MEP Flashcards
1
Q
A profession can be described as an occupation that:
A
Is recognised by the public as a profession
Has a recognised representative professional
body
Benefits from professional standards and codes of conduct
Is regulated to ensure the maintenance of standards and codes of conduct
2
Q
A professional can be described as:
A
- A member of a profession
- A member of a professional body
- An individual who:
– Behaves and acts professionally
– Exercises professionalism and professional
judgement
– Undertakes continuing professional development
– Has professional values, attitudes and behaviours.
3
Q
Pharmacy professionalism can be defined as:
A
a set of values, behaviours and relationships that underpin the trust the public has in pharmacists.
4
Q
Exercising professional judgement
A
- IDENTIFY THE ETHICAL DILEMMA OR PROFESSIONAL ISSUE
- GATHER ALL THE RELEVANT INFORMATION AND RESEARCH THE PROBLEM
- IDENTIFY ALL THE POSSIBLE SOLUTIONS
- WEIGH UP THE BENEFITS AND RISKS OF EACH OPTION
- CHOOSE AN OPTION - ENSURING YOU CAN JUSTIFY THE DECISION
- RECORD THE DECISION-MAKING PROCESS
It is important to point out that professional judgement is not a blanket defence or a blanket reason to take the most convenient choice.
5
Q
Professional empowerment
A
is about enabling professionalism and professional judgement through through guidance, standards, news and alerts; through webinars and our mentoring programme; through our Leadership Development Framework; through influencing policy and embedding and nurturing the right culture.
6
Q
Standards and Guidance (Appendix 1 - 6)
A
Regulation=>Professional Standards=>Best Practice Guidance=>Local Policy and Procedure=>Patient and Public Outcomes and Experiences
7
Q
CONFLICTS OF INTEREST
INTERFACE BETWEEN PERSONAL AND PROFESSIONAL LIVES
Patient Or Person-Centred Healthcare
A
8
Q
PROFESSIONAL INDEMNITY
A
The GPhC has advised
“that the professional indemnity arrangement you have in place provides appropriate cover. This means that the cover needs to be appropriate to the nature and extent of the risks involved in your practice.”
9
Q
Revalidation
A
- Four continuing professional development (CPD) records (at least two planned)
- A peer discussion
- A reflective account.
10
Q
An independent prescriber (IP)
A
is a practitioner, who is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and can make prescribing decisions to manage the clinical condition of the patient.
11
Q
A supplementary prescriber (SP)
A
is a practitioner who prescribes within an agreed patient specific written clinical management plan (CMP), agreed in partnership with a doctor or dentist.
12
Q
PHARMACISTS IN RESEARCH
A
research is often a multidisciplinary team activity
will require ethical approval by a Research Ethics Committee (REC); a group
of experts who hold the responsibility of ensuring research conforms to accepted standards. Professional bodies, such as the Health Research Authority, use these committees to help govern and regulate research in the UK.
13
Q
BEING CULTURALLY INFORMED
A
- Age
- Gender
- Ethnicity
- Sexual orientation
- Nationality
- Religion
- Social class
- Profession
14
Q
just culture
A
a culture based upon fairness and is achieved when attitudes, behaviours and practices are fair.
right culture=>open culture/reporting culture/learning culture=>safety and quality culture: balance accountability and learning=>for work environment, improved patient experience, improved patient safety and quality of care
15
Q
punitive culture
A
based upon assigning blame and punishment. It contributes to creating a
culture of fear. People and organisations see what happens to others and if what they see is perceived to be draconian or unjust, this leads to fear, stifling reporting and stifling the raising of concerns. We lose the opportunity to learn, and patient safety is affected.
punishment=>stifles reporting and learning=>reduction in patient safety and quality of care
16
Q
no-blame culture
A
It can breed complacency or nonchalance which can also impact upon patient safety. At its worst it can appear unacceptable
to society overall due to the immunity from accountability which can also be abused.
blanket immunity=>lack of accountabilty=>not acceptable to society, unfair
17
Q
HANDLING DISPENSING ERRORS
A
1 Take steps to let the patient know promptly
2 Make things right (this may involve contacting
the prescriber)
3 Offer an apology
4 Let colleagues involved in the error know.
RSLAR : Report, Share, Learn, Act, Review
18
Q
The Pharmacy (Preparation
and Dispensing Errors – Registered Pharmacies) Order 2018
A
a legal defence to prevent the automatic criminalisation of inadvertent dispensing errors
The legal defence against criminal prosecution can be used when the error has been:
1 Dispensed in a registered pharmacy, and
2 Dispensed by or under the supervision of a
registered pharmacist, and
3 Supplied against a prescription, PGD or direction
from a prescriber, and
4 Promptly notified to the patient once the pharmacy team are aware of the error.
19
Q
SAFEGUARDING: PROTECTING CHILDREN AND YOUNG PEOPLE/Adults (18+, suffers from mental or physical disability, has learning difficulties is frail or elderly, is in an abusive relationship, is a substance misuser)
A
Emergency=>999
Otherwise=>local social services
Physical abuse (Unusual/unexplained injuries, injuries in inaccessible places, bite marks, scalds, fingertip bruising, fractures, repeated injuries, age of injuries inconsistent with account given by adult, injuries blamed on siblings)
Neglect (Poor growth and weight. Poor hygiene, dirty and messy. Inappropriate food or drink)
Emotional abuse (Evidence of self-harm/self mutilation, behavioural problems, inappropriate verbal abuse, fear of adults or a certain adult)
Sexual abuse (Indication of sexually transmitted disease, evidence of sexual activity or relationship that is inappropriate to the child’s age or competence), under the age of 13 are too young to consent to sexual activity
Additional signs (Parent/carer delays seeking medical treatment or advice and/or reluctant to allow treatment, detachment from the child, lacks concern at
the severity or extent of injury, reluctant to give information, aggressive towards child or children)
*Adults: Financial abuse (sudden changes to their finances, e.g. getting into debt. Inappropriate, exploitative or excessive control over the finances of the vulnerable adult)
**if unsure if an adult pt has capacity, seek advice from GP
20
Q
You can provide contraception (e.g. on prescription or under PGD) or sexual health advice to a child or young person under 16 as long as, in England and Wales, the Fraser criteria are met, i.e. that:
A
- They have sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
- They cannot be persuaded to tell her parents or to allow the practitioner to tell them
- They are very likely to begin or continue having sexual intercourse with or without contraceptive treatment
- Their physical or mental health is likely to suffer unless they receive the advice or treatment
- The advice or treatment is in the young person’s best interests.
