Pharmacy Law (MEP) Flashcards
If a veterinary prescriber is prescribing something under the cascade, what is it recommended they also include on the prescription to maximise safety (bar all the appropriate wording)
<p>Any safety warnings/ advice that should be included on the label</p>
e.g. take with food
How many CPDs must pharmacists record per year?
4
What is a GSL medicine?
Sold in a registered pharmacy or retail outlet that can close to the publicHold an EU/ UK Marketing Authorisation or Traditional Herbal registration or GSL homeopathic product.
Can GSL medicines be sold in the absence of the responsible pharmacist?
Yes!
GSL sale can only commence once the RP has signed in.
Unless they have been absent for over 2 hours- then you can’t unless another pharmacist becomes the RP.
Can P medicines be sold in the absence of the RP? What if a second pharmacist becomes RP?
NO- not in absence of RP, unless a second pharmacist is present.NB: P medicines should not be available for self-selection!
What cannot take place when the Responsible pharmacist is absent for under 2 hours?
Sale of P Medicines
Handing out prescriptions and bagged meds
Handing prescriptions to delivery driver
These CAN all take place if a second Pharmacist is present.
What is the only activity that can be done if the RP is absent for over 2 hours and there is no second pharmacist?
Taking in prescriptions- the pharmacy would be closed in this situation but could take prescriptions at door.
What two drugs used in Cold and Flu must you NOT sell together at the same time?
Products containing Pseudoephedrine and Ephedrine
Who can suspicions of possible misuse of OTC products be reported to?
Local GPhC inspector
Local Controlled Drugs liaison
police officer
Accountable officer
What are the two licensed EHC drugs that can be obtained from a pharmacy?
Levonorgestrel 1500 mcg (Levonelle One Step)Ulipristal Acetate 30mg (Ella One)
How many days after unprotected sex is Levonorgestrel licensed for?What about Ulipristal Acetate?
Levonorgestrel= 3 days (72 hours)Ulipristal acetate= 5 days (120 hours)
What age is Levonorgestrel licensed for?What about Ulipristal Acetate?
Levornorgesterol is licensed for use in over 16 years. Can be given to under 16’s only if a locally commissioned PGD is in place.
Ella One can be used in any girl of child-bearing age- so can be used in under 16’s!!
Bear in mind- children under 13 are legally too young to consent to any sexual activity. Any younger requesting this should be reported to social services.
Children under 16 also not legal although it may be consensual- i.e. with a boy also under 16.
Can pharmacists provide an advanced supply of EHC?
Yes e.g. for holiday abroad
If you decided to supply a child under 16 with EHC, can patient information be disclosed without consent?
No- still need to obtain consent in order to disclose information. Info can be shared if safeguarding an issue- judge on a case by case basis.
EHC: If the patient vomits within how many hours of Levonelle/ Ella One should they take another dose?
2 hours of taking Levonorgesterel
3 hours of taking Ella One (Ulipristal acetate)
At what point in the menstrual cycle should EHC be taken? Can it be taken more than once per cycle?
Can be taken at any point.
SPC for Levonelle states It is not advisable to take more than 1 per cycle as it can disrupt the cycle.
NB: RPS guidance says that women can take more than one if appropriate but should be advised about cycle disruption.
A patient, who you are aware has alcoholic liver cirrhosis, asks for EHC. What do you do?
EHC- levonorgestrel and Ulipristal- both not recommended in severe liver dysfunction. Try and find out how severe the liver disorder is- refer.
What medication can Levonorgestrel increase the toxicity of?
Ciclosporin (immunosuppressant used after transplants)
Can EHC be used in breast feeding women?
Levonorgestrel appears in small amounts in breast milk- should not be harmful, but take tablet after a feed to allow maximal time until next feed (avoid nursing for atleast 8hrs - spc).
Ulipristal acetate is present in breast milk for 1 week after administration. Advise mother not to BF in this time but express and discard the milk to maintain lactation.
Which EHC drug can reduce the efficacy of COC and POP pills?
Ulipristal acetate. Patients should use barrier methods until next period as their normal contraceptive cover will be reduced
A patient has received EHC, and asks if they have unprotected sex again before their next period, will they be okay?
No- it does not provide protection against pregnancy for the rest of the cycle- they will need to use contraceptive measures if they want to have sex again such as start the pill or condoms.
What is the max number of paracetamol non effervescent and aspirin non effervescent you can buy OTC?
100 of each but remember they come in packs of 16 and 32 so you would not be able to sell this amount anyway!
What is OTC codeine/ dihydrocodeine products indicated for?
Short term (3 days max) treatment of acute - moderate pain not relieved by paracetamol, ibuprofen or aspirin alone.
NOT for cold, flu sore throat etc.
What is the largest pack size of codeine/ dihydrocodeine products available OTC?
32 anything bigger requires an MA as a POM
RPS recommends the sale of just one pack of 32 at any one time.
NB: Extra warning label needed: “Can cause addiction. For three days use only”. Users can get an ‘overuse headache if they use it for longer.
Why are many cough and cold remedies now no longer used in children under 6 years?
No evidence they are effective - more risk than benefit
Sometimes the ingredients can be linked to SEs including allergies, sleep disturbances and hallucinations.
Medicines containing what 4 types of cough and cold remedy ingredients have been deemed unsuitable for children under 6 years?
Antitussives (eg dextromethorphan, pholcodine)
Expectorants (eg Guaifenesin)
Nasal decongestants (pseudoephidrine, phenyephidrine, oxymetazoline)
Antihistamines- but these may still be used in hayfever These medications should only be used second line in children 6-12 years, for a maximum of 5 days
A 2 year old child presents to the pharmacy with their mother saying that they have a raised temperature. What do you do?
Take their temperature- use a digital thermometer under their armpit (always under armpit in child under 5 years) for around 15 seconds. If the reading >37.5 degrees then it is likely to be a fever.
What to offer: Paracetamol or ibuprofen. Do not use these at the same time in children under 5 years (however if one doesn’t seem to be helping, it’s OK to try the other one before the next dose is due)
Dose in this child:Paracetamol- 2 years old- 180mg (7.5ml) every 4-6 hours. Ibuprofen- 100mg (5ml) TDS
What is first line treatment for nasal congestion in children?
Saline nasal drops
Vapour rubs
Decongestants- e.g. Karvol decongestant drops
What is first line treatment for a cough in a child?
Warm, clear fluids, honey and lemon if child is OVER 1 year old.
Simple cough mixtures- eg. glycerol or simple linctus
Can podiatrists and physiotherapists independent prescribers prescribe POMs? What about CDs?
POMs- Yes- if in their area of expertise They can only prescribe the following CDs for oral administration:DiazepamDihydrocodeineLorazepamTemazepamPhysiotherapist IPs can also prescribe: Oxycodone (oral)Morphine (oral or injection)Fentanyl (transdermal)
What is the ‘appropriate date’ on a prescription?
Rx’s are valid for 6 months for thisThis is the later of either the date the prescription was signed or the date indicated by the prescriber.For PRIVATE Rxs: the appropriate date will always be the date on which the Rx was signed
When must age be stated on a prescription?
If the patient is under 12 years old
Is it okay to issue carbon copies of prescriptions to patients?
Yes as long as they’re signed in ink
What units need to be written in full on prescriptions?
MicrogramsNanogramsUnits (i.e for insulin)
What length of time to dispense requirements apply to EPS prescriptions?
Same things- must be dispensed 6 months from appropriate date, 28 days for CDs
What does ‘repeatable prescription’ mean?
It means the prescriber has added an instruction onto the main prescription for the item to be repeated.It is NOT referring to the prescription counterpart that patients tick in the pharmacy to indicate to their prescriber what they need on their Rx next time.
Are NHS prescriptions repeatable?
NHS Rx’s are NOT repeatable. This is because Repeatable prescriptions are a different concept to prescribing for regular items made under the NHS repeat dispensing scheme. This is where patients tick what they want each time, and the Electronic repeat dispensing service is used where a prescriber issues a batch of repeat Rx’s electronically that can be used until the patients next review.
Are Rx’s for Sch 2, 3, 4 and 5 CDs repeatable?Are private prescriptions repeatable?
Rx’s for Schedules 2 and 3 CDs are NOT repeatable.Rx’s for Schedule 4 and 5 are.Private prescriptions can be repeated, indicated by prescriber, e.g. ‘Repeat x 3’ means the Rx can be dispensed 4 times in total.
If the number of repeats is not stated on an Rx- i.e. it just says ‘Repeat’, they can only be repeated once. What is the exception to this rule?
Prescriptions for an oral contraceptive. This can be dispensed 6 times if the number of repeats is not specified, within 6 months of appropriate date.
For repeatable Schedule 5 CD Rx’s, the first dispensing date must be within _____.For schedule 4 CDs it must be within ____. Schedule 2 and 3 are not repeatable.
Schedule 5- 6 monthsSchedule 4- 28 daysFollowing this there is no legal time limit for remaining dispensing- clinical judgement.
You have OWINGS on a Rx for P meds and GSL meds. How long do you have to dispense these owed items?
6 months6 months for POMS + Sch 5 CDs28 days for Sch 2,3,4 CDs
How long should private Rxs be kept? How long should the POM book be kept?
2 years- for repeatable Rx this should be 2 years from last dispensing date.Keep POM book for 2 years from last entry.
What needs to be entered in the POM register?
NAME?
Prescriptions for What are exempt from having to be written in the POM register?
For oral contraceptivesFor schedule 2 CDs- as these will be recorded in the CD register
Are Details of the medicinal product (Name, strength, quantity, dose) legal requirements for POM prescriptions?
No!!But they are obviously needed for supply
Can you dispense against a Faxed prescription?
No- not legally validNot written in indelible inkRisk not receiving an original prescriptionDo it as an emergency supply instead- then it is on their back to get the original prescription to you
Can you dispense from prescriptions from an EEA (EU) country and Switzerland (Not part of EU)?
