Which drug should be prescribed using the BRAND name in the NHS?
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Oral tacrolimus.
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Which drug should be prescribed using the BRAND name in the NHS?
Oral tacrolimus.
Can advanced electronic signatures be used for electronic prescriptions?
Yes, they can be used and are linked uniquely to the signatory.
What uncertainty exists regarding the 75 micrograms patch?
It may have been prescribed in error and not administered.
Why is a hospital inpatient drug chart not subject to the same legal requirements as an NHS prescription issued by a GP?
Because the inpatient chart is a Patient Specific Direction (PSD), which is an instruction for the administration of a drug to a patient.
Which professionals cannot prescribe unlicensed medicines?
Physios, chiropodists, therapeutic radiographers, and optometrists.
What is Neomag® licensed for?
Management of hypomagnesaemia.
What are the basic prescription requirements for all drugs?
Name and address of patient, age or DOB if under 12, prescriber signature, dated, written indelibly, and contain a prescriber identifier.
What additional identifying details may prescribers add?
Their professional number or prescribing status (e.g., independent nurse prescriber).
What is the correct concentration of chloramphenicol eye drops for treating infective conjunctivitis?
0.5%.
Who is permitted to prescribe unlicensed medicines?
Registered doctors or dentists, and non-medical prescribers under certain restrictions.
What is required to prescribe non-formulary drugs?
Permission from the Pharmacotherapy Committee or Drugs and Therapeutics Committee.
Why is it important to write 'both eyes' in full instead of using 'BE'?
Because 'BE' can also mean both ears, leading to potential confusion.
What should be avoided when indicating doses in prescriptions?
Abbreviations for doses, as they can lead to misinterpretation.
What is the recommendation for writing drug names on prescriptions?
Write all drug names in full and in capital letters.
What method can be used to create a prescription that is maintainable and controlled by the prescriber?
Smart card.
Why should oral tacrolimus be prescribed by brand name only?
To minimize the risk of inadvertent switching between products, which can lead to toxicity and graft rejection.
What must be included in a prescription regarding the prescriber's information?
The prescriber's address and professional registration number (e.g., GMC number).
What is the initial dosing schedule for a patient commencing treatment?
200 mg twice a day for seven days, then 200 mg once daily thereafter.
What type of prescription forms are primarily used in the NHS?
NHS approved prescription forms.
What must be satisfied prior to issuing a prescription for an unlicensed medicine?
There are no suitable alternatives to meet the patient’s needs.
What should be obtained prior to generating a prescription for Naspetin cream?
Cultures from the nasal swab.
How long are prescriptions for Schedule 2-4 controlled drugs valid?
28 days.
What color code is used for prescriptions issued by dentists?
Yellow (e.g., FP10D).
Is it a legal requirement for the date of birth to be stated on an inpatient drug chart?
No, it is not a legal requirement, but it is good practice.
What is the first line of treatment regarding licensed medicines?
Licensed medicines are always first line compared to unlicensed alternatives.
What happens if a hospital formulary needs to be amended?
An application and submission of new evidence must be made.
Which schedules of controlled drugs are most relevant for prescribing?
Schedule 2 and 3.
Which healthcare professionals can be supplementary prescribers (SP)?
Dieticians, nurses, midwives, and radiographers.
What is the correct way to write 500 micrograms?
0.5 milligrams.
What should be considered for TTOs/TTAs regarding variable dosing?
Extending the supply of medication to cover the relevant period.
What can omissions of required details on prescriptions lead to?
Delays in supply or administration errors, which can be fatal.
What should be avoided when writing dosages?
Avoid trailing zero and decimal point.
What is the importance of reviewing 'as required' drugs?
To remove them when no longer required and consider converting them into a regular prescription.
How can electronic prescribing systems help?
They can reduce documentation and administration errors associated with the route of administration.
What minor changes can pharmacists make to a Schedule 2 or 3 controlled drug prescription?
Minor spelling mistakes or minor typographical mistakes.
What legal aspects should be described in prescribing?
The prescribing of drugs subject to control under the Misuse of Drugs Act 1971.
