MEP Flashcards
Pseudoephedrine & Ephedrine
No more than 720mg pseudoephedrine
No more than 180mg ephedrine
Cannot supply both at same time
What age is considered too young to consent to sexual activity?
Under 13
Licensed age for Ulipristal Acetate?
Licensed for any female of childbearing age
Licensed age for Levonelle?
16 years
Can EHC be supplied in advance?
✅ YES
Paracetamol & Aspirin
No more than 100 non-effervescent tabs/caps
No legislation for effervescent
Codeine & Dihydrocodeine
- No more than 32 dose units
- Only indicated for short-term treatment of acute, moderate pain not relieved by other analgesics alone
What warning labels should be positioned on packs of codeine & dihydrocodeine?
- Can cause addiction - 3 days use only
- Both package and PIL must state indication and that it can cause addiction and overuse headache if used for longer
- PIL must also contain WARNING SIGNS of addiction
If number of repeats is not stated on an RX how many times can it be repeated?
Any exceptions?
Can only repeat once (dispensed twice)
EXCEPT:
- Oral contraceptives - can be repeated x5 (dispensed 6 times)
Can prescriptions for CD’s be repeated?
❌ Schedule 2 and 3
✅ Schedule 4 and 5
How long is a repeat prescription valid for?
- 1st dispensing must take place within 6 months
- No legal time limit for remaining repeats
CD Schedule 4:
- First dispensing must take place within 28 days
How long do you keep PRIVATE Rxs?
POM - 2 YEARS
Schedule 2 and 3 - submitted to relevant NHS agency
POM register requirements for private Rxs?
1) Date of supply
2) Date on prescription
3) Medicine details
4) Name & address of prescriber
5) Name & address of patient
- Retain for 2 YEARS
- Record on day of supply or following day
EXEMPT from record keeping?
- Oral contraceptives
- Schedule 2 CD’s (seperate CD register entry made)
Rules for dental prescriptions?
- Can legally prescribe any POM
- NHS prescriptions - restricted to dental formulary
Approved HCP’s?
- Doctors
- Dentists
- Pharmacists
- Nurses
- Optometrists
- Chiropodists/Podiatrists
- Paramedics
- Physiotherapists
- Therapeutic radiographers
Approved countries?
Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Republic of Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, The Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland
EMERGENCY SUPPLY:
How long to receive prescription?
Within 72 hours
Legal requirements for dispensing labels?
- Name of the patient
- Name and address of the supplying pharmacy
- Date of dispensing
- Name of the medicine
- Directions for use
- Precautions relating to the use of the medicine.
Good practice requirements for dispensing labels?
- ‘Keep out of the reach and sight of children’
- ‘Use this medicine only on your skin’ where applicable.
When can a pharmacist administer adrenaline?
- Emergency anaphylaxis
- Must also call 999 and state suspected case of anaphylaxis
EMERGENCY SUPPLY:
CD’S?
❌ Schedule 1, 2 and 3 (except phenobarbital for epilepsy)
EMERGENCY SUPPLY:
Length of treatment?
Schedule 4 and 5 (& phenobarbitol) - max 5 DAYS
POM - max 30 DAYS
Insulin/creams/inhalers - smallest pack size
Oral contraceptive - FULL cycle
SIGNED ORDER REQUIREMENTS:
Salbutamol inhalers & adrenaline autoinjectors to schools
- Name of school
- Product details
- Strength (if relevant)
- Purpose of supply
- Total quantity
- Signature of headteacher
Prescription validity for Oral Retinoids
(Isotretinoin, Alitretinoin, Acitretin)
- Prescription only valid for 7 DAYS
- Max supply 30 DAYS
- Do not accept REPEAT or FAXED RX’s
- Telephone request: only at request of a PPP specialist prescriber + confirmation of negative pregnancy test within last 7 days
Biologic vs Biosimilar Medicine
Biologic = a medicine made from a variety of natural sources that may be human, animal or microorganism in origin (vaccines, blood)
Biosimilar = a biologic medicine that is similar to an already licensed biologic medicine in terms of quality, safety and efficacy.
PRESCRIBING CD’s:
Veterinary Surgeons
YES ✅
Prescriptions for Schedule 2 and 3 CDs do not need to be on the standardised forms but must include the RCVS registration number of the prescriber
EMERGENCY SUPPLIES?
Veterinary Surgeons
NO ❌
PRESCRIBING CD’s:
Nurse or Midwife
Independent Prescriber
YES ✅
(but not cocaine, diamorphine or dipipanone for treating addiction)
PRESCRIBING CD’s:
Optometrist Independent Prescriber
NO ❌
EMERGENCY SUPPLIES?
Paramedics
Therapeutic Radiographers
YES ✅
(but not CD Schedules 1, 2 or 3 incl phenobarbatol)
PRESCRIBING CD’s:
Pharmacists
Nurse / Midwife
Supplementary Prescribers
YES ✅
(but not cocaine, diamorphine or dipipanone for treating addiction)
EMERGENCY SUPPLIES?
