a private Rx?

A

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

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56
Q

What is exempt from recording keeping?

A

Oral contraceptives -

Schedule 2 CDs - as already in CD register

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57
Q

What is not a legal requirement on a prescription?

A

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

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58
Q

Prescriptions for Discharged prisoners?

A

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.

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59
Q

Is a fax prescription legal?

A

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

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60
Q

What can Dentist prescribe?

A

Any POM legally but if prescribing on FP10 NHS DENTAL PRESCRIPTION then can restricted to the medicines listed on the Dental prescribers formularly.

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61
Q

Who would we report forged prescriptions to?

A

Discuss with patient or prescriber if feel this can resolve it .. otherwise
Refer to police or NHS counter fraud services (for NHS prescriptions only)

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62
Q

Which EEA or SWISS prescribers than can be recognised?

A

Doctors
Dentist
Prescribing Pharmacist
Nurses

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63
Q

What countires are in the EEA?

A 
Austria
Belgium, Bulgaria
Croatia, Cyprus, Czech Republic
Denmark
Estonia
Finland, France, 
Germany, Greece
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64
Q

Can EEA or Swiss Prescriber do an emergency Supply?

A

Yes but no schedule 2 or 3

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65
Q

What are the prescription requirements for a EEA OR Swiss prescription?

A

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

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66
Q

What cant EEA OR SWISS prescribers supply?

A

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

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67
Q

How to check registration status of EEA or Swiss Prescriber

A

If unable to check registration status of a prescriber, then can still make a supply but need to make record

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68
Q

What can EEA prescribers emergency supply?

A

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

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69
Q

Who dispenses Military prescriptions?

A

Only Pharmacies who have Ministry of Defense (MOD) contract can dispense military script
A military script is called an FMED 296

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70
Q

If FMED 296 is presented to a non contracted pharmacy then how would you treat this script?

A

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.

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71
Q

What is legally required on a label?

A

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

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72
Q

What is considered good practice for a label?

A

Keep out of the reach and sight of children

Use this medicine only on your skin where applicable

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73
Q

If labelling medicine for someone in prison what should it include?

A

Prisoner number also included in order to identify patient

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74
Q

Is it true the inner container must legally be labelled e.g. bottle of amoxicillin?

A

NO
Only legal requirement to label the outside because it is good practice to label inner bottle as people could throw packaging away

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75
Q

What is required for labelling medicines broken down from bulk containers?

A

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

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76
Q

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

A

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

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77
Q

What is a Patient Specific Direction?

A

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

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78
Q

What is a Patient Group Direction?

A

•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

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79
Q

What can Pharmacist supply under a PGD to a sick or injured person?

A

Pharmacist can supply, offer to supply and administer diamorphine or morphine under a PGD for the immediate necessary treatment of sick or injured person.

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80
Q

What are the conditons of prescriber requesting emergency supply?

A

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

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81
Q

What would you write in POM register for emergency supply at request of prescriber?
3dates

A

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

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82
Q

What are the conditions for an emergency supply at the request of the patient?

*never going to get prescription

A

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

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83
Q

What length of treatment would you give if patient requesting emergency supply?

A

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

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84
Q

What would you record in POM register for emergency supply at request of patient?

A

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

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85
Q

What does label need to include for medicine supplied via emergency supply at request of patient?

A

In addition to standard labelling requirements the words ‘ Emergency Supply’ needs to be added to the dispensing label

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86
Q

Refusal of emergency supply?

A

Then advise patient how to obtain prescription i.e. referal to doctor, NHS walk in center or A&e department

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87
Q

In a Pandemic does a pharmacist need to supervise supply?

A

No

Also collection points would not need to be registered pharmacies premises.

88
Q

Can optometirst or podiatrist write prescriptions?

A

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
Q

What is an ‘additional supply optometrist’?

A

These are optometrist who have undertaken additional training and can issued patient orders for an extended range of medicines.

90
Q

What are the legal requirements of a signed order?

A

No legal requirements but should be satisfied that they have provided sufficient advice to allow patient to use medicine safely and effectively.

91
Q

Self prescribing and for family?

A

Is considered poor practice to self prescribe or to person for person who there is close relationship with but legal for doctors.

92
Q

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?

A

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
Q

Can UK doctors prescribe CDs?

A

Yes
Need Home office for prescribing Cocaine, Diamorphine and Dipipanone for treating addition.
If EEA/swiss can only prescribe schedule 4 &5 CD?

94
Q

Can optometrist independent prescriber prescribe CDs?

