MEP Flashcards
1
Q
T/F?: MEP is legal advice
A
False
2
Q
Medicines Optimisation Principle 1
A
Aim to understand the patient’s experience
3
Q
Medicines Optimisation Principle 2
A
Evidence based choice of medicines
4
Q
Medicines Optimisation Principle 3
A
Ensure medicines use is as safe as possible
5
Q
Medicines Optimisation Principle 4
A
Make medicines optimisation part of routine practice
6
Q
Goal of medicines optimisation
A
Improve “patient outcome”, improve adherence, no unnecessary meds, reduce wastage, improve safety.
Alligned measurement and monitoring of meds optimisation
7
Q
Evidence based choice of medicines means
A
Clinically, cost effective treatment for patient
8
Q
Safe use of medicines includes
A
Side effects, interactions, safe systems, effective communication between professionals
9
Q
Pharmaceutical Care (Scotland) key principles
A
ID, Plan, Agree outcomes, Action, Follow up
10
Q
Assessment of Pharmaceutical care will establish
A
Appropriate? Additional? Safe dose? Side effects reduction? Effective?
11
Q
A profession is
A
Recognised, Professional Body, Standards/codes, Regulated
12
Q
Principles of professionalism
A
Altruism, Accountability, Compassion, Duty, Excellent, Continuous Development, Honour, Integrity, Professional judgement, Respect for others, Partnerships
13
Q
Professional judgement is
A
knowledge, experience and critical thinking
Take into account law, ethics, standards, circumstances
resonated with core values, attitudes, behaviours
14
Q
Process of professional judgement
A
- ID dilemma
- Get info
- ID options
- Benefits Vs Risks
- Choose option
- Record
15
Q
In primary care information can be obtained from
A
Prescription, Patient, Representative/carer, PMR, Medical records
16
Q
In secondary care information can be obtained from
A
primary + healthcare professionals, notes, ward charts, lab results
17
Q
Areas to consider when doing clinical check
A
- Patient characteristics
- Medication regimen factors
- Administration and monitoring
- Record keeping
18
Q
What is the meaning of patient characteristics
A
Patient type (children, elderly, ethnicity) Co morbidities (renal, hepatic impairment) Patient's intolerance/preference (allergy, religious, veg)
19
Q
What are patient regimen factors
A
Indication, Changes, Dose/Frequency/Strength, Formulation, Compatibility, Monitoring requirements
20
Q
What administration considerations should be made
A
Route correct, aids (spacer, dropper device, braile, pictogram)
21
Q
Asian on Rosuvastatin
A
20mg
22
Q
Enteral feeds avoid
A
Phenytoin
23
Q
Information to obtain in taking medication history
A
Generic name, Brand name, Dose, Strength, Formulation, Route, Frequency, Length, Device + Brand (for injectables), date of administration
24
Q
Which medicines need monitoring booklets
A
Lithium, Insulin, Anticoagulant, Methotrexate
25
T/F?: 100mg liquid Phenytoin is equal to 100mg Phenytoin tablet
False
26
What is a just culture
Based on fairness. Achieved via attitudes, behaviour, practices. Learn from mistakes, share lessons, reduce mistakes.
27
What is punitive culture
Based on punishment
28
What is no-blame culture
Never assign blame, lack of accountability
29
Principles of just culture
1. Patient safety paramount
2. Deliberate harm/unacceptable risk musn't be tolerated
3. Forthcoming in raising concerns, learning from incidents
4. Accountability fair, proportionate. View in context root cause, deficiencies, mitigating circumstance and contributing factors
30
Decision Incident Tree contains
Deliberate harm test, Incapacity test, Foresight test, Substitution Test
31
Results of Decision Incident tree
Highlight any system failures, System failure
Consult NCAA/regulatory body, Advise to go to trade union
Suspend, Refer, Adjust duties, Sick leave, Training, Supervision
32
CPD cycle consists of
Reflection, Planning (decide what to learn)
| Action (record), Evaluation (identify benefits of what you learn)
33
CPD is a
statutory requirement
34
How many CPD
9/yr. 3 starting at reflection
35
CPD must be
relevant to safe and effective to practice of pharmacy in scope of practice
36
RPS faculty is
recognition programme for RPS members after early years of practice. Identify what you need to know, advance, demonstrate.
37
RPS foundation pharmacy framework
Knowledge, Skills, Behavior = building blocks of pharmacists across al sectors.
Structure approach to realise competence, demonstrate experience, facilitate advancement, develop special interest.
38
FPF is for
Recently qualified, been on break, changing scope practice or other
39
Leadership Competency Framework
All pharmacy professionals have shared leadership focussed on achievement of group
40
RPS Mentoring service
benefit from more experienced colleagues. Online to find mentor/volunteer
41
When involving in research
1. Patient first so relevant to patient
2. Professional judgement for patient so conflict of interest
3. Respect sp confidential. decision
4. Encourage patient to participate in their care so inform and consent given
5. Develop professional knowledge and competence so follow protocol. Be competent/seek training
6. Be honest trustworthy so accurate, eligible, real
7. Take responsibility for working practices so is appropriate resources?
42
Human Medicines Regulations 2012 did what to old law
Consolidated most legislation of Medicines Act 1968
43
Veterinary Medicines Regulations did what
Consolidated most animal related legislation of Medicines Act 1968
44
Pharmacist must sell GSL?
