Prescription medication in United Kingdom

In the United Kingdom, a patient visits a general practitioner who is able to prescribe medicines. If given an NHS prescription, this can be taken to a pharmacy to be dispensed. District nurses and health visitors have had limited prescribing rights since the mid-nineties where prescription for dressings and simple medicines would have had to have been signed by a doctor. Extended prescribing was introduced in late 1999, where appropriately trained nurses could prescribe from a limited list of POMs. From 2006, some nurses and pharmacists will be permitted to prescribe all medicines in the British National Formulary, except controlled drugs directly. Each item on the prescription is liable to a prescription charge in England and Scotland of £6.85 (as of April 2007), although many patients are exempt from this charge. This includes those over 60, under 16 (or under 19 if in full-time education), patients with certain medical conditions and those on certain benefits. However in Wales prescription charges have been abolished - a situation the SNP government of Scotland hopes to emulate within the next four years.

An HC2 certificate can be applied for — although not automatically granted — by those on a low income or in receipt of incapacity benefit. Claimants of "Jobseekers" and "Income support" automatically receive free prescriptions and dentistry.

Those requiring regular prescriptions may make a saving by purchasing a pre-payment certificate which covers the cost of all prescriptions required for four months or a year. This charge is paid entirely to the NHS through the pharmacy, while the pharmacy claims the cost of the medicine dispensed. Each "item" can cover any prescribed item in a very large or very small quantity according to the doctor's prescription. This means that the patients perceived "value" of the charge varies enormously - the actual cost of the medicine given out will routinely vary from a few pence to hundreds of pounds.

The majority of items dispensed on NHS prescription are exempt from charges. This is because of the large number of medicines needed by, for example, the elderly or those with medical exemptions. NHS prescriptions can also be written for certain items by dentists and nurses. Some patients also receive private prescriptions, typically either from a doctor seen privately or for medicine not permitted on the NHS. For these, the patient will pay the pharmacy directly for the cost of the medicine and the pharmacy's markup.

Prescription medication

A prescription drug is a licensed medicine that is regulated by legislation to require a prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription. Different jurisdictions have different definitions of what constitutes a prescription drug.

Dispensation of prescription drugs often includes a package insert (in Europe, a Patient Information Leaflet or PIL) that gives detailed information about the drug.

In the United States, the Federal Food, Drug, and Cosmetic Act defines what requires a prescription. Prescription drugs are generally authorized by veterinarians, dentists, optometrists, physicians and nurse practitioners, though physician assistants do an increasing amount of drug prescribing under a physician's supervision. It is generally required that an MD, DO, DPM, NP, DVM, DDS, DMD, OD, or PA write the prescription; basic-level registered nurses (as opposed to advanced practice nurses such as a nurse practitioner, clinical nurse specialist, nurse anesthetist, and nurse midwife), emergency medical technicians, psychologists (but not psychiatrists, who are physicians), and social workers as examples, do not have the authority to prescribe drugs.

Unlike most other countries, the United States does not have governmental control of prescription drug prices, and US drug prices are usually viewed as very expensive in comparison to those countries who do. For those with health insurance, many health insurance programs (generally paid partially or in full by the patient's employer) have prescription payment plans where the patient pays only a small copayment and the pharmacy is reimbursed for the remaining cost by the insurance company using the premiums collected from all of the insured individuals and their employers. The uninsured typically must pay whatever higher drug price their local pharmacy charges. Some indigent people can get assistance through publicly funded drug assistance programs such as Medicaid or private support through drug company prescription assistance programs.

The safety and effectiveness of prescription drugs in the US is regulated by the federal Prescription Drug Marketing Act of 1987. The Food and Drug Administration is charged with implementing this law.

Psychiatric medication

Psychiatric medication is a licenced psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually utilized in psychiatric settings, these medications are made of synthetic chemical compounds, although some are naturally occurring.

Administration

Prescription psychiatric medications, like any prescription medication, usually require a prescription from a physician, such as a psychiatrist, before it can be obtained. Some U.S. states and territories, following the creation of the prescriptive authority for psychologists movement, have granted prescriptive privileges to clinical psychologists that have undergone additional training.

Research

Psychopharmacology studies a wide range of substances with various types of psychoactive properties, though the professional and commercial fields of pharmacology and psychopharmacology don't typically focus on psychedelic or recreational drugs; the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactives by both fields, psychopharmacology focuses primarily on the psychoactive and chemical interactions with the brain. Physicians who research psychiatric medications are psychopharmacologists, specialists in the field of psychopharmacology.

Side effects

Psychiatric medications sometimes have adverse side effects that may reduce patients' drug compliance. Some of these side effects can be further treated by using other drugs such as anticholinergic (antimuscarinic) medications. Some side effects, including the possibility of a sudden or severe re-emergence of psychotic features, may appear when the patient stops taking the drug, particularly if a drug is suddenly discontinued instead of slowly tapered off.

