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Yr 3 - Primary Care > Prescribing in Primary Care > Flashcards

Prescribing in Primary Care Flashcards

1
Q

Give 4 examples of independent prescribers

A
  • Nurse
  • Pharmacist
  • Optometrist
  • Physiotherapist
  • Podiatrist

They can only prescribe medications within their competence and their scope of practice.

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2
Q

What is the form colour of the prescriptions issued by GPs?

A

Green

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3
Q

What is the code of the prescriptions issued by GPs?

A

All prescription forms originating in England begin with the code FP10.

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4
Q

What does FP10 HNC indicate?

A

The suffix (HNC) indicates the prescriber - HNC for hospital

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5
Q

What does a blue prescription form indicate?

A

Prescribers managing substance abuse patients

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6
Q

What does a lilac prescription form indicate?

A

Community/independent nurse prescribers and AHP prescribers

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7
Q

What does a yellow prescription form indicate?

A

Dentists

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8
Q

How does 0.25 milligrams be written on a prescription? Why?

A

25 micrograms - helps to avoid confusion and miscalculation

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9
Q

Describe how a prescription is sent using the Electronic Prescription Service (EPS)

A
  • The prescription is generated by the GP and stored in the prescribing system
  • The prescription is digitally “signed” by the Doctor
  • The prescription is then sent directly to the Pharmacy electronically
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10
Q

If the patient does not have a nominated pharmacy, what can they be issued with?

A

A prescription token - can be taken to any pharmacy

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11
Q

What are ‘off license’ indications for drugs?

A

When drugs may be used successfully for other purposes, not stated in the list of indications, but accepted in current medical practice.

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12
Q

Who takes responsibility in the context of off license prescriptions?

A

the individual prescriber must take personal responsibility for the use of a drug in a particular situation

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13
Q

Example of ‘off licence’ use of lansoprazole (PPI):

A

Widely and successfully used by Paediatricians for reflux in children, but the manufacturer has no indication for its use in children

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14
Q

Example of ‘off licence’ use of Domperidone (an antiemetic):

A

used by Obstetricians and Midwifes to enhance Breast Feeding, because it promotes Prolactin production, but the manufacturer has no indication for this use

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15
Q

Example of ‘off licence’ use of paroxetine (SSRI):

A

used by some psychosexual counsellors as a treatment for Premature Ejaculation, because one of the side effects of SSRIs is to reduce sexual performance, but it’s use in this area is not indicated by the manufacturer

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16
Q

Give some additional considerations when prescribing for the elderly

A
  • Polypharmacy - greater risk of drug interactions
  • Physiological changes - reduced renal & hepatic function
  • Changes in pharmacodynamics - reduced absorption of drugs
  • Patient factors e.g. confusion, poor vision, manual dexterity problems (think about container!)
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17
Q

How can a reduced renal and hepatic function in the elderly affected prescribing?

A

Reduced renal and hepatic function can lead to reduce excretion of medications and possible accumulation & toxicity

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18
Q

What is the drug reaction shown in this picture? Cause?

A

Typical macular rash that occurs in people allergic to broad-spectrum penicillins e.g. Amoxicillin

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19
Q

What is this drug reaction? Why does it occur?

A

This is staining of the teeth (and bones) from tetracyclines → medication binds to calcium

20
Q

Who is staining of the teeth and bones by tetracyclines most common in?

A

Children

21
Q

What should you advise patients NOT to take tetracyclines with?

A

With milk or calcium products → affects absorption of medication

22
Q

What is this drug reaction?

A

This is hypopigmentation following a steroid injection (for De Quervains tendonitis)

This reaction may occur with any steroid (but this picture shows tracking of the hypopigmentation along the lymphatic drainage → indicates Trimacinolone)

23
Q

What are green drugs?

A

drugs which can be initiated and re-prescribed in Primary Care

24
Q

What are amber drugs?

A

require monitoring

25
Q

Where must amber drugs be initiated?

