MEP Flashcards
1
Q
What are the four principles of medicines optimisation
A
safety
patient experience
evidence based
part of routine practice
2
Q
What are the new CPD (or revalidation) requirements?
A
- 4 entries a year
- minimum 2 planned learning
- maximum 2 unplanned learning
- 2 additional records must be submitted from end of 2019: one peer discussion and one reflective account.
3
Q
what is the hierarchy of research?
A
meta analysis systematic reviews RCTs cohort studies case studies expert opinion
4
Q
What are the 9 GPHC standards for pharmacy professionals?
A
- professionalism
- professional judgement
- maintain, develop, use professional knowledge
- leadership
- patient centered care
- communication
- working in partnership with others
- observe confidentiality
- speak up when things go wrong
5
Q
What is a PO medicine?
A
A GSL medicine that the manufacturer wants to restrict sales to pharmacies only. e.g 30 sachet packs fybogel
6
Q
Which wording must be prominent on codeine and dihydrocodeine?
A
Can cause addiction. For three days use only
7
Q
Can cough and cold medicines (antitussives, expectorants, decongestants) be given to children under 12?
A
Not for children under 6
For children 6-12 years old they should be used second line and not for more than five days.
8
Q
What is the age restriction for codeine linctus?
A
12 years- contraindicated
12-18 not recommended
9
Q
What are the 7 prescription requirements?
A
- Signature
- Address of prescriber
- Date
- Particulars (type of prescriber)
- Patient name
- patient address
- age of patient (if under 12)
10
Q
What is the law in regards to repeat prescriptions?
A
- If a number of times to be repeated isn’t stated it can only be repeated once (twice in total). If it’s an oral contraceptive, it can be repeated 5 times.
- CANNOT repeat schedule 2+3 but can for 4+5
- First dispensing must be within 6 months, after that there is no legal time limit
- For schedule 4, first dispensing must be within 28 days after which there is no time limit.
11
Q
How long is an owing valid for?
A
6 months
28 days (from date on script/ start date on the script) for schedule 2,3,4
12
Q
How long should a private prescription be retained?
A
2 years
Private scripts for CD 2 and 3 must be submitted to the relevant NHS agency.
13
Q
Which prescriptions are exempt from record keeping?
A
Prescriptions for oral contraceptives
Prescriptions for schedule 2 CDs where a separate CD register entry has been made.
14
Q
Are the details of a medicine a legal requirement on a prescription?
A
No
15
Q
Are faxed prescriptions legally valid?
A
No
NOTE: Supplying a schedule 2/3 CD this way is a ciminal offence.
16
Q
Can dentists prescribe any POM?
A
Yes- on a private script
No on an NHS dental prescription form.
17
Q
What patient and prescriber details are required by law on an EEA prescription?
A
Patient: full name and DOB
Prescriber: full name, qualifications, contact details, work address (including country)
18
Q
Which medicines are not available on EEA prescriptions?
A
CDs schedule 1,2,3
Medicines without a UK marketing authorisation
19
Q
Can you supply phenobarbital for an emergency supply at the request of an EEA prescriber?
A
No
20
Q
Can you supply CD schedule 4 and 5 for an emergency supply at the request of an EEA prescriber?
A
Yes
21
Q
What are the exceptions to sale and supply of medicines without a prescription?
A
- Emergency supply
- PGDs/ PSDs
- Salbutamol inhalers for schools
- Naloxone for individuals providing drug services
- Pandemic exemptions
- Adrenaline auto injectors for schools
- Optometrist or podiatrist signed orders for patients
22
Q
What is a PGD? What is an example of this?
A
Written direction that allows supply of specific medicine(s) by a named authorised HCP to a well-defined group of patients for a specific condition
e.g diamorphine/ morphine for immediate necessary treatment of sick or injured persons.
23
Q
Within what timeframe must you receive a prescription after an emergency at the request of a prescriber?
A
72 hours
24
Q
Which three dates must be recorded in the POM register after an emergency at the request of a prescriber?
A
Date of supply
Date on prescription
Date prescription is recieved
25
What is the exception to the no CD schedule 1,2,3 rule for emergency supplies?
Phenobarbital for epilepsy
26
What is the maximum length of treatment that can be supplied for an emergency supply at request of the patient?
30 days
5 days if its a CD
oral contraceptive- full course
Smallest pack available if inhaler or cream, insulin etc
27
Do you need to state the nature of the emergency in the POM register record for an emergency supply?