No. Pharmacists can refuse sale/supply of ANY medicine if contrary to clinical judgement
45
Who else can sell GSL
Pharmacies and retail outlets that can close so as to exclude the public
46
What is PO
Pharmacy only. GSL but manufacturer wants only Pharmacies to sell
47
What is a P med
Must be sold under supervision of pharmacist
48
What is prohibited in P med sales
Self selection
49
What's a POM
Prescription only medicine given out after prescription received from appropriate practitioner
50
Who is an appropriate practitioner
Doctor/Dentist,
Supplementary prescriber,
Nurse/Pharmacist independent prescriber,
EEA/Swiss Dr/Dentist (not CD),
EEA/Swiss prescribing Pharmacist/Nurse,
Community practitioner nursers (a few POMs),
optometrist independent prescriber (no CD/Parenteral),
Podiatrist,
physiotherapist independent prescriber (for certain meds)
51
How much Pseudoephedrine and Ephedrine can one buy?
720mg Pseudoephedrine
OR
180mg Ephedrine
Not together
52
Signs of misuse behaviour
Nervous/guilty, Lack symptoms, rehearsed answers, impatient/aggressive, opportunistic, specific products, paraphernalia, quantities, frequency
53
Suspicious activity with Pseudoephedrine, reprt to
GPhC inspector
local CD liaison police officer
accountable officer
54
EHC is
Levonorgestrel 1500 micrograms
55
Who can take EHC at any pharmacy
>16 within 72 hours UPSI
56
What are the conditions for selling EHC
Pharmacists must sell themselves
| Interview patient
57
Can you provide advanced supply of EHC
yes if patient is competent and intend to use medicine appropriately
58
Sale out of marketing authorisation, where to refer
Family planning clinic
GP
PGD
GUM (Genitourinary medicines) clinic
59
Max paracetamol OTC
100 non effervescent tabs/caps
60
Max paracetamol effervescent OTC
Up to you, no limit
61
Max Aspirin OTC
100 non effervescent tabs/caps
62
Max Asprin effervescent OTC
Up to you, no limit
63
Max Codeine/DHC
32 including effervescent. Recommended either Codeine of DHC sold not both
64
When can you give codeine/DHC OTC
short term acute moderate pain relief which hasn't responded to aspirin, para, ibu
65
Label for Codeine/DHC OTC
Can Cause Addiction. For three days use only
66
Other things with Codeine/DHC sale
PIL and packaging = state indication, med can cause addiction or overuse headache if used for more than 3 days
PIL must contain warning signs of addiction
67
What is unsuitable for children under 6 with cold/cough
1. Antitussives: Dextromethorphan (night nurse/actifed), Pholcodeine
2. Expectorants: Guaifenesin (Benilyn/Tixlyx), Ipecacuanha (Covonia)
3. Nasal decongestants: Ephedrine, Oxymetazoline, Phenylephrine, pseudoephedrine, xylomethazoline
4. Antihistamines: Brompheniramine, chlorphenamine, dephenhydramine, doxylamine, promethazine, triprolidine
68
For 6-12 can the dodgy excipients be used?
As second line for 5 days
69
Fever/pain in
Ibuprofen OR paracetamol
70
Child with nasal congestion
saline nasal drops, vapour rub, decongestant, steam inhalation
71
Child with cough
warm, clear fluid, warm lemon and honey (
72
So chlorphenamine can't be used?
No, for hayfever it can but not for cough/cold
73
Codeine preparations for children
nope. >18 only
74
POM to P changes
```
Amorolfine nail lacquer
Azithromycin
Chloramphenicol eye drops/ointment
Omeprazole
Orlistat
Sumatriptan
Tamsulosin
Tranexamic Acid
```
75
What can podiatrists prescribe
All POMs but only DHC and Temazepam CD's
76
What can physiotherapists prescribe
All POMs but only DHC, Fentanyl, Morphine, Oxycodone, Temazepam
77
What are a prescription's requirments
1. Signature (unless electronic)
2. Address of practitioner
3. Date valid generally for 6 months
4. Particulars
5. Patient Name
6. Patient Address
7. Patient age if
78
Prescription in another language
legal but pharmacist must be able to understand
| But must label in English so others can understand
79
Can schedule 2, 3, 4 and 5 be repeated
not 2 and 3
80
Private prescriptions are repeated
As many times as indicated unless not specified (then its once) except contraceptive (six times - repeat 5 times)
81
Repeatable scripts validity
First dispensing within 6 months for Sch 5 and everything else
First dispensing within 28 days for Sch 4
No further time limit for remaining repeats - professional judgement
82
What if patient wants subsequent repeats from another pharmacy
mark your pharmacy name and address as well as date for what supply made
83
Validity of owing for P, GSL, POM and Sch5
6 months
84
Validity of owing for Sch 2, 3 and 4
28 days
85
Private scripts destination
retain for 2 years in pharmacy from date of supply/last repeatable
86
What record kept for private Rx
```
In POM register enter:
Supply date
Prescription date
Medicine details: name, quantity, formulation, strength
Prescriber details - name, address
Patient details - name, address
```
87
What is exempt from record keeping
oral contraceptives, Sch 2 (CD reg made already)
88
What is not a legal requirement on a prescription
medicinal product name, strength, form, quantity, dose
89
Prisoners can't have
FP10
90
HMP address
exempt from payment
91
Is a faxed prescription legal?