21
Q
PHARMACEUTICAL CARE
A
the pharmacist’s contribution in the care of individuals in order to optimise medicines and improve health outcomes
22
Q
MEDICINES OPTIMISATION
A
It may involve stopping some medicines as well as starting others and considers opportunities for lifestyle changes and non-medical therapies to reduce
the need for medicines
PRINCIPLE 1: AIM TO UNDERSTAND THE PATIENT’S EXPERIENCE
PRINCIPLE 2: EVIDENCE-BASED CHOICE OF MEDICINES
PRINCIPLE 3: ENSURE MEDICINES USE IS AS SAFE AS POSSIBLE
PRINCIPLE 4: MAKE MEDICINES OPTIMISATION PART OF ROUTINE PRACTICE
23
Q
MEDICINES RECONCILIATION
A
the process of identifying an accurate list of a patient’s current medicines (including over-the-counter and complementary medicines) and carrying out a comparison of these with the current list in use, recognising any discrepancies, and documenting any changes. It also takes into account the current health of the patient and any active or long- standing issues. The result is a complete list of medicines that is then accurately communicated. remember to ask about other medicines that may not be listed: over-the-counter (OTC) medicines, herbal products, vitamins, dietary supplements, recreational drugs (e.g. alcohol and tobacco) and remedies purchased over the internet
should take place whenever patients are transferred from one
care setting to another, when they are admitted to hospital, transferred between wards and on discharge. The way that the process is carried out will vary between care settings.
Sources of information:
Patient or patient’s representative Patient’s medicines
Repeat prescriptions
GP referral letters
The patient’s GP surgery
Hospital discharge summaries or outpatient appointment notes
Community pharmacy patient medication records
Care home records
Drug treatment centre records
Other healthcare professionals and specialist clinics
Patient medical records where available (e.g. in prisons or the Emergency Care Summary (Scotland), Summary Care Record (England), or Welsh GP Record (see also section 2.6.5).
24
Q
POLYPHARMACY
A
- A reduction in problematic polypharmacy
- Improved health
- Patients more likely to take their medicines
- Fewer wasted medicines.
25
Human Medicines Regulations 2012 (GSL: General Sales List, P: Pharmacy Only, POM: Rx Only)
legislation regulating
the authorisation, sale and supply of medicinal products for human use, made under the Medicines Act 1968
26
GSL (self-selection, other retail outlets) and RP
GSL medicines can only be
sold when a pharmacist has assumed the role of responsible pharmacist; however, the pharmacist may be physically absent for a limited period of time while remaining responsible, thus permitting sales of general sale medicines during this absence
27
Pharmacy (P) Medicines (otherwise known as OTC, non-prescription medicines)
a medicinal product
that can be sold from a registered pharmacy premises by a pharmacist or a person acting under the supervision of a pharmacist. Pharmacy medicines must not be accessible to the public by self-selection.
28
PRESCRIPTION-ONLY MEDICINES (POM)
escription written by an appropriate practitioner.
29
PSEUDOEPHEDRINE AND EPHEDRINE
ue to their potential for misuse in the illicit production of methylamphetamine (crystal meth), there are legal restrictions on the quantities that can be sold or supplied
It is unlawful to supply a product or combination of products that contain more than 720mg of pseudoephedrine OR 180mg of ephedrine at any one time, without a prescription
It is unlawful to sell or supply any pseudoephedrine product at the same time as an ephedrine product without a prescription
30
ORAL EMERGENCY CONTRACEPTIVES
Levonorgestrel 1500 microgram tablet and ulipristal acetate 30mg tablet are licensed as pharmacy medicines for emergency hormonal contraception (EHC). Levonorgestrel is licensed for women aged
16 years or over for emergency contraception within 72 hours of unprotected sexual intercourse or failure of a contraceptive method. Ulipristal acetate is licensed for emergency contraception within 120 hours (five days) of unprotected sexual intercourse or failure of a contraceptive method.
31
PARACETAMOL AND ASPIRIN
Paracetamol
Not more than 100 non effervescent* tablets or capsules can be sold to a person at any one time. Since most OTC pack sizes are for 16 or 32 dose units, this means that, in practice, 96 is the maximum number that can be sold.
There are no legal limits on the quantity
of over-the-counter effervescent* tablets, powders, granules or liquids that can be sold to a person at any one time. Use professional judgement to decide the appropriate quantity to supply and what limits to impose.
Aspirin
Not more than 100 non-effervescent* tablets or capsules can be sold to a person at any one time. Since most OTC pack sizes are for 16 or 32 dose units, this means that, in practice, 96 is the maximum number that can be sold.
There are no legal limits on the quantities
of over-the-counter effervescent* tablets
or powders that can be sold to a person at any one time. Use professional judgement
to decide the appropriate quantity to supply and what limits to impose.
32
CODEINE AND DIHYDROCODEINE
restricted to the short-term treatment of acute, moderate pain that is not relieved by paracetamol, ibuprofen or aspirin alone. All other previous indications, including cold, flu, cough, sore throats and minor pain have been removed.
Any pack containing more than 32 dose units (including effervescent formulations) is a POM.
The warning ‘Can cause addiction. For three days use only’ must be positioned in a prominent clear position on the front of the pack. In addition, both the PIL and packaging must state the indication and that the medicine can cause addiction or headache if used continuously for more than three days. The
PIL must also contain information about the warning signs of addiction.
33
Prescription requirements
Name of the patient
Address of the patient
Age (if under 12)
Signature of the prescriber
Date
Particulars of Prescriber
Address of Prescriber
**indelible ink
**valid 6 months, CD 28 days
34
repeatable prescriptions
are done by private rx (If a number is not stated, they can only be repeated once (dispensed twice) unless the prescription is for an oral contraceptive in which case it can be repeated five times (dispensed six times in total), Sch 2 and 3 cannot be repeated, 1st dispensing must be made within 6 months (Sch, 2, 3, 4, within 28 days)
The patient can choose to have repeats dispensed from different pharmacies and can retain the prescription. To maintain an audit trail mark on the prescription the name and address of the pharmacy from where supply has been made and the date of supply.
RECORD KEEPING
Private prescriptions for a POM must be retained for two years from the date of the sale or supply or for repeatable prescriptions from the date of the last sale or supply. Private prescriptions for Schedule 2 and 3 CDs must be submitted to the relevant NHS agency. Records must be made in the POM register (written or electronically), which should be retained for two years from the date of the last entry in the register. The record must include:
* Supply date
* Prescription date
* Medicine details
* Prescriber details
* Patient details
The record should be made on the day the sale or supply takes place or if that is not practical, on the next day following.
