Random 'role of a pharmacist' notes

What is dispensing?

-turning a prescription into medicine

What is the role of legal classes/laws of medicine?

-affects how patients can obtain medicines, who can order them and who can give/administer to patient. Every medicine should have a product license.

What are the 3 main classes of medicines?

GSL, P and POM

What does a GSL medicine mean? Give an example of one

-the medicine can be sold in most places freely to the public e.g. supermarkets, garages.

-Examples include: paracetamol, calpol

What is a P medicine? Give an example of one

-Pharmacy only medicine

- the medicine can only be sold or supplied by a registered pharmacist or pharmacist under supervision. it must be sold in pharmacy premises.

-examples include:

emergency contraceptive (i.e. morning after pill), acnecide cream

What is a PO medicine?

-a subsection of P medicine

-legally classified as GSL but manufacturer wants it to be sold in pharmacy only.

What is a POM medicine?

-medicine is only given to person if prescribed by prescriber

What is PGD medicine?

-prescription-only but can be given without prescription based on certain criteria. e.g. influenza vaccine, oral antivirals

What is a prescription item?

-each medicine listed in prescription.

-e.g. 2 medicines in the prescription means 2 prescription items

What does inpatient mean?

-the patient would be staying at least 1 the night

What does outpatient mean?

-visit, not staying

What is a drug chart?

-every time inpatient takes their medication, it is recorded by nurse

What’s the difference between a an NHS prescription and a private prescription?

-nothing

What’s patient counselling? Why is it done?

-telling the patient how to take their medication and explaining why they are taking it and answering their questions.

-to improve medicine adherence.

What is the difference between compliance and adherence?

-compliance measures whether the patient is physically taking their medications as prescribed whereas adherence is the study of the patient’s medication-taking behaviour.

-compliance is more passive. Adherence emphasises the patient's commitment and understanding, while compliance focuses on the act of following instructions.

What is the dispensing process?

1. read prescription

2. legal then clinical check of prescription done by pharmacist

3. label made for medicine

4. medicine taken from shelf

5. final check done to make sure there are no errors.

6. patient counselling

State the 7 standard requirements that a prescription must have (LEGAL CHECK)

1. patient name preferably with title

2. patient address

3. patient’s DOB or age if patient is under 12

4. signature of prescriber

5. address of prescriber

6. appropriate date of prescription (usually 6 months but commonly 28 days for CD and depending on medication).

7. particulars of prescriber (indicates if prescriber is doctor, pharmacist and has their registration number etc).

What does x/7 mean on a prescription e.g. 4/7?

-number of days

e.g. 4/7=4 days, 23/7=23 days

What does x /52 mean? e.g. 5/52

-number of weeks

5/52= 5 weeks

What does x/12 mean?

-number of months

What does o.d. mean?

-Once a day

What does o.m mean?

-one every morning

What does o.n mean?

-one every night

What does b.d mean?

-twice a day

What does t.d.s (tds) mean?

-thrice a day

What does qds mean?

-4 times a day

What is the risk of controlled/modified drug release medications? Explain

Dose dumping=unintended and rapid release of a large amount of the medication, leading to an excessive dose being delivered to the system in a short period of time. This can potentially result in serious side effects, toxicity, or overdose.

How much is words a factor in communication?

50%

NEVER dispense from the…

-NEVER dispense from the labels, always from the prescription

How many CPD records must a pharmacist complete each year in order to stay on the register?

-4 including 2 planned events

How many statutory committees does the GPhC have?

3

Which TWO organisations are responsible for publishing the BNF?

RPS and BMA

What does the term MHRA stand for?

Medicines and Health Care Products Regulatory Agency

Give an example of something that is NOT a legal requirement on the label of a dispensed medication?

Patient’s address

What is co-morbidity?

-The presence of additional diseases in relation to an initial disease

If the strength or dose of a regular patient’s medication has been changed, a pharmacist should..

-Speak to the doctor and the patient to confirm this change

Assessment of pain acronym

SOCRATES

Site

Onset

Character e.g. throbbing, sharp etc

Radiation

Associated symptoms

Timing

Exacerbating and relieving factors

severity

In role play, if patient is 65 or older, what must you ask them?

-if they are up to date with their flu vaccine

If a prescription has a signature but the person’s name is different to the signature, is the prescription legally valid?

-technically yes

-BUT, you MUST contact the GP for confirmation that the person who signed it is a prescriber. Sometimes, other people sign prescriptions on behalf of the prescriber.

If the prescription says ‘every morning’ but it should be taken at night, should you call the prescriber?

no, don’t need to

Should advice on anaphylactic reactions be mentioned in counselling points?

yes

What MUST you always check when getting the medication off the shelf (including in the OSCEs)

expiry date of the medication, including if it will expire when the pt has it

What must before pouring suspension into a measuring apparatus?

