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Pre-Registration Revision > Medicines, Ethics and Practice > Flashcards

Medicines, Ethics and Practice Flashcards

1
Q

What records must pharmacy professionals submit every year for revalidation?

A

Four CPD records (at least 2 planned)
A peer discussion
A reflective account

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2
Q

What is ‘punitive culture’?

A

Is based upon assigning blame and punishment- can lead to reduced reporting and reduced raising of concerns

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3
Q

What is a ‘no-blame culture’?

A

Where nobody is blamed for mistakes- can lead to complacency and nonchalance. Lack of accountability.

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4
Q

What is a ‘right culture’ or a ‘just culture’?

A

A culture based upon the principles of fairness, quality, transparency, reporting, learning and safety,

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5
Q

Emergency Supply by the Pharmacist

-Must be an immediate need for the POM, and it MUST have been previously prescribed for the person requesting it.

-No greater quantity than for 5 days must be supplied for phenobarbital or schedule 4 or 5 CD’s.

-YOU CANNOT GIVE AN EMERGENCY SUPPLY FOR A SCHEDULE 1,2 OR 3 DRUG.

-No greater than 30 days supply for other POM’s, eccept if the medication is insulin, an ointment/cream, an inhaler, oral contraceptive or antibiotic.

-Prescription book entry must contain the date of supply, the name/quantity/strength of medication supplied, name and address of the patient, the nature of the emergency.

A

.

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6
Q

What are some examples of class A drugs?

A

-Cocaine
-Diamorphine hydrochloride (heroin)
-Fentanyl
-Methadone
-Morphine
-Oxycodone
-MDMA

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7
Q

What are some examples of class B drugs?

A

-Cannabis
-Barbiturates
-Codeine phosphate
-Dihydrocodeine
-Ketamine
-Pholcodine
-Oral amfetamines

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8
Q

What are some examples of class C drugs?

A

-Buprenorphine
-Most benzodiazepines
-Tramadol
-Zolpidem
-Zopiclone
-Gabapentin and pregabalin
-Androgenic and anabolic steroids

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9
Q

Controlled drugs are divided into 5 schedules. These specify the requirements for importing, exporting, production, supply, possession, prescribing and record keeping for such drugs.

A
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10
Q

Schedule 1 drugs are not medicinally used. A Home Office Licence is required for their production, possession or supply. A CD register must be used to record details of these drugs if received or supplied by a pharmacy.
What are some examples of schedule 1 drugs?

A

Hallucinogenic drugs (LSD)
Ecstasy-type substances
Raw opium
Cannabis

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11
Q

Schedule 2 CDs are subject to full CD requirements in relation to prescriptions, safe custody and the need to keep a CD register. Possession, supply and procurement is authorised for pharmacists.
What are some examples of schedule 2 CDs?

A

-DIamorphine hydrochloride (heroin)
-Morphine
-Methadone
-Oxycodone
-Major stimulants, e.g. amphetamines
-Cocaine
-Ketamine
-Cannabis-based products for medicinal use in humans

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12
Q

What is the difference between the ‘class’ system of CDs and the ‘schedule’ system?

A

Class= intended to reflect the harm associated with the drug
Schedule= reflects the laws/regulations surrounding the production, supply, etc of that drug.

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13
Q

Schedule 3 drugs are subject to special prescription requirements. Records in regsisters do not need to be kept, however. Invoices must be retained for 2 years.
What are some examples of schedule 3 CDs?

A

-Buprenorphine (CD cupboard)
-Gabapentin
-Midazolam
-Pregabalin
-Temazepam
-Tramadol
-Pentazocine

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14
Q

Schedule 4 CDs are not subject to CD requirements. Records do not need to be kept (exept for Sativex).
What are some examples of schedule 4 CDs?

A

-Zolpidem
-Zopiclone
-Benzodiazepines (except temazepam and midazolam)
-Sativex
-Androgenic and anabolic steroids

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15
Q

Schedule 5 drugs includes preparations of certain CDs, and are exempt from virtually all CD requirements, other than the retention of invoices for two years.
What are some examples of schedule 5 CDs?

A

Codeine
Pholcodine
Morphine

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16
Q

Prescription Requirements for Schedule 2&3 Drugs

  • Name and address of patient
    -Form and strength of medication
    -Total volume/quantity in both words and figures
    -Dosing instructions are specific (not just ‘as directed’)
A
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17
Q

What does it mean if a solution concentration is written as ‘ppm’?

A

mg/L (so 1 ppm would be 1mg/L)
For examples, 3500-ppm would be 3500mg/L

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18
Q

What does molarity mean?

A

mol/L (number of moles of solute per litre of solution)

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19
Q

What is % w/v?

A

g/100ml, so how many grams are in 100ml of solution written as a percentage.