Yes- if its at the request of the patient
| No if its the request of the prescriber
28
Must the wording 'emergency supply' be present on the label for an emergency supply?
Yes- if its at the request of the patient
| No if its the request of the prescriber
29
What are the exceptions when it comes to a pandemic?
When the DOH relaxes legislation on emergency supplies so the pharmacist wouldn't have to interview the patients.
Medicines may need to be collected from designated collection points that don't need to be pharmacies or have a pharmacist present.
30
Should signed orders from optometrists or podiatrists be recorded in the POM register?
Yes
31
What is required for supply of salbutamol to schools?
A written order from the head teacher with:
name of the school, purpose and quantity required
Either retain the signed order for 2 years OR make an entry in the POM register.
Doesn't have to be on headed paper.
32
What is required for supply of adrenaline auto-injectors to schools?
A written order from the head teacher with:
name of the school. purpose and quantity required
Either retain the signed order for 2 years OR make an entry in the POM register.
Doesn't have to be on headed paper.
33
Who can be supplied naloxone for the purpose of saving a life in an emmergency?
What is the dose?
Anyone (family members, friends etc of adicts)- as long as members of staff engaged in drug treatment services give this supply.
IM- 400mg every 2-3 mins until ambulance arrives/ takes effect.
34
Is it illegal for a doctor to prescribe for himself?
No- poor practice
35
What are the rules surrounding isotretinoin prescriptions?
Women of childbearing potential must be on the PPP and must remain on PPP at least 1 month after stopping.
- Prescription valid for 7 days only (neg pregnancy test must be specified)
- Maximum 30 days supply if patient is on PPP
- Can only supply as an emergency if its at the request of prescriber and they confirm pregnancy status within last 7 days is negative.
36
What is the latest information about valproate use in women of childbearing potential?
Contraindicated in women of childbearing age. Only to be used if conditions of PPP (pregnancy prevention programme) are met and ONLY for EPILEPSY when there are no other options
PPP
- Given patient card + guide, review by specialist within last year, on highly effective contraception.
- Annual review with specialist- complete and sign risk acknowledgement form
- Pharmacists must dispense whole packs where possible, warning label (or sticker) on all containers, discuss risks each time a prescription is collected.
If pregnancy occurs, do not stop taking see Dr asap.
37
What should also be recorded when reporting an ADR for a biologic or biosimilar?
Proprietary name, brand name, batch number
38
What is the biosimilar of lantus (insulin glargine) ?
abasaglar
39
How should biologics be prescribed?
By brand
40
Which prescribers registered in the UK have the same rights as doctors from the UK except cocaine or diamorphine for treating addiction?
Pharmacists
Dentists
Nurse independent prescriber
Supplementary prescribers in all fields (only in an agreed clinical area)
NOTE: dentists and nurses limited to what they can prescribe on an NHS form but not on a private script.
41
Can vets prescribe for humans under any circumstances? Can they prescribe CDs?
No
Vets can prescribe CD 4+5 (for animals)
They can only prescribe CD 2+3 if they are surgeons and have their registration number on the prescription.
42
Can EEA prescribers prescribe CDs? Unlicensed meds?
Only CD 4+5
No to unlicensed meds
Only medicines with a UK MA can be prescribed.
43
What are community practitioner nurses allowed to prescribe?
Meds on the nurse prescriber's formulary only
| No CDs or unlicensed medicines.
44
What are optometrist independent prescriber's allowed to prescribe?
Medicines for ocular conditions for the eye area only
| No CDs and only off-label not unlicensed.
45
What are physio + podiatrist independent prescriber's allowed to prescribe?
A set list of CDs, off label meds (not unlicensed)
| Can request emergency supplies but not CDs
46
What records should be kept when wholesaling from a pharmacy (selling stock to another HCP)?
Entry in the POM register or keep the invoice for at least 2 years.
NOTE: a wholesale license is required
47
What is a POM-V prescription?
POM that can only be prescribed by a veterinary surgeon and can be supplied by a pharmacist or vet surgeon with a written prescription.
48
What is a POM-VPS prescription?
Can be prescribed and supplied by a suitably qualified person using an oral or written prescription. Written script only needed if the supplier is not the prescriber.
49
What is a NFA-VPS prescription?
