DPP: MEP Flashcards
What are the classifcations of medicines?
- GSL (General Sales List):
- can be sold in retialers and pharmacies.
- Responsible pharmacist can be abscent for a period of time and sales still made
- PO: GSL medicines with restricted sales
- Pharmacy only: Can only be sold in a pharmacy by a pharmacist of person under the supervision of a pharmacist
- POM: prescription only: Requires a prescription by an appropriate practioner
Who are examples of approproate practioners?
- Doctors
- Dentist
- Independent pharmacist/ nurse presriber
- Optimitrist/ Podiatrist indepent prescriber
- Physiotherapist
- Radioologist independ prescriber
- supplemenatary prescriber
- VET
- EEA Swiss Doctor, dentist, N/P independent prescribe
- Community nurse
What are the legal issues regarding pseudoephedrine and ephedrine?
- Decongestent meds
- Can be used to make crystal meth
- Can’t be sold together without a prescription
- Can’t sell more than 720mg Pseudoephedrine or 180mg ephedrine without a prescription
- Must be sold by a pharmacist of pharmacy trained staff
What are emergency oral contraceptives licenced for use?
- Leveonogestetel 1500ug - Over 16s for 72hours after intercourse
- Ulipristal aceatate 30mg - not contraindicated in U16s. Use 120hr after intercourse
- Can supply advanced supplies
- Pharmacists should be involved in assessing suitability and sales
What are the legal issues surrounding aspirin and paracetomal
- Toxic in overdose
- Maximum OTC is 96 non-effervescent tablets
- No limit for effervescent
What are the legal issues surrounding codeine and dihydrocodeine
- Only used for short term treatment of acute-moderate pain that isn’t treated by paracetomal, aspirin or ibuprofen
- Max OTC pack is 32, above is POM (including effervescents). It is reccomened that not more than one OTC should be given as would defy smaller pack size
- Must be labeled “use for 3 days only - may cause addiction”
What are general prescription requirements?
- Signiture of prescriber
- Address of prescriber
- particulars of prescriber
- Name of patient
- Address of patient
- Date of prescription
- Age if U12
- Can be written in different languages
- Needs to be written in iledgible ink or computer generated
- What are repeatable prescriptions?
- How many times can they be repeated?
- What are exceptions to repeats?
- Private prescriptinos which can be dispensed more than once
- If no repeat stated repeat once (i.e. dispense X2) unless oral contraceptive - repeat 5 times (dispense 6)
- Can’t have repeat prescriptions for SC1,2 CD
- When must repeatable prescriptions be dispensed?
- POM - first dispesning must be done in 6months and the rest have no time frame
- CD 2,3,4 the first dispensing must be done in 28days -the rest have no time frame
What happens to a repeatable prescription once it has been dispensed?
- The prescription must be marked with the date of supply and name and address of the pharmacy
What records are required for private prescriptions
- A record must also be made into the POM register on the day or supply or if not the following day and kept for 2 years from the last date
- SC 2&3 CDs must also be submitted to the relevnt NHS agency
- Prescriptions also need to be retaine dfor 2 years from the date of supply or last date of supply
What record details for Private prescriptions need to be recorded in the POM reg?
What are the exemptions to the register?
- Name patient
- Address patient
- Name, quantity, strength, form medicine
- Name prescriber
- Address prescriber
- Date of supply
- Date of prescription
- Emergency oral contraceptives
- SC2 CD as entery made into CD reg
- What is an installment prescription?
- What is an incomplete prescription?
- Used to dispense CD is installments
- Some essential detials missing e.g. name, strength, quantity of med even though not legal requirement are essential
What is the falsified medicines directive?
They aim to ensure the safety of medicines for sale in the UK and reduce the risk of fake medicines
Are faxed prescriptions valid?
No - not signed in ink or written in iledgible ink
What are dental able to legally prescribe?
- Private: any POM within there areas of competance
- NHS: restricted to the dental formulary - no brands
In the event of a forged prescription what should you look out for and what actions should you take?
Consider:
- Behaviour of patient?
- Is the patient known?
- Is the prescriber known?
- Dr inserted in front of signiture?
- Excessive quanity?
- Medicine known to be abused?
Actions:
- Scrutinize signiture carefully
- Check with prescriber
- Don’t use patient as a source to obtain contact details of prescriber
Are prescriptions from EEA/ Swiss legal? What are they allowed to do?
- Prescriptions and repeatable prescriptions valid
- Emergency supplies allowed
- Can’t supply SC 2 or 3 CD including phenobarbtal
What are EEA/ Swiss prescription requirments?
- Patients full name and DOB
- Prescribers full name, work address, professional qualification, direct contact details (including email and telephone or fax no.)
- Name, quantity, strength, form, dosage details
- Signiture
- Date
- What is the appropriate date for EEA/Swiss prescriptions?
- What are the restrictions of what they can supply?
