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Medicines, Legislations and Optometrists
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Medicines, Legislations and Optometrists

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Usage of drugs in optometry practice.

Usage of drugs in optometry practice.
Legislation
Prescription of drugs
Precautions

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Medicines, Legislations and Optometrists Medicines, Legislations and Optometrists Presentation Transcript

  • Duties and Responsibilities of an Optometrist • The optometrist has a duty to take due care in the use of drugs in optometric practice and to only supply drugs when it is appropriate to do so.
  • Drug nomenclature
  • Drug nomenclature • Drug nomenclature is the act of creating names for a drug or other pharmaceutical substance. • Drugs generally have 3 names: – the chemical name, – the International Nonproprietary Name (INN, also known as the generic or nonproprietary name), and – the brand name.
  • Scientific name/chemical name • Based on molecular structure of the drug • Usually long and complex Brand name • Usually given by pharmaceutical company
  • Generic name • Internationally, generic names, known as the International Nonproprietary Name, are issued by the World Health Organization (WHO) in several languages, including English. • Drugs that are marketed in the United States are further assigned generic names, officially known as the United States Adopted Name (USAN), by the USAN Council. • Likewise, drugs are assigned a British Approved Name (BAN) in Great Britain by the British Pharmacopoeia, a standard followed in many other countries. • For example, • generic (USAN) acetaminophen = chemical N-(4-hydroxyphenyl)acetamide = (BAN & INN paracetamol).
  • Chemical name Generic name Brand name / Trade name N-(4-hydroxyphenyl)acetamide Acetaminophen (USAN) Paracetamol (BAN) Tylenol Panadol (3R,5R)-7-[2-(4-fluorophenyl)-3- phenyl-4-(phenylcarbamoyl)-5- propan-2-ylpyrrol-1-yl]-3,5- dihydroxyheptanoic acid Atorvastatin Lipitor
  • Generic names and affixes • Generic names provide – a clear and unique identifier for active chemical substances, – appearing on all drug labels, – advertising and other information about the substance. • The prefixes and infixes have no pharmacological significance and – are used to separate the drug from others in the same class. – Suffixes or stems may be found in the middle or more often the end of the drug name, – normally suggest the action of the drug. • Generic names often have suffixes that define what class the drug is.
  • Affixes Drug class Examples -axine Dopamine and serotonin– norepinephrine reuptake inhibitor Venlafaxine -barbital Barbiturates Phenobarbital -cillin Penicillin-derived antibiotics Penicillin, carbenicillin, oxacillin -grel Coagulation inhibitor Clopidogrel -lukast Leukotriene receptor antagoni sts[2] Montelukast
  • Optometrists and their exemptions to the drug list
  • Exemptions to drugs • Optometrists are exempt from some of the general rules laid down in the medicines act. • Able to access the basic exemption list of drugs. • Who finished further course of training approved by GOC ( General optical council) – (‘additional supply optometrists’) – are able to access an additional list of drugs.
  • • The Medicines Act has traditionally granted exemptions from the general rules laid down in the act “to allow optometrists to use certain prescription-only medicines (POMs) in the course of their professional practice” and in particular circumstances to supply them to their patients.
  • Optometrist from UK • UK optometrists were among the first optometrists in the world to legally use diagnostic drugs in the course of their professional practice and • historically have used antibacterial agents for prophylaxis following scleral contact lens fitting, applanation tonometry and foreign body removal.
  • Legislative Changes • The last 10 years • has seen radical changes in medicines • legislation that has impacted on the • optometric profession.
  • Most important change for optometrists • The most widely publicised change • within this period was the introduction • of optometrist independent prescribing.
  • Concept of independent prescribing • The concept of independent prescribing by non-medical health professions – was first proposed in the ‘Crown Review of Prescribing, Supply and Administration of Medicines’ – following a change in June 2008, – optometrists were given the opportunity to obtain the necessary accreditation to prescribe any licensed medicine for ocular conditions affecting the eye and surrounding tissues.
  • Another Important change • Rules relating to injury or disease of the eye in 2000, • formally allowed optometrists to use their professional judgement • to decide not to refer a patient with an ocular abnormality to a medical practitioner and to render appropriate therapeutic treatment.