35
PRESCRIPTIONS FROM THE EEA OR SWITZERLAND
Approved countries comprise EEA countries and Switzerland:
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.
PRESCRIPTION REQUIREMENTS
The following details are required on a prescription from an approved health professional from an approved country:
* Patient details
Patient’s full first name(s), surname and date of birth
* Prescriber details
Prescriber’s full first name(s), surname, professional qualifications, direct contact details including email address and telephone or fax number (with international prefix), work address (including the country they work in)
* Prescribed medicine details
Name of the medicine (brand name where appropriate), pharmaceutical form, quantity, strength and dosage details
* Prescriber signature
* Date of issue
Prescriptions are valid for up to six months from the appropriate date (prescriptions for Schedule 4 CDs 28 days). For prescriptions from these countries the appropriate date is the date on which the prescription was signed.
Even if the prescription requirements have been written in a foreign language the prescription is still legally acceptable. However, you will need to have enough information to enable the safe supply of medicines considering patient care and wellbeing.
36
EMERGENCY SUPPLY
EMERGENCY SUPPLY AT THE REQUEST OF A PRESCRIBER
EMERGENCY SUPPLY AT THE REQUEST OF A PATIENT
Emergency supplies at the request of a patient, or at the request of an approved health professional, are legally possible
Schedule 1, 2 and 3 CDs (including phenobarbital) or unlicensed products cannot be supplied in
an emergency to a patient of an approved health professional.
Relevant prescriber
Satisfied with Emergency Reason
Prescription within 72 hours
Directions
Not for CDs, except phenobarbital
Schedule 1, 2 or 3 CDs cannot be supplied in an emergency whether requested by UK, EEA or Swiss health professionals. Phenobarbital (also known as phenobarbitone or phenobarbitone sodium) is the exception and can be authorised by UK doctor, dentist, nurse or pharmacist independent prescriber or supplementary prescriber in an emergency for the treatment
of epilepsy.
Record kept (Rx info such as date of rx and date rx is received should be documented)
Interview
Immediate need
Must have had previous treatment with medicine
Dose
Not for CDs, except phenobarbital for epilepsy
Length of treatment: Sch 4/5 CD-5 days, POM-30 days, smallest pack sizes available, contraceptive: full cycle, antibiotic: smallest quantity to complete course
Record Kept (why emergency was needed)
‘Emergency supply’ need to be added to the dispensing label.
37
LABELLING OF DISPENSED MEDICINAL PRODUCTS
It is a legal requirement for the following
to appear on dispensed medicinal products:
* 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.
The RPS recommends the following also appears on the dispensing label:
‘Keep out of the reach and sight of children’
‘Use this medicine only on your skin’ where applicable.
**the actual container (e.g. inhaler or tube of cream) should
be labelled rather than the outer container.
38
Patient specific directions (PSDs)
PATIENT GROUP DIRECTIONS (PGDS)
a written instruction from a doctor, dentist or non-medical prescriber for a medicine
to be supplied or administered to a named patient after the prescriber has assessed that patient
on an individual basis.
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
39
SUPPLY OF MEDICINES TO SCHOOLS
The signed order should contain:
* Name of the school
* Product details (including spacer if relevant)
* Strength (if relevant)
* Purpose for which the product is required
* Total quantity required
* Signature of the principal or head teacher
Ideally, appropriately headed paper should be used; however, this is not a legislative requirement.
The signed order needs to be retained for two years from the date of supply or an entry made into the POM register.
Even when the signed order is retained, it is good practice to make a record in POM register for audit purposes.
40
Who can purchase Naloxone?
41
Pregnancy Prevention Programmes (PPP)
rotect females of childbearing potential by minimising the risk of becoming pregnant while taking these medicines: e.g. oral retinoids, valproate, thalidomide, lenalidomide and pomalidomide
Oral retinoids (including acitretin, alitretinoin and isotretinoin) are used for severe skin conditions.
1 Prescription Validity
Under the PPP, prescriptions are valid only
for seven days and ideally should be
dispensed on the date the prescription is written. Prescriptions which are presented
after seven days should be considered expired and the patient should be referred back to the prescriber for a new prescription. Pregnancy status may need to be reconfirmed by a further negative pregnancy test.
2 Quantity
Check that the quantity is for a maximum of 30 days’ supply. A quantity for more than 30 days can only be dispensed if the patient is confirmed by the prescriber as not being under the PPP.
42
SIGNED ORDERS AND RECORD KEEPING
When a POM is supplied from a registered pharmacy to healthcare professionals or organisations, an entry needs to be made in the POM register or the signed order/invoice needs to be retained for two years from the date of supply. Even where the signed order/invoice is retained, it is good practice to make a record in the POM register for audit purposes.
43
44
45
MEP CHANGES
1. CLINICAL AUDITS
2. SELF-CHECKING BY PHARMACISTS. When is it necessary ? Entire process of dispensing is done on its own; bad practice, increased risk of errors, at least 2 people involved in process
3. PHARMACISTS PRESCRIBING
4. CULTURE IN PHARMACY
5. HANDLING DISPENSING ERRORS.
6.CODEINE AND DIHYDROCODEINE SALES: only can be sold for acute moderate pain, short-term use not for sore throat/minor pain/cold and flus bc of abuse
7. RESPONSIBLE PHARMACIST
46
Which of the following drugs are you not allowed to supply as an emergency supply under any circumstance ?
A. Zopiclone
B. Phenobarbital
C. Morphine 10mg/5ml oral solution
D. Pregabalin
E. Clobazam
D. Pregabalin
Phenobarbital: only for epilepsy for 5 days
47
Appendices/Standards
1. GPHC STANDARDS FOR PHARMACY PROFESSIONALS.
2.GPHC STANDARDS FOR REGISTERED PHARMACIES.
3. GPHC GUIDANCE ON CONFIDENTIALITY: can wife also pick up husbands medication? if husband hasnt given consent, cannot handout or wife may not know meds husband may be on
4. GPHC GUIDANCE ON CONSENT
5.GPHC GUIDANCE ON RAISING CONCERNS: coworker arrives to work drunk=>raise concern with a superior and document, not directly to coworker as they can become hostile or a mistake has already been made before you had the chance to report it
6. FORGED PRESCRIPTIONS: patient handwrites additional drug on rx=>withhold rx, dont supply any items=>refer pt back to gp, pt must receive new rx=>report police
48
GPhC Revalidation
GPHC REVALIDATION- must learn !