Yes- only for schedule 4& 5 CDs and POMs, must have a UK Marketing Authorisation!Rx has to include prescriber details- full name, qualifications, direct contact details (email address and phone), address- including countryThey are allowed to be in a foreign languageIf confirmation of registration status of the prescriber is not possible- may still be able to make a safe legal supply
Can emergency supplies be made for EEA/ Swiss prescribers?
Emergency supplies from these prescribers are also allowedPrescription still needs to be received in 72 hours from EEA prescriberNB: Schedule 1,2,3 CDs cannot be supplied- INCLUDING phenobarbital!
Can community nurse practitioners, optometrist, pharmacist independent, physiotherapist, podiatrist, EEA/ Swiss doctors request emergency supplies?
Yes
How long have prescribers got to get a written prescription to the pharmacy if they request an emergency supply?
72 hours
Emergency supplies cannot be made for CDs Schedule 1, 2, 3. With the exception of what?
Phenobarbital (also called phenobarbitone) for EPILEPSY by as UK-registered Doctor(NOT EEA)
Can an emergency supply be made to a patients relative?
No- must be able to interview the patient themselves.However at times this may not be possible- e.g. a young child or patient being cared for. In this case use professional judgement
Medicinal products containing ammonium bromide, calcium bromide, fluanisone, hexobarbitone, pemoline… and many more cannot be what?
Cannot be given as an emergency supply
Maximum quantity for an Emergency supply for CD’s (Phenobarbital, Schedule 4’s and 5’s) is?What about for POMs?
CD’s: 5 daysSo things like Zopiclone can only be given for max 5 days.POMs: 30 days
Who can Isotretinoin (for severe acne) therapy be initiated by?
Directly by or under the supervision of a consultant dermatologist, and under the conditions of the Pregnancy Prevention Programme.This programme protects women at risk of becoming pregnant during therapy, as isotretinoin is a retinoid and will cause severe malformations in a foetus and there is also risk of spontaneous abortion.
How long are prescriptions for Isotretinoin valid for under the pregnancy prevention programme? What is the maximum quantity that can be supplied?
R valid for 7 days- I.e. have to dispense it within 7 days of date due to pregnancy test window. Rx’s presented after this 7 days are considered expired.Maximum of 30 days supply. If not under the Pregnancy prevention programme, more than 30 days may be supplied.
Can you dispense repeat prescriptions of isotretinoin? What about faxes? What about emergency supplies?
No repeatsNo faxesEmergency supply only if at request of a pregnancy prevention programmes practitioner and confirmation of pregnancy status has been established as negative within the previous 7 days.
Can registered UK doctors prescribe Cocaine, dipipanone or diamorphine for treating addiction?
Only if they have a Home Office License!!If not they can only prescribe these drugs for treating organic disease or injury.
Can pharmacist independent Prescribers prescribe Cocaine, dipipanone or diamorphine for treating addiction?
NoNurse independent prescribers, pharmacist independent prescribers and supplementary prescribers cannot prescribe these at all for addiction, but can for organic disease/ injury.Can prescribe CDs, but must only prescribe drugs for medical conditions within their competence.
Which two professions independent prescribers can only prescribed ‘Off-label’ medicines as opposed to unlicensed?
PhysiotherapistsPodiatristsOptometrists Cannot Rx unlicensed, all other IP’s can apart from Community practitioner nurses and EEA doctors.
Can EEA/ Swiss HCP’s and UK Community practitioner nurses prescribe unlicensed or Off-label medicines?
NoThe product must hold a UK Marketing Authorisation
If a pharmacist is supplying an oncall doctor a small quantity of certain medicines for his doctors bag, do they require a Wholesale Dealers License?
NoPharmacies can supply other healthcare professionals in the UK who need to hold small quantities for drugs for treatment/ onward supply of their patients.
You are working a Lloyds pharmacy and realise you do not have any spiriva inhalers left. Mrs P is due to come in an hours time to pick up her prescription and you know she is going away tomorrow. Can you ring up Boots down the road and request a spiriva inhaler to meet this patients needs, do you need a Wholesalers Dealers License to do so?
Community + Hospital pharmacies can obtain small quantities of a medicine from other pharmacies to meet patients needs.A Wholesalers dealers license is not needed for this, as it is considered as ‘Provision of healthcare services’, not seen as commercial dealing.
Pharmacies can give other pharmacies medicines and also give HCP’s small quantities of medicines without the need for a Wholesalers dealers license, as it is seen as providing a healthcare service and not commercial dealing. This is as long as 4 criteria are met, what are these?
NAME?
If a pharmacy wants to engage in commercial trading it requires a wholesalers dealers license. What if the pharmacy wants to exchange stock between itself and another pharmacy…. what if the other pharmacy intends to use the stock to wholesale deal/ commercial trade?
If the other pharmacy is part of the same legal entity, i.e. it does not intend to wholesale deal/ commercially trade the stock, a WSDL is not needed.If it does intend to do these, the supplying pharmacy must also be named on the wholesale dealers license.
How long do signed order/ invoices, used when pharmacy supplies a POM to a HCP, need to be kept for?
2 years from date of supplyGood practice to also make an entry in the POM register
Use by?Expires?
Use by: End of previous monthExipires: End of current month
A patient returns some unwanted medicines to your pharmacy. Some of it is blister strips in their outer packaging, some of it is bottles of liquids. How should these be disposed?
Blister strips can be removed from their outer packaging (but do not pop out tablets from blister) and ensure and patient info is confidentially disposed of. Liquids- do not empty the contents into the waste container- just put the whole bottle in- could be hazardous otherwise.
What do members of the public require if they wish to purchase dangerous poisons or chemicals (that could be used in explosives) from a pharmacy?
Valid license issued by the home office
When medicines are dispensed from an ‘In-house’ pharmacy for administration or supply to patients within a prison, does the pharmacy need to be registered with the GPhC?
noBut legal and good practice guidelines should still be followed
What is the dose of adrenaline that should be given intramuscularly in anaphylaxis?
Adrenaline is given intramuscularly in a dose of 500 micrograms (0.5 mL adrenaline injection 1 in 1000)(a dose of 300 micrograms (0.3 mL adrenaline injection 1 in 1000) may be appropriate for immediate self-administration)The dose is repeated if necessary at 5-minute intervals according to blood pressure, pulse, and respiratory function.
Whats the issue with using Adrenaline in patients on beta blockers?
Severe anaphylaxis in patients taking beta-blockers may not respond to adrenaline—consider bronchodilator therapy, e.g. IV salbutamol, adrenaline can cause severe hypertension and bradycardia in those taking non-cardioselective beta-blockers.
What are the symptoms of anaphylaxis?
Rapid development of airway and/or hypotension.Skin and mucosal changes may be present, e.g. urticaria (hives like rash) and angio-oedema of the face.
There are new laws around drugs and driving that affect patients taking prescribed medicines. What are these prescribed drugs that can be tested for in drivers?
The Benzo’s:ClonazepamDiazepamLorazepamOxazepamTemazepamFlunitrazepam (not licensed in UK)(Note: Nitrazepam not listed)Also:MethadoneMorphineAmphetamine
A patient has been pulled over and a saliva screen performed for drugs. Their level of Diazepam has come back above the set limit. If this patient is taking their medicine as prescribed by their GP, they have their prescription with them to prove this, can they be prosecuted?
If their driving was NOT impaired then NO, they have something called a ‘Medical defence’ that can be raised.If driving was impaired- i.e. the patient was sleepy, dizzy, unable to concentrate, slowed thinking, then they CAN be prosecuted. Therefore they need to be capable of knowing when their driving ability is impaired.
A driver has been pulled over and a drug saliva test performed. The level of Morphine in their system comes back high. The patient claims they have been prescribed this drug and thats why they have it in their system at this level. How can this be proved?
By showing an FP10 for morphine, or by speaking to their prescriber to confirm the advice given to the patient on how to take this.This is used as the basis for the patients ‘Statutory medical defence’. This new legislation allows protection for patients who may test positive for certain drugs as a result of taking it as prescribed.
What 5 things relating to the Veterinary prescriber must be present on the prescription for it to be valid?
NameAddressTelephone numberQualificationSignature If the Rx is for a Schedule 2 or 3 CD: Royal college of Veterinary Surgeons Qualification number is needed!!
How long are veterinary prescriptions valid for?What if its a CD?
6 monthsSchedule 2, 3, 4 CD Rx’s valid for 28 daysSchedule 5 CD Rx’s for 6 months(This is the same as human Rx’s)
Can veterinary prescribers use ‘As directed’ on their prescriptions?
No- not acceptable as an administration instruction, should state ‘with food’
When must the words ‘Prescribed under the cascade’ be used on veterinary prescriptions?
The cascade allows the supply of medicines not licensed in animals. It is ILLEGAL to supply a human medication for an animal if this wording is not present.E.g:-A medicine authorised in the UK for human use but being used in an animal -A vet medicine not authorised in the UK but in another European country for use in any animal species and in accordance with an import certificate issued by the VMD
When is ‘prescribed for an animal or herd under the care of the veterinarian’ required on a vet prescription?
For Schedule 2 or 3 CD’sNB: Usual CD prescription requirements apply here- words and figures for quantity,
Are standardised forms required for veterinary prescriptions? What about if its a CD?
NO to both(Differs to human prescriptions: for private Rxs for Sch 2 and 3 CD’s a standardised form is needed- FP10PCD)
How long should veterinary prescriptions be retained for? What about records (e.g. POM book entries) and documents for Vet supplies in general?
Keep all of them for 5 years They do not get submitted to an NHS agency
Are orignal private prescriptions for Schedule 2 and 3 CDs retained in the pharmacy? If so, for how long?
No- they must be sent of to the relevant NHS agency.NB: these Rx’s will be on standardised FP10PCD forms
How many days supply is considered good practice for Veterinary CD Prescriptions?
