MEP Flashcards
What are the FOUR principles of medicines optimisation?
1) Aim to understand the patient’s experience
2) Evidence-based choice of medicines
3) Ensure medicines use is as safe as possible
4) Make medicines optimisation part of routine practice
How many CPDs must pharmacists record per year?
How many of these must start at reflection?
9 minimum
3 starting at reflection
What is a GSL medicine?
Sold in a registered pharmacy or retail outlet that can close to the public
Hold an EU/ UK Marketing Authorisation or Traditional Herbal registration or GSL homeopathic product.
Can GSL medicines be sold in the absence of the responsible pharmacist?
Yes! Providing they have signed in as RP on the pharmacy Record. Unless they have been absent for over 2 hours- then you can’t unless another pharmacist becomes the RP.
If they have not (i.e. they are late) then GSL sale can only commence once the RP has signed in.
Can P medicines be sold in the absence of the RP? What if a second pharmacist becomes RP?
NO- not in absence of RP, unless a second pharmacist is present.
NB: P medicines should not be available for self-selection!
What cannot take place when the Responsible pharmacist is absent for under 2 hours?
Sale of P Medicines
Handing out prescriptions and bagged meds
Handing prescriptions to delivery driver
These CAN all take place if a second Pharmacist is present.
What is the only activity that can be done if the RP is absent for over 2 hours and there is no second pharmacist?
Taking in prescriptions- the pharmacy would be closed in this situation but could take prescriptions at door.
What two drugs used in Cold and Flu must you NOT sell together at the same time?
Products containing Pseudoephedrine and Ephedrine
Who can suspicions of possible misuse of OTC products be reported to?
Local GPhC inspector
Local Controlled Drugs liaison police officer
Accountable officer
What are the two licensed EHC drugs that can be obtained from a pharmacy?
Levonorgestrel 1500 mcg (Levonelle One Step)
Ulipristal Acetate 30mg (Ella One)
How many days after unprotected sex is Levonorgestrel licensed for?
What about Ulipristal Acetate?
Levonorgestrel= 3 days (72 hours)
Ulipristal acetate= 5 days (120 hours)
What age is Levonorgestrel licensed for?
What about Ulipristal Acetate?
Levornorgesterol is licensed for use in over 16 years. Can be given to under 16’s only if a locally commissioned PGD is in place.
Ella One can be used in any girl of child-bearing age- so can be used in under 16’s!!
Bear in mind- children under 13 are legally too young to consent to any sexual activity. Any younger requesting this should be reported to social services. Children under 16 also not legal although its may be consensual- i.e. with a boy also under 16.
Can pharmacists provide an advanced supply of EHC?
Yes
If you decided to supply a child under 16 with EHC, can patient information be disclosed without consent?
No- still need to obtain consent in order to disclose information. Info can be shared if safeguarding an issue- judge on a case by case basis.
EHC: If the patient vomits within how many hours of Levonelle/ Ella One should they take another dose?
2 hours of taking Levonorgesterel
3 hours of taking Ella One (Ulipristal acetate)
At what point in the menstrual cycle should EHC be taken? Can it be taken more than once per cycle?
Can be taken at any point.
SPC for Levonelle states It is not advisable to take more than 1 per cycle as it can disrupt the cycle.
NB: RPS guidance says that women can take more than one if appropriate but should be advised about cycle disruption.
A patient, who you are aware has alcoholic liver cirrhosis, asks for EHC. What do you do?
EHC- levonorgestrel and Ulipristal- both not recommended in severe liver dysfunction. Try and find out how severe the liver disorder is- refer.
What medication can Levonorgestrel increase the toxicity of?
Ciclosporin (immunosuppressant used after transplants)
Can EHC be used in breast feeding women?
Levonorgestrel appears in small amounts in breast milk- should not be harmful, but take tablet after a feed to allow maximal team until next feed.