4 entries – 2 of 4 must be planned, planned=think about it in advanced and know what youll achieve from it, unplanned is more spontaneous and can lead to knowledge development
Reflective account: GPhC chooses a guideline and you must write how you meet that requirement
Peer discussion: discuss a topic with a colleague, someone who works in a different pharmacy (name, gphc number, where they work, contact details)
What happens if the registrant is sick or pregnant? contact gphc and put under mitigating circumstances
***groin pain, tenderness, smell=>forniere gangrene from SGLT2, stop taking drug
49
Legal Limits
Pseudoephedrine and Ephidrine - used for production of methylamphetamine (Crystal Meth) – CLASS A controlled drug
Don’t supply more than *720mg* Pseudoephedrine
Don't supply more than *180mg* Ephedrine
max Sudafed decongestant tabs: each tab 60mg, can only sell 12
Don’t sell both Pseudoephedrine and Ephedrine at same time
Supervised by pharmacist or SUITABLY TRAINED UNDER SUPERVISION OF PHARMACIST
Paracetamol (~147 tabs to overdose) and aspirin and codeine: *100 max* but comes in packs of 16 or 32, so patient gets 96 OTC; for codeine is *32* max
Dispersible vs Effervescent vs suspension, powder (page 58)=>treat as normal tablets for dispersible, effervescent/suspension formulation has no legal limit/use clinical judgement
50
Social Media
maintain the same standards on social media as in real life: have the same behaviour as you would have inside the pharmacy, outside the pharmacy
Professionalism online
51
Culture in Pharmacy
3 TYPES: PAGE29MEP44
PUNITIVE CULTURE: staff feels they will be punished/penalised if something goes wrong, so people refrain from reporting mistakes as it creates an environment of fear/anxiety
NO-BLAME CULTURE: people get away with alot, opposite of punitive culture, no one takes accountability
RIGHT OR JUST CULTURE: ideal environment to have, only seek things that have gone wrong as a learning/teachable opportunity and develop/grow, educate staff and explore why it happened and how it can be prevented from happening in the future
52
As pharmacists, when there’s been a dispensing error, we have to make things right. Four options below are right options listed in the MEP except one?
a. As soon as you are aware of a dispensing error, take steps to let the patient know promptly. Offer an apology
b. Contact the prescriber in order to make things right (sometimes error doesnt occur in the pharmacy=>swiss cheese model)
c. Let colleagues involved in the error know
d. Always get the colleagues who made the error to apologise themselves
e. Legislation came into force in 2018 to reduce prosecution due to dispensing error.
d. Always get the colleagues who made the error to apologise themselves
53
SELECT AN OPTION WHICH IS NOT A POPULAR EXAMPLE OF LASA (look alike, sound alike) ERRORS.
a. **Amlodipine and Amitriptyline
b. **Carbamazepine and carbimazole
c. **Atenolol and Allopurinol
d. Co-codamol and Co-amilozide
e. **Pregabalin and gabapentin
--------------------------4 ideas to reduce risk??
1. place in different locations/areas in the dispensary
2. lasa labels
3. educate staff about lasa
4. write a reminder/stamp on rx
d. Co-codamol and Co-amilozide
54
Classification of Medicines
GSL
P
POM
CDs
Reclassification of medicines: Amorolfine, sumatriptan, Nexium, Viagra connect, Hana pill tablets (OTC pill, Progesterone only, child-bearing age/if under 16 check capacity via fraser guidelines to verify they understand information given of sexual health, under 18: 3 months supply max, over 18: 12 months supply max), GINA (vaginal atrophy, F, age 50+, 1 yr w/o period, no history of cervical cancer), Cialis together
Codeine linctus: P to POM
55
Reference Sources
Green book: detailed information on various vaccines
PINK book: contains information on which diseases have a vaccine; yes or no, no further information
Orange guide: distribution and manufacturing of medicine
Yellow book: patients on warfarin
Maudsley: mental health drugs
Martindale: proprietary names in different languages
Medicines compendium: EMC=>contains SPC and PIL (good practice from RPS)
British Pharmacopoeia: excipients, ingredients, and raw materials, storage of the drug
Stockley drug interaction: drug interactions involved with drugs
56
Labelling Question
Differences with Label and Item
Label=50g, item=10g
Label=2%, item=1%
57
Which of the following statements concerning the label stuck on the cream is TRUE .p68
1. The quantity and strength is wrong
II. Putting the pharmacist initials in the
checking box is a legal requirement. (good practice)
III. Telephone number is a legal requirement on a LABEL
Iv. Keep out of sight and reach of children is a legal requirement on a LABEL (good practice by RPS)
A.No,No,Yes,Yes
B. Yes, No, Yes, Yes
C.Yes,Yes,Yes,Yes
D. Yes, No, No, No
E. Yes, No, Yes, No
D. Yes, No, No, No
58
A Pharmacist would like to find out about psychiatric medicines. Which resource is best for this ?
A. Medicines compendium
B. Maudsley guidelines
C. British pharmacopoeia
D. Martindale: The complete drug reference
E. SPC of the drug
B. Maudsley guidelines
59
A patient has just walked into your pharmacy on a Saturday morning. She arrived in the UK from Germany yesterday. She shows you one of her current medicines labelled in German proprietary names and asks some questions about it. Which one of the following reference sources would you use to find the generic name so you could help her?
A. Medicines compendium
B. Maudsley guidelines
C. British pharmacopoeia
D. Martindale: The complete drug reference
E. SPC of the drug
D. Martindale: The complete drug reference (proprietary names in various languages)
60
Emergency Contraception
CU-IUD (most effective), ELLA ONE (childbearing age, 120hrs/5days, can be passed off to breastmilk=>must wait 7 days to feed, can affect 5 days if taking another regular contraceptive), LEVONELLE p.g. 56 to 57
Levonogesterol 1500mcg – Levonelle ® is licensed as a PHARMACY medicine (P) for women over the age of 16 (must wait 8hrs in breastfeeding woman after taking). Pharmacist MUST have consultation before supply. Therefore, for ETHICAL grounds cannot just pass off to suitably trained staff- need to refer to ANOTHER PHARMACY.
Pharmacist can refuse sell as to not be part of the EC service, but they must signpost patient to another pharmacy where they can receive help
Can it be sold to a transgender patient? Yes, if it is a transgender male without hormonal/surgical changes. If there is a transgender female without hormonal/surgical changes, then an issue. If no mention of hormonal/surgical changes, only judge them of clinical aspects of the drug.
Can be sold in advance where appropriate.