  • • main legislative changes occurred in 2005 – is removing some barriers – Updating to the list of POMs available to all registered optometrists
  • • The POMs that are available to optometrists for supply can be sold or supplied directly to patients in emergency situations only. • Routinely, these drugs should be supplied via an order written by the optometrist, which can be presented by the patient to a registered pharmacist (signed order = prescription writing)
  • An order for POMs should include: ● The optometrist’s name and address ● The date ● The name and address of the patient (if applicable) ● The name of the drug ● Quantity, pharmaceutical form and strength of the POM (eg 0.5 per cent eye drops 10ml) ●The original signature of the optometrist. • The signed order must be written in indelible ink; this includes typewritten and computer generated orders. • The College of Optometrists’ guidance recommends that the optometrist’s GOC number should also be included (College of Optometrists 2012).
  • • The 2005 changes consolidated the list of POMs available to optometrists and at the same time addition to the POMs available for sale and supply (Table 1).
  • Another important legislative change • Another important legislative change in 2005 was a relaxation of the law governing the supply of medicines by optometrists. • It was recognised that the restriction on supply of these agents to ‘in an emergency’ was unnecessarily restrictive. • The removal of the emergency restriction allows the direct supply to patients of any P medicine that is used in the course of an optometrist’s professional practice eg lubricants, anti-allergy preparations and antimicrobials (Table 2).
  • • Although legally the drugs can be sold from optometry practices, the College of Optometrists Guidance states:
  • • “ If they are supplying therapeutic drugs to their patients, practitioners have a duty to ensure that this drug is appropriate for the patient. This will mean the optometrist has to make a diagnosis of the patient’s condition. Supply should normally only be made following an eye examination, or within a reasonable time afterwards. Patients should be made aware of the need to have their condition periodically reassessed to determine whether or not the drug is still appropriate. This is particularly important if the patient has already sought treatment elsewhere. All actions and advice should be noted on the patient record.”
  • Use and supply of drugs or medicine in optometric practice
  • Use of drugs in optometric practice • Optometrist has a duty to maintain a reasonable level of knowledge of drugs eg. Actions, interactions, cautions and contraindications. • has a responsibility to support adverse drug reactions reporting system.
  • • When using any diagnostic drug, patient should be made aware of the effects and possible side effect of the drug. • Optometrists should record the batch number and expiry date of the drugs. • Patients should be asked about any previous intolerance to drops and any known allergy.
  • • Optometrists should check carefully that it is the correct drug and check the manufacturer’s instructions before installing. • Should explain to the patient prior to instillation: – Reasons for installation – What effect the drops may have (in simple lay-person terms) – How long the effect may last – Normal side effects of dilation – To avoid driving or any other activity which is not advised after dilation – Not to wear contact lenses after anaesthesia
  • Self-prescribing and treatment • Optometrists should avoid self-prescribing or treatment whenever possible. • Except – minor ailments and emergency • Should not normally prescribe or prepare written orders for POM drugs for their own personal use or that of members of their close family.
  • Storage and disposal of drugs – Optometrists should ensure that all diagnostic and therapeutic drugs are stored according to the manufacturers’ instructions. – Should be out of patients’ reach. – Legislation is in place to cover the disposal of hazardous waste. – Must ensure that drug waste is disposed of in accordance with the regulations.
  • Reporting schemes on adverse drugs reactions • www.mhra.gov.uk • Two reporting systems operated by MHRA – “Yellow card” scheme which covers systemic adverse reactions to ocular medicines and ocular reactions to systemic medications – Medical devices reporting form (covering adverse events to mainly contact lenses and care products).
  • More Information • The optometrist’s formulary – eMedInfo • Advised to check for the most up to date information. • MHRA website (Medicines and Healthcare Products Regulatory Agency) www.mhra.gov.uk • www.aop.org.uk • www.college-optometrist.org • www.pharmacyregulations.org
  • References • http://www.opticianonline.net/Articles/2012/07/20/29757 /Legislation+and+the+optometrist.htm • http://www.college-optometrists.org/en/qualifying-as-an- optometrist/at-university-/emedinfo.cfm • www.aop.org.uk • www.mhra.gov.uk • http://en.wikipedia.org/wiki/Drug_nomenclature