Dispensing Exam Guide Final Version PDF

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THE DISPENSINGEXAM GUIDEUNIVERSITY OF SUNDERLANDMOHAMMED AL-TAEE, YAQEEN AL-BADRI, STEPHEN DUNN, SAHAR SALEEM, RAFCHANA KHANAM, JORDAN ROONEY, THOMAS HINDMARCHTable of Contents AIM...........................................................................................................................

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THE DISPENSING EXAM GUIDE UNIVERSITY OF SUNDERLAND

MOHAMMED AL-TAEE, YAQEEN AL-BADRI, STEPHEN DUNN, SAHAR SALEEM, RAFCHANA KHANAM, JORDAN ROONEY, THOMAS HINDMARCH

Table of Contents AIM............................................................................................................................................3 INTRODUCTION.....................................................................................................................3 What is Dispensing?...........................................................................................................3 The Dispensing exam layout.............................................................................................4 SECTION 1...............................................................................................................................7 1.1

LEGAL CLASSIFICATION OF MEDICINES:.......................................................7

1.2 CONTROLLED DRUGS (CD) CLASSIFICATION...................................................8 

Schedule 1............................................................................................................8



Schedule 2............................................................................................................8



Schedule 3..........................................................................................................13



Schedule 4..........................................................................................................13



Schedule 5..........................................................................................................13

1.3 LABELLING.................................................................................................................14 1.4 DEFINITION OF REQUEST AND THE TYPES OF REQUESTS.......................14 What is a request?......................................................................................................14 1.5

THE LEGAL REQUIREMENTS FOR EACH TYPE OF RQUEST..................15

1.5.1

Green FP10 Prescription.............................................................................15

1.5.2

Dentist (yellow) prescriptions (FP10D)...................................................28

1.5.3

Community Nurse Prescription (FP10P).................................................35

1.5.4

Private Prescription......................................................................................40

1.5.6

FP10MDA prescription.................................................................................53

1.5.7

NHS repeat dispensing:..............................................................................67

1.5.8

Private Repeat Prescription.......................................................................72

1.5.9

POM requisition (signed order).................................................................79

1.5.10 CD Requisitions............................................................................................82 1.5.11 Emergency supply at the request of a patient......................................84 1.5.12 Emergency supply at the request of a prescriber...............................87 1.5.13 VET PRESCRIPTIONS..................................................................................89 SECTION 2.............................................................................................................................94 CLINICAL CHECKING......................................................................................................94 

INTRODUCTION.................................................................................................94



CHILDREN BNF.................................................................................................96



LIQUID DOSAGE FORMS................................................................................99

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CONTROLLED DRUGS SCHEDULE 2 AND 3...........................................101 1

 MODIFIED RELEASE SOLID DOSAGE FORMS (TABLETS AND CAPSULES)................................................................................................................102 

FP10MDA DOSE..............................................................................................104

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PRESCRIBING BY BRAND...........................................................................106

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MEDICINES THAT REQUIRE BOOKLETS.................................................107

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PATIENT INFORMATION LEAFLET (PIL)...................................................113



WHAT ABOUT VET MEDICINES AND DOSES.........................................113

 DENTAL PRESCRIPTION AND CHANGING THE MEDICINE INTO ANOTHER ONE..........................................................................................................114 

WHAT IS COUNSELLING?............................................................................115



WHAT SHOULD I COUNSEL THE PATIENT ON?....................................115

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WARNING LABELS.........................................................................................116

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SUMMARY.........................................................................................................117

SECTION 3......................................................................................................................119 DRUG-DRUG INTERACTIONS....................................................................................119 

What is drug-drug interaction?...................................................................119



How can the two medicines interact (Mechanism of interaction).....120

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How to deal with the interaction prescription?......................................123

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When Stockley’s does not give a suitable management plan............124

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Most common drug interactions and their management.....................125

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Which medicine out of the two interacting drugs should be changed? 130

SECTION 4..........................................................................................................................132 THE DISPENSING SHEET...........................................................................................132 

WHAT IS THE DISPENSING SHEET?.........................................................132



HOW TO FILL IN THE DISPENSING SHEET?...........................................132

PERFORMING A “FINAL CHECK”...............................................................................141 University’s Dispensary Design Class “A”............................................................142 University’s Dispensary Design Class “B”............................................................143

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AIM During the preparation for the dispensing exam we, as second year pharmacy students, had to refer to many sources to be able to gather all the required information to pass the exam. However, despite all efforts, we were not confident that we had covered all bases. The aim of this book is to combine all the information from lectures and dispensing classes into one comprehensive guide for the dispensing exam. In addition, it will contain advice and guidance to help you avoid the common errors made by students.