No because it is not written in indelible ink or signed in ink but can make supply based on professional judgement + record decision making process and reasons
92
Dentists can prescribe
within their competency and use in dentistry
| Only DPF on NHS
93
Who to report forged prescription to
police
NHS counter fraud service
resolved by discussion with patient/prescriber
94
Which EEA/Swiss prescribers are recognised
Doctors, Dentists, Prescribing Pharmacist (where they exist), Prescribing Nurse (where they exist)
95
What countries are in the EEA
Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden
96
Is emergency supply permitted from EEA/Swiss prescriber
yes
97
EEA/Swiss prescription requirements
1. Patient first name(s), surname and DOB
2. Prescriber first name(s), surname, qualification, contact details, email address and phone/fax, work address
3. Medicine(s) name, form, quantity, strength and dosage
4. Signature
5. Date of issue (6month valid/28day Sch 4)
98
What can't EEA/Swiss prescribers prescribe
Sch 1, 2, 3
| Meds no marketing authorisation (unlicensed) in UK
99
How can you check registration status of prescriber
get info from GMC, GDC, NMC regarding how to check that countries registration
100
If you can't check registration status, can you make supply
yes but make a record. Due diligence exists
101
EEA/Swiss prescriber/pt emergency supply
yes. Same requirements (72 hours)
| Not Sch 1, 2, 3 (including phenobarbital) but 4 and 5 can
102
Who dispenses military scripts
In house dispensary
| Community pharmacy with MOD contract
103
Military script is called
FMed 296
104
Non-contracted pharmacy receives FMed 296
Treat as private Rx and charge patient - give receipt
105
Military CDs
Written on designated standard form (like private)
106
BFPO
British Forces Post Office
| Generated abroad
107
Legal requirements for a label
1. Patient name
2. Name and address of supplying pharmacy
3. Date dispensing
4. Name of medicine
5. Direction for use
6. Precautions
108
Good practice for a label
Keep out of sight and reach of children
| Use this medicine only on your skin (when applicable)
109
In prison label also include
prisoner number
110
Inner container must legally be labelled?
No. Outer can be but advised that inner is labelled
111
Do you have to refer patient to Doctor if there is direction or precaution or name are not suitable
No you can substitute this on the label. But make a note
112
To supply a separate legal entity, assembly and pre-packaging is
subject to a license from MHRA
113
Labelling broken down bulk items
Medicine name, quantity, batch number, ingredients, handling/storage requirements, expiry date
114
Parenteral POM medicines administration is
not allowed unless acting in accordance with directions of prescriber
UNLESS to save a persons life/small pox vaccine/to do with exposure/specific people (midwives/paramedic)
115
Patient Specific Direction is
Written instruction by doctor, dentist, independent prescriber for meds to be supplied/admin to patient after assessment
Can be inpatient chart or transcribed from onto order form or direction to make sale/supply - verbal/telephoned
Can be two nurses phoning each other
116
Exemptions to one-to-one prescribing on prescription
```
Patient Group Direction (PGD)
Patient Specific Direction (PSD)
Emergency supply
Pandemic exemptions
Optometrist/Podiatrist signed orders for patients
```
117
What is a PGD
Written direction allowing supply/admin of specific medicine by authorised healthcare profession to a well defined group of patients for a specific condition
118
Pharmacist with sick/injured person can give
Diamorphine/Morphine under PGD
119
Emergency supply in Scotland
National PGD allows pharmacists to supply repeat meds/appliances/ACBS if urgent
120
Conditions of prescriber requesting emergency supply
1. Appropriate prescriber
2. Actual emergency
3. Prescription in 72 hours
4. Directions
5. For POM or Sch 4, 5 NOT 1, 2, 3
6. POM register entry: date supply, medicine (name, strength, quantity, form), prescriber name address, patient name address, date on Rx, date Rx received
7. Usual labelling
121
Conditions of Patient requesting emergency supply
1. Interview
2. Need
3. Previously had
4. Dose
5. Not Sch 1, 2, 3 and other excipients except Phenobarbital
6. 30 days, 5 days Sch 4, 5 unless pack/ full pack for AB/contraceptive
7. POM register entry: date supply, medicine (name, strength, quantity, form), patient name address, detail of emergency
8. Label saying "Emergency Supply"
122
What other excipients are not allowed for emergency supply
ammonium bromide,
calcium bromide, calcium bromidolactobionate,
embutramide, fencamfamin hydrochloride, fluanisone,
hexobarbitone, hexobarbitone sodium, hydrobromic
acid, meclofenoxate hydrochloride, methohexitone
sodium, pemoline, piracetam, potassium bromide,
prolintane hydrochloride, sodium bromide,
strychnine hydrochloride, tacrine hydrochloride,
thiopentone sodium
123
If refuse emergency supply then what do you tell the patient
Refer to GP, walk-in-centre, AandE
124
In Pandemic a Pharmacist in a Pharmacy needs to supervise supply T/F?
False. Designated collection centres don't have to be Pharmacies and they don't need a Pharmacist
125
Can Optometrists or Podiatrists write prescriptions
not unless they are an independent/supplementary prescriber
| They can give signed orders - must be med that can be legally sold/supplied by them
126
Medicines which can only be administered by optometrists and podiatrists can
not be given directly to patient
127
Additional Supply Optometrists can
give signed order for a large range of medicines
128
Requirements on a signed order
none except to satisfy you of safe and effective use
129
When dispensing from signed order
label, additional safety info, PIL, POM register entry
130
Self-prescribing and for family is
poo-practice but legal for Doctors. May be ok for emergency
Nurse/Midwives must not for themselves and only emergency for someone close
Can refer to CD accountable officer for CD or GMC if risk of harm
131
Isotretinion main side effect
In pregnancy causes serious malformation of foetus and spontaneous abortion
132
Conditions for dispensing Isotreinion
1. Prescription
133
What to watch out for with Isotreinion
No free samples, no repeat prescriptions, no faxed rx, telephone for emergency only with confirmed no pregnancy within last 7 days
134
Can UK registered Doctor prescribe CD?
Yes. Address within UK unless 4 or 5
| HO license for Cocaine, Dipipanone, Diamorphine
135
Who can prescribe Sch 2 - 5 (No Cocaine, Dipipanone, Diamorphine for addiction) with address in UK unless 4 or 5?
Dentist, Pharmacist Independent Prescriber, Nurse Independent Prescribe, Supplmentary Prescriber's (Pharmacist, Midwife, Nurse, Chiroprodist, Podiatrist, Physiotherapist, radiographer, optomoterist
136
Can Optometrist Independent Prescriber prescribe CD?
