What are the different classifications of medicine?
-general sale list (GSL)
-pharmacy only medicines (P)
-prescription only medicines (POM)
-controlled drugs (CD) of various schedules: need to understand these for prescribing them
Sch.1 - non medicinal use
Sch.2 - opiates and stimulants (clinically used eg morphine)
Sch.3 - barbiturates, temazepam, tramadol
Sch.4 - benzodiazepines
Sch. 4.2 - anabolic steroids
Sch.5 - dilute Sch.2’s
What’s at the back of the bnf?
Dental practitioners formulary which lists all the drugs dentists are allowed to prescribe. Form FP10D is the form on the nhs you’d use to prescribe.
On a private prescription you are allowed to prescribe anything that’s within your competency to do so.
Licensing?
All drugs seen in bnf are licensed if given correctly (correct dose and aware of contraindications). We are covered legally if something goes wrong and we prescribed like this. Whereas we hold responsibility if we prescribe something ‘off-label’ prescribing a licensed drug but give it to someone or for something it shouldn’t be or at a dif dose. And definitely responsible if we prescribe an ‘unlicensed’ drug.
How do you prescribe controlled drugs?
Same as a cheque, in words and figures and all the details. Must write a specific dose and how often to take.
What’s the worst that can go wrong?
Prescribing a drug to an allergic patient could cause death.
List some penicillins? What do you need to be careful of?
- amoxicillin
- augmentin
- co-amoxiclav
Be careful if patients taking anticoagulants such as warfarin and heparin as prolongs the bleeding time so may need to adjust the anticoagulant dose.
Acceptable INR levels
If below 4 treatment can go ahead.
Anticoagulants? Should also be aware of injectable anticoagulants such as heparin.
Warfarin Dabigatran (NADS new anticoagulants but no remedy for them can't just give vit.k like for warfarin to reverse the effects) Phenindione (rarely used) Rivaroxiban (another new one) Apixaban (again a new one) Acenocomarol (rarely used)
Antiplatelet drugs?
Aspirin Diclofenac Clopidogrel Dipyridamole Prasugrel Ticagrelor
What do you tell a patient on metronidazole or clarithromycin?
It’s an antibiotic so course should be finished. Don’t drink will make you feel very ill.
What to tell a patient on diazepam?
Don’t drive, might get a hangover effect.
What to tell a patient on chlorphenamine? (Antihistamine)
Don’t drive can cause drowsiness.
Don’t drink alcohol as will make you even more drowsy.
What does the CQC check when you’re prescribing?
They want to see you’re:
- Explaining be purpose and the potential side effects of the drug
- That you’re giving information about dosage and how to take the medication
- That your communicating information well
- That you checked the patients understanding capacity
What makes good prescribing according to NPC prescribing competencies?
- Knowledge
- Options
- Shared decision making
- Safe
- Professional
- Always improving
- The healthcare system
- Information
- Self and others
What errors are there for drug prescribing?
- Wrong patient
- doses omitted
- wrong dose
- unprescribed drug given
- wrong dosage form given
- wrong route of administration
- wrong rate of administration
- wrong time of administration (in relation to food etc)
- using unstable/ expired drug
- wrong administration technique
- incorrect reconstitution
- extra dose given
Who are high risk patients?
-children
-elderly
-renal impairment
-hepatic impairment
-pregnancy or breastfeeding
-drug interactions
Also take care if drug is unknown to you or it’s a very new drug (black triangle next to it in BNF)
What resources are available to you to learn about medication safety?
- eMC (summary of product characteristics for each medicine)
- pharmacy of medicines information
- BNF
- national guidance eg NICE guidelines
How should you prescribe?
- clear and unambiguous
- approved name of drug (no abbreviations)
- care with IVs
- care with units
- legal
- is it weight related dosing? Is weight accurate?
- clear decimal points (zero in front of point)
- rewrite charts regularly
- take time eg read labels
What is the safety checklist? ENCoRE
Explore: -identify patient -nature of symptoms -other medicines or treatment -allergies -adherence to treatment -exclude serious disease No medication options: -unnecessary -contraindications Care over: -elderly -children -pregnancy/lactation Refer: -potentially serious problems -persistent symptoms Explain: -suggested course of action
