Counseling Patients

Question 1

Federal Laws

Omnibus Reconciliation Act 1990 (OBRA)

Definition

Answer 1

• Prospective DURs (pharmacy)
• Retrospective DURs (state required for Medicaid)
• Counseling Requirements - “offer to discuss” medications with patient/caregiver
• Obtain patient specific information

State specifies pharmacists personally offers to counsel on all new Rxs

Question 2

Pharmacist Duties for Prospective DURs

What aspects of the pharmacy patient record must pharmacists review with each Rx drug order presented for dispensing to promote therapeutic appropriateness?

Answer 2

• Over/under utilization
• Therpeutic duplication
• Incorrect drug dose or duration of therapy
• Drug-disease contraindications
• DDIs and drug-allergy interactions
• Clinical abuse/misuse

Most are required by OBRA and all are included for state

Question 3

Federal vs. State

OBRA establishes requirements to counsel for ___ patients, but SC requires for ____

Answer 3

OBRA establishes requirements to counsel for Medicaid patients, but SC requires for all new Rxs

Question 4

Pharmacist Duties Prospective DURs

If a problem is found during a prospective DUR, what must the pharmacist do?

Answer 4

Pharmacist must take appropriate steps to avoid or resolve the problem, including consulting with the prescriber

Question 5

Pharmacist Counseling Duties

Alternative forms of information like leaflets, pictogram labels, and video programs may replace counseling if the pharmacist is unavailable.

True or False

Answer 5

False
* These forms may supplement counseling
* Pharmacist must PERSONALLY offer counseling for a new Rx - perferably in person, but telephone is accepted

Question 6

Pharmacist Counseling Duties

When is patient counseling not required?

Answer 6

• Inpatients or ER, when other licensed health care professionals administer
• Refused by patient or caregiver

Question 7

Pharmacist Counseling Duties

What are the pharmacist counseling topics?

Answer 7

• Name/description of drug/dose
• Dosage form
• Route of administration
• Techniques for self-monitoring
• Duration of therapy / refill information
• Side effects / contraindications
• Proper storage
• How to handle a missed dose

Question 8

Patient Package Inserts (PPIs)

Failure to distribute a PPI is considered what?

Answer 8

Misbranding
* educates the patient about proper use and potential dangers of using certain products (primarily focused on oral contraceptives)

Question 9

Patient Package Inserts (PPI)

When are PPIs required for ambulatory care?

Answer 9

Initial fill and every refill

Question 10

Patient Package Inserts (PPI)

When are PPIs required in institutions?

Answer 10

Prior to first administration and every 30 days thereafter

Question 11

Patient Package Inserts (PPI)

PPIs apply to anyone who dispenses drugs, including hospital pharmacies, LTCFs, and doctors in their own practice

Answer 11

True

Question 12

MedGuides

When does the FDA require dispensers to give MedGuides to patients?

Answer 12

• Patient labeling could prevent serious adverse effects
• Product has serious risks relative to benefits
• Patient adherence to directions is crucial

Question 13

MedGuides

The FDA approves the language of MedGuides after its initial distributions

True or False

Answer 13

False - before distribution

Question 14

MedGuides

What are common therapeutic classes that require MedGuides?

There are trends within categories; not necessarily class warnings

Answer 14

• Antidepressants / SSRIs
• ADHD
• NSAIDs
• Fluoroquinolones
• Thiazolidinediones