MEP - CDs Flashcards
What are the 5 pieces of legislation that relate to CDs?
Misuse drug act 1971
Misuse drugs regulations 2001
Misuse drug (safe custody) 1973.
Health Act 2006
CD regulations 2013
What did the 1971 Misuse drugs act introduce?
Prohibit possession, suply, manufacture and import/export of CDs.
What did the Health act 2006 introduce?
Concept of “accountable officer” and SOPs in place for managing CDs.
What are the 5 roles of the accountable officer?
- Oversight, monitoring and audit of CDs.
- Ensuring SOPS in place for recording incidents with CDs.
- Attend local intelligence network meetings.
- Submit occurrence reports describing details of any concerns the organisation had regarding mgmt of CDs.
- Appoint authorised witness for CD destruction.
Name of Sch 1?
CD Lic POM
Name of Sch 2?
CD POM
Name of Sch 3?
CD no reg POM
Name of Sch 4?
(i) CD Benz POM
(ii) CD Anab POM
Name of Sch 5?
CD Inv P and CD Inv POM
Describe Sch 1 CDs + eg?
No therapeutic use
Need home office license to possess.
LSD, ecstacy-type, raw opium cannabis.
Describe Sch 2 CDs + eg?
Pharmacist and other persons named in 2001 reg have authority to possess, supply and procure.
Eg - opitates, major stimulants (amphet), quinalbarbitone and ketamine.
Describe Sch 3 CDs + eg?
No CD register POMs but some may have storage requirements.
Eg - minor stimulants and others (tramadol, midazolam, buprenorphine, temazepam).
Gabapentin and pregabalin now also.
What are the Sch 3 CDs that have storage requirements?
Buprenorphine
Temazepam
Describe Sch 4 (i) CDs + eg?
CD Benz POM
benzo’s (diazepam)
non-benzo hypnotics (z-drugs)
Sativex (cannabinoid oromucosal mouth spray).
No storage requirements.
Describe Sch 4 (ii) CDs name + eg?
CB Anab POM
anabolic and androgenic steroids,
clenbuterol
growth hormone.
Describe Sch 5 CDs + eg?
Preparations of some CDs which are exempt from full control when present in low quantities.
eg codeine, morphine and pholcodeine.
Which schedules have Rx requirements?
Sch 2 + 3
How long are Rx for CDs valid for?
Sch 2, 3, and 4 - 28 days.
Sch 5 - 6 months.
For which CD schedules does the prescriber address need to be within UK?
Sch 2 + 3
EEA and Swiss prescribers can legally prescribe which Schedules of CDs?
Sch 4 + 5
For which schedules of CDs are prescriptions repeatable?
Sch 4 + 5
Are emergency supplies allowed for CDs?
Allowed for all sch 4 + 5.
Allowed for phenobarbital (Sch 3) for indication of epilepsy by a UK-reg prescriber.
For which schedules is a CD requisition necessary?
Sch 2 + 3
For which schedules must invoices be retained in pharmacy for 2 years?
Sch 2 + 5!
Not for Sch 1 - wouldn’t have these in pharmacy from normal wholesaler.
Is a licensed needed for import/export of CDs?
Yes for all schedules except 5.
Sch 4 (ii) - steroids - can be imported without licence for personal use.
What are the 6 legal requirements for a CD requitision?
- Recipient - Signature
- Recipient - Name
- Recipient - Address
- Recipient - Profession/occupation
- Total quantity of drug
- Purpose of requisition
What 3 CDs can be obtained on a midwife supply order?
diarmorphine
morphine
pethidine
What 6 things must a midwife supply order contain?
- Name of midwife
- Occupation of midwife
- Name of person to whom CD is to be administered.
- Purpose for which CD is required.
- Total quantity to be obtained.
- Signature of appropriate medical officer - doctor authorised to supervise.
What are the 12 Rx requirements for CDs?
- Pt name
- Pt address
- Name
- Strength
- Form
- Qty - W+F
- Dose
- Instalments
- Date
- Px signature
- Px particulars
- Px address
Can a CD be signed for by another prescriber?
