PH2113 - Abuse of drugs in theory & practice 4 Flashcards
What details need to be on a prescription for Controlled Drugs?
Dose - clearly defined - "as directed" is not acceptable Form Strength - if more than one available Total quantity - words and figures Patient's name - schedule 2 and 3 CDs - must be returned to prescriber to be amended Patient's address - schedule 2 and 3 CDs - must be returned to prescriber to be amended Prescriber name Prescriber's address - must be in the UK Signature - recognisable
When does a prescription for a Controlled Drug not need to be returned to the prescriber to be amended?
Minor typographical or spelling errors
Total quantity specified in either words OR figures, but not both
Are emergency supplies of Controlled Drugs allowed?
Not for Schedule 2 or 3 Controlled Drugs
- except phenobarbitone if is for the treatment of epilepsy
Emergency supplies of Schedule 4 and 5 Controlled Drugs are allowed
What wording must be added to a prescription for a Schedule 2 or 3 Controlled Drug from a dentist?
“For dental treatment only”
Who can request supplies of Controlled Drugs from a community pharmacy?
Practitioner
Person in charge of a hospital, organisation providing ambulance services or care home
Person in charge of a laboratory
Owner or master of a ship which has no doctor employed on board
Manager of an off-shore installation
- oil rig
Master of a foreign ship in port in Great Britain
Supplementary prescriber
Nurse independent prescriber
Pharmacist independent prescriber
Person who is a registered paramedic
What are the legal requirements for a Controlled Drug requisition?
Signature of the recipient Name and address of the recipient Profession or occupation Total quantity required Purpose for which the CD is required
Which Schedule 2 Controlled Drugs are midwives allowed to possess for use in practice of her profession?
Diamorphine
Morphine
Pethidine
How are Schedule 2 Controlled Drugs supplied to midwives?
Midwives do not write requisitions to obtain supplies
- supplies can only be made on the authority of a midwives’ supply order
- name of the midwife
- occupation
- name of the person to whom the CD is to be administered or supplied
- purpose for which the CD is required
- total quantity required
- signature of the appropriate medical officer
- doctor authorised in writing by the local supervising authority
How long should a midwives’ supply order be kept for?
After entering the supply in the appropriate register (CD register or POM book) you should retain the original midwives’ supply order for two years
What is an instalment prescription?
Allow repeat supplies of Schedule 2 or 3 Controlled Drugs (and some other CDs) on an NHS prescription
- treatment of substance misuse of opioids and other drugs of abuse to provide substitution therapy during a withdrawal programme
- methadone
- buprenorphine
- dexamfetamine
What information is needed on an instalment prescription?
Amount of medicine per instalment
Interval between each time the medicine can be supplied
Dose and instalment amount specified separately
What is Wernicke-Korsakoff syndrome?
Degenerative brain disorder associated with alcoholism
Which is the communicating part of the brain?
Corpus callosum
What effect does alcohol have on the cerebellum?
Staggering
What effect does alcohol have on the brain stem?
Breathing
Temperature control
Consciousness
What effect does alcohol have on the chemicals in the brain?
Alcohol directly targets the brain
- specific systems
- GABA
- inhibitory
- increases activity
- sluggish movement
- slurred speech
- sleepiness
- Glutamate
- excitatory
- inhibits the neuronal driver
- Dopamine and serotonin
- pleasure transmitters enhanced by alcohol
How is the brain affected by alcohol?
Excessive alcohol
- increased GABA
- decreased glutamate
- increased dopamine
- confusion
- lack of motor control
- slurred speech
Alcohol withdrawal
- decreased GABA
- increased glutamate
- decreased dopamine
- hangover
- tremors
- Delirium Tremens
Repeated alcohol withdrawal
- severely decreased GABA
- severely increased glutamate
- severely decreased dopamine
- severe seizures
- increased risk of hospitalisation
- anxiety
- altered subjective effects of alcohol
What are the conditions needed for change regarding alcohol dependence?
Engagement - motivation Treatment - positive support - social behaviour and network therapies - behaviour change plan - cognitive behavioural therapies Recovery - building the recovery capital to sustain and build on change when treatment ends
What pharmacotherapy is available to help treat alcohol dependence pre-detoxification?
Oral thiamine
- important energy source in metabolism
- poorly absorbed in dependent drinkers
- alcohol prevents absorption
- deficiency in thiamine can lead to Wernickes-Korsakoff’s syndrome
Pabrinex
- administered either intravenously or intramuscularly
- IM within the community
- rapidly corrects the severe depletion of vitamin B and C
What pharmacotherapy is available to help prevent relapses when treating alcohol dependence?
Disulfiram (antabuse)
- blocks the processing of alcohol in the body
- compliance is increased when taken under supervision
- only suitable for clients pursuing abstinence
Acamprosate (campral)
- restores the disrupted changes in neurobiology
- alleviates alcohol cravings
- reduces reward drive
- safe in conjunction with alcohol
- no addiction potential
- works in approximately 30% of people
Naltrexone
- blocks the alcohol reward pathways
- opioid receptor antagonist
- needs liver function monitoring
- not suitable for methadone patients or patients using any opiates