Medicines for non- food animals. A written prescription is not required.
50
What is a AVM-GSL prescription?
Authorised vet med that is available for general sale
51
How long are vet prescriptions valid for?
| If repeatable when must all the repeats be issued?
6 months
| Issue all repeats within 6 months (of date on script)
52
What additional wording does a prescription for a schedule 2 or 3 CD for use in animals have?
'Prescribed for treatment of an animal or herd under my care'
53
Are standardised forms required for vet scripts?
| What about vet CD 2+ 3 scripts?
No (including CDs 2+3)
54
How long must you retain a vetinary CD script for?
| Is it submitted to the relevant NHS agency like human CD prescriptions?
5 years
No
55
What extra information is needed on a vetinary CD 2 and 3 prescription?
The prescriber's RCVS registration number
56
Do normal CD restrictions; valid for 28 days, quantity in words and figures apply to vet meds?
Yes
57
What wording must be on a label produced for a vetinary medicine?
'For animal use only'
58
Does a pharmacist need to be present for supply of vetinary medicines?
Yes
| Unless- authorised in advance by the pharmacist and the person handing out is judged to be competent.
59
If a medicine is not prescribed under the cascade, does it require a dispensing label?
No
60
Is it a requirement to keep records of receipt and supply of POM-V and POM-VPS meds?
Yes including batch number for at least 5 years.
61
What are examples of schedule 1 (CD LIC POM) drugs?
LSD, opium, cannabis
Not used medicinally
Home office license needed for production, possession and supply.
62
What are examples of schedule 2 (CD POM) drugs?
Opiates (morphine, methadone, pethidine oxycodone, diamorphine [heroin])
amphetamines
ketamine
quinalbarbitone/ secobarbital
63
What are examples of schedule 3 (CD NO REGISTER POM) drugs?
```
buprenorphine
tramadol
temazepam
midazolam
phenobarbital
barbiturates (except quinalbarb)
```
64
What are examples of schedule 4 part 1 (CD BENZ POM) drugs?
Benzodiazepines (diazepam)
hypnotics (zopiclone)
Sativex (cannabinoid mouth spray)
65
What are examples of schedule 4 part 2 (CD ANAB POM) drugs?
anabolic steroids and growth hormones (e.g clenbuterol)
66
What are examples of schedule 5 (CD INV POM/ P) drugs?
codeine, pholcodeine, morphine liquid.
67
Which CDs are subject to prescription requirements?
CD2 + 3
68
What are the requirements for CD drugs?
Dose must be specified
Quantity in words and figures
Formulation must be stated without abbreviation
30 days max recommended (not legal requirement)
69
After how many missed days of an instalment prescription should the prescriber be contacted?
3 days
70
What are pharmacists allowed to amend on CD scripts? What cant they amend?
They can amend: typos and quantity if either words or figures missing but not when both are missing.
Cannot amend: missing date, wrong dose, form or strength. Can only be corrected by the prescriber
71
How long is a CD valid for?
28 days?
| 6 months for CD 5
72
Which CDs require the address of the prescriber to be in the UK?
CD 2+3
73
Which CDs are repeatable?
CD 4 +5
74
Which CDs are eligible for supply as an emergency?
CD 4 + 5
NOT 2 + 3 only exception is phenobarbital for epilepsy
75
For which CDs is a requisition necessary?
CD 2 + 3
76
Which CD invoices must be retained for 2 years?
CD 3 + 5
77
After how long of travelling will a license be needed to carry CDs? What CDs does this affect?
3 months
| Affects Schedule 1,2,3,4
78
Does an approved form have to be used during requisitions of CD2 and CD3?
Yes
| Exceptions for hospice and prisons, or if it is in hospital within the same department/ legal entity.
79
Can a Schedule 2 or 3 CD be supplied to a doctor or dentist in an emergency?
Yes- if they agree a requisition will be provided within 24 hours. Failure to do this is an offence.
80
What is the approved requisition form for CDs?
FP10CDF
81
Who can access diamorphine, pethidine and morphine via signed order?
Midwives
| must be signed by a supervising doctor
82
Which controlled drugs require safe custody?
Schedule 1
Schedule 2 (except quinalbarbitone/ secobarbital and some liquids)
Schedule 3- buprenorphine and temazepam
83
Which patient returned medicines must be denatured before disposal?
Is an authorised witness required?