Can it be sold to a patient’s representative? Must interview (face/phone) the patient and are satisfied, may dispense to representative.
Safeguarding vulnerable adults and children=>supply and report to child protective officer in cases of suspected abuse
61
Guidelines and Definitions
Frazer guidelines: (under 16) guidelines to ascertain capacity=>pt understand information given on sexual health
Gillick competence: (under 16), pts understanding on general health
Duty of candour (3 principles): 1. Pharmacists must be open and honest when things go wrong. 2. Offer an apology 3. Rectify the problem
Gosport report (Portsmouth): pharmacists must raise concerns when they observe practices that are dangerous/unsafe
Cases where patient’s consent can be breached? Police Officer demands confidential information about patient=>don't disclose unless they come in person, a written letter is provided with their ID as proof of information to be released=>yes if public safety is at risk, instructed by court of law
62
Ben is a counter assistant at Pharmacy X. The pharmacist phones Ben at 8.55am to inform him that he will be running late due to traffic and will be arriving at 9.30am. The pharmacy is due to open at 9am and an angry lady is already waiting outside the pharmacy. She would like to purchase some Calpol suspension, Buscopan tablets for her 6 year old son and Canesten pessary for herself. Which of the following course of action is appropriate?
A. Ben should not sell anything to the customer and make her wait for thirty minutes.
B. Ben should refer the customer to her GP.
C. Ben should sell Calpol suspension and Buscopan tablets for the 6 year-old and
ask the woman to return later for Canesten pessary.
D. Ben should sell all three items to the customer.
E. Ben should sell Calpol suspension only for the 6 year-old and ask the woman to return later for Buscopan and Canesten pessary.
**if responsible pharmacist hasnt signed in/showed up, cannot sell anything, no GSL/P/POM, no shampoo or random items as the entire premises is under the pharmacists responsibility
A. Ben should not sell anything to the customer and make her wait for thirty minutes.
63
Consider the following statements about the responsible pharmacist and choose which options are LEGAL REQUIREMENTS.
1. Responsible pharmacists must ask for an ID before supplying CDs. (good practice)
2. Recording near miss errors in the near miss logbook. (good practice)
3. Displaying the responsible pharmacist notice in a pharmacy.
4. Stating a reason in the register if a responsible pharmacist chooses to leave/absent from the pharmacy briefly during their shift. (reason: good practice, time: legal requirement) if healthcare professional is picking up CDs, must require name and address.
A. YES, NO, YES, YES
B. NO, NO, YES,NO
C.YES,NO, YES,NO
D. YES, YES, NO, NO
E. YES, YES, YES, YES
B. NO, NO, YES,NO
64
Responsible Pharmacist
Secure safe and effective running of pharmacy: before start of shift, check if CD cupboard left open/CD keys missing or fridge was left open
Displaying notice/Legal Requirement: Responsible Pharmacist (Name, GPhC Number, statement of being the RP)
RP record: legal requirement
Absence - how long? 2 hrs, if 2 pharmacists, 2 hrs must be shared between pharmacist, report to CCG if RP is gone for more than 3hrs
SCENARIOS FOR ABSENCE
RP running late vs RP leaves temporarily (can assemble medicines: crate labels, dispense, place orders for stock, can clean, can accept returned medicines but no CDs, can accept deliveries but no CDs, can receive rx from pts, but pharmacist must do clinical check, process waste no CDs, stock check, sell GSL)? Pg 141 to 145
65
Some CD invoices (sch. 3 and 5) need to be kept for 2 years in the pharmacy after stock is received. Which of the following invoices should be kept for 2 years in the pharmacy?
A. Midazolam oromucosal solution
B. Methylphenidate tablets (sch. 2 in CD record)
C. Diazepam tablets
D. Creon 10000 capsules
E. Loprazolam tablets
**cheat sheet=MEP table
A. Midazolam oromucosal solution
66
Controlled Drugs
MEP PAGE 104 and 105
CD prescription requirements: 28 days (sch. 2, 3, 5), quantity in words and figures (pharmacist allowed to amend if one is missing and sign, directions must be suitable and acceptable=>take BD, should say take TWO), 6 months (sch. 5)
Private Rxs standardised form: sch. 2 and 3, FP10PCD, pink, sch. 4 and 5 can be on any paper
CD invoices (sch. 3 and 5)/CD register (sch. 2), unwanted CDs returned must go in a separate CD return log
Emergency supply and prescriber: sch. 4, 5 and phenobarbital for epilepsy
CD safe custody (all sch. 2, sch. 3: temazepam, buprenorphine patches/tablets)- Sativex? contains cabbinoid, sch. 4
*CD destruction*– patient return and expired (sch. 2, 3, 4 pt. 1: diazepam must be denatured). pg117
CD REQUISITION
67
Requisition
THE LEGAL REQUIREMENTS FOR A CONTROLED DRUG REQUISITION ARE: CDs without Rx from another pharmacy (sch. 2 and 3)
1. Signature of the recipient
2. Name of the recipient
3. Address of the recipient
4. Profession or occupation
5. Total quantity of drug
6. Purpose of the requisition
**do no need a requisition when returning what was taken
SNAP TP
68
Choose an option that is NOT TRUE about veterinary medicines.
a. Veterinary prescription should be kept for 5 years
b. Human medicines cannot be sold OTC for animal treatment
c. Controlled Drug veterinary prescriptions should be KEPT for 5 years
d. Its good practice to add ‘’prescribed under the cascade on VET prescriptions’’ on vet prescriptions for human medicines.
e. Standardised forms are not required for veterinary prescriptions.
d. Its good practice to add ‘’prescribed under the cascade on VET prescriptions’’ on vet prescription (it is a legal requirement)
69
A patient wants an emergency supply for Co- codamol 30mg/500mg tablets. If you decide to supply, how many days supply is the maximum recommended ?
A. 7 days
B. 28 days
C. 30 days
D. 6 months
E. 5 days
E. 5 days (all emergency CDs only give 5 days, 30 day max given if its a POM)
70
Emergency Supply
Emergency Supply At request of PATIENTS
At request of PRESCRIBER Why unable to supply Rx?
