Professional Pharmacy Flashcards
(169 cards)
1
Q
What are the 4 principles of medicines optimisation?
A
- aim to understand the patient’s experience
- Evidence based choice of medicines
- Ensure medicines are as safe as possible
- Make medicine optimisation part of routine practice
2
Q
What is professional judgement?
A
The use of accumlated knowledge, experience and critical reasoning to make an informed decision
3
Q
Sources of information for medicines reconciliations
A
PMR, repeat prescription, patient, PODS, relative, GP, Care home, discharge summary, community pharmacy
4
Q
What is the name of the culture where blame and punishment is assigned?
A
Punitive culture
5
Q
Why is a non blame culture inadequate?
A
It can breed complaincency which can impact patient care
6
Q
What is the right culture?
A
Just culture - based on principles of fairness, quality, transparency, reporting and learning
7
Q
What system can be used to anonymously report incidents?
A
NRLS (national reporting learning system)
8
Q
What logs should be completed following an error?
A
Near miss logs - should regularly review
9
Q
What needs to be submitted each year for revalidation?
A
- 4 x CPDS ( at least 2 planned)
- A peer discussion
- A reflective account
10
Q
What are the 9 Gphc standards for pharmacy professionals?
A
- Provide person centered care
- Work in partnership with others
- Communicate effectively
- Maintain, develop and use professional knowledge and skills
- Use professional judgement
- Have a professional manne
- Respect and maintain confidentiality
- Speak up when things go wrong
- Demonstrate leadership
11
Q
What can a GSL medication also be reffered as?
A
PO medication
12
Q
Can GSL medications be sold when the Pharmacist is absent?
A
GSL can only be sold under the responsible pharmacist - however the pharmacist can be physically absent for a limited period of time while remaining responsible thus permiting sale of GSL
13
Q
What is the maximum quantity of pseudoephedrine + ephedrine that can be supplied OTC?
A
Pseudo - no more than 720mg
Ephedrine - no more than 180mg
- cannot sell both together
14
Q
Who can sell pseudo / ephedrine?
A
Pharmacist or staff who are suitably trained
15
Q
What group is Levonorgestrol licensed for?
A
> 16 years, within 72 hours
16
Q
How long after UPSI can uilpristal be used?
A
120 hours
17
Q
What is the appropriate action for a 13 y/o requesting EHC
A
legally too young to consent to sexual activity, report to social services unless exceptional cricumstances backed by documentation
18
Q
If a pharmacy does not have a PGD for EHC and it is unlicensed to sell OTC, what other options can be sought?
A
refer to other providers e.g. GUM clinic, family planning clinic, general providers of PGDs for EHC
19
Q
what is the legal restriction on OTC paracetamol / Aspirin?
A
no more than 100 non effervescents, no legal limit on OTC effervescents
20
Q
What indications can codeine and DH codeine be sold OTC for? q
A
short term treatment of acute, moderate pain that is not relieved by ibuprofen / paracetamol / aspirin
21
Q
What pack size of codeine / dihydrocodeine is classified as a POM?
A
> 32 dose units ( inc. effervescent)
22
Q
What warning must be on codeine / DH codeine?
A
Warning: can cause addiction to use for 3 days only
23
Q
What classification is Amorolifine?
A
P medications - for 18 years and above
24
Q
How many nails can be treated with Amorolifine at one time?
A
Maximum of 2 nails
25
How many days does Amorolifine lacquer diffuse through the nail plate for?
7 days
26
How long does it take for the affected nails treated with Amorolfine to grow out?
nine to twelve months for toenails and six months for finger nails
27
How often should Amorolfine be applied?
once weekly
28
When should amorfoline not be supplied?
- < 18
- Pregnacy / lactation
- Hypersensitive to ingredients
- refer if diabetic/immunosupressed/ peripherla circulatory disease
29
Can Amorolfine be supplied to a third party?
Yes - but need to ensure it is being supplied in line with products MA
30
What age is Chloramphenicol licensed for?
> 2 years
31
What 3 symptoms need to be present to consider sale of chloramphenicol?
- yellow purulent discharge
- Swelling eyelid
- irritated, itchy red or watery eye / gritty sensation
32
Dose of chloramphenicol drops?
1 drop AE every 2 hours for first 48 hours then every 4 hours
33
Treatment course for chloramphenicol?
5 days
34
When should you refer a patient asking for Chloramphenicol?
- eye pain
- swelling
- foreign body in the eye
- Galucome
- Recent infection
- Suspeced viral infection
- contact lenses
- pregnant/BF
- Using other eye drops
35
What eye symptoms requrie urgent referral?