A

No

95
Q

Can physiotherapist independent prescriber prescribe CDs?

A

Yes Dihydrocodeine, temezepam, lorazepam, diazepam, oxycodone for oral admin, Morphine IV or Oral and fentanyl patches

96
Q

Can Veterinary surgeons and practitioners prescribe CDs?

A

Yes for animals. Address must be in UK unless it is for schedule 4/5

97
Q

Can EEA OR Swiss Doctors and dentist prescribe CDs?

A

Yes if its for schedule 4 or 5 only

98
Q

Can community practitioner nurses (CPN) prescribe CDs?

A

NO.

They are restricted to dressing, appliances and licensed medicines which are listed in the nurse prescriber formulary

99
Q

Who can prescribe unlicensed medicines?

A 
UK registered Doctor
Dentist
Pharmacist/ independent prescribers
Supplementary prescribers
Vets

*EEA/Swiss prescribers cannot prescribe unlicensed medicines

100
Q

Can Vets prescribe unlicensed medicines?

A

Yes for the treatment of animals under the treatment of veterinary cascade

101
Q

Who can supply Emergency supply including phenobarbital for epilepsy but not 1/2/3

A

UK doctors
Dentist
Pharmacist/Nurse independent prescribers
Supplementary prescribers

102
Q

Can physiotherapist and podiatrist independent prescribers supply emergency supply?

A

Yes but not schedule 1,2,3, including phenobarbital.

103
Q

Can VETS do emergency supply?

A

n/a

104
Q

Can Community Practitioner Nurse or Optometrist Independent prescribers authorise an emergency supply?

A

Yes but no CDs

105
Q

UK DENTIST?

A

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
Q

Supplementary prescribers must prescribe in competence with?

A

An agreed clinical management plan

107
Q

Nurse/Pharmacist Independent prescribers

A

Prescribe within there competence

108
Q

Optometrist independent prescribers must prescribe for

A

Only ocular conditions affecting eye and surrounding tissue only.

109
Q

Physiotherapist and Podiatrist independent prescribers must prescribe

A

Within there competence

110
Q

EEA/SWISS PRESCRIBERS MUST PRESCRIBE

A

Only items which have a marketing authorisation within the UK

111
Q

A person trading in medicines must hold?

A

Wholesale dealers license 35minn

112
Q

Who can a wholesaler deal to?

A

Other wholesalers
Pharmacies
People authorised to supply medication

113
Q

TRUE/FALSE: Pharmacist can hold medications in a pharamcies and take small quantities from another pharmacy?

A

TRUE

Under provision of healthcare services

114
Q

What are the conditions which allow pharmacies to obtain small quantities of medicines from other pharmacies without a having to hold a WDA(H)?

A

1) Takes Place on occasional basis
2) Small quantity
3) Not for profit
4) Supply is not for onward wholesale distribution

115
Q

If 2 Pharmacies are part of the same legal entity, can the other one wholesale?

A

No its only the pharmacy registered for wholesaling that can wholesale

116
Q

Who can not receive medicines from wholesalers?

A

Non-medical prescribers e.g. Pharmacist or nurse independent prescribers

117
Q

How long should a signed order be kept for?

A

2 years

118
Q

Is it a legal requirement to make a POM register entry for signed orders?

A

No its good practice as signed order is retained

119
Q

Does signed order have to be written?

A

No its good practice

120
Q

What would be included in POM register entry for a signed order?

A

Date POM supplied
Name, quantity, form, strength
Name, Address , profession of person supplied
Purpose of supply

121
Q

What must be included in a signed order?

A

No requirements just need to be satisfied it is safe. But minimum is knowing the details so can fill out POM entry

122
Q

What does ‘Use by 06/2019 mean?

A

Product should not be used after 31st May 2019

i.e. by the time it hits june want it to be used

123
Q

What does an expiry date of 12/2019 mean?

A

The product should not be used after 31st December 2019

124
Q

Can scotish Pharmacist recieve waste?

A

Yes

125
Q

Where should waste medicines be stored?

A

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
Q

How should you deal with confidential information?

A

Ensure patient identifiable information is destroyed or totally obscured.

127
Q

How should tablets and capsule be thrown away?

A

Tablets and capsules should not be de-blistered.

128
Q

How should liquids be thrown away?

A

The whole bottle should be placed into pharmaceutical waste container

129
Q

How should sharps be thrown away?

A

Dispose syringes and needles in a sharps container

130
Q

What advice should you give to patients regarding waste?

A

Advice that unused, unwanted medicines should be returned to pharmacy for safe disposal.

