MEP

Question 1

What is a PO medicine?

Answer 1

Licensed as a GSL medicine however the manufacturer wishes to restrict sales/supplies through pharmacies only e.g. 30 sachet packets of Fybogel.

Question 2

Within a pharmacy, when can a GSL medicine be sold?

Answer 2

When a pharmacist has assumed the role of RP. However, the pharmacist may be physically absent for a limited period of time whilst RP.

Question 3

What is the max amount (in mg) of pseudoephedrine and ephedrine you can sell over the counter at any one time?

Answer 3

720mg pseudoephedrine and 180mg of ephedrine

Question 4

Can you sell a product containing pseudoephedrine at the same time as selling a product with ephedrine over the counter?

Answer 4

No

Question 5

What other products would be concerning if a patient were to buy as well as requesting ephedrine containing products?

Answer 5

Lithium batteries and chemicals such as acetone

Question 6

If you suspect a customer is misusing ephedrine products to make meth, who can you report this to?

Answer 6

Local GPhC inspector, local controlled drugs liaison police officer or accountable officer

Question 7

What 2 medicinal products are licensed as EHC?

Answer 7

1. Levonorgestrel 1500 micrograms
2. Ulipristal acetate 30mg

Question 8

EHC: What age group is levonorgestrel licensed for and within what time frame of unprotected sex?

Answer 8

1. > 16 years
2. Within 72 hours
   ( higher dose for BMI over 26kg or >70kg (2 tablets ))

Question 9

EHC: What age group is ulipristal licensed for and within what time frame of unprotected sex?

Answer 9

1. Supply is not contraindicated < 16 years however pharmacist may wish to consider additional factors e.g. consent, Gillick competency
2. Within 120 hours (5 days)

Question 10

Can you give an advance supply of EHC?

Answer 10

Yes - need to make sure the patient is competent, intend to use the medicine appropriately and that it is clinical appropriate to give it to the patien

Question 11

Children under what age are legally too young to consent to any sexual activity?

Answer 11

Under 13 years

Question 12

If someone wanted EHC however the sale would be inappropriate e.g. outside the marketing authorisation, who could you refer them to?

Answer 12

GP, family planning clinics, GUM clinics

Question 13

What is the legal restriction on selling paracetamol?

Answer 13

No more than 100 non-effervescent tablets (although typically would be equivalent to 96 tab/caps).

There is no legal limit on quantity of effervescent tablets, powders, liquids or granules however professional judgement should be used.

Question 14

What is the legal restriction on selling aspirin?

Answer 14

No more than 100 non-effervescent tablets There is no legal limit on quantity of effervescent tablets or, powders however professional judgement should be used.

Question 15

What are the indications for solid dose OTC codeine and dihydrocodeine?

Answer 15

1. Short term treatment of acute, moderate pain that is not relieved by paracetamol, ibuprofen or aspirin alone.
2. All other indications such as flu, cough, sore throats and minor pain have been removed

Question 16

What is the maximum pack size of codeine and dihydrocodeine OTC?

Answer 16

32 (any more is a POM) This includes effervescent formulations

Question 17

What warning label must be on the front of codeine and dihydrocodeine packs?

Answer 17

“Can cause addition. For 3 days use only”

Question 18

What info must the PIL and packaging of codeine and dihydrocodeine contain?

Answer 18

1. They need to state the indication and that the medicine can cause addiction or overuse headache if used continuously for more than three days.
2. The PIL must also contain information about the warning signs of addiction.

Question 19

What medicines OTC are deemed unsuitable for children under 6 years?

What are the recommendations for this in the 6-12 years age group?

Answer 19

1. Antitussives:Dextromethorphan, pholcodine
2. Expectorants:Guaifenesin, ipecacuanha
3. Nasal decongestants:Ephedrine, oxymetazoline, phenylephrine,pseudoephedrine, xylometazoline
4. Antihistamines:Brompheniramine,diphenhydramine, doxylamine, promethazine,triprolidine.
5. For 6-12 years:These medicines should be used as 2nd line and should not be used for more than 5 days

Question 20

What is 1st line treatment for children with coughs and colds?

Answer 20

1. Drink plenty of fluids- Paracetamol for fever and pain - Can use ibuprofen if child does not respond to paracetamol, however paracetamol and ibuprofen is not recommended together under 5 years
2. Saline nasal drops, vapour rubs, decongestants or steam inhalation for nasal congestion- Warm, clear fluids or warm lemon and honey drinks (honey if > 1 year)- Simple cough mixture e.g. glycerol or simple linctus

Question 21

What age is honey unsuitable for?

