pharmacology Flashcards
up to what age do you write the age of the patient on a prescription
12
what details of the drug should go on a prescription
name, formulation, dose, frequency, quantity to be dispensed
how should you write a prescription
black ink, block capitals
why should you not write “” on a prescription
can be confused for 11
do you write brand names on a prescription
no, generic prescribing unless clinically significant bioavailability between brands
what is the dose of a liquid expressed at
milligrams of the active ingredient
how would you stop a medicine on a prescription
crossing name
date and sign
what is an off label medication
prescribed out with the terms of marketing authorisation. I.e. used for a different condition
what is the GMC guidance for unlicensed medication
You should usually prescribe licensed medicines in accordance with the terms of their licence. However, you may prescribe unlicensed medicines where, on the basis of an assessment of the individual patient, you conclude, for medical reasons, that it is necessary to do so to meet the specific needs of the patient.” (be able to justify)
what legal act introduced controlled drugs
The misuse of drugs regulations 2001
what can controlled drug cause
dependence - therefore abuse
how are controlled drugs kept
locked in cupboards
how many days are controlled drug schedules 2,3 and 4 allowed to be given for
30 days
what information for controlled drugs must be specified
formulation, strength and dose in words and figures
what act classifies different types of medications that need prescription
Human medicines regulations 2012
what are prescription only medications (POM)
normally new medicines until evidence of safety, written by an appropriate practitioner before it can be supplied e.g. doctor, dentist, advanced nurse practicioner.
what are Pharmacy (P) OTC medications
sold from a registered pharmacy premises by a pharmacist or a person acting under the supervision of a pharmacist, pharmacist must check for contra-indications or problems before sale
where can general sales list drugs be purchase (GSL)
suitable for general sale, can be sold in retail outlets
which 2 companies wrote the BNF
British Medical Association and the Royal Pharmaceutical Society
what information is given for all drugs in the BNF
indications and dosages route of administration contraindications/ cautions side effects drug interactions medicinal products available
which speciality has its own BNF
paediatrics
where its the most up to date copy of the BNF
online
how often is the BNF updated
6 monthly
childs - 12 months
what resource does each local health board have to aid decisions when prescribing
joint formulary
what are the Scottish evidence based guideline
Developed by multidisciplinary working groups that follow a systematic review of available evidence and have the aim to reduce potential bias. After a set period of time, the guidelines are reviewed. Currently SIGN has 150 evidence clinical guidelines covering a wide range of topics.
what are the UK evidence based guidelines
national institute for clinical excellence
Amongst other things will provide recommendations, based on the best available evidence, on the appropriate treatment and care of people with specific diseases and conditions.
what are the aims of evidence based guidelines
support healthcare professionals
provide is the best possible quality,
reduces variations in practice,
offers best value for money.
where must all prescription and administration records be filed
in patients medical records - on completion/ diacharge
list some other prescription sheets that may appear in a patients notes
Diabetes Prescription sheet Warfarin Chart Fluid additive prescription sheet Variable rate IV Infusion Syringe volumetric Pump Record Insulin infusion prescription sheet Subcutaneous syringe pump recording chart
what are the aims of the MHRA (medicine and healthcare products regulatory agency)
Ensures that human medicines meet acceptable standards on safety, quality and efficacy.
Ensures that the sometimes difficult balance between safety and effectiveness is achieved. E.g. side effects against benefits
what is required before any medicine can be used to treat someone in the UK
market authorisation from the MHRA (product license)
what is required before a drug is allowed to be clinically trailed in the UK
clinical trail authorisation form the MHRA
what are the roles of the MHRA (medicine and healthcare products regulatory agency)
- Assessment & Authorisation of medicinal products for sale in UK
- Ensure medicine meets the standards of safety, quality and efficacy.
- Post-marketing surveillance – ADRs and incidents
- Monitor Internet sales & counterfeiting
- Clinical Trials regulation
- Statutory controls
- Promotion of safe use
- Manage British Pharmacopoeia & Clinical Practice Research Database
how long are marker authorisations (product license) valid for
5 years
what are the roles of the SMC
Provide advice to NHS Scotland regarding all new licenced medicines, new formulations of existing medicines and new indications for established products.
