RAMAs, Storage And Disposal Flashcards
What are the 4 distribution categories of veterinary medicines
POM-V
POM-VPS
NFA-VPS
AVM-GSL
POM-V
Prescription Only Medicine
Only prescribed by a veterinary surgeon
POM-VPS
Prescription Only Medicine
Prescribed by veterinary surgeon, pharmacist or RAMA/SQP
NFA-VPS
Non-Food Animal
supplied by a veterinary surgeon, pharmacist or RAMA/SQP
AVM-GSL
Authorised Veterinary Medicine - General Sales List
Supplied by any retailer
Eg pets at home
Which controlled drugs CANT nurses/pharamacist/RAMAs prescribe
Diamorphine
Cocaine
Dipipanone for addiction treatment
What are the schedules of controlled drugs
Schedule l
Schedule ll
Schedule lll
Schedule lV
Schedule V
Schedule l drugs
Little or no therapeutic value
High potential for abuse/misuse
Only used for research purposes in vet practice
Illegal recreational drugs
Schedule ll drugs
High potential for abuse/misuse
highly addictive but with therapeutic value
Their use is strictly controlled
Opioids
Schedule l drug example
Cocaine and heroin
Schedule ll drug examples
Opioids such as methadone hydrochloride, fentanyl, morphine and ketamine
Schedule lll drugs
High potential for abuse/misuse but have therapeutic value
Their use is controlled
Schedule lll drug examples
Buprenorphine hydrochloride
Tramadol
Gabapentin
Phenobarbital
Schedule lV drugs
Some potential for abuse/misuse and has therapists value
Schedule IV drugs examples
Diazepam
Chronic gonadotropin
Clenbuterol hydrochloride
Schedule V drugs
Some potenitnal for abuse/misuse and has therapeutic value
Schedule V drug examples
Paracetamol and codeine phosphate
Controlled drugs requirements - lockable cupboard
All schedule 2 except Quinalbarbitone
Only burenorphine from schedule 3
Controlled drugs requirement - prescription validity
28 days for 2,3 and 4
6 months for 5
Controlled drugs repeat prescription
Only schedule 4 and 5
Controlled drugs register
Only for schedule 2 and buprenorphine from schedule 3
RCVS recommends all schedule 3 to be in CD cabinet
Controlled drugs witness destruction
Only for schedule 2 drugs
How long does the invoice get kept on controlled drugs
2 years
What is required on a prescription for schedule 2 and 3 drugs
Declaration that it is for an animal or herd under vet care
Full name and address of owner and animal
Name and form of drug
Amount prescribed in words and figures
Strength of preparation
Dose to be administered
RCVS number of prescribing vet
Sharps bin has what waste
Used needles
Syringes with fixed needles
Broken single use vials/ampules
Cytotoxic and cytostatic bin has what waste
Any cytotoxic or cytostatic medications (chemotherapy drugs) including syringes, needles and bottles/vials
Pharmaceutical waste bin has what waste
Multiuse medication bottles
Used syringes without fixed needles
Out of date medication
Returned medication from owners
Disposal of schedule 2 controlled drugs
Out of date or unused need to be denatured and disposed of in pharmaceutical waste bin in presence of either
A police officer (CD liaison officer)
Inspector appointed under VMR
vet from another practice (can’t be partners or friends - must provide RCVS number)
Drugs must be kept in cabinet and only removed from register once destroyed
Process of disposing schedule 2 drugs
Empty into a denaturing kit
Place on pharmaceutical waste bin
Record disposal in the CD register
Countersign from witness on register
Schedule 3,4,5 do not need to be witnessed
How would you destroy transdermal fentanyl patch
Food and place into denaturing gel
How would you destroy phenobarbital tablets
Crush and mix with water then add to denature gel
What is significant about denaturing kit
Turns to gel so the drug can’t be extracted
Waste vs stock on disposing of controlled drugs
If CD is waste then witnessed denaturing and destruction is NOT required
If CD is stock witnessed denaturing and destruction IS required
What is stock
Any out of date controlled drugs
Any multiuse vial that is beyond 28 day broached life
What is waste
Small out of medication left in single use vial after drawing up dose
If dose if drawn up but not administered
Unusable amount of medication left over in multiuser vial
Part used infusions
Storage requirements of medicines in accordance to Summary of Product Characteristics (SPC)
pharmacy between 8 and 25
Pharmacy fridge between 2 and 8
Temp to be monitored and recorded daily incl min and max temps
Can we accept medications back from clients and use them
No
What is the formula for the order up to level regarding stock
OULT(order up to level) = D(daily demand) x L(lead time) which is how long it takes for drug to come.
