Rules of Prescribing

Question 1

Who provides advice to the BNF?

Answer 1

Clinical experts

Question 2

What information does the BNF provide in regards to medicines?

Answer 2

1. Drug name
2. Indications
3. Cautions
4. Contra-indications
   - Hepatic impairment
   - Renal impairment
   - Pregnancy
   - Breast-feeding
5. Side-effects
6. Dose
   - Approved name
   - Proprietary name
7. Relative Costs

Question 3

How often is the BNF updated?

Answer 3

Every 6 months

Question 4

What are the TWO main routes of drug administration?

Answer 4

1. Local

2. Systemic

Question 5

What are the TWO subcategories of a systemic drug route? And their subcategories?

Answer 5

1. Enteral (drug placed directly into gut)
   a. Oral
   b. Rectal
   c. Sublingual
   d. Buccal
2. Parenteral (not directly into gut)
   a. Injection (SC, IM, IV, Intra-arterial, intra-thecal)
   b. Transdermal
   c. Inhalation

Question 6

Draw the sign for:
- 'Prescription less suitable for prescribing'
- 'Prescription only medicine'
- 'Controlled drug'
- 'Not available on the NHS'
found in the BNF

Answer 6

1. [ /#]
2. [PoM]
3. [CD]
4. [NHS] striked out

Question 7

Summarise The Medicines Act 1968

Answer 7

• Most medicines can only be sold or supplied against a prescription at a pharmacy, under supervision of pharmacist
• General Sales List drugs (GLS) may be sold at other premises AS LONG as they are pre-packed and the premise can be closed to the public (e.g. NOT car boot sale)

Question 8

Summarise The Misuse of Drugs Act 1971

Answer 8

• Introduced concept of ‘controlled-drug’ rather ‘dangerous drugs’
• Prevents misuse of CDs but complete BAN on possession, distribution, manufacture and import/export
• EXCEPTIONS = regulations/ license from Secretary of State

   Class A e.g. cocaine, MDMA, diamorphine
   Class B e.g. cannabis, codeine
   Class C e.g. benzodiazepines, buprenorphine

Question 9

What legal aspect regulates The Misuse of Drugs Act 1971? And summarise this regulation

Answer 9

• The Misuse of Drugs Regulation 2001
• Defines classes of person authorised to SUPPLY and POSSESS CDs
• They act in their professional capacities and determines conditions which these activities are carried out
• Drugs dived into 5 schedules = CD1, CD2, CD3, CD4-1, CD4-2

Question 10

Name the legal aspect that ALL drug/ medicine acts are streamlined into

Answer 10

The Human Medicine Regulations 2012

Question 11

What are the THREE legal categories of drugs?

Answer 11

1. GSL - General Sales List
2. P - Pharmacy medicine (pharmacist must see pt before med is sold)
3. PoM - Prescription only Medicine

Question 12

Who is legally responsible for a prescription?

Answer 12

The doctor/ dentist who signed the prescription

Question 13

What are some considerations to take when prescribing a drug?

Answer 13

• Tx whole pt not just symptoms
• Side-effects/ interactions
• Risks v Benefits
• Drugs can kill
• Only prescribe when medicine is essential! (e.g. AB v surgical drainage)
• Be street-wise with those abusing system
• Drug names (chemical, approved, brand)
• CHILDREN/ ELDERLY = age-appropriate doses, SF?
• PREGNANCY = teratogenecity (drugs affecting baby)
• BREAST-FEEDING
• LIVER DISEASE = metabolism
• RENAL DISEASE = excretiong

=> ALWAYS CHECK BNF!

Question 14

What should be advised to pts in regard to medicine?

Answer 14

• Take at CORRECT TIME and FINISH COURSE
• Any UNEXPECTED REACTIONS –> STOP and contact prescriber
• Discuss any KNOWN SIDE-EFFECTS e.g. metronidazole & alcohol
• Keep AWAY FROM CHILDREN

Question 15

What NHS prescription form is used in general dental practices?

Answer 15

GP14 - only drugs in DPF can be prescribed

Question 16

What NHS prescription form is used in dental hospitals?

Answer 16

HBP (external) - any drug can be prescribed (as long as it is for DENTAL use)

Special cards (internal) - for out-pts and discharged (local guidelines to be followed)

Question 17

What are the principles and information required when writing an NHS prescription form? (13)

Answer 17

1. Patient’s full name and address
2. Age IF UNDER 12 (legal required for PoM); otherwise not essential
3. Date (valid for 6m)
4. Prescriber’s full name and address
5. Status of prescriber (GDP, consultant etc.)
6. Signature of prescriber (IN INK, computerised not accepted)
7. Name of drug (no abbrvs, generic name)
8. Form & strength (physical form of drug & the amount of drug PER dose)
9. Dose & frequency (amount of drug taken at one time, & how often)
10. Duration of treatment
11. SEND/ SUPPLY (total quantity of drug)
12. LABEL (how & when to take drug)
13. Score out any residual space on form

Question 18

What are the principles and information required when writing a prescription for a CONTROLLED DRUG? (9)

Answer 18

1. Prescriber’s OWN writing throughout/ printed from comp (sig must be in handwriting!) using SAME PEN
2. Name and address of pt
3. Form and strength
4. Dose and frequency
5. SEND (either total quantity OR number of dose units - in BOTH numbers and letters) e.g. eighty (80) milligrams OR four (4) tablets of twenty (20) milligrams
6. LABEL (how & when)
7. Prescriber’s name, address and SIGNATURE
8. Date (CDs only valid for 28 days!)
9. Endorse = FOR DENTAL TREATMENT ONLY