Cloudy looking, unusual pupil, affected visio, photophobia, painful eye movement, worsening symptoms, eye/head injury, eye or laser surgery in last 6 months, contact lenses
36
What practical advice can be offered to a person with conjunctivitis?
- remove discharge with warm water / fresh cotton wool
- apply a cool compress around the eye
- Lubricating drops
- Cotangious - avoid spreading by not sharing towels, washing hands etc
- you do not need to avoid school/work
- do not wear contacts for at least 24 hours after chloramphenicol use
37
If a patient requestion Levonorgesterl has had an enzyme inducing drug within the last 4 weeks, what options are there?
- double dose LVG
| - copper IUD
38
What population is LVG less effective in?
Women who weigh >70kg (BMI>26)
39
What patients is Ulipristal not recommended for use in?
- severe liver impairment
| - Severe asthma who are on oral glucocorticoid
40
How long after having Ulipristal is breastfeeding not recommended for?
1 week
41
What is the advice regarding regular contraception alongside Ulipristal?
Ulipristal can reduce efficacy of COC + POC/ Progesterone containing drugs should not be restarted for 5 days afterwards (pt to use reliable barrier method)
42
What could be implied if a patient has severe lower abdominal pain after taking oral emergency contraceptive?
Ectopic pregnancy
43
What patient population can mometasone spray be sold to?
>18 year olds for up to 3 months of tx
44
What can mometasone spray help to treat?
Nasal inflammation, sneezing, itching, blocked or runny nose
45
Before first adminsitration of mometasone what should be done to the spray?
Prime the spray by actuating the pump 10 times until a fine mist is obtained, re-prime with 2 sprays if the pump has not been used for 14 days
46
What pack size of lidocaine products are sold as P medicines?
10g
47
What warning should lidocaine containing products be labelled with?
Not suitable for treatment of teething children
48
What is first line treatment for teething?
Gentle rubbing, biting on a clean + cool object, Paracetamol / Ibuprofen suspensions
49
What is the maximum frequency a lidocaine product can be used?
dose can be repeated 3 hourly, max of 6 times a day
50
At what BMI can orlistat be supplied OTC?
BMI >28, aged over 18
51
What population of patients who want Orilistat should be refered?
- Diabetic
- Patients on BP meds / hypercholesterolaemia
- pt on amiodarone
- Patinets on levothyorxine
- Pt on antiepileptics
- patinets who have been using orlistat for >6months
- Pt with rectal bleeding / CKD
52
Whast is the risk when orlistat is taking alongside antiepileptics?
Increased risk of convulsions
53
What vitamin absorption may be impaired with concurrent olistat?
Fat soluble ADEK
54
what PPIs are available OTC?
Omeprazole 10mg + pantoprazole 20mg
55
What patient population are the OTC PPIs indicated for?
> 18 years with symptoms of acid reflux
56
How long should patients take PPIs for OTC?
omeprazole - refer to GP if no improvement in 2 weeks
| Pantoprazole - refer to GP if no improvement in 4 weeks
57
What can PPIs mask the symptoms of?
Gastric cancer
58
In what patients should PPIs be used in caution?
>55 years, unexplained dyspepsia that has not responded to treatment and patients who have dyspepsia + bleeding, dyphagiga, recurrent vomiting, weight loss
59
MHRA alert regarding PPIs
very low risk of subacute cutaneous lupus erythematosus
60
What patient is Viagra connect indicated for?
> 18 year olds with ED
61
How long before sexual activity should Viagra be taken?
one hour
62
If viagra is taken with food what can happen to the onset of action?
Delayed onset compared to the fasted state
63
Drugs that are contraindicated alongise Viagra
Nitrates, Guanylate cyclase stimulators (Riociguat), Ritonavir
64
What patients are not fit for sexual activity?
Severe cardiovascular disease (within last 6 months), pt who feel breathless wiht light/moderate exercise, uncontrolled hypertension etc
65
Severe side effects associated wiht Sildenafil
Priapism, sudden visual defects, severe allergic reaction
66
What anti-malarial is a P medicine?
Maloff protect 250mg/100mg (atovaquone wiht proguanil)
67
What is the indication for Maloff protect?
Prevention of plasmodium falciparum malaria in adults >18 years weighing >40kg
68
What are the four antimalarials available as a P medication?
1) Maloff protect (atovaquone + proguanil)
2) Avloclor (Chloroquine)
3. Paludrine (proguanil)
4. Paludrine/Avlovlor (proguanil + Chloroquine)
69
POM antimalarials
Malarone (atovaquone + prouganil)
Doxycycline
Mefloquine (Lariam)
70
Dose of Maloff protect
One tablet, commence 1 to 2 days before entering malarial area, continue for 7 days after
71
How should Maloff protect be taken?