Pharmacists
Supplementary Prescribers
YES ✅
Including phenobarbital for epilepsy ✅
PRESCRIBING CD’s:
Physiotherapists
Can only prescribe the following:
Oral - diazepam, dihydrocodeine, lorazepam, morphine, oxycodone, temazepam
Injection - morphine
Transdermal - fentanyl
EMERGENCY SUPPLIES?
Physiotherapists
YES ✅
(but not CD Schedule 1, 2 and 3 incl. phenobarbital)
PRESCRIBING CD’s:
Podiatrists / Chiropadists
Only the following:
Oral - diazepam, lorazepam, temazepam, dihydrocodeine
PRESCRIBING CD’s:
EEA & Swiss
Schedule 4 and 5 ONLY
POM register entry for a SIGNED ORDER?
- DATE of supply
- Name, quantity, formulation and strength (where not apparent)
- Name and address, trade, business or profession to whom the supply was made
- Purpose of supply
- (Register made in POM register OR signed order/invoice kept for 2 years)*
- (Good practice to do both)*
VETERINARY RX REQUIREMENTS
(POM-V, POM-VPS & Meds under Cascade)
- Name, address, telephone number, qualification & signature of prescriber (+ RCVS number if CD 2 or 3)
- Name and address of owner
- Identity and species of animal
- Address of animal (if different from owner)
- Date
- Name, quantity, dose and administration instructions (AS DIRECTED not acceptable)
- Warnings
- Number of repeats
- Prescribed under the Cascade
NB: “the item has been prescribed for an animal or herd under the care of the veterinarian” for Schedule 2 and 3
Differences between VET and HUMAN Rx’s for CD’s?
VET:
- Standardised forms not required for Schedule 2 and 3
- Retain for 5 YEARS
- 28 DAY supply (good practice)
- Must include RCVS number
HUMAN:
- Require standardised forms for Schedule 2 and 3
- Subimitted to relevant NHS agency
- 30 DAY supply (good practice)
- Prescriber indentification number
The Veterinary Cascade is an exemption that specifies where a licensed veterinary product is not available, other medicines may be considered.
What is the order of the Cascade?
- Medicine with a GB/UK-wide marketing authorisation for the species and condition indicated
⬇️
- Medicine with a Northern Ireland (NI) marketing authorisation for species and condition indicated
⬇️
- GB, NI or UK-wide medicines licensed for another species or different condition
⬇️
- GB, NI or UK-wide licensed human medicine
OR
Veterinary medicine authorised outside the UK
⬇️
- Extemporaneous or special
Labelling requirements of dispensed veterinary medicines
- Name of prescribing veterinary surgeon
- Name & address of owner
- Name & address of pharmacy
- Identification and species of animal
- Date of supply
- Expiry Date
- Description of product / active ingredients
- Dosage and administration instructions
- Storage instructions (if appropriate)
- Warnings
- “For animal treatment only”
- “Keep out of reach of children”
FOUR classes of Veterinary Medicine?
POM-V:
- Prescribed by a vet and supplied by vet or pharmacist with a written prescription
- Need Rx
POM-VPS:
- Prescribed AND supplied by a vet, pharmacist or suitably qualified person - Oral or written Rx (written only required when supplier is not the prescriber)
NFA-VPS:
- Medicine for non-food animal supplied by vet, pharmacist or suitably qualified person
- No Rx
AVM-GSL:
GSL vet medicine
When can Schedule 1 CD’s be prescribed / administered?
Under a Home Office License
Cocaine, diamorphine and dipipanone for treating addiction?
- Only medicial prescribers who hold special license from the Home Secretary
- Not required for treating organic disease or injury
CD Requisition Requirements?
1) Name & address of recipient
2) Signed by recipient
3) Profession / occupation
4) Quantity
5) Purpose of requisition
Can you supply Schedule 2 and 3 CD’s without a obtaining a requisition first?
- Only in an emergency to doctors or dentists
- Requisition must be supplied within 24 hours
Midwife Supply Orders
Can use to obtain the following:
- Diamorphine
- Morphine
- Pethidine
CD’s EXEMPT from Safe Custody?
Schedule 2:
Quinalbarbitone (secobarbital)
Schedule 3:
Midazolam
Gabapentin / Pregab / Tramadol
Phenobarbital
Pentazocine
Meprobamate
Denaturing and destruction of CD’s
- All CD Schedule 2, 3 and 4 (part 1) should be denatured before disposal
Patient-returned CD’s
- No authorised witness required for denturing
- Record Schedule 2 destruction in seperate register (not CD register)
Expired CD’s
- Schedule 2 - require authorised witness for destruction
- Schedule 3 - another staff member to witness (good practice)
- CD register entry required for Schedule 2