- The date on the prescriptions
- Cant prescribe SC1,2,3 CD or unlicenced medicines
What are the labelling requirements of a medicinal product?
- Name of patient
- Name and address of pharmacy
- Date of supply
- Name of medicine
- Directions for use
- Warnings/ precautions
- ‘Keep out reach/ site of children’
- ‘Apply to skin only’ IR
What is optimisation of labelling?
- Although not legal requirment, good practice to label bottle, inhaler as opposed to outer container
- If directions, name, precautions not approproate it is possible to subsite with words to the similar effect without contacting the prescriber
What are the labelling requirements of a pack broken down from bulk?
- Name of med
- quantity
- Expiry date
- ingredients or particulars
- Batch no.
- Special storage/ handling requirement
- normal labeling requirements
What does PSD stand for? What is it?
- Patient specific directions
- Can’t be specifically defined but generally accepted to be written instuctions from a doctor, dentists ot suitable medical professional to supply or administered specified medicine to a specified named person.
- Any competent and trained health profession is capable of supplying or administering
- PSDs apply to specific named patients but normal prescription requirements don;t apply
- HMR provides a rangeof exemptions on sale, supply and adminsitration, a number of which are under PSD
What are the exemptions to sale or supply of medicines without a prescription?
- Pandemic
- PSD
- PGD
- Emergency supply
- Optomistrist/ podiatrist signed orders
- Supply of salbutamol inhalers or adrenaline autoinjectors to schools
- Supply of naloxone to indivduals involved in drug treatment services
What is PGD? What is it also known as?
- Patient group directive aka URGENT SUPPLY
- Written instuction from a suitable practioner to allow the supply or administration of a certain medicine to a well defined group of people for a specific condition
When are pharmacists able to supply/ administer dimorphine or morphine? Why are they allowed too?
Under the PGD pharmacists can supply dimorphine or morphine for the immediate, necessary treatment or sick or injured patients
What are the steps taken in the PGD scheme?
- Interview patient to assess eligibility:
- Registered with GP in scotland (even temporaly)?
- Has the medicine being requested been previously prescribed for the patient by an appropriate practioner registered and practicing in the UK?
- Is the medicine allowed to be supplied on the PGD?
- Fill in CP4 form:
- Name and address patient
- CHI no. (if not DOB)
- GPHC number
- Pharmacy contractor code
- PAtient prescribe refence number
- Dosage instuctions
- Name, quantity,strength, form of medicine
- Dispense and Label medicine
- Patient signs back
- Stamp with name and address of pharmacy and date
- Send photocopy to prescriber
- Send original to NHS agency
What other alternative is there to PGD?
Emergency (aka TRUE) supply at request of an approproate practioner or patient
What steps are involved in emergency supply at request of a prescriber?
What are the restrictions?
- Approproate practioner? - allowed to prescribe this?
- Emergency/ immediate need? - If there an immediate need and it is unpractical to obtain a prescription?
- Prescription - prescriber agrees to send a prescription to be obtained within 72 hours of the request
- Directions - medicine to be supplied in accordance with prescriber
- Not for SC 2 or 3 excluding phenobarbitone
What Records need to be kept and what details are required?
- Entery into the POM reg on the day of supply of following day. Kept for 2 years
- Details:
- Name and address patient
- Name and address prescriber
- Name, quantity, strength, form of medicine
- Date of Supply
- Date of prescription recevial
- Date on prescripition
What labeling requirements are there?
Normal
What steps are involved in emergency supply at the request of a patiet?
Exceptions?
- Interview patient -
- immediate? - immediate need and it is inpractial to obtain a prescription due to the nature of the emergency without undue delay
- Has it previously been prescribed for patient?
- Pharmacist is satisfied at knowing dosage/ directions
- Not for CD 2 or 3 expept phenobrabital for epilepsy
What length of treatement can be prescribed?
What pack sizes shoulf be given?
- CDs - max treatment 5 days
- POM - max treatment 30 days
- Smallest pack size for creams, tubes, inhalers
- Oral contraceptives - full cycle
- liquid antibiotic - smallest quantity that gives full course
What records are required? What details are required in these?
- POM reg on day or following day of supply an kept for 2 years
- Details:
- Name and address patient
- Name, quantity, strength, form medicine
- Nature of emergency and why prescription not obtained
- Date of supply
What labelling requirements are there?
Normal bar ‘for emergency treastment’
What are pandemic exceptions?
- During pandemics legislation is in place which relaxes in emergecny supply requirements
- There is collection points for patients to collect medicines - doesn’t have to be a pharmacy and pharmacist not needed for sale
- Patient doesn’t need interviewed
What are optomitrost and podiatrist signed orders?
