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Pharmacy Pre-Registration > MEP > Flashcards

MEP Flashcards

1
Q

T/F?: MEP is legal advice

A

False

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2
Q

Medicines Optimisation Principle 1

A

Aim to understand the patient’s experience

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3
Q

Medicines Optimisation Principle 2

A

Evidence based choice of medicines

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4
Q

Medicines Optimisation Principle 3

A

Ensure medicines use is as safe as possible

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5
Q

Medicines Optimisation Principle 4

A

Make medicines optimisation part of routine practice

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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

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7
Q

Evidence based choice of medicines means

A

Clinically, cost effective treatment for patient

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8
Q

Safe use of medicines includes

A

Side effects, interactions, safe systems, effective communication between professionals

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9
Q

Pharmaceutical Care (Scotland) key principles

A

ID, Plan, Agree outcomes, Action, Follow up

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10
Q

Assessment of Pharmaceutical care will establish

A

Appropriate? Additional? Safe dose? Side effects reduction? Effective?

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11
Q

A profession is

A

Recognised, Professional Body, Standards/codes, Regulated

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12
Q

Principles of professionalism

A

Altruism, Accountability, Compassion, Duty, Excellent, Continuous Development, Honour, Integrity, Professional judgement, Respect for others, Partnerships

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13
Q

Professional judgement is

A

knowledge, experience and critical thinking
Take into account law, ethics, standards, circumstances
resonated with core values, attitudes, behaviours

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14
Q

Process of professional judgement

A
  1. ID dilemma
  2. Get info
  3. ID options
  4. Benefits Vs Risks
  5. Choose option
  6. Record
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15
Q

In primary care information can be obtained from

A

Prescription, Patient, Representative/carer, PMR, Medical records

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16
Q

In secondary care information can be obtained from

A

primary + healthcare professionals, notes, ward charts, lab results

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17
Q

Areas to consider when doing clinical check

A
  1. Patient characteristics
  2. Medication regimen factors
  3. Administration and monitoring
  4. Record keeping
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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)
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19
Q

What are patient regimen factors

A

Indication, Changes, Dose/Frequency/Strength, Formulation, Compatibility, Monitoring requirements

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20
Q

What administration considerations should be made

A

Route correct, aids (spacer, dropper device, braile, pictogram)

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21
Q

Asian on Rosuvastatin

A

20mg

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22
Q

Enteral feeds avoid

A

Phenytoin

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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

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24
Q

Which medicines need monitoring booklets

A

Lithium, Insulin, Anticoagulant, Methotrexate

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25
Q

T/F?: 100mg liquid Phenytoin is equal to 100mg Phenytoin tablet

A

False

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26
Q

What is a just culture

A

Based on fairness. Achieved via attitudes, behaviour, practices. Learn from mistakes, share lessons, reduce mistakes.

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27
Q

What is punitive culture

A

Based on punishment

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28
Q

What is no-blame culture

A

Never assign blame, lack of accountability

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29
Q

Principles of just culture

A
  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
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30
Q

Decision Incident Tree contains

A

Deliberate harm test, Incapacity test, Foresight test, Substitution Test

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31
Q

Results of Decision Incident tree

A

Highlight any system failures, System failure
Consult NCAA/regulatory body, Advise to go to trade union
Suspend, Refer, Adjust duties, Sick leave, Training, Supervision

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32
Q

CPD cycle consists of

A

Reflection, Planning (decide what to learn)

Action (record), Evaluation (identify benefits of what you learn)

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33
Q

CPD is a

A

statutory requirement

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34
Q

How many CPD

A

9/yr. 3 starting at reflection

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35
Q

CPD must be

A

relevant to safe and effective to practice of pharmacy in scope of practice

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36
Q

RPS faculty is

A

recognition programme for RPS members after early years of practice. Identify what you need to know, advance, demonstrate.

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37
Q

RPS foundation pharmacy framework

A

Knowledge, Skills, Behavior = building blocks of pharmacists across al sectors.
Structure approach to realise competence, demonstrate experience, facilitate advancement, develop special interest.

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38
Q

FPF is for

A

Recently qualified, been on break, changing scope practice or other

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39
Q

Leadership Competency Framework

A

All pharmacy professionals have shared leadership focussed on achievement of group

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40
Q

RPS Mentoring service

A

benefit from more experienced colleagues. Online to find mentor/volunteer

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41
Q

When involving in research

A
  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?
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42
Q

Human Medicines Regulations 2012 did what to old law

A

Consolidated most legislation of Medicines Act 1968

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43
Q

Veterinary Medicines Regulations did what

A

Consolidated most animal related legislation of Medicines Act 1968

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44
Q

Pharmacist must sell GSL?