YES - as long as address on Rx is still applicable for signatory.
How long are CD Rx’s valid for?
28 days - including Sch 4 (i) and (ii) CDs.
How long are owing “balances” valid for, for CD Rx’s?
28 days - same validity as Rx.
Is the strength required on ALL CD Rx’s?
Can only be omitted if medicine is only available in ONE strength.
How many days should be prescribed for CDs?
Should NOT exceed 30 days - but only direction - not legal requirement.
What must be included on a CD dental rx?
“for dental Tx only” wording.
Is the “name” of the CD on Rx a legal requirement ?
No - only good practice - cannot dispense without it?
Is “as directed” a legal dose?
No
Is “PRN” a legal dose?
No
Is “as per chart” a legal dose?
No
Is “weekly” a legal dose?
No - only a frequency - no actual dose.
Is “twice a day” a legal dose?
No - again only a frequency - no actual dose.
Is “two PRN” a legal dose?
Yes - dose is 2 - frequency is PRN
What are the 2 instalment directions legally required?
- Amount per instalment
2. interval between each instalment.
For which Sch CDs is instalment wording legally required?
Sch 2 + 3
Can instalments be dispensed beyond 28 days for Sch 2 + 3 CDs?
YES - provided the first instalment is dispensed within the 28 day window.
What is the max number of days Tx that can be missed on ORT before prescriber needs to be contacted?
3 days Tx - then pt may have lost tolerance and may need dose reduced.
Can private Rx be written on any form?
Yes - private Rx do not need to be on standardised form.
Can private Rx for CDs be on any form?
No must be on standardised form.
PPCD(1) Scotland.
FP10 PCD England.
In England, what must be present on a private Rx CD from the prescriber?
Prescriber ID number - different form GMC number.
Do private Rx for CDs need to be submitted?
YES - pharmacy must submit original private Rx for CD with ID code for pharmacy (not Scotland).
Do vet private Rx for CDs need to be on standard forms?
No - can be on normal paper.
What are the 3 considerations for private Rx for CDs?
- Standardised form?
- Prescriber ID number required?
- Submission required (Pharmacy ID Number?)
Can a representative collect on behalf of a drug misuse pt?
Yes - if pt provides a letter detailing who is collecting on their behalf.
Representative also needs ID.
Can police collect on behalf of a substance misuse pt?
Yes - but need letter from pt naming the police officer who will collect.
Do you need a new letter each time someone else collects for subs misuse pt?
Yes
Which CDs require denaturing before disposal?
Sch 2, 3 and 4(i)
When would CD denaturing require witnessing by authorised person?
If there is a requirement to make a register entry = denaturing requiring witnessing.
Is an authorised witness required for destruction of pt returned stock?
NO - would not write this in CD register - so no need for witnessing.
What 3 things are required in CD register when receiving CDs?
- Date
- Name, address from whom received.
- Qty received.
What 7 things are required in CD register when CDs are supplied?
- Date
- Name + address of recipient
- Details of authority to possess - Px details.
- Qty supplied
- Person collecting
- Whether proof ID was requested
- Whether proof ID was given.
What 4 stipulations are made about entries in CD register?
- Should be chronological
- Entered promptly.
- In ink or indelible.
- Unadultered.
How long should CD registered be kept after date of last entry?
2 years
How should spent methadone bottles be disposed or?
Rinsed and liquid added to denaturing kit.
What Sch are cannabis-based products for medicinal use (CBPM)
Sch 2
Describe Sativex?
Contains cannabis extracts - TCH and CBD.
Licensed in UK for Tx for spasticity in MS.
What Sch is Sativex?
Sch 4
What is Nabilone and its license?
synthetic non-natural cannabinoid
Tx resistant n+v in chemo - no response to normal anti-emetics.
What is Epidiolex and license?
Pure CBD approved by FDA for Lennox-Gastaut syndrome and Dravet syndrome in pts 2yo and older.
Not licensed in UK.
Is Epidiolex available in UK?
Yes - as unlicensed “special” through Extended Access Scheme.
