prescriptions and drug classes and exemptions

Question 1

what does the legal classes of medicines determine?

Answer 1

• affect how patients can obtain them
• who can order, give AND administer medicines

Question 2

three legal classes

Answer 2

GSL = General sale list (e.g. in gas stations etc)

P = Pharmacy meds

POM = Prescription only medicine (only under authorised prescriptions)

Question 3

what is pgd, under pom’s

Answer 3

under POMS →some are PGD = Patient group direction: can be given to patients without needing prescriptions e.g. flu vaccine

Question 4

what are po meds

Answer 4

legally classified as a GSL med, but usually advice needed to be given with them, so can only be sold from a pharmacy

Question 5

why are medicines classified in this way?

Answer 5

To enable access to medicines without having to see a doctor
Allow people to self-care and manage their conditions.
Limit overdose risk, limit access to medicines that could cause addiction
Ensures that medicines are supplied with appropriate advice
Safety – Some medicines are too unsafe to be on general sale (cytotoxic)

Question 6

examples of POM-P Switch meds

Answer 6

• Amorolfine Nail Laquer: fungal nail infections
• Levonorgestrel and ulipristal: emergency contraceptives
• Proton Pump Inhibitors (Omeprazole, pantoprazole): acid reflux
• Sumatriptan: migraines
• Tranexamic acid: heavy menstrual bleeding

Question 7

how long are prescriptions valid for

Answer 7

6 months

Question 8

what are prescriptions

Answer 8

• document details medicine to be dispensed
• individual named patient

Question 9

prescriptions are written by who

Answer 9

• written by authorised prescriber / practitioner
• each medicine listed = prescription item

Question 10

a prescription fulfils what 3 roles

Answer 10

clinical document, legal document, invoice

Question 11

prescriptions come in what forms

Answer 11

electronic or paper

Question 12

examples of prescribers

Answer 12

PRESCRIBERS
|
|– Doctors
|
|– Dentists
|
|– Vets
|
|– Non-medical prescribers
|
|– Pharmacists
|
|– Nurses
|
|– Opticians
|
|– Specialists with training

Question 13

main 3 types of prescription

Answer 13

community, hospital and private

Question 14

traits of NHS community prescriptions

Answer 14

• only to be used for NHS patients
• differ in colour and format by devolved nation
  FP10 - GPs = green prescription

Question 15

traits of NHS hospital prescriptions

Answer 15

• only to be used for NHS patients:
  -> Inpatient (STAY IN HOSPITAL) & outpatient (VISITING E.G FOR A CLINIC)
• May include electronic prescribing systems → format varies
  -Drug chart (known as the prescription) also includes administrative record.

Question 16

traits of private prescriptions

Answer 16

mostly same info as nhs scripts, just no set template
- no standard format except controlled drugs
- has qualifications of the prescriber e.g. doctors etc
- all vet prescriptions

Question 17

NHS prescription journey - community

Answer 17

• Patient visits GP
  
  • Prescription is issued as appropriate
  • Patient takes to community pharmacy or accessed electronic prescription
  • Prescription is clinically checked and medicines dispensed & accuracy checked, plus check details e.g. DOB, if they’re medically exempt
    
    • Patient counselled and takes medicines away

Question 18

what happens after the patient is counselled

Answer 18

Prescription goes to NHS Business Services Authority (NBSA) for pricing & payment

Question 19

prescription legal requirements: (7)

Answer 19

1. signature of appropriate practitioner (indelible ink)
2. Address of the appropriate practitioner
3. Appropriate Date on which signed
4. Particulars of the prescriber
5. Patient NAME
6. Patient Address
7. Patient Age if under 12 years old

Question 20

do the same reqs apply to private and public prescriptions

Answer 20

yes

Question 21

where are medical exemptions shown

Answer 21

(all shown on the back of the prescription AKA its receipt)

Question 22

examples of exemptions

Answer 22

• low income
• benefits
• medical conditions like diabetes
• maternity leave / after birth
• armed forces
• age e.g. under 18 & full time education

Question 23

medical abbreviations: time

Answer 23

• x /7 indicates a number of days
• x/52 indicates a number of weeks
• x/12 indicates a number of months

Question 24

latin dosage abbreviations

Answer 24

• 1 od – omni die – one each day
• 1 om – omni mane – one each morning
• 1 on – omni nocte – one at night
• b.d or b.i.d – bis die / bis in die – twice a day
• t.d.s – ter die sumendus – three times a day
• q.d.s – quarter die sumendus – four times a day

Question 25

What is a clinical check of a prescription?