A

No. Pharmacists can refuse sale/supply of ANY medicine if contrary to clinical judgement

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45
Q

Who else can sell GSL

A

Pharmacies and retail outlets that can close so as to exclude the public

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46
Q

What is PO

A

Pharmacy only. GSL but manufacturer wants only Pharmacies to sell

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47
Q

What is a P med

A

Must be sold under supervision of pharmacist

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48
Q

What is prohibited in P med sales

A

Self selection

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49
Q

What’s a POM

A

Prescription only medicine given out after prescription received from appropriate practitioner

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50
Q

Who is an appropriate practitioner

A

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)

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51
Q

How much Pseudoephedrine and Ephedrine can one buy?

A

720mg Pseudoephedrine
OR
180mg Ephedrine

Not together

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52
Q

Signs of misuse behaviour

A

Nervous/guilty, Lack symptoms, rehearsed answers, impatient/aggressive, opportunistic, specific products, paraphernalia, quantities, frequency

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53
Q

Suspicious activity with Pseudoephedrine, reprt to

A

GPhC inspector
local CD liaison police officer
accountable officer

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54
Q

EHC is

A

Levonorgestrel 1500 micrograms

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55
Q

Who can take EHC at any pharmacy

A

> 16 within 72 hours UPSI

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56
Q

What are the conditions for selling EHC

A

Pharmacists must sell themselves

Interview patient

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57
Q

Can you provide advanced supply of EHC

A

yes if patient is competent and intend to use medicine appropriately

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58
Q

Sale out of marketing authorisation, where to refer

A

Family planning clinic
GP
PGD
GUM (Genitourinary medicines) clinic

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59
Q

Max paracetamol OTC

A

100 non effervescent tabs/caps

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60
Q

Max paracetamol effervescent OTC

A

Up to you, no limit

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61
Q

Max Aspirin OTC

A

100 non effervescent tabs/caps

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62
Q

Max Asprin effervescent OTC

A

Up to you, no limit

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63
Q

Max Codeine/DHC

A

32 including effervescent. Recommended either Codeine of DHC sold not both

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64
Q

When can you give codeine/DHC OTC

A

short term acute moderate pain relief which hasn’t responded to aspirin, para, ibu

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65
Q

Label for Codeine/DHC OTC

A

Can Cause Addiction. For three days use only

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66
Q

Other things with Codeine/DHC sale

A

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

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67
Q

What is unsuitable for children under 6 with cold/cough

A
  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
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68
Q

For 6-12 can the dodgy excipients be used?

A

As second line for 5 days

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69
Q

Fever/pain in

A

Ibuprofen OR paracetamol

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70
Q

Child with nasal congestion

A

saline nasal drops, vapour rub, decongestant, steam inhalation

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71
Q

Child with cough

A

warm, clear fluid, warm lemon and honey (

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72
Q

So chlorphenamine can’t be used?

A

No, for hayfever it can but not for cough/cold

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73
Q

Codeine preparations for children

A

nope. >18 only

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74
Q

POM to P changes

A 
Amorolfine nail lacquer
Azithromycin
Chloramphenicol eye drops/ointment
Omeprazole
Orlistat
Sumatriptan
Tamsulosin
Tranexamic Acid
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75
Q

What can podiatrists prescribe

A

All POMs but only DHC and Temazepam CD’s

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76
Q

What can physiotherapists prescribe

A

All POMs but only DHC, Fentanyl, Morphine, Oxycodone, Temazepam

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77
Q

What are a prescription’s requirments

A
  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
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78
Q

Prescription in another language

A

legal but pharmacist must be able to understand

But must label in English so others can understand

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79
Q

Can schedule 2, 3, 4 and 5 be repeated

A

not 2 and 3

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80
Q

Private prescriptions are repeated

A

As many times as indicated unless not specified (then its once) except contraceptive (six times - repeat 5 times)

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81
Q

Repeatable scripts validity

A

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

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82
Q

What if patient wants subsequent repeats from another pharmacy

A

mark your pharmacy name and address as well as date for what supply made

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83
Q

Validity of owing for P, GSL, POM and Sch5

A

6 months

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84
Q

Validity of owing for Sch 2, 3 and 4

A

28 days

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85
Q

Private scripts destination

A

retain for 2 years in pharmacy from date of supply/last repeatable

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86
Q

What record kept for private Rx

A 
In POM register enter:
Supply date
Prescription date
Medicine details: name, quantity, formulation, strength
Prescriber details - name, address
Patient details - name, address
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87
Q

What is exempt from record keeping

A

oral contraceptives, Sch 2 (CD reg made already)

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88
Q

What is not a legal requirement on a prescription

A

medicinal product name, strength, form, quantity, dose

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89
Q

Prisoners can’t have

A

FP10

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90
Q

HMP address

A

exempt from payment

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91
Q

Is a faxed prescription legal?

