Guidance To Prescribing/ preliminary Flashcards
Define multimorbidity
Presence of two or more life long health conditions in a patient
What is deprescribing and why’s it done?
Process of discontinuing or reducing the dose of medicines to manage poly pharmacy
What are some example for lack of adherence
Prescription not dispensed or collected Purpose of meds not clear Perceived lack of efficacy Real or perceived adverse effects Patient fears risks or s/e Administration instructions not clear Physical difficulty taking the meds Unattractive formulation Complicated regime
What is the new medicines service?
Provides education and support to patients newly prescribed a medicine to manage long term conditions. Involves patient engagement, intervention and follow up
Eg asthma copd htn t2d
What is medicines use review and who should it be done for?
Adherence entered review Pts taking high risk meds Pts recently discharged from hospital Certain respiratory meds Patients with or at risk of cvd On atleast 4 different meds
Why should the brand name of biological medicines be written on the prescription
To avoid inadvertent switching. Substitution of brands is not appropriate for biological medicines
What are biosimilar medicines ? Give examples
Biological medicines that is highly similar and clinically equivalent (interns of safety efficacy and quality) to an existing biological/ originator medicine that has already been approved by the EU.
Eg:
Enaxaparin
Infliximab
Insulin glargine and insulin lispro
When is unlicensed meds use necessary
If clinical needs cannot be met by licensed meds but use should be supported by appropriate evidence and experience and should be able to be justified
What makes a preparation sugar free?
Does not contain glucose fructose or sucrose
How do you provide extemporaneous preparations?
Recently prepared and with sterile water
Apart from misused drugs, what meds are involved in drug imaged driving rules?
Opioids
Benzodiazepines
How should patients dispose of unwanted meds?
Return them to the supplier for destruction
What’s the legal requirement of what should be on a label
Name of patient Name and address of supplier Date of dispensing Name of medicine Direction for use of medicine Precaution for medicine Keep out of reach of children
Requirements for a pharmacy only prescription
Written in idelible ink
Dated
Name and address of the patient
Address of the prescriber
The type of prescriber and their signature in ink not printed
Age and DOB (legal requirement for both under the age of 12)
What should not be abbreviated on prescriptions
Micro gram and Mano gram
And units
Drug name
Directions (excluding the approved Latin ones)
What do dentist prescribe on
FP10D
When sending a CD electronic prescription, what must the prescriber do?
Print it off and sign it
What should the pharmacist assess when deciding to give an emergency supply of medicines. What should they do after?
There’s Immediate need for the meds
It has previously been prescribed for the person requesting it
It would be the appropriate dose
No greater quantity than 5 days is given for CD schedule 4 and 5 or phenobarbitone
No supply of CD schedule 1 2 3
No more than 28 days for normal P meds
Smallest pack for creams, inhaler, insulin supplied
Entry should be made by the pharmacist stating the date, name, quantity, name and address of patient and nature of emergency
Label should state emergency supply
How does an emergency supply requested by a prescriber work?
Pharmacist must be satisfied with the reason
Prescription provided in 72 hours
The meds is not a CD schedule 1 2 or 3
The meds are recorded with the label stating emergency supply
What should the pharmacist do if they cannot make an emergency supply
Advice the patient on how to obtain essential medical care
What drugs are included in schedule 1 CD and Prescribing requirements
Drugs not used medically such as LSD
A home office license is required for their production possession or supply
Cd register must be kept
What drugs are included in schedule 2 CD and Prescribing requirements
Includes opiates morphine methadone Ocycodone
Full CD requirements with prescriptions
Safe custody
Drug register
What drugs are included in schedule 3 CD and Prescribing requirements
Includes barbiturates bupernorphine gabapentin pregabalin tramadol
Special prescription requirements
Safe custody
But no register required
What drugs are included in schedule 4 & 5 CD and Prescribing requirements
Retain invoiced for 2 years
Requirement for CD prescription
All of the normal legal ones Quantity written in words and figures As directed not suitable State the form State the strength if more than one is available
For dental practice only if prescribed by dentist
Quantity you can supply and how long a CD prescription is valid for schedule 1-4
28 day valid prescription
Can supply for 30 days
how long a CD prescription is valid for schedule 5