Types

There are four main groups of psychotropic medication. These are the anxiolytic/hypnotics, the antipsychotics, the mood stabilisers and the antidepressants. Additionally, there are various other miscellaneous types of medications, such as those used in the treatment of substance misuse and dementia.

Types of medication

For the gastrointestinal tract or digestive system:

* Upper digestive tract: antacids, reflux suppressants, antiflatulents, antidopaminergics, proton pump inhibitors, H2-receptor antagonists, cytoprotectants, prostaglandin analogues;
* Lower digestive tract: laxatives, antispasmodics, antidiarrhoeals, bile acid sequestrants, opioids.

For the cardiovascular system:

* General: beta-receptor blocker, calcium channel blockers, diuretics, cardiac glycosides, antiarrhythmics, nitrate, antianginals, vasoconstrictor, vasodilator, peripheral activator;
* Affecting Blood pressure: ACE inhibitors, angiotensin receptor blockers, alpha blocker;
* Coagulation: anticoagulant, heparin, antiplatelet drug, fibrinolytic, anti-hemophilic factor, haemostatic drugs;
* Atherosclerosis/cholesterol agents: hypolipidaemic agents, statins.

For pain & consciousness (Further information: Analgesic)

The main classes of painkillers are NSAIDs, opioids and various orphans such as paracetamol, tricyclic antidepressants and anticonvulsants.

For musculo-skeletal disorders:

NSAIDs (including COX-2 selective inhibitors), muscle relaxant, neuromuscular drug
anticholinesteraseж

For the eye:

* General: adrenergic neurone blocker, astringent, ocular lubricant;
* Diagnostic: topical anesthetics, sympathomimetics, parasympatholytics, mydriatics, cycloplegics;
* Anti-bacterial: antibiotics, topical antibiotics, sulfa drugs, aminoglycosides, fluoroquinolones;
* Anti-viral;
* Anti-fungal: imidazoles, polyenes;
* Anti-inflammatory: NSAIDs, corticosteroids;
* Anti-allergy: mast cell inhibitors;
* Anti-glaucoma: adrenergic agonists, beta-blockers, carbonic anhydrase inhibitors/hyperosmotics, cholinergics, miotics, parasympathomimetics, prostaglandin agonists/prostaglandin inhibitors. nitroglycerin.

For the ear, nose and oropharynx:

* Sympathomimetic, antihistamine, anticholinergic, NSAIDs, steroid, antiseptic, local anesthetic, antifungal, cerumenolyti.

For the respiratory system:

* Bronchodilator, NSAIDs, anti-allergic, antitussive, mucolytic, decongestant
corticosteroid, beta-receptor antagonist, anticholinergic, steroid.

For endocrine problems:

* Androgen, antiandrogen, gonadotropin, corticosteroid, growth hormone, insulin, antidiabetic (sulfonylurea, biguanide/metformin, thiazolidinedione, insulin), thyroid hormones, antithyroid drugs, calcitonin, diphosponate, vasopressin analogues.

For the reproductive system or urinary system:

* Antifungal, alkalising agent, quinolones, antibiotic, cholinergic, anticholinergic, anticholinesterase, antispasmodic, 5-alpha reductase inhibitor, selective alpha-1 blocker, sildenafil, fertility medication.

For contraception:

* Hormonal contraception;
* Ormeloxifene;
* Spermicide.

For obstetrics and gynecology:

* NSAIDs, anticholinergic, haemostatic drug, antifibrinolytic, Hormone Replacement Therapy, bone regulator, beta-receptor agonist, follicle stimulating hormone, luteinising hormone, LHRH gamolenic acid, gonadotropin release inhibitor, progestogen, dopamine agonist, oestrogen, prostaglandin, gonadorelin, clomiphene, tamoxifen, Diethylstilbestrol.

For the skin:

* emollient, anti-pruritic, antifungal, disinfectant, scabicide, pediculicide, tar products, vitamin A derivatives, vitamin D analogue, keratolytic, abrasive, systemic antibiotic, topical antibiotic, hormones, desloughing agent, exudate absorbent, fibrinolytic, proteolytic, sunscreen, antiperspirant, corticosteroid.

For infections and infestations:

* antibiotic, antifungal, antileprotic, antituberculous drug, antimalarial, anthelmintic, amoebicide, antiviral, antiprotozoal.

For immunology:

* Vaccine, immunoglobulin, immunosuppressant, interferon, monoclonal antibody.

For allergic disorders:

* anti-allergic, antihistamine, NSAIDs.

For nutrition:

* Tonic, iron preparation, electrolyte, parenteral nutritional supplement, vitamins, anti-obesity drug, anabolic drug, haematopoietic drug, food product drug.

For neoplastic disorders:

* Cytotoxic drug, sex hormones, aromatase inhibitor, somatostatin inhibitor, recombinant interleukins, G-CSF, erythropoietin.

For diagnostics:

* Contrast media.

For euthanasia:

* A euthanaticum is used for euthanasia and physician-assisted suicide, see also barbiturates.

* Euthanasia is not permitted by law in many countries, and consequently medicines will not be licenesed for this use in those countries.