A

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

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92
Q

Dentists can prescribe

A

within their competency and use in dentistry

Only DPF on NHS

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93
Q

Who to report forged prescription to

A

police
NHS counter fraud service
resolved by discussion with patient/prescriber

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94
Q

Which EEA/Swiss prescribers are recognised

A

Doctors, Dentists, Prescribing Pharmacist (where they exist), Prescribing Nurse (where they exist)

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95
Q

What countries are in the EEA

A

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

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96
Q

Is emergency supply permitted from EEA/Swiss prescriber

A

yes

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97
Q

EEA/Swiss prescription requirements

A
  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)
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98
Q

What can’t EEA/Swiss prescribers prescribe

A

Sch 1, 2, 3

Meds no marketing authorisation (unlicensed) in UK

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99
Q

How can you check registration status of prescriber

A

get info from GMC, GDC, NMC regarding how to check that countries registration

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100
Q

If you can’t check registration status, can you make supply

A

yes but make a record. Due diligence exists

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101
Q

EEA/Swiss prescriber/pt emergency supply

A

yes. Same requirements (72 hours)

Not Sch 1, 2, 3 (including phenobarbital) but 4 and 5 can

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102
Q

Who dispenses military scripts

A

In house dispensary

Community pharmacy with MOD contract

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103
Q

Military script is called

A

FMed 296

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104
Q

Non-contracted pharmacy receives FMed 296

A

Treat as private Rx and charge patient - give receipt

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105
Q

Military CDs

A

Written on designated standard form (like private)

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106
Q

BFPO

A

British Forces Post Office

Generated abroad

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107
Q

Legal requirements for a label

A
  1. Patient name
  2. Name and address of supplying pharmacy
  3. Date dispensing
  4. Name of medicine
  5. Direction for use
  6. Precautions
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108
Q

Good practice for a label

A

Keep out of sight and reach of children

Use this medicine only on your skin (when applicable)

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109
Q

In prison label also include

A

prisoner number

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110
Q

Inner container must legally be labelled?

A

No. Outer can be but advised that inner is labelled

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111
Q

Do you have to refer patient to Doctor if there is direction or precaution or name are not suitable

A

No you can substitute this on the label. But make a note

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112
Q

To supply a separate legal entity, assembly and pre-packaging is

A

subject to a license from MHRA

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113
Q

Labelling broken down bulk items

A

Medicine name, quantity, batch number, ingredients, handling/storage requirements, expiry date

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114
Q

Parenteral POM medicines administration is

A

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)

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115
Q

Patient Specific Direction is

A

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

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116
Q

Exemptions to one-to-one prescribing on prescription

A 
Patient Group Direction (PGD)
Patient Specific Direction (PSD)
Emergency supply
Pandemic exemptions
Optometrist/Podiatrist signed orders for patients
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117
Q

What is a PGD

A

Written direction allowing supply/admin of specific medicine by authorised healthcare profession to a well defined group of patients for a specific condition

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118
Q

Pharmacist with sick/injured person can give

A

Diamorphine/Morphine under PGD

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119
Q

Emergency supply in Scotland

A

National PGD allows pharmacists to supply repeat meds/appliances/ACBS if urgent

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120
Q

Conditions of prescriber requesting emergency supply

A
  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
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121
Q

Conditions of Patient requesting emergency supply

A
  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”
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122
Q

What other excipients are not allowed for emergency supply

A

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,
thiopentonesodium

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123
Q

If refuse emergency supply then what do you tell the patient

A

Refer to GP, walk-in-centre, AandE

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124
Q

In Pandemic a Pharmacist in a Pharmacy needs to supervise supply T/F?

A

False. Designated collection centres don’t have to be Pharmacies and they don’t need a Pharmacist

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125
Q

Can Optometrists or Podiatrists write prescriptions

A

not unless they are an independent/supplementary prescriber

They can give signed orders - must be med that can be legally sold/supplied by them

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126
Q

Medicines which can only be administered by optometrists and podiatrists can

A

not be given directly to patient

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127
Q

Additional Supply Optometrists can

A

give signed order for a large range of medicines

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128
Q

Requirements on a signed order

A

none except to satisfy you of safe and effective use

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129
Q

When dispensing from signed order

A

label, additional safety info, PIL, POM register entry

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130
Q

Self-prescribing and for family is

A

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

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131
Q

Isotretinion main side effect

A

In pregnancy causes serious malformation of foetus and spontaneous abortion

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132
Q

Conditions for dispensing Isotreinion

A
  1. Prescription
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133
Q

What to watch out for with Isotreinion

A

No free samples, no repeat prescriptions, no faxed rx, telephone for emergency only with confirmed no pregnancy within last 7 days

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134
Q

Can UK registered Doctor prescribe CD?

A

Yes. Address within UK unless 4 or 5

HO license for Cocaine, Dipipanone, Diamorphine

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135
Q

Who can prescribe Sch 2 - 5 (No Cocaine, Dipipanone, Diamorphine for addiction) with address in UK unless 4 or 5?

A

Dentist, Pharmacist Independent Prescriber, Nurse Independent Prescribe, Supplmentary Prescriber’s (Pharmacist, Midwife, Nurse, Chiroprodist, Podiatrist, Physiotherapist, radiographer, optomoterist

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136
Q

Can Optometrist Independent Prescriber prescribe CD?

A

No

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137
Q

Can Physiotherapist Independent Prescriber prescribe CD?

A

Only DHC, Fentanyle, Morphine, Oxycodone, Temazepam

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138
Q

Can Podiatrist Independent Prescriber prescribe CD?

