PLR- medicines regulations 5

medicine abuse, misuse owings and barnd or gerneric

What are the most commonly misused medicines?

codeine, dihydride ,pseudoephedrine and ephedrine

Why are codeine and dihydrocodeine addictive ?

• both can be broken down into morphine. = addiction

what is codeine and dihydrocodeine used for ?

• short term treatment of acute , moderate pain , that isn’t relieved by paracetamol , ibuprofen or aspirin alone NOT symptoms such as cold “flu, sore throat "

NOTE- only sold if tried paracetamol as first line treatment 

What are restrictions of pack sizes on codeine and dihydrocodeine ?

Pack sizes

Maximum pack size is 32 tabs/caps (pack size > 32 is POM)

●Good practice to sell only ONE pack at a time

What Must be provided on the leaflets and labels for codeine and dihydrocodeine ?

3) Patient information leaflets and labels

“Can cause addiction. For three days use only’

What is codeine linctus ?

-Codeine linctus (liquid) for dry coughs reclassified as POM owing to risk of dependence, addiction and overdose

• used to be over counter not anymore

What is Pseudoephedrine and ephedrine? 

●Pseudoephedrine and ephedrine- decongestants BUT used in Illicit production of methylamphetamine (crystal meth)

What are the Over counter restrictions on pseudoephedrine and ephedrine?

side effects of hallucination = restrictions

●OTC restrictions on quantities:

○No more than 720 mg of pseudoephedrine or 180 mg of ephedrine at any one time

○Do not sell any pseudoephedrine product at same time as an ephedrine product

●Sale made by a pharmacist or staff trained and know when to refer to pharmacist

What are some signs that might make you suspect misuse of Pseudoephedrine?

●They want a large amount , repeated requests

●Aggressive ,desperate behavior

●Group requests

●If they  - don’t appear to know the symptoms

●Paraphernalia – someone using a piece of equipment  associated with illicit substances

●Rehearsed answers

,opportunistic – staff are flustered

What are signs of possible misuse ?

●Eye contact – lying

●Impatient

●Largest pack – large quantities

●Go to the pharmacist

●Medical history

●Have you tried paracetamol first why do you need them

●Busy – opportunistic – hoping you won’t ask too many questions

What are some other otc medications that can be misused?

●Laxative- for weight loss

●Sleep aids- night nurse ,sedative

●Antihistamine-sedation

What is an owing ?

• when a pharmacy might not have the meds available or a replacement so owe th emedication

What are the validity of owings ?

What is a ssp ?

serious shortage protocols

●Way to manage shortages of medicines without needing to refer patient back to prescribers

●SSP issued nationally, time-limited

● what you can do Can specify:

○Alternative strength/formulation

○Generic substitute

○Therapeutic alternative

○Reduced quantity

●Pharmacist must use professional judgment to assess if appropriate must gain consent of patient

eg - 20 mg give 10 mg twice 

what are the impacts of owings on a patient ?

●Inconvenient

●Stressful

●Health deteriate

●assure

●Clinically consider what would happen

●Option- other pharmacies,  wait

What is a brand name medicine?

●Brand name

○Also known as ‘proprietary name’ or ‘trade name’

○Company that first produces and markets a drug gives it a proprietary name - no other companies can ever use that name

●After the patent expires, another company can produce a generic version of the branded product.

original medicine

what is a generic name medicine?

●Generic name

○also known as the ‘approved name’

○Usually related to chemical structure and medical classification of drug

when a another company manufactures a version of medicine, cheaper 

Differences between brand and generic products

●Generic products are usually cheaper than branded products (but not always)

●If a prescription is written generically, the pharmacist will get paid for a generic product, even if they dispense a more expensive branded equivalent product.

●If a prescription is written by brand name, the branded product must be dispensed.

Example- Lipitor – brand name for atorvastatin

Generic name – atorvastatin