D15 - safe and effective prescribing

Question 1

Authority to prescribe

Answer 1

• WA poisons act
  ○ S2 - supermarkets etc. (eg. Paracetamol)
  ○ S3 - pharmacy only
  ○ S4 - prescription only (eg. Amoxycillin)
  ○ S8 - prescription only (drugs of abuse)
  ○ S5-7, 9 - non-prescription poisons
  ○ Unscheduled - anywhere (eg. Many b-group vitamins)
  
  • WA poisons act authorises doctors to keep, lawfully use and prescribe S4 and S8 drugs
  • Scheduling is in state law, but is uniform throughout Australia
    ○ Standard for the uniform scheduling of medicines and poisons (poison standard)

Question 2

S2

Answer 2

S2 - supermarkets etc. (eg. Paracetamol)

Question 3

S3

Answer 3

S3 - pharmacy only

Question 4

S4

Answer 4

S4 - prescription only (eg. Amoxycillin)

Question 5

S8

Answer 5

S8 - prescription only (drugs of abuse)

Question 6

S5-7, 9

Answer 6

S5-7, 9 - non-prescription poisons

Question 7

How do you know what drug to give, and in what dose

Answer 7

• Safety and efficacy trials
  ○ Decide on optimal doses, routes of administration, dosing regimens, treatment durations for particular indications
  Then, these are adopted into the pharmacopeia

Question 8

Why do we restrict prescribers

Answer 8

• Because they are poisons
  
  • Non-standard patients: big, small, kids, elderly, pregnant, lactating, imapired elimination function, allergies, interactions
  • Protection of the drug: antibiotic resistance
    Protection form misuse: schedule 8 drugs

Question 9

Schedule 8 scripts

Answer 9

• Drugs of addiction - morphine, oxycodone, hydromorphone, methadone, amphetamine etc.
  
  • Differences from S4 scripts
    ○ Prescribing more tightly regulated
    ○ More information required on script
    ○ Records must be kept: drug book
    § Date of each transaction
    § Quantity of drug used/received
    § Supplier
    § Patient recipient
    Running balance of stock

Question 10

Types of prescriptions (who pays, who sets rules)

Answer 10

• Private script - patient pays all - script only has to meet state laws
  
  • Pharmaceutical benefits scheme (PBS) or repatriation pharmaceutical benefits scheme (RPBS)
    ○ Commonwealth contributes
    ○ Script written for exactly what the scheme offers (that is really all that the PBS website supplies)
    ○ Includes information verifying patient’s entitlement
    Prescribing in hospital: for later