CHAPTER 3- CDS Flashcards
What procedures in place to cover the management of CDs?
Security, including access to CDs
Ordering + receipt
Record-keeping, including audit requirements
Prescribing + clinical monitoring
Administration
Supply, access to ensure care not compromused
Denaturing + disposing including withness
Use + storing patients’ own CDs
Transport
report concerns
What do accountable officers do?
Manage use of CDs
- monitor + audit
Ensure systems in place for recording concerns + incidents involving CDS
attend local intelligence network meetings
submit occurence reports
Appoint authorised witnesses for CD destruction
What 3 organisations do not need an accountable officer?
GP
Dental clinic
community
What are 5 drug schedules?
Sch 1 CD lic POM
Schedule 2 (CD POM)
Schedule 3 (CD No Register POM)
Schedule 4 (CD Benz POM + CD Anab POM)
Schedule 5 (CD INV P + CD INV POM)
Schedule 2 , 3 ,4 validity?
28 days after appropriate date
What schedule drugs need address of prescriber to be within UK?
sch 2 + 3
What schedule drugs can EEA/swiss prescribers give?
Sch 4
Is schedule 2 + 3 rx repeatable?
No
Is requisition needed for schedule 2 + 3 for human and vet use?
Yes
Who can possess, supply and procure sch 2,3,4 +5 CDs?
Pharmacist, doctor, dentist
Who else can possess CDs?
Home office license, Home office group authority, legistlation, patients given drug
Can pharmacist take sch 1 CD for destruction or hand to police?
yes
Who can prescribe cocaine, diamorphine or dipapanone for addiction?
Medical prescriber with special license from Home secretary.
Can pharmacist prescribers prescribe ocaine, diamorphine or dipapanone for addiction?
No only for organic disease
What is needed to import/export sch 1,2,3 +4 part 1 CDs?
License
When is a license not needed to import/export schedule 4 part 2 CD?
If for self administation
When is a personal import license not needed by Home office is patient carrying CD?
When travelling they carry less than 3 months supply.
What is recommended for travellers carrying CDs?
Bring cover letter signed by RXer with patient and drug details
Which 2 areas do not need requisition form for CD 2 + 3?
Hospice
Prison
What are 6 legal requirements for CD requisition?
1 Signature of the recipient
2 Name of the recipient
3 Address of the recipient
4 Profession or occupation
5 Total quantity of drug
6 Purpose of the requisition
What happens if request not by same legal entity for requisition of CD 2 +3?
Need to fill out approved requisition form.
What 3CD drugs can registered midwife use supply order to gain?
Diamorphine
morphine
pethidine
What 5 things should order of midwife supply order have?
Name of the midwife
Occupation of the midwife
Name of the person to whom the CD is to be administered or supplied
Purpose for which the CD is required
Total quantity of the drug to be obtained
Sign of an appropriate medical officer – a DOC authorised (in writing) by the local supervising authority or the person appointed by the supervising authority to exercise supervision over midwives within the area.
How to process requisition forms?
Mark indelibly with supplier name + address
Send form to NHS agency
Keep copy for 2 years good practice
How long to keep requisition form?
2 years
When does CD requisition processing to relevant NHS agency not apply?
If person dispensing and supplying at hospital, care home, hospice, prison
Vet reqs - keep for 5
Keep it for 2 years
How long to keep vet requisition form?
5 years
What 13 things are needed legally in sch 2 + 3 RX?
Signature
Date
Prescriber’s address
Name of CD
Form
Strength
Dose
Total quantity
Patient details
Installment direction
How is total qty put on SCH 2+ 3 CDS?
words and figures
What should dental SCH 2 + 3 rx have written?
For dental tx only
What is more likely in sugar free meds?
More likely to be abused
What 6 doses are NOT legally valid?
As directed
When required
PRN
As per chart
Titration dose
Weekly (this is just a frequency and not a dose)
Decrease dose by 3.5ml every four days
Twice a day.
Which 5 doses are legally allowed?
One as directed
Two when required
One PRN
Three ampoules to be given as directed (better still – three ampoules to be given over 24 hours as directed)
One to two when required.
What is installment direction for sch 2 +3?
Amount of meds per installment and interval of time between when this can ebgiven
When is 1st installment dispensed fo sch 2 + 3 drugs?
within 28 days after appropriate date
What are 5 home office wordings for installments of CD 2 + 3?
Please dispense instalments due on pharmacy closed days on a prior suitable day.
If an instalment’s collection day has been missed, please still dispense the amount due for any remaining day(s) of that instalment.
Consult the prescriber if three or more consecutive days of a prescription have been missed.
Supervise consumption on collection days.
Dispense daily doses in separate containers.
Can pharmacist give supply is home office approved wording used for CD instalment but interval date missed?
Yes as remaining amount can be dispensed within the time frame (day 2)
Can pharmacist supply treatment for sch 2+3 drugs per installment before start date on RX if pharmacy closed for bank holiday?
Yes - based on judgement , choose siutable day
What happens if missed 3 days of prescribed tx as per instalment?
contact prescriber- risk of lost tolerance so overdose can occur.
What forms are sch 2 + 3 private CD written on?
Standardised form
Should not be accepted if not- unless vet rx and same legal entity then no need.
What is number is needed to be included in standard private RX?
Prescriber ID number- different to reg number
Where is private CD sent?