Pharmacist interview and define if there is an IMMEDIATE NEED
Satisfaction that Rx cannot be provided immediately and prescriber is genuine:
Will there be a prescription for it, or will it be redeemed after? Furnished within 72 hours by the prescriber
Prescriber: reason, immediate need, 72 hrs return, Patient: only an immediate need
ACCESS SCR: summary care records, must ask for consent to review pts scr
Controlled Drugs - Only CD 4/5 and Phenobarbital for epilepsy=>5 days, POMS=30 days, NOT schedule 1/2/3
QUANTITY: Pill (COC: 21 tabs, PO: 28 tabs), eye drops, insulin (1 pen)=> dispense smallest pack size
71
Veterinary Medicines
TYPES – POM-V, POM-VPS, NFA-VPS, AVM-GSL
PRESCRIPTION REQUIREMENTS – cd 2/3 *treatment of animal under my care*, no standardised form regardless of schedule, particulars, name and address of prescriber, telephone number, name of owner, name of animal, species
OTC MEDICINES??
VET CASCADE: *use under the cascade* when human medicine given to animal
LABELLING: on vet label not human: batch number, expiry, for animal use only, name of animal
RECORD KEEPING (rx, records, invoices): 5 yrs
72
Signed Order
Sample of Signed Order: What is missing?
Headteacher / principal
*Purpose*
Quantity and drug details
Signature
Name and address of school
pg 77 to 81
RECORD kept: 2 years
73
Consider the following statements about a registered pharmacist and choose which options are LEGAL REQUIREMENTS.
1. Keeping invoices for schedule 2 CDs in the pharmacy for 2 years.
2. Having an authorized witness when denaturing/destroying patient returned CDs e.g., Tramadol capsules.
3. Completing GPHC revalidation requirements every year.
4. A requisition form in necessary to obtain zopiclone tablets from another pharmacy
A. NO, YES, YES, NO B.NO,NO, YES,YES
C.YES,NO, YES,NO D.YES,YES, YES,NO
E. YES, YES, YES, YES
74
You are working in a community pharmacy one Saturday when Josh-29-years, a regular patient comes to your pharmacy and asks for an emergency supply for clobazam for the management of his epilepsy. He explains to you that he ordered his prescription a few days ago but his surgery hasn’t issued it yet. Which of the following is the most appropriate next line of action?
A. Refuse emergency supply and ask him to contact his surgery on Monday.
B. Refuse emergency supply as only phenobarbital is permitted in a situation
like this.
C. Make an emergency supply for 5 days.
D. Ask him to buy sumatriptan over the counter instead.
E. Refer him to the local hospital as that’s the only way he can get a prescription for the controlled drug he needs.
75
Which one of the following is true regarding controlled drugs (schedule 4)?
a. Repeatable prescriptions of schedule 4 CDs are not permitted.
b. Schedule 4 prescriptions are allowed on a green FP10 form but not on electronic prescriptions (EPS)
c. Emergency supply of Diazepam is not allowed.
d. 2-month prescriptions for schedule 4 controlled drugs are
allowed.
e. Patient returned drugs do not need denaturing.
76
One morning you get a phone call from the police asking you for personal information regarding one of your regular patient who has been involved in a robbery. The police tells you they would like you to provide his Date of birth and address to enable them complete their investigation. What would your next line of action be ?
* A. Refuse to continue the conversation and put the phone down.
* B. Legally , you must call the patient and ask for his permission to
enable you give out his personal details.
* C. Ask the police for their registration I.D and then give the information they want over the phone as face-to-face meeting is unnecessary.
* D. Refer the police to the patient’s GP surgery instead.
* E. Ask the police to come to your pharmacy in person, with an ID
and written letter of request.
77
You work a Saturday shift in a local pharmacy from 9am to 5pm .One Saturday evening at 4.55pm, one of your regular female patients walks into your pharmacy and asks you for emergency supply of pregabalin 100mg capsules. She tells you that she has a lot of nerve pain and that she did put in a request for her repeat but the prescription was not quite ready yet. What would be the most appropriate next line of action?
* A. Tell her to wait till Monday to collect her prescription.
* B. Sell her some Ibuprofen and tell her to wait till Monday.
* C. Give her an emergency supply of pregabalin for 5 days.
* D. Refer to another pharmacy for an emergency supply as you are about to finish work.
* E. Ask the lady to call NHS 111
78
Choose an option that is NOT TRUE about veterinary medicines.
a. Veterinary prescriptions are valid for 6 months except CDs.
b. The wording for animal use only must be stated on all veterinary
prescriptions.
c. Controlled Drug veterinary prescriptions should be KEPT for 5 years
d. The telephone number of veterinary surgeries must be stated on the prescription.
e. Standardised forms are not required for private veterinary prescriptions for controlled drugs.
79
Mr. V a 50-year-old patient comes into your pharmacy to see you . He mentions that upon getting home after collecting his medicines from your pharmacy he found the repeat prescription slip of a female patient inside his bag of medicines . He would like you to rectify this. Which GPHC standard/ regulation does this scenario fall under ? Choose most appropriate option
A. Breach of consent
B. Breach of safeguarding vulnerable patients.
C. Breach of patient confidentiality
D. Breach of sexual boundaries
E. Show respect for others
80
Choose an option listed below that is NOT a TRUE statement.
A. No requirement for Schedule 3 Controlled drug invoices to be kept for 2 years within a pharmacy.
B. It is a legal requirement for the Responsible pharmacist notice to be displayed during each shift.
C. It is good practice to keep log of all near miss dispensing errors within a pharmacy.
D. It is a legal requirement for the telephone number of the Veterinary surgery to be stated on a VET prescription.
E. It’s a legal requirement to add ‘’prescribed under the cascade” on vet prescriptions for human medicines.
81
Regarding emergency supply at the request of a patient .Which of these drugs can emergency supply be made for 5 days supply ?
A. Tramadol
B. Methylphenidate
C. midazolam
D. Oxazepam
E. Gabapentin
82
Which measure is a least appropriate measure you would put in place to reduce the risk of LASA errors ?
A. Keeping records of near miss errors
B. Separating location of identical boxes on shelves of
pharmacy
C. Get the pharmacy staff who made the error to apologise to the patient every time an error happens.
D. Using LASA warning stickers to warn pharmacy staff of likelihood of error.
E. Educating pharmacy staff about LASA errors
83
You are working a night shift in a community pharmacy one Monday night when a-19-year-old presents in your pharmacy and asks for an emergency supply for diazepam 5mg tablets. He explains to you that on his way back from college earlier that day he was beaten up by a group of boys and had his diazepam 5mg tablets stolen from him. He would like an emergency supply as his regular pharmacy is now shut for the day. Which of the following is the most appropriate next line of action?
A. Refuse emergency supply and ask him to contact his surgery on Tuesday.
B. Refuse emergency supply as diazepam is not permitted for emergency
supply.