- Same time each day
- with food/milky drink
- do not crush tablets
72
What is the ABCD approach for malaria prevention?
A - awareness
B - bite protection
C - Chemoprophylaxis
D - Diagnosing early
73
Malarial bite avoidance measures
- Air conditioning, screening on doors/windows
- Mosquito net
- DEET 50%
- Loose fitting trousers rahter than shorts
74
Malarial symptoms
Fever, sweats + Chills, headache, vomiting, muscle pain, diarrhoea, tiredness
75
What strength of Sumatriptan is available as a P medication?
50mg
76
What is the supply criteria for OTC sumatriptan?
- migraine diagnosed
- Establsih pattern of migraine (5 or more attacks over a year)
- simple analgesics ineffective
77
What are the precautions for use of OTC sumatriptan?
- SSRI/SNRI
- ST J. wort
- COC
- Heart disease factors (e.g. 3 or more i.e diabetes, smoking, hypercholesteramia)
78
How soon after taking sumatriptan should symptoms be relieved?
30 minutes
79
What is the supply criteria for OTC tamsulosin?
- Male aged 45 - 75
- BPH symptoms for at least 3 months
- 2 week supply of Tamsulosin initially
- If no improvement, 4 weeks can be supplied
- at 6 weeks a Dr must see the patinet
80
Precautions for Tamsulosin use OTC
- planned glaucome/ cataract surgery
- CYP3A4 inhibitors
- Enhanced hypotensive effect if taken with antihypertensives
81
Can a women >45 years purchase TXA OTC?
no - must refer anyone <18 or >45 years old
82
Dose of TXA for heavy bleeding
500mg TDS ( max 4g daily)
83
Main side effects of TXA
GI discomfort, N+V, diarrhoea
84
Prescription requirements on an FP10
1. signature of prescriber (in ink)
2. address
3. Date (valid for 6 months)
4. drug particulars
5. Name of patient
6. Address of patient
7. Age (if <12)
85
For an NHS prescription, what is the appropriate date of supply?
the later of either the date of prescription was signed or a date indicated by the appropriate practitioner as the date before which it should not be dispensed
86
For private prescriptions, what is the appropriate date of supply?
The date on which it was signed
87
Where must schedule 2/3 prescribed?
UK
88
What type of prescriptions are repeat prescriptions written on?
Private prescription
89
If a repeat prescription does not have a repeat number on it, how often can it be repeated?
Repeat one (dispense twice) unless its is an oral contraceptive, which can be repeated five times (dispensed total of six)
90
What CDs can be repeated?
Schedule 4 & 5 not CD 1 or 2
91
Within how many months should the first repeat prescription be dispensed?
6 months
92
If a repeat prescription is written for a CD 4 when is does it have to be dispensed by?
within 28 days
93
Can patients take repeat prescriptions to different pharmacies?
Yes - to maintain an audit trail the name and address of the dispensing pharmacy should be made and the date of supply
94
How many years must private prescriptions for a POM be retained for?
2 years from the date of sale or for repeatable prescriptions from the date of last sale/supply
95
what records need to be kept when making an entry into the POM register?
- Supply Date
- Prescription date
- Medicines details
- prescriber details
- patient details
96
When should the record be made into the POM register after sale of a private prescription?
On the day of sale or if not practical, the following day
97
What medications are exempt from POM register recording keeping?
contraceptives + Schedule 2 CDs (separate CD register used)
98
If a patient is discharged from prison how can they obtain a prescription on discharge?
Prisoners can be given FP10 to take to community pharmacy (they have the name and address of the prison printed on) and patient is exempt from paying by virtue of having HMP in the address
99
What is the aim of the Falsified medicines directive?
Aims to create a system that ensures medicines supplied in the UK are safe. Ensure the trade in medicines is controlled to reduce the risk of fake medicines entering the supply chain
100
What are the FMD features on medication packs?
- new electronic scanning authentication process to be undertaken at point of dispensing `
101
Why is a faxed prescription not legal?
It is not written in indelible ink and has not been signed in ink by an appropriate practitioner
102
What form are military prescriptions written on?
FMed
103
If an FMed is presented to a non contracted pharmacy how should it be treated?
As a private prescription (charge the patient)
104
What forms are CD prescriptions written on?