No
137
Can Physiotherapist Independent Prescriber prescribe CD?
Only DHC, Fentanyle, Morphine, Oxycodone, Temazepam
138
Can Podiatrist Independent Prescriber prescribe CD?
only DHC, Temazepam
139
Can Veterinary Surgeon/Veterinary prescribe CD?
Yes for animals
| Address in UK unless Sch 4 or 5
140
Can EEA/Swiss Doctor/Dentist prescribe CD?
Sch 4 and 5 only
141
Can Community Practitioner Nurse prescribe CD?
no
142
Who can prescribe unlicensed medicines subject to accepted clinical good practice
UK Doctors, UK Dentist, Pharmacist Independent Prescriber, Nurse Independent Prescriber, Physiotherapist Independent Prescriber, Podiatrist Independent Prescriber, Supplmentary Prescriber's (Pharmacist, Midwife, Nurse, Chiroprodist, Podiatrist, Physiotherapist, radiographer, optomoterist
143
Who can NOT prescribe unlicensed medicines subject to accepted clinical good practice
EEA/Swiss Doctor/Dentists, Community Practitioner Nurse
144
Who can prescribe unlicensed medicines.?
Optometrist Independent Prescribers
145
Can Veterinary Surgeon/Veterinary prescribe Unlicensed Meds
Yes for animals under the cascade
146
Who can prescribe emergency supply including Phenobarbital for epilepsy but not 1, 2, 3
UK Doctors, UK Dentist, Pharmacist Independent Prescriber, Nurse Independent Prescriber, Supplmentary Prescriber's (Pharmacist, Midwife, Nurse, Chiroprodist, Podiatrist, Physiotherapist, radiographer, optomoterist
147
Can Physiotherapist and Podiatrist independent prescribers authorise emergency supply?
Yes but not 1, 2, 3 not Phenobarbital
148
Can EEA/Swiss Doctor/Dentist, Optometrist Independent Prescribers and Community Practitioner Nurses authorise emergency supply
Yes
149
Can Vet Surgeons/Vet prescriber authorise emergency supply
n/a
150
UK Doctors must prescribe
within expertise
151
UK Dentists must prescribe
for dental use although can prescribe anything
| On NHS from DPF
152
Supplementary Prescribers must prescribe
in competence within an agreed clinical management plan
153
Nurse Independent Prescribers must prescribe
within competence
154
Pharmacist Independent Prescribers must prescribe
within competence
155
Optometrist Independent Prescribers must prescribe
for ocular conditions affecting eye and surrounding tissue only
156
Physiotherapist Independent Prescribers must prescribe
within competence
157
Podiatrist Independent Prescribers must prescribe
within competence
158
Veterinary Surgeon/Veterinary Prescriber must prescribe
for treatment of animals only
159
EEA/Swiss Doctor/Dentist must prescribe
within UK marketing authorisation
160
Community Practitioner Nurse must prescribe
restricted to dressings, appliances and licensed medicines in NPF
161
Person trading in medicines must hold a
Wholesaler's license: WDA(H)
162
Person trading in medicines must apply
GDP Good Distribution Practice
163
Who is named on wholesale license
Responsible PERSON
164
Who can wholesalers deal to
Other wholesalers, pharmacists and people authorised to supply meds
165
Pharmacists can hold meds in pharmacy and take small quantities from other pharmacies: T/F?
true. This is under provision of healthcare services and not commercial dealing
166
Conditions for taking/giving medicines between pharmacies
- occasional
- small quantity
- no profit
- not for onward wholesale distribution
167
If two pharmacies are part of same legal entity
Don't need WDA(H)
168
If two pharmacies part of same legal entity, can other one wholesale?
No only the pharmacy registered for wholesaling
169
Who can not receive medicines from wholesaler
Non medical prescribers (eg. Pharmacist prescribers, Nurse prescriber etc)
170
Signed order/invoice must be kept for
2 years
171
It is legal requirement to make a POM register for audit purposes for signed order/invoice: T/F?
False. It is good practice
172
It is legal requirement to have written signed order/invoice: T/F?
False. It is good practice
173
POM register entry for signed order
Date POM supplied
Name, quantity, formulation, strength of POM
Name and address of trade/business/profession of person to who supplied
Purpose for which it was sold/supplied
174
What must be included in a sigend order
Nothing but details for POM entry would be minimum
175
Trading Medicines for Human Use: Shortages and Supply Chain Obligations is about what
Legal ethical duties of short supply in UK and jeopardising patient care
176
Use by 06/2015
Last day of use 31 May 2015
177
Expires 06/2015
Last day 30 June 2015
178
Waste Enforcement body England and Wales
Environment agency
179
Waste Enforcement body Scotland
Scottish Environment Protection Agency
180
Can England and Wales Pharmacies receive waste
Yes. Comply to terms of exemption from license
181
Can Scottish pharmacies receive waste
Yes
182
Waste medicines storage
Secure container
Away from meds
If sharps - in sharps container
183
How to deal with confidential information
Destroyed or obscured
184
How should tablets and capsules be dooped
blister strips not deblistered
185
How should sharps be dooped
syringe/needle in sharps container
186
How should liquid be dooped
whole bottle
187
What should patients do with their unused meds
Bring them back into pharmacy and have them safely disposed of
188
Conditions for selling Zero Powdered contact lens
under supervision of optician/dispensing optician/doctor
189
For chemicals what needs to be done apart from packaging and labelling
CHIP and COSHH
190
For delivery/postage of medicines consider
```
Consent
Confidentiality
Need face-to-face
Interview needed?
Has met prescriber
Wherever possible signature
Storage requirements?