Ulipristal acetate is present in breast milk for 1 week after administration. Advise mother not to BF in this time but express and discard the milk to maintain lactation.
Which EHC drug can reduce the efficacy of COC and POP pills?
Ulipristal acetate. Patients should use barrier methods until next period as their normal contraceptive cover will be reduced
A patient has received EHC, and asks if they have unprotected sex again before their next period, will the be okay?
No- it does not provide protection against pregnancy for the rest of the cycle- they will need to use contraceptive measures if they want to have sex again such as start the pill or condoms.
What is the max number of paracetamol non effervescent and aspirin non effervescent you can buy OTC?
100 of each
but remember they come in packs of 16 and 32 so you would not be able to sell this amount anyway!
What is OTC codeine/ dihydrocodeine products indicated for?
Short term (3 days max) treatment of acute - moderate pain not relieved by paracetamol, ibuprofen or aspirin alone.
NOT for cold, flu sore throat etc.
What is the largest pack size of codeine/ dihydrocodeine products available OTC?
32
anything bigger requires an MA as a POM
RPS recommends the sale of just one pack of 32 at any one time.
NB: Extra warning label needed: “Can cause addiction. For three days use only”. Users can get an ‘overuse headache if they use it for longer.
Why are many cough and cold remedies now no longer used in children under 6 years?
No evidence they are effective
Sometimes the ingredients can be linked to SEs including allergies, sleep disturbances and hallucinations.
Medicines containing what 4 types of cough and cold remedy ingredients have been deemed unsuitable for children under 6 years?
Antitussives (eg dextromethorphan, pholcodine)
Expectorants (eg Guaifenesin)
Nasal decongestants (pseudoephidrine, phenyephidrine, oxymetazoline)
Antihistamines- but these may still be used in hayfever
These medications should only be used second line in children 6-12 years, for a maximum of 5 days
A 2 year old child presents to the pharmacy with their mother saying that they have a raised temperature. What do you do?
Take their temperature- use a digital thermometer under their armpit (always under armpit in child under 5 years) for around 15 seconds. If the reading >37.5 degrees then it is likely to be a fever.
What to offer:
Paracetamol or ibuprofen.
Do not use these at the same time in children under 5 years (however if one doesn’t seem to be helping, it’s OK to try the other one before the next dose is due)
Dose in this child:
Paracetamol- 2 years old- 180mg (7.5ml) every 4-6 hours.
Ibuprofen- 100mg TDS
What is first line treatment for nasal congestion in children?
Saline nasal drops
Vapour rubs
Decongestants- e.g. Karvol decongestant drops
What is first line treatment for a cough in a child?
Warm, clear fluids, honey and lemon if child is OVER 1 year old.
Simple cough mixtures- eg. glycerol or simple linctus
Can podiatrists and physiotherapists independent prescribers prescribe POMs? What about CDs?
POMs- Yes- if in their area of expertise
They can only prescribe the following CDs for oral administration: Diazepam Dihydrocodeine Lorazepam Temazepam
Physiotherapist IPs can also prescribe: Oxycodone (oral)
Morphine (oral or injection)
Fentanyl (transdermal)
What is the ‘appropriate date’ on a prescription?
Rx’s are valid for 6 months for this
This is the later of either the date the prescription was signed or the date indicated by the prescriber.
For PRIVATE Rxs: the appropriate date will always be the date on which the Rx was signed
When must age be stated on a prescription?
If the patient is under 12 years old
Is it okay to issue carbon copies of prescriptions to patients?
Yes as long as they’re signed in ink
What units need to be written in full on prescriptions?
Micrograms
Nanograms
Units (i.e for insulin)
What length of time to dispense requirements apply to EPS prescriptions?
Same things- must be dispensed 6 months from appropriate date, 28 days for CDs
What does ‘repeatable prescription’ mean?
It means the prescriber has added an instruction onto the main prescription for the item to be repeated.