Pink FP10CD
105
Legal requirements of labelling medications
- Name of patient
- Name and address of supplying pharmacy
- Date of dispensing
- Name of medicine
- Direction for use
- Precautions for use
106
Is it a legal requirement to state ' keep out of the sight nad reach of children' on medicine labels?
No - but it is recommeneded
107
If you are supplying a medicine from a bulk container what additional information should be on the label?
Batch number, expiry
108
what patient group can be considered to receive their medications covertly?
those that lack mental capacity
| pharmacies must sign a covert adminsitration document
109
What is a Patient specific direction?
exemptions to the restrictions on the sale, supply and adminsitration of medicines whereby a written instrction from a Dr, dentist or orther independent prescriber can supply a medicine or administer a medicine to a named patient after the prescriber has assessed that patient on an indivdual basis
110
Example of a PSD
Inpatient charts on a ward
111
Examples of exemptions where POMS can be supplied without a prescription
- PGDs
- PSDs
- Emergency supply
- Pandemic exemptions
- Optometrist / podiatrist signed orders
- salbutamol inhalers to schools
- naloxone to people in drug treatment services
112
What is a PGD?
A written direction that allows the supply and/or adminstration of a specified medicine(s) by named authorised health professionals to a well defined group of patients requiring treatment for a specific condition
113
Can pharmacies supply morphine/diamorphine under a PDG?
Yes - for the immediate necessary treatment of sick or injured people
114
Can an EEA / Swiz Dr request an emergency supply
No - not recognised as 'relevant prescribers' in the UK
115
Can CDs be given on an emergency supply basis?
No -only phenobaribtal or phenobarbitone for the treatment of epilepsy
116
If the patient requests a CD what is the maximum number of days supply that can be given?
5 days ( unless pack cannot be broken)
117
If a patient requests an emergency supply what additional information needs to be included in the POM register & on the label?
Reason for supply/nature of emergency in POM register + 'emergency supply' on the label
118
What must be included on a signed order for Salbutamol for schools?
- School name
-purpose of supply
-total quantity required
Ideally on headed paper but this is not legal
119
How long do you retain a signed order for salbutamol school inhalers
2 years `
120
Other than salbutamol, what other medication can be obtained by schools without a prescription?
Adrenaline autoinjectors
121
Who can supply naloxone without a prescription/PGD/PSD?
staff engaged or employed in the lawful drug treatment services
- they are able to obtain naloxone (inc. intranasal) rom a wholesaler and supply to patients
122
What programme must patients receiving oral retinoids be under?
A pregnancy protection scheme - during and for at least 1 months after stopping treatment
123
Under the PPP how long are scripts valid for?
7 days and should be dispensed on the day they are written
124
What is the maximum quantity of Oral retinoids that can be supplied under the PPP?
30 days
125
What medication other than retinoids needs prescribing under a PPP?
Sodium valporate
126
Do supply of medicines from community /hosptial to other healthcare professionals needs a WDA?
No - as long as it is a small quantity, occassional supply, not for profit and not for onward sale
127
If a pharmacy need a WDA what other license does it need for supplying CD 2-5?
Home office CD license
128
Veterinary prescription requirements
1) Name/address/phone/qualification/signature of prescriber (If CD Rx, need RCVS number too)
2) Name + address of owner
3) Identification of species + address (if different from owner)
4) Date (valid 6 months)
5) name,quantity,dose and administration of medicine
6) any necessary warnings
7) 'under casacade' when necessary
8) Where CD 2/3 needs to state 'this item has been prescribed for an animal or herd under the care of the veterinarian' + CD requirements
9) if repeatable, number of repeats
129
How many years should a veterinary prescription be retained for?
5 years
130
How many days are human + veterinary CD prescriptions valid for?
28 days
131
What is a legal requirement for pharmacist selling NFA-VPS and POM VPS medications?
- advise on how to use the product safely
- advise on any applicable warnings
- be satisfied that the recipient intends to use medicine correctly + is competent to do so
- Prescribe/supply the minimum quantity required for treatmet
132
Is the physcial presence of the pharmacist needed to supply POM-V, POM-VPS and NFA-VPS prescriptions?
Yes - unless transation has been indivdually authorised in advance by a pharmacist
133
What are the labelling requirements for veterinary prescriptions?
- name of vet
- name and address of owner
- name and address of pharmacy
- date of supply
- identification and species of animal
- expiry
- name of product / quantity
- administration instructions
- warning labels
- if appropriate, withdrawl period
- 'FOR ANIMAL TREATMENT ONLY'
- 'KEEP OUT OF THE SIGHT + REACH OF CHILDREN' ( RPS recommend only if it is a cascade medication)
134
What must be recorded in the POM register following sale of a veterinary prescription (POM V or POM VPS)
- name of medicine
- date of the supply
- batch number
- quantity
- name + address of supplier/recipient
- name + address of prescriber (if prescription + keep a copy)
135
What is the equivalent of the yellow card scheme for veterinary medicines?
