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Kirsty FTY > CDs > Flashcards

CDs Flashcards

1
Q

What are Controlled drugs?

A

Controlled drugs are medicines which are controlled under the misuse of drugs legislation (UK). There are 2 classes within the law depended on their therapeutic effect and potential for misuse:- Class A or B.

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2
Q

What does the Misuse of Drugs Act (1971) controls?

A
  • Possession - Collection
  • Supply - Dispensing
  • Requisitions
  • Prescriptions
  • Storage
  • Record Keeping
  • Destruction
  • Manufacture
  • Import and export – travel abroad
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3
Q

What are CD Accountable Officers?

A

Accountable officers are responsible for supervising and managing the use of CDs in their organization or setting. Their roles and responsibilities include:

  • Oversight of the monitoring and auditing of the management, prescribing and use of CDs
  • Ensuring systems are in place for recording concerns and incidents involving CDs and the operation of these systems
  • Attendance at local intelligence networks and meetings
  • Submission of occurrence reports which describe the details of any concerns the organization has had regarding the management of CDs in a required time frame
  • The appointment of authorized witnesses for the destruction of CDs

CDAO takes on roles such as:
• Development of standards in all aspects of CD management
• Inspect premises to ensure they are dealing with controlled drugs appropriately – including GPs
• Monitoring storage, purchase, destruction, prescribing, dispensing and administration of CDs and associated documentations
• Dealing with CD incidents and concerns

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4
Q

What are the 5 schedules of controlled drugs?

A
  • Schedule 1 (CD lic POM)
  • Schedule 2 (CD POM)
  • Schedule 3 (No Register POM)
  • Schedule 4 (CD Benz POM and CD Anab POM)
  • Schedule 5 (CD INV P and CD INV POM)
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5
Q

What are examples of drugs found in schedule 1?

A

Most schedule 1 drugs have no therapeutic use and a licence is generally required for their production, possession or supply. Examples include hallucinogenic drugs (e.g. LSD), ecstasy-type substances and raw opium.

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6
Q

Examples of drugs in schedule 2 CDs?

A

Schedule 2 CDs include opiates (e.g. diamorphine, morphine, methadone, oxycodone, pethidine, major stimulants (e.g. amphetamines), quinalbarbitone and ketamine).

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7
Q

Examples of schedule 3 CDs?

A

Schedule 3 CDs include minor stimulants and other drugs (e.g. buprenorphine, temazepam, tramadol, midazolam, phenobarbital, gabapentin and pregabalin) that are less likely to be misused (and less harmful) than those in schedule 2.

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8
Q

Example of schedule 4 CDs:

  • Part 1
  • Part 2
A

Part I (CD Benz POM):

  • Contains most of the benzodiazepams (e.g. diazepam), non-benzodiazepine hypnotics (e.g. zopiclone) and Sativex (a cannabinoid oromucosal mouth spray)

Part II (CD Anab POM):

  • Contains most of the anabolic and androgenic steroids, together with clenbuterol (an adrenoceptor stimulant) and growth hormones
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9
Q

Example of schedule 5 CDs

A

Contains preparations which contain a certain amount of CDS (such as codeine, pholcodine and morphine) that are exempt from full control when present in medicinal products of specifically low strengths

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10
Q

Fill in the blanks for each schedule

A
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11
Q

What type of licence is required to be held to posses schedule 1 controlled drugs?

When is this licence not required?

A

A home office licence

When pharmacists take possession of these CDs for the purpose of destruction or to hand over to the police

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12
Q

Should the police be informed in a patient is found to have schedule 1 controlled drugs?

A

Yes, although the patients confidentiality should be maintained and there should be an understanding that when telling the police the source will not be identified. However if a large quantity is found that it could not be soley for personal use then it may be in the greater intrest of the public to inform the police of the source - however a discussion with other health care professions involved in the pt care should occur first

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13
Q

Does the pt need to consent for you to take control of and dispose of scheudle 1 controlled drugs?

Can these controlled drugs be given back to the pt?

A

The pt should give authority for the drugs to be removed and destroyed. If the pt refuses the pharmacist may feel like he or she has no alternative but to call the police - under no circumstances shouls the drug be handed back to the pt.

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14
Q

For which schedule controlled drugs is a licence required to import or export controlled drugs?

If a patient is travelling is a personal licence required and if so when?

A

A licence is needed for a pharmacy to import or export schedule 1,2,3 and 4 CDs, unless the substance is imported/exported by the person self-administering. There are no restrictions on the import/export of schedule 5s.

