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4 Flashcards

1
Q

Latest regs on CD’s

A

Controlled drugs (Supervision of management and use) regulations 2013Misuse of drugs act 1971 (imposed total ban)Misuse of drugs regs 2001 (imposed limitation on possession)

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2
Q

Who enforces the law?

A

Secretary of state can give licenses via the home officeHome office enforces rules through the police

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3
Q

MDR 2001 classes: Sch 1

A

No therapeutic use License needed for production, possession or supplyeg. cannabis, ecstasy,hallucinogens etc

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4
Q

MDR 2001 classes: Sch 2

A

Pharmacists when acting in their professional capacity have authority to possess, supply and procure theseEg. Morphine, dimorphine, amphetamines etc

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5
Q

MDR 2001 classes: Sch 3

A

Minor stimulants less likely than Sch 2 to be abused eg. benzphetmaine, buprenorphine, temazepam, tramadol etc

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6
Q

MDR 2001 classes: Sch 4

A

Part 1: Benz POMBenzopdiazepines, non-bz hypnotics and sativex (CB mouthspray)Part 2: Anab POMAnabolic and androgenic steroids, clenbuterol and growth hormones

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7
Q

MDR 2001 classes: Sch 5

A

Not under full control as they are at such low strengthseg codiene, pholcodiene, morphine

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8
Q

Who can possess/supply?

A

Pharmacist/doctor/dentists have general authority over sch 2-5 which includes administration and/or prescriptionOthers can be given authority via home office license, paramedics/midwives (certain drugs)Patients can have them if they have a valid prescription

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9
Q

Sch 1 special rules

A

Usually requires special license from home office Pharmacists can have them on grounds of either destroying it or handing over as evidence to the policeCan also be administered or prescribed with special license

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10
Q

Import/export

A

License needed for import/export of sch 1-4No license necessary for patients transporting sch 4No license for import/export of sch 5’s

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11
Q

Traveling abroad

A

Patient with less than 3 months of CD’s need no license Advisable to carry prescriber letter sating name, travel plans, drug name, dose and quantityShould also have a quick check with embassy/airline about restrictions

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12
Q

Safe custody requirements

A

Sch 2/3’s must be kept in a locked ‘safe, cabinet or room which is constructed so as to prevent unauthorised access’Exemptions possible for other non regulation storage eg. gun cabinet, bank safe’s etcAccess to CD’s should b documented

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13
Q

Exceptions to safe custody

A

Sch 2: Some liquid preparations and quinalbarbitoneSch 3: Phenobarbital, midazolam, tramadolWhen a CD’s is not in safe custody it should be under the personal supervision of the pharmacist

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14
Q

Resources can be categorised as..

A

Land LabourCapitalTime

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15
Q

Satisfaction in economics is known as…

A

Utilities We gain a certain amount of satisfaction from each economic decision and therefore will make such decisions based on the satisfaction we gain

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16
Q

Marginal utility

A

The point at which where it isn’t really worth investing in the same product as the utility gained is less the money invested. This is tied to the principle of diminishing utility

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17
Q

Opportunity costs

A

The cost of be unable to spend time/money on an opportunity due to the capital be locked up in other assets

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18
Q

Economic evaluation

A

Comparison of two or more alternative treatments in terms of costs and consequences

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19
Q

Quality adjusted life years (QALY)

A

Utility is quality of life and is deteremined by EQ-5D-5L health questionnaire giving a score out of 1 This is multiplied by the number of years

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20
Q

Cost minimisation

A

Assumes effectiveness is equal Intervention which achieves the desired outcome at the lowest price

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21
Q

Cost effectiveness

A

Does not make assumptions on effectiveness Beneifts usually measured in QALYs Essentially looks for best value for money but only considers costs to the NHS

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22
Q

Incremental cost effectiveness ratio (ICER)

A

Difference in treatment costs/ difference in effectivenessTied to diminishing utility of the utility gained decreasing over many repititions

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23
Q

Cost benefit analysis

A

Compares medical outcomes and expresses it in monetary terms Difficult due to the need to cost every factor Most common method of assigning value is the ‘willingness to pay’ approach ie what are those extra few years actually worth to you

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24
Q

Important questions to ask: Nausea/vomiting

A

• Blood in vomit?• Weight loss?• Have you travelled recently?• Can you keep fluids down?

