system chapter. It starts with a clear contents section indicating what can be found in the chapter and is followed by information on the associated diseases, conditions and disorders, treatment summaries and individual medication information. Focusing on constipation, find and read the description of the condition and its associated overview and management.
The classification of the individual drug is indicated in blue (e.g. Laxatives: Bulk‐forming laxatives) with the drug name and drug monograph sited below. The drug monograph provides comprehensive information on the drug all in one concise section. Pertinent guidance is offered relating to drug action, indications and dose, adjustments and interactions, safety information, contraindications, signposting to the correct section of interactions, side effects and medicinal forms.
Drug class monographs have been created by the publishers of the BNF. Where there is common information relating to a class of drugs, the shared properties are contained in a drug class monograph. 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).
In the example in Figure 2.1, the monograph depicted displays a flag, this indicates that the drug class monograph for Beta‐adrenoceptor blocker (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 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