Principal remit is to make decisions on the cost effectiveness of new/existing pharmaceutical products in respect of their use
what do the SMC review medications based on
How well the medicine works
Which patients could benefit from it
Whether is as good or better than medicines the NHS already uses to treat the particular condition
Whether it is good value for money
which proffesions sit on the SMC
Pharmacists -Health economists
Pharma representatives Lay representatives
Physicians -NHS management
who must accept a medication before it is prescribed in scotland
SMC
what is the process of the SMC accepting a mediation to be licensed
3 month assessment process at time of launch
Submission by manufacturer Health economic analysis
Cost per QALY (£20-30,000)
Attempt to be fair and reasonable
Approved for use or approved for restricted use
what does the commission on human medicine (CHM) do
Advises Ministers on matters relating to human medicinal products
Advises Licensing Authority (LA)
Considers representations by an applicant or MA holder
Promotes collection and investigation of information relating to adverse Drug Reactions to human medicines.
give an example of a drug that has benefited from the RCMF (rare conditions medicines fund)
provision of ivacaftor to CF patients with G551D-CFTR mutation (~12% cases in Scotland)
shown 10% improvement in FEV1, respiratory symptoms and weight
QALY = £330,657 and cost per patient per year £182,625
what reporting scheme is used for adverse drug reactions
yellow card reports
how many deaths a year are contributed to by NHS medication errors
22,000
what percentage of hospital patients experience an adverse drug effect
just under 11%
increase hospital stay by 8.5 days
what patients are most at risk of an adverse drug reaction
Those undergoing cardiothoracic surgery, vascular surgery, or neurosurgery
Those with complex conditions
Those in the emergency room
Those looked after by inexperienced doctors
Older patients
what factors increase the rate of medication errors
More rapid turnover of patients
New drug developments, extending medicines into new areas
Increasing complexity of medical care
Increased specialisation
Increased use of medicines generally
Sicker and older patients, more vulnerable to adverse effects
list some people related causes of medication incidents
Fatigue/ Sleep deprivation Hunger Concentration: Stress: Distraction -Lack of training Lack of access to information Other factors: Alcohol, drugs & illness
in what stage do most medication errors occur
prescribing - 39%
administrating - 38%
dispensing - 12%
transcribing - 11%
what things should you check about a patient before prescribing
age weight renal and hepatic function concurrent medication allergies pregnancy
what are the 5Rs of prescribing
right patient right drug right dose right route right time
what is a complementary alternative medicine
a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system
a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine
what things are included in CAM
herbal medicines massage homeopathic therapy acupuncture hypnosis aromatherpay Reiki meditation chinese medicine
who are high risk patients for using CAM
children
pregnancy - teratogenesis
poly pharmacy
what percentage of pregnant women have used CAM
60%
why do people take CAM
Think it’s safe, natural and harmless
Perception that conventional medicine lacks/disregards a holistic approach
relatives use
which is the biggest CAM used in the UK
herbal medicines - activity ingredients of plants
why do a lot of breast cancer patients take CAM (70%)
oestrogenic - soya, evening primrose, garlic, red clover, cranberry, grapefruit
what are the strongest predictors for CAM use during pregnancy
use by family or friends
use prior to pregnancy
what CAM were commonly used in pregnancy
raspberry , ginger, cranberry
what herbal drug has a major interaction with warfarin
St johns wart (depression)
what is the principle of homeopathy
minute concentration of toxins mixed with water or alcohol - water memory not proven
what is the principle of acupuncture
needles in trigger points for dealing with pain
(Stimulates pain fibres entering the dorsal horn of the spinal cord. These cause inhibition of pain impulses. Stimulate release of endogenous opioids and other neurotransmitters such as serotonin.)
what conditions do people use acupuncture to treat
chronic low back pan
stroke
(? asthma/ epilepsy)
what may be complications of acupuncture
Infection, Pneumothorax, Pneumopericardium and Organ puncture
what is aromatherapy
the use of concentrated essential oils extracted from herbs, flowers, and other plants to treat diseases. It is commonly administered by massaging into the skin.
(inhalation, diffusion, bath)
what are harms of aromatherapy
Skin irritation with frequent use
Photosensitivity-Avoid prolonged exposure to the sun,
Excessive inhalation can cause headaches and fatigue / Bronchial spasms (people with asthma should not use )
Insomnia -peppermint,
