Clinical Pharmacology - The Use of Medicines Flashcards

Question

Prescription Only Medicine: Written by an appropriate ___________ before it can be sold or supplied Some medicines - more than one category of ____________ (formulation, strength, quantity, indication or marketing authorisation). Increasing number reclassified from ___ to _ – improved access to medicines with safety net of Pharmacists.

Answer 1

Written by an appropriate **practitioner** before it can be sold or supplied. Some medicines - more than one category of **classification** (formulation, strength, quantity, indication or marketing authorisation). Increasing number reclassified from **POM** to **P** – improved access to medicines with safety net of Pharmacists.

Answer 2

doctor dentist supplementary prescriber nurse independent prescriber pharmacist independent prescriber EEA and Swiss doctors and dentists (limited) community practitioner nurses (limited) optometrist independent prescribers (limited)

Answer 3

* Schedules 2, 3, and 4 limited to supply of up to 30 days' treatment. (cant supply more than that) * Specify formulation and strength. * Specify dose * Total amount in words and figures For hospital discharges, even for electronic prescriptions, the prescriber must send a signed paper copy down to the pharmacy dispensary before the pharmacy can release the CD’s Controlled drug – have to specific amount you want supplied in both words and figures

Answer 4

Less than 1 g – write as mg, E.g. 500mg not 0.5g Less than 1 mg – write as micrograms, E.g. 500 micrograms not 0.5mg Note: Do not abbreviate micrograms and nanograms to mcg or ng or other symbols!

Answer 5

The Prescription and Administration Record is available in three formats to accommodate patients on varying numbers of medicines and lengths of stay in hospital: 2-page; standard; long stay. All Prescription and Administration Records must be filed in the patient’s medical records on completion/discharge whether or not any entries have been made. Prescription and Administration Records belonging to patients transferred within NHS Grampian may continue to be used in the receiving ward/hospital if staff are confident and familiar with the system. A new record must be used for readmitted patients regardless of the amount of time that has elapsed.

Answer 6

Ensure good Medicine Reconciliation – accurate drug history taking (Know what medications the patient is taking at point of admission) Decide/discuss with seniors if the medicine is to continue, change dose/ frequency, be with-held or stopped – record on medicine reconciliation form Check the BNF if unsure of drug/dose/frequency

Answer 7

All patients must have a PAR (“kardex”) Use permanent black ink Legible! In BLOCK letters Maximum of 2 PARs at a time Use 24 hour clock Don’t use dittos “ – can be confused with 11 Sign for each medicine AND PRINT NAME! All routes of administration go onto this chart Generic prescribing unless clinically significant differences in bioavailability between brands – e.g. beclometasone dipropionate inhalers, ciclosporin (immunosuppressants for organ transplant). \*Branded prescribing of insulins\* Keep all charts together No bracketing meds together - causes misinterpretation when prescriptions are cancelled All medicines, e.g. oral and injectables, should be written together

Answer 8

e.g. Medicine/form = CO-AMILOFRUSE 2.5/20 Dose = “ONE TABLET” Circle times = 08:00

Answer 9

e.g. Medicine/form = Seretide 500 Dose = One inhalation/ puff Circle times = 08:00 and 22:00 Additional instructions – “Accuhaler”

Answer 10

Dose expressed as e.g. milligrams of the active ingredient, not mL as many formulations may exist PARACETAMOL ORAL SUSPENSION: - 120mg/5mL - 250mg/5mL - 500mg/5mL

Answer 11

These are not acceptable and can compromise patient safety. Warfarin – 3/4mg – what does this mean? 3 or 4 or three quarters, and how does the nurse decide? Also warfarin should be prescribed on a separate warfarin prescription sheet, which should be referred to from the main drug kardex. It is prescribed on a daily basis in hospital. Warfarin is an anticoagulant and the dose varies depending on the patients INR so often patients take different doses on different days and because of this warfarin should be given on a different prescription chart, this is in hospital, dose will vary and you have to prescribe it every day Levothyroxine – 50 micrograms should be written out in full, no “mu” symbol. Fludrocortisone – not signed, and dose is less than 1mg, so should be prescribed as 100 micrograms (NB. not 100mcg). Amoxicillin – wrong dose, but otherwise written OK. Paracetamol – route should not be written at “O” – write out as “oral”, and gram as “g” is fine If not signed then its not legal and you cant give it Frequency box has not been filled in Amoxicillin – dose incorrect and normally given 8 hourly so 3 times a day

Answer 12

Hydroxocobalamin – given every 3 months so prescriber should score through the days not required Digoxin – 250mcg not acceptable write out as “micrograms”. Gliclazide – this is diabetes medication so should be prescribed on diabetes chart – at the moment! There will be a change in the diabetes prescription sheet in the future, when oral diabetes meds MAY be prescribed on the main drug kardex, but until then, refer to the separate prescription sheet from the main kardex. Senna – not discontinued properly, and note no times circled. Picture shows how you should score of a medicine – score the name, score the day it has been stopped, and the blank space and always sign and date it when stopping a medication so if someone wants to know why a meidcaiton has been stopped you can find the person

Answer 13

Paracetamol looks OK, but write gram as “g”. Dihydrocodeine – no frequency or indication, and no maximum dose in 24 hours Need to have a max dose The BNF will tell you if not sure Make sure to specify how often it can be given and what for

Answer 14

Minimum of 3 different HC professionals thought this was acceptable Poor hand writing No frequency Write in block capital Normal sailine Some prescribers hand writing is very poor Important of using block capitals Other people need to be able to read it