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86 Cards in this Set

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Why some medicines can be classified under more thanone category?

depending upon formulation, quantity, strength, indication and marketing authorization

GLS/P/POM

How many different types of “appropriateprescribers” of POM are there?

13


-Doctor (GMC)


- Dentist (On the dental register – GDC)


- Supplementary prescriber


- Nurse independent prescriber


- Pharmacist independent prescriber


- EEA and Swiss doctors and dentists*


- EEA and Swiss prescribing pharmacists andnurses where they exist*


- Community practitioner nurse prescriber


- Optometrist independent prescribers**


Since August 2013


- Podiatrist independent prescribers*** - Physiotherapist independent prescribers***

Is stating a total quantity of each drug legal requirement?

NO


It is a good practice

for normal prescriptions i.e. not CD

Is it possible to have multiple dispensing for one private prescription?

Yes


Private prescriptions can be repeated as indicated by theprescriber (e.g. repeat x 3)

Is NHS prescription repeatable?

NO

Is there any requirement for dispensing from a repeatable prescription?

the first dispensingmust be made within six months of the appropriate date,following which there is no legal time limit for the remainingrepeats.

Can we dispense any time?

What is the only exceptional drug that can be dispensed from a private prescription which is not stated as repeatable?

oral contraceptive, which can be dispensed sixtimes (i.e. repeated five times) within six monthsof the appropriate date.

What are the exceptional occasions for NOT making a POM record?

(i) Supply is on NHS script


(ii) Any script for an Oral Contraceptive


(iii) A separate record is made in the Controlled Drugs Register ieschedule 2 controlled drugs


(iiii) Sale or supply is by wholesale dealing for a professionalperson and the signed order or invoice relating to the sale isretained for 2 years

Is POM record a private record?

yes


POM Book= POM Register = Private prescriptionbook

How long does a private record need to be kept?

2 years




What do you need to add on a private prescription and labels when dispensing?

The private record references;


BOOK / Page/ Column




Both on the prescription itself and the labels on the medicines

A pharmacist working in a registered pharmacycan supply a POM to a patient under certainconditions, in an emergency when...?

Under Patient’s request and prescriber’s request

At the request of a prescriber, you can supply POMs in emergency but the prescriber needs to agree to furnish a written prescription within...?

72 hours

Under a request from UK prescriber,


does emergency supply cover Controlled Drugs?

CD Schedule 1, 2 and 3 CANNOT be supplied except phenobarbital for epilepsy

Under a request from EEA/Swiss doctors or dentists, does emergency supply cover all Controlled Drugs?

NO,


CD schedule 1,2 and 3 cannot be supplied with NO exception

Do you need to write a POM record for emergency supply?

Yes, with in 24 hours after supplying




You need to add the date on prescription (can be added once prescription received) and the date on which prescription received (added once prescriptionreceived)




You need to add the nature of emergency (• Why patient needs POM immediately• Why a prescription cannot be obtained) for the request of a patient

For the emergency supply,


what are the main differences between a request of a patient and a prescriber?

At the request of a patient, a pharmacist need to


1. interview; a patient with RPS guidance (professional judgement)


2. dose; must be identified


3. labeling; add "Emergency Supply" on a dispensing label

At a request of a patient, does the emergency supply cover all POM and CDs?

POMs must be previously prescribed from appropriate prescribers.


CD schedule 1,2 and 3 are not allowed except phenobarbital for epilepsy

For Emergency supply, what is the length of treatment for POM?

@ POM = ≤ 30 days treatment


@ Insulin, ointment, cream, inhaler (i.e. Packs cannot bebroken) = give smallest pack available in the pharmacy


@ Oral contraceptive = give ONE full treatment cycle


@Antibiotic in oral liquid form = give smallest quantity thatprovides a full course of treatment

For Emergency supply, what is the length of treatment for CDs?

For CD schedule 4,5 and phenobarbital,


max 5 days of treatment

Under your ethical and professional judgement, you may refuse to supply in emergency.


What do you advice to a patient?

Advise patient on how to obtain a prescriptionfor the medicine or appropriate medical care


Referral to doctor


NHS walk-in centre


Family planning clinic


A&E department

Under a request of a patient, you do not need to interview a patient at when?

Legislation in place that relaxes emergency supplyrequirements in event of pandemic or imminentpandemic declared by DoH.


E.g. Swine flu (Tamiflu®)

Emergency supply from a patient request:


Does interview to a patient HAVE TO be face to face?

Preferably face to face, but also accept a telephone interview if not possible

When making a POM record for emergency supply from a prescriber's request, is the date on the prescription when you receive it LEGALLY required?

Yes

Is the pharmacy's name and address LEGALLY required for the POM record under the emergency supply?

NO

Is stating "the nature of the emergency" LEGALLY required for POM record under emergency supply from a prescriber's request?

NO.


Only required from a patient's request

Is stating "the purpose of medicine" LEGALLY required for POM record under emergency supply?

NO for both patient and prescriber's request

Maintaining clear sexual boundaries is set by...?

GPhC guidance


(General Pharmaceutical Council)

What is schedule 1 CD?