What is needed for stock storage
Set stock levels (min and max)
Named person responsible for stock level
Store products in original packaging
Supply a product leaflet with products dispensed
Dispense products with shortest expiry date first
Store products with different batch numbers together (in case of any recall they’ll have spares)
What records should be kept in vet medicine
Dates of deliveries and items
Batch numbers for food producing animals
Record first usage on each box/bottle
Wholesaler to keep transaction records for 3 years
Vet practices to keep for 5years
What are the reasons for stock loss
Products going OOD
broken/damaged
Items not charged
Theft
Items charged but not received
Wholesaler credit for goods returned/missing not received
Consumable wastage
What is a stocktake
VMD requires all practices to do annually
Must include OOD products and broken/damaged stock aswell as the rest of the srock
Controlled drugs record keeping
Register to be kept for all schedule 2 drugs for 2 years after the last entry
Chronological order
Separate page for each strength and form of that drug
Separated into each drug class
Be able to be audited
No corrections or alterations
Dated and signed
Recorded in a bound book
What should every entry have in the register book for schedule 2 drugs
Date
Name and address of owner/animal/case number
Batch number
Amount dispensed and disposed of
Name or sig of prescriber
RCVS number
Amount remaining/ running balance
Should we use CD returned by a client
No
Should. Record any CD that are returned and destroyed
Yes
CD cabinet requirements
Attached by bolts to wall of building
Multi point lock
Double lock
Kept locked when not in use
Different to any other lock
Keys to authorised members of staff
Key can be left in combination box but code must be changed monthly and should not be next to CD
CD in vehicles
Lockable bag/box/glove compartment
Vehicle should not be left unattended
Separate register must be maintained
Can CD be sent in the mails
Only in exceptional circumstances and must be recorded and signed fora
Can CD be supplied by internet pharmacies
Yes but prescription must be received before the CDs are supplied
Can CDs be advertised to clients
No but a VS can discuss the use of CDs during a consult
What do SOPs cover
Order and receipts of CDs
Who has access to CD
Where are they stored
Dispensing of CD
Transportation of CD
Disposal and destruction of them
Who to alert if complications occur
Record keeping (what to do if discrepancies)
28 days after opened stock of ketamine left in a bottle what should happen to it
Must be denatured and recorded in register and witnessed by independent vet surgeon
What happens to remaining methadom in syringe from client
It is waste and is denatured ideally witnessed by another team member
Not recorded in register
Tramadol drug RCVS recommendations
That it should be locked in CD cabinet even tho it’s schedule 3 drug and can be kept on dispensary shelf
A discrepancy of methadone is noted at the end of the month what should be done
Consult the discrepancy policy SOP
A - RAMA (AVM)
Birds
L-RAMA (FAM)
Farm
J-RAMA (EQM)
Horses
C-RAMA (CAM)
Cats and dogs
CA-RAMA
Companion and avian
EA-RAMA
Companion equine and avian
K-RAMA
Farm and companion
G-RAMA
Farm and equine
E-RAMA
Equine and companion
JA-RAMA
Equine and avian
RAMA training timeline
Register with AMTRA as a student RAMA/sit base module (VN don’t need to do this)
Sit modular exam in chosen species
Face to face exam
Register with AMTRA and maintain CPD
Roles of a RAMA
Prescribe VMP within drug category POM-VPS
supply VMP within the drug categories POM-VPS, NFA-VPS, AVM-GSL
Identify infestations
Advise on prevention and control of disease
refer a client to vet if required
Ensure VMP are appropriate for client
What info must be gathered before a RAMA can prescribe or supply
Species
Number to be treated
Clinical signs
Age, sex, weight, lifestyle, temperament
Current medical history
Repeat or not
When was Last clinical exam
If the owner knows how to use product
What don’t RAMAs do
Diagnose disease
Treat disease
Don’t need to see the animal