131
Q

What is a secure environment?

A

Includes prison, police custody sites, secure hospitals, immigration removal centres and other places where persons are detained.

132
Q

An in house pharmacy within a pharmacy does not need to be registered with the GPHC

A

True

But pharmaceutical legal and good practice guidelines should be followed

133
Q

Where can you check the registration of Vets?

A

RCVS

134
Q

For Animal CDs, do we need a standard form?

A

NO

135
Q

Unlicenced medicine prescribed by Vet?

A

Should be under cascade

136
Q

When do we not need to give a child resistant container?

A

1) Specific Request - i.e. pt requests as have difficulty opening it
2) Original pack may not be child resistant

137
Q

How to contact X-directory?

A

Dial 100 to contact patients in emergencies

Must be life or death situation

138
Q

Homeopathy?

A

Treating like with like

Involves administering dilute and ultra dilute products

139
Q

Herbal preperations?

A

Plant derived materials either as raw or processed ingredients which may be from one or more plan

140
Q

What is the evidence for homeopathy?

A

NO EVIDENCE - advice pts on lack of evidence

Also ensure pts do not stop taking prescribed meds

141
Q

What is the difference between herbal and homeopathic licensing?

A

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
Q

Can a child collect a prescription?

A

See pg 119

143
Q

If suspect child abuse what should you do?

A

In emergency call the police
Or Take advice and refer to social services
Pg 120

144
Q

What age of sexual activity should be reported to social services?

A

Under 13s

As legally too young to consent to any sexual activity

145
Q

What do you do if suspect abuse of a vunerable adult?

A

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
Q

All medical devices must have CE?

A

Means it is fit for purpose

Pg 124

147
Q

What is anaphylaxis?

A

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
Q

VET PRESCRIPTION- WHAT IS A POM V?

A

POM that can only be prescribed by vet surgeon and supplied by vet surgeon or a pharmacist with a WRITTEN PRESCRIPTION

149
Q

What is a POM- VPS?

A

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
Q

What is NFA-VPS?

A

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
Q

AVM-GSL?

A

Authorised Veterinary Medicine that is available on general sale

152
Q

What is the Small animal exemption scheme (SAES)?

A

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
Q

Unauthorised veterinary medicine?

A

An unlicensed medicine that does not have MA. So can only be prescribed by vet surgeon under the cascade

154
Q

What are the prescription requirements for VET prescription?

A

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
Q

What is the difference between Veterinary and Human Controlled drug prescriptions?

A

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
Q

What is similarities between vet and human CD Rx?

A

Both valid for 28 days

Usual cd prescription content requirements apply to both

157
Q

When can a medicine be prescribed under the cascade?

A

When there is no existing licensed Vet medicine?

158
Q

Veterinary Medicine

A

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
Q

Label requirements for Vet medicine?

A

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
Q

When is a dispensing label for a veterinary medicine required?

A

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
Q

What record do we need to keep for POM-V and POM-VPS products?
*records kept for 5 years

A

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
Q

Can GSL or P medicine be supplied for animals?

A

NO even if vets asks you verbally

Unless this takes place under the veterinary cascade

163
Q

Supply of NFA-VPS and POM-VPS medicines?

A

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
Q

When is the physical presence of pharmacist required for Vet meds?

A

When POM-V, POM-VPS and NFA-VPS (like p meds) medicines are to be supplied.

165
Q

What human caution is there with animal meds?

A

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
Q

What is a Schedule 1 (CD Lic POM)?

A

No therapeutic use and license generally required for their production, possession or supply.
E.g. LSD, raw opium, ecstasy and cannabis

167
Q

What is a Schedule 2 (CD POM)?

A

Opiates e.g. diamorphine, morphine, methadone, pethidine
Major stimulants e.g. amphetamines, methylphenidates, dexamphetamine , lisdexamphetamine
Quinalbarbitone (Secobarbital)
And Ketamine

168
Q

What is Schedule 3 (CD No Register POM)?

A

Minor stimulants and other drugs e.g.
Buprenophine, Temazepam, Tramadol, midazolam and phenobarbital
Also Gabapentin and Pregabalin rescheduled 1st april 2019

169
Q

What are Schedule 4 (CD BENZ POM OR CD ANAB POM)

A

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
Q

What is schedule 5 (CD INV POM OR CD INV P)?

A

Codeine, pholcodine and morphine <13mg/5ml

171
Q

What two schedules do CD prescriptions requirements apply to?

