Clinically and Accuracy Checking Controlled Drugs (3113)

Question 1

The clinical check: key points

Answer 1

Purpose is to ensure the medicine supplied is both safe and effective for use by a particular patient in relation to the risk and benefit to the patient
Safety and therapeutic effectiveness can be affected by patient factors, the type of the medicines involved and administration and monitoring of medicines
Should obtain information from other relevant sources

Question 2

Patient characteristics

Answer 2

Specific types of patient that you would need to be aware of include: children, elderly, pregnant/breast feeding, male/female patients, certain ethnic groups
Co-morbidities e.g. renal and hepatic impairment, heart failure
Patient intolerance and preferences

Question 3

Medication regimen factors

Answer 3

Indication
Changes in regular treatment
Dose, frequency and strength- check appropriate for individual patient characteristics including age, renal/hepatic function, weight, co-morbidities, other drug treatments, lifestyle patterns

Question 4

Administration and monitoring

Answer 4

Is the prescribed route of administration suitable for the patient and is a preparation available for the route prescribed?
Are there compatibility issues that may arise from administration via a given route or co-administration with food or other medicines?
Are any adherence aids required by the patient?

Question 5

Clinical check records

Answer 5

Record keeping is important for continuity of care, evidence of the benefit of pharmacy input and improving patient care
Should make a record of significant clinical checks and interventions made
Can be recorded in patient’s medical record, an interventions record book, hand-over record book or the prescription register

Question 6

Opioid classes

Answer 6

Schedule 2: morphine, oxycodone, diamorphine, fentanyl, tapentadol, pethidine
Schedule 3: buprenorphine, tramadol

Question 7

Opioid doses

Answer 7

Morphine is the opioid by which we compare all other opioids
Starting dose for an adult in chronic pain = initially 5-10mg every 4 hours, adjusted according to response
For pain management in palliative care, initially 20-30mg daily in divided doses using immediate release preparation, or a 12 hour modified release preparation

Question 8

Stimulants: indication

Answer 8

Schedule 2: methylphenidate, dexamfetamine, lisdexamfetamine
Primary indication is ADHD, dexamfetamine also used in narcolepsy
Should not be used to treat depression, obesity, senility, debility or for relief of fatigue

Question 9

ADHD overview

Answer 9

A group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness
Symptoms tend to be noticed at an early age and may become more noticeable when a child’s circumstances change, such as when they start school, most diagnosed 6-12 years old
Exact cause of ADHD is unknown, but it has been shown to run in families

Question 10

ADHD symptoms

Answer 10

Can be categorised into two types of behavioural problems: inattentiveness, and hyperactivity and impulsiveness
Most people with ADHD have problems that fall into both these categories, but this isn’t always the case

Question 11

ADHD: symptoms in adults

Answer 11

By the age of 25, an estimate 15% of patients still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives
Carelessness and lack of attention to detail, continually starting new tasks before finishing old ones, poor organisational skills, inability to focus or prioritise, continually losing or misplacing things, forgetfulness

Question 12

ADHD diagnosis in children

Answer 12

Symptoms must meet the diagnostic criteria in DSM-IV or ICD-10 and:
Be associated with at least moderate psychological, social and/or educational or occupational impairment based on interview, and
Be pervasive, occurring in two or more important settings

Question 13

ADHD treatment

Answer 13

Parent training/education programme is first line treatment
Drug treatment should be reserved for those with severe symptoms or impairment
Before starting drug treatment, children should have a full pre-treatment assessment
Drug treatment should be initiated by a specialist but can be continued by GPs

Question 14

ADHD choice of drug

Answer 14

Depends on a range of factors such as the presence of coexisting conditions, side effects and patient preference

Question 15

Benzodiazepine schedules

Answer 15

Schedule 3: temazepam, midazolam

Schedule 4: diazepam, lorazepam, clonazepam, lormetazepam, clobazam, nitrazepam

Question 16

Benzodiazepine indications

Answer 16

Temazepam: insomnia, conscious sedation for dental procedures and premedication before surgery or investigatory procedures
Midazolam: status epilepticus and febrile convulsions, convulsions in palliative care, confusion and restlessness in palliative care, sedation of patient receiving intensive care, conscious sedation for procedures, sedative in combined anaesthesia, premedication