-shake

If i take medication from one pack and put it in another, what must be written on this pack?

expiry date, product name and batch number of the other pack on this pack

State the things you MUST always write in the label for children

-’give …. by e.g. mouth)

-if it is a solution or suspension, you must include how many mL spoonfuls e.g. x2 5mL spoonfuls

Example:

‘‘Give x2 5mL spoonfuls

-usually spoons have 5mL and 2.5mL on other side. Always check spoons beforehand

prescription states the pt’s age instead of DOB and they are over 12. Is this prescription legally valid?

yes

perimenopause and menopause.. what is the link with bones?

-weakens bones

What MUST you ALWAYS go through with pt whenever you are consulting them?

referral symptoms

-BBBPPSSCLAWHV

If child is around 3 or under, what should be used instead of a spoon when they are given their oral medication?

-syringe

Is it a legal requirement for DOB or age to be on the prescription?

no

prn

when required

mitte

give

What does subtherapeutic mean?

-lower dose than usually prescribed is given, which could be a mistake

if you’re giving something OTC, is a label required?

no

Why is sudocrem not good for fungal infections?

-doesn’t have antifungal properties

-gives moisture

a.c.

before meals

pc=after meals

What counselling point to give pt if the MP is something you put on the skin e.g. a type of cream?

-keep it away from open or gas fires or hobs or naked flames if it’s flammable. No smoking near product

-bedding and clothing washed frequently so it doesn’t build up

-avoid contact with eyes. Any contact, rinse immediately with water

-if skin irritation occurs, stop use and contact doctor

-can be slippery, so be careful, especially if applying it to a baby

When doing label check, INCLUDING IN OSCES, do we need to check the storage instructions?

yes, storage instructions could be wrong or missing (if important)

Does the prescriber address and pharmacy address need to be the same?

no

What should pt not consume if they’re tired?

alcohol

A prescription requires 300g of a 1 in 4 dilution of Dermovate ointment in white soft paraffin. Which option represents the quantities that should be used?:

a. 75g dermovate and 300g white paraffin

b. 75g dermovate and 225g white paraffin

c. 60g dermovate and 240g white soft paraffin

d. 60g dermovate and 300g soft white paraffin

e. 75g dermovate and 245g white soft paraffin

1 in 4 means:

• 1 part Dermovate ointment

• 3 parts diluent (white soft paraffin)

• Giving 4 parts total

So:

¼

-dermovate= ¼ x300g= 75g

-white soft paraffin=300-75= 225g (or 75×3 because it’s 3/4)

-therefore, answer is b

What are the 7 dispensing steps?

1. legal and clinical check of prescription

2. collect medications from shelves and cupboard into box. Accuracy check of products

3. generate label

4. accuracy check (label, products, prescription again)

5. place items in bag if everything is correct

6. final accuracy check before closing bag

7. hand to pt after they have confirmed 2 pt identifiers. Give counselling points if necessary

Explain how an electronic message becomes a legal prescription (4)

-the prescription has been created in electronic form

-signed with electronic signature

-must have been sent via the NHS EPS and no other messaging system

-after all these have been done, it’s then transferred to the dispensing site as an electronic communication

State the 4 requirements of a Responsible Pharmacist notice

1. name of RP

2. RP GPhC registration number

3. states that the RP is in charge of the pharmacy at that time

4. if the RP is temporarily absent from the pharmacy but remains RP, the notice should be removed even if there’s a second pharmacist in the pharmacy. However, if the RP changes throughout the day, then the notice should be changed

Give 4 roles of a responsible pharmacist

-make sure the pharmacy is running safely and effectively

-display their RP notice

-complete a pharmacy notice

-review, establish, maintain and review pharmacy procedures

Explain what the pharmacist should do when they spill a controlled drug

-clean it up and you must keep the tissues for evidence. Report to superintendent team first and then log in a report. Leave tissues in a bag in the CD cabinet

Before RP puts up RP notice, what must they do?

-sign in on the system that they are the RP of the day

What is an RTEC stamp?

-stamp on prescription that means that NHS know of pt’s exemption, s don’t need to ask pt if they’re exempt or what exemption they have

-’’RTEC not known’= ask pt if they’re exempt and what their exemption is

Does the superintendent pharmacist assign the RP?

no

When counselling pt on side effects, which should you mention?

Very common or common and referral symptoms

Why do young children need a less strength of medication compared to if they were adults?

-their organs haven’t fully developed, so can’t fully metabolise the drug compared to if they were older

What to do if child spits out medication

-give same amount they spat out again to them. Do NOT give them a new dose otherwise that is overdose.

What is the only P form of cocodamol? (i.e. OTC at pharmacy)

8/500 every other strength is POM

sig

label

What does increase in morbidity mean?

-A greater incidence of ill health in patients

What is the lower limit reading for stage 2 hypertension?

-150/95 mmHg

Is HSV1 and HSV2 same thing?

no

-HSV1 causes cold sores and HSV2 causes genital herpes