CDs schedule 2, 3, 4 part 1.
| No for AUTHORISED witness but they should show another member of staff especially if CD2.
84
Must an entry be made in the CD register for patient returned CD drugs?
No. A SEPARATE record should however be kept for patient returned CD2s.
85
Which expired/unwanted stock must be denatured before disposal?
Is an authorised witness required?
CDs schedule 2, 3, 4 part 1
Yes for authorised witness if CD2 only.
For other CDs they should just show a member of staff.
86
Must an entry be made in the CD register for expired/ unwanted CD drugs?
Yes for CD2 only
87
For which medicines should an entry be made in the CD register for receipt and supply?
CDs schedule 1+2
| sativex (CD schedule 4 part 1)
88
How long must CD registers be kept?
2 years from the date of the LAST entry
89
How can a used methadone bottle be disposed off?
Rinse out remaining bits with water into denaturing kit.
Remove labels and patient identifiable info.
Bottle can be thrown into the normal bin.
90
If a product is labelled as use by or use before 6/19, when is the last day it can be used?
31st May 2019
91
If a product is labelled as expiry date 6/19 when is the last day it can be used?
30th June 2019
92
Should tabs/caps be de-blistered when disposing of medicines?
No (except CDs that need de-blistering).
| But you can remove the blister strips from the outer box.
93
What is MCA and MDS?
Multi-compartment compliance aids
| monitored dosage system
94
When can a statuory medical defence be raised if caught driving with higher levels of the specified drugs in the road traffic act?
If there is evidence that the medicine has been taken in accordance with instructions from a HCP or the PIL
AND
Driving NOT impaired.
If driving is impaired it is still an offence even if its on prescription
95
Can an entry in the RP record be made remotely if it is electronic?
Yes
96
What is the maximum amount of time an RP can be absent for?
2 hours
97
If there are more than one RP in a day in a pharmacy, what is the maximum total period of absence for all the RPs?
2 hours
98
Which activities can occur if the RP is not physically present at the pharmacy?
The prescription assembly process (inc blister packs)
| Accuracy checking
99
Which activities can occur if the RP is phisically in the pharmacy premesis but not supervising (not in disp/ went out for whatever reason)
Sale of GSL
| Processing waste medicines and patient returns (except CDs)
100
Which activities can occur if there is no RP signed in?
- Ordering, receiving and putting away stock (excluding CDs)
- Processing scripts that have been dispensed + collected
- receiving patient returns (not CDs)
- Receiving scripts from eps or collecting from surgery
- Responding to questions (including about medicine use)
101
If a child (<16) has demonstrated competence wants to keep something confidential, are you allowed to tell their parents about their medicine?
No
102
Can P medicines be sold on a website?
Yes- if the website is associated with a registered pharmacy.
103
What are the 6 legal requirements of a CD requisition?
```
Recipients signature
Name of recipient
Address of recipient
Profession/occupation
Total quantity of drug
Purpose of requisition
```
104
What should be done if a bottle of methadone spills on the floor?
Clean it up with tissues and store the tissues in a bag in the CD cupboard.
Destruction of CDs need to be witnessed by an authorised person. This includes spillages.
105
How should a private script for a schedule 2 drug be processed after it has been dispensed?
It should be submitted to the relevant NHS authority.
106
How should a requisition for a schedule 2 drug be processed after it has been dispensed?
It should be submitted to the relevant NHS authority.
107
How should a veterinary prescription for a schedule 2 drug be processed after it has been dispensed?
It should be retained for 5 years.
NOTE: it is not submitted like other CD scripts.
108
How frequently should SOPs be reviewed minimum?
Every 2 years
109
How long should the written RP log (pharmacy log) be kept?
5 years from the date of the LAST entry
110
How long should the electronic pharmacy log (RP log) be kept?
5 years from the date of the FIRST electronic record
111
If you have an NHS prescription dated on 1/1/19 but the script says supply from 15/1/19 Which date do you go off in terms of validity?
The later date- 15/1/19
112
If you have a private prescription dated on 1/1/19 but the script says supply from 15/1/19 Which date do you go off in terms of prescription validity?
You always go off the date on the prescription 1/1/19.
113
Can private prescriptions for Schedule 2 + 3 CDs be on any paper?
No - must be on special form FP10PCD
114
If a veterinary prescription is for a product that is licensed in animals, must it say under the cascade on the prescription?
No