A

In 2ary care BUT have a Shared Care arrangement, such that they can be monitored and re-prescribed in Primary Care, e.g. Methotrexate for Rheumatoid Arthritis

26
Q

Is methotrexate green, amber or red?

A

Amber

27
Q

What are red drugs?

A

may only be prescribed in Secondary Care, e.g. cytotoxic agents, biologics and most cancer chemotherapy.

28
Q

Are biologics green, amber or red drugs?

A

Red

29
Q

Average cost of prescriptions dispensed in community per year?

A

£8/9 billion

30
Q

What % of prescriptions are dispensed free of charge?

A

Around 90%

31
Q

In England, how much do we pay for a prescription?

A

In England we pay £9.00 per item on prescription, or prepaid for 3 months £29.00, 12 months £104.00

32
Q

What patient age groups do NOT pay for prescriptions

A
  • <16
  • 16, 17 or 18 BUT in full time education
  • 60 or over y/o
33
Q

Give some other patient populations who do NOT have to pay for prescriptions

A
  • Pregnancy or within 12 months of giving birth
  • Certain medication conditions → need to apply for a Medical Exemption Certificate
  • Low income
  • All contraceptives (not HRT unless >60)
  • Some State Benefits
34
Q

What details are included in the top section of a FP10 prescription form?

A
  • Patient age (in years and months if <5 y/o)
  • Patient DOB
  • Patient name
  • Patient address
35
Q

What details are included in the middle section of a FP10 prescription form?

A
  • DRUG: name, strength (e.g. 40mg) and formulation (e.g. tablets)
  • DOSING: patient-friendly dose in numbers (e.g. 1 tablet) followed by frequency in words (e.g. four times a day)
  • QUANTITY: quantity to be dispensed (e.g. 28 tablets)

Example:

Paracetamol 500mg tablets

Take one to two tablets as required every four to six hours

Maximum eight tablets in 24 hours

Supply 28 tablets

36
Q

What details are included in the bottom section of a FP10 prescription form?

A
  • Signature
  • GMC number
  • Date of signing prescription
  • Prescriber’s name and address (usually pre-printed)
37
Q

How should milligrams vs micrograms be written?

A

Milligrams → mg

Micrograms → WRITE OUT micrograms

38
Q

How should gram be written?

A

g

39
Q

How should millilitres be writen?

A

mL

40
Q

How should litres be written?

A

L

41
Q

What should you do with any unused space in the prescription box?

A

Cross out any unused space

42
Q

What colour pen must you write in?

A

Black (must be inedible)

43
Q

With controlled drug prescriptions (e.g. diamorphine), how must these be written?

A

Strength must be spelled out in words as well as numeric e.g. 30mg (thirty mg)

Dose must be spelled out in words as well as numeric e.g. 60mg (sixty mg) by subcutaneous infusion over 24 hours

Quantity must be spelled out in words as well as numeric e.g. 6 (six) ampoules

44
Q

Give prescription example for Beclomethasone 100 migrograms inhaler

A

DRUG: Beclomethasone 100micrograms/puff inhaler

DOSE: Two puffs twice a day

QUANTITY: 1 inhaler

  • Write the inhaler and puff content in the drug box
  • Write how many puffs in the dose box
45
Q

What are PRN prescriptions?

A

The PRN prescription stands for ‘pro re nata,’ which means that the administration of medication is not scheduled. Instead, the prescription is taken as needed e.g. Tramadol, Paracetamol

46
Q

For PRN prescriptions, what must be included?

A

Minimum dose interval e.g. as required every 4 to 6 hours

Maximum total daily amount e.g. maximum eight tablets in 24 hours

47
Q

Use generic drug names (not brand names), except for which drugs?

A
  • Inhalers
  • Insulin
  • Psychiatric drugs
  • Epilepsy drugs
  • Narrow therapeutic range ranges:
    • Gentamycin
    • Warfarin
    • Lithium
    • Digoxin
    • Theophylline
    • Methotrexate
    • Insulin
    • Ciclosporin
    • Carbamazepine

Yr 3 - Primary Care (2 decks)

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