What should be discussed with the patient regarding their treatment?
How their treatment will be monitored and reviewed.
Is the patient's NHS number a legal requirement on a prescription?
No, it is not a legal requirement, but it is typically present on computer-generated prescriptions.
What documentation prevents consecutive doses of diazepam from being administered close together?
The minimum dose interval.
What should be sought if prescribing against formulary recommendations?
Permission from the approved committee, documented in medical notes.
What is a key consideration when prescribing Naspetin nasal cream?
Documentation of drug and non-drug allergies.
What details must be included in a legal prescription for controlled drugs?
Drug name, strength, form, dose, and total quantity supplied in words and figures.
What is a legal requirement for NHS prescriptions issued by a GP for a 10-year-old?
The age or date of birth must be present.
Can drug names be abbreviated in prescriptions?
No, abbreviations for drug names should not be used due to the risk of misinterpretation.
What type of guidance does the Royal Pharmaceutical Society provide?
Guidance on the administration of medicines in healthcare settings.
What should be done before prescribing an unlicensed medicine?
Inform the patient and obtain consent where possible.
Is the abbreviation 'QDS' approved for prescriptions?
Yes, it is approved.
What is the purpose of the FP10MDA prescription form?
To prescribe drugs of misuse for managing opioid dependence (e.g., methadone, buprenorphine).
What should all prescriptions contain regarding patient details?
Full patient details, including full name, address, and hospital number in a hospital setting.
What should be included in the inpatient chart for variable dosing regimens?
Clear instructions to prevent administration errors.
What does 'SC' stand for in prescription abbreviations?
Subcutaneous administration.
What is one of the seven deadly sins of prescribing?
Not knowing your drug.
What regulations do PSDs exempt from?
Many restrictions stated in the Human Medicines Regulations 2012.
What patient identifier is recommended to include on prescriptions for controlled drugs?
NHS number.
What should be done if multiple routes of administration are prescribed?
They should be documented separately and cross-referenced to prevent accidental overdose.
Is it a legal requirement to include the indication for treatment on a prescription?
No, it is not a legal requirement.
Is 'T-TT' an acceptable abbreviation for indicating dose?
False: The dose should always be stated in full, e.g., one or two.
What is the maximum length of time for the supply of controlled drugs upon discharge?
Hospitals often state a maximum length of time for controlled drugs, typically 7 or 14 days.
What is the legal requirement regarding the date of birth on a prescription for patients under 12?
The date of birth must be stated if the patient is under the age of 12.
What is an unlicensed drug?
A drug that does not have a UK marketing authorization.
What is the significance of the maximum dose to be administered in 24 hours?
It helps prevent overdosing by limiting the total amount of medication given.
Which abbreviations are acceptable for strength in prescriptions?
Only 'g' for grams and 'mg' for milligrams.
What should a prescriber do if unsure about a prescription?
Seek advice from more senior medical colleagues or a hospital pharmacist.
What is required regarding patient consent for unlicensed medicines?
Written consent is not necessary, but the patient should be informed and consent gained where possible.
What is the guideline regarding decimal points in handwritten prescriptions?
Refrain from using decimal points where possible.
What is the recommended dosage for chloramphenicol eye drops in this case?
ONE drop into both eyes QDS for 5 days.
Why is it important to document changes in medication?
To prevent confusion among healthcare providers and to maintain accurate medical history.
What are the two types of non-medical prescribers (NMPs)?
Supplementary prescribers (SP) and independent prescribers (IP).
What should be included on a prescription if available?
The NHS number.
What should be indicated when prescribing 'as required' (PRN) medication?
The maximum dose and frequency to avoid excessive dosing.
What identifies the prescriber as responsible on a prescription?
The signature of the prescriber.
What is the purpose of the prescriber identifier?
To identify the prescriber responsible for the prescription.
What risks do Medicines Policies help manage?
Risks that medicines can pose to patients, service users, residents, and staff.
What is the Inpatient Prescribing and Administration Chart?
A PSD used to document drug treatment for a patient during their inpatient stay.
What does the phrase 'Maximum 30 day supply' indicate?