It is NOT referring to the prescription counterpart that patients tick in the pharmacy to indicate to their prescriber what they need on their Rx next time.
Are NHS prescriptions repeatable?
NHS Rx’s are NOT repeatable. This is because Repeatable prescriptions are a different concept to prescribing for regular items made under the NHS repeat dispensing scheme.
This is where patients tick what they want each time, and the Electronic repeat dispensing service is used where a prescriber issues a batch of repeat Rx’s electronically that can be used until the patients next review.
Are Rx’s for Sch 2, 3, 4 and 5 CDs repeatable?
Are private prescriptions repeatable?
Rx’s for Schedules 2 and 3 CDs are NOT repeatable.
Rx’s for Schedule 4 and 5 are.
Private prescriptions can be repeated, indicated by prescriber, e.g. ‘Repeat x 3’ means the Rx can be dispensed 4 times in total.
If the number of repeats is not stated on an Rx- i.e. it just says ‘Repeat’, they can only be repeated once. What is the exception to this rule?
Prescriptions for an oral contraceptive. This can be dispensed 6 times if the number of repeats is not specified, within 6 months of appropriate date.
For repeatable Schedule 5 CD Rx’s, the first dispensing date must be within _____.
For schedule 4 CDs it must be within ____.
Schedule 2 and 3 are not repeatable.
Schedule 5- 6 months
Schedule 4- 28 days
Following this there is no legal time limit for remaining dispensing- clinical judgement.
You have OWINGS on a Rx for P meds and GSL meds. How long do you have to dispense these owed items?
6 months
6 months for POMS + Sch 5 CDs
28 days for Sch 2,3,4 CDs
How long should private Rxs be kept?
How long should the POM book be kept?
2 years- for repeatable Rx this should be 2 years from last dispensing date.
Keep POM book for 2 years from last entry.
What needs to be entered in the POM register?
- Patient name and address
- Prescriber name and address
- Medicine- Name, quantity, form, strength (strength only needed if more than one strength available)
- Prescription Date
- Date supplied
Prescriptions for What are exempt from having to be written in the POM register?
For oral contraceptives
For schedule 2 CDs- as these will be recorded in the CD register
Are Details of the medicinal product (Name, strength, quantity, dose) legal requirements for POM prescriptions?
No!!
But they are obviously needed for supply
Can you dispense against a Faxed prescription?
No- not legally valid
Not written in indelible ink
Risk not receiving an original prescription
Do it as an emergency supply instead- then it is on their back to get the original prescription to you
Can you dispense from prescriptions from an EEA (EU) country and Switzerland (Not part of EU)?
Yes- only for schedule 4& 5 CDs and POMs, must have a UK Marketing Authorisation!
Rx has to include prescriber details- full name, qualifications, direct contact details (email address and phone), address- including country
They are allowed to be in a foreign language
If confirmation of registration status of the prescriber is not possible- may still be able to make a safe legal supply
Can emergency supplies be made for EEA/ Swiss prescribers?
Emergency supplies from these prescribers are also allowed
Prescription still needs to be received in 72 hours from EEA prescriber
NB: Schedule 1,2,3 CDs cannot be supplied- INCLUDING phenobarbital!
Can community nurse practitioners, optometrist, pharmacist independent, physiotherapist, podiatrist, EEA/ Swiss doctors request emergency supplies?
Yes
How long have prescribers got to get a written prescription to the pharmacy if they request an emergency supply?
72 hours
Emergency supplies cannot be made for CDs Schedule 1, 2, 3. With the exception of what?
Phenobarbital (also called phenobarbitone) for EPILEPSY by as UK-registered Doctor
(NOT EEA)
Can an emergency supply be made to a patients relative?
No- must be able to interview the patient themselves.
However at times this may not be possible- e.g. a young child or patient being cared for. In this case use professional judgement
Medicinal products containing ammonium bromide, calcium bromide, fluanisone, hexobarbitone, pemoline… and many more cannot be what?