28 daysFor humans this is max 30 days
If a vet prescribes a product and writes ‘prescribed under the cascade’ on the Rx, but there is an alternative licensed vet medicine that could be used, what happens?
The cascade requires the Licensed veterinary product to be supplied, not the medicine only licensed for human use, this is because licensed veterinary products should be given where available, even if it is for use in a different species.
When must the expiry date appear on a label for veterinary prescriptions?
When the medicine is supplied under the cascade- i.e. human medicine for animal use.Also need other details on label e.g. N/A of owner, N/A pharmacy, Name of VET, Name/ species of animal
What is the difference between POM-V and POM-VPS?
POM-V: Can only be prescribed by a VETERINARY SURGEON. The animal must be clinically assessed before these are prescribed. POM-VPS: Can be prescribed by a Registered qualified person- e.g. Veterinarian, Pharmacist. A clinical assessment of the animal is not needed in this situation, however sufficient info must be provided e.g. how the animal is kept. Minimum quantity should be prescribed.
What is a NFA-VPS Vet medicinal product?
Can be SUPPLIED by a Registered Qualified Person e.g. a Vet, a pharmacist, and DO NOT need a prescription- i.e. the vet can give this directly to the animal without needing to write and Rx for it. Minimum quantity should be supplied.
What is a AVM-GSL Vet medicinal product?
Products with no legal restrictions- same as OTC products.
Receipts and supplies of POM-V and POM-VPS medicines must be recorded in the POM book. What must be included in POM book entries for these?
Name of medicineDate of receipt/ supplyBATCH NumberQuantity Name and address of supplier/ recipient
How often must pharmacies supplying POM-V and POM-VPS medicines undertake an audit?
ANNUALLY
What is the Small Animal Exemption Schemes (SAES)?
Allows certain medicines to be placed on the market without a Marketing Authorisation, for use exclusively in certain animals, such as aquarium fish and caged birds.
A woman comes to your counter with a pack of ranitidine tablets. You ask “are these for yourself?” and she says no “they’re actually for my dog”. Can you sell them?
It is unlawful to sell unlicensed veterinary medicines/ human medicines, including GSL and P medicines, unless this takes place under the cascade. This applies even if the Vet has told to owner to purchased an OTC human medicine. It is on your back.
For what veterinary medicines must the pharmacist be physically present when handing them out? (Unless the individual handing it out is judged to be competent enough)
POM-V (Rx’d by the veterinary surgeon)POM-VPS (Rx’d by a registered qualified person)NFA-VPS (supplied by a registered QP- do not need a prescription)
Schedule 1 controlled drugs are called “CD Lic POM”, what does this mean?
You need a Home Office license to produce, possess or supply these.No therapeutic use- e.g. LSD, ecstasyHowever a pharmacist may be required to possess these if they’re taken off a patient on a ward, allowed to if:1) For purpose of destruction2) For handing over to Police Protect patients confidentiality- only disclose if they had enough to be a drug dealer, or if the patient is refusing to give authority for destruction.
Name some Schedule 3 CD’s?
BuprenorphineTemazepamMidazolamPhenobarbital
Name some Schedule 4 CD’s?Hint: Part I CD Benz POMPart II CD Anab POM
CD Benz POM: diazepam, clonazepam, nitrazepam, clobazam Also non bento hypnotics e.g. Zopiclone Also SATIVEX- cannabinoid oromucosal mouth sprayCD Anab POM: Anabolic (e.g testosterone)/ androngenic steroids, plus clenbuterol
What schedule of CD’s is Sativex? What does good practice with this drug involve?
Schedule 4 Part I (CD Benz POM)It is a cannabinoid oromucosal mouth sprayBut still good practice to write in CD book or keep a log of it going in/out the pharmacy
How long are prescriptions for Schedule 4 CD’s valid for?What about Schedule 5?
Schedule 4: valid for 28 daysSchedule 5: valid for 6 months
What are the Schedule 5 Controlled drugs?
May be CD INV P or CD INV POM Examples:Co-codamol, codeine linctus BP, codeine phosphate tablets, co-dydramol, pholcodine, DHC (dihydrocodeine) Continus ®, Oramorph ® oral solution 10mg in 5ml Can you guess which ones are P’s and which are POM’s?
What can pharmacist independent prescribers do with Schedule 2, 3, 4 and 5 CD’s?
Prescribe themAdminister themDirect their administration (to e.g. a nurse)
What schedule CD’s is a license needed for to import or export them?
Schedule 1, 2, 3, 4 (part I)Also needed for 4 (part II) unless it is imported/ exported by a person for self-administration.No restrictions on schedule 5’s
How does a patient go about taking Controlled drugs abroad on holiday?
A personal license is NOT required if they are carrying less than a 3 month supplyA covering letter from their prescriber is advised
Is the requisition of controlled drugs on a standardised CD requisition form a legal requirement?
Yes! In the community (FP10CDF)New from Nov 2015- requisitions in the community must be on a standardised form now!! Keep a copy of these for 2 years.Hospitals use a controlled drugs requisition book- each ward has its own and carbon copies made, similar system in prisons. Only needed for Schedule 2 and 3 CD’s (Sch 4 and 5 don’t need requisitions)
What are the six legal requirements for a requester to write on a controlled drug requisition?
1) Name of recipient2) Address of recipient3) Signature of recipient4) Profession/ occupation of recipient5) Total quantity of drug6) Purpose of requisitionThese are all indicated on the standardised FP10CDF forms so the requester won’t forget any!When the requisition is received, the pharmacy must add on their name and address (section for this on form).
A Doctor calls you to tell you he has faxed across a requisition form for some Oxycodone MR tablets for his doctors bag, and will be picking them up tomorrow. What do you do?
If it is an emergency, this would be okay but ONLY if the original requisition is supplied in 24 hours otherwise it would be their offence!!If not an emergency: Tell him he will have to provide the original requisition form or the supply cannot be made.Supplies against faxed or photocopied requisitions are not acceptable.
Does a requisition in writing need to be provided if a pharmacy is requesting CD’s from another registered pharmacy?
Not legallyBut good practice for an audit trail! It IS a legal requirement for other recipients however, such as: doctors, hospitals, care homes
Someone comes into your pharmacy claiming that they are the messenger for someone that has sent a requisition form for CD’s, they are here to collect the supply. What do you do?
Ask them if they have a letter of authorisation from the requester, this empowers them to receive the CD on behalf of the purchaser. This letter should be retained for 2 years, along with a copy of the original requisition form!
You have made a supply against a FP10CDF to a doctor for some CD’s for his doctors bag. He has collected it, What do you now do with the requistion form?
Make sure your pharmacy name and address is marked on the formSend the original to the NHS BSARetain a COPY of the form for 2 years
When do you NOT need to send a CD requisition form (FP10CDF) off to the relevant NHS agency?
Only for community pharmaciesThis does not need to be done when supplied by:Hospitals/ care homes Pharmaceutical companies/ wholesalersPrisons (when supplied to prison wings)Midwife supply ordersVet requisitions- Animals not covered under NHS!!
What THREE Controlled drugs may a midwife request on a midwife supply order?
DIAMORPHINEMORPHINEPETHIDINE
What special signature is required on midwife supply orders?
Signature of an appropriate medical officer that has been authorised (by local supervising authority) to supervise all midwives in the area!
Where a CD prescription is written by a dentist, what extra wording is required on the prescription?
“For dental treatment only”
Is ‘Keep out of reach and sight of children’ a legal requirement on a label? Are cautionary labels?
Keep out of reach and sight: No-Just good practice Cautionary labels: Yes- legal requirement
Is temazepam exempt from Schedule 2 and 3 CD prescription requirements? (e.g. Quantity in words and figures etc)
No- not exempt from prescription requirements as of June 2015.It is a CD schedule 3, only thing its exempt from is CD register requirements.Must be kept in CD cupboard
On a normal FP10 prescription, are the name of drug, strength, formulation, quantity legal requirements?
No!!Prescription still legal without these on it, but need this information to actually give the drug and cannot write any of these in yourself!
On a CD prescription, is the name of the drug a legal requirement?
No!the dose, formulation, quantity etc are though….. but name would be needed to dispense medication!
Can a CD prescription be signed by another prescriber than the one whose name is on the prescription?
Yes- the prescription can be signed by another prescriber other than the named prescriber and still be legally valid.The name of the prescriber on the prescription isn’t actually a legal requirement just the signature and prescribers address..Therefore the address still needs to be applicable to the prescriber who signed it- i.e. work at same practice.
Can electronic signatures ever be used on CD prescriptions?
Yes for 2,3,4,5 CD’s- where EPS (electronic prescribing service) is used.
Is the “appropriate date” the earlier or later one on a CD prescription out of the signature date and any other appropriate date?
The later one
Some examples of inappropriate wording of the dosage on CD prescriptions…
Titration doseAs directed (One as directed would be ok)PRN (One PRN would be ok)When required (One when required would be ok) Decrease dose by 3.5ml every 4 days…. Needs to be instalment prescribing?
The strength only needs to be written on a CD prescription if there is more than one strength available. True or False?
True!
How should quantities of liquids be expressed on CD prescriptions?
In millilitres- and best to write this out in full.Words and figures
What is the maximum quantity of controlled drugs that should be supplied? Is this a legal restriction?
30 days maximum
‘No fixed abode’ is written as the patients address on a CD Rx, whilst another states PO Box 4300 as the address. Which one is okay to dispense from?
No fixed abode- could even put NFA
Is abbreviations like ‘tabs’ and ‘caps’ acceptable on a CD prescription?
Yes
Whats the deal with sugar free and colour free products?
They have a greater potential for abuse!More likely to be incorporated into illegal produce. Only supply these if specifically prescribed.
How long are instalment prescriptions valid for? (i.e. Methadone prescriptions)
The first instalment has to be dispensed within 28 days of the appropriate date on the prescription, then the rest can be supplied any time afterInstalment prescriptions on need to be signed once by the collector (but not a legal requirement)
If the prescription is intended to be supplied in instalments (CD schedule 2 and 3), for example methadone, what is a legal requirement on the prescription?