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25
Q

Refer if (nausea/vomiting):

A

• Severe abdominal pain• Dehydration• Vomiting in <1 months• Projectile vomiting in <3 months• 24hr vomiting in <1 year • Pregnant and uncontrollable vomiting • Blood in vomit• Weight loss

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26
Q

Nausea/vomiting treatments: Re-hydration

A

Only if fluids tolerated Replaces lost fluids Offer range of flavours

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27
Q

Nausea/vomiting treatments: Anti-emetics

A

-Migraine associated: prochlorperazine buccal tabs for 18+>1-2 tabs daily for 2 days only

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28
Q

Nausea/vomiting treatments: Anticholinergics

A

-Travel sickness (anticholinergics) >Hyoscine: 300mcg tab 20mins before travel repeat every 6 hours if needed (max of 3 tabs/24 hours)

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29
Q

Dyspepsia

A

Upper abdominal symptoms caused by:-Indigestion -Heartburn -Increased gastric content -Gastritis -Duodenal/gastric ulcers

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30
Q

Dyspepsia symptoms

A

-Belching -Nausea/vomiting-Early satiety -Upper ab/lower discomfort -Bloating-Flatulence -Heartburn -Duodenal ulcer (2-3hrs after food, especially at night)-Gastric ulcer (sharp pain in stomach, 30mins after food)

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31
Q

Important questions (Dyspepsia)

A

-Describe pain (sharp, gnawing, stabbing)-Point to where the pain is-Does the pain radiate anywhere?-Does food make it better or worse?-Any other lifestyle factors that make it worse?

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32
Q

Referral symptoms (Dyspepsia):

A

-Anaemia (pale, tired, SoB) (!)-Loss of weight (!)-Anorexia (!)-Recent onset of symptoms (!)-Melaena (dark fecal matter,blood in stool) (!)-long standing change in bowel habit-Debilitating pain-Referred pain (possible cardiac problem)-Treatment failure -Indigestion with medicines

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33
Q

Dyspepsia: Lifestyle advice

A

1st ID the causeThen: modify diet, cease smoking, alcohol, caffeine, reduce weight, correct posture

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34
Q

Treatment: mild dyspepsia

A

AntacidsAl salts cause constipation, Mg salts cause diarrheaeg.ReneeAlso alginates can be used in combo

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35
Q

H2 antagonists

A

eg. ZantacBarely better than antacid/alginate16+ only

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36
Q

PPI’s

A

Highest efficacyeg. Zanprol (Omerazole 10mg) BD until symptoms improve then 1xdailyMax 4 weeks treatment

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37
Q

Mouth ulcer questions

A

How many?where?Shape and size?Painful?Any new/increased meds?Do you know of any possible cause?

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38
Q

Mouth ulcer referral

A

<10yrs oldLarger than 1cmin groups larger than 5-10+>14daysPainless ulcers Involvement of eye

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39
Q

Mouth ulcer treatment

A

Chlorhexidine mouthwash (antibacterial)- reduces pain/symptomsCholine salicylate (analgesic)- 16+ onlyLido/bencocaine available for <16yrsHydrocortisone buccal tabs- reduces inflammation, pain and healing

40
Q

Anti-emeticsAntihistamines

A

-Travel sickness (antihistamines) >Cinnarizine: 2 tabs 2 hours before journey and 1 every 8 hours of journey (adult)>Promethazine: 25mg on night before journey then every 6-8 hours as required (adult)

41
Q

Most common prescribing error

A

Dosage error Followed by incomplete prescriptions, therapy omission, illegibility…

