MPharm 4 PHAR0037 Law & Ethics Case Studies 
          The aim of this study is to develop your-problem solving skills when faced with legal 
          and ethical problems in pharmacy practice. 
          Objectives 
          Following your revision and completion of this background work you will be 
          expected to:- 
           • Understand the legal requirements of the Medicines Act 1968 concerning the 
             appropriate supply of prescription only medicines 
           • Understand how the Misuse of Drugs Act 1971 restricts your ability to supply 
             CDs. 
           • Apply a structured problem-solving approach to "real world" ethical 
             dilemmas. 
          Please work through the following cases, most of which are real and not fictitious. You 
          may find the ethical problem-solving structure that was presented to you in the 3' 
          year helpful in providing a systematic approach. Talking through the cases with a 
          colleague is perfectly acceptable once your have given each case some initial thought. 
          Prepare answers to each case which will be discussed in the lecture in week 10. 
          Students will be drawn at random to present answers. 
            1. It is 12.45pm on Sunday rota, and you are due to close in 15 minutes. One of 
             your methadone addicts arrives wanting methadone as he forgot his "daily 
             pickup" on Saturday. On examining his prescription, methadone is prescribed 
             40ml each day under supervised consumption with Sunday's dose "normally 
             to be supplied on Saturday". 
             Will you supply? 
          
         2. You are the owner of a small group of pharmacies. Business on Saturday 
           afternoons at one of your branches has progressively declined, to the point 
           where the income from dispensing and sales of pharmacy medicines no longer 
           covers the cost of paying a pharmacist. You are therefore considering keeping 
           the branch open on Saturday afternoons without a pharmacist as a 'drug store', 
           to sell non-medicinal goods and GSL medicines. You intend to instruct the 
           staff both verbally and in writing not to sell any pharmacy medicines or hand 
           out prescriptions and would leave prominent notices to this effect for the 
           customers to see. 
           Is what you are considering permissible? 
         3. Late on Saturday evening a supermarket pharmacy received a prescription for 
           5 Cyclimorph injections. The pharmacist checked the CD cupboard to find the 
           only ones in stock had been returned unopened by the relatives of a deceased 
           patient. 
           Should the pharmacist dispense them? 
            
         4. The mother of one of your Satuday assistants phones you and wants to know 
           what Dianette is for. She found a box in the daughter's bedroom that had been 
           supplied by you a couple of weeks earlier. 
           What will you tell the mother? 
         5. You receive an FP10(HP) for 7 fluoxetine 20mg capsules one o.d. for an 11 
           year old. Fluoxetine is not licensed in the under 16s. 
           Will you dispense this prescription? 
          
         6. It is 5.20pm on a Saturday evening and an Australian lady comes into your 
           pharmacy wanting a bottle of flucloxacillin elixir 250mg /5ml for her 10 year 
           old son who has cystic fibrosis and has an acute lower respiratory infection. 
           When giving a dose earlier in the afternoon she dropped and smashed the 
           bottle. The family are visiting the UK to attend a wedding, and the medicine 
           was prescribed and dispensed in Melbourne two days earlier. 
           What will you do? 
          
         7. It is 11.30 on a Sunday morning and you are open for rota until 12 noon. A 
           nurse appears with a prescription for five Diamorphine 30mg ampoules and 
           water for injections. The prescription is legally valid but you do not know the 
           patient or GP. You do not have the item in stock but do have 15 Diamorphine 
           lOmg ampoules. What will you do? No other convenient pharmacy is open 
           until Monday morning. 
            
         8. On Saturday afternoon a lady telephones you saying she has a dental abscess
                                           
           and wants to know if she could use some other husband's Amoxil antibiotics. 
           The husband regularly suffers from abscesses associated with an impacted 
           wisdom tooth and always has a reserve course of antibiotic to hand. 
           What will you tell the patient? 
         9 A patient presents you with a private prescription from an optician for 
           chloramphenical eye drops 0.5% and timolol eye drops 0.25 %. 
           Are you able to dispense this prescription? 
           If this prescription had been written by a dentist would you be able to supply 
           it? 
          
         10 A pre-registration pharmacist dispensed a prescription for Levonelle 2. She 
           asked the pharmacist to check the prescription. However, the pharmacist 
           refused stating that she did not support the use of post-coital contraception as 
           she considered it a form of abortion. 
           What should the pre-reg do?                                      . 
           Was the pharmacist right in expressing her personal or religious views in this 
           way? 
          
         11 A person you know is a doctor in a local hospital presents you with a 
           FP10(HP) prescription for 100 Temazepam Tablets l0mg made out to himself. 
           A local dentist presents you with a similar private prescription. Both 
           prescriptions are written in accordance with the necessary legal requirements. 
           Could you dispense these prescriptions? 
          
         12 On 10th January 2000 Mrs Y entered a pharmacy owned by X Ltd. Her valid 
           private prescription, dated the previous day, for 21 butobarbitone 100mg 
           tablets was dispensed by a young locum pharmacist, recorded in the 
           prescription book and handed back to Mrs Y without it being endorsed in any 
           way. Mys Y returned to the pharmacy on 24th January 2000 and presented the 
           prescription to the pharmacist in charge, who dispensed the prescription, 
           endorsed it with the name and address of the pharmacy and the date of 
           dispensing and retained it in the prescription file. 
           Mrs Y demanded her prescription back and the pharmacist in charge refused, 
           but eventually agreed to write out a copy which Mrs Y could keep for 
           reference. On 12th October 2000 Mrs Y returned to the pharmacy and 
           presented the prescription copy to another locum pharmacist who dispensed 
           the tablets and endorsed the copy prescription 'repeated on 12.10.00' then 
           recorded this repeat in the prescription book before handing it back to Mrs Y. 
           What offences were committed under current legislation in making the above 
           supplies?