MEP and RTS

Question 1

What is colic ?

Answer 1

Common condition affecting babies leading to excessive, intense, severe inconsolable crying and exhibit clenched fists/ arched back / drawn up knees, facial redness. In serious cases may lead to failure to thrive, dehydration and electrolyte imbalance.

Potential causes are lack of lactase enzyme, inability to regulate crying response, food protein allergy, psychosocial (parental anxiety, poor infant family relationship) and women smoking during pregnancy.

It can be reduced with maternal support and high partner involvement in care.

Question 2

Colic; what is the rule of three?

Answer 2

Colic usually lasts:
At least 3 hours a day
At least 3/7
At least 3/52.

Question 3

Colic; questions to ask parents?

Answer 3

Baby eating normally?
Baby growing?
High temperature?
Normal stools?
Colic free periods?
Does crying follow a pattern? (Cry diary) 

Warnings:
Weak high pitched crying?
Floppy when lifted?
Reduce fluids? Passes less urine?
Vomited green fluid?
Blood in stools?
Fever over 38 if under 3 months or over 39 if 3-6 months
High temp but cold extremities?
Bulging Fontanelle? 
Blue, blotchy, pale?
Breathing difficulties? 
Meningitis signs (e.g. purple red rash) 
Poor growth?
Refusing to feed due to pain? 
How long has it lasted (not improved after 4 months?)

Question 4

Colic; differential diagnosis?

Answer 4

Constipation (solid pellets. Should be 5cm and soft)

Caffeine and spices in Mother’s diet (can pass through breast milk)

GORD (vomiting, coughing, irritability, poor feeding and blood in stools)

Question 5

Colic; treatment?

Answer 5

Non pharm- Picking up, wrapping baby, warm bath, burping after feeding, massage

Pharm -
Lactase (trial for one week, can be used until 3/4 months)
Simeticone (release trapped air)
Probiotics
Fennel oil

Question 6

What are the additional requirements needed on a veterinary POM-V / POM-VPS Rx?

Answer 6

Prescriber phone no.
Prescriber qualification
Name address of owner (and where animal kept if different)
Animal ID (including species)
Withdrawal period (if relevant)
Any necessary warnings
“For administration under the cascade” if necessary

6 month validity (except CDs)
If repeatable all supplies < 6 months.

Question 7

Rules for the veterinary cascade?

Answer 7

Supply vet product if exists

Unlawful to supply human product against veterinary Rx unless states “for use under the cascade”

Can’t supply product vet licensed for another species/ for another clinical condition in the same or different species or extemp medicine unless states “for administration under the cascade”.

Question 8

What additional labelling is needed for products dispensed under the cascade?

Answer 8

Prescriber name
Name and address of owner
Animal ID and species
Supply date
Product expiry
Warnings for use
Withdrawal period (if there is one)
“For animal treatment only”.

Question 9

If a medicine is not prescribed the cascade you do not have to legally label it, however what are the professional requirements?

Answer 9

Name and address of pharmacy
Name and address of animal owner
Dispensing date

*At the minimum

Question 10

How long are records kept for POM-V and POM-VPS?

Answer 10

5 years

Question 11

What additional things are to be recorded for POM-V and POM-VPS (as well as normal record requirements)?

Answer 11

Batch number

Question 12

How often to audit if pharmacy stocks veterinary medicines?

Answer 12

Annual audit of veterinary medication

Question 13

Veterinary; CD requirements?

Answer 13

28 day expiry for Sch 2, 3, 4

RCVS prescriber registration number required for Sch 2 and 3.

“Item prescribed for herd / animal under care of veterinarian”

Question 13

Categories of veterinary medicines?

Answer 13

POM V

POM VPS - POM prescribed by veterinary surgeon, supplied by veterinary surgeon /pharmacist via written Rx

NFA VPS - POM prescribed / dispensed by vet surgeon / pharmacist / suitably qualified on oral / written Rx. Must be written if supplier not prescriber

AVM GSL - Medicine for non-food animals supplied by vet surgeon, pharmacist or suitably qualified (written Rx not needed)

SAES - meets exemption criteria in Sch 6 of VMR

UNAUTHORISED veterinary medicine - Unlicensed, not SAES eligible. Only prescribed by vet via cascade

Question 14

Difference between human and vet CDs Rx?

Answer 14

No standardised Rx needed for vet but does need “for animal under care….”

Retain vet for 5 years

Vet it is good practice for 28 days worth of treatment supplies (except long term)

RCVS registration number for Sch 2 and 3

Question 15

What does the HMR say about OTC ephedrine and pseudoephedrine?