A

only DHC, Temazepam

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139
Q

Can Veterinary Surgeon/Veterinary prescribe CD?

A

Yes for animals

Address in UK unless Sch 4 or 5

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140
Q

Can EEA/Swiss Doctor/Dentist prescribe CD?

A

Sch 4 and 5 only

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141
Q

Can Community Practitioner Nurse prescribe CD?

A

no

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142
Q

Who can prescribe unlicensed medicines subject to accepted clinical good practice

A

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

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143
Q

Who can NOT prescribe unlicensed medicines subject to accepted clinical good practice

A

EEA/Swiss Doctor/Dentists, Community Practitioner Nurse

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144
Q

Who can prescribe unlicensed medicines.?

A

Optometrist Independent Prescribers

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145
Q

Can Veterinary Surgeon/Veterinary prescribe Unlicensed Meds

A

Yes for animals under the cascade

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146
Q

Who can prescribe emergency supply including Phenobarbital for epilepsy but not 1, 2, 3

A

UK Doctors, UK Dentist, Pharmacist Independent Prescriber, Nurse Independent Prescriber, Supplmentary Prescriber’s (Pharmacist, Midwife, Nurse, Chiroprodist, Podiatrist, Physiotherapist, radiographer, optomoterist

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147
Q

Can Physiotherapist and Podiatrist independent prescribers authorise emergency supply?

A

Yes but not 1, 2, 3 not Phenobarbital

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148
Q

Can EEA/Swiss Doctor/Dentist, Optometrist Independent Prescribers and Community Practitioner Nurses authorise emergency supply

A

Yes

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149
Q

Can Vet Surgeons/Vet prescriber authorise emergency supply

A

n/a

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150
Q

UK Doctors must prescribe

A

within expertise

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151
Q

UK Dentists must prescribe

A

for dental use although can prescribe anything

On NHS from DPF

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152
Q

Supplementary Prescribers must prescribe

A

in competence within an agreed clinical management plan

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153
Q

Nurse Independent Prescribers must prescribe

A

within competence

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154
Q

Pharmacist Independent Prescribers must prescribe

A

within competence

155
Q

Optometrist Independent Prescribers must prescribe

A

for ocular conditions affecting eye and surrounding tissue only

156
Q

Physiotherapist Independent Prescribers must prescribe

A

within competence

157
Q

Podiatrist Independent Prescribers must prescribe

A

within competence

158
Q

Veterinary Surgeon/Veterinary Prescriber must prescribe

A

for treatment of animals only

159
Q

EEA/Swiss Doctor/Dentist must prescribe

A

within UK marketing authorisation

160
Q

Community Practitioner Nurse must prescribe

A

restricted to dressings, appliances and licensed medicines in NPF

161
Q

Person trading in medicines must hold a

A

Wholesaler’s license: WDA(H)

162
Q

Person trading in medicines must apply

A

GDP Good Distribution Practice

163
Q

Who is named on wholesale license

A

Responsible PERSON

164
Q

Who can wholesalers deal to

A

Other wholesalers, pharmacists and people authorised to supply meds

165
Q

Pharmacists can hold meds in pharmacy and take small quantities from other pharmacies: T/F?

A

true. This is under provision of healthcare services and not commercial dealing

166
Q

Conditions for taking/giving medicines between pharmacies

A
  • occasional
  • small quantity
  • no profit
  • not for onward wholesale distribution
167
Q

If two pharmacies are part of same legal entity

A

Don’t need WDA(H)

168
Q

If two pharmacies part of same legal entity, can other one wholesale?

A

No only the pharmacy registered for wholesaling

169
Q

Who can not receive medicines from wholesaler

A

Non medical prescribers (eg. Pharmacist prescribers, Nurse prescriber etc)

170
Q

Signed order/invoice must be kept for

A

2 years

171
Q

It is legal requirement to make a POM register for audit purposes for signed order/invoice: T/F?

A

False. It is good practice

172
Q

It is legal requirement to have written signed order/invoice: T/F?

A

False. It is good practice

173
Q

POM register entry for signed order

A

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
Q

What must be included in a sigend order

A

Nothing but details for POM entry would be minimum

175
Q

Trading Medicines for Human Use: Shortages and Supply Chain Obligations is about what

A

Legal ethical duties of short supply in UK and jeopardising patient care

176
Q

Use by 06/2015

A

Last day of use 31 May 2015

177
Q

Expires 06/2015

A

Last day 30 June 2015

178
Q

Waste Enforcement body England and Wales

A

Environment agency

179
Q

Waste Enforcement body Scotland

A

Scottish Environment Protection Agency

180
Q

Can England and Wales Pharmacies receive waste

A

Yes. Comply to terms of exemption from license

181
Q

Can Scottish pharmacies receive waste

A

Yes

182
Q

Waste medicines storage

A

Secure container
Away from meds
If sharps - in sharps container

183
Q

How to deal with confidential information

A

Destroyed or obscured

184
Q

How should tablets and capsules be dooped

A

blister strips not deblistered

185
Q

How should sharps be dooped

A

syringe/needle in sharps container

186
Q

How should liquid be dooped

A

whole bottle

187
Q

What should patients do with their unused meds

A

Bring them back into pharmacy and have them safely disposed of

188
Q

Conditions for selling Zero Powdered contact lens

A

under supervision of optician/dispensing optician/doctor

189
Q

For chemicals what needs to be done apart from packaging and labelling

A

CHIP and COSHH

190
Q

For delivery/postage of medicines consider

A 
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
Q

What is a secure environment

A

Prison, police custody suite, secure hospital, immigration removal centre, or somewhere a person can be detained

