Prescribing safety Flashcards
Controlled drug schedule 1
Controlled drug licence
Have no recognised medicinal use and include cannabis, coca leaf, lysergic acid diethylamide (LSD) and mescaline.
Controlled drug schedule 2
Controlled drugs
Includes diamorphine (heroin), morphine, remifentanil, pethidine, secobarbital, glutethimide, amfetamine, and cocaine.
Controlled drug schedule 3
Includes a small number of minor stimulant drugs and other drugs which are less likely to be misused than the drugs in Schedule 2.
Examples are the barbiturates (except secobarbital, now Schedule 2), buprenorphine, diethylpropion, mazindol, meprobamate, midazolam, pentazocine, phentermine, and temazepam.
The government has now placed tramadol in Schedule 3 to the Misuse of Drugs
Controlled drug schedule 4
Exempt from safe custody requirements, with destruction requirements only applying to importers, exporters and manufacturers.
Specific CD prescription-writing requirements do not apply.
Controlled drug schedule 5
Includes preparations of certain controlled drugs
(e.g. codeine,pholcodeine, morphine) which are exempt from full control when present in medicinal products of low strengths, as their risk of misuse is reduced.
CD prescription should include the following…
Patient’s name and address Drug name and form Strength Dose Total quantity in words and figures Must be hand signed by prescriber
What is the general prescribing advice?
Indelible ink/legible Signature/Dated Generic Prescribing* No abbreviations Changes- clear strikethrough
Which drug group has a wide variation of dose?
Opioids
Weekly prescribed drugs
Methotrexate, alendronate
Twice weekly prescribed drugs
HRT patches, fentanyl patches
Loading dose (IV/oral) drugs
Amiodarone, digoxin
Alternate daily dosing drugs
Metolazone (thiazide), furosemide
CYP450 inducers
Carbamazepine (anti-epileptic) Rifampicin (anti-TB) Alcohol, chronic Phenobarbitone (anti-epileptic) Griseofulvin (antifungal) Phenytoin (anti-epileptic) Sulfonylureas (oral hypoglycaemics)
CYP450 inhibitors
Sodium valproate (anti-epileptic) Isonaizid (anti-TB) Cimetidine (anti-histamine) Ketoconazole (anti-fungal) Fluconazole (anti-fungal) Alcohol, binge Ciprofloxacin (quinolone) Erythromycin (macrolide) Sulphonamides (antimicrobial) . Chloramphenicol (antimicrobial, misc) Omeprazole (PPI) Metronidazole (nitroimidazole) Grapefruit juice
IV paracetamol (acetaminophen), key points…
Dose is dependant on the weight of the patient
Doses should always be prescribed in mg not ml.
What are the key sources of information when considering medication on admission?
Patient Recent HMR GP printout Relative/Carer Nursing home/MARS Community Pharmacist Specialist Clinic
What are the important things to be aware of when looking at medication on admission?
Out of date information Recent changes, partners medication Insulin’s Anticonvulsants Hepatic and renal impairment Substance misuse e.g. alcohol, methadone
Adverse drug reaction
An unwanted or harmful reaction experienced following the administration of a drug or a combination of drugs, and is suspected to be related to the drug
Black triangle drugs
New medications, report ALL suspected ADRs
Examples of serious suspected ADRs
Fatal
Life threatening
Involves or prolongs inpatient hospitalisation
Involves persistent or significant disability or incapacity
Congenital abnormality
Medically significant
Drug interaction
Occurs when the effects of one drug are changed by the presence of another drug, food, drink, or an environmental chemical agent.
An interaction may alter the effectiveness or toxicity of the drug
Therapeutic index
a ratio between the toxic and therapeutic doses of medications
Which situations is therapeutic drug monitoring (TDM) useful?
1) Drugs used to maintain the absence of a condition
2) To avoid serious toxicity
Examples of drugs with narrow therapeutic range
Vancomycin Gentamicin Phenytoin Digoxin Lithium Aminoglycosides