What is it called?

CD Lic POM


No real uses. Licence reqLSD, ecstasy, cannabis

What is schedule 2 CD called?


what are the examples?


Are they dispensed commonly?

CD POM


Yes it is common.


Morphine,methadone, diamorphine

Does registration required for schedule 2 drugs?

Yes, register required

What are schedule 3 CD?



Buprenorphine,temazepam, phenobarbital

Does registration required for schedule 3 CD?

No

What are the sub sections for schedule 4 CDs?

CD Benz POM and


CD Anab POM

What are the examples of schedule 4 CD?

BenzodiazepinesAnabolic and AndrogenicSteroids

What are anabolic and androgenic steroids?

They are synthetic substances related to the male sex hormones (androgens.) The anabolic effects of the drugs promote the growth of skeletal muscle, and the androgenic effects promote the development of male sexual characteristics.

What are schedule 5 CDs?

Codeine, Pholcodeine,morphine – low strengths

What is special about schedule 5 CDs?

some can be in P meds incombination

Schedule 2 and 3 prescription:


What is the valid dates from appropriate date?

28 days

Schedule 2 and 3 prescription:


Can a patient with address which is out side UK get CDs?

No


address must be in UK

Schedule 2 and 3 prescription:


Is stating formulation for CD LEGALLY required?

yes

Schedule 2 and 3 prescription:


Is stating strength LEGALLY required for CDs?

Only if there are more than ONE strength available

Schedule 2 and 3 prescription:


What is the legal requirement for stating quantity for CDs?

Written in BOTH figures and words


2 packs of 30 tabs – two packs of thirty tablets

Schedule 2 and 3 prescription:


what is the maximum length of treatment?

Guidance DoH supply not exceed 30 days treatment

Can a dentist prescribe schedule 2 and 3 CDs?

Yes,


prescription must be written


"for dental treatment only"

What is the form of private prescription for schedule 2 and 3 CDs?


What colour is that?

FP10PCD


pink

What is the additional requirement for the prescriber in order to prescribe schedule 2 and 3?

stating Prescriber identification number on script (not GMC number)

Is repeating allowed for schedule 2 and 3 CDs?

NO

What is the role of pharmacy after collecting "dispensed FP10PCD"?

Original scripts sent off with rest of NHS scripts at endof month to NHS BSA

Is a pharmacist allowed to amend Minor spelling mistakes for CD prescription?

Yes

The CD prescription:


the quantity is written in figures but not with words.


Can a pharmacist amend it?

Yes


but not BOTH

What dose a pharmacist need to state in order to amend a CD prescription?

Made in ink


Name of Pharmacist, date, signature and GPhCregistration number

Can Pharmacists add the dose if missing?

NO

If a script for MST continus has 20 written for itsstrength can the Pharmacist add the “mg”?

NO

If a script says “Methadene” can the Pharmacistchange it?

YES

What are requirements for making Controlled Drug Records?

Need to record both when CD is supplied and dispensed.



It must be


Entered chronologically Entered promptly within 24 hr


Ink or indelible


Unaltered

What should you do if you make a mistakewhen writing a CD register entry?
Note at foot of page or in the margin with * or ()



“Should read………”




Show who is responsible:


+Name of person making the amendments


+initials or signature


+ GPhC number


+ date of amend

What are the 7 legal components that need to be stated on CD registers for "supply"?

1.Date supplied


2. Name and address of person supplied


3. Details of authority to posses i.e. prescriber detail


4.Person collecting


5.Was ID asked for?


6. Was ID provided ? (what)


7. Quantity supplied– Update balance

What are 4 legal components that need to be stated on CD register for "receipt"?

1.Date supply received


2.Name and Address of “from whom received” (supplier info)


3.Quantity received


4.Update the running balance

What does a pharmacist need to ask in order to hand in the medication to the patient or the representative?

Sign the back of prescription to Confirm collection




Proof of ID (Schedule 2)


However, it is Pharmacist’s discretion whether to supply without it

What is the form of prescription for treatment of addiction in UK?

FP10MDA light blue, double sides

FP10MDA


What is the maximum treatment period for installments?

14 days

What does a prescriber need to specify on the prescription FP10MDA?

No of instalments

How much to dispense at each instalment


Interval between instalments

1st instalment must be within ...days after the date of prescription

28 days

Can a pharmacist supply double the amount if a patient misses the dose?

NO

Can a pharmacist provide extra methadone doses while a pharmacy is closed? I.e. weekends and bank holidays

You can only do that as indicated on prescription.


Call prescriber to add the information about installment.


Need to dispense daily doses in separate containers

who can collect the CDs?

• Patient• Patient’s representative• Healthcare professional acting on behalf of thepatient in their professional capacity

what can you to confirm that the patient has already collected the CD prescription?

- Ask the person to sing at the back of the prescription


- good practice to ask individual to sing to confirm that CD has been collected from pharmacy


- person can refuse, but a pharmacist must use discretion on whether or not to supply CDs

When person comes to pharmacy to collect CD, what can you do to check their identity?