C. Make an emergency supply for 5 days.
D. Ask him to buy Phenergan tablets over the counter.
E. Ask him to contact his regular pharmacy when it opens tomorrow.
84
A transgender man visits your pharmacy for advice following an episode of unprotected sexual intercourse with their male partner 4 days ago. They tell you that they are worried that they will become pregnant. The man also feels very embarrassed about this situation and does not wish to see another healthcare professional.
What is the most appropriate further action in this situation?
A.) Refer to a sexual health clinic for a IUD device as it is the most effective emergency contraception.
B.) Supply Ella one
C.) Supply levonelle
D.) Explain to the man that it is impossible for them to get pregnant and that they should not worry about getting pregnant.
E.) Refer to the GP
85
A box of Propranolol 40mg tablets has the expiry date of 12/2023 on the Box. The pharmacy technician who is date checking the medications in the dispensary asks you when this box of medication can be used till.......?
Which of the following is correct in relation to the expiry date above?
A. 1ST December 2023 30TH B. November 2023 31st
C. December 2023 15TH D. December 2023
E. 01st January 2024.
86
A prescription for isotretinoin 20mg capsules was brought into your pharmacy by a 25-year-old female patient . The pharmacy technician tells you that the date on the prescription is 20th SEPTEMBER 2023.
Which of the following is correct in relation to the expiry date of this prescription?
A. 26th SEPTEMBER 2023
B. 28TH SEPTEMBER 2023
C. 27th SEPTEMBER 2023
D. 20th March 2024
E. 18th OCTOBER 2023.
87
A worried woman comes into your pharmacy asking to speak to you, she has run out of her desogestrel pill. It is a Sunday night, and she will not be able to obtain a prescription before Monday. You decide to give her an emergency supply after interviewing her. How many tablets would you give her?
A. 5 B. 7 C. 30 D. 21 E. 28
88
Miss F. came into the pharmacy and requests information about the yellow fever vaccine, she explains that she and her partner are travelling abroad to a yellow fever endemic area and want to find out more about the vaccine. Which of the following should you consult as a reference?
A. Orange book
B. Green book
C. Pink book
D. Martindale
E. Maudsley
89
Mr. A. is the head teacher at one of the primary school near your pharmacy. He comes to your pharmacy with a signed order for 15 salbutamol 100mcg inhalers. Mr. A. confirms his school has trained personnel who are trained to administer medication to children. Which of the following would make a signed order illegal ?
A.
B.
C.
D.
E.
If the name of the headteacher at the school is missing.
If the name of children who require the inhalers are missing. If the purpose of which the inhalers are required is missing. If the signed order is not written on a letter headed paper.
If the telephone number of the school is missing.
90
You work as a responsible pharmacist in a community pharmacy. You decide to discuss a query with a doctor at the local surgery. You inform your members of staff that you would be absent for ten minutes. Which of the following tasks would be the most appropriate for your staff to undertake during your absence?
A.
B.
C.
D.
E.
Hand out bagged controlled drugs to the delivery driver. Sell GSL medicines over-the-counter
Clinically check prescriptions.
Hand out checked medication over to patients
Emergency supply of medicine(s) at the request of prescriber.
91
Which of the following regarding veterinary controlled drug prescriptions is incorrect?
A. Standardized forms are not required for veterinary prescriptions.
B. It is a good practice for only 30 days worth of treatment to be prescribed on veterinary prescription for all CDs.
C. Veterinary prescriptions for Schedule 2 and 3 controlled drugs must include the RCVS number of prescriber
D. Veterinary prescription should be retained for 5 years and not submitted to the relevant NHS agency.
E. The prescription is valid for 28 days from the appropriate date
92
Miss C , a female patient comes into the pharmacy asking to speak to the pharmacist regardingthepurchaseof Lovima®(Desogestrel75mgtabs).Youspeaktothe patient in the consultation room and ask questions to determine whether you can make a supply.
Which of the following statements is NOT TRUE regarding the supply of Lovima by pharmacists?
A. Fraser guidelines should be used when supplying Lovima to under 16-year-olds.
B. A maximum of 2 months supply can be made to patients under 18 years.
C. A maximum of 3 months supply can be made to patients under 18 years.
D. A maximum of 12 months supply can be made to patients over 18 years.
E. It is not recommended to supply Lovima to a diabetic patient.
93
1. Mrs. Happy a 60-year-old woman presents a prescription for Zomorph 60mg m/r capsules for the management of chronic pain. What is the maximum recommended duration of supply on a single prescription for this medicine?
A. 30 days
B. 28 days
C. 14 days
D. 2 months
C. 6 months
94
A pharmacist wants to obtain guidance on the Rules and Guidance for Pharmaceutical Manufacturers and Distribution of medicines in the UK.
Which of the following is the most appropriate reference source to consult for this information?
Select only one option
A. Pink guide
B. British Pharmacopoeia
C. Green Book
D. Martindale: The Complete Drug Reference E. Orange Guide
95
You are the responsible pharmacist in a community pharmacy. You are the only pharmacist working in the pharmacy on this day. You decide to grab a quick take-away across the street during your lunch break. The pharmacy will remain open during your temporary absence of less than two hours and a pharmacy technician will be present in the dispensary area during this time.
Which option below represents the activities which may lawfully occur in the pharmacy during your absence?
A. Handing over bagged, clinically and accuracy checked dispensed products to a delivery driver
B. sale of paracetamol 500mg tablets (32 pack) to an adult patient for headache. C. Clinical check of a batch of repeat prescriptions from the local GP surgery
D. Assembly of prescription only medicines for dispensing.
E. Emergency supply of a POM at the request of a patient
96
You are working in a community pharmacy one day when a school teacher hands you a signed order for some inhalers. She explains to you that she has been asked to drop it off by her Head Teacher.
Which of the following statements is not true about signed orders?
A. Signed orders must be written on a letter headed paper of the school .
B. The purpose of a signed order must be stated .
C. Signed orders should be kept in a pharmacy for 2 years after dispensing.
D. The name of the head teacher is good practice and not legal requirement on a signed order.
E. The name and details of the drug requested must be stated.
97
You are working as a pharmacist in Chemitex pharmacy. A pharmacy student wants to find out information about controlled drugs during his placement in your pharmacy. Consider the following statements and choose a CORRECT option about Tramadol 50mg capsules.
A. The address of the prescriber can be in an EEA country
B. Emergency supply is plausible
C. Prescription for the drug is repeatable
D. Requisition is not necessary under the rules for CD requisition.
E. The drug must be denatured and rendered irretrievable before disposal.
98
Regarding denaturation of controlled drugs which of the following statements is the most appropriate way of denaturing AEROSOL forms of controlled drugs.