6 months
Can you write p and cd meds on the same script
Not cd schedule 2 and 3 and normal p meds
Can pharmacist dispense cd meds with no quantity in words and figures
Yes if one is present but sign and date it
What is required to travel with CD drugs (exc schedule 5)
Import export license if they carry more than 3 months and home office licence for schedule 1 regardless of the amount
How are drugs that produce unwanted or unexpected adverse affects reported
The yellow card scheme
How long do products usually retain the black triangle
Five years but can be extended if required
Why is it important to report adverse reactions in children to the yellow card scheme
The effect of the drugs in children may be different from that in adults
Drugs may not have been extensively tested in children
Many drugs are not licensed for use in children and are used off label or as unlicensed products
Drugs may affect the way the child develops
What should you look out for when prescribing in hepatic (liver) impairment
Impaired drug metabolism
Hypoproteinaemia (reduced protein binding and increased toxicity of some highly bound drugs)
Reduced clotting by reduced synthesis of clotting factors and prolonged prothrombin time
Hepatic encephalopathy (hepatic coma)- further impair cerebral function
Fluid overload
Reduced bile excretion
Malabsorption of fat soluble vitamins
Hepatotoxicity
What should you look out for when prescribing in renal (kidney) impairment
Reduced renal excretion of a drug or is metabolise may cause toxicity
Sensitivity to some drugs is increased
Many side-effects are tolerated poorly by patients with renal impairment
Some drugs are not affective when renal function is reduced
What are the two methods used to estimate renal function
Estimated glomerular filtration rate and creatinine clearance
When should drugs be prescribed in pregnancy
Only if the expected benefit to the mother is thought to be greater than this to the fetus and all drugs should be avoided if possible during the first trimester
What is important to note when prescribing in breastfeeding
For many drugs insufficient evidence is available to provide guidance and it is advisable to administer only essential drugs to a mother during breastfeeding because the absence of information does not imply safety
What is the order of prescribing in Perative care for pain
Start with a non-opioid analgesics such as paracetamol if it’s not sufficient alone then an opioid analgesic alone or in combination with a non-opioid analgesic at an adequate dose
Start with a weak opioid like codeine or tramadol if they do not control the pain morphine such as transdermal bupronorphine transdermal fentanyl hydromorphone oxycodone and methadone If the patient is not opioid naive
Name enzyme inhibitors and their effects of drugs
SICKFACES. COM
Increased risk of enzyme toxicity
Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol Chloramphenicol Erythromycin Sulphonamide
Ciprofloxacin
Omeprazole
Metronidazole
Name enzyme inducers and their effects on drugs
Increased risk of subtherapeutic treatment
Barbiturates St. John’s wort Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital Sulfonylureas
What drugs colour the urine/ bodily secretion red
Dantron
Doxorubicin
Levodopa
What drugs colour the urine/ bodily secretion red/ orange
Rifampicin
What drugs colour the urine/ bodily secretion orange
Sulfasalazine
What drugs colour the urine/ bodily secretion yellow/ brown
Nitrofurantoin
Senna
What drugs colour the urine/ bodily secretion pink or orange
Pheninidione
What drugs colour the urine/ bodily secretion blue
Triamterene
What drugs colour the urine/ bodily secretion black tarry
Iron
Bismuth
What drugs colour the urine/ bodily secretion brown
Prostaglandin analogues
What cautionary advice is on sedatives
This medicine may make you sleepy if this happens do not drive or use tools or machinery
Do not drink alcohol
How do you report adr
Yellow card scheme
When to report adr
Newer drugs and vaccine indicated by the triangle symbol
medication errors
Medical devices
Defective medication or suspected fake medicines
What are side effects probability listed as
1 in 10 very common 1 in 100 common 1 in 1000 uncommon 1 in 10000 rare < 1 in 10000 very rare
What drugs cause myrlosuppression
DMARDs: methotrexate
Antiepileptic: carbamazepine, phenytoin, lamotrigine
Antibiotic: chloramphenicol, trimethoprim
Immunosuppressant: azathioprine, cytotoxic
Anti folate
Other: aminosalicylates, clozapine
What does freshly prepared and recently prepared medication mean
Freshly prepared: less than 24 hours
Recently prepared 4 week expiry when stored at 15-25 degrees
What’s the general rule for S/c infusions
Should be given at different sites and not mixed
What are the BMI classification
Healthy weight- 18.5-24.9 Overweight- 25-29.9 Obesity 1- 30-34.9 Obesity 2- 35-39.9 Obesity 3- 40+
