MEP Flashcards
Documents to submit for the revalidation process
4 x CPD (at least 2 planned)
1 x peer discussion
1 x reflective
Pseudoephedrine + Ephedrine limits
when without a Rx,
Pseudoephedrine ≤720mg or
Ephedrine ≤180mg
not at the same time
Emergency contraception choices, time limits, age limits
- Copper intrauterine device
- Ulipristal 30mg - 120 hours (5 days)
- Levonorgestrel 1500mcg - 72 hours (3 days), >16 years old
- Under 16 years old is a sexual offence, but maybe mutual enough to make a decision. It is illegal for those under 13 years for sexual activities => Social service
Paracetamol & aspirin OTC limits (no. of non/effervescent tablet/cap) normal pack size
No more than 100 non effervescent tab/cap
(normal pack size 16 or 32 dose unit)
no limits for effervescent formulations (tab/powder/granules/liquid) => use judgement
Codeine & dihydrocodeine OTC - indication, pack size limit, the PIL & package labelling requirement, duration limit
Indication: short-term acute moderate pain that is not relieved by paracetamol/ibuprofen/aspirin alone
Pack size: no more than 32 unit dose (above this number is POM)
Warning on the package: “can cause addiction. For three days only”
PIL much contain information of warning signs of addition
Good practice: no more than 1 pack when selling
Rx requirements
- Patient’s name
- Patient’s address
- Age if under 12
- Date of Rx
- Prescriber’s signature
- Prescriber’s particulars (type of practitioner)
- Prescriber’s address
Repeats Rx - meaning, contraception repeats, which class of drugs can be repeated, time limit to dispense repeats Rx
“repeat” without number = total dispense 2 times; contraception can be repeated 5 times ( dispense 6 times in total)
“repeat X” = repeat X times+1
CD 2/3 = NOT REPEATABLE
CD 4/5 = repeatable
CD 4 : 1st dispensing must be within 28 days, following has no time limit
CD 5/POM : 1st dispensing must be within 6 months, following has no time limit
Validity of owning (time limit) - CD2/3/4, POM&CD5, P&GSL
CD2/3/4: 28 days after the appropriate dates (supply of owing can exceed 7 days from when the Rx is written only if follow the Pregnancy Prevention Programme to ensure Pt is not pregnant)
POM&CD5, P&GSL: 6 months from the appropriate dates
Appropriate dates = date when the Rx is signed/ indicated start date
Record keeping for private Rx (POM requirements, repeats, years to keep in the pharmacy)
what to do if it’s a CD 2/3
Exemption from record keeping
Regular med keep POM register for 2 years from the date of sales/ last supply of repeat Rx; CD2/3 send to NHS agency
POM:
1. Supply date
2. Rx date
3. Medicine: Name, formulation, strength, quantity
4. Rx’er detail: name & address
5. Pt’s details: name & address
Oral contraception does not need record keeping
CD2 does not require record keeping as it already made a CD register entry
Is faxed Rx valid
No
EEA counties (31 counties + Non EEA 1)
Switzerland
EEA:
Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Republic of Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland
Rx requirement for EEA Rx’er
What med is not allowed to EEA Rx
- Pt: Full name, DoB
- Px’er’s details: Full name, qualification, direct contact details (incl. email + (international prefix)tel./fax, work address (incl. country)
- Medicine: Name (brand if required), formulation, strength, quantity, dosage details
- Rx’er signature
- Date of issue (up to 6 months; 28 days if CD4) appropriate date is when the Rx is signed
CD1/2/3 and med without a UK MA cannot be supplied
Emergency request from an EEA Pt/EEA Rx’er (what to do)
Request from EEA Pt - normal supply process
Request from EEA Rx’er - normal supply process, but Rx need to be received within 72 hours
Military Rx form name for regular med/CD, which form cannot be dispensed in a community pharmacy, charges?
FMed 296; pink FP10PCD for CD2/3; written CD2/3 on MOD FMed296 is not permitted to dispense in community pharmacy as most are computer generated.