INTRODUCTION What is Dispensing? Dispensing is the process of supplying a medicine that usually takes place in a pharmacy. In the pharmacy, the pharmacist receives a valid request, from either a healthcare professional or a patient, to supply a certain medicine. The request received must be legally valid otherwise; it would be considered a criminal offence to dispense the medicine based on illegal request. There are different ways that a healthcare professional or a patient can request a medicine and the pharmacist must ensure that they are legally valid (this will be discussed in section 1). A medicine is usually requested to treat a certain condition that is specific for a particular patient. The pharmacist, as well as checking that the request is legally valid, must also check that it is clinically valid i.e. the request is stating the correct medicine with the correct dose for the indication (disease) being treated. The process of checking that the request is clinically valid will be discussed in sections 2 and 3. Thus, the pharmacist has two responsibilities before supplying a medicine on a request: 1. Checking that the request is legally valid. 2. Checking that the request is clinically valid.

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The Dispensing Exam Layout The purpose of the dispensing exam is to examine your abilities to dispense (supply) medicines, both legally and safely. During the exam, you will have to check if the requests are legally valid and clinically valid before supplying the requested medicine. If any of the requests are not legally and/or clinically valid, you will need to contact the prescriber and/or the patient (which will be examiners on the day of the dispensing exam) to change and correct the mistakes. After that, you need to get the medicine from the shelves, print a label using pharmacy manger (shown in video 2) and send the medicine to the examiner to be marked. You need to ensure that you supply the correct quantity of the medicine and stick the correct label on it. Furthermore, you need to record the mistakes that you have found on the request and how you have corrected them on a sheet known as the dispensing sheet, as shown below.

Page 1 of the dispensing sheet

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Page 2 of the dispensing sheet

The sections of the dispensing sheet have to be filled out with the drug details, the errors on the request, how you corrected these errors, any records requirements as well as how you will counsel (advise and guide) the patient on the medicine being requested. This document is solely used for examination purposes so that the examiner can mark your dispensing process; these sheets are not found in pharmacies. You have 3 hours to check eight requests and supply nine required medicines. You have to supply all the medicines requested correctly to pass the exam.

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SECTION 1 In this section, a detailed description and explanation of the legal requirements for each type of request is provided.

1.1 LEGAL CLASSIFICATION OF MEDICINES: In the UK, medicines are legally classified into three categories; ‘POM’, ‘P’ and ‘GSL’. i)

Prescription Only Medicines (POM)

POMs are medicines that are found in the pharmacy (i.e. in the dispensary) which patients can usually only obtain if they have a valid prescription from an appropriate healthcare professional. ii)

Pharmacy Medicines (P)

P medicines are found in the pharmacy (i.e. over the counter). The patient does not need a prescription to obtain them. However, a patient cannot buy these medicines unless the pharmacist is in the pharmacy and the medicines are sold under his/her supervision. P medicines are usually not available for patient self-selection as the pharmacist or the pharmacy staff need to ask the patient some questions to assess the suitability of the medicine before selling it to the patient. iii)

General Sale List (GSL)

GSLs are medicines that can be sold in both a pharmacy and other premises, such as supermarket, as long as they meet specific requirements. These medicines are considered ‘safe’ enough that a patient can have greater access to them and pharmacist supervision is not required.

NOTE: To be able to find the legal classification of a medicine, there are two sources to refer to: 1. The packaging of the medicine (the box); the outer box that contains the medication will either have a “POM” or a “P”. If there is no letter indication, then the medication is a “GSL”. 2. The BNF WATCH “VIDEO 1” TO LEARN HOW TO ACCESS THE BNF AND HOW TO OBTAIN THE LEGAL CLASSIFICATION OF THE MEDICINE USING THE BNF

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1.2 CONTROLLED DRUGS (CD) CLASSIFICATION CDs are medicines that require more control due to additional risks associated with them. They are considered dangerous and are prone to misuse (abused or overused in a dangerous way that can lead to addiction or death) by a patient. This has resulted in the UK government requesting that extra care and caution be taken in both the supply and the storage of these medicines. By law, there should be extra control and care when it comes to supplying some classes of controlled drugs. CDs are classified into five groups called schedules; schedule 1 has no medical use in the UK, however, schedule 2 to 5 do and are frequently dispensed.

 Schedule 1 These medicines are not supplied or kept within the pharmacy because they do not have a medical use in the UK therefore will not make an appearance in the dispensing classes. Examples include: Cannabis, Khat etc.  Schedule 2 These medicines are prone to the most controlled requirements when it comes to supplying, receiving and storing them in the pharmacy. Storage: All the medicines within this group, except quinalbarbitone, should be kept under safe custody i.e. locked in a safe known as a “CD cupboard”. An example of a CD cupboard can be seen below:

If you receive a prescription to supply schedule 2 medicines such as methadone or morphine, the medicine will not be located on the dispensary shelves but will be located in the CD cupboard such as the one above.

