PPP Week 21 Flashcards
define requisition
a formal request for a stock of medicines
Since 2015, what has been needed to get a requisition for Sch 2 and 3 CDs in the COMMUNITY?
an approval form
When do hospitals not need an approval form for a requisition?
if the request is from a ward or department within that hospital - ‘same legal entity’
Where are requisitions forms sent off to?
the NHSBSA
What must be written legally on a Sch 2 or 3 CD requisition?
- name of recipient
- signature of recipient
- address of recipient
- their profession or occupation
- total quantity of drug
- purpose of the requisition
How do you know if a request is genuine?
- check person’s ID
- look their name up on a professional system - registration
- you would most likely know them professionally
What type of requisitions are NOT legal?
faxed or photocopied - you MUST have a physical piece of paper
When must the requisition be received?
BEFORE the supply is made - except in an emergency, but the requisition must be given within the next 24 hours
What does the supplier (you) need to mark the requisition with?
the supplier’s (pharmacy) name and address - can use stamp
Where is the original requisition sent to?
NHSBSA
How long does a copy of the requisition have to be kept for?
2 years from supply date - for good practice
Who are the only people exempt from having to keep requisitions?
pharmaceutical manufacturers and wholesalers
For veterinary requisitions, how long must you keep the original requisition?
5 years
Which CD drugs can midwives order?
diamorphine, morphine and pethidine
What must a midwife have to obtain these drugs?
a Midwife Supply Order (MSO)
What information must an MSO state?
- name of midwife
- their occupation
- name of person who will receive the CD
- purpose for which CD is supplied
- total quantity to be supplied
- signature of ‘appropriate medical officer’ doctor or supervisor authorised by the NHS trust
What are the prescription requirements for Sch 2 and 3 CDs?
- name of patient
- address of patient
- name, formulation, strength and dose of CD drug
- total quantity of drugs
- quantity prescribed
- prescriber’s signature and address
- date of signing
How long is a Sch 2, 3, 4 CD prescription valid for after signing?
28 days after the appropriate date
What could be the ‘appropriate date’?
either:
1. the signature date
2. any other date indicated on prescription as a date before which supply should not be made
Where must the prescriber’s address be?
in the UK
What type of dose indications are NOT legal?
‘when required’, ‘rpm’, ‘weekly’
How must the total quantity be written?
in BOTH words and figures e.g. dispense twenty-eight, 28)
What is the recommendation of the maximum quantity of Sch 2, 3, and 4 CDs that should be supplied at one time?
30 days
What is the difference between total quantity and quantity prescribed?
total quantity - the total quantity prescriber for the entire course of treatment
quantity prescriber - the amount the pharmacy can dispense and should dispense at a given time
What is a pharmacist legally required to do when someone is collecting a CD?
determine who the collecting person is (patient, patient’s representative etc)
If a healthcare professional is collecting a CD, what must you ask?
- name
- address (work)
- evidence of identity
What must you get the collector for Sch 2 and 3 CDs to do?
sign the back of the prescription in the CD collector box
Which Schedules of CDs must be recorded in the CD register?
Schedules 1 and 2 - ALSO Sativex (Schedule 4, part 1)
Which 3 things does the law require to be at the top of a CD register?
- class
- form
- strength
Are electronic CD registers allowed by law?
yes - but entries must be attributable, capable of being audited and compliant with best practice
What information must be recorded in the CD register when CDs come into the pharmacy?
- date received
- name and address from who it was received - good practice to include invoice number
- quantity received
What information is recorded when CDs are supplied from the pharmacy?
- date of supply
- name and address of recipient
- details of authority to possess (prescriber or licence holder details)
- quantity supplied
- details of person collecting
- whether ID proof was requested
- whether ID proof was supplied and which type
What is the time frame in which CD register entries must be made after supply?
24 hours - LEGAL
What must you not do to CD entries?
alter them - crossing out - ILLEGAL
How must you make corrections in a CD register?
by dated notes in the margin or bottom of page - include name, signature, GPhC number
Why are ‘running balances’ carried out?
to help discrepancies and irregularities be spotted quickly
How often is a balance check usually done?
once a week, but may be more or less frequent
How must you check liquids?
by visual checks, measure volumes periodically and check the balance at the end of a bottle
What must the healthcare professional running the check do?
record, sign and date the check
Who legally has responsibility for running balance checks?
the pharmacist
What must you do if you find a discrepancy but can resolve it?
make a margin or footnote and correct the running balance
What must you do if you find a discrepancy and cannot resolve it?
fully investigate and notify CDAO
Where must Schedule 2 CD private prescriptions be recorded?
CD register AND POM book for good practice
What must you put on private Schedule 2 POM prescriptions?
reference number on prescription, label AND CD register
What are the 5 main stages of structured consultations?
- initiating the session
- gathering information
- physical examination
- explanation and planning
- closing the session and safety netting
What does the upper respiratory tract consist of?
nasal cavity, pharynx and larynx
What are illnesses involving the upper respiratory tract?
sore throat, cold/flu, rhinitis
What does the lower respiratory tract consist of?
trachea, bronchi and lungs
What are illnesses involving the lower respiratory tract?
coughs, Covid-19
What causes coughing?
irritation of the respiratory mucosa as a response to infection or contamination
What are the main causes of coughs?
- bacterial or viral infections
- allergies
- post-nasal drip
- covid-19
What is the most important thing in differential diagnosis of a cough?
you MUST exclude a more serious condition or infections - there is higher risk for a patient if they have underlying pathology or an issue outside of your competency
What are the red flags for a cough?
- wheezing, SOB
- coloured sputum
- lasted more than 3 weeks
- chest pain
- drug induced cough or wheeze
- dry, night-time cough in children
What are 3 examples of OTC treatments for chesty coughs?
