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

2. 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.

3. Drug nomenclature

4. 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.

5. Scientific name/chemical name
• Based on molecular structure of the drug
• Usually long and complex
Brand name
• Usually given by pharmaceutical company

6. 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).

7. 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

8. 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.

9. 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

10. Optometrists and their exemptions to
the drug list

11. 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.

12. • 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.

13. 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.

14. Legislative Changes
• The last 10 years
• has seen radical changes in medicines
• legislation that has impacted on the
• optometric profession.

15. Most important change for optometrists
• The most widely publicised change
• within this period was the introduction
• of optometrist independent prescribing.

16. 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.

17. 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.

18. • main legislative changes occurred in 2005 – is
removing some barriers
– Updating to the list of POMs available to all registered
optometrists

19. • 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)

20. 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).

22. • 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).

24. 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).

26. • Although legally the drugs can be sold from optometry practices,
the College of Optometrists Guidance states:

27. • “ 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.”

28. Use and supply of drugs or medicine
in optometric practice

29. 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.

30. • 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.

31. • 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

32. 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.

33. 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.

34. 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).

35. 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

36. 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