Ch 3: Texas Dangerous Drug Act (TDDA)

Question 1

Dangerous Drugs

Answer 1

Include prescription medical devices and drugs that are not controlled substances

Question 2

Designated Agent

Answer 2

• Authorized person designated by practitioner to communicate drug orders to pharmacy
• Can be nurse, PA, pharmacist, or other designated individual
• Can also authorize licensed vocational nurse to call in scripts for NP/PAs
• Practitioner must designate in writing each agent authorized to verbally communicate scripts (pharmacist may require this list from provider)

Question 3

Independent Prescriptive Authority

Answer 3

Practitioners that can prescribe independently under own license:

• Physicians (MD/DO)
• Dentists (DMD, DDS)
• Podiatrists (DPM)
• Vets (DVM)
• Optometrists (OD) - therapeutic and glaucoma specialists

Question 4

Dependent Authority

Answer 4

• PA

- APRN

Question 5

Out-of-State/Country Providers

Answer 5

• Practitioner definitions include persons licensed in other states, Mexico, and Canada in HC field that can legally prescribe dangerous drugs in Texas
• If from Canada/Mexico, script must be written
• Can also fill scripts for dangerous meds from out-of-state APRN/PAs but NOT CS

Question 6

Scope of Practice Issues

Answer 6

• Physician practitioners can legally prescribe to treat any disease/illness even if they chose a specialty
• For other practitioners, limited by prescriptive authority
• APRN/PAs can prescribe under prescriptive authority agreement with a supervising physician (limits to CS prescribing)
• Vets can’t write for humans, dentists only for teeth, etc.

Question 7

Self-Prescribing/For Family

Answer 7

• Nothing in federal/Texas law that prohibits this, even for dangerous drugs/CS
• Texas Medical Board states that inappropriate prescribing includes this situation(s)
• Medical Board DOES permit prescribing these meds when there is immediate need (max 72-hour supply)

Question 8

“Office Use” Scripts

Answer 8

• No such thing
• If prescriber wishes to purchase dangerous drugs/CS for “office use” must order from manufacturer, wholesaler, or submit invoice/DEA 222 to the pharmacy depending on the class of drug ordered

Question 9

What if prescriber dies?

Answer 9

• No specific rules on this federally or in Texas

- Texas Medical Board agrees that pharmacists can provide 30-DS of med and inform patient that they need a new provider

Question 10

Transport of Dangerous Drugs

Answer 10

Nurses of Home/Community Support Agencies can purchase/store/transport the following in portable-sealed container:

• Sterile water/saline for injection and irrigation
• Hep B/influenza vaccine
• Tuberculin purified protein derivative
• Max of five of next card

Question 11

Dangerous Drug Transport: 5 Dosage Unit Max

Answer 11

• Heparin sodium lock flush (10u or 100u/mL)
• Epi 1:1000
• Diphenhydramine 50 mg/mL
• Methylprednisolone 125 mg/2mL
• Naloxone 1mg/mL 2mL vials
• Promethazine 25 mg/mL
• Glucagon inj 1 mg/mL
• Furosemide 10 mg/mL
• Lidocaine 2.5% + prilocaine 2.5% in 5gm tube
• Lidocaine 1% soln in 2mL vial

Question 12

Opioid Antagonists

Answer 12

• May be dispensed by pharmacist under a valid prescription to a person at risk for opioid-related overdose or family member/friend/person in a position to assist someone at risk of overdose
• Dispensed this way is considered legitimate medical purpose in usual course of professional practice
• Pharmacist cannot be held to any liability for choosing to dispense/failing to dispense the antagonist and any outcome that results from using the opioid antagonist

Question 13

OTC DM Sales

Answer 13

• Texas Health/Safety Code Chapter 488 prevents DM sales to customers <18 yo
• Must be provided ID indicating customer is 18+ before selling product with DM
• Doesn’t apply if dispensed from a valid prescription

Question 14

Prescribing from APRN/PAs

Answer 14

• May prescribe under Prescriptive Authority Agreement with supervising practitioner that identifies locations and types/categories of meds that can be prescribed
• LTCF and hospitals can designate this authority through protocols - doesn’t include freestanding clinics or other medical practices owned/operated by hospital/LTCF
• If patient <2yo, must consult with delegating physician and notate this consultation
• Physician max of 7 APRN or PAs
• Scripts must have name/address/phone number/identifying number of APRN/PA AND their supervising physician

Question 15

Exception to Max APRN/PA Rule

Answer 15

• Medically underserved areas
• Facility-based practice in hospital
• Facility-based practice in LTCF

Question 16

CS from APRN/PAs

Answer 16

• Generally CII not allowed unless permitted in hospital-based practice policies approved by medical staff
• Patients must be admitted for a length of stay >=24 hours, be receiving ED care, or have a terminal illness in hospice care
• CIII-CV may be prescribed in any setting; 90-DS limit
• APRN/PA must be registered with DEA as mid-level prescriber
• DEA of APRN/PA and their supervising physician must both be on script

Question 17

Therapeutic Optometrists

Answer 17

• License ends in “T”
• May prescribe dangerous drugs that treat eye/adnexa (tissue around eye), but NOT oral/parenteral drugs for glaucoma
• May not prescribe >3 day supply of CIII-CV (therefore they CAN’T prescribe CII)

Question 18

Optometric Glaucoma Specialists

Answer 18

• License ends in “TG”
• Have all privileges of therapeutic optometrist but can also administer oral/parenteral meds for glaucoma
• Quite a few restrictions/requirements connected to the law that allows them to prescribe meds to treat glaucoma

Question 19

Cocaine Eye Drops for Diagnostics

Answer 19

• Both therapeutic optometrists and optometric glaucoma specialists may possess and administer a max of 10% cocaine eye drop soln in prepackaged liquid form
• May NOT dispense cocaine solution
• Must have DEA registration to possess/store cocaine eye drops and can only have a max of 2 vials