42
Q

Stage in dispensing where most errors occur

A

Stock selection

43
Q

Greatest impact on dispensing errors

A

Workload Followed closely by similar drug names/packaging

44
Q

Clinical governance is defined as…

A

the framework through NHS organisations are held accountable for continuous improvement of services and safeguarding excellent standards of care by creating an environment where excellence in clinical care will flourish

45
Q

Ways in which clinical governance is implemented

A

Audits CPDRemedying under performance Accountability Clinical effectiveness Patient/public involvement

46
Q

Methods of preventing errors

A

SOP’s to standardise methods in order to reduce errorsNo blame culture and error reporting allows analysis of procedures to minimise errors Use of dispensing robots to reduce human errors

47
Q

Duty of candour definition

A

Legal duty on medical professionals to own up to and apologise for any mistakes that have been made which may have led to harm coming to them.

48
Q

Contraindication definition

A

A condition which my make a treatment or procedure possibly inadvisable. Either relative or absolute.Relative: Cation should be used but is acceptable if the benefit outweighs the risksAbsolute: an event or a substance that could cause a life threatening situation. Should be avoided

49
Q

ADR definition

A

A noxious reaction that is unintended resulting from the use of a drug not only in the use of a product at normal doses but also outside of market authorisation, including the misuse, off label use and abuse of a medicinal product

50
Q

Adverse drug event

A

An event that occurs while a person is on a drug but not necessarily caused by it

51
Q

Most common adverse drug reaction

A

GI bleed

52
Q

ABCDE ADR classification

A

A- augmented: due to dose/pharmacologyB- bizarre: weird and nobody knows whyC- chronic: due to long term useD- Delayed: occurs some time after drug use has stoppedE- End of use: Occurs due to the cessation of a drug (withdrawal)

53
Q

DoTS ADR classification

A

Do- DoseT-TimeS-Susceptibility

54
Q

Where are ADR’s reported to?

A

The MHRA yellowcard scheme

55
Q

AssesSment of ADR

A

Nature/severity of ADRHistory of ADRDrug history ADR profile for the drug Further monitoring?Review/discuss with patient Management of symptomsReporting?

56
Q

Allergies definition

A

When immune system reacts to substances in the environment that are harmless to most people With drugs it will occur at doses much lower than therapeutic

57
Q

Drug intolerance definition

A

Lower threshold to the normal pharmacological action of a drug

58
Q

Principles of medicines optimisation

A

Principle 1: Understand patient experience Principle 2: Evidence based choice of medicines Principle 3: Ensure meds are as safe as possible Principle 4: Make M.O. part of routine practice

59
Q

Max no. of MUR’s per year

A

400 per community pharmacy per fiscal year

60
Q

Aims of an MUR

A

Establishing patient knowledge and experience of the medicineIdentifying poor use of medication Identifying potential side effects and interactions Improving clinical effectiveness of given medication thereby reducing wastage

61
Q

Requirements to be able to provide MUR service

A

Higher education systems will provide courses which will assess a pharmacists ability to do MUR’s Such places include, medway, manchester, keele and cardiff (Universities)

62
Q

Target groups for MUR’s

A

70% of MUR’s must include:High risk medicines (NSAIDS, Anticoagulants/platelets, diuretics) Recent discharge from hospital where medication was changed Respiratory disease CVD and has >4 meds regularly prescribed

63
Q

Requirements for respiratory MUR

A

Must be on 2 or more medicines 1 of which must be on COPD/asthma list for NMS

64
Q

Requirements for hospital discharge patients

A

Within 4 weeks is preferable but up to weeks later is acceptable

65
Q

Standards for a consultation area

A

Clearly designated and signed as a consultation area Distinctly separate from public areas and public should not be able to over hear patient/pharmacist talking in normal toneMUR must take place in pharmacy unless a suitable alternative is available

66
Q

Patient requirements for an MUR

A

Patient must give consent both for the consult to take place and for the info to be shared May only have 1 every year unless significant benefits May not have 1 within 6 months of an NMSMay not have 1 if there is only one drug unless that drug is a high risk medicine