An instalment direction. This is a legal requirement: i.e. supply X amount on //_then Y on //_Special wording can be used to take into account missed doses or if the pharmacy is closed.
What happens if a patient misses their dose of methadone on an instalment prescription? They have unsupervised consumption. The prescriber wants to make sure the patient is supplied with their remaining doses.
The prescription must have special wording that indicates that if collection is missed, the remainder of the instalment, minus the days missed can be collected.This is providing that no more than THREE days have been missed.
What happens if you have an instalment prescription, and you realise the pharmacy is closed tomorrow and the day after for bank holiday?
The prescription needs to state “Instalments due on days when the pharmacy is closed should be dispensed on the day immediately prior to closure”UNLESS the prescriber has already taken the bank holiday into account when choosing the instalment dates!NB: Its not the end of the world if this specific wording isn’t on it, but does not provide the same protection, so should try get prescriber to include this approved Home Office wording.
What are the legal requirements on a CD prescription (Schedules 2,3)?
As for POM’s, plus:- If a preparation - the form- If needed- the strength- total quantity in words and figures- the doseDrug name is not a legal requirement!
Most Schedule 3 (CD No Reg POMs) are exempted from being stored in the CD cabinet. Which two drugs are not exempt from this?
TemazepamBuprenorphine
True or false: CD register entries must be entered on the day of supply?
False- can be entered the following day
What can pharmacists edit themselves on CD prescriptions?
Minor Typo’s.Add quantity in either words or figures if missing. Should not correct anything else- i.e. adding form or MR etc
A private prescription for buprenorphine tablets is presented to you. It is not on a standard FP10PCD form. The prescriber has included his General Medical Council number. You can dispense it. True or False?
FalseALL private CD Rx’s MUST be on the standard FP10PCD form, following the Shipman enquiry.Also the GMC number is NOT the correct number to include: must be the prescriber ID number issued by their relevant NHS agency!Only exception: Vet Rx’s. In hospitals if the private Rx was written by someone in that hospital. If it has come from outside the hospital: must be on FP10PCD.
You receive a prescription on an FP10PCD for Morphine sulphate tablets, Zopiclone and ibuprofen. Is there any issues here?
You are required to send FP10PCD forms off to the relevant NHS agency. This is so they can keep track of CD’s being prescribed. The Zopiclone (sch 4) and ibuprofen need to be entered into the POM book and the prescription for these kept for 2 years. Therefore this would not be possible in this case.Need a separate prescription for the zopiclone and ibuprofen!
Can a representative pick up for a drug misuser?
Yes if they have a letter from the drug misuser, a separate letter each time they pick up, and that the pharmacist sees the drug misuser at least once a week.If the medication is supervised consumption- contact doctor- legally acceptable to confirm with Dr they are happy with this over the phone. This is because supervised consumption is not a legal requirement. If it was a police officer collecting as the person is in custody then don’t need to contact doctor- as consumption will be supervised by a HCP.
Is supervised consumption a legal requirement?
No
Getting the person collecting a CD schedule 2 or 3 to sign the back the Rx is a legal requirement, true or false?
False.It is good practice
Are there any schedule 2 CD’s that don’t have to be kept in the CD cupboard?
Quinalbarbitone (aka Secobarbital)Some liquid preparations
Is destruction required for a patient- returned controlled drug? If so, does this need to be witnessed by an authorised witness?
Destruction is required- if schedule 1,2,3,4 Part I. Use a denaturing kit.Patient returns destruction does NOT need to be witnessed by an authorised witness. IT is good practice to get another member of staff to witness it and to keep a separate record of patient returned CD’s that have been destroyed.
Is destruction required for expired controlled drugs? If so, does this need to be witnessed by an authorised witness (e.g. police officer)? What records should be made?
Yes destruction required if schedule 1,2,3,4 Part I. This does need to be witness by an authorised witness for SCHEDULE 2’s, and its good practice to get another member of staff to witness for schedule 3’s. This applied to any destruction of pharmacy stock (expired, unwanted). Make an entry in the CD register so that the balance can be amended for schedule 2’s (schedule 3’s don’t go in the register anyway!)
All CD’s schedule 2,3 and 4 (part I) should be destroyed by being denatured and rendered irretrievable before being placed in what?
A waste container to be sent for incineration
How should tablets and capsule CD’s be disposed of? What about liquids?
Grind / crush and add to a denaturing kit, ensure not retrievable. Can add to warm soapy water and poor onto cat litter.Liquids can be poured straight into a denaturing kit or cat litter.
How should CD ampoules and vials be disposed of? What about patches? Aerosols?
Ampoules: empty contents into a CD denaturing kit and dispose of glass in sharps bin.Patches: fold patch over on itself and place in waste disposal bin or denaturing kit.Aerosols: squirt contents into water or absorbent material and dispose.
How long does a CD register need to be kept? Can the register be electronic?
2 years from the last entry date Yes can be electronic as an alternative to paper book
Is keeping a running balance in the CD register a legal requirement?
No- good practice Be sure to notify the owner, superintendent, GpHC inspector, accountable officer or Controlled Drug liaison officer of any discrepancies.
What is the difference between unlicensed and off-label?
Unlicensed= does not hold a UK marketing authorisation, so will not be listed in the BNF, has to be manufactured as a special.Off-label= has a UK marketing authorisation (i.e is licensed) but is being used for a different condition to the one it has a licensed indication for- i.e. being used for an unlicensed indication. Don’t get confused in the BNF if it states unlicensed use: this does not mean the product itself is unlicensed, just means its being used for an unlicensed indication!
Medicines disposal is an ESSENTIAL service. Pharmacies do not need a license to store waste as long as it is stored in _____. No more than ___ cubic meters of waste is storedThe waste cannot be stored for over __ monthsService is not provided as a waste management service i.e. you don’t receive ___ The waste must not have a flash point of less than ___ (lowest temp that vapours of a fluid will ignite)
stored in secure containers- separate area from your stockno more than 5 cubic metersWaste not stored for over 3 monthsDont receive payment for the serviceFlash point less than 21 degrees
Only schedule 2 and 3 CD’s need to be denatured before disposal. True of False?
False: schedule 4 part I e.g. Zopiclone, diazepam also need to be!!
If you’re the only pharmacist in the pharmacy, you don’t need to sign in as the RP as it could only be you. True or false?
False- need to still sign in the the RP record and put the sign up.
What schedule drug is Tramadol?
Schedule 3(CD No Reg POM)So Rx only valid for 28 daysCD prescription requirements neededRequisitions neededDenaturing neededAddress of prescriber in UK neededSafe custody not needed
T or F:Pharmacist independent prescribers are able to prescribe and Controlled Drugs in Schedule 2 to 5.
TrueApart from diamorphine or cocaine for treatment of addiction (but can for pain/ organic disease)
If a school wants to obtain a salbutamol inhaler for use in the school who must the request come from?
The head teacherHeadteacher does not need to have any other involvement with childs medicines- confidentiality, only school nurser/ carer needs to know
Which CD schedules do invoices need to be retained for? And how long for?
Schedule 3 and schedule 5 Schedule 2 you are going to be writing in the CD book any stock received so no need for these. Schedule 4 you just randomly don’t need to…
Can you think of anything that Cannot be given under PGD’s? (5)
Unlicensed drugsSpecials: dressingsAbortificantsCD’s for addiction Radiopharmaceuticals
A swiss patient comes into your pharmacy requesting an emergency supply of phenobarbitone for epilepsy as she is on holiday. Can you supply it?
No- cannot supply Phenobarbital/ phenobarbitone as an emergency supply to patients of Non-UK prescribers (Swiss & EEA)! Only for UK patients
How long must the RP log be retained?
5 years from last entry
If a prison pharmacy needs to obtain a supply of CDs from another pharmacy do they need to use the standardised FP10CDF requisition form?
No
Can pharmacist and nurse Independent prescribers prescribe unlicensed medicines? Who can’t?
nurse and pharmacist independent prescribers can prescribe patients medicines ‘for use outside of their licensed indications’. The law also now permits them to prescribe ‘unlicensed medicines for their patients, on the same basis as doctors’.PhysiotherapistsPodiatristsOptometristscan only prescribe ‘off-label’ as opposed to ‘unlicensed’
What does the ‘withdrawal period’ on a vet Rx indicate?
The length of time after administering the drug before the animal can be used for food
For high severity community acquired pneumonia what ABs should be used, what would you add in if MRSA is suspected?
Benzylpenicillin + Clarithromycin/ Erythromycin OR benzypenicillin + DoxycyclineAdd Vancomycin if MRSA
In general, considering record keeping either involves 2 years or 5 years, what is the general rule (not just for vet stuff- for EVERYTHING)?
<p><strong>2 years for things to do with CDs and private Rx's:</strong></p>
<p>- CD register (from date of last entry) (legal)</p>
<p>-Requisitions (send off but keep copy) order records etc (legal)</p>
<p>-Invoices for schedule 3 and 5 CDs (legal)</p>
<p>- POM book- 2 yrs last entry, private prescriptions (legal)</p>
<p>-MUR/ NMS records (legal)</p>
<p></p>
<p><strong>5 years for:</strong></p>
<p>-Vet prescriptions- POM-V and POM-VPS (legal)</p>
<p>-Responsible Pharmacist record (from date of last entry) (legal)</p>
<p>-Extemporaneous dispensing records (legal- community, 13 yrs reference hospital)</p>
What are the extra requirements on a Vet label when compared to a human label?
<p>For animal treatment only</p>
<p>Pet details and Owner details</p>
<p>Expiry date if not on box</p>
<p>Warnings for owner re administration etc</p>
Are standardised forms needed when a vet prescribes a CD? What needs to be written on the prescription?
<p>No</p>
<p>"prescribed for the treatment of an animal under my care"</p>
How long are are vet prescriptions for CD’s 2 and 3’s valid for?