192
Q

In house pharmacy must be registered with

A

no one (not GPhC) but GPhC legal and Good practice guidelines followed

193
Q

Pharmacy service to prison from another in-house pharmacy

A

get advice from GPhC and MHRA

194
Q

What is SEPG

A

Secure Environment Pharmacists Group

Giving medicines management and professional pharmacy services to secure environments

195
Q

Where can you check registration of Pharmacy technicians

A

GPhC

196
Q

Where can you check registration of Doctors

A

GMC

197
Q

Where can you check registration of Dentists

A

GDC

198
Q

Where can you check registration of Nurses

A

Nurse and Midwifery Council

199
Q

Where can you check registration of Veterinary Surgeons

A

Royal College of Veterinary Surgeons

200
Q

Use Health and Care Professions Council to check registration of

A

Where can you check registration of Paramedics, Chiropodists, Podiatrists, Physiotherapists

201
Q

Where can you check registration of Optometrists

A

GOC

202
Q

Regarding standard from for Animal CD

A

Not needed

203
Q

Unlicensed for animal use meds

A

Under cascade

204
Q

The websites contain registration status and

A

Further details regarding prescribing info

205
Q

Child resistant container not given if

A

Specific request
Original pack

But counsel to keep out of reach and sight of children

206
Q

Emergency connection to ex-directory telephone numbers can be used when

A

in real emergency - life/death situation and patient’s phone number can not be obtained

207
Q

How to contact ex-directory

A

Dial 100, explain situation and request

208
Q

What are the criteria for ex-directory to connect you

A

life/death situation (they will believe you)

they’ll take pharmacists name, pharmacy premises

209
Q

Homeopathy is

A

complementary/alternative therapy based on like to treat like
Administration of dilute and ultradilute products

210
Q

Herbal preparations are

A

plant-derived materials - raw or processed from one or more plants

211
Q

What is the evidence for homeopathy

A

NONE

212
Q

Advice for patient asking about homeopathy

A

explain lack evidence - relevant to their condition
ensure they don’t stop taking meds
minor/self-limiting conditions - ok
NEVER serious medical condition

213
Q

Difference between Herbal and Homeopathic licensing

A

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
Q

Donating medicines

A

WHO encourage you donate standard health kits (eg UN Childrens Fund)
WHO encourages after acute phase you donate cash

215
Q

Can you donate patient returns

A

No

216
Q

All Nicotine-Containing Products (NCP) are regulated or not

A

Now they are yes. To ensure public confidence in safety and quality

217
Q

Are all NCP the same?

A

No, they vary a lot

218
Q

Which NCP can you recommend

A

Ones which have Marketing authorisation

219
Q

When using social media wacth out for

A

How you treat people

Maintaining boundaries with patients especially vulnerable people

220
Q

Can a child collect prescription

A

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
Q

If you select child abuse what should you do

A

In emergency - police
Take advice
Social services
No action

222
Q

What age of sexual activity should be reported to social services

A
223
Q

Contraception

A

Contraception or sex advice under PGD

224
Q

What to do if you suspect abuse/neglect of vulnerable adult

A

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
Q

All medical devices must have

A

CE - meaning fit for purpose and risks reduced

226
Q

What is anaphylaxis

A

severe, life-threatening, systemic hypersensitivity reaction
resulting in breathing difficulty/hypotension
skin mucosal change eg angiodema/urticaria (rash)

227
Q

What is POM-V

A

Rx from veterinary surgeon and supplied by veterinary surgeon/pharmacist with written Rx

228
Q

What is POM-VPS

A

POM supplied by veterinary surgeon, pharmacist or suitably qualified person on oral/written Rx
Written if supplier not prescriber

229
Q

NFA-VPS

A

non-food animals supplied by vet, pharmacist, suitably qualified.
Written Rx not needed

230
Q

AVM-GSL

A

Authorised Veterinary Medicine available on general sale

231
Q

Exempt medicines under SAES (Small animal exemption scheme)

A

unlicensed veterinary medicine not requiring marketing authorisation because its in SAES criteria

232
Q

Unauthorised Veterinary medicine

A

Unlicensed, no marketing authorisation and not SAES (including human medicines used for animals)
Only veterinary surgeon can prescribe under the cascade

233
Q

Veterinary Script requirements

A
  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
Q

Differences between Vet and Human Rx

A

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
Q

Similarities between Vet and Human Rx

A

Both valid for 28 days

Rx content requirements (total quantity words and figures)

