MEP

Question 1

Pseudoephedrine and ephedrine max doses OTC

Answer 1

Pseudoephedrine 720mg
Ephedrine 180mg
Cannot be sold together

Question 2

EHC products available OTC

Answer 2

Levonorgestrel 1500microgram eg Levonelle One Step (licensed 16 and over)
Ulipristal acetate 30mg eg EllaOne (not CI under 16 - can be used under 16 using professional judgement - look out for signs of abuse)

Question 3

EHC products: window of use

Answer 3

Levonorgestrel - max 72 hours (3 days)

Ulipristal - max 120 hours (5 days)

Question 4

EHC products: advanced sale

Answer 4

Legal- must be satisfied no signs of abuse, no signs of misuse, will only take appropriately

Question 5

OTC paracetamol sale limit

Answer 5

Up to 100 non-effervescent tabs, (unlimited sale of effervescent, liquid etc legal, use judgement)

Question 6

OTC aspirin sale limit

Answer 6

Up to 100 non-effervescent tabs (unlimited sale of effervescent, use judgement. Disp tabs =/= effervescent, sale limit applies to disp)

Question 7

OTC (dihydro)codeine sale limit

Answer 7

Good practice 32 unit doses (as pack size limit is 32 doses)

Question 8

Prescriptions from crown dependencies (Isle of Man, Channel islands)

Answer 8

Legal (CD 2&3 must have a UK prescriber address)

Emergency supplies made on a case by case basis

Question 9

Repeatable prescriptions

Answer 9

Private prescriptions
Contain a direction that they can be
dispensed more than once e.g. “repeat x 5”
If no number stated, only repeat once (unless oral contraceptive, can be dispensed up to 6 times)

Question 10

Repeatable prescriptions: CDs

Answer 10

Schedule 2,3 - not allowed

Schedule 4, 5, allowed

Question 11

Repeatable prescriptions: validity

Answer 11

Must be first dispensed w/i 6 months of date (28 days if CD 4). Subsequent supplies, no time limit - use judgement

Question 12

Repeatable prescriptions: patient wants to keep the prescription

Answer 12

Okay, can be dispensed at multiple pharmacies. Need to annotate on prescription in indelible ink the date of supply and address of supplying pharmacy

Question 13

Instalment prescriptions

Answer 13

Used for supply of CDs. Single prescription, multiple installments (eg Methadone daily dispensing scripts)

Question 14

Validity of owings

Answer 14

GSL, P and POM medicines: 6 months from date on prescription.
Schedule 2,3,4 CDs: 28 days
(Owed items should be supplied within validity period)

Question 15

POM register details required

Answer 15

Supply date, prescription date, medicine details (name, quantity, strength, form), prescriber details (name and address), patient details (name and address)
Entry should be made on date of supply, in extenuating circumstances, can be next day

Question 16

POM register: when to enter

Answer 16

Private prescriptions
CD 2s not legally required in POM register as in CD register (CD 2,3 private scripts need to be sent to NHS)
Oral contraceptives do not need to be entered.
Supply of salbutamol inhalers/ adrenaline autoinjectors to schools (good practice if retained order, legal requirement if not retained).

Question 17

Supply of salbutamol inhalers to schools

Answer 17

Order must be by headteacher/principal, contain name of school, why it is needed, total quantity required (no legal limit, use prof judgement). Must enter into POM register or keep order for two years (gp to do both). May be asked to teach how to use and any relevent info, advise on how to select the most appropriate spacer devices/how to use

Question 18

Supply of adrenaline autoinjectors to schools

Answer 18

Order must be by headteacher/principal, contain name of school, why it is needed, total quantity required (no legal limit, use prof judgement). Must enter into POM register or keep order for two years (gp to do both). May be asked how to use and advice on storage, disposal, miss fired or expired stock. Need to explain the importance of keeping record of stock and ensuring that they haven’t expired.

Question 19

Supply of naloxone by individuals employed or engaged in the provision of drug treatment

Answer 19

Naloxone remains a POM, but Human medicines regulations (amendment 3) allows staff engaged or employed in “lawful drug treatment services” to obtain naloxone from wholesalers, and make direct supplies without prescription, PGD, PSD. Groups allowed to provide include those working for: an NHS body, a local authority, PHE, or public health agency. This therefore includes pharmacists providing needle and syringe programs and opiate substitution. Supplies can be made be adequately trained staff without a RP. Anyone can administer legally to save a life.

Question 20

Dispensing self prescribed/prescribed for close family members/friends

Answer 20

Generally considered poor practice to self prescribe/prescribe for those with close relationships, professional judgement may be impaired. Remember with CDs - a referral to local CD accountable officer may be required, risk of abuse of CDs.