<p>28 days</p>
<p>All the normal CD Rx requirements are followed as for humans e.g. total quantity in words and figures</p>
How long should veterinary prescriptions be retained for?
<p>5 years</p>
How many days worth of treatment for Vet CD’s is considered good practice?
<p>28 days max quantity</p>
<p></p>
<p>Unless ongoing treatment needed e.g. epilepsy in dog</p>
<p>(differs to human which is 30 days)</p>
Human private prescriptions for schedule 2 and 3 CDs must be submitted to the relevant agency to track CD prescribing. Does this therefore apply to Vet private prescriptions for CD’s?
<p>No</p>
<p>Just retain in pharmacy for 5 years</p>
What specific thing relating to the Vet needs to be present on Rx’s for schedule 2 and 3 CDs?
<p>Royal College of Veterinary Surgeons reg number</p>
<p>(for human CD's: need a specific prescribed identification number on the standardised form so that prescribing of CDs can be tracked).</p>
Which should be first line: Prescribing a licensed human medicine for an animal Prescribing a licensed Vet medicine for another species or in a different condition
<p>1) Prescribing a licensed Vet medicine for another species or in a different condition (basically Off-label)</p>
<p>2) Prescribing a licensed human medicine for an animal</p>
Would an EU unlicensed vet medicine be allowed to be prescribed in the UK?
<p>NO- EU Vet medicines are allowed under the veterinary cascade but they must be licensed!</p>
<p>Note: only EU VET medicines- not human medicines</p>
- In the event that a military prescription is presented in a non-contracted pharmacy, how should it be dispensed and how is it paid?2. What about a military personnel that presents with an NHS prescription?
- It should be treated as a private prescription. The pharmacy are not to invoice the MOD directly but should charge the patient. It is then up to the patient if they wish to recover this cost from their military unit.This should only happen in exceptional circumstances as there are contracted pharmacies to dispense these prescriptions2. Same process as a normal NHS prescription, unless they fall under NHS exemption and do not have to pay for their prescriptionsThe person can then try and claim the money back from the military
What are the 9 standards for pharmacy professionals?
- Provide person-centred care.2. Work in partnership with others. 3. Communicate effectively.4. Maintain, develop and use their professional knowledge and skills. 5. Use professional judgement.6. Behave in a professional manner. 7. Respect and maintain the person’s confidentiality and privacy. 8. Speak up when there are concerns or when things go wrong. 9. Demonstrate leadership.
What is the problem with a punitive culture?
Stifles learning and reporting.Reduction in patient saety and quality of care.
What is the problem with a no-blame culture?
Lack of accountability. Not acceptable to society: unfair.
What term describes medicines that are GSL but can only be sold or supplied via a pharmacy?
PO
Which of the following is correct?It is unlawful to supply a product or combination of products that contain more than 720mg of pseudoephedrine AND 180mg of ephedrine at any one time without prescription. It is unlawful to supply a product or combination of products that contain more than 180mg of pseudoephedrine OR 720mg of ephedrine at any one time without prescription. It is unlawful to supply a product or combination of products that contain more than 720mg of pseudoephedrine OR 180mg of ephedrine at any one time without prescription. It is lawful to supply a product or combination of products that contain more than 720mg of pseudoephedrine OR 180mg of ephedrine at any one time without prescription.
It is unlawful to supply a product or combination of products that contain more than 720mg of pseudoephedrine OR 180mg of ephedrine at any one time without prescription.
The supply of which EHC to under 16s is not contraindicated by the manufacturer?
EllaOne, levongest 16+
How many NHS prescription charges do warfarin 1 mg tablets and warfarin 5 mg tablets levy (assuming the patient is not exempt for NHS charges) for an NHS prescription written in England?01234
1 charge:Same drug with the same formulation but different strengths is classed as one prescription charge.
To be a valid prescription for a Schedule 2 CD from a doctor who has seen a patient privately, how must the prescription be presented?Be computer generatedBe hand writtenBe prescribed on the NHS only Be on an approved formBe on letter-headed paper
Private prescriptions for Sch2 and 3 CDs must be on an approved form.
Normally, when a requisition form for Sch 2 or 3 CDs is recieved by a community pharmacy, and the request is from a hospital, community health provider (e.g. GP) or a veterinary surgeon, an approved form must be used. What are the exceptions to this?
If the request is from a hospice or a prison an approved form does not need to be used.
Which of the following is not a legal requirement for a CD requisition?Signature of recipientName of recipientAddress of the recipient Profession or occupation Purpose of the requistionDetails of patients to recieve requested CDs
The details needed are:Signature of recipientName of recipientAddress of the recipient Profession or occupation Purpose of the requistionTotal quantity of CDNo information regarding patients is needed.
In which of the following circumstances is an approved form not needed? (regarding CDs)GP requisition received by a community pharmacyVeterinary requisition received by a community pharmacy. Requisition from a ward in the same hospital received by a hospital pharmacyRequisition from a ward or department in a different legal entity recieved by a hospital pharmacy
An approved form is not required if the request for CD is from a ward or department in the same legal entity.
In which of the following circumstances is an approved form not needed? (regarding CDs)GP requisition received by a community pharmacyVeterinary requisition received by a community pharmacy. Requisition from a ward or department in a different legal entity recieved by a hospital pharmacyRequisition from a hospice recieved by a community pharmacy
If the request is from a hospice or a prison an approved form does not need to be used.
In an emergency, a doctor or dentist can be supplied with a Sch2 or Sch3 CD on the undertaking that a requistion will be supplied within the next 24 hours. Failure to do so would be an offense on the part of who?
The doctor or dentist
Where CD stock is collected by a messenger on behalf of a purchaser, a written authorisation must be provided to the supplying pharmacist that empowers the messenger to recieve the medicines on behalf of the purchaser. How long must this authorisation be retained by the pharmacist/pharmacy?
2 years
Which of the following does not legally require the use of an approved form (regarding CD requisitions)? <p>GP requisition received by a community pharmacy</p><p>Veterinary requisition received by a community pharmacy </p><p>A request received from another GPhC registered pharmacy premises by a community pharmacy</p>
Legislation does not provide that requests between GPhC registered pharmacies use an approved form BUT the Home Office advises that supplies from one registered pharmacy to another registered pharmacy only be made after recieving a written requistion on an approved form.
Growth hormones are contained in what sch?
Sch 4 part II
Legally, invoices of which of the following DO and DO NOT need to be retained for 2 years:Sch 2Sch 3Sch 4 (part I)Sch 4 (part II)Sch 5
Sch 2: NOSch 3: YESSch 4 (part I): NOSch 4 (part II): NOSch 5: YESNICE advise that organisations should consider retaining all CD invoices for 6 years for the purpose of HM Revenue and Customs.
NICE recommends keeping records of the destruction of a patient’s own returned controlled drugs for a minimum of what?
7 years Invoices for CDs 6 years
What is the maximum length of time it would be required to keep a CD register for?1 year2 years3 years5 years7 years
Normally 2 years from last entry. However, if a record of patient returned and subsequent destruction of CDs is also recorded in the CD register book it would need to be kept for 7 years.
When a requisition for a Schedule 1, 2 or 3 CD is received, it is a legal requirement to:Mark the requistion indelibly with the suppliers name and address (pharmacy name etc)ANDSend the original requisition to the relevant NHS agency. When do these processing requirements NOT apply?
These processing requirements do not apply when the suppy is made:By a person responsible for the dispensing and supply of medicines at a hospital, care home, hospice, prison or organisation providing ambulance services who must mark and retain the original requisition for two years. By pharmaceutical manufacturers or wholesalers. Against veterinary requisitions (the original should be retained for five years) NB: as a matter of good practice, pharmacies should rtain a copy of the requisition for two years from the date of supply.
A registered midwife may use a midwife supply order to obtain what CDs? (3)
DiamorphineMorphine Pethidine
A registered midwife may use a midwife supply order to obtain diamorphine, morphine or pethidine. Which of the following is NOT required on the order?Name of the midwifeOccupation of the midwifeAddress of the midwife place of workName of the person to whom the CD is to be administered or supplied. Purpose for which the CD is required.Total quantity of the drug to be obtained. Signature of an appropriate medical officer.
Do not need address details of midwife.
A registered midwife may use a midwife supply order to obtain diamorphine, morphine or pethidine. Which of the following is NOT required on the order?Name of the midwifeOccupation of the midwifeName of the person to whom the CD is to be administered or supplied. Purpose for which the CD is required.Total quantity of the drug to be obtained. Signature of the midwife
Signature of an appropriate medical officer must be present not midwife.
Which of the following are examples of doses that ARE legally acceptable on CD scripts:As directedPRNPer chartOne PRNDecrease dose by 3.5ml every four daysWeekly
The following are okay:One as directed. Two when required. One PRNOne or two when required.
Which ONE of the following is a legal requirement?The date of birth of a patient if under 12The dose of the medicine when entering a private prescription in the POM register The dose of the medicine on a prescription issued by a doctor in NorwayFor an Es at request of a patient, the surgery must be closed. For an Es at request of the doctor, the prescription must be received within 48 hours
The age of the patient if under 12 is a legal requirement.
Which of the following is NOT an off-label use of a licensed drug?Amitriptyline for neuropathic pain.Metformin for PCOSQuinine sulphate for nocturnal leg crampsSeretide Evohaler for COPDTemazepam for conscious sedation in dental procedures.
Quinine for nocturnal leg cramps is only licensed one.