Postage carrier agree to transport medicines
Abroad what are the restrictions
```
191
What is a secure environment
Prison, police custody suite, secure hospital, immigration removal centre, or somewhere a person can be detained
192
In house pharmacy must be registered with
no one (not GPhC) but GPhC legal and Good practice guidelines followed
193
Pharmacy service to prison from another in-house pharmacy
get advice from GPhC and MHRA
194
What is SEPG
Secure Environment Pharmacists Group
| Giving medicines management and professional pharmacy services to secure environments
195
Where can you check registration of Pharmacy technicians
GPhC
196
Where can you check registration of Doctors
GMC
197
Where can you check registration of Dentists
GDC
198
Where can you check registration of Nurses
Nurse and Midwifery Council
199
Where can you check registration of Veterinary Surgeons
Royal College of Veterinary Surgeons
200
Use Health and Care Professions Council to check registration of
Where can you check registration of Paramedics, Chiropodists, Podiatrists, Physiotherapists
201
Where can you check registration of Optometrists
GOC
202
Regarding standard from for Animal CD
Not needed
203
Unlicensed for animal use meds
Under cascade
204
The websites contain registration status and
Further details regarding prescribing info
205
Child resistant container not given if
Specific request
Original pack
But counsel to keep out of reach and sight of children
206
Emergency connection to ex-directory telephone numbers can be used when
in real emergency - life/death situation and patient's phone number can not be obtained
207
How to contact ex-directory
Dial 100, explain situation and request
208
What are the criteria for ex-directory to connect you
life/death situation (they will believe you)
| they'll take pharmacists name, pharmacy premises
209
Homeopathy is
complementary/alternative therapy based on like to treat like
Administration of dilute and ultradilute products
210
Herbal preparations are
plant-derived materials - raw or processed from one or more plants
211
What is the evidence for homeopathy
NONE
212
Advice for patient asking about homeopathy
explain lack evidence - relevant to their condition
ensure they don't stop taking meds
minor/self-limiting conditions - ok
NEVER serious medical condition
213
Difference between Herbal and Homeopathic licensing
Homeopathic products don't need to show quality and safety
Herbal products must have marketing authorisation based of safety, quality, efficacy
or Traditional Herbal Registration (THR) based on safety, quality, evidence of traditional use
214
Donating medicines
WHO encourage you donate standard health kits (eg UN Childrens Fund)
WHO encourages after acute phase you donate cash
215
Can you donate patient returns
No
216
All Nicotine-Containing Products (NCP) are regulated or not
Now they are yes. To ensure public confidence in safety and quality
217
Are all NCP the same?
No, they vary a lot
218
Which NCP can you recommend
Ones which have Marketing authorisation
219
When using social media wacth out for
How you treat people
| Maintaining boundaries with patients especially vulnerable people
220
Can a child collect prescription
If you know them, they are mature, they medicine isn't one of misuse, has been previously agreed, there is a proper reason, they understand counselling, if local policy allows, child might not have ID for Sch2
221
If you select child abuse what should you do
In emergency - police
Take advice
Social services
No action
222
What age of sexual activity should be reported to social services
223
Contraception
Contraception or sex advice under PGD
224
What to do if you suspect abuse/neglect of vulnerable adult
Emergency - police
If capacity - obtain consent to escalate
If incapacitated - take advice (GP) - refer to social services
Consider confidentiality - enough ground to refer - refer
225
All medical devices must have
CE - meaning fit for purpose and risks reduced
226
What is anaphylaxis
severe, life-threatening, systemic hypersensitivity reaction
resulting in breathing difficulty/hypotension
skin mucosal change eg angiodema/urticaria (rash)
227
What is POM-V
Rx from veterinary surgeon and supplied by veterinary surgeon/pharmacist with written Rx
228
What is POM-VPS
POM supplied by veterinary surgeon, pharmacist or suitably qualified person on oral/written Rx
Written if supplier not prescriber
229
NFA-VPS
non-food animals supplied by vet, pharmacist, suitably qualified.
Written Rx not needed
230
AVM-GSL
Authorised Veterinary Medicine available on general sale
231
Exempt medicines under SAES (Small animal exemption scheme)
unlicensed veterinary medicine not requiring marketing authorisation because its in SAES criteria
232
Unauthorised Veterinary medicine
Unlicensed, no marketing authorisation and not SAES (including human medicines used for animals)
Only veterinary surgeon can prescribe under the cascade
233
Veterinary Script requirements
1. Name, address, telephone number, qualification, signature prescriber
2. Name and address of owner of animal
3. Identification of species and its address (if diff)
4. Date (within 6 months and 2, 3, 4 - 28 days)
5. Medicine name, quantity, dose, admin instruction (as directed no enough)
6. Warning including withdrawal (so can be eaten)
7. "Under the cascade" if required
8. Sch 2, 3: "This item has been prescribed for an animal/herd under the care of the veterinarian"
9. If repeat - how many times
234
Differences between Vet and Human Rx
Standard from for humans Sch 2, 3 not Vet
Vet needs to write "This item has been prescribed for an animal/herd under the care of the veterinarian" Sch 2, 3
Vet Rx kept for 5 years
Human Rx sent to NHS and private kept for 2 years
Human CD treatment 28 days (unless justifiable)
Animal CD treatment 30 days (unless justifiable)
235
Similarities between Vet and Human Rx
Both valid for 28 days
| Rx content requirements (total quantity words and figures)
236
When can the medicine be prescribed under the cascade
When it doesn't exist within licensed veterinary medicine
237
What to consider before prescribing under cascade
licensed vet med not exist -> licensed for another species/different condition ->EU licensed veterinary medicine -> Extemporaneous/Specials
All above except first "under cascade"
238
Label for veterinary medicines under cascade
```
Name of veterinary surgeon
Name and address of animal owner
Name and address of pharmacy
Identification of animal
Date of supply