Answer 15

Unlawful to supply combo or product with over 720mg Pseudoephedrine or over 180mg Ephedrine and they can’t be sold at the same time without a Rx.

Question 16

What advice has the MHRA issued regarding cough / cold medicine in children?

Answer 16

If under 6, the following are unsuitable (allergies, sleep disturbances, hallucinations and if over if between 6-12 they are second line (and 5 days max):
Antitussives -Pholcodine, Dextromorphan
Expectorants - Guaifenesin,Ipecacuanha
Nasal decongestants - ephedrine, phenylephrine, pseudoephedrine, oxymetazoline, xylometazoline
Antihistamines - Brompheniramine, chlorphenamine, diphenhydramine, doxylamine, promethazine, triprolidine

First line:
Hydration
Paracetamol or Ibuprofen
Saline nasal drops, vapour rubs, steam
Simple linctus/ glycerol, lemon and honey

Question 17

What are the legal requirements to prescriptions as specified by the HMR 2012?

Answer 17

Signature - Appropriate practitioner in indelible ink or advanced electronic signature

Address of appropriate practitioner

Appropriate date - the later of signing date or date before which it should not be dispensed

Prescriber particulars - UK, EAA or Switzerland reg

Patient name

Patient address

Patient age (if <12 years)

Question 18

What are the additional prescription requirements for Sch 2 and 3?

Answer 18

Signature - Can be signed by another prescriber other than named but address needs to be applicable to signatory and the signatory needs to be put in the CD register

28 day validity after appropriate date (either signature date or date indicated by prescriber).

UK prescriber address

Clearly defined dose

Formulation - caps and tabs ok

Total quantity (words and figures)

Strength if more than one available (should be separate if multiple of same medication)

Patient name and address (No fixed abode / NFA accepted but not PO box)

“For dental treatment only” for dentist written CD Rx.

Valid instalment direction where appropriate (amount of med per instalment and interval between each supply)

Written in indelible ink (can be computer generated)

Mark the Rx with the date of supply at time supply made

No more than 30 days supplied (not legal but must be able to be justified clinically if more)

Question 19

What are non legal considerations of CD Sch 2 and 3 prescriptions?

Answer 19

Name of medicine is not legal requirement but needed to ID medicine and good practice as SPC

SF and CF products have greater abuse potential so RPS advise to supply only if needed.

Recommendation is 30 days supply but can give over if clinically justifiable

Question 20

What can a pharmacist amend on a Sch 2 / 3 Rx?

Answer 20

If the total quantity is missing words OR figures (not both) or minor typos / spelling error and the pharmacist is satisfied it is genuine and in accordance to prescribers directions they can amend it indelibly and put their name, signature, GPhC reg and date

Question 21

A patient presents with blistering around the mouth, what further questioning is needed to identify cold sores? How would you rule other things out? What requires referral?

Answer 21

Cold sores are associated with a prodromal period starting with tingling, itching or burning on lips before the blisters form, burst and crust. Ask patient if stressed, been ill, exposed to sunlight and if menstruating.

Axial cheilitis won’t have a prodromal period and neither will sycosis / tines barbae (which normally presents in middle aged men who shave)

Impetigo could be ruled out due to lack of prodromal period and can spread to the limbs it will also start out red and weepy before crusting. It is more common in children. This would require referral.

Infective eczema would also require referral (ask about Hx of eczema)

Referral:
Secondary bacterial infection (malaise/ fever, weeping sores)
Infective eczema
Atopic eczema getting cold sores
Immunocompromised (e.g. ask medication?)
If over two weeks (normally 10-14 days)
Eye affected

Question 22

What are the five double checks to prevent medication errors? Hint “right X”

Answer 22

Right medicine
Right patient
Right dose
Right route
Right time

Question 23

How long to notify the ICO if data breach under the General Data Protection Regulation?

Answer 23

Without undue delay within 72 hours, If later must provide a valid reason.

Question 24

Who can be the Data Protection Officer in the pharmacy?

Answer 24

A named individual in the pharmacy business or an external data protection adviser.

Question 25

What is the change in monetary fines that come with the GDPR?

Answer 25

Increased from £500,000 to £17.9 million (20 million euros) or 4% of annual worldwide turnerover - highest taken.

Question 26

Under what situations can a patient ask for the right to erasure (one month to respond)?

Answer 26

Consent is withdrawn, data not necessary anymore, objects to data held for marketing purposes, have processed it unlawfully, to comply with legal obligation

Question 27

You sign in as reponsible pharmacist but have to leave to speak in person to a GP, you will be gone for one hour but contactable via phone, what can staff do?

Answer 27

GSL can be sold during this time but nothing else (no dispensing, giving out Rx.