Cannot be given as an emergency supply
Maximum quantity for an Emergency supply for CD’s (Phenobarbital, Schedule 4’s and 5’s) is?
What about for POMs?
CD’s: 5 days
So things like Zopiclone can only be given for max 5 days.
POMs: 30 days
Who can Isotretinoin (for severe acne) therapy be initiated by?
Directly by or under the supervision of a consultant dermatologist, and under the conditions of the Pregnancy Prevention Programme.
This programme protects women at risk of becoming pregnant during therapy, as isotretinoin is a retinoid and will cause severe malformations in a foetus and there is also risk of spontaneous abortion.
How long are prescriptions for Isotretinoin valid for under the pregnancy prevention programme?
What is the maximum quantity that can be supplied?
R valid for 7 days- I.e. have to dispense it within 7 days of date due to pregnancy test window. Rx’s presented after this 7 days are considered expired.
Maximum of 30 days supply. If not under the Pregnancy prevention programme, more than 30 days may be supplied.
Can you dispense repeat prescriptions of isotretinoin? What about faxes? What about emergency supplies?
No repeats
No faxes
Emergency supply only if at request of a pregnancy prevention programmes practitioner and confirmation of pregnancy status has been established as negative within the previous 7 days.
Can registered UK doctors prescribe Cocaine, dipipanone or diamorphine for treating addiction?
Only if they have a Home Office License!!
If not they can only prescribe these drugs for treating organic disease or injury.
Can pharmacist independent Prescribers prescribe Cocaine, dipipanone or diamorphine for treating addiction?
No
Nurse independent prescribers, pharmacist independent prescribers and supplementary prescribers cannot prescribe these at all for addiction, but can for organic disease/ injury.
Can prescribe CDs, but must only prescribe drugs for medical conditions within their competence.
Which two professions independent prescribers can only prescribed ‘Off-label’ medicines as opposed to unlicensed?
Physiotherapists
Podiatrists
Optometrists
Cannot Rx unlicensed, all other IP’s can apart from Community practitioner nurses and EEA doctors.
Can EEA/ Swiss HCP’s and UK Community practitioner nurses prescribe unlicensed or Off-label medicines?
No
The product must hold a UK Marketing Authorisation
If a pharmacist is supplying an oncall doctor a small quantity of certain medicines for his doctors bag, do they require a Wholesale Dealers License?
No
Pharmacies can supply other healthcare professionals in the UK who need to hold small quantities for drugs for treatment/ onward supply of their patients.
You are working a Lloyds pharmacy and realise you do not have any spiriva inhalers left. Mrs P is due to come in an hours time to pick up her prescription and you know she is going away tomorrow. Can you ring up Boots down the road and request a spiriva inhaler to meet this patients needs, do you need a Wholesalers Dealers License to do so?
Community + Hospital pharmacies can obtain small quantities of a medicine from other pharmacies to meet patients needs.
A Wholesalers dealers license is not needed for this, as it is considered as ‘Provision of healthcare services’, not seen as commercial dealing.
Pharmacies can give other pharmacies medicines and also give HCP’s small quantities of medicines without the need for a Wholesalers dealers license, as it is seen as providing a healthcare service and not commercial dealing.
This is as long as 4 criteria are met, what are these?
- Takes place on an occasional basis
- Quantities are small
- Supply made on a not for profit basis
- Supply is not for onward wholesale distribution
If a pharmacy wants to engage in commercial trading it requires a wholesalers dealers license. What if the pharmacy wants to exchange stock between itself and another pharmacy…. what if the other pharmacy intends to use the stock to wholesale deal/ commercial trade?
If the other pharmacy is part of the same legal entity, i.e. it does not intend to wholesale deal/ commercially trade the stock, a WSDL is not needed.
If it does intend to do these, the supplying pharmacy must also be named on the wholesale dealers license.