236
Q

When can the medicine be prescribed under the cascade

A

When it doesn’t exist within licensed veterinary medicine

237
Q

What to consider before prescribing under cascade

A

licensed vet med not exist -> licensed for another species/different condition ->EU licensed veterinary medicine -> Extemporaneous/Specials

All above except first “under cascade”

238
Q

Label for veterinary medicines under cascade

A 
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
Q

Label for normal veterinary medicine

A

No label required

Adviseable to generate one

240
Q

Records for POM-V/POM-VPS

A

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
Q

Can human GSL/P be sold for animals

A

No, unless under cascade even if verbally requested by vet

242
Q

Selling NFA-VPS or prescribing POM-VPS you must

A

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
Q

Physical presence of Pharmacist required for which vet Rx

A

POM-V, POM-VPS, NFA-VPS

244
Q

What human caution is with animal meds

A

Can cause ADR in humans (spray on human skin)

245
Q

What is the adverse reaction scheme

A

Vet version of Yellow card scheme for both animal and human ADR from veterinary meds

246
Q

Sch 1 CD Lic POM is

A

meds with no therapeutic use
license required for their production, possession, supply
eg LSD, raw opium, cannabis

247
Q

Sch 2 CD POM is

A

Pharmacists and other classes have authority to possess, supply and procure
eg Opiates, major stimulants and quinalbarbitone

248
Q

Sch 3 (CD No Reg POM)

A

minor stimulants and other drugs (buprenorphine, tamazepam, midazolam, phenobarbital) that are less likely to be misused and less harmful if misused than Sch2

249
Q

Sch 4 part I (CD benz POM)

A

contains benzodiazepines and ketamine

250
Q

Sch 4 Part II (CD anab POM)

A

contains anabolic and androgenic steroids and clenbuterol and growth hormones

251
Q

Sch 5 (CD Inv P/CD InvPOM)

A

Exempt from full control because low strength (codeine, pholcodeine, morphine)

252
Q

Prescription requirements for

A

Sch 2, 3

253
Q

Prescription requirements not for

A

4 (I), 4 (II), 5

254
Q

28 days Prescription validity for

A

Sch 2, 3, 4 (I), 4 (II)

255
Q

6 months prescription validity for

A

Sch 5, all other POMs

256
Q

Address prescriber must be in UK for

A

Sch 2, 3

257
Q

EEA/Swiss prescribers can not prescribe

A

Sch 2, 3

258
Q

Prescriton not repeatable for

A

Sch 2, 3

259
Q

No emergency supply

A

Sch 2, 3 (except phenobarb for epilepsy)

260
Q

Requisition necessary for

A

Sch 2, 3

261
Q

Requisition marked by supplier for

A

Sch 2, 3

262
Q

Invoices need to be kept for 2 years for

A

Sch 3, 5

263
Q

Which schedules require license to import/export

A

Sch 2, 3, 4 (I), 4 (II) [4(II) unless for self-admin]

264
Q

Apart from Doctors and Dentists and Pharmacists who can possess Sch 2, 3, 4 and 5

A 
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
Q

Possession of Sch 1 CD if

A

HO license
ALSO to remove from patient for purpose destruction or to give to police (can not hand back to patient. mantain confidentiality)

266
Q

Who can administer Sch 1

A

under HO license only (for addiction)

267
Q

Who can adminster Sch 2

A

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
Q

Pharmacist independent prescribers can prescribe and administer

A

Sch 2, 3, 4 and 4 CD and administer them (or direct their admin)

269
Q

Who can prescribe cocaine, diamorphine, dipipanone for treating organic disease/injury

A

Doctors, Dentists, Pharmacist/Nurse Independent Prescribers but NOT for addiction

270
Q

Which CDs require a license to import/export

A

Sch 1, 2, 3, 4 (I), 4 (II)

4(II) unless its for self-admin (personal license>3months)

271
Q

Travelling less than 3 months

A

Personal license not required. Covering letter from GP with patient name, travel plans, the CD name/dose/quantity
Check embassies/travel operator

