Fundamentals of Pharmacology. Группа авторов
such as for a cough suppressant.
Indication and dose: all the information that relates to an individual drug; for example, drug action, indication and dose, contraindications, cautions, interactions, side effects, allergies and so on.
Specific preparation name: if the dose varies with a specific preparation or formulation, it appears under the heading of the preparation name.
Evidence grading: this reflects the strength of recommendation applied.
Legal categories: applied to those preparations that are available only on a prescription issued by an appropriate practitioner and preparations that are subject to the prescription requirements of the Misuse of Drugs Act.
The information found in the medicinal forms section of the monograph is vital for healthcare professionals to be able to understand the various routes of administration, supply and dose schedule considerations. Alongside this, the medicinal forms section shows the legal category of the drug indicated by a specific category abbreviation or controlled drug schedule abbreviation. Table 2.2 demonstrates the abbreviations and their meanings. In practice, this information may make the difference between generating prescriptions, or giving health advice. The variance between categories may be determined by the drug itself, the dose and amount to be dispensed (see Box 2.1).
Figure 2.1 Extract drug class monograph.
Table 2.2 Abbreviations of medication categories
| Category | Description |
|---|---|
|
P – pharmacy‐only medicine |
A product that may only be sold in a registered pharmacy under the supervision of a registered pharmacist, e.g. bisacodyl suppositories |
|
PoM – prescription‐only medicine |
A product that may only be sold or supplied to the public on a practitioner's prescription, e.g. warfarin tablets |
|
GSL – general sales list |
A product that may be sold from a retail outlet without the supervision of a registered pharmacist, e.g. NiQuitin 2 mg medicated chewing gum |
|
CD – controlled drug |
A product that is controlled by the Misuse of Drugs Act 1971 and is listed in Schedule 2 or 3 of the Misuse of Drugs Regulations 2001 as amended, which may be subject to specific restrictions relating to supply, prescription, storage, record‐keeping, labelling, and destruction; e.g. morphine sulphate (modified release tablets) 60 mg oral tablet |
| ACBS – Advisory Committee on Borderline Substances | A product that may be prescribed for the treatment of certain conditions. Prescriptions for these products must be endorsed ‘ACBS’. e.g. gluten‐free bread |
Box 2.1 Paracetamol sales
Paracetamol 500 mg tablets in 16 tablet packs are available as GSL and can be purchased without supervision of a pharmacist. Pharmacists may sell packs of a maximum of 32 tablets as pharmacy only (P) drugs: requiring supervision of a pharmacist. Over 32 tablets per pack are prescription only medication (PoM). This example shows that while the drug itself remains the same, other factors (in this instance, quantity) may impact on the classification of a medication. Other licensing considerations may change the legal status of the medication as well, even if the drug remains the same (Joint Formulary Committee, 2019b).
Skills in practice
Using the BNF index, locate docusate sodium.
What is the drug classification?
What are the cautions associated with this drug?
Is this drug harmful in pregnancy?
Is the drug available as an enema?
Back matter
The back matter of the BNF contains a number of appendices which offer detailed supplementary information on drug interactions, borderline substances, cautionary and advisory labels, and wound management products and elasticated garments. It also includes specific formularies for dental practitioners and the nurse prescribers formulary (for registered and qualified community practitioner prescribers).
Interactions
As a practitioner and professionally accountable for your actions, you must ensure that you know how to review and find out information on potential interactions. A comprehensive list of drugs with known interactions is found in Appendix 1 (as signposted to in the drug monograph). Appendix 1 provides tables and details of specific medications, medication combinations, and their associated pharmacodynamic effects. Each drug or group is listed twice, by name alphabetically and with the specific drug or group that it interacts with.
Borderline substances
In some conditions, such as coeliac disease, food products and toilet preparations may have characteristics of drugs. These products are reviewed and determined by the Advisory Committee on Borderline Substances (ACBS), as such, they may be treated as a prescribed medication. Some examples are enteral feeds, nutritional supplements, gluten free or low protein foods, and nutritional supplements given to treat metabolic diseases (e.g. maple syrup urine disease) alongside toilet preparations for topical use (for example, E45® or Aveeno Cream® for the treatment of dermatitis).
Nutritional supplements are common in care settings. Providing support with supplement drinks and puddings, for example, may form part of your everyday practice, but these should be treated as medication and prescribed based on individual patient need as with any medication.
Clinical considerations
You are looking after a lady for an extended period of time. It is common to offer her a supplement pudding as she only eats small amounts. You support her with her eating and drinking. On discussion with your practice supervisor, you realise this is not prescribed for her and she is being prepared for a transfer of care to a community care setting.
What implications does this practice have? Jot down your initial thoughts.
1 For her (both now and post transfer of care)?
2 For you as a healthcare professional or student?
3 For discharge planning?
4 For the doctors responsible for her medications?
Revisit these considerations and your initial thoughts when you have explored more about the legal and ethical considerations, as well as pharmacokinetics and pharmacodynamics.
Cautionary