- Robitussin Chesty Cough
- Benylin Chesty Cough
- Covonia Chesty Cough
What are 2 examples of OTC treatments for a dry cough?
- Robitussin Dry Cough
- Benylin Dry Cough
What are examples of other OTC treatments for coughs?
- Linctus
- Broncho Stop syrup
- Broncho Stop Pastilles
When can you give antibiotics for a cough?
if patient is showing certain symptoms associated with a bacterial infection - coughing up lots of phlegm
What are the 7 main causes of a sore throat?
- bacterial/viral infection
- candida
- glandular fever
- quinsy
- poor inhaler technique
- cancer
- tonsillitis
For which illness must you refer a patient to a GP?
candida, glandular fever, tonsillitis, quinsy, cancer concerns
What is candida?
an unusual illness only really seen in immunocompromised patients
What is the main sign of candida?
plaques extending down the throat and the underlying surface is raw and inflamed
What is glandular fever caused by?
the Epstein-Barr virus
How is glandular fever treated?
NOT using antibiotics - treated symptomatically
What is the main symptom of quinsy?
an abscess between the back of the tonsil and the wall of the throat
Why is quinsy so serious and must result in going to A&E?
infection spread from the tonsils to the area around them
Which clinical score is used to make differential diagnoses for a sore throat?
FeverPain score
What is the 1st line treatment option for a sore throat?
analgesics- then a lozenge, spray or mouthwash if needed
What are 3 examples of analgesics?
- paracetamol
- aspirin
- ibuprofen
What are 3 examples of other products for sore throat relief?
- Ultra Chloraseptic Spray
- Strepsils Honey and Lemon
- Olbas Pastilles
What must you advice patients on when giving sore throat products?
- gargles have a shorter duration of action than lozenges
- diabetics should take ONLY sugar-free lozenges
- check for contraindications
- do NOT swallow mouthwashes
What is the most important thing when treating people with colds?
make sure it isn’t flu - as some patient groups may get very unwell
What are the main differences between a cold and influenza?
colds:
develop over a few days, with a sore throat, then runny nose, coughing, congestion etc
influenza:
sudden onset of symptoms including shivers, chills, aching, non-productive cough and loss of appetite
What are red flags for colds?
- symptoms of flu
- persistent uncontrollable fever
- chest infection signs
- chest pain
What conditions could chest pain indicate?
pneumonia, heart issues, secondary infections
How should you decide what to give a patient with a common cold?
ask them about their most problematic symptoms - or would they like an all-in-one treatment?
What are examples of analgesics you can offer to patients with a cold?
paracetamol, ibuprofen, aspirin
What are other combination cold treatment you can offer?
- Lemsip Max sachets
- Benylin Day and Night
- Beechams all-in-one tablet
Why must you be careful with giving both Lemsip Max sachets and Beechams all-in-one?
they both contain Phenylephrine which has contraindications for diseases such as CVD, angina, hypertension
How do decongestants work?
by constricting the dilated blood vessels in the nasal mucosa
What are 3 examples of OTC decongestants?
- Otrivine nasal spray
- Sudafed
- Sinutab
- Vicks Vaporub
Which drugs, since 2009, should no longer be given to children under 6 for coughs and colds?
brompheniramine, chlorphenamine, diphenhydramine, dextromethorphan, guaifenesin, ipecacuanha, phenylephrine, pseudorephedrine, ephedrine, oxymetazoline and xylometazoline
What are examples of different pollens and when they affect patients?
tree pollen - early spring
grass pollen - peaks in June and July
fungal spores - autumn
perennial - dust mites, cats, dogs
What is the main way you can differentiate between allergic rhinitis and a cold?
the patient won’t be particularly unwell, and will mainly be suffering from nasal and eye symptoms
What are the referral signs for allergic rhinitis?
- wheezing or SOB - exacerbation of asthma
- treatment failure
- earache, facial pain, eye problems
- unilateral discharge - could suggest some form of blockage e.g. nasal polyps or deviated nasal septum
What is the first line of treatment for allergic rhinitis?
allergen avoidance, if possible
What advice can you give to patients with allergic rhinitis?
- identify cause and avoid
- stay indoors/close windows
- avoid hanging washing on high pollen days
- avoid smoking
- avoid grassy areas
- modify house to remove dust etc
What is the main issue with antihistamines?
most are sedating
What must you advise patients on when giving antihistamines?
driving and using heavy machinery
Which generation of antihistamines are sedating?
1st generation
Why are 1st generation antihistamines sedating?
they are lipophilic and can cross the blood-brain barrier, so cause drowsiness
What is an example of a 1st generation antihistamine?
Piriton (chlorphenamine)
Why are 2nd generation antihistamine non-sedating?
the cross the blood-brain barrier to a much lower extent
Which is the only true non-sedating antihistamine?
loratadine
What are 3 examples of non-sedating antihistamines?
- loratadine
- certirizine
- Benadryl Plus
What do corticosteroids do for allergic rhinitis?
reduce the underlying inflammatory response
What is the main issue in using corticosteroids for allergic rhinitis?
they do not have an immediate effect and may take several weeks for a full response to be seen
What is the minimum age for corticosteroids?
18
What are 2 examples of corticosteroids used to treat allergic rhinitis?
- Beclometasone (Beconase)
- Flucticasone (flixonase)
What is the issue with using mast cell stabilisers for eye symptoms?
there are compliance issues due to frequent administration - may limit efficacy
What is an example of a mast cell stabiliser used to help eye symptoms caused by allergic rhinitis?
Opticdrom Allergy eye drops (sodium cromoglycate)