Which of the following pieces of legislation regulating the activities of pharmacists and pharmacies applies to:A pharmacist who wanted to take part in the new NHS influenza vaccination service. Controlled Drugs (supervision and management of use) Regulations 2013Human Medicines Regulations 2012Medicines Act 1968Misuse of Drugs Regulations 2001 (as amended)NHS (pharmaceutical and local pharmaceutical services) regulations 2013Pharmaceutical servises (advance and enhanced services) (England) Directions 2013Responsible Pharmacist Regulations 2008Veterinary Medicines Regulations 2013
Pharmaceutical servises (advance and enhanced services) (England) Directions 2013
Which of the following pieces of legislation regulating the activities of pharmacists and pharmacies applies to:A pharmacist who destroys certain patient returned medicines and who has a SOP in place to cover this would be complying with: Controlled Drugs (supervision and management of use) Regulations 2013Human Medicines Regulations 2012Medicines Act 1968Misuse of Drugs Regulations 2001 (as amended)NHS (pharmaceutical and local pharmaceutical services) regulations 2013Pharmaceutical servises (advance and enhanced services) (England) Directions 2013Responsible Pharmacist Regulations 2008
Controlled Drugs (supervision and management of use) Regulations 2013
Which of the following pieces of legislation regulating the activities of pharmacists and pharmacies applies to:Your pharmacist colleague has been repeatedly selling cetirizine tablets to the owner of a cat who has a skin complaint as a result of flea bites. Under which legislation may the colleague be committing an offence? Controlled Drugs (supervision and management of use) Regulations 2013Veterinary Medicines Regulations 2013Human Medicines Regulations 2012Medicines Act 1968Misuse of Drugs Regulations 2001 (as amended)NHS (pharmaceutical and local pharmaceutical services) regulations 2013Pharmaceutical servises (advance and enhanced services) (England) Directions 2013Responsible Pharmacist Regulations 2008
Veterinary Medicines Regulations 2013
Who is responsible for a dispensing doctor’ practice which has a pharmacy attached to it, where stock is purchased via the dispensing doctor’ practice for both the dispensing services and the two businesses share facilities for refrigeration and CD storage?Care Quality Commission (CQC)GPhCHealth and Safety Executive HealthwatchMHRANHS EnglandTrading standards at your Local Authority
Care Quality Commission
Who is responsible for investigating a pharmacy suspected to be the original source of a number of counterfeit medicines in the locality?Care Quality Commission (CQC)GPhCHealth and Safety Executive HealthwatchMHRANHS EnglandTrading standards at your Local Authority
MHRA
The price of certain drugs which may be available as a branded product or a generic product is calculatec based on the manufacturers’ price for branded products and the generic product price. If not generic product is available the pharmacist will be paid for the cost of the branded product if they endorse on the rx. Which of the following best describes the category of payment for basic prices of drugs described above? Category ACategory BCategory CCategory ECategory M
Category A: Drugs which are readily available.The Secretary of State determines the prices for Category A drugs to be the weighted average of the prices listed by the following four manufacturers and suppliers; AAH, Alliance Healthcare (Distribution) Ltd, Teva UK and Actavis on or before the 8th of the month being reimbursed. In the weighted formula, AAH and Alliance Healthcare (Distribution) Ltd prices have a weighting of 2, the prices from the other suppliers have a weighting of one.Category B: Drugs whose usage has declined over time.Category C: Drugs which are not readily available as generic and price is determined by Secretary of State based on that listed by supplier. Category E: ???Category M: Drugs which are readly available and price determined on information supplied by manufacturers - not an average.
Which of the following best describes the time in which the pharmacist has to react to a satisfactory but needing some improvements report by the GPhC Inspector?2 days to respond to confirm accuracy, 10 days to resolve any other outstanding issues in the action plan. 2 days to respond to confirm the accuracy, 14 days to resolve any other outstanding issues in the action plan5 days to respond to confirm the accuracy, 10 days to resolve any other outstanding issues in the action plan5 days to respond to confirm the accuracy, 20 days to resolve any other outstanding issues in the action plan7 days to respond to confirm the accuracy, 28 days to resolve any other outstanding issues in the action plan
5 days to respond to confirm the accuracy, 20 days to resolve any other outstanding issues in the action plan
Your pharmacy premises are being inspected by a GPhC inspector who has serious concerns about the policies and procedures you have in place.One major concern is that you record keeping for date checking is poor and there is a significant amount of stock on the shelves that is out of date and not fit for purpose.From the scenario above, which of the following principles would a pharmacy premises most likely be in breach of?Principle 1 - governance arrangementsPrinciple 2 - empowered and competent staffPrinciple 3 - managing pharmacy premisesPrinciple 4 - delivering pharmacy servicesPrinciple 5 - equipment and facilities
Delivering pharmacy services
In mid-2015 it was decided that a new advanced service for seasonal influenza vaccination is to be provided via community pharmacies in addition to the general medical services.Which of the following bodies would be the most appropriate body tocommission or provide the need identified in the scenario above?CCGsHealth and Wellbeing Board (HWB)Local Authority NHSPharmaceutical Services Negotiating Committee (PSNC)
NHS
Which of the following groups is least likely to be considered an appliance by the NHS?BandagesCathetersDiabetic blood monitoring machine and test stripsDressing packsIrrigation systems
Diabetic blood monitoring machine and test strips
GPhC inspection: premises are very dirty, shelving has not been cleaned in ages, evidence of rodent infestation on the floor in the dispensary. Which of the following principles would the pharmacy premises most likely be in breach of?Principle 1: goverance arrangements. Principle 2: empowered and competent staff.Principle 3: managing pharmacy premisesPrinciple 4: delivering pharmacy servicesPrinciple 5: equipment and facilities
Managing pharmacy premises
Which of the following information is least necessary to be included on the dispensing label for a vet med for a milk producing cow?A withdrawal periodBatch number of product suppliedDose or admin instructionsIdentification and species of animal The words ‘for animal treatment only’ or similar
Not batch number on label.
Which of the following situations can you sell Sumatriptan OTC?66 year oldEpileptic taking carbamazepine5 migraine attacks in the last yearTakes candesartan for hypertensionMigraines usually last 36 hours without treatment
5 migraine attacks in last year. All others are contraindications to sale.
Which of the following statements regarding Clinical Management Plans is least accurate?A CMP is part of a voluntary relationship between an independent prescriber and a patient. A CMP must be individualised for each patient. CMPs enable a supplementary prescriber to prescribe medication without needing repeated approval from an independent prescriber. CMPs must state the circumstances that require a patient to be referred back to the independent prescriber. CMPs must not include options for the prescribing of a Controlled Drug
Can include CDs
Which of the following situations is most applicable to Pharmacist Independent Prescribers?They need to have a clinical management plan in placeThey cannot prescribe any Controlled DrugThey cannot prescribe GSL medicinesThey can only prescribe items included on their Practioners Formulary They can only prescribe if their GPhC register entry is annotated with the letters IP
They can only prescribe if their GPhC register entry is annotated with the letters IP
Locally commissioned services may be commissioned by NHS England area teams, local authorities or CCGs. Which of the following statements is least accurate?The commissioning body can determine how a service is provided but must provide the service to a nationally agreed minimum standard. NHS England oversees public health services provided by local authoritiesNHS England and Clinical Commissioning Groups are both able to commission enhanced servicesLocally commissioned services must follow the nationally negotiated templates for locally commissioned servicesHealth and wellbeing boards ensure public health services are provided effectively and are responsible for creating pharmaceutical needs assessments.
NHS England and Clinical Commissioning Groups are NOT both able to commission enhanced services.Local NHS England teams commission all services in the NHS Community Pharmacy Contractual Framework (CPCF), i.e. Essential, Advanced and Enhanced Services. Other commissioners cannot commission these services from community pharmacies.The services that CCGs commission include planned hospital care, rehabilitative care, urgent and emergency care (including out-of-hours and accident and emergency services), most community health services, maternity services, mental health and learning disability services.
Clobazam is allowed on NHS if endorsed SLS for any patient, for the treatment of what?
Epilepsy
Cyanocobalamin Tablets are allowed on the NHS for the treatment or prevention of vitamin B12 deficieny if endrosed SLS for what patient groups?
A person who is a vegan or who has a proven vitamin B12 deficiency of dietary origin. NB: Cyanocobalamin tablets are not suitable for treatment of vegans as the tablets contain products of animal origin. The injection would be better.
A person with asthma is deemed to be ‘at clinical risk’ if what criteria is met?
They have asthma which requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.
Nizoral Cream is allowed on the NHS for the treatment of what condition in any patient group so long as it is endorsed SLS by the prescriber?
Seborrhoeic dermatitis and pityriasis versicolor.
Can pharmacy staff amend SLS to a prescription for Niferex Elixir 30ml Paediatric Dropper Bottle can only be prescribed to infants born prematurely for prophylaxis in the treatment of iron deficiency that the prescriber forgot to endorse themselves?
Prescribers must endorse prescriptions for these products ‘SLS’. If the ‘SLS’ endorsement is missing, the prescription should not be dispensed and will not be passed for payment by NHS Prescription Services. Pharmacy staff cannot make the SLS endorsement themselves.
Borderline substance list:Will pharmacies be paid for borderline substance products dispensed that were not endorsed ACBS by prescriber?
YES
- When you receive a CD 2 or 3 requisition, what should you legally do?2. What are the exceptions to this?
- Mark the requisition indelibly with name and address of supplier e.g. name of pharmacy Send the original requisition to the relevant NHS agencyGood practice- retain a copy for 2 years 2. Exceptions- if the supply is made by a person dispensing at a hospital, care home, hospice, prison- By pharmaceutical manufacturers or wholesalers- Veterinary requisitions
A midwife may use a midwife supply order to obtain what 3 controlled drugs?
- Diamorphine2. Morphine3. Pethidine
A mother approaches you and asks for a spacer for her five year old son because his has broken. What would be the most appropriate course of action?
Sell the mother a spacerA spacer is a medical device not a medicine. Therefore there are no restrictions on the sale of the spacer.
A patient brings in a script during GP opening hours to community pharmacyWhat should you do if a non-CD script does not have a quantity on it?
Contact the prescriber for guidance and add a ‘PC’ endorsement to the prescription
A prescription which is hand written by a German doctor registered in Germany as he stands in your pharmacy for amoxicillin. Can you dispense this?