SADRS - suspect adverse drug reactions
136
What is an accountable officer?
Person responsible for supervising and managing the use of CDs in their organization/ setting
137
Roles and responsibilities of accountable officers
- oversight and monitoring/auditing prescribing the use of CDs
- ensuring systems are in place for recording concerns
- attendance of local intelligence network meetings
- appointment of authorized witness for CD destruction
138
Examples of CD schedule 1
- usually no therapeutic use
| - hallucinogens (LSD), ecstasy, raw opium, cannabis
139
Example of CD schedule 2
Morhine, fentanyl, oxycodone, methadone, amfetamines
140
Example of CD schedule 3
Buprenorphine, temazepam, tramadol, midazolam, phenobarbital, pregabalin, gabapentin
141
What CD schedules need to be put in the CD register?
CD 1 + 2
142
Example of CD 4s
- Schedule 4 split into 2 parts- CD benz POM + CD anab POM
| - includes benzodiazepines and sativex (cannabinoid oromucosal mouth spray) + steroids
143
Example of CD schedule 5
codeine, pholcodine, morphine
144
Do schedule 4 + 5 CDs need prescription requirements?
no
145
How long is a prescription for a CD 5 valid for?
6 months
146
Can CD prescriptions be repeated?
No - only CD 4 + 5
147
What schedule of CDs need the invoice to be kept for 2 years?
CD 2 + 5
148
When is a home office license needed for a patient travelling with CDs?
If travelling with >3 month supply however it is advised that a covering letter is signed by the prescriber outlining the travel plans, name of prescribed CDs, total quantities
149
Legal requirements for a CD requistion
- signature of recipient
- name of recipient
- address of recipient
- profession
- total quantity
- purpose of requisition
150
What are the names of the approved mandatory requisition forms for Cds?
England - FP10CDF
Wales - WP10CDF
Scotland - CDRF ( private) or GP10A (NHS supplies)
151
If a CD prescription is written by a Dentist, what wording needs to be included?
For dental treatment only
152
What 2 pieces of information need to be combined on a CD instalment?
1) amount of medicine per instalment
| 2) interval between each time the medicine is supplied
153
What should be done if the patient misses doses of their instalment medication?
Pateint may have lost tolerance and the usual dose may cause overdose - contact the prescriber
154
What are the requirements for private prescription CDs?
- written on a standard form (FP10 PCD)
- Prescriber identification number
- Submission to relevant NHS agency
155
What type of CD prescription does NOT need to be written on a standardised form?
Veterinary CD scripts
156
If a representative is picking up a CD for a drug misuse patient, what does the MEP advise?
- obtain a letter from drug misuer to authorise representative
- a separate letter each time of collection
- it is also good practice to insist on seeing the patient once a week
157
If a healthcare professional is collecting a CD on behalf of the paitent, what does the MEP advise?
- obtain name of HCP + address + ID
158
How many times do an instalment prescription need to be signed?
once only
159
Does Gabapentin + pregabalin need to be kept in a CD cabinet>
no - they are exempt from safe custody
160
What CD schedules need to be denatured?
CD 1, 2 and 4a
161
What CD destruction needds to be witnessed?
Out of date stock (PODS returned does not need witnessing)
162
How frequent should the CD balance be checked?
once a week
163
What is sativex/
The only licensed cannabis based medicinal product avaliable in the UK used to treat spasticisty in MS
164
What needs to be considered before supplying a dispensed item to a child?
1) knowledge of the child
2) Maturity of the child
3) Nature of medicine to be supplied
4) Prior arrangement
5) Reason for collection
6) advise on the use of medicines
7) local policies
8) proof of identity
165
What does the responsible pharmacist notice need to display?
Name of RP, GPhc registration number, the fact that the RP os incharge of the pharmacy at the time
166
How many years does the RP record need to be kept for?
5 years
167
What is the maximum period of time that the RP can be absent for?
2 hours
168
What activities can be carried out with the RP being absent but still in charge of the supervision of the pharmacy?
- generating labels
- taking medicines off the disp shelves
- assembling the item (counting tablets)
- labelling containers iwth hte dispensing label
- accuracy checking
169
What tasks can take place with a RP in charge of the pharmacy (but does not require supervision of the pharmacist)
- Sale of GSLs
| - processing waste stock medicines or return medications (NOT CDs)
