Post 7th October
1)Learning objectives:Familiarisation with the FP10.
i)What is the FP10?
ii)What does the FP10 do?
iii)Who can complete it?
iv)What is the minimum information required for a legal prescription for a non-controlled drug?
v)What does the patient do with the FP10and what payment is made?
The FP10 is a prescription that can be issued by a GP, nurse, pharmacist prescriber, supplementary prescriber or a hospital doctor in England. FP10 is green and is used by GP’s for prescriptions in England.
(There is also an FP10D which is yellow and issued by dentists, FP10MDA which is blue and used for drugs such as methadone. FP10P, PN, SP or CN - these are purple or green forms used by prescribers such as nurses or pharmacists.)
A prescriber should include the following on an FP10 prescription:
1)The prescriber's signature - this should include his or her initials, or forenames, and surname.
2)The prescriber's address - this is usually the practice address for a GP or dentist and it isoften pre-printed on the FP10. FP10s also contain a number to identify the prescriber.
3)A date must appear on the FP10 next to the prescriber's signature. For most prescriptions this is the date the prescriber signed the prescription but the prescriber is also allowed to put a date before which the prescription should not be dispensed.
4)Patient's details - name and address must be given but the format for this information is not specified. It's not essential to give the patient's title but it can be helpful. For patients under 12 years, the age or date of birth must be stated but this is not required for older patients. GP computer systems should print the age or date of birth on the FP10 for all patients and this information is very useful for the pharmacist.
5)Information about the product supplied - apart from some controlled drugs there is no legal requirement to provide particular information about the product.
The FP10 can be taken to any chemist/pharmacy in England; unless the patient has an exemption a prescription charge of £8.40 is made for each item.
Post 21st October
2)GP case: Elderly patient with multi-morbidity. Drugs used; salbutamol, clenilmodulite, paracetamol, diclofenac, Ramipril, bendroflumethiazide, amlodipine, lansoprazole.
Learning objectives; routes of administration.
- What different routes can be used to administer drugs to a patient?
- What is the abbreviation used on a prescription for each of these routes?
- For each of the drugs taken by this patient list the route of administration.
- For salbutamol and clenil modulate, explain why this route is used rather than orally.
- Write an FP10 prescription for the new drug, lansoprazole.
There are many different routes of administration for drugs, these include;
oral (po),
intravenous (iv),
rectal (pr),
subcutaneous (sc),
intramuscular (im),
intra-nasal (in),
topical (top),
sublingual (sl),
inhaled (inh),
nebulised (neb).
Salbutamol – inhaled, nebulised, oral and intravenous
Clenil modulate – inhaled
Paracetamol – oral, rectal and intravenous
Diclofenac – oral, rectal, topical
Ramipril – oral
Bendroflumethiazide – oral
Amlodipine – oral
Lansoprazole – oral
Salbutamol and clenil modulate are administered by inhalation to;
1)avoid first pass metabolism
2)so that the drug gets directly to the small airways where it will exert its effects.
Please check your prescription for lansoprazole with your early years GP trainer
Post 4th November
3)GP case: Patient with angina.Drugs used; GTN, β-blocker, aspirin, statin.
Learning objectives; first pass metabolism.
GTN is a drug used to vasodilate the coronary arteries. It increases the blood supply to the heart to reduce the risk of myocardial damage and treat myocardial pain (angina).
i)What does GTN stand for?
ii)How is GTN administered to a patient (give two routes)?
iii)Why is GTN not used orally?
iv)What is ‘PRN’ when written on a prescription?
v)Write a prescription for GTN using the term PRN.
GTN stand for Glyceryl trinitrate and is administered sublingual (sl) and transdermal (top).
After a drug is swallowed it is absorbed by the GI tract and enters the hepatic portal system. The liver metabolizes many drugs, and this first pass through the liver can substantially reduce the bioavailability of some drugs of which GTN is one. Drugs absorbed through the mucosa of the mouth or through the skin directly enter the systemic circulation, hence sublingual and transdermal routes are preferred.
PRN stands for ‘pro Re Nata’ and means as needed, so a medication given PRN would be used as and when needed by the patient up to the maximum advised limit.
Please check your prescription for GTN with your early years GP trainer
Post 18th November
4)GP case: Patient with COPD. This patient is given five different drugs; salbutamol, tiotropium, steroids, antibiotics (Amoxycillin) and oxygen.
Learning objectives; prophylaxis and treatment.
Two of the drugs are taken regularly, two have just been added to treat the recent deterioration and one drug he takes when needed (PRN).
i)What is meant by the term prophylaxis?
ii)Which of these drugs is given for prophylaxis?
iii)Which drugs are being used to treat therecent deterioration?
iv)Write a prescription for the antibiotic.
v)Include a note on when the drug should be taken relative to food.
Prophylaxis is a treatment or action taken to prevent a disease developing. Tiotropium is given for prophalaxis, it prevents exacerbations of chronic obstructive airways disease, COPD. It is a long acting anticholinergic bronchodilator. Steroids, antibiotics and possibly the oxygen are being used to treat the recent deterioration of COPD.
Please check your antibiotic prescription with your early years GP trainer
You can take amoxicillin with or without food.
Post 2nd December
5)GP case: Cancer survivor, previous chemotherapy.
Learning objectives; plasma protein and receptor binding.
A consideration when prescribing a drug is the way that the drug is distributed in the body. Fat soluble drugs have a higher concentration in lipid (Eg. fat and cell membranes) whereas water soluble drugs have a higher concentration in aqueous solution (Eg. plasma and cytosol). Drugs may have a specific receptor which binds to the drug and holds it on the receptor or drugs may bind to plasma proteins. These differences will alter the distribution of drugs in the body and effect their action and elimination.
i)How much of the drug warfarin is bound to plasma proteins and how much is freely dissolved in plasma?
ii)Is it the protein bound warfarin or the free plasma warfarin which is responsible for the action of the drug?
iii)What happens if tamoxifen is given to a patient taking warfarin?
iv)The active metabolite of tamoxifen, 4-hydroxytamoxifen, competitively binds to the intracellular oestrogen receptor. What is meant by ‘competitive binding’?
v)Write a prescription for tamoxifen.
99% of warfarin is bound to plasma proteins and 1% is free in plasma. It is only the free warfarin (1%) which is responsible for the action of the drug. Tamoxifen increases the effects of warfarin and so increases the risk of bleeding by an unknown mechanism.
Competitive binding means that both the and oestrogen bind to the same oestrogen receptor. They compete with each other for the receptor. If 4-hydroxytamoxifen is bound to the receptor it prevents oestrogen from binding to it and so reducing oestrogen effects.
Please check your tamoxifen prescription with your early years GP trainer
Post 16th December
6)GP case: Liver disease.
Learning objectives; alteration of liver metabolism.
Mr Abdulkader’s neighbour had been taking warfarin prior to his very heavy drinking. Warfarin is a drug which blocks the action of vitamin K in the liver. In the weeks before he died he always had bruises on his arms and legs. The effects of warfarin can be reversed by giving an injection of vitamin K.
- What substances are produced in the liver using vitamin K
- What is the effect of blocking the action of vitamin K
- What is the effect of drinking alcohol whilst on warfarin
- How would this effect blood clotting
- Write a prescription for a vitamin K injection
Vitamin K is used within the liver to make clotting factors II, VII, IX and X. Blocking the action of vitamin K leads to an inability to form blood clots efficiently. Drinking alcohol can affect the ability of the liver to manufacture the clotting factors II, VII, IX and X and increase the anticoagulant effects of the warfarin causing bleeding.
Please check your vitamin K prescription with your early years GP trainer