Answer 21

Below 1 year of age

Question 22

What age group is codeine linctus unsuitable for?

Answer 22

Below 18 years of age

Question 23

What 7 pieces of info must be present for a standard prescription to be legal?

Answer 23

1. Signature of prescriber
2. Address of prescriber
3. Date
4. Particulars of prescriber (type of prescriber)
5. Patient name
6. Patient address
7. Age is below 12

Question 24

How long is a standard FP10 valid for from the date of prescribing?

Answer 24

6 months

Question 25

What is a P med and when can it be sold?

Answer 25

1. A pharmacy medicine- can be sold from a registered pharmacy premises by a pharmacist or a person acting under the supervision of a pharmacist.
2. GSL + P medicines are collectively known as over-the-counter (OTC)

Question 26

What is the difference between validity of prescriptions in terms of dates between NHS and private prescriptions?

Answer 26

1) For an NHS prescription, the appropriate date is the LATER of either the date on which the prescription was signed or a date indicated by the appropriate practitioner as the date before which it should not be dispensed.
2) For private prescriptions, the appropriate date will always be the date on which it was signed.
3) Still 6 months for POM and 28 days for CD for private and NHS

Question 27

Is it permissible to issue carbon copies of prescriptions?

Answer 27

Yes, as long as it is signed in ink

Question 28

Can an advanced electronic signature be used to sign a prescription?

Answer 28

Yes

Question 29

What are instalment prescriptions?

Answer 29

Provided for a single prescription for a controlled drug so it can be dispensed in several instalments

Question 30

1) If a repeat number is not stated on a repeat prescription, how many times can it be repeated?
2) What is an exception to this rule?

Answer 30

1) Only once (so dispensed twice in total)
2) Oral contraceptives can be repeated 5 times (dispensed 6 times in total)

Question 31

Are controlled drugs repeatable on prescription?

Answer 31

1) 2 and 3 cannot be repeated
2) however 4 and 5 can be

Question 32

On repeat prescriptions, is there a time limit?

Answer 32

1) No- the first dispensing must be made within 6 months of the date like a normal prescription
2) However after this, there is no legal time limit for the remaining repeats. However, pharmacists should use professional judgement

Question 33

For repeat prescriptions, can they be dispensed from different pharmacies?

Answer 33

1) Yes, the patient can retain the prescription and choose to have repeats dispensed from different pharmacies.
2) You can maintain an audit trail mark on the prescription (name and address of pharmacy, date of supply)

Question 34

1) Are FP10 forms used in prison?
2) Is there any exceptions to this?

Answer 34

1) FP10 prescriptions are not allowed for patients
while they are in prison (unless authorised by the
Prison Trust)

2) However, if a prisoner is about to be released and the usual method of ensuring continuity of supply in the community has not happened e.g. being released unexpectedly, can be given an FP10 or FP10MDA to take to a community pharmacy. These forms have the prison address and are exempt from paying

Question 35

What is the time limit on prescription owings for:

1) POM
2) GSL/P
3) CD 2, 3, 4

Answer 35

1) 6 months
2) 6 months
3) 28 days

Question 36

How long must a record be kept for a POM private prescription?

Answer 36

2 years from the date of supply

Question 37

1) What must you do if you dispense a private or NHS CD 2 or 3 medicine?
2) Is this the same with vet private CD prescription

Answer 37

1) Private and NHS CD 2 and 3 prescriptions should be submitted to the relevant NHS agency
2) Do not need to submit vet private CD script however the prescription needs to be retained for 5 years

Question 38

When recording private prescriptions, when should the record be made into the POM register?

Answer 38

On the day of supply, and if this is not practical, on the next day following

Question 39

What 2 medicine classes are exempt from record keeping for private prescriptions?

Answer 39

Oral contraceptives and CD2s where a separate controlled drug register has been made

Question 40

Do you need to have details of the medicine in order for a prescription to be legal?

Answer 40

No, you do not legally need name, strength, form, quantity and dose however these are important to identify what medicine you need to dispense.

Question 41

Is a faxed prescription a legal document?

Answer 41

No as it has not been written in indelible ink and has not been signed in ink. There are various risks associated with faxed prescriptions e.g. sent to multiple pharmacies for multiple supplies, forged prescriptions. There are other options with a better risk profile Pharmacists considering supplying medicines against a fax should make an informed decision and consider record making of the decision-making process

Question 42

1) What can dentists legally prescribe?
2) Is there a restriction on NHS Dental prescriptions?

Answer 42

1) Any POM however the General Dental Council advises that dentists should restrict their prescribing to within their competency
2) On NHS dental prescriptions, dentists are restricted to the Dental Prescribers’ Formulary