Expiry date of product
Name/description of product/active ingredients and content quantity
Dose admin instructions
Storage instructions
Warnings
Withdrawal period
Words "For animal treatment only"
The words "Keep out of reach of children"
```
239
Label for normal veterinary medicine
No label required
| Adviseable to generate one
240
Records for POM-V/POM-VPS
receipt and supplies of POM-V/VPS showing name of medicine, date of receipt/supply, batch number, quantity, name and address of supplier/recipient
Written Rx - records name and address prescriber - keep copy of Rx
Keep all documents showing info/make record in private book
Records can be electronic
Keep for at least 5 years
Pharmacies giving POM-V/VPS must undertake annual audit
241
Can human GSL/P be sold for animals
No, unless under cascade even if verbally requested by vet
242
Selling NFA-VPS or prescribing POM-VPS you must
Advise how to use
Advise on warnings, contraindications on pack and label
Ensure med will be used correctly by competent person
Prescribe/supply minimum quantity required for treatment
243
Physical presence of Pharmacist required for which vet Rx
POM-V, POM-VPS, NFA-VPS
244
What human caution is with animal meds
Can cause ADR in humans (spray on human skin)
245
What is the adverse reaction scheme
Vet version of Yellow card scheme for both animal and human ADR from veterinary meds
246
Sch 1 CD Lic POM is
meds with no therapeutic use
license required for their production, possession, supply
eg LSD, raw opium, cannabis
247
Sch 2 CD POM is
Pharmacists and other classes have authority to possess, supply and procure
eg Opiates, major stimulants and quinalbarbitone
248
Sch 3 (CD No Reg POM)
minor stimulants and other drugs (buprenorphine, tamazepam, midazolam, phenobarbital) that are less likely to be misused and less harmful if misused than Sch2
249
Sch 4 part I (CD benz POM)
contains benzodiazepines and ketamine
250
Sch 4 Part II (CD anab POM)
contains anabolic and androgenic steroids and clenbuterol and growth hormones
251
Sch 5 (CD Inv P/CD InvPOM)
Exempt from full control because low strength (codeine, pholcodeine, morphine)
252
Prescription requirements for
Sch 2, 3
253
Prescription requirements not for
4 (I), 4 (II), 5
254
28 days Prescription validity for
Sch 2, 3, 4 (I), 4 (II)
255
6 months prescription validity for
Sch 5, all other POMs
256
Address prescriber must be in UK for
Sch 2, 3
257
EEA/Swiss prescribers can not prescribe
Sch 2, 3
258
Prescriton not repeatable for
Sch 2, 3
259
No emergency supply
Sch 2, 3 (except phenobarb for epilepsy)
260
Requisition necessary for
Sch 2, 3
261
Requisition marked by supplier for
Sch 2, 3
262
Invoices need to be kept for 2 years for
Sch 3, 5
263
Which schedules require license to import/export
Sch 2, 3, 4 (I), 4 (II) [4(II) unless for self-admin]
264
Apart from Doctors and Dentists and Pharmacists who can possess Sch 2, 3, 4 and 5
```
People with HO license (eg Museum)
HO group authority (eg paramedics)
Certain class of people - postman
Certain drug classes - 4 (II) and 5 possession legal
Patients who been prescribed it
```
265
Possession of Sch 1 CD if
HO license
ALSO to remove from patient for purpose destruction or to give to police (can not hand back to patient. mantain confidentiality)
266
Who can administer Sch 1
under HO license only (for addiction)
267
Who can adminster Sch 2
Doctor, Dentist, Pharm/Nurse independent prescriber (acting in their own right), supplementary prescriber (as part of clinical management plan), person acting with directions of prescriber to prescribe CD (inc pharmacist independent prescribers)
268
Pharmacist independent prescribers can prescribe and administer
Sch 2, 3, 4 and 4 CD and administer them (or direct their admin)
269
Who can prescribe cocaine, diamorphine, dipipanone for treating organic disease/injury
Doctors, Dentists, Pharmacist/Nurse Independent Prescribers but NOT for addiction
270
Which CDs require a license to import/export
Sch 1, 2, 3, 4 (I), 4 (II)
4(II) unless its for self-admin (personal license>3months)
271
Travelling less than 3 months
Personal license not required. Covering letter from GP with patient name, travel plans, the CD name/dose/quantity
Check embassies/travel operator
272
Requisition requirements for Sch 1, 2, 3
Good practice/strongly recommended standard forms used but legal if the following included
Recipient name, address, signature, profession/occupation and total quantity of drug and purpose of requisition
273
Are faxed requisitions ok
no. Neither are photocopies
274
It is good practice to get a written requisition before supply
legal requirement. Good practice between pharmacies
275
When does a written requisition not need to be given by Doctor/Dentist
In an emergency but one must be furnished within 24 hours
276
Can a messenger pick up the requisition's supply
No. Written authorisation needed which is retained for 2 years
277
What is a FP10CDF
Standard requisition form in England
278
What is a CDRF
Standard requisition form for Private supplies in Scotland
279
What is a GP10A
Standard requisition form in Scotland for NHS
280
What is a WP10CDF
Standard requisition form in Wales
281
Standard requisition forms can be obtained from
Local primary care organisation - england
| Local NHS health board - scotland and wales
282
What must you do when a requisition is received
Mark indelibly with supplier's name and address (pharmacy) (stamp ok)
Retain a copy for 2 years from date supply
Send original to NHS agency
283
When does marking and sending to NHS agency not apply
```
When supply made by hospital/carehome
Pharmaceutical manufacturers/wholesalers
Prison pharmacy within wings of prison
Against Midwife supply order
Against a Veterinary requisition (orginal retained 5 years)
```
284
What can a midwife obtain on a supply order
Diamorphine
Morphine
Pethidine
285
A Midwife Supply Order must contain
```
Midwife name
Occupation of midwife
Purpose for CD
Total quantity
Signature of medical officer (doctor authorised by local supervising authority or person appointed by superbising authority for supervision of midwife)
```
286
Prescription requirments for Sch 2 and 3
1. Signature - recognise. record actual prescriber
2. Date - 28 days validity from signed/indicated date
3. Address of prescriber - in UK
4. Dose - clearly define - not needed in words/figures
5. Formulation - no abbreviations
6. Strength - only if available in more than one strength
7. Total quantity - words and figures as dosage units (can be multiplication of numbers)
