Prescribing 1 (Basics)

Question 1

What is prescribing?

Answer 1

Advise and authorise the use of (a medicine or treatment) for someone, especially in writing.

Question 2

What is dispensing?

Answer 2

Provision of drugs or medicines as set out properly on a lawful prescription. A prescription can only be filled, the drugs supplied, by a registered pharmacist, veterinarian, dentist or member of the medical profession.

Question 3

What is prescription-only medicine?

Answer 3

Aprescriptiondrug (alsoprescription medicationor prescription medicine) is a pharmaceutical drug that legally requires amedical prescriptionto be dispensed.

Question 4

What is over-the-counter medicine?

Answer 4

Drugs that can be obtained at a pharmacy without a prescription.

Question 5

What are controlled drugs?

Answer 5

Controlled under the Misuse of Drugs legislation 2001 (and subsequent amendments). Stricter Legal controls apply to controlled medicines to:

• Prevent them being misused, being obtained illegally, causing harm
• Govern how controlled medicines canbe stored, produced, supplied, prescribed

Question 6

What are pharmacy-only drugs?

Answer 6

Can be attained if approved by a pharmacist but not over the counter. No need for a prescription.

Question 7

What is the BNF?

Answer 7

British National Formulary
Constantly updated
Good resource to find out common side effects - you are not expected to know the side effects and interactions of every drug.

Question 8

What are the common drug presentations?

Answer 8

Tablets
Capsules
Caplets
Liquid - suspension and emulsions

Question 9

What are tablets?

Answer 9

Solid unit dosage form of medicament or medicaments with or without excipientsand prepared either by molding or compression.
2/3 of all medications prescribed
Most are for oral use

Question 10

What are capsules?

Answer 10

Medicine encapsulated in a relatively stable shell known as acapsule,
Can be seen as “better” by consumers
Led to Caplets (capsule shaped tablets) to foster the link in patients minds
Soft Shell usually oils or oil suspensions

Question 11

What are suspensions?

Answer 11

Finely divided, undissolved drugs (powders for suspension) dispersed in liquid vehicles for oral or parenteral use.
Can be given in various ways
Will settle out over time

Question 12

What are emulsions?

Answer 12

Lipid soluble drug dissolved in an inert lipid based substance
Can be given in various ways

Question 13

What are the different drug administration methods?

Answer 13

Intramuscular injection - absorbed in capillaries of muscles
Subcutaneous injection - absorbed through subdermal layers
Intravenous
Inhaled - straight to the lungs
Topical - given onto the skin
Transcutaneous - absorbed slowly through the skin
Oral
Rectal e.g. supositories good blood supply
Vaginally
Buccal - through the oral muscosa e.g. anti-sickeness
Intraocular e.g. painkillers after surgery
Intranasal e.g. decongestants
Epidural - analgesia for surgery or childbirth
Spinal - surgery uses
Intraural - ear drops for ear infection
Intraosseous - into the bone marrow
Intrathecal - directly into an organ
Nebulised - drug into a mist which is inhaled

Question 14

What factors determine which method of drug administration is used?

Answer 14

Acceptability for the patient
The kind of drug
Other drugs they are taking
Speed of action
Varies by patient e.g. age
Varies by tolerability
Appropriate delivery for the problem

Question 15

What’s the difference between branded and generic drugs?

Answer 15

When first produced drugs are under patent protection
This supports the initial investment
After a time period the patent ends and other companies can produce a generic equivalent at lower cost.

Question 16

What is a generic drug?

Answer 16

A generic drug is identical–or bioequivalent–to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
Do not have to have the same non-active ingredients

Question 17

Should we only used generics?

Answer 17

Drugs have specific licenses – sometimes the generics may not be licensed e.g. Pregabalin
Some drugs e.g. certain antiepileptics patients must be kept on their specific brand as issues with changing
Some brands are cheaper than other versions – inhalers most common

Question 18

What are our responsibilities in prescription?

Answer 18

Is it appropriate?
Patient vs. NHS - cost issues
Consider holistic issues
Safety
Education

Question 19

What factors must you consider when prescribing?

Answer 19

Local formulary
Potential side effects
Patient preference
Past medical history
Delivery method

Question 20

What makes a good prescription?

Answer 20

In ink and legible
Avoid unnecessary decimal points
Use appropriate units and abbreviations
Dose and frequency must be stated
Names of drugs and preparations must be clear and not abbreviated
Directions ideally in English without abbreviation although some Latin allowed

Question 21

What are Patient Group Directions?

Answer 21

Patient Group Directions (PGDs) are documents permitting the supply of prescription-only medicines (POMs) to groups of patients, without individual prescriptions. Healthcare workers using PGDs should be sufficiently trained to be able to supply and administer POMs

Question 22

Who can give Patient Group Directions?

Answer 22

PGDs provide a legal framework that allows some registered health professionals to supply and/or administer a specified medicine(s) to a pre defined group of patients, without them having to see a doctor (or dentist). However, supplying and/or administering medicines under PGDs should be reserved for situations in which this offers an advantage for patient care, without compromising patient safety.

Question 23

What are Patient Specific Directions?

Answer 23

A Patient Specific Direction is the traditional written (or electronic) instruction, signed by a doctor, dentist, or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis.

Question 24

What are emergency exemptions to patient group directions or patient specific directions?

Answer 24

This list of medicines for use by parenteral administration (injection/infusion), are exempt from PGDs, prescriptions or PSDs when administered for the purpose of saving life in an emergency.
Doses are not specified in the legislation
e.g. adrenaline, glucose, antivenom

Question 25

Give some examples of an adverse event?

Answer 25

Wrong drug prescribed
Wrong route of administration
Incorrect instructions to patient
Side effects
Interactions
Anaphylaxis
Overdose
Errors in instructions
Patient compliance

Question 26

What is the problem behind adverse events?

Answer 26

Most errors are Human Errors
Most are errors of omission
Correct prescribing is a fundamental part of patient safety

Question 27

How would you manage an adverse event?

Answer 27

Simply manage at source
Significant event analysis
Reporting via regulatory framework
Reporting via national reporting systems

Question 28

What is the yellow card system?

Answer 28

The Yellow Card Scheme is the UK system for collecting information on suspected adverse drug reactions to medicines. The scheme allows the safety of the medicines and vaccines that are on the market to be monitored.