A. Remove from outer packaging and place in denaturing kit. Then add soapy water into the kit.
B. Remove from the package and fold over onto itself. Then place in denaturing kit and add water. Wear gloves as precaution
C. Expel into water in a well ventilated room. Wear facemask as precaution . Pour mixture into the denaturing kit .
D. Pour liquid content directly into denaturing kit. Wear gloves as precaution. Then place denaturing kit in the medicines waste bin.
E. None of the above is appropriate for CD aerosols.
99
A female patient wants the morning after pill. You take her to the consultation room for a consultation. During the consultation she tells you that she had unprotected sexual intercourse 2 days ago , she takes no other medication and also meets the rest of EHC criteria. She mentions that she weighs 85kg. Which of the following options is the most appropriate.
A. Refer her to her GP.
B. Refuse sale of EHC.
C, Sell a tablet of levonelle-one-step
D. Sell a tablet of Ella-one
E. Sign-post her to another family
100
A patient would like to buy SUDAFED decongestant tablets. You remember from a recent lecture you attended that the each tablet of the product contains 60mg of pseudoephedrine. Using this information, what is the maximum number of SUDAFED decongestant tablets you can sell to one patient at a time ?
A. 6 tablets
B. 12 tablets
C. 18 tablets
D. 24 tablets
E. 28 tablets
101
A patient walks into your pharmacy with a box of her medication . She shows you the expiry which is written as DEC 2023. She would like you to interpret this . What would the expiry date be legally ? Choose an option below
A. 1st December 2023
B. 30th November 2023
C. 31st December 2023
D. 1st January 2024
E. 30th December 2023
102
You are working as a pharmacist and at about 11am on a Monday morning , a young man of about 21-years-old comes into your pharmacy. He mentions that whilst in the park he was beaten and robbed of his Diazepam 5mg tablets. He tells you he usually takes one tablet at night as directed by his doctor. He now has no medicines to take. What would be your next line of action ? Choose most appropriate option below.
A. Refuse emergency supply as you don't believe his story.
B. Make an emergency supply of 7 tablets to tide him over until a new prescription is ready.
C. Ask him to buy over the counter sleeping tablets instead.
D. Ask him to call NHS 111 for urgent supply
E. Refer him to the local hospital .
103
Which of the drugs listed is exempted from denaturation before disposal as per rules of controlled drugs stipulated in the M.E.P ?
A. Tramadol 50mg capsules
B. Zopiclone 3.75mg tablets
C. Methylphenidate 5mg tablets
D. Gabapentin 300mg capsules
E. Co-codamol 30/500mg tablets
F. Temazepam 10mg tablets.
G. Phenobarbital tablets
H. Oxycodone 40mg m/r tablets
I. Buprenorphine tablets
104
Which of the drugs listed can be prescribed by an EEA prescriber with an address in Germany for a maximum of 30 days supply as recommended in the M.E.P ?
A. Tramadol 50mg capsules
B. Zopiclone 3.75mg tablets
C. Methylphenidate 5mg tablets
D. Gabapentin 300mg capsules
E. Co-codamol 30/500mg tablets
F. Temazepam 10mg tablets.
G. Phenobarbital tablets
H. Oxycodone 40mg m/r tablets
I. Buprenorphine tablets
105
Which of the drugs listed can be described as a partial agonist ?
A. Tramadol 50mg capsules
B. Zopiclone 3.75mg tablets
C. Methylphenidate 5mg tablets D. Gabapentin 300mg capsules E. Co-codamol 30/500mg tablets
F. Temazepam 10mg tablets.
G. Phenobarbital tablets
H. Oxycodone 40mg m/r tablets
I. Buprenorphine tablets
106
Which drug does the prescription date expire after 6 months ?
A. Tramadol 50mg capsules
B. Zopiclone 3.75mg tablets
C. Methylphenidate 5mg tablets D. Gabapentin 300mg capsules E. Co-codamol 30/500mg tablets
F. Temazepam 10mg tablets.
G. Phenobarbital tablets
H. Oxycodone 40mg m/r tablets
I. Buprenorphine tablets
107
Which drug is a schedule 3 CD which does not require Safe custody ?
A. Tramadol 50mg capsules
B. Zopiclone 3.75mg tablets
C. Methylphenidate 5mg tablets D. Gabapentin 300mg capsules E. Co-codamol 30/500mg tablets
F. Temazepam 10mg tablets.
G. Phenobarbital tablets
H. Oxycodone 40mg m/r tablets
I. Buprenorphine tablets
108
The 4 principles listed below are components of .............................?
i. Aim to understand the patient's experience.
ii. Evidence-based choice of medicines.
Iii. Ensure medicines use is as safe as possible.
iv. Making it part of routine practice.
A. Clinical Governance
B. Duty of candour
C. Medicines optimization
D. Medicines Reconciliation E. Principles of sustainability
109
There are two types of consent: explicit and implied. In some exceptional cases, pharmacists are allowed to disclose patients' information without consent . Which of the following personnel are you NOT allowed to disclose patient's information to by law?
A. A police officer
B. A GPHC inspector
C. A coroner or Judge of a court of law .
D. An NHS counter fraud investigation officer.
E. A representative of a pharmaceutical company .
110
One Friday morning , you get a phone call from Mr. B one of your methadone patients. He mentions that he is feeling poorly and he is not able to pick up his methadone from your pharmacy. He mentions that he would like his new girlfriend to collect on his behalf and wonders if that is okay with you. What would your reply be to mr. B ?
A. Inform Mr. B that he needs to collect his methadone himself today as you cannot supply to a representative.
B. Inform Mr.B that you cannot supply to his new girlfriend as you have never met her before and don't know who she is. He should send a familiar person.
C. Inform Mr. B that you can supply his medication to his girlfriend but she has to come with her ID.
D. inform Mr. B that if he comes in tomorrow (Saturday ) he can pick up both Friday and Saturday’s doses as you want to supply to him directly .
E. inform Mr. B that you can supply his medication to his girlfriend but she has to come with her ID and a covering letter from him.
111
Private prescriptions for some controlled drugs must be written on a standardized form i.e. FP10PCD . Which of the following drugs must be written on a standardized form when prescribed privately ?
A. Zopiclone 7.5mg tablets B. Codeine 30mg tablets
C. Tramadol 50mg capsules D. Loprazolam 1mg tablets E. Diazepam 5mg tablets
112
20. Write the definition of clinical governance