Question 21

Oral retinoids

Answer 21

Supply must be initiated by consultant dermatologist. PPP: includes education, therapy management, contraception requirements and distribution control.
Risk of pregnancy: prescription validity : 7 days only. Quantity: max 30 days supply. Any supply over 30 days must be confirmed with prescriber as patient not being in PPP. Emergency supply: only if confirm with prescriber as being negative in last 7/7.

Question 22

Sodium valproate in those with (future) childbearing potential

Answer 22

Valproate used in epilepsy, Bipolar & migraine prevention (unlic). Only used in women and girls as last resort and under PPP.
Need to ensure that patients are aware of risks and under a PPP. Need to advise if planning to get pregnant to schedule appointment with prescriber before stopping. If unplanned pregnancy, continue taking, risk is greater if epilepsy uncontrolled.

Question 23

Originator biologics, biosimilar

Answer 23

Originator, first on market, biosimilar = similar to originator. Biosimilars are not generics. All biosimilars/originators must be prescribed by brand name. Eg: insulin glargine is drug, lantus is originator, abasaglar is biosimilar.

Question 24

Doctor prescribing restrictions

Answer 24

CDs: needs a home office license for cocaine, dipipanone, diamorphine for addiction. Address must be w/i UK.

Question 25

Pharmacist prescribing restrictions

Answer 25

CDs: not cocaine, dipipanone, diamorphine for addiction.
Unlicensed: yes.
All meds must be w/i competency, can authorise emergency supply (inc phenobarbital for epilepsy)

Question 26

Physio prescribing restrictions:

Answer 26

CD: diazepam, dihydrocodeine, lorazepam, oxycodone, temazepam (all po only. Morphine po or inj, fentanyl t/d.
Unlicensed: off label only.
All meds must be w/i competency, can authorise emergency supply (NOT inc phenobarbital for epilepsy)

Question 27

Podiatrist prescribing restrictions:

Answer 27

CD: diazepam, dihydrocodeine, lorazepam, temazepam (po only)
Unlic: Off label only.
All meds must be w/i competency, can authorise emergency supply (NOT inc phenobarbital for epilepsy)

Question 28

UK dentist prescribing restrictions:

Answer 28

CDs: not cocaine, dipipanone, diamorphine for addiction.
Unlic: Yes
Legally can prescribe anything, good practice to only prescribe w/i field - NHS scripts limit to dental formulary.
can authorise emergency supply (inc phenobarbital for epilepsy)

Question 29

Supplementary prescriber restrictions:

Inc pharmacist, midwife, nurse, chiropodist, dietician, podiatrist, physio, radiographer, optometrist)

Answer 29

CDs: not cocaine, dipipanone, diamorphine for addiction. Address must be w/i uk unless CD4/5.
Unlic: yes
Can only prescribe w/i competence and included w/i an agreed clinical management plan. Can authorise emergency supply (NOT inc phenobarbital for epilepsy)

Question 30

Nurse IP restrictions

Answer 30

CDs: not cocaine, dipipanone, diamorphine for addiction. Address must be w/i uk unless CD4/5.
Unlic: Not reimbursed in scotland
Can only prescribe w/i competence, can authorise emergency supplies inc phenobarb for epilepsy

Question 31

Optometrist IP restictions

Answer 31

No CDs. Unlicensed: only off label. For occular conditions affecting eye/surrounding tissue only. can authorise emergency supplies

Question 32

Therapeutic radiographer IP restrictions

Answer 32

CDs: looks like yes? (tramadol, lorazepam, diazepam, morphine, codeine, oxycodone oral and morphine injection). Unsure if passed into law.
Unlicensed: Only off label. Can only prescribe within competence. can authorise emergency supplies not including phenobarb for epilepsy

Question 33

Veterinary surgeon and veterinary practitioner restrictions

Answer 33

CDs: yes- must be UK address except CD4,5. For CD2,3, must have RCVS reg number.
Unlicensed: yes, subject to treatment cascade
FOR ANIMALS ONLY - no emergency supplies legal

Question 34

EEA/Swiss prescribers restrictions

Answer 34

CDs: CD4,5 only. No unlicensed, only items with market authorisation (eg. no fludrocortisone for post hypo). Can authorise emergency supplies

Question 35

Community practitioner nurses restrictions

Answer 35

restricted to dressings, appliances and medicines in nurse prescribers formulary- can authorise emergency supplies

Question 36

Paramedic IP restrictions

Answer 36

CDs: subject to legal change. Only off license, no unlicensed. Must be w/i competence. Can authorise emergency supplies, including phenobarbital for epilepsy.