5g/100ml= 5%

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20
Q

REMEMBER:
- 1 TO 7 solution of drug X= 8 total parts
-1 IN 7 solution of drug X= 7 total parts

A
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21
Q

Displacement Factors:

If it says, for example, Drug X has a displacement factor of 0.3ml per 600mg of the drug, that means that if you add 600mg of the drug to a solution, the solution volume will INCREASE by 0.3ml.

e.g. Dissolve 600mg of drug X in 10ml, the final solution volume = 10.3ml.

A

..

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22
Q

Remember:
Moles= Mass/MR, the mass is in grams.

A

.

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23
Q

What are the rules for selling GSL medications?

A
  • Can be sold in a pharmacy or other retail outlets
    -To be sold in a pharmacy, a pharmacist must be signed on as the responsible pharmacist, but can be absent for a limited period of time
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24
Q

Supply Pseudoephedrine and Ephedrine OTC

  • Can be used to potentially make crystal meth- reason behind OTC limitations
  • Unlawful to supply the product, or combination of products, that contain more than 720mg of pseudoephedrine OR 180mg of ephedrine at any time without a prescription.
    -Cannot sell a pseudoephedrine product alongside an ephedrine product without a prescription.
A

.

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25
Q

What are the three methods of emergency contraception?

A

Copper IUD
Oral ulipristal acetate
Oral levonorgestrel

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26
Q

Oral Emergency Contraceptives (Levonorgestrel 1500mcg and ulipristal acetate 30mg)

-Available as P medicines
-Levonorgestrel is licensed in over 16s up to 72h after UPS or contraception failure
-Ulipristal licensed up to 120h after UPS or contraception failure

A
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27
Q

What is the maximum number of aspirin tablets that can be sold OTC?

A

100 per patients

28
Q

What are the 6 prescriptions requirements in order to make a prescription legal?

A
  1. Prescriber signature
  2. Address of prescriber
  3. Date
  4. Particulars of prescriber
  5. Patient name
  6. Patient address
    (7. Patient age IF under 12 years old)
29
Q

Repeat Prescriptions

-Prescriptions for schedule 2&3 drugs are NOT repeatable (they are for 4 and 5)
-The first dispensing for a repeat prescription must be within 6 months of the date on the script; there is no legal time limit for the remaining repeats. For schedule 4 CDs, it must be within 28 days for the first issue.
-If no repeat number is specified (how many repeats are prescribed) then the script can only be repeated once (dispensed twice)- for oral contraceptives, it is different and can be dispensed six times in total.

A
30
Q

Record Keeping

-Private prescriptions for a POM must be retained for _ years from the date of supply.
-A record should be made in the POM register: supply date, prescription date, medicine details (name, quantity, formulation, strength), prescriber details and patient details
-Private prescriptions for Schedule 2&3 drugs- submit to relevent NHS agencies
-Private prescriptions for oral contraceptives are exempt from record-keeping, as are scripts for schedule 2 CDs where a separate CD register record has to be made.

A
31
Q

What details need to be included in a POM book entry?

A

-A record should be made in the POM register: supply date, prescription date, medicine details (name, quantity, formulation, strength), prescriber details and patient details

32
Q

When dentists are prescribing on an NHS dental prescription, they are restricted to the medicines listed in the Dental Prescribers’ Formulary.

A
33
Q

Why does a fax of a prescription not fall within the definition of a legally valid prescription?

A

-Not written in indelible ink
-Not been signed in ink by an appropriate prescriber

34
Q

Schedule 1, 2 and 3 drugs cannot be supplied via an emergency supply (including phenobarbital).
True or False?

A

True

35
Q

There are times where POMs may be sold or supplied without a prescription. What are some examples?

A
  • PGDs
    -PSDs
    -Emergency suplies
    -Optometrist or podiatrist signed patient orders
    -Supply of salbutamol inhalers to schools
    -Supply of adrenaline autoinjectors to schools
    -Supply of naloxone by individuals providing recognised drug treatment services
36
Q

What is a PGD?

A

A written direction that allows the supply and/or administration of a specified medicine or medicines, by named authorised health professionals, to a well-defined group of patients requiring treatment for a specific condition.

37
Q

Emergency Supply at the Request of a Prescriber

-Prescription cannot be provided immediately, e.g. patient is unablt to collect prescription, etc
-The prescription must be sent over within 72 hours of the emergency supply
-Not allowed for Schedule 1, 2 and 3 CDs (phenobarbital allowed for the treatment of epilpesy)
-Entry must be made into POM register (date of supply, details of the drug, prescriber details, patient details, date on the prescription and the date the prescription was received).

A
38
Q

Emergency supplies are only legal when GP surgeries are closed.
True or False?

A

False
Emergency supplies can still be done when doctor surgeries are open- use professional judgement

39
Q

Length of Treatment for Emergency Supplies

-Schedule 4&5 CDs- up to five days treatment
-Other medications- up to 30 days treatment
-Insulin, creams, inhalers etc- smallest possible pack size
-Oral contraceptive- full treatment cycle

A
40
Q

What is a signed order, and what needs to be included in order for it to be legal?