272
Q

Requisition requirements for Sch 1, 2, 3

A

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
Q

Are faxed requisitions ok

A

no. Neither are photocopies

274
Q

It is good practice to get a written requisition before supply

A

legal requirement. Good practice between pharmacies

275
Q

When does a written requisition not need to be given by Doctor/Dentist

A

In an emergency but one must be furnished within 24 hours

276
Q

Can a messenger pick up the requisition’s supply

A

No. Written authorisation needed which is retained for 2 years

277
Q

What is a FP10CDF

A

Standard requisition form in England

278
Q

What is a CDRF

A

Standard requisition form for Private supplies in Scotland

279
Q

What is a GP10A

A

Standard requisition form in Scotland for NHS

280
Q

What is a WP10CDF

A

Standard requisition form in Wales

281
Q

Standard requisition forms can be obtained from

A

Local primary care organisation - england

Local NHS health board - scotland and wales

282
Q

What must you do when a requisition is received

A

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
Q

When does marking and sending to NHS agency not apply

A 
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
Q

What can a midwife obtain on a supply order

A

Diamorphine
Morphine
Pethidine

285
Q

A Midwife Supply Order must contain

A 
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
Q

Prescription requirments for Sch 2 and 3

A
  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
Q

Pharmacy must do what to Sch 2 and 3 prescription

A

mark on day it was supplied

IF instalment then mark date of each supply

288
Q

Is this valid on a Sch 2, 3 rx: As directed

A

no

289
Q

Is this valid on a Sch 2, 3 rx: when required

A

no

290
Q

Is this valid on a Sch 2, 3 rx: prn

A

no

291
Q

Is this valid on a Sch 2, 3 rx: One prn

A

yes

292
Q

Is this valid on a Sch 2, 3 rx: as per chart

A

no

293
Q

Is this valid on a Sch 2, 3 rx: one as directed

A

yes

294
Q

Is this valid on a Sch 2, 3 rx: two when required

A

yes

295
Q

Is this valid on a Sch 2, 3 rx: weekly

A

no

296
Q

Is this valid on a Sch 2, 3 rx: three ampoules to be given as directed

A

yes

297
Q

Is this valid on a Sch 2, 3 rx: decrease dose by 3.5ml every four days

A

no

298
Q

What info needed for installment of Sch 2, 3

A

Amount per instalment, interval between each time med supplied

299
Q

Script validity of instalment

A

28 days from first instalment - the rest in accordance with whats written even if it goes over

300
Q

Approved wording exists for

A

missed dose, when pharmacy closed

301
Q

What can pharmacists amend on a Sch 2, 3 rx

A

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
Q

What can pharmacists not amend on a Sch 2, 3 rx

A

missing date, incorrect dose, form, strength, omissions

303
Q

Can Sch 2,3 rx amendments be made on a covering letter

A

no

304
Q

Can Sch 2, 3 amendments be made by another doctor

A

in an emergency

305
Q

What is a FP10PCD

A

Private prescription standard form in England

306
Q

What is a PPCD (I)

A

Private prescription standard form in Scotland

307
Q

What is a WP10PCD

A

Private prescription standard form in Wales

308
Q

Private prescription requirements for Sch 2, 3

A

Must be on standard form
Prescriber Identification Number (from NHS agency not GMC no)
Submit orignial to NHS BSA

309
Q

When does a standard form not need to be used for private prescriptions

A

Veterinary, within same legal entity

310
Q

Destination of Veterinary scripts

A

retain for five years

311
Q

Several items on Private rx for sch 2, 3 and POM

A

POM seperate because POM original retained in pharmacy for 2 years and Sch 2, 3 needs to go to NHS agency

312
Q

If a healthcare professional acting in their professional capacity on behalf of patient wants to pick up Sch 2 CD

A

Unless already know take their Name, Address and look at ID

313
Q

Representative wants to collect Drug misuse patient

A

Letter from patient naming representative - even if in police custody authorising the officer
Separate letter each time
Seen them once a week

314
Q

Representative wants to collect Drug misuse patient who is on supervised consumption

A

Ask prescriber (they can verbally agree but make a record)

315
Q

Which drugs require safe custody

A 
Sch 1
Sch 2 (except secobarbital)
Sch 3 (expect phenobarbital, mazindol, meprobamate, midazolam, tramadol, pentazocine, phentermine) but tamazepam and buprenorophine do
316
Q

CD key should have

A

a key log to keep an audit trail including transfer/overnight storage

317
Q

Patient returned CD must

A

kept in safe custody, segregated and clearly marked

318
Q

To denature CDs do pharmacies require a license

A

No they are exempt but need to register their exemption “T28” with Environmental Agency
Unless Scotland where it is Scottish Envirmonent Protection Agency

319
Q

Which CD need to be denatured

A

Sch 2, 3, 4 (I) so they are rendered irretrievable before disposal

320
Q

Which CD denaturing need to be witnessed

A

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
Q

When must a record be made in CD regsiter regarding denaturing

A

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
Q

who can witness destruction of CD

A

Police officer under HO or Secretary of State for Health or accountable officer

323
Q

Can an accountable officer authorise themself

A

no

324
Q

Destruction of Solid dosage forms

A

Grind/crush, use water prevent dust, add warm soapy water and stir, pour over cat litter and add to waste disposal bin

325
Q

Destruction of liquid dosage forms

A

Pour into CD denaturing kit

Or pour over cat litter

326
Q

Destruction of ampoules/vials

A

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
Q

Destruction of patches

A

Remove back and fold on itself. Put in waste disposal bin or CD denaturing kit

328
Q

Destruction of Aerosol Formulation

A

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
Q

Control Drug Register receiving must record

A

Date received, name and address from who, quantity received

330
Q

CD register supply must record

A

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
Q

CD register must specify

A

Class, strength, form of CD

All separate in bound book

332
Q

Entries in CD register must be

A

Chronological, Entered promptly, in ink/indelible, unaltered (*mistakes)

