common information relating to a class of drugs, the shared properties are contained in a drug‐class monograph (Hand and Pryor, 2021). Drug‐class monographs are emphasised by a circled flag symbol next to the title of the drug‐class monograph The corresponding individual drug monographs generally follow the drug‐class monograph, these are highlighted by a non‐circled flag symbol (see Figure 2.1)
Figure 2.1 Drug‐class monographs.
Source: BMJ Publishing Group Ltd.
In the example in Figure 2.1, the monograph depicted for atenolol will display a flag; this indicates that the drug‐class monograph for Beta‐adrenoceptor blockers (systemic) should be consulted in tandem.
Within the drug monograph the following are also highlighted:
Drug classification – may be based on pharmaceutical class, for example opioids, but may also be related to the use of the drug, such as 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 a heading of the preparation name
Evidence grading – This reflects the strength of recommendations 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 a prescription or giving health advice. The variance between categories may be determined by the drug itself, dose and amount to be dispensed (see Box 2.1).
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 2mg medicated chewing gum |
|
CD – controlled drug |
A product that is controlled by the Misuse of Drugs Act 1971 and is listed in 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 sulfate (modified‐release tablets) 60mg 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 500mg tablets in 16 tablet packs are available as General Sales List (GSL) and can be purchased by an adult or young person over 16 years of age, without supervision of a pharmacist. Pharmacists may sell packs of a maximum of 32 tablets as Pharmacy only (P) drugs, requiring the supervision of a Pharmacist. Over 32 tablets per pack are Prescription‐only Medication (PoM).
This example shows whilst 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.
Source: Medications and Healthcare products Regulatory Agency, 2009; Joint Formulary Committee, 2019b.
Skills in Practice
Using the BNFc index, locate docusate sodium.
What is the drug classification?
What are the cautions associated with this drug?
Is this drug present in breast milk?
Back Matter
The back matter of the BNFc contains a number of appendices which offer detailed supplementary nformation on drug interactions, borderline substances, cautionary and advisory labels, and the specific formularies for dental practitioners and the nurse prescribers formulary (for registered community ractitioner 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 of the BNFc