Do NOT dispense the prescription, the prescriber is not allowed to prescribe whilst in the UKEEA and Swiss prescribers can only prescribe whilst in the country they are registered in. They can not prescribe in the UK unless also registered with the GMC.
A Scottish lady asking for a emergency dutasteride for her husband who has taken his last tablet this morning. What should you do?
Need to speak to the patientEmergency supply at the request of a patient requires interviewing the patient
After a GPhC inspection, what is the time limit to resolve any outstanding issues in the action plan?
The inspector will already have identified whether the improvement action in relation to each standard, must be completed within 10, 20 or 60 working days.
After a GPhC inspection, what is the time limit to respond to confirm accuracy of report?
5 days
Approved CD requisition forms must be used for CD2 and 3 drugs except if the request is from what two places?
HospicePrison
Are controlled drugs repeatable on prescription?
2 and 3 cannot be repeated, however 4 and 5 can be
Are emergency supplies for patients of registered EEA/Switzerland prescriber allowed?Are there any exceptions?
YesNot for CD2 or 3 (INCLUDING phenobarbital) But can for CD4 and 5
Are FP10 forms used in prison?Is there any exceptions to this?
No, unless in a special circumstance where it has been authorised However, if a prisoner is about to be released and the usual method of ensuring continuity of supply in the community has not happened e.g. being released unexpectedly, can be given an FP10MDA to take to a community pharmacyThese forms have the prison address and are exempt from paying
Are patients that have newly prescribed medicine for Type 1 diabetes eligible for new medicines service?
No, only Type 2
Are repeatable prescriptions from a registered EEA/Switzerland prescriber allowed?
Yes
Are vet prescriptions repeatable?
Yes
Can a child collect a prescription on someone else’s behalf?What about a CD2 drug?
Yes but need to use professional judgement regarding maturity of child, reason for collection, understanding counselling pointsShould get identification for CD2 drugs but a child may not have this. Use professional judgement
Can a pharmacy receive patient returned medicines if there is no RP and what is the exception?
Yes apart from CDs
Can a prescriber on an NHS prescription indicate “repeat x times”?
No- usually used on private prescriptions
Can advanced electronic signatures be accepted for CD 2 and 3 drugs?
Yes where the electronic prescribing service (EPS) is used
Can an accountable officer be an authorised witness person?
No
Can an advanced electronic signature be used to sign a prescription?
Yes
Can an emergency supply be made at the request of an EEA patient?
Yes
Can CD2 drugs be repeated on a prescription?
No
Can CD3 drugs be repeated on a prescription?
No
Can CD4 drugs be repeated on a prescription?
Yes
Can controlled drugs be issued as an emergency supply?Is there any exceptions?
1,2,3 no 4 and 5 yes Exception is phenobarbital which can be supplied
Can EEA prescriptions have unlicensed meds?
No And can only prescribe medicines that have a MA in the UK
Can military CD prescriptions be on a standard FMed 296 form?
No, you need designated standardised forms which can be obtained from local primary care organisation/NHS health boards, in the same manner as prescribers wishing to prescribe CDs privately
Can optometrist independent prescribers authorise emergency supplies?
Yes
Can optometrist independent prescribers prescribe CDs?
No
Can schools stock hold salbutamol inhalers and epi pens?
Yes
Can you give an advance supply of EHC?
Yes - need to make sure the patient is competent, intend to use the medicine appropriately and that it is clinical appropriate to give it to the patient
Can you give an emergency supply of controlled drugs via EEA/Swiss prescriber?
Cannot give schedule 1,2, 3 including phenobarbitalHowever can supply schedule 4 and 5
Can you have an electronic CD register?
Yes
Can you issue an emergency supply for isotretinoin?
Should only be accepted if this is an emergency supply at the request of a PPP specialist prescriber together with confirmation that pregnancy status has been established as negative within the preceding seven days.
Can you issue faxed prescriptions for oral isotretinoin?
No
Can you issue repeat prescriptions of oral isotretinoin?
No
Can you sell a product containing pseudoephedrine at the same time as selling a product with ephedrine over the counter?
No
CD requisitions:In an emergency, can a doctor/dentist be supplied with a CD 2 or 3 drug without a CD requisition? What must be supplied and within what time frame?
Yes but the requisition needs to be supplied within 24 hours (failure to do so is an offence on behalf of doctor/dentist)
Children under what age are legally too young to consent to any sexual activity?
Under 13 years
Do “in house” pharmacy prisons need to be registered with the GPhC?
No
Do CD2 and 3 vet prescriptions need to be submitted to the relevant NHS agency?
No - but prescription should be retained for 5 years
Do CD2 and 3 vet prescriptions need to be written on a standardised form?
No
Do emergency supplies need to be entered into the POM register?If it is a the request of a patient, what information should be documented?
Yes If a patient request, should include information and nature of emergency - why the patient needs the POM and why a prescription cannot be obtained
Do vet CD prescriptions need to be written on a standardised private CD form?
No
Do you need an authorised witness when destroying CD stock?
Yes if schedule 2Good practice for schedule 3
Do you need patient consent to do an appliance use review?
Yes
Do you need to have details of the medicine in order for a prescription to be legal?
No, you do not legally need name, strength, form, quantity and dose however these are important to identify what medicine you need to dispense.
Do you need to make a record when destroying CD stock?
Yes in the CD register for CD2 drugs
Does a controlled drug requisition need to have the patient’s name on?How does this differ from a midwife supply order for CD (morphine, pethidine, diamorphine)?
NoMidwife supply order needs to have the patient name
Does a pharmacist have to be physically present during the sale of a POM-V/POM-VPS/NFA-VPS medicine?
Yes unless the transaction has been individually authorised in advance
Does buprenorphine require safe custody requirements?
Yes
Does midazolam require safe custody?
No
Does phenobarbital require safe custody?
No
Does safe custody apply to returned CDs from patients?
Yes until destroyed
Does temazepam require safe custody requirements?
Yes
Does the strength of a medicine always need to be on a CD prescription?
If there is more than one strength available, yes
Does tramadol require safe custody?
No
Due to the falsified medicines directive, market authorisation holders are required to place what safety features on prescription medicines?
Unique 2D identifier- barcode that can be scanned to determine its authenticityAnti-tamper device
Due to the falsified medicines directive, what are pharmacy contractors required to do?
Check the anti-tampering device to ensure its intact prior to dispensingChange the status of the pack in the verification system from “active” to “inactive-supplied” via scanning the barcode
EHC: What age group is levonorgestrel licensed for and within what time frame of unprotected sex?
> 16 yearsWithin 72 hours
EHC: What age group is ulipristal licensed for and within what time frame of unprotected sex?
Supply is not contraindicated < 16 years however pharmacist may wish to consider additional factors e.g. consent, Gillick competencyWithin 120 hours (5 days)
For a patient to have capacity and to be able to make an informed decision, what 4 things must they be able to do?
• Understand the information provided• Remember the information provided• Use and weigh up the information provided• Communicate their decision to the pharmacy professional (by any means).
For CD 2 and 3 prescription, if either the words or figures (but not both) of the quantity has been omitted, can a pharmacist amend this?
Yes- should mark the prescription to show amendment has been made
For CD 2/3 prescriptions, can a pharmacist amend a date, dose, form or strength?
No
For emergency supplies, what is the max quantity that can be supplied for:1. CD 4 and 5s2. Any other POMsWhat are the exceptions to this?
- 5 day supply max2. 30 day supply maxExceptions include insulin, creams, inhaler where a pack cannot be broken down. The smallest pack available should be given.
For emergency supply at the request of a prescriber: Within how many hours does a prescriber need to provide a prescription after an emergency supply?
Within 72 hours. The date of receiving the prescription should be documented in POM register
For MDA (methadone) scripts, what is the maximum number of days you can prescribe on one script?
14 days
For patient returned CDs, should a record be made when destroying them?
A record should not be made in the Controlled Drugs register but records of patient- returned Schedule 2 Controlled Drugs and their subsequent destruction should be recorded in a separate record for this purpose
For repeat prescriptions, can they be dispensed from different pharmacies?
Yes, the patient can retain the prescription and choose to have repeats dispensed from different pharmacies. You can maintain an audit trail mark on the prescription (name and address of pharmacy, date of supply)
How do you dispose of used methadone bottles?
Once a methadone bottle is emptied as faras possible, bottles can be rinsed and the liquid added to a denaturing kit and treatedas pharmaceutical waste.Empty container is then disposed of into the recycling or general waste
How does dispensing of military prescriptions work?
Large military medical centres do their own in house dispensingSmaller centres outsource the dispensing process to designated community pharmacies under a Ministry of Defence contract. These pharmacies will invoice the Ministry and Defence directly
How long after having a baby are female patients eligible for free prescription charges?
Up to 12 months after having the baby
How long are isotretinoin prescriptions under the pregnancy prevention programme valid for?
7 days
How long can the responsible pharmacist be absent for?
Max of 2 hours in 24 hour period
How long do you need to keep a record of an appliance use review?
12 months
How long do you need to keep a record of an MUR for?
2 years
How long does a record of salbutamol and epi pen supply for a school need to be kept for?
Signed record needs to be retained for 2 years or an entry in the POM register. You need to include the purpose of supply in this record
How long is a standard FP10 valid for from the date of prescribing?
6 months
How long must a record be kept for a POM private prescription?What should the record include?
2 years from the date of supplyThe record should include:1. Supply date2. Prescription date3. Medicine details4. Prescriber details (name and address)5. Patient details (name and address)
How long must you keep the Pharmacy record for (records responsible pharmacist info)?
5 years
How long should a CD register be kept for?
2 years from date of last entry
How long should the CD register be kept for?
2 years
How long should the following be retained:An invoice for a Schedule 3 CD taking account of tax.
6 years Although the law relating to CDs requires the invoices to be retained for 2 years (as per the BNF advice), the law relating to tax requires the invoices to be kept for 6 years (as per SPS advice).
How long should the responsible pharmacist record be kept for?