8. Quantity prescribed - for 30 days unless justifiable
9. Patient name
10. Patient address - NFA (no fixed abode)
11. Dental wording if appropriate - "for dental treatment only"
12. Instalment wording if appropriate - valid direction required
287
Pharmacy must do what to Sch 2 and 3 prescription
mark on day it was supplied
| IF instalment then mark date of each supply
288
Is this valid on a Sch 2, 3 rx: As directed
no
289
Is this valid on a Sch 2, 3 rx: when required
no
290
Is this valid on a Sch 2, 3 rx: prn
no
291
Is this valid on a Sch 2, 3 rx: One prn
yes
292
Is this valid on a Sch 2, 3 rx: as per chart
no
293
Is this valid on a Sch 2, 3 rx: one as directed
yes
294
Is this valid on a Sch 2, 3 rx: two when required
yes
295
Is this valid on a Sch 2, 3 rx: weekly
no
296
Is this valid on a Sch 2, 3 rx: three ampoules to be given as directed
yes
297
Is this valid on a Sch 2, 3 rx: decrease dose by 3.5ml every four days
no
298
What info needed for installment of Sch 2, 3
Amount per instalment, interval between each time med supplied
299
Script validity of instalment
28 days from first instalment - the rest in accordance with whats written even if it goes over
300
Approved wording exists for
missed dose, when pharmacy closed
301
What can pharmacists amend on a Sch 2, 3 rx
Minor typographical errors, spelling mistake, where words or figures (only one) is missing
And must mark rx to show pharmacist name, date signature, GPhC reg no)
302
What can pharmacists not amend on a Sch 2, 3 rx
missing date, incorrect dose, form, strength, omissions
303
Can Sch 2,3 rx amendments be made on a covering letter
no
304
Can Sch 2, 3 amendments be made by another doctor
in an emergency
305
What is a FP10PCD
Private prescription standard form in England
306
What is a PPCD (I)
Private prescription standard form in Scotland
307
What is a WP10PCD
Private prescription standard form in Wales
308
Private prescription requirements for Sch 2, 3
Must be on standard form
Prescriber Identification Number (from NHS agency not GMC no)
Submit orignial to NHS BSA
309
When does a standard form not need to be used for private prescriptions
Veterinary, within same legal entity
310
Destination of Veterinary scripts
retain for five years
311
Several items on Private rx for sch 2, 3 and POM
POM seperate because POM original retained in pharmacy for 2 years and Sch 2, 3 needs to go to NHS agency
312
If a healthcare professional acting in their professional capacity on behalf of patient wants to pick up Sch 2 CD
Unless already know take their Name, Address and look at ID
313
Representative wants to collect Drug misuse patient
Letter from patient naming representative - even if in police custody authorising the officer
Separate letter each time
Seen them once a week
314
Representative wants to collect Drug misuse patient who is on supervised consumption
Ask prescriber (they can verbally agree but make a record)
315
Which drugs require safe custody
```
Sch 1
Sch 2 (except secobarbital)
Sch 3 (expect phenobarbital, mazindol, meprobamate, midazolam, tramadol, pentazocine, phentermine) but tamazepam and buprenorophine do
```
316
CD key should have
a key log to keep an audit trail including transfer/overnight storage
317
Patient returned CD must
kept in safe custody, segregated and clearly marked
318
To denature CDs do pharmacies require a license
No they are exempt but need to register their exemption "T28" with Environmental Agency
Unless Scotland where it is Scottish Envirmonent Protection Agency
319
Which CD need to be denatured
Sch 2, 3, 4 (I) so they are rendered irretrievable before disposal
320
Which CD denaturing need to be witnessed
Sch 2 Legal requirement
Sch 3 Good practice for another member of staff
Not Sch 2 if patient return (another member of staff can)
321
When must a record be made in CD regsiter regarding denaturing
Expired, obsolute, unwanted stock denatured for Sch 2 (Sch3 in prison)
Not for patient returns - a separate record should be kept where ANY destruction recorded
322
who can witness destruction of CD
Police officer under HO or Secretary of State for Health or accountable officer
323
Can an accountable officer authorise themself
no
324
Destruction of Solid dosage forms
Grind/crush, use water prevent dust, add warm soapy water and stir, pour over cat litter and add to waste disposal bin
325
Destruction of liquid dosage forms
Pour into CD denaturing kit
| Or pour over cat litter
326
Destruction of ampoules/vials
Open and empty into CD denaturing kit/cat litter
Sharps in sharps bin
Or plastic bag grind ampoule, add warm soapy water or to cat litter/CD denature kit and disposal of liquid medicines
327
Destruction of patches
Remove back and fold on itself. Put in waste disposal bin or CD denaturing kit
328
Destruction of Aerosol Formulation
Expel into water - then disposal as liquid
Expel into absorbent material and dispose in pharm waste
If safe to open then add to cat litter and in pharm waste
329
Control Drug Register receiving must record
Date received, name and address from who, quantity received
330
CD register supply must record
Date of supply, name and address of recipient, details of authority to possess (prescriber), quantity supplied, details of person collecting, whether proof of ID was requested, whether proof of ID was provided
331
CD register must specify
Class, strength, form of CD
| All separate in bound book
332
Entries in CD register must be
Chronological, Entered promptly, in ink/indelible, unaltered (*mistakes)
333
What are requirements of record keeping of CD registers
kept on premises, for 2 years from last entry, copies can be kept/computerised form, available for inspection
334
Electronic CD register entries must be
```
Attributable
Capable of being audited
Compliant with best practice
Accessible from premises
Available for printing
Author identifiable
Entries can't be altered at later date
Log of all data entered kept and recalled for auditing
Safe from unauthorised access
Backups
Inspectable without disrupting dispensing process
```
335
How often should a running balance be done
weekly. More if busy
336
Running balances affected by
overaged, residue, spillage
337
How to dispose of methadone bottles
empty as much possible then put bottle in waste container
338
What class is Sativex spray
Sch 4 (I) was Sch 1
339
What is Sativex
Cannabis oromucosal spray for neuropathic pain, spasticity, overactive bladder
340
What are the storgae requirements for Sativex
Not safe custody
Fridge with other meds ok.