The quantity supplied must not exceed a 30-day supply.
What change occurred in April 2018 regarding pregabalin and gabapentin?
They were reclassified as Class C controlled drugs.
What should be done with any unused space on a prescription for controlled drugs?
It should be blocked out to prevent additional prescriptions from being added fraudulently.
What should underpin prescribing regardless of professional background?
Common prescribing competencies.
What should be avoided when writing prescriptions?
Illegible handwriting and inappropriate abbreviations.
What is considered good practice regarding the date of birth on a prescription?
It is considered good practice to always state the date of birth on a prescription.
What should be done when referring to the number of dosage units?
Write it out in words (e.g., use 'two' instead of '2').
Why should the reducing dose schedule be annotated?
To avoid continued administration at a high dose.
What is the status of GTN patches for Raynaud's phenomenon?
They are used off-label.
What responsibility does a prescriber bear when issuing a prescription?
The responsibility for that treatment.
When can a frequency be abbreviated in a prescription?
If it is an approved Latin abbreviation.
How is medication dispensed for outpatients?
Using a hospital approved outpatient prescription at the hospital pharmacy department.
What is the requirement for the date on a prescription?
It must be valid and may be computer-generated.
What is the licensed use of salbutamol nebulas?
Management of chronic bronchospasm and acute severe asthma.
What color code is used for private sector prescriptions for Schedule 2 and 3 controlled drugs?
Pink (e.g., FP10PCDNC/SS).
What should be done to prevent administration errors when changing doses?
The new dose should be prescribed and the chart annotated.
What factors should be considered before prescribing?
Patient’s medication history and other factors that might alter treatment benefits and risks.
What does the Human Medicines Regulations 2012 state about advanced electronic signatures?
They must be uniquely linked to the prescriber and capable of identifying the prescriber.
What is a potential risk when prescribing drugs with variable dosing regimens?
Administration errors.
How can inpatient drug charts be formatted?
They can be paper-based or electronic.
Can a pharmacist supply a Schedule 2 or 3 controlled drug with missing legally required information?
No, a CD prescription cannot be supplied until all required information is present.
Are optometrists permitted to prescribe controlled drugs?
No, optometrists are not permitted to prescribe any controlled drugs.
What are Patient Specific Directions (PSD)?
Directions to supply or administer a medicine to a named patient.
What must a prescriber provide when using the abbreviation TOP for topical?
Additional information about where the topical medicine is to be applied.
What additional requirements do prescriptions for controlled drugs have?
They have additional requirements above standard prescriptions.
What additional requirements apply to the prescribing of Schedule 2 and 3 controlled drugs?
Additional prescription requirements must be followed.
Which abbreviation is approved for milligrams?
mg.
What must be ensured before prescribing an off-label drug?
It must be indicated in the BNF and approved for use.
How should doses be stated to avoid confusion?
Clearly, without using leading or trailing zeros.
Is 'mcg' an approved abbreviation?
'mcg' is not approved.
How should a prescription be cancelled on an inpatient drug chart?
Cross through it entirely, annotate with your signature and date, and document any changes in the medical notes.
What is a PSD in emergency situations?
A verbal direction issued by an independent prescriber to administer a medicine.
What are Schedule 1 controlled drugs (CDs) in terms of prescribing?
They are rarely used in medicine and require a license from the Home Office to prescribe.
Is 'ISMN' an approved abbreviation for prescriptions?
No, it is not approved; drug names should not be abbreviated.
What is oral vancomycin licensed for?
Treatment of Clostridium difficile.
Which patients may require brand prescribing?
Patients requiring critical doses, such as those on immunosuppressants or anti-epileptics.
What is the aim of the Medicines Policy?
To lay out principles for medicine prescription, storage, transportation, supply, and administration.
Who can be both supplementary and independent prescribers?
Optometrists, pharmacists, physiotherapists, and advanced paramedics.
What is a common error in prescribing related to patient history?
Failing to take an accurate drug history.
What must always be stated on a prescription for a Schedule 2 controlled drug?
The strength of the preparation.