5 years
How long should vet prescriptions be retained for?
5 yearsEntry into POM register requiredThey do not need to be submitted to an NHS agency, but pharmacies that supply veterinary medicines must undertake an annual audit
How long should you keep a signed order?
2 years
How long should you keep private prescriptions?
2 years
How many CPD entries do you have to do a year to revalidate?
- 2 must be planned learning activities
How many public health campaigns a year are recommended by PHE for community pharmacy?
6
How much of a liquid antibiotic should you give in an emergency supply?
If an antibiotic in liquid form, smallest quantity that will provide full course should be supplied
How much of an oral contraceptive should you give in an emergency supply?
If an oral contraceptive, a full treatment cycle should be provided
How often should CD stock be checked?
At least once a week (could be less frequent based on risk assessment)
How often should community pharmacies do a complaints report?
Annually
How often should SOPs be reviewed in community pharmacy?
Every 2 years
How often should you have a self-assessment of clinical governance compliance in community pharmacy?
Annually
How would you destroy aerosol products containing CDs?
Expel into water and dispose of the resulting liquid in accordance with the guidance on destroying liquid formulations
How would you destroy ampoules and vials if they contain CDs?i) Liquid containing vialsii) Powder containing vials
i) For liquid containing ampoules, open the ampoule and empty the contents into a CD denaturing kitDispose of ampoules into sharps bin ii) For powder containing ampoules, open the ampoule and add water to dissolve the powder inside. The resulting mixture can be poured into the CD denaturing kit and the ampoule disposed of as sharps pharmaceutical waste
How would you destroy liquid dosage form CDs?
Pour into a CD denaturing kit e.g. DOOP kitIf this is not available, pour into a suitable product then add to an appropriate waste disposal bin
How would you destroy patches that are CDs?
Remove the backing and fold the patch over on itself. Place into a waste disposal bin or a CD denaturing kit
How would you destroy solid dosage form CDs?
Grind or crush the solid dose formulation before adding to the CD denaturing kit to ensure that whole tablets or capsules are not retrievableThe resulting mixture may then be poured onto an appropriate amount of suitable product and added to an appropriate waste disposal bin If a CD denaturing kit is not available - mix it with warm soapy water
If a CD script is meant to be supervised but a representative with a consent letter from the patient turns up to the pharmacy, what should you do?
You should contact the prescriber before the medicine is supplied tothe representative – since supervision will not be possible. It is legally acceptable to confirm verbally with the prescriber that they are happy with this arrangement since supervision, while important, is not a legal requirement under the 2001 Regulations.It would not be necessary to contactthe prescriber if the person has been detained in police custody and the representative collecting the dose is a police custody officer
If a drug misuser wants a representative to collect a CD on their behalf, what are pharmacists advised to do?
Obtain a letterfrom the drug misuser that authorises and names the representative. (This includes those detainedin police custody who should supply a letter of authorisation to a police custody officer to present to the pharmacist)A separate letter should be obtained each time and the record of supply should be included about the representative in the CD register
If a healthcare professional is picking up a CD2 on behalf of a patient, what is required?
Name of HCPAddress of HCPIdentity required - if they do not have identity, it is up to discretion of pharmacist
If a hospital is dispensing a private CD 2/3 prescription within the same legal entity, is a standardised form required?
No
If a patient came into the pharmacy with a prescription for:Amoxicillin 500mg capsAmoxicillin 250/5mL solutionHow many charges would this be?
2 charges as different formulations
If a patient came into the pharmacy with a prescription for:Levothyroxine 25 mcgLevothyroxine 50 mcgHow many charges would this be?
1 charge as same drug and formulation
If a patient is homeless, what should you put in the address section on a prescription?
No fixed abode
If a product has an expiry date of 6/2019, when should the product be used?
Should not be used after 30th June 2019
If a product says “Use by 6/2019” what does this mean?
The product should not be used after 31st May 2019
If a repeat number is not stated on a repeat prescription, how many times can it be repeated?What is an exception to this rule?
Only once(so dispensed twice in total)Oral contraceptives can be repeated 5 times (dispensed 6 times in total)
If a veterinary surgeon has told the animal owner to purchase a human medicine for their pet, would you be able to do sell this?
No- it has to be prescribed under the veterinary cascade
If a woman of child bearing age is on valproate, do they have to be on the pregnancy prevention programme?
Yes- Government warning came in April 2018 stating they should not be prescribed it unless on PPP
If an EEA/Switzerland prescription is written in a foreign language is it legally acceptable?
Yes, but the pharmacist must have enough information to carry out the safe supply
If it has not been possible to confirm the registration status of an EEA prescriber after taking all reasonable steps, is it possible to make a legal supply?
Yes, but it is recommended that you keep a record of decision making and any steps taken. This includes questioning the patient and using professional judgement
If someone wanted EHC however the sale would be inappropriate e.g. outside the marketing authorisation, who could you refer them to?
GP, family planning clinics, GUM clinics
If the responsible pharmacist absence exceeds 2 hours, can the pharmacy still be open?
No- after the 2 hours in 24 hours, the pharmacy must close if the pharmacist needs to be absent
If there is a minor typographical error/spelling mistake on a CD 2/3 prescription, can a pharmacist amend this?
Yes - should mark the prescription to show amendment has been made
If there is an unplanned pregnancy and patient is on sodium valproate what should you advise the patient?
Do not stop your treatment and arrange to see prescriber ASAP
If there is more than one responsible pharmacist in 24 hours, what can the total hours absent be?
2 hours
If you give an emergency supply via an EEA/Swiss prescriber, within how many hours does the prescription need to be received?
Within 72 hours
If you suspect a customer is misusing ephedrine products to make meth, who can you report this to?
Local GPhC inspector, local controlled drugs liaison police officer or accountable officer
In addition to standard labelling requirements, what else needs to be included on the dispensing label in an emergency supply?
The words “Emergency supply”
In community pharmacy, only CD2s are entered into the register. How does this advice differ in prisons?
It is recommended to maintain a robust audit trail of Schedule 3 and 4 drugs
In secure environments (prison) what is strongly recommended that is also on the label to identify the patient?
Prisoner number
In terms of driving, when can a statutory medical defence be raised?
When the driver has been taking a prescribed drug on the list of specified drugs (e.g. morphine, diazepam) but driving is not impairedIf driving is impaired, it can lead to an offence
In what situations would you not need the person’s consent to share their information?
• Disclosure is required by law, or• the disclosure can be justified in thepublic interest, or• To do so is impracticable, would put the pharmacy professional or others (including the person receiving treatment or care) at risk of serious harm, or would prejudice the purpose of the disclosure, for example to prevent a crimeHowever, only disclose the necessary information required Make a record about the details of the disclosure
Is a faxed prescription a legal document?
No as it has not been written in indelible ink and has not been signed in inkThere are various risks associated with faxed prescriptions e.g. sent to multiple pharmacies for multiple supplies, forged prescriptions. There are other options with a better risk profile Pharmacists considering supplying medicines against a fax should make an informed decision and consider record making of the decision-making process
Is it permissible to issue carbon copies of prescriptions?
Yes, as long as it is signed in ink
Is it possible to do an emergency supply during GP opening hours?
Yes, need to use professional judgement to see if the patient cannot get a prescription that day
Is the quantity on a prescription a legal requirement for non CD scripts?
No
Is there a standardised form for vet prescriptions?
No
Is there an online platform to check for all registered EEA/Swiss prescribers?
No, however you can contact EEA competent authorities to check registration details (can get contacts for these via GMC and other registered UK professional bodies)
Is written consent needed for MUR?
Yes
Most medicines recalls fall into what classes according to the MHRA?
2 and 3
On CD scripts, is it recommended that multiple strengths of the same medicine are prescribed separately?
Yes
On prescriptions, if it states “repeat x times”, when must the first dispensing be done?What about controlled drugs?
Within 6 months (following this no time limit) CD2 and 3 are not repeatable CD4 within 28 days (following this no time limit)
On repeat prescriptions, is there a time limit?
No- the first dispensing must be made within 6 months of the date like a normal prescriptionHowever after this, there is no legal time limit for the remaining repeats. However, pharmacists should use professional judgement
On vet prescriptions, is “as directed” suitable directions?
No
OTC is a collective term for what categories of medicines?
P and GSL
Out of the 4 CPDs you have to do to revalidate, how many of them should be planned learning?
2
Patient groups of what ages will get free prescriptions?
> 60 years<16 years16-18 and in full time education OR <20 AND you are dependent on someone receiving income support
Patient satisfaction survey comes under what essential service for community pharmacy?
Clinical governance
Pharmacists are required to keep a register for CD 2 drugs. What additional drug needs to have a record?(Hint- schedule 4 part 1)
Sativex (cannabis-based medicine)
What schedule is buprenorphine?
CD3
What schedule is co-codamol?
CD5
What schedule is codeine phosphate?
CD5 for tablets and oral solutionBut CD2 for injection
What schedule is dihydrocodeine?
CD5 for tablets and oral solutionBut CD2 for injection
What schedule is gabapentin?
CD3
What schedule is pregabalin?
CD3
What schedule is fentanyl?
CD2
Apart from the oral solution, what schedule is morphine?
CD2
What schedule is morphine oral solution?
CD5
What schedule is oxycodone?
CD2
What schedule is pethidine?
CD2
What schedule is tapentadol?
CD2
What schedule is tramadol?
CD3 - exempt from safe custody requirements
Apart from a few exceptions, what schedule are benzodiazepines?
CD4-1Temazepam - CD3Midazolam- CD3
What schedule is zolpidem?
CD4-1
What schedule is zopiclone?
CD4-1
What schedule is temazepam?
CD3
What schedule is Sativex cannabis extract spray?
CD4
What schedule is diamorphine?
CD2
What schedule is methadone?
CD2
What schedule is ketamine?
CD2
What schedule is midazolam?
CD3
What schedule is phenobarbitone?
CD3
What schedule is testosterone?
CD4-2