67
Q

Difference between prescription intervention MUR and ordinary MUR

A

The prompt for the consult.P.I.MUR is reactive in response to an significant adherence problem

68
Q

NMS therapy areas

A

HypertensionAsthma/COPDAntiplatelets/Anticoagulants Type 2 diabetics

69
Q

Steps undertaken in an NMS

A
  1. Initial consult where patient is given info about new med 2. Patient comes back 1-2weeks later at a time suitable for them and they will be given more advice 3. Patient comes back 2-3 weeks later so pharmacist can find out about adherence and general experience Money for NMS can only be claimed after steps 1-2 have been completed
70
Q

To obtain consent the patient must..(4 things)

A

Patient must be able to:1. Understand given info2. Believe the info3. Retain and weigh up info4. Be free from duress

71
Q

Automatic blood pressure

A

Unsuitable for those with irregular heartbeats Should be calibrated every yearNot as accurate as manual blood pressure monitor (unless the person is useless at taking blood pressure’s)

72
Q

Normal glucose range for adults

A

4-7mmols/lShould be highest after meals and lowest in the morning

73
Q

Aims of UKmi

A

To support safe, effective and efficient use of meds by providing evidence based information and advice.This service is for healthcare providers

74
Q

No of UKmi enquiries per year

A

300,000

75
Q

Phase 1 trials

A

Generates intial PK/PD info20-50 participantsGiven to the healthy if trt is non toxic or the severely ill if very toxicUsually only a single dose or a few weeks of treatment `

76
Q

Phase 2 trials

A

Provides exp with trt and administration <100peopleMeasures trt efficacyShort/moderate follow up (few weeks to a year)Determines daily dosage and trt regimen for P3

77
Q

Phase 3 trials

A

Gives definitive data against a control Evaluates toxicity/efficacy500-3000 patients

78
Q

Roles

A

1) Analyse NHS/private prescribing of CD’s 2)Request declarations of self assessment3)Periodic inspections4)Ensure adequate steps taken to protect patients/public about inappropriate use of CD’s5) Convene incident panels to investigate concerns6) Ensure individuals working with CD’s have appropriate training

79
Q

What is an LIN?

A

Local intelligence network Led by lead CDAO, it has representatives from responsible bodies:Police, CCG, prescription pricing division (PPD), care quality commission (CQC), NHS protect, local authorities and designated bodies

80
Q

Types of incidences that are reported

A

Suspected fraudulent activity/theftBalance discrepanciesDispensing/prescribing errorsWrong formPoor governence

81
Q

Part VIII

A

Basic prices (A)Payments for specials (B)Cat A is readily available, BB allowed if smallest pack>£50Cat C not available as generic, BB allowedCat M reimbursement determined by manufacturer price, BB if samllest pk >£50

82
Q

Part VI

A

Payments for essential and advanced services

83
Q

Part VII

A

Payments for quality care

84
Q

Part III

A

Fees for stuff

85
Q

Part IX

A

AppliancesBB for parts B, C and ROOPE for B and C

86
Q

Part XIV

A

Payment for fraud and errors

87
Q

Part XVII

A

payments for dental, nurse and non medical prescribing

88
Q

How is reconstitution indicated?

A

Black circle

89
Q

Special containers are indicated by…?

A

Black square

90
Q

Requirements for part 7 quality payments are?

A

Must offer MUR/NMSNHS choices page must be upto dateAble to send/recieve NHS emailSupports EPS

91
Q

What does the double S symbol mean?

A

Selected list schemeDrugs which can only be given under certain conditions

92
Q

Part XV

A

Borderline substancesCan only be given for certain conditions

93
Q

Part XVIIIA

A

The black list

94
Q

FP10CDF

A

Form filled for audit purposes and sent to NHSBSA

95
Q

8 headings under the new NHS pharmacy contract

A

Dispense scriptsDispense repeatsDispense appliancesSignpostSupport self-carePromote healthy lifestylesClinical governance

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