Reclassification of POM to P

Question 1

To reclassify a from POM to P, what requirements must the medicine NOT fulfil? (4)

Answer 1

• Present a danger to health even when used correctly without supervision of doc
• Frequently incorrectly used, results in danger to health
• Has substance that has activity or S/E that require further investiation
• Prescribed for parenteral administration (injection)

Question 2

P to POM

Answer 2

• New identified risks

- P meds no longer meet the P meds requirements

Question 3

P to GSL

Answer 3

Minister satisfied that med is reasonably safe to supply without supervision of pharmacist
(safely used for years)

Question 4

Recent POM to P changes (6),

just know first 4 at least!

Answer 4

Diclofenac
Domperidone 
Tamsulosin 
ellaOne
Tranexamic acid
Esomeprazole

Question 5

Which organisation evaluates applications to reclassify medicines?

Answer 5

Medicines and Healthcare products Regulatory Agency (MHRA)

Question 6

Name two emergency hormonal contraception

Answer 6

• Ulipristal acetate (ellaOne) 30mg tabs

- Levonorgestrel (Levonelle) 1500mcg tab

Question 7

ellaOne:

Age, up to how many hours, price

Answer 7

• Women of childbearing age incl. adolescents
• up to 120 hours after unprotected sex
• £35

Question 8

Mechanism of action of ellaOne (3)

Answer 8

Progesterone receptor modulator
inhibits/delays ovulation
alters endometrial endothelium

Question 9

Levonelle:

Age, up to how many hours, price

Answer 9

• Women 16 and older (unless through PGD)
• Up to 72 hours after unprotected
• £27

Question 10

EHC discussion, what things do you need to consider or ask? (6)

Answer 10

1) Age
2) When they had unprotected sex
3) Any meds, herbal, OTC?
4) Medical conditions, pregnant, breastfeeding?
5) Ensure she understands all info to make the decision
6) Counsel on EHC and future contraceptive options

Question 11

Referral of patients wants EHC (7)

Answer 11

• unproteted is over 120h
• pregnant
• taking carbamazepine, griseofulvin, phenobarbital, phenytoin, st Johns wort (and more)
• affecting absorption (crohns, vom, severe diarrhoea)
• severe hepatic dysfunction
• previous allergy to EHC
• EllaOne note for severe asthma with oral corticosteroid

Question 12

Tamsulosin indication and mechanism of action

Answer 12

• benign prostate hyperplasia

- alpha 1 adrenoceptor antagonist; relax smooth muscle in prostatic hyperplasia

Question 13

Symptoms of Benign prostatic hyperplasia: (6)

Answer 13

• needing to wait before start peeing
• stop and start when pee
• strain to pee
• bladder never feels completely empty
• dribbling at end
• pee more and at night

Question 14

Non-pharm advice for tamsulosin (Flomax relief) (5)

Answer 14

• Avoid drinking liquids up to 2 hours before bed
• Stop or limit consumption of alcohol and caffeine
• Regular exercise can improve symptoms
• increase fruit + fibre- limits constipation, less pressure on bladder
• Avoid decongestants and antihistamines which effect muscles of bladder

Question 15

Sumatriptan mechanism of action and indication

Answer 15

• 5HT1 receptor agonist

- stabilise blood vessel in brain involved in migraine- only treats

Question 16

What is a migraine the result of?

How do migraines differ from headache?

Answer 16

Over dilation of certain arteries in the brain causing a recurrent throbbing headache on one side of the head

They differ as they also are accompanied by nausea, vomiting, changes in vision and hearing

Question 17

Sumatriptan counselling points

Answer 17

• Take tab ASAP after migraine onset
• If 1st dose ineffective, the 2nd dose will be too
• If experiencing 4 or more migraine a month, go GP
• Excessive use can exacerbate headache or lead to chronic daily headache