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Supply: There are two requirements that must be achieved when supplying any schedule 2 medication. These are: 1. Receiving a valid request from a healthcare professional: You need to receive a valid prescription or request to supply medicines in schedule 2 as they are POM. However, unlike regular POM medication, they have additional legal requirements which the prescription/request must comply with before a supply can be made. These requirements will be discussed in section 1.5. 2. Filling in the CD register: The CD register is a legal requirement that must be completed every time you supply a schedule 2 medicine. The CD register should only be completed for schedule 2 drugs. In the dispensing exam, the CD register is found on page 2 of the dispensing sheet as shown below.

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Page 2 of the dispensing sheet has the CD register (upper half) and the POM register (lower half). In the CD register, you should enter the medicine details, date of supply, the prescriber’s details, patient’s details, and the quantity supplied as shown in the example below:

Morphine (generic name)

Date of supply

Name and address of patient

60 mg

MXL

Name and address of prescriber

Patient

Yes

M/R Capsules

Yes

28

--

NOTE: The column labelled as balance is for auditing purposes; it keeps tracks of the total amount of the medicine that remains in the pharmacy after a supply has been made. In the dispensing exam, this is left blank because other students might dispense the same medicine, so you won’t really know how much of this medicine is left in stock. The CD register once completed must be retained in the pharmacy for 2 years after the last entry.

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Correcting mistakes on the CD register: If you make an error in the CD register, such as spelling mistake or writing the wrong date, you are NOT allowed to cross out or strike through the error. Instead, you should put the error in brackets and mark it with an asterisk/star (*). Then, at the bottom of the sheet, you should add the correction as shown in the example below.

Morphine (generic name)

(17/8/2017)

*

Name and address of patient

60 mg

MXL

Name and address of prescriber

Patient

Yes

M/r Capsules

Yes

28

--

* Error: should read 17/8/2018 Sign your name and date of correction

If you make another mistake, then you can put 2 asterisks/stars (**) next to the error and correct it the same way shown above.

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 Schedule 3 Storage: There are only FOUR medicines in this schedule that are found in the CD cupboard:    

Temazepam Buprenorphine Diethylpropion Flunitrazepam.

All other medications in this schedule such as phenobarbital and tramadol are found on the regular dispensary shelves with all the other normal POM, P and GSL medicines. NOTE: It is important that you know where the medicines are located in the dispensary as many students’ waste time looking in the wrong place for medicines. Supply: Although these medicines require the same extra legal requirements as schedule 2 medicines (discussed in section 1.5), there is NO requirement to complete a CD register entry.  Schedule 4 Schedule 4 is split into two parts: Part 1: Contains benzodiazepine medication e.g. diazepam and nitrazepam Part 2: Contains anabolic steroids NOTE: In the dispensary, we haven’t seen any medicines from part 2. However, medicines from part 1 have been present in both the classes and exams. There are no legal requirements for safe custody or completing the CD register for these medicines. There are some extra legal requirements related to this schedule, however they are less than that required for schedule 2 and 3; these will be discussed in section 1.5.  Schedule 5 These are mostly dilute preparations of schedule 2 medicines and are of much lower strength or in alternative dosage forms. These medicines don’t have additional requirements when it comes to storage or supply and some can be classified as P or POM. All medicines in schedule 2 to 4 are POMs. Schedule 5 medicines can be either POM or P. 11

1.3 LABELLING Before we discuss the type of requests that a pharmacy can receive to dispense a medicine, you should know that every medicine that is dispensed in the dispensing exam must have a label attached on it. This label describes, to either the patient or the healthcare professional receiving the medicine, directions on how to use the medicine, such as dose and administration, as well as warnings, pharmacy details, patient details etc. Thus, after you bring the medicine from the shelves or the CD cupboard, it is a legal requirement that you stick a label on it before you send it to the examiner to be marked. You will generate and print the label using a computer program called “pharmacy manager”. The dispensing label for each type of request/prescription has some legal requirements that must appear on the label. However, by choosing the correct type of label on pharmacy manager, some of these legal requirements will be automatically printed on the label. Other legal requirements should be printed in the “directions section” as discussed in Video 2. WATCH “VIDEO 2” TO LEARN HOW TO USE PHARMACY MANAGER The extra legal requirements that must be printed on the label in the “direction section” will be discussed below relating to each type of request.

1.4 DEFINITION OF REQUEST AND THE TYPES OF REQUESTS What is a Request? A request is when a healthcare professional or a patient asks the pharmacy to supply a medicine either by giving the pharmacy a written form or verbally. Depending on the type of the medicine being req...