333
Q

What are requirements of record keeping of CD registers

A

kept on premises, for 2 years from last entry, copies can be kept/computerised form, available for inspection

334
Q

Electronic CD register entries must be

A 
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
Q

How often should a running balance be done

A

weekly. More if busy

336
Q

Running balances affected by

A

overaged, residue, spillage

337
Q

How to dispose of methadone bottles

A

empty as much possible then put bottle in waste container

338
Q

What class is Sativex spray

A

Sch 4 (I) was Sch 1

339
Q

What is Sativex

A

Cannabis oromucosal spray for neuropathic pain, spasticity, overactive bladder

340
Q

What are the storgae requirements for Sativex

A

Not safe custody
Fridge with other meds ok.
Stored upright before opening
Once opened room temp for 42 days

341
Q

Length treatment Sativex

A

28 days

342
Q

Standard form when private for sativex?

A

no

343
Q

Destruction of Sativex

A

Denatured but no witness

344
Q

Record keeping for Sativex

A

yes. keep for 2 years

345
Q

Requirements of Extemporaneous Methadone

A

At quality of licensed medicine

Must mitigate risk, meet GPhC standard

346
Q

RPS created these professional guidances on professional practice

A

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
Q

Pharmacist support provides

A

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
Q

Why was Human A-Z list of medicines taken out

A

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
Q

Why was lists derived from med legislation (wholesale/smallpox conditions) taken out

A

Reproduction of legislation and lists from legislation is not a core role of aprofessional body Some lists are of little relevance to daily practice Alternative sources of information arealso available

350
Q

Why was poisions list taken out

A

No longer relevant to day-to-day practice

351
Q

Why was CHIP or COSSH regulation taken out

A

Alternative available

352
Q

Why was denatured alcohol taken out

A

Alternative available

353
Q

Why was Veterinary A-Z list of medicines taken out

A

Reliable and robust alternative sources of information freely available

354
Q

Why was Community pharmacy conractual framework taken out

A

Alternative available

355
Q

Why was Specials/unlicensed medcines taken out

A

Alternative available on RPS website

356
Q

Why was health and safety taken out

A

Alternative availble

357
Q

What is APN

A

AMBULANCE PHARMACISTS NETWORK

358
Q

What is APTUK

A

ASSOCIATION OF PHARMACY TECHNICIANS

359
Q

What is BOPA

A

BRITISH ONCOLOGY PHARMACY ASSOCIATION

360
Q

What is BPNG

A

BRITISH PHARMACEUTICAL NUTRITION GROUP

361
Q

What is BSHP

A

BRITISH SOCIETY FOR THE HISTORY OF PHARMACY

362
Q

What is CMHP

A

COLLEGE OF MENTAL HEALTH PHARMACY

363
Q

What is FCP

A

FACULTY OF CANCER PHARMACISTS

364
Q

What is HIVPA

A

HIV PHARMACISTS ASSOCIATION

365
Q

What is IPM

A

INSTITUTE OF PHARMACY MANAGEMENT

366
Q

What is JPAG

A

JOINT PHARMACEUTICAL ANALYSIS GROUP

367
Q

What is NAWP

A

NATIONAL ASSOCIATION OF WOMEN PHARMACISTS

368
Q

What is NPCTAG

A

NATIONAL PHARMACY CLINICAL TRIALS ADVISORY GROUP

369
Q

What is NPPG

A

NEONATAL AND PAEDIATRIC PHARMACY GROUP

370
Q

What is PCPN

A

PALLIATIVE CARE PHARMACISTS NETWORK

371
Q

What is PLEA

A

PHARMACY LAW AND ETHICS ASSOCIATION

372
Q

What is PCCPN

A

PRIMARY AND COMMUNITY CARE PHARMACY NETWORK

373
Q

What is PCPA

A

PRIMARY CARE PHARMACISTS’ ASSOCIATION

374
Q

What is UKRG

A

RADIOPHARMACISTS GROUP

375
Q

What is SEPA

A

SECURE ENVIRONMENT PHARMACISTS GROUP

376
Q

What is UKCPA

A

UNITED KINGDOM CLINICAL PHARMACY ASSOCIATION

377
Q

What is UKMi

A

UNITED KINGDOM MEDICINES INFORMATION

378
Q

What is UKOP

A

UK OPHTHALMIC PHARMACY GROUP

379
Q

What is UKRPG

A

UNITED KINGDOM RENAL PHARMACY GROUP

380
Q

What is the difference between the BOPA and FCP

A

BOPA - pharmacists, pharmacy technicians, people in pharmaceutical indusry
FCP - cancer pharmacists, has a constitution, board of 6 elected people

381
Q

What does the Joint Pharmaceutical Analysis group do

A

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
Q

What are the objectives of NPCTAG

A

give advice of NHS pharmacy services
support education and training of pharmacy staff
a forum for communication with MHRA on clinical trial issues

383
Q

What does the PCCPN do

A

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

Pharmacy Pre-Registration (5 decks)

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