Stored upright before opening
Once opened room temp for 42 days
341
Length treatment Sativex
28 days
342
Standard form when private for sativex?
no
343
Destruction of Sativex
Denatured but no witness
344
Record keeping for Sativex
yes. keep for 2 years
345
Requirements of Extemporaneous Methadone
At quality of licensed medicine
| Must mitigate risk, meet GPhC standard
346
RPS created these professional guidances on professional practice
Professional standards for Hospital Pharmacy Services
Interim statement of professional standard for the Supply of OTC Medicines
Public Health standards
Transfer of Care principles
Medicines Optimisation principles (England)
Homecare Services
347
Pharmacist support provides
Financial assistance
Information
Listening friends
Specialist advice about debt, benefits, employment
Health and support programme (alcohol, drugs, dependency)
For Pharmacists, their families, former pharmacists, pre-reg student, pharmacy students
348
Why was Human A-Z list of medicines taken out
Limited use in day-to-day practice as information is available by marketing authorisation on the packaging of the medicine. Lists are not exhaustive and information exists elsewhere
349
Why was lists derived from med legislation (wholesale/smallpox conditions) taken out
Reproduction of legislation and lists from legislation is not a core role of a professional body Some lists are of little relevance to daily practice Alternative sources of information are also available
350
Why was poisions list taken out
No longer relevant to day-to-day practice
351
Why was CHIP or COSSH regulation taken out
Alternative available
352
Why was denatured alcohol taken out
Alternative available
353
Why was Veterinary A-Z list of medicines taken out
Reliable and robust alternative sources of information freely available
354
Why was Community pharmacy conractual framework taken out
Alternative available
355
Why was Specials/unlicensed medcines taken out
Alternative available on RPS website
356
Why was health and safety taken out
Alternative availble
357
What is APN
AMBULANCE PHARMACISTS NETWORK
358
What is APTUK
ASSOCIATION OF PHARMACY TECHNICIANS
359
What is BOPA
BRITISH ONCOLOGY PHARMACY ASSOCIATION
360
What is BPNG
BRITISH PHARMACEUTICAL NUTRITION GROUP
361
What is BSHP
BRITISH SOCIETY FOR THE HISTORY OF PHARMACY
362
What is CMHP
COLLEGE OF MENTAL HEALTH PHARMACY
363
What is FCP
FACULTY OF CANCER PHARMACISTS
364
What is HIVPA
HIV PHARMACISTS ASSOCIATION
365
What is IPM
INSTITUTE OF PHARMACY MANAGEMENT
366
What is JPAG
JOINT PHARMACEUTICAL ANALYSIS GROUP
367
What is NAWP
NATIONAL ASSOCIATION OF WOMEN PHARMACISTS
368
What is NPCTAG
NATIONAL PHARMACY CLINICAL TRIALS ADVISORY GROUP
369
What is NPPG
NEONATAL AND PAEDIATRIC PHARMACY GROUP
370
What is PCPN
PALLIATIVE CARE PHARMACISTS NETWORK
371
What is PLEA
PHARMACY LAW AND ETHICS ASSOCIATION
372
What is PCCPN
PRIMARY AND COMMUNITY CARE PHARMACY NETWORK
373
What is PCPA
PRIMARY CARE PHARMACISTS’ ASSOCIATION
374
What is UKRG
RADIOPHARMACISTS GROUP
375
What is SEPA
SECURE ENVIRONMENT PHARMACISTS GROUP
376
What is UKCPA
UNITED KINGDOM CLINICAL PHARMACY ASSOCIATION
377
What is UKMi
UNITED KINGDOM MEDICINES INFORMATION
378
What is UKOP
UK OPHTHALMIC PHARMACY GROUP
379
What is UKRPG
UNITED KINGDOM RENAL PHARMACY GROUP
380
What is the difference between the BOPA and FCP
BOPA - pharmacists, pharmacy technicians, people in pharmaceutical indusry
FCP - cancer pharmacists, has a constitution, board of 6 elected people
381
What does the Joint Pharmaceutical Analysis group do
Aim to encourage, assist, extend knowledge and study of pharmaceutical analysis
Scientific meetings, lectures, demos, discussions
People interested in Pharm analysis and meds control and registration
382
What are the objectives of NPCTAG
give advice of NHS pharmacy services
support education and training of pharmacy staff
a forum for communication with MHRA on clinical trial issues
383
What does the PCCPN do
Advice and services to community healthcare workers/social care/voluntary organisations/carers/patients/local authority
Influence national policy and strategies
Support members day-to-day practice
Promote standards