What standards are expected of hand-written prescriptions?
Hand-written prescriptions should be clear, legible, and include all necessary information such as patient details, medication name, dosage, and administration route.
What can inaccurate or ambiguous prescribing lead to?
Medication administration errors.
What are the potential consequences of ambiguous prescription documentation?
Patient deaths due to overdoses, underdoses, or omissions of medication.
What should be documented in the patient's medical notes when prescribing a controlled drug?
The indication and dosing regimen.
How should multiple routes of administration for a controlled drug be prescribed?
Each route needs to be written down as a separate item.
What does TDS mean in a prescription context?
Three times a day, often interpreted as every 8 hours.
What must prescriptions be for supply?
Physically signed.
Why is arachis oil a concern in Naspetin cream?
It is contraindicated in patients with a nut allergy, which could cause severe allergic reactions.
Which organization provides guidance on good practice in prescribing for doctors?
The General Medical Council (GMC).
Is it a legal requirement to include the patient's date of birth for patients under 12 years on a prescription?
Yes, it is a legal requirement, and good practice for all prescriptions.
What must be documented on a prescription for Schedule 2 or 3 controlled drugs?
The form of the preparation (e.g., tablets, capsules).
What additional legal requirements exist for Schedule 2 and 3 controlled drugs?
Dose, form of preparation, strength (unless only one is available), and total quantity in both words and figures.
What is the typical duration of training for healthcare professionals to prescribe?
Typically a 6-month course.
What is the FP10HNC outpatient prescription used for?
To prescribe medication that will be obtained from a community pharmacy.
Is oral carbamazepine for mood stabilization considered licensed or unlicensed?
Licensed.
Who is not permitted to prescribe on an FP10HNC?
FY1 doctors.
Why is it important to consider future prescription/dosing instructions?
To prevent potential dosing errors later on.
Which healthcare professionals can be independent prescribers (IP)?
Optometrists, pharmacists, physiotherapists, and podiatrists.
What is the correct way to write 3 mg?
3.0 mg.
How are controlled drugs classified in the UK?
Under the Misuse of Drugs Act 1971 into three classes: A, B, and C.
What does the Misuse of Drugs Regulations 2001 define?
The groups of individuals authorized to apply for and possess controlled drugs.
What is the minimum legally acceptable dosing instruction for a Schedule 2 controlled drug?
'ONE when required.'
What is the most common therapeutic intervention in the NHS?
The use of medicines.
Is it a legal requirement to state the 'form' of a controlled drug on a prescription?
True.
What factors should be considered when making decisions about controlled drugs?
Benefits and risks, patient's full medication history, whether the patient is opioid naïve, and evidence-based resources.
What must be considered before supplying a controlled drug on discharge?
Any pre-existing supplies of the controlled drug the patient may have at home.
What should you consider when prescribing medications?
Your limitations of knowledge, skills, and experience.
What is a key consideration for a healthcare professional reviewing a patient's pain control?
They need to know how long the patient has been on the 75 micrograms patch.
How long should the doctor wait to assess pain control after initiating a new patch?
At least 72 hours.
What is the correct way to write 0.1 mg?
It is better to write 0.1 g than 100 mg.
What are the GMC guidelines regarding unlicensed medicines?
You must ensure no suitable licensed alternatives exist, have sufficient evidence for use, and document the decision.
What is the purpose of a hospital formulary?
To limit the number of drugs available for prescribing, managing risks and healthcare costs.
What should be documented regarding a patient's allergy status?
Both drug and non-drug allergies should be documented in medical notes and inpatient charts.
Which dose units can be abbreviated?
Only milligrams and grams; micrograms must be written out in full.
What is a common prescription error related to quantity?
Not prescribing the total quantity or number of dosage units in both words and figures.
When should brand names be used in prescribing?
When different preparations of the same drug have different release mechanisms or bioavailability profiles.
How should solid preparations be prescribed?
Prescribe the number of dosage units in both words and figures.
What are Patient Specific Directions (PSDs)?
Written instructions from a prescriber for a medicine to be supplied or administered to a named patient.