Treat as private Rx, up to the Pt wants to claim back the cost (provide receipt)
Labelling of medicine requirements (original package), where to stick the label
- Pt’s name
- Pharmacy’s name & address
- Date of dispensing
- Name of medicine
- Directions of use
- Precautions
Good practice:
- Keep out of reach and sight of children
- Use this medicine only on your skin where applicable
Stick to the inner container if possible
Labelling of broken down medicine from bulk
- Name of medicine
- Quantitative particulars of the medicine (ingredient)
- Quantity in the container
- Handling and storage if appropriate
- Expiry date
- Batch number (LOT number/BN)
Adrenaline: administration route, which regulation allows administration of adrenaline in life emergency situation
i.m. route
Regulation 238 of Human Medicines Regulations 2012
Situations/ under which “Directions” of when medicines can be supplied without a Rx
- PGD (patient group direction) => POM labelling should be the same as dispensing a POM against a Rx
- PSD (patient specific directions)
- Emergency supplies
- optometrist/podiatrist signed patient orders
- Salbutamol/ Adrenaline autoinjectors to school
- Naloxone if individuals providing recognised drug treatment services
Which professional can request emergency supply of medication
Doctor
Dentist
SP
community nurse
EEA/Swiss professional
IP of: pharmacist, nurse, physio, podiatrist, therapeutic radiographer, optometrist, paramedic
Emergency supply, request by Rx’er:
Nature requirements, the dosage of the med, Rx time limit to reach pharmacy, which med can/can’t be supplied (request by which professions), record keeping requirements, labelling
Requirement: ensure it’s an emergency situation that Rx can’t be reached to the pharmacy
Rx need to be provided within 72 hours
Supply med according to Rx’er instruction
NO CD1/2/3 by UK/Swiss/EEA Rx’er
The exception is phenobarbital (phenobarbitone/phenobarbitone sodium) for epilepsy by UK (Doc/dentist/nurse/pharmacist IP or SP)
Record keeping POM:
POM:
1. Supply date.
2. Rx date - add back when receiving the Rx
3. Medicine: Name, formulation, strength, quantity.
4. Rx’er detail: name & address.
5. Pt’s details: name & address.
6. Date of receiving the Rx
Labelling requirement: as usual
Emergency supply, request by Pt:
which regulation requires the Pharmacist to interview Pt, what to consider, requirements, dose, which med cannot be supplied, length of treatment, record keeping, labelling
Regulation 225 of Human Medicine Regulation 2012 requires the pharmacist to interview pt. If not possible, use professional judgement
Ensure Pt is in immediate need, impossible to obtain Rx even if surgery is open
The POM must be prescribed previously by a UK/Swiss/EEA Rx’er.
The pharmacist must be satisfied with the dose given to the pt (according to PMR/repeat slip etc)
NOT CD1/2/3 or ammonium bromide, calcium bromide, calcium bromidolactobianoate, embutramide, fencamfamin HCL, fluanisone, hexobarbitone, hexobarbitone sodium, hydrobromic acid, meclofenoxate HCL, methohexitone Na, pemoline, piracetam, potassium bromide, strychnine HCL, Tacrine HCL, thiopentone Na
**except for phenobarbital, can be given
Length of treatment:
CD4/5/phenobarbital => 5 days
POM => 30 days/smallest pack size if it’s insulin/ointment/cream/inhaler for asthma or full cycle if it’s oral contraception or smallest quantity for a full course of antibiotic liquid form.
Record keeping
1. Supply date.
2. -
3. Medicine: Name, formulation, strength, quantity.
4. -
5. Pt’s details: name & address.
6. Nature of emergency
Labelling:
1. Pt’s name.
2. Pharmacy’s name & address.
3. Date of dispensing.
4. Name of medicine.
5. Directions of use.
6. Precautions.
7. “Emergency supply”
What should the pharmacist do if he refuses the emergency supply request from the pt?
refer to Dr/ NHS111/ NHS walk in/ A&E
NHS111 can arrange emergency supply of regular medicine
Which items can be supplied to the school? Documentations required, the maximum number to supply; record keeping, which type of school
Salbutamol inhaler + autonormic adrenaline injector
School: Primary, secondary (maintained school, independent school, pupil referral unit, maintained nersery school
Signed order:
1. Name of school
2. Product details (incl. spacer if relevant)
3. Strength (if relevant)
4. Purpose for the supply
5. Total quantity
6. Signature of the principal/head teacher
#idealy use headed paper
#have different brands of salbutamol/adrenaline, try to avoid confusion
The maximum number to supply: no limit
Signed order record keeping: 2 years from the date of supply/entry from the POM register
Good practice for making a POM register
1. Date of supply
2. Name, quantity, formulation, strength
3. Name/address of business or profession of the person
4. Purpose
Advices give to primary school when supplying salbutamol/adrenaline
Directions of use, age group for different type of spacers
Storage and disposal advises
Internal record keeping, regular expiry date check, when to replace