Sent to relent NHS agency
What is needed if a drug misuse patient wants to send relative to collect?
Get letter from patient which IDs representative and separate letter each time rep comes in
Does prescriber need to be contacted if supervision of CD drug not possible?
Yes - contact and ask if needed
as supervision is not a legal requirement.
What drugs must be kept in CD safe custody?
sch 1, sch2 except some liquid preps - secobarbital
Sch 3 unless exempt
What 6 drugs are exempt from safe custody?
Gabapentin
meprobamate
midazolam
pentazcine
phentermie
phenobarbital
pregabalin
tramadol
What 2 cd 3 drugs need safe custody?
Temazepam
buprenorphine
Do pharmacies need license to denature CDs?
usually but can register exempt without needing licence.
What is CD denaturing exemption called?
t28
What drugs need to be denatured before disposing?
sc 2,3 4 part 1
Do patient returned CDs need authorised witness?
No need
In prisons what should be done when denaturing sch 3 CDs?
cd register
recommended for sch 4 diazepam and chlordiazepoxide
What does accountable officer do?
Appoint authorised witnesses but cannot themself be a Authorised person
If pharmacy does compounding , importing and exporting sch 3+4s, do we need authorised witness?
Yes
For patient return SCH 2 cd what record is made?
Record in PATIENT- RETURNED CD
not cd reg
For expired/unwanted CD 2 drug denaturing, is authorised witness needed?
YES
For expired/unwanted CD 2 drug denaturing, is record needed?
yes but in normal cd register for sch 2
How to denature solid CDs?
crush + add cd denature kit
can add water too.
If no kit- add warn soapy water to disolve + pour into suitable product and into waste bin
How to denature Liquid CD?
Pour into cd denature kit
or pour into suitable product + add to disposable bin.
Rinse out bottles using kit.
How to denature liquid Amps/vial of CD?
open + add to kit or do same as liquids.
Get rid of ampule in sharps bine
How to denature CD ampules with powder?
open the ampoule + add water to dissolve the powder.
Poured into the CD denaturing kit
OR
crush powder and amp together inside plastic bag and add soapy water or suitable product.
How to denature patches?
Remove backing + fold in half
add to bin/cd denaturing kit
How to denature aerosol formulations?
Spray into water + get rid of liquid
or expel into a sponge + dispose this
If safe then open container + dispose
What is a suitable product?
Make CD irretrievable without affecting safety of person,evironment
What specific CD drug are records needed for?
sativex
What 3 things need to be recorded for received sch 1 and 2 CDs?
Date supply received
Name and address from whom received
Quantity received.
What 3 things need to be recorded for sch 1 and 2 CDs which are supplied?
Date supplied
Name + address of recipient
Details of authority to possess – prescriber or licence holder’s details
Quantity supplied
Details of person collecting Schedule 2 CD – patient, patient’s representative
Proof of ID requested + given
How are CD entries made in register?
In time order, enter it on the day or next day
In ink
Un altered - if mistake, mark to show.
How long to keep CD register?
2 years
Can CDs be copied + kept in computer?
yes
What should be available for CDs during inspection?
Copy of register, receipt of supply and other details of stock.
Computerised CD entries should be: (3)
Attributable
Capable of being audited
Compliant with best practice.
Electronic CD register should be accessible from premise + able to be printed? T or F
True
When to do CD stock checks?
At least Once a week
What drug schedule is sativex?
Schedule 4 part 1
What schedule is nabilone?
schedule 2 CD
What schedule is CBD- epidyolex?
SCH 5
What schedule is dronabinol?
CD 2
Treat loss of appetite in aids, N+ V in chemo.
What is a CANNABIS-BASED PRODUCTS FOR MEDICINAL USE?
Has cannabis, resin, cannabinol or derivative
produced for med use in humans
regulated
Who can prescribe cannabis products?
Clinicians on specialist register of GMC
What should CBD oil not contain?
thc- CONTROLLED SUBSTANCE
What does “use before” or “use by” mean?
Use before end of previous month
e.g. use by 6/24
so should not be used after 31st may 2024
What does ‘expiry date’ mean?
product not used after end of month
e.g. 12/24 - should not be used after 31st dec
What is needed to purchase a poison?
License from home office
Is there evidence for homeopathy?
No- does not endorse it as method
explain lack of evidence - does not require these meds to be effective, just show quality and safety
Do herbal meds need an MA?
Yes based on safety, quality + efficacy or traditional herbal registration based on safety, quality + evidence of traditional use
Donating medicines to charity?
NO patient returned meds
Health kits are better
Donate cash instead
Who regulated medical devices?
MHRAq
What do medical devices need to be marked with?
CE or UKCA
What are alternatives to MCA?
MAR chart
Label with pictograms
large print labels
info sheets
reminder alarms
it solutions - apps
Is it a crime to drive with prescribed drugs which affect driving?
yes
What specific 1st group drugs affect driving?
Cannabis
Cocaine
heroin
ket
MDMA
methylamfetamine
What second geoup drugs affect driving?
Diazepam
clonazepam
flunitrazepam
lorazepam
morphine
methadone
What should pharmacist tell patients about meds that effect driving?
Make sure you do not drive if feeling dizzy and follow PIL
When is medical defence valid for driving with prescribed drugs?
If driving not impaired
What is nps?
New psychoactive substance- can cause effect
e.g. herbs, seeds
Not illegal but offence to buy them
