MEP and RTS Flashcards
What is colic ?
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.
Colic; what is the rule of three?
Colic usually lasts:
At least 3 hours a day
At least 3/7
At least 3/52.
Colic; questions to ask parents?
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?)
Colic; differential diagnosis?
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)
Colic; treatment?
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
What are the additional requirements needed on a veterinary POM-V / POM-VPS Rx?
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.
Rules for the veterinary cascade?
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”.
What additional labelling is needed for products dispensed under the cascade?
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”.
If a medicine is not prescribed the cascade you do not have to legally label it, however what are the professional requirements?
Name and address of pharmacy
Name and address of animal owner
Dispensing date
*At the minimum
How long are records kept for POM-V and POM-VPS?
5 years
What additional things are to be recorded for POM-V and POM-VPS (as well as normal record requirements)?
Batch number
How often to audit if pharmacy stocks veterinary medicines?
Annual audit of veterinary medication
Veterinary; CD requirements?
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”
Categories of veterinary medicines?
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
Difference between human and vet CDs Rx?
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
What does the HMR say about OTC ephedrine and pseudoephedrine?
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.
What advice has the MHRA issued regarding cough / cold medicine in children?
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
What are the legal requirements to prescriptions as specified by the HMR 2012?
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)
What are the additional prescription requirements for Sch 2 and 3?
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)
What are non legal considerations of CD Sch 2 and 3 prescriptions?
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
What can a pharmacist amend on a Sch 2 / 3 Rx?
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
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?
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
What are the five double checks to prevent medication errors? Hint “right X”
Right medicine Right patient Right dose Right route Right time
How long to notify the ICO if data breach under the General Data Protection Regulation?
Without undue delay within 72 hours, If later must provide a valid reason.