A personal licence is not required for pts carrying less than 3 months supply of CDs. However, it is advisable that a covering letter signed by the prescriber is obtained that confirms the name of the patient, travel plans, name of the prescribed CDs, total quantities and doses

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15
Q

What are the legal requirements for requisitions for schedule 2,3 and 4 CDs

A
  • Signiture of recipent
  • Name of recipent
  • Address of recicipent
  • Profession or occupation
  • Total quantity of drug
  • Purpose of requisition
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16
Q

What are prescription requirements for controlled drugs schedules 2 and 3?

A
  • Signiture
  • Date (valid for 28 days for S1-4 and 6m for SC 5)
  • Prescribers address
  • Name of CD
  • Form
  • Strength (if more than 1)
  • Dose
  • Total quantity (word/fig)
  • Quantity prescribed (reccomended not exceed 30 days)
  • Name of patient
  • Address of patient
  • Dental prescriptions - ‘for dental treatment only’
  • Instalment - amount and intevrals
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17
Q

What are the requisition requirements for CD 2 and 3 drugs and what places are exempt from this?

A

1) Need to use approved forms: Requisitions should be in writing (not faxed/photocopied) before delivery
2) Hospices and prisons are exempt from this requirement

3) If the request is within a hospital setting for a ward/department within the same legal entity, an approved form is not required

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18
Q

1) CD requisitions:In an emergency, can a doctor/dentist be supplied with a CD 2 or 3 drug without a CD requisition?
2) What must be supplied and within what time frame?

A

1) CD requisitions:In an emergency, can a doctor/dentist be supplied with a CD 2 or 3 drug without a CD requisition?
2) What must be supplied and within what time frame?

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19
Q

What is an FP10CDF form?

A

Requisition form for CD 2 and 3 for private supplies

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20
Q

What is an FP10GP10A form?

A

Requisition form for CD 2 and 3 for NHS supplies

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21
Q

1) When you receive a CD 2 or 3 requisition, what should you legally do?
2) What are the exceptions to this?

A

1) Mark the requisition indelibly with name and address of supplier e.g. name of pharmacy Send the original requisition to the relevant NHS agency.
↳ Good practice- retain a copy for 2 years

2) Exceptions- if the supply is made by a person dispensing at a hospital, care home, hospice, prison- By pharmaceutical manufacturers or wholesalers- Veterinary requisitions

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22
Q

A midwife may use a midwife supply order to obtain what 3 controlled drugs?

A

1) Diamorphine
2) Morphine

3) Pethidine

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23
Q

What does the quantity on a CD 2 and 3 prescription need to be written as?

A

Words and figures

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24
Q

1) What does the DOH recommend that the maximum prescribed quantity of Schedule 2, 3 and 4 drugs on one prescription (in terms of days)?
2) Is this a legal restriction?

A

1) 30 days
2) Not a legal restriction but prescribers should be able to justify the quantity requested

25
Q

When a controlled drug is supplied, it is a requirement to mark the prescription with what?

A

mark the prescription with the date of supply at the time the supply is made.

26
Q

Would the instructions “as directed” be acceptable on a controlled drug prescription?

A

No “One as directed” would be acceptable

27
Q

For CD 2 and 3 prescription, if either the words or figures (but not both) of the quantity has been omitted, can a pharmacist amend this?

A

1) Yes- should mark the prescription to show amendment has been made
2) (name, date, signature and GPhC registration

number)

28
Q

If there is a minor typographical error/spelling mistake on a CD 2/3 prescription, can a pharmacist amend this?

A

1) Yes- should mark the prescription to show amendment has been made
2) (name, date, signature and GPhC registration number).

29
Q

For CD 2/3 prescriptions, can a pharmacist amend a date, dose, form or strength?

A

No

30
Q

True or false:Private CD 2/3 prescriptions must be written on standardised forms

A

TRUE

31
Q

If a hospital is dispensing a private CD 2/3 prescription within the same legal entity, is a standardised form required?

A

No

32
Q

What must you have on a private CD prescription to identify the prescriber and what is it?

A

A prescriber identification number must be included on standardised private prescriptions.It is a number issued by the relevant NHS agency and the prescriber can obtain it from their local primary care organisation

33
Q

Do vet CD prescriptions need to be written on a standardised private CD form?

Should these forms be kept?

A

NO:

Vet prescriptions for CDs do not need to be written on standardised forms and do not need to be submitted to the relevent NHS agency.

Keep forms for 5 years

34
Q

If a healthcare professional is picking up a CD2 on behalf of a patient, what is required?

A

1) Name of HCP
2) Address of HCP Identity required - if they do not have identity, it is up to discretion of pharmacist

35
Q

If a drug misuser wants a representative to collect a CD on their behalf, what are pharmacists advised to do?

A

1) Obtain a letter from the drug misuser that authorises and names the representative. (This includes those detained in police custody who should supply a letter of authorisation to a police custody officer to present to the pharmacist)
2) A separate letter should be obtained each time and the record of supply should be included about the representative in the CD register

36
Q

If a CD script is meant to be supervised but a representative with a consent letter from the patient turns up to the pharmacy, what should you do?

