W7: Health Info Systems And Resources: The BNF, Drug Tariff, SPC, Newt guidelines Flashcards
What is a formulary?
Examples?
At basic, it is a list of medicines
BNF- British national formulary
BNFc- British national formulary for children
DPF and NPF
What are the definitions of:
Indications and dose?
Contraindication?
Caution?
-Why it is being used and the dose (amount)
-When not allowed to use it
-What to avoid
Everything that ends in …pril is an..
ACE inhibitor
What is the definition of Interaction?
‘An interaction occurs when the effects of one drug are changed by the presence of another drug, food, drink or by some other chemical agent.’
What is the role of a pharmacist with interactions?
ANTICIPATE interactions before they occur
RECOGNISE them if they occur
COUNSEL patients on their therapy
What information is in the BNF?
- Drugs – provides (almost) everything we need to
know about using a particular medicine - Summaries – gives an overview of how to treat
various different diseases and conditions - Medical devices – some information on various
“devices”, but more information on these in the Drug Tariff - Borderline substances – again, more info in Drug Tariff
- Guidance – useful section with lots of information ranging from adverse reactions reporting, through life support, prescribing in pregnancy and breast-feeding, how to legally write prescriptions, etc.
- Wound care – primarily dressings and bandages
- DPF and NPF – see drug tariff lecture
What is an interaction?
An interaction occurs when the effects of one drug are changed by the presence of another drug, food, drink or by some other chemical agent.
What is the nature of the interaction between
- Carbamazepine and Warfarin?
- What decision to make when both are prescribed together?
Carbamazepine decreases the effects of warfarin. Manufacturer advices monitor and adjust dose.
- We know that there are lots of interactions with warfarin
- Monitor the INR
- Adjust the dose of warfarin accordingly
What is the nature of the interaction between;
Clarithromycin and theophylline
- What decision to make when both are prescribed together?
Theophylline is predicted to cause hypo leukaemia when given with clarithromycin.
AND
Clarithromycin is predicted to increase the exposure to theophylline .
- Difficult decision to make
- Avoid if possible, but monitor closely if needed
- Withold/decrease theophylline dose
What is the nature of the interaction between;
Omeprazole and clopidogrel
- What decision to make when both are prescribed together?
Omeprazole is predicted to decrease the efficacy of clopidogrel. Manufacturer advises avoid.
- Don’t use this combination
- Use alternative to omeprazole
What’s in the Drug Tariff? (6)
- Basic prices of drugs – Part VIII
- The ‘Black List’ – Part XVIIIA
- DPF, NPF and NMIP – Part XVIIA, Part XVIIB(i), Part XVIIB(ii)
- Appliances – Parts IXA, IXB, IXC, IXR
- Fees paid to contractors – Part IIIA
- Prescription charges – Part XVI
What is allowed on an NHS Rx?
Drugs, foods, toiletries, cosmetics, appliances, incontinence appliances, stoma appliances, reagents
Generic vs branded names – what’s the difference?
Can blacklisted brands be prescribed?
- Generic name is the name of the active ingredient/s
- Brand name is a trademarked name given by the company marketing the drug
e.g. Brand: Calpol
Generic: Paracetamol
-Blacklisted brands can prescribed generically as long as the generic name isn’t also listed
What is the SLS list?
The selected list scheme.
*Some medicines that aren’t blacklisted can only be prescribed on the NHS in defined circumstances, e.g. for certain indications
Special Containers (for info)
Payment is based on the number of packs nearest to the quantity ordered:
- Examples
1. Glyceryl trinitrate sublingual tablets 500mcg x 140 Quantity to be dispensed, 100 tablets
- Betamethasone valerate 0.1% cream 50g
Quantity to be dispensed, 2 x 30g (= 60g)
What does… stand for?
emc?
NICE-CKS?
SPS?
Electronic medicines compendium
Clinical knowledge summaries
Specialist Pharmacy Services
What is the emc?
Where does the information come from?
What information does it contain?
- Database / databank of regulated and approved information on medicines available in the UK
All the information comes directly from the pharmaceutical companies who have carried out the clinical trials on
that medicine:
SPC- Summary of Product Characteristic
PIL- Patient Information Leaflet
Who checks the SPCs and PILs before they are approved for the emc?
The MHRA (UK) and EMA (EU)
What are the NEWT Guidelines?
- Guidelines on the administration of medication:
- Patients with swallowing difficulties
- Patients requiring medication to be administered via feeding tubes
- Guidelines are made up of theoretical, practical and anecdotal information-unlicensed information
- No clinical trials data available for “crushing” tablets
What is the Green Book?
- Latest information on vaccines, vaccine schedules
and infectious diseases that can be prevented by
vaccines in the UK - Part 1 – principles, practices and procedures
- Part 2 – diseases, vaccinations and vaccines
- Information collate by public health England
- Free to access online
What is the Renal drug database?
Provides practical advise on the dosing of
medication in patients with a poor kidney function
- Information collated using a wide range of
resources and clinical experience-some of the
information may be unlicensed - Need a subscription-available to use on
placement - Access: https://renaldrugdatabase.com/
What is the Medusa IV Guide?
- Provides practical information on the preparation and administration of medication via the:
- Intravenous route
- Subcutaneous route
- Intramuscular route
- Subscription needed available to use whilst on
placement - Accessed via health board intranet page
What is the Palliative Care Guidelines Website?
- Vase array of information and guidelines on
palliative medicine - Useful pharmacy tools:
- Pain killer conversion calculator
- Syringe Driver drug compatibility
- General EOL guidelines
- Free to access online: https://book.pallcare.info/
What is the SPS?
What is it?
What is on the website?
Specialist Pharmacy Service (SPS)
- NHS England funded website
- Provides information to support healthcare professionals providing NHS commissioned care on a day to day basis
- Fridge stability data
- Compliance aid stability data
- UKMI (UK Medicines Information) Q&A documents
- Medicines monitoring tool – new feature
- Publications
- Guidelines
What can nurses prescribe? (4)
*Medicines listed in the NPF – Part XVIIB(i)
*Stoma & incontinence appliances listed in Parts IXC & IXB
*Appliances listed in Part IXA (unless they are POM medicines)
*Reagents listed in Part IXR
What can Dentist’s prescribe?
*Only those medicines listed in the DPF
*E&W: can prescribe drugs either by brand or generic name
*Cannot prescribe any appliances or reagents
Non-Medical Independent Prescribing (Nurses,
Pharmacists, Optometrists, Physiotherapists and
Chiropodists/Podiatrists) – Part XVIIB(ii)
*Nurses and pharmacists can prescribe all licensed medicines including CDs (but not diamorphine, cocaine or dipipanone for treatment of addiction)
*Optometrists can prescribe for limited conditions related to their practice but cannot prescribe any CD
*Physiotherapists and Podiatrists can prescribe any licensed medicine within their area of competence and since June 2015 can prescribe temazepam, lorazepam, diazepam, dihydrocodeine and physiotherapists can also prescribe morphine, fentanyl and oxycodone
What are the tests using prescribed chemical agents used for?
e.g. detection strips
*Testing urine for
– glucose
– ketones
– protein
*Testing blood for
– glucose
– ketones
*Testing INR
– anticoagulant monitoring
*Testing sweat
- neuropathy
What does NICE stand for?
National Institute for Health Care and Excellence