A

2 & 3

172
Q

Prescriber address must be in the UK for which controlled drug schedule?

A

2 & 3

173
Q

Prescriptions are not repeatable for which schedules?

A

2&3

174
Q

Which schedules require a requisition?

A

Schedule 2 and 3

Requisition must be marked by supplier

175
Q

What schedules do invoices need to be kept for?

A

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
Q

What schedule need a licence to import or export?

A

2,3,4,

But dont need if schedule 4 part 2 if imported or exported by person for self administration

177
Q

What is the special exception with Sativex?

A

Need to keep a record even though it is schedule 4

178
Q

Apart from Doctors, dentist, Pharmacist, or IP, who else can possess CDS

A

Museums hold home office license to possess cds
Home office group authority- Paramedic
Class of of person- Postal operator

Pg 92

179
Q

What are the 2 exceptions where pharmacist can possess a Schedule 1 CD without having to obtain home office license?

A

1) If removing it from patient for purpose of destruction

2) Purpose of handing over to a police officer

180
Q

Who can possess schedule 1?

A

Need home office licence

181
Q

Who can prescribe Cocaine, Diamophine or dipipanone for treating addiction?

A

Only medical prescribers that hold a special licence from home secretary.

Others can prescribe it for organic disease or injury but not addiction.

182
Q

Which CDs require a license to import or export?

A

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
Q

Travelling and CDs?

A

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
Q

Legal requirements for a CD Requisition?

A

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
Q

Do we need a written requisition to supply CD 2 AND 3s?

A

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
Q

When is a requisition not needed before supply?

A

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
Q

Can stock be collected by a messenger ?

A

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
Q

What is the FP10CDF?

A

Standard Requisition form for CD2/3s

189
Q

What is FP10 PCD?

A

Standard private CD prescription form

190
Q

How do we process requisition forms?

A

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
Q

What can a midwife obtain on a supply order?

A

Diamorphine
Morphine
Pethidine

192
Q

What should a midwife supply order contain?

A

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
Q

What are the prescription requirements for Schedule 2 and 3 CDs?

A

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
Q

What must you do with a schedule 2 or 3 prescription?

A

Mark it with the date of supply

If instalment then mark date of each supply

195
Q

Is as directed valid on a schedule 2 or 3 script?

A

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
Q

What 2 pieces of information should an instalment direction contain?

A

1) Amount of medicine per instalment

2) Interval between each time the medicine can be supplied

197
Q

What is validity of instalment prescription?

A

First instalment dispensed within 28 days and the rest is in accordance with the instructions.

198
Q

What can a pharmacist amend on a schedule 2 or 3 RX?

A

Minor typographical errors
Where missing total quantity in either words/figures

Need to mark Rx with name,signaure, date and GPHC number

199
Q

What are the requirements for private Rx for Schedule 2 or 3 CDs?

A

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
Q

When do we not need a standardised form if supplying private rx for CD2/3?

A

Vet prescriptions for CD do not need to be on standardised form
Also if issued and dispensed within the same legal entity

201
Q

If HCP wants to collect scheduled 2 controlled drug for a patient?

A

Unless already known, need to obtain
1) Name of HCP
2) Address of HCP
ALSO request ID

202
Q

If a representative wants to collect for a drug misuser?

A

Need letter from patient which authorises and names the representative, even if in police custody.
Also need separate letter each time

203
Q

If a representative comes to collect methadone but they are on supervised consumption what should you do?

A

Ring prescriber who can verbally agree this is ok.

But make sure keep record

204
Q

To denature CDs do pharmacist need a licence?

A

NO

But need to get exemption which is issued by environment agency which is known as T28 exemption

205
Q

Which CDs need to be dentured before disposal?

A

Schedule 2,3 and 4 part 1s

to ensure they are rendered irretrievable

206
Q

Which CDs need an authorised person to witness the dentauring of CD?

A

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
Q

Can an Accountable officer authorise himself to be a witness?

A

NO

208
Q

Destruction of Controlled Drugs?

A

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
Q

For controlled drugs received what must we record in CD register?

A

1) Date supply received
2) Name and address from whom received
3) Quantity received

210
Q

For controlled drugs supplied, what should you record in CD register?

A

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
Q

Entries in a CD register must be?

A

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
Q

What are the requirements for record keeping of CD register?

A

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
Q

How often should a running balance be done?

A

at least Weekly but may be more or less frequent

Running balance is good practice

214
Q

Sativex

A

Pg 110?

215
Q

APPENDICES?????

A

Pg 149 onwards need to read??

MEP (1 decks)

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