It is legal requirement to find out who is collecting.




- if patient ask for ID (if the patient comes to collect many times from your pharmacy, you may use your judgement whether or not to ask for ID)


- patient's representative, then ask for ID
- Health care professional, must obtain the name and address and must ask for proof of ID unless already known to pharmacist


- pharmacist discretion whether to supply ID




IDs; driving license, card detail, passport...

For schedule 2 CDs:pharmacists are LEGALLYREQUIRED to determinewhether the personcollecting is the patient, ortheir representative orhealthcare representative

yes

Pharmacists CANNOTgive out CDs to apatient’s healthcareprofessional collectingon their behalf if theyhave no ID available

false

What about collection of a CD by arepresentative of a drug misuse patient?
• Pharmacists should obtain a letter from the patientauthorising and naming the representative

– Friend/relative, often if patient is unwell


– If in police custody, a letter of authorisation allowing thepolice custody officer to collect on their behalf


• Note: a separate letter should be presentedeverytime the representative collects


• The representative should bring ID with them


• Good practice: pharmacist insists on seeingpatient at least once a week





What about collection of a CD by arepresentative of a drug misuse patient?



And when the patient is under the supervised dose?

• If the medication is prescribed to be a supervised dose, the pharmacist should contact the prescriber before supplying to the representative (as supervision is not possible without patient there)



• Pharmacists should make records of such conversations.




• It is legally acceptable to verbally confirm thisarrangement with the prescriber as supervisionis not a legal requirement under the 2001regulations.

CD collection:




If the prescription is installment prescription, how many times is it needed to be signed?

 Instalment prescriptions only need to be signedONCE

CD collection:




If the CD is sent to the patient by delivery, how do you confirm successful delivery?

A representative, including a delivery driver, cansign on behalf of the patient.



a robustaudit trail should be available, confirmingsuccessful delivery of the CD to the patient (e.g.implementing an SOP which requires the patientto sign a form on receipt of the CD)

what are the minimum standards for safe custody for CD?

It is derived from safe custody regulations that Requires that pharmacies, private hospitals, andcare homes keep relevant CDs in a ‘locked safe,cabinet or room which is constructed as to preventunauthorised access to the drugs’

what kinds of CD must be kept under safe custody?

– Schedule 1 drugs

– Schedule 2 drugs except quinalbarbitone (secobarbital)


– Schedule 3 drugs unless exempted under the Misuse ofDrugs (Safe Custody) Regulations 1973 as amended *Common exemptions inc. phenobarbital and pentazocine




* Common Schedule 3 CDs requiring safe custody inc. temazepam and buprenorphine

What do you need to do when CDs requiring safe custody are not in the CD cupboard?

When CDs requiring safe custody are not in theCD cupboard (e.g. during the dispensing process)they must be under ‘direct personal supervision’ ofthe pharmacist

What do you need to do in order to handle a CD key?

Access to CDs, including the handling of CD keys,should be restricted and documented. Incommunity pharmacy it is common for thepharmacist to keep the CD keys on their personat all times



• A key log should be used to keep an audit trail ofwho has had access to keys; including overnightstorage in the pharmacy, transfer of keys from onepharmacist at the end of shift to another, etc.

Safe custody: what about patient-returned,out-of-date, and obsolete CDs?

- safe custody still applies to these drugs until they can be destroyed




- To minimise the risk of accidentally supplyingthese CDs to patients, this stock should besegregated from pharmacy stock and clearlymarked (e.g. in a bag labelled ‘patient returnsawaiting destruction’ or ‘expired CDs awaitingdestruction’)

what is the drug driving legislation updated march 2015?

- it is now offence to be caught driving with certain drugs in excess of specified levels




- Patient’s who have been prescribed orare taking specified drugs for legitimatemedical reasons should keep somesuitable evidence with them (E.g. repeat prescription slip for aprescribed medicine or the patientinformation leaflet for a P or GSLmedicine.)

what are the two groups of specified drugs that are concerned under driving?

1st group: commonly abused drugs




2nd group: licensed medicines that are likely to be abused

Give examples of 2nd group of specified drugs

- clonazepam


- methadone


- morphine


- temazepam


- diazepam


- lorazepam


- flunitrazepam


- oxazepam


- amphetamine



Is dihydrocodein considered as 2nd group?

not sure


depends on the concentration (if too high that causes driving impaired, then offensive)

Is codeine considered as 2nd group?

not sure



depends on the concentration (if too high that causes driving impaired, then offensive)

What can you advice to patient if he/she is taking 2nd group drugs?

• Pharmacist must counsel affected patientseffectively


• C and A label 2


• Greater awareness that it could affected drivingability or slow thinking or sight problems etc


• Find out how it affects you first


• Issues with interactions to be raised


• Avoidance of alcohol concurrent with medicines


• Not taking your medicines could also affect drivingability


• Pharmacist must counsel on importance ofcarrying evidence that you are taking medicinesas prescribed or supplied


• Patients made aware of the general issue


• Evidence e.g. repeat prescription slip, PIL etc.


• If they feel impaired … don’t drive !