PH2113 - Abuse of drugs in theory & practice 4

Question 1

What details need to be on a prescription for Controlled Drugs?

Answer 1

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

Question 2

When does a prescription for a Controlled Drug not need to be returned to the prescriber to be amended?

Answer 2

Minor typographical or spelling errors

Total quantity specified in either words OR figures, but not both

Question 3

Are emergency supplies of Controlled Drugs allowed?

Answer 3

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

Question 4

What wording must be added to a prescription for a Schedule 2 or 3 Controlled Drug from a dentist?

Answer 4

“For dental treatment only”

Question 5

Who can request supplies of Controlled Drugs from a community pharmacy?

Answer 5

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

Question 6

What are the legal requirements for a Controlled Drug requisition?

Answer 6

Signature of the recipient
Name and address of the recipient
Profession or occupation
Total quantity required
Purpose for which the CD is required

Question 7

Which Schedule 2 Controlled Drugs are midwives allowed to possess for use in practice of her profession?

Answer 7

Diamorphine
Morphine
Pethidine

Question 8

How are Schedule 2 Controlled Drugs supplied to midwives?

Answer 8

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

Question 9

How long should a midwives’ supply order be kept for?

Answer 9

After entering the supply in the appropriate register (CD register or POM book) you should retain the original midwives’ supply order for two years

Question 10

What is an instalment prescription?

Answer 10

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

Question 11

What information is needed on an instalment prescription?

Answer 11

Amount of medicine per instalment
Interval between each time the medicine can be supplied

Dose and instalment amount specified separately

Question 12

What is Wernicke-Korsakoff syndrome?

Answer 12

Degenerative brain disorder associated with alcoholism

Question 13

Which is the communicating part of the brain?

Answer 13

Corpus callosum

Question 14

What effect does alcohol have on the cerebellum?

Answer 14

Staggering

Question 15

What effect does alcohol have on the brain stem?

Answer 15

Breathing
Temperature control
Consciousness

Question 16

What effect does alcohol have on the chemicals in the brain?

Answer 16

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

Question 17

How is the brain affected by alcohol?

Answer 17

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

Question 18

What are the conditions needed for change regarding alcohol dependence?

Answer 18

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

Question 19

What pharmacotherapy is available to help treat alcohol dependence pre-detoxification?

Answer 19

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

Question 20

What pharmacotherapy is available to help prevent relapses when treating alcohol dependence?

Answer 20

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