What could result from incorrectly or poorly completed patient information?
Medication being given to the incorrect patient.
What do Medicines Policies ensure for hospital staff?
That they are aware of their roles, responsibilities, and limitations regarding medication.
What is the purpose of providing an auditable trail for handling medicines?
To ensure accountability and safety in medication management.
What is a legal requirement for prescribing Schedule 2 and 3 CDs?
The patient's address must be included.
What is the maximum quantity of Schedule 2, 3, and 4 controlled drugs that can be prescribed?
Should not exceed 30 days.
What is the status of controlled drugs in terms of prescription?
They are POM status and can only be prescribed by registered practitioners.
What does circling 'no' for readmission indicate on a prescription?
It indicates that the patient was not on this treatment prior to admission, although this should be confirmed.
What legislation governs the authorization of medicines for human use in the UK?
The Human Medicines Regulation 2012.
What does off-label prescribing refer to?
Using a drug that has a marketing authorization outside the terms of its license.
What is off-label prescribing?
Prescribing a drug outside the terms of its license.
What are TTOs and TTAs used for?
To prescribe medication for inpatients upon discharge.
What color code is used for prescriptions issued by nurse independent and supplementary practitioners?
Lilac (e.g., F10PN, SP10SP).
What is the difference between generic and branded drugs?
Generic drugs are non-proprietary, while branded drugs are proprietary.
What are the ten principles of good prescribing focused on?
Clarity, patient history, risk factors, patient expectations, effective medicine selection, adherence to guidelines, legal documentation, monitoring effects, and communication.
Is it necessary to document the strength of a controlled drug preparation if only one form is available?
No, it should only be stated if there is more than one available.
What should be monitored after prescribing medication?
Beneficial and adverse effects of medicines.
What should be done when altering a dose or frequency?
Re-write the prescription in full and make an entry in the medical notes.
What do Medicines Policies provide?
Guidance and procedures for medicine management in different situations.
What is required for patients under 12 on a prescription?
Their age or date of birth must be present.
Can F1 doctors prescribe controlled drugs?
No, they cannot prescribe CDs within the supervisory conditions of their employment.
What is essential to know about the patient's treatment before prescribing?
Whether the patient is commencing treatment or has received it IV or if it is longer term.
What role do good practice guidelines play in prescribing?
Good practice guidelines provide a framework to ensure safe and effective prescribing, helping to minimize risks associated with unlicensed and off-label use.
What is a Discharge Summary?
A document summarizing the medication prescribed upon a patient's discharge.
Can dose units be abbreviated if written in block capitals?
False: Only grams (g) and milligrams (mg) may be abbreviated; all other dose units should be written in full.
What types of prescription documentation should be discussed?
Different types available in both primary and secondary care.
What do local and national prescribing policies aim to encourage?
Evidence-based practice and cost-effective prescribing.
What must be included in the address of the prescriber?
The address must be in the UK.
What should be done to ensure the prescription cancellation is clear?
The cancellation should be signed and dated to identify the prescriber.
What is the recommended minimum duration for medication prescribed upon discharge?
14 days.
Do hospital prescriptions require additional details?
No, the address is identified by the hospital-approved stationery.
What is oral propranolol licensed for?
Migraine prophylaxis.
What guidance did the Royal Pharmaceutical Society issue in 2016?
Guidance for the prescribers of Specials to help in safe and appropriate prescribing.
How are verbal PSDs documented?
They are retrospectively documented on the drug chart.
What type of ink must prescriptions be written in?
Indelible ink.
Can the topical route be abbreviated in prescriptions?
No, it should not be abbreviated simply to TOP without additional information.
Who can prescribe controlled drugs?
Doctors, dentists, and veterinary surgeons can prescribe CDs, except for Schedule 1.
Why is it important to include the age or date of birth for patients under 12?
It enables accurate dosing verification.
Why is it important to document the route of administration?
Omission can lead to administration errors, so it should always be clearly documented.
Are inpatient drug charts subject to the same prescription requirements?
No, they are orders for administration, not for supply.
When is it a legal requirement to state the strength of a controlled drug preparation?