Answer 25

“The purpose of a clinical check by a pharmacist is to ensure that the medicine supplied is both safe and effective for use by a particular patient in relation to the risk and benefit to the patient”

Question 26

Aspects of a clinical check: what do we look out for?

Answer 26

- is the medicine right for the presenting patient - is the medicine right for the presenting condition - is the dosage appropriate - is the formulation appropriate - are there any interactions with the patients existing meds

Question 27

THE 3 KEY ELEMENTS OF A CLINICAL CHECK

Answer 27

1. the patient 2. the medication 3. administration and monitoring of the prescribed medication

Question 28

things we look at when considering administration of med

Answer 28

- route suitable - does the prescribed preparation exist - does it need to be taken with food - any adherence aids needed? - does any monitoring need to happen during treatment - any extra devices to get the best out of their medicine e.g. spacer for inhaler

Question 29

Patient factors: the type of patient

Answer 29

- who are they? do they fall into a group where treatment is cautioned or contra-indicated - specific patients that fall into these groups = children, pregnant/breastfeeding, and elderly - consider gender, certain ethnic groups, and past or present drug use - consider intolerences / preferences: allergies, dietary intolerances & religious beliefs - if there are any co-morbidities (conditions to check as we may have to adjust doses etc)

Question 30

cautioned meaning

Answer 30

when the drug should be used with care to avoid any danger or personal risk

Question 31

contra-indicated meaning

Answer 31

when the drug should not be used because it may be harmful to the patient: can be relative & absolute

Question 32

medication factors - what do we look at:

Answer 32

- whether the medication has any interactions with the patients other drugs, maybe even antagonistic ones - it’s indication of the medication, whether treatment is appropriate, if its within recommended guidelines - if the prescription or it’s strength or dose has changed

Question 33

checking if the dose, freq & strength is appropriate includes looking at

Answer 33

- age - renal or hepatic function - weight - lifestyle patterns - co-morbidities - other drug treatments - whether it’s appropriate for the formulation

Question 34

GSL medicines are medicinal products that can be sold or supplied to the public without a prescription or pharmacist supervision, provided they are what?

Answer 34

pre-packed and sold from premises that can be closed to exclude the public.

Question 35

What are the legal storage requirements for GSL medicines?

Answer 35

Stable at ambient temperatures Stored in a clean, tidy environment Protected from direct sunlight and moisture Kept in their original packaging Have facilities that can be locked when premises are closed

Question 36

What sales restrictions apply to GSL medicines?

Answer 36

GSL medicines: Must be pre-packed by the manufacturer Are subject to legal maximum pack size limits (e.g., 16 tablets for paracetamol in supermarkets) Cannot be sold if expired or damaged Must have patient information leaflets included Must be sold in child-resistant packaging where required by law

Question 37

What are the legal requirements for P medicines?

Answer 37

Must be sold under the supervision of a registered pharmacist Must be sold from registered pharmacy premises Require the pharmacist to be available on the premises Cannot be self-selected by customers in most cases (must be requested)

Question 38

How must P medicines be stored in a pharmacy?

Answer 38

Stored behind the pharmacy counter or in areas inaccessible to the public Kept in appropriate temperature-controlled environments (typically 2-25°C) Protected from unauthorized access Stored according to manufacturer specifications Subject to regular stock rotation and expiry date checks

Question 39

What criteria determine if a medicine receives POM classification?

Answer 39

They may present a direct or indirect danger if used without medical supervision They are frequently used incorrectly They require further investigation into effects or side effects They are administered parenterally (by injection) They contain substances which activity/adverse reactions require further investigation They are new medicinal products containing a substance not included in previously authorized medicines

Question 40

What are the storage requirements for POM medicines?

Answer 40

Stored in the dispensary or other secure area Kept in temperature-controlled conditions as specified by manufacturer Some require refrigeration (2-8°C) Controlled drugs (certain POMs) must be stored in a locked controlled drug cabinet Protected from unauthorized access at all times

Question 41

What is the legal framework governing medicine classification in the UK?

Answer 41

The Medicines Act 1968 and subsequent Human Medicines Regulations 2012 provide the legal framework. The MHRA (Medicines and Healthcare products Regulatory Agency) oversees medicine classification, with the Commission on Human Medicines advising on changes to legal categories.