- Optomitrists can’t prescribe unless qualifrd as independent or supplementary presciribers to authoise POMS
- However they are able to prescribe using a signed order. This must be something they are allowed to suipply
- These aren’t prescriptions so normal prescription requirements don’t apply. Should be statisifed enough info given for patient to use medicine safely
- Normal labelling
- Patient info leaflet given
- POM reg made
When supplying salbutamol inhalers:
- Who can sign the order?
- What info is needed?
- How many can be requested?
- What records and details are needed?
- Is headed note paper required?
- Head or principle teacher
- Name of school, total quantity and purpose
- A small amount: depends on size of school, number of parts to school, no. children with ahstma, no. incidences of being unable to acess inhaler
- Signed order kept for 2 years from dtae of supply or enetry into POM. Info needed:
- Date POM supplied
- Name, quantity, strength, form
- Name, addresses, trade, business or profession of whom med supplied
- Purpose sold
- No but preferred
When supplying adrenaline autoinjectors:
- Who can sign the order?
- What info is needed?
- How many can be requested?
- What records and details are needed?
- What strngth is required?
- Discuss brands
- Head or principle teacher
- Name of school, total quantity and purpose
- A small amount: depends on size of school, number of parts to school, no. children with ahstma, no. incidences of being unable to acess inhaler
- Signed order kept for 2 years from dtae of supply or enetry into POM. Info needed:
- Date POM supplied
- Name, quantity, strength, form
- Name, addresses, trade, business or profession of whom med supplied
- Purpose sold
- Depends o body weight and age
- different brands have different instuctions
Disucss supplying naloxone to individuals in drug treatment services
- Naloxone opiod antagonist used to reduce completely or partially centeral NS depression from acute opiod overdose
- Staff involved in drug treatment services are able to obtain naloxone form wholesaler without prescription, PGD, PSD and given to patients
Is self dispensing allowed?
- Poorpratice - should be avoided
- Nurses and pharmacist indepenent prescribers should under no circumstanes unless exceptional circumstance
What are oral retinoids are what should be done whens supplying them?
- Used for serves skin conditions but can cause foetal malformations or spontanious abortions inuborn children
- Shouldn’t be given to women or girls or child bareaing age/ pregnant unless no suitable alternative
- Pharmacists should ensure on a PPP. Should at least be on it during use and for 1 month after stopping
What are special controls for females on oral retinods?
- Prescriptions valid for 7 days only - after need new one and may need to reconfirm preg status
- Max length treatment 30 days unless not on PPP
- No repeats or faxed prescriptions allowed
- Only telephone allowe dif form PPP specialist and have confirmed -ve pregn in last 7 days
- What is valporate used for?
- When should it be takne?
- What are the problems?
- WHat should pharmacists do?
- epilepsy, bipolar, migrane (unlnced)
- if no other alternative
- serious harm to unborn child
- Have convo to see if aware of risks and on PP. If planning preg make appointment with prescriber. If preg continue med but make apppointmnet urgently. Reoirt ti yellow card shceme
What are the prescribing restrictions for a doctor?
- Can supply SC 2-5 CD. And can supply dimorphine, cocaine for treating drug addiction
- Can prescibe unlinced med
- Can prescribe in emergency. Not Sc 2 or 3 bar phenobabital for epilepsy
What are prescribing requirments for an indepenent prescribing pharmacist?
- Can prescribe SC 2- 5 CD. Can’t prescribe dimorphine or concaine for treating drug addiction
- Can supply unlicenced medince
- Can prescribe in emergencies. Can’t prescribe SC2/3 unless phenobsrbital
What are the prescribing restrictions for a independent physiothepist prescriber?
- Can prescirbe certain CDs
- Can prescribe off-label medicines
- Can supply in emergencies - not SC2/3 CD including pheno
What are the prescribing restricitions for a podiatrist?
- Can prescibe certain CDs
- Can prescribe off-licence meds
- Can prescribe in emergencies - not SC2/3 CD including phenobarbital
What are the prescribing restrictions for a dentist?
- Can prescribe SC 2-5 CDs. Can’t supply dimorohine of cocaine for addiction
- Can prescribe off lincenced
- Can supply emergency - Not CD 2-5 bar pheno
What are the prescribing restrictions of a supplementary prescriber?
- Can supply SC2-3 CD. Can’t prescribe dimorphone or cocaine for treating addiction
- Can supply off-licnce med
- Can supply in emergency - bar SC 2/3 CD exp pheno
What are the prescribing restritctions for an independent nurse prescriber?
- Can supply SC2/3 CD. Not dimorphone or cocaine for addiction
- Unlinced med exlcluded from nurse formulary
- Can presribe in emergency - not SC 2/3 CD exp pheno
What are the prescribing restrictions of optomitrist?
- Can’t supply CDs
- Off label med
- Can supply emergecny
What are the prescribing restrctions of a independednt radiologist prescriber?
- CD undecided
- Can supply off label
- Can supply in emergency - not SC 2/3 CD inclufing pheno