A

1) You should contact the prescriber before the medicine is supplied to the representative – since supervision will not be possible. It is legally acceptable to confirm verbally with the prescriber that they are happy with this arrangement since supervision, while important, is not a legal requirement under the 2001 Regulations
2) It would not be necessary to contact the prescriber if the person has been detained in police custody and the representative collecting the dose is a police custody officer

37
Q

Does phenobarbital require safe custody?

A

No

38
Q

What drugs need to be kept under safe custody?

A

1) Schedule 1, 2 (except some liquids e.g. quinalbarbitone)
2) Schedule 3 (common examples include buprenorphine, temazepam), except some exceptions:- tramadol, gabapentin, pregabalin, midalozam, phenobarbital, pentazocine, mazindol, meprobamate, phentermine

39
Q

True or false:

Schedule 2 or 3 CDs can be written on the same private prescription as other CDs/non-CDs

A

No!

This is because the form needs to be sent to the relevent NHS agency.

Pharmacists would not be able to keep provate prescriptions for a POM for 2 years as required

40
Q

Does safe custody apply to returned CDs from patients?

A

Yes until destroyed

41
Q

What controlled drug schedules need to be denatured before disposal?

A

Schedules 1, 2, 3 and 4 (part 1)

42
Q

What is the difference between destroying CDs that are pharmacy stock, and that are patient returned POMs?

A

1) Pharmacy stock needs a witness by authorised person for CD2
2) patient returned returned POMs do not - however it is preferable for denaturing to be witnessed by another staff member

43
Q

For patient returned CDs, should a record be made when destroying them?

A

A record should not be made in the Controlled Drugs register but records of patient- returned Schedule 2 Controlled Drugs and their subsequent destruction should be recorded in a separate record for this purpose

44
Q

Do you need an authorised witness when destroying CD unwanted stock/patient returned expired stock?

A

1) Yes if schedule 2
2) Good practice for schedule 3

45
Q

In community pharmacy, only CD2s are entered into the register. How does this advice differ in prisons?

A

It is recommended to maintain a robust audit trail of Schedule 3 and 4 drugs

46
Q

True or false:An accountable officer has the power to authorise other persons to witness the destruction of Controlled Drugs.

A

True

47
Q

Can an accountable officer be an authorised witness ?

A

No

48
Q

Pharmacists are required to keep a register for CD 2 drugs. What additional drug needs to have a record?(schedule 4 part 1)

A

Sativex

49
Q

How long should a CD register be kept for?

A

2 years from date of last entry

50
Q

Can you have an electronic CD register?

A

Yes

51
Q

How often should CD stock be checked?

A

At least once a week (could be less frequent based on risk assessment)

52
Q

When should entries within the CD reg be made?

Can you alter the register?

A

On the day or day after transaction

CD reg should be unaltered - corrections must be made by dated marginal notes or footnotes. Mark change with name, initals/signiture, GPhC number)

53
Q

What should you do if a patient has missed 3 days of an controlled drug?

A

may have lost tolerance to the drug and their usual dose may cause an overdose. It is therefore in best interest to consider contacting prescriber to discuss appropriate next steps

54
Q

What should installments for CDs 2 and 3 contain on the prescription?

A
  • Amount of medicine to be supplied each instalment (in addition to dose)
  • Interval betwenn supplies
55
Q

What is the time limit on prescription owings for:

1) POM
2) GSL/P
3) CD 2, 3, 4

A

1) 6 months
2) 6 months
3) 28 days

56
Q

Can instalmments for schedule 2 or 3 CDs be given out after 28 days?

A
  • Can you give out installments for longer than 28 days?
    • Yes as long as this is scheduled directions from prescriber
    • First installment MUST be given out within first 28 days
57
Q
  • Do patients need to provide identification to collect CD scripts?
A
  • People collecting schedule 2 controlled drugs should be asked to sign the back of the prescription form (NHS or private) and to provide evidence of identity.
    • In all cases, if the person collecting the drug declines to sign the form the dispenser has the discretion to supply the drug
    • The dispenser will not be required to seek evidence of identify if it is felt that this request would compromise patient confidentiality (e.g. if a neighbor is picking up the patients prescription as this would highlight this drug is different to normal prescriptions)
    • If the person collecting the drug is already known to the dispenser the evidence of identify need not be requested
58
Q
  • Doctors prescribing for themselves or family members?
A
  • GMC states that doctors should avoid prescribing for themselves or anyone whom they have a close personal relationship where possible.
  • Doctors can only prescribe CDs for themselves or close relatives/friends if there is no one else available or a delay could put the person’s life or health at risk or cause significant pain
59
Q
A

Kirsty FTY (18 decks)

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