If there is more than one strength available.
What additional requirement was introduced for prescribing from June 1, 2015?
Temazepam and tramadol were included in the additional prescription writing requirements.
What standards are expected of computer-generated prescriptions?
Computer-generated prescriptions must be accurate, legible, and include all required information, ensuring they comply with legal and clinical guidelines.
Why is it important to prescribe within the limits of your knowledge, skills, and experience?
Prescribing within these limits ensures patient safety, reduces the risk of errors, and promotes effective treatment outcomes.
Is it a requirement for all patients to receive a 28-day supply of regular medicines upon discharge?
False: The quantity can vary between Hospital Trusts and should be discussed with the patient.
What must be communicated to the patient's GP when prescribing controlled drugs?
All of the prescribing decisions that have been made.
What should be documented if guidance on controlled drugs is not being followed?
This needs to be clearly documented in the patient's medical notes.
What processes are prescribers involved in according to the Human Medicines Regulation?
Supply, administration, and monitoring of medicines.
What color code is used for prescriptions issued by GPs, hospitals, and independent prescribers?
Green (e.g., DP10NC, FP10HNC, FP10SS).
What should be done when reviewing prescriptions?
All medications must be reviewed regularly, unnecessary medications must be stopped, and review dates should be documented.
What is the licensed use of oral hyoscine hydrobromide?
Prevention and relief of travel sickness.
What is necessary for good prescribing beyond legal requirements?
Adherence to best practice elements.
Why is it good practice to prescribe generically?
It allows any suitable presentation of the drug to be supplied, providing flexibility and assisting in managing healthcare costs.
What should be included in the allergy documentation?
The type of reaction should be clearly documented.
What must be stated in words and figures on a prescription for controlled drugs?
The total quantity, not the dose.
What should be noted if a patient has no known allergies?
The section should be completed to say 'no known allergies.'
Is a computer-generated signature sufficient on a printed FP10 prescription?
False; the signature must be handwritten.
What is another deadly sin of prescribing?
Not knowing your patient.
How can you identify Schedule 2 and 3 preparations in the BNF?
They are identified by symbols (CD2 and CD3 in a square box) next to the drug.
What is the purpose of NHS England’s Single Operating Model?
To strengthen the governance arrangements for the use and management of controlled drugs.
Who can prescribe controlled drugs?
Doctors, dentists, and non-medical prescribers (NMPs) depending on their profession.
What are the three classes of licensed drugs in the UK?
General sales list medicines (GSL), Pharmacy medicines (P), and Prescription only medicines.
What is essential when writing prescriptions?
To write unambiguous, legal prescriptions using the correct documentation.
What is the current licensing status of carbamazepine for prophylaxis of manic-depressive episodes?
It is now licensed for this use in patients unresponsive to lithium.
How should liquid preparations be prescribed?
Prescribe the total quantity in both words and figures.
What should be communicated and documented in prescribing?
Prescribing decisions and the reasons for them.
What is the purpose of a 'Medicines policy' or 'Medicines Code' in hospitals and prisons?
To define the authorizations to supply and administer medicines.
What is meant by unlicensed and off-label prescribing?
Unlicensed prescribing refers to using a medication that has not been approved for a specific indication, while off-label prescribing involves using a licensed medication for an indication not specified in its approved labeling.
What must be stated for the total quantity of Schedule 2 and 3 CDs?
The total quantity or number of dose units must be stated in both words and figures.
What is a key area of focus in good prescribing practice?
The underpinning knowledge required to prescribe legally, safely, and unambiguously.
What is the advised quantity limit for controlled drugs in NHS hospitals?
Between 7-14 days.
What framework has been developed by the Royal Pharmaceutical Society?
A single competency framework for all prescribers.
What guidance did NICE issue in 2016 regarding controlled drugs?
Guidance on 'Controlled drugs, safe use and management.'
What should be annotated on a prescription for a 'when required' controlled drug?
Clear instructions on use, indication, max dose, and frequency.
What is required for a medication to be licensed in the UK?
It must be granted a Marketing Authorisation (MA) by the MHRA.