A

Signed orders can be used by schools to obtain supplies of adrenaline autoinjectors and salbutamol inhalers from a pharmacy/

Must include:
-School name
-Product details
-Strength (if relevent)
-Purpose for which the product is required
-Total quantity required
-Head teacher signature

Records must be kept by the pharmacy for two years OR an entry made in the POM register (best to do both)

41
Q

What are some examples of medications that carry a high risk of foetal malformations if the patient were to get a pregnant whilst taking them?

A

Oral retinoids (acitretin, isotretinoin)- for severe skin conditions
Valproate
Thalidomide
Lanalidomide

42
Q

What is a biologic?

A

A medicine made from a variety of natural sources that may be human, animal or microorganism in origin.

43
Q

Veterinary Prescription Requirements

-Name, address, telephone number, qualification and signature of prescriber.
-Name and address of owner
-Identification and species of animal
-Date; Rx are valid for 6 months (sch 2,3,4 CDs are 28 days)
-Name, quantity, dose and administration instructions of the medicine
-Necessary warnings

A
44
Q

The Veterinary Cascade

-The Cascade is an exemption within the Veterinary Medicines Regulations and specifies that where a licensed veterinary product is unavailable, other medicines can be considered.

-Unlawful to supply a human medicine against a veterinary prescription unless it is prescribed by a vet and specifically states that it is ‘for administration under the Cascade’.

IMPORTANT: ‘for administration under the veterinary cascade’ is only a legal requirement if the medication being prescribed is a HUMAN POM, not required if it is a medication that is only used in animals.

A

.

45
Q

Labelling of Veterinary Medicines

-Name of vet
-Name and address of the animal owner
-Name and address of the pharmacy
-Identification and species of animal
-Date of supply
-Product expiry date
-Name of product
-Administration instructions
-‘For animal treatment only’

A

.

46
Q

Record Keeping- Veterinary Prescriptions

-Name of medicine
-Date of the supply
-Batch number
-Quantity
-Name and address of recipient
-Name and address of prescriber

Keep records and documents for at least 5 years

A
47
Q

For how long do veterinary prescription records need to be kept?

A

5 years

48
Q

Responsible Pharmacist Legal Requirements

-Display a notice that give RP details in the pharmacy
-Making and keeping records
-Pharmacy procedures

A

.

49
Q

Responsible Pharmacist: Absence From the Pharmacy

-Legally can be absent from a registered pharmacy for 2 hours in a 24 hour day, and continue to sell GSL medicines. Must return within reasonable promptness and be contactable. No P or POM allowed.
-If another pharmacist is present, GSL, P and POM medicines can be sold and supplied, but the absent responsible pharmacist is still accountable for what happens.

A
50
Q

How long does a GP have to send over the original copy of a prescription if they have faxed a prescription over for a POM?

A

72 hours

51
Q

How many days supply of phenobarbital can be supplied on an emergency supply for epilepsy?

A

5 days

52
Q

Which CDs can pharmacist independent prescribers not prescribe?

A

Diamorphine
Dipipanone
Cocaine

53
Q

What is the minimum length of time a record of the responsible pharmacist needs to be kept?

A

5 years

54
Q

Pregnancy Prevention Programme Script Validity

  • Isotretinoin script validity is _ days
    -Sodium valproate script validity is 6 months
A

7

55
Q

How long should the CD register be kept after the last entry?

A

2 years

56
Q

What does ‘bioavailability’ mean?

A

The craction of the drug that reaches the systemic circulation and is expressed a number from 0 to 1. Basically how much drug can be ‘used’ for its indication.

57
Q

Remember: Private AND NHS prescriptions for schedule 2 and 3 CDs should be submitted to the relevent NHS agency.

A

.

58
Q

REMEMBER: mEq/L is the same as mmol/L.

A
59
Q

How often should SOPs in a pharmacy be reviewed?

A

At least every 2 years

60
Q

How long do doctors have to supply a script if they have requested an emergency supply for a patient?

A

72 hours

61
Q

What does a P value of <0.05 represent?

A

Indicates a result that is significant

62
Q

NHS scripts can have a date of issue and also a date on it for when the prescription can be dispensed, for example ‘dispense on 10/4/23’, even if the script was issue 3/4/23. For private scripts, the date of issue has to be the date that a script can be supplied from, can’t state a later date.

A

.

63
Q

Where can you look to see which drugs can be prescribed by a dentist on an FP10D script?

A

BNF

64
Q

Which classification is used to help determine how to manage a patient that presents with a sore throat?

A

FeverPAIN score

65
Q

Which classification is used to determine whether a patient requires anticoagulation?

A

CHA2-DS2-VASc score

66
Q

Which classification is used to aid the prescribing decisions for contraceptive methods?

A

UKMEC